Kids and Stuff Flashcards
Appropriate Techniques for Pediatric Assessment of Infants
- examine newborn in presence of parents
- swaddle and undress newborn as exam proceeds
- dim lights and rock newborn to encourage eyes to open
- observe feeding if possible
- demonstrate calming maneuvers to parents
- observe and teach parents about transitions as new born arouses
- sequence for exam: careful observation, head, neck, heart, lungs, abdomen, GU, lower extremities and back, ear, mouth, eyes (when open spontaneously), skin as you go along, neuro, hips
When are kids assessed?
- immediately after delivery
- comprehensive exam within 24 hours of birth
- subsequent PEs when infant is ill/at regular intervals
- well child encounters: birth, 3-5 days, 2 wks, 1 month, 2, 4, 6, 9, and 12 months, then annually (usually in line with vaccinations)
Appropriate Techniques for Pediatric Assessment of Infants
- approach infant gradually
- perform much of exam with infant in parent’s lap
- speak softly, mimic infant’s sounds
- make sure well fed before examining (the pt not you)
- ask parent about infant’s strengths to elicit useful development and parenting info
- don’t do head-to-toe in specific order; SAVE MOUTH AND EARS FOR LAST
What is the significance of the general appearance of the newborn?
- observation of infant’s communication with parents: look for abnormalities (developmental delay, language delay, hearing deficits, inadequate parental attachment) or maladaptive nurturing patterns (maternal depression or inadequate social support)
- skin color and hair (jaundice, cyanosis, vascular markings from birth)
- observation produces important information about every organ system
- carefully assess respirations and breathing patterns (newborns, especially premies, show normal rate - 30 to 40/min - with periodic breathing of slowed rate)
Benign Murmurs in Newborns
- closing ductus: newborns, transient, soft, ejection heard at upper LSB
- peripheral pulmonary flow murmur: newborn-1yr, soft slightly ejectile, systolic heard to the L upper LSB and in lung fields and axillae
Pediatric Weight
- 7.7 lbs average at birth
- decreases 10% at 1 wk, return to birth weight at 2 wks, x2 at 4-6 months, x3 at 12 months
Temperature in the Newborn
99-101F
Heart Rate in the Newborn
- 90-190 at birth-1 month
- 80-180 1-6 months
- 75-155 6-12 months
Somatic Growth of the Infact
- growth compared by age and sex
- for children <2 yrs, measure length with child held still (hips and knees extended)
- fontanelles: anterior closes between 4-26 months; posterior closes by 2 months
Vaccinations in Children
- Hep B (birth, 1-2months, 6-18months)
- Rotovirus: 2, 4, 6 months
- D-Tap: Diptheria, tetanus, pertussis (2, 4, 6, 15 months, 4-6 years)
- Haemophilus influenzae (2, 4, 12 months)
- Pneumococcal conjugate (2, 4, 6, 12 months)
- Poliovirus (2, 4, 6months)
- Influenza (annually)
- HPV 3 series (start at age 11-12: 0, 1-2, 6 months)
- 2, 4, 6 months shots are DRIPP: D-Tap, Rotavirus, Influenzae, Pneumococcal conjugate, Poliovirus
What are the risk factors for Failure to Thrive?
- insufficient nutrition
- inadequate absorption
- added metabolic requirements (from disease mechanism)
What are the parameters for normal growth?
- measurement deviations beyond 2 standards for age (or >95th or indication for more detailed evaluation
- Down syndrome, prematurity may cause such deviations
Height/Length in the Infant
- 14-20 in normal (not sure if this is from Bates)
- 20 inches at birth –> +10 (50%) in 1st year –> + 5 inches 13-24 months; until 10-12 yrs in females or 14-16 yrs in males grow 4-5 in/year
What is the normal development of gross motor skills?
- 1-3 months: head, trunk control
- 4-6 months: holds head anteriorly
- 7-9 months: pulls to stand
- 10-12 months: crawls, cruises, walks
What is the normal development of fine motor skills?
- 1-3 months: involuntary grasp (voluntary at 3 months, thumb sucking), hands to midline
- 4-6 months: holds bottle
- 7-9 months: rakes, neat pincer grasp
- 10-12 months: stacks blocks, peg in hole, acuity
What is the normal development of vision?
- 1-3 months: fix on object, coordinate eye movements, eyes converge
- 4-6 months: reach for object 12” away
What is the normal development of vocabulary?
- 2 years: no jargon, 150-500 words
- 3 years: -
- 4 years: -
- 5 years: definitions
What is the normal development of sentence length?
- 2 years: 2 words
- 3 years: 3-4 words
- 4 years: 5 words, paragraphs
What is the normal development of intelligibility?
- 2 years: 25%
- 3 years: 75%
- 4 years: 100%
What is the normal development of grammatic forms?
- 2 years: verbs, some adj
- 3 years: plurals, nouns
- 4 years: past tense
- 5 years: future tense
What is the normal development of fluency?
- 2 years: dysfluency common
- 3 years: dysfluency common
- 4 years: some dysfluency
- 5 years: no dysfluency expected
Port Wine Stain
- new capillaries
- flat, red, or purple
- do not blanch
Stork’s Beak
- nevus simplex
- on eyes, glabella, occipital areas
- blanchable
- disappears within 1 yr of life
Thrush
- candida albicans
- white (looks like curdled milk)
Jaundice
- “physiologic” appears 2-3 days after birth
- peaks on 5th day
- disappears within 1 week
- “late appearing” persists past 2-3 wks, concern for biliary obstruction or liver disease
- Rh incompatibility
- ABO incompatibility
- G6PD Spherocytosis
Ortalani Test
abduct both hips simultaneously until they touch the table
Barlow Test
- pull leg forward and adduct with posterior force, press in the opposite direction with your thumbs toward the table and outward
- normal test feels stable
Denver Developmental Screening Test
- birth to 6 years
- personal-social (acquisition of standards of society and culture)
- fine motor-adaptive (manipulatory skills and utilization of sensorimotor system in daily life)
- language (vocalization, comprehension and expression in oral and other types of communication)
- gross motor (perambulatory skills, walking, and advanced physical activities)
Apgar Scoring System
- assessed at 1-min and 5-min post birth
- Appearance, Pulse, Grimace, Activity, Respiration
- 1 min: 8-10 (normal), 5-7 (some nervous system depression), 0-4 (severe depression requiring immediate resuscitation)
- 5 min: 8-10 (normal), 0-7 ( high risk for subsequent CNS and other organ system dysfunction)
Heart Rate in the Apgar Scoring System
- absent: 0
- 100: 2
Respiratory Effort in the Apgar Scoring System
- absent: 0
- slow and irregular: 1
- good; strong: 2
Muscle Tone in the Apgar Scoring System
- flaccid: 0
- some flexion of arms and legs: 1
- active movement: 2
Reflex Irritability in the Apgar Scoring System
- no responses: 0
- grimace: 1
- crying vigorously, sneeze or cough: 2
Color in the Apgar Scoring System
- blue, pale: 0
- pink body, blue extremities: 1
- pink all over: 2
Newborn Classifications (SGA, AGA, LGA)
- SGA: small for gestational age (90th)
Classification by Gestational Age
- Preterm: 42 wks
Classification by Birth Weight
- Extremely low birth weight: <2,500g
- Normal: ≥2,500g
Risk Factors for Childhood Obesity
- genetic: 3x if one parent obese; 10x if both
- low activity/excess tv
- absent family meals
- large portions
- over consumption of sweetened beverages
Important Factors in Maternal Hx
- age (>35 or <18)
- race
- parity
- PMH
- labor (duration, anesthesia, complications)
- infections (STI, viral illness)
- drug use (cigarettes, illicit drugs, ETOH)
- chronic illness (HTN, DM)
- abnormal pregnancies
Tanner’s Stages of Breast Development
1: Preadolescent: elevation of nipple only
2: Breast budding, elevation of breast/nipple (8.9-12.9)
3: Breast areola enlargement, no separation of contour (9.9-13.9)
4: Projection of areolae and nipple, secondary mound (10.5-15.3)
5: Mature breasts (14.5)
Sex Maturity Ratings In Girls: Pubic Hair
1: Preadolescent: no pubic hair except for fine body hair
2: Sparse growth of long, slightly pigmented downy hair chiefly along labia
3: Darker, coarser, curlier hair, spreading sparsely over pubic symphysis
4: Coarse and curly hair as in adults; area covered greater than in 3 but not as great as in adult
5: Hair adult in quantity and quality (spread on medial surfaces of thighs but not up over abdomen)
Sex Maturity Ratings in Boys
1: no pubic hair except fine body hair, penis, testes, and scrotum size same as in childhood
2: sparse growth of hair at base of penis, slight/no enlargement of penis, tests and scrotum larger
3: Darker, coarser, curlier hair spreading over pubic symphysis; larger, longer penis; further enlargement of scrotum and testes
4: coarse and curly hair (not full quantity); further enlargement of penis (dvlpmt of glans); further enlargement of tests and scrotum (scrotal skin darkened)
5: hair adult in quantity and quality; adult size and shape of penis, scrotum and testes
