Kids and Stuff

Question 1

Appropriate Techniques for Pediatric Assessment of Infants

Answer 1

• 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

Question 2

When are kids assessed?

Answer 2

• 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)

Question 3

Appropriate Techniques for Pediatric Assessment of Infants

Answer 3

• 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

Question 4

What is the significance of the general appearance of the newborn?

Answer 4

• 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)

Question 5

Benign Murmurs in Newborns

Answer 5

• 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

Question 6

Pediatric Weight

Answer 6

• 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

Question 7

Temperature in the Newborn

Answer 7

99-101F

Question 8

Heart Rate in the Newborn

Answer 8

• 90-190 at birth-1 month
• 80-180 1-6 months
• 75-155 6-12 months

Question 9

Somatic Growth of the Infact

Answer 9

• 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

Question 10

Vaccinations in Children

Answer 10

• 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

Question 11

What are the risk factors for Failure to Thrive?

Answer 11

• insufficient nutrition
• inadequate absorption
• added metabolic requirements (from disease mechanism)

Question 12

What are the parameters for normal growth?

Answer 12

• measurement deviations beyond 2 standards for age (or >95th or indication for more detailed evaluation
• Down syndrome, prematurity may cause such deviations

Question 13

Height/Length in the Infant

Answer 13

• 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

Question 14

What is the normal development of gross motor skills?

Answer 14

• 1-3 months: head, trunk control
• 4-6 months: holds head anteriorly
• 7-9 months: pulls to stand
• 10-12 months: crawls, cruises, walks

Question 15

What is the normal development of fine motor skills?

Answer 15

• 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

Question 16

What is the normal development of vision?

Answer 16

• 1-3 months: fix on object, coordinate eye movements, eyes converge
• 4-6 months: reach for object 12” away

Question 17

What is the normal development of vocabulary?

Answer 17

• 2 years: no jargon, 150-500 words
• 3 years: -
• 4 years: -
• 5 years: definitions

Question 18

What is the normal development of sentence length?

Answer 18

• 2 years: 2 words
• 3 years: 3-4 words
• 4 years: 5 words, paragraphs

Question 19

What is the normal development of intelligibility?

Answer 19

• 2 years: 25%
• 3 years: 75%
• 4 years: 100%

Question 20

What is the normal development of grammatic forms?

Answer 20

• 2 years: verbs, some adj
• 3 years: plurals, nouns
• 4 years: past tense
• 5 years: future tense

Question 21

What is the normal development of fluency?

Answer 21

• 2 years: dysfluency common
• 3 years: dysfluency common
• 4 years: some dysfluency
• 5 years: no dysfluency expected

Question 22

Port Wine Stain

Answer 22

• new capillaries
• flat, red, or purple
• do not blanch

Question 23

Stork’s Beak

Answer 23

• nevus simplex
• on eyes, glabella, occipital areas
• blanchable
• disappears within 1 yr of life

Question 24

Thrush

Answer 24

• candida albicans

- white (looks like curdled milk)

Question 25

Jaundice

Answer 25

• “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

Question 26

Ortalani Test

Answer 26

abduct both hips simultaneously until they touch the table

Question 27

Barlow Test

Answer 27

• 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

Question 28

Denver Developmental Screening Test

Answer 28

• 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)

Question 29

Apgar Scoring System

Answer 29

• 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)

Question 30

Heart Rate in the Apgar Scoring System

Answer 30

• absent: 0

- 100: 2

Question 31

Respiratory Effort in the Apgar Scoring System

Answer 31

• absent: 0
• slow and irregular: 1
• good; strong: 2

Question 32

Muscle Tone in the Apgar Scoring System

Answer 32

• flaccid: 0
• some flexion of arms and legs: 1
• active movement: 2

Question 33

Reflex Irritability in the Apgar Scoring System

Answer 33

• no responses: 0
• grimace: 1
• crying vigorously, sneeze or cough: 2

Question 34

Color in the Apgar Scoring System

Answer 34

• blue, pale: 0
• pink body, blue extremities: 1
• pink all over: 2

Question 35

Newborn Classifications (SGA, AGA, LGA)

Answer 35

• SGA: small for gestational age (90th)

Question 36

Classification by Gestational Age

Answer 36

• Preterm: 42 wks

Question 37

Classification by Birth Weight

Answer 37

• Extremely low birth weight: <2,500g

- Normal: ≥2,500g

Question 38

Risk Factors for Childhood Obesity

Answer 38

• genetic: 3x if one parent obese; 10x if both
• low activity/excess tv
• absent family meals
• large portions
• over consumption of sweetened beverages

Question 39

Important Factors in Maternal Hx

Answer 39

• 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

Question 40

Tanner’s Stages of Breast Development

Answer 40

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)

Question 41

Sex Maturity Ratings In Girls: Pubic Hair

Answer 41

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)

Question 42

Sex Maturity Ratings in Boys

Answer 42

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