Lab Midterm Flashcards
Signs and symptoms webster’s coronal suture technique
Increase intracranial pressure
Bulging and/or eccentric head shape
Palpable suture, palpates like a ridge, firm spaghetti
Webster’s coronal suture technique analysis
- Measure circumference of child’s head from glabella over EOP back to glabella
- Measure the right and left sides of the head from glabella to EOP - should add to equal the circumference. If uneven, side of larger measurement is fixated side
Webster coronal correction
PP = on parent’s chest SCP = posterior aspect of frontal bone and anterior aspect of parietal bone, straddling coronal suture CP = size of SCP will determeine size of CP - infants = pinky tips; toddler = index or thumbs LOD = AP and PA separating sutures THRUST = 3 quick thrusts pushing the suture apart, may use toggle head piece for a drop
Fingers straddle the coronal suture to allow you to push it apart
Pediatric clinic exam appearance
Alert Hyperactive Attentive Lethargic Hyper-irritable Communicative Curious NAD
Pediatric clinic exam - reflexers
Moro startle
Blink, dazzle
Acoustic blink
Brachycephaly
Flattened on the back
Plagiocephaly
Flattened diagnollogy on back
Scaphocephally
Smushed length wise, longer head front to back
Caniosynestosis
Bigger forehead or upper head
To realign head shapes
Sleeping aides
Postural aides
The helmet
Head reflexes pediatric exam
TMJ function
Asymmetric tonic neck reflex
Mouth and face reflexes
Rooting
Sucking
Tongue
Tongue tied - fenulum of tongue
Lip tied
Protrusion of tongue
Protrusion of tongue
Macroglossia - down syndrome Small mouth - diGeorge syndrome Hypotonia Masses Mouth breathing
Facial symmetry
Eyes
Eye brows
Ears
Facial paralysis
Bells palsy
Skin rashes
Baby acne
Diaper rash
Allergic reaction
Dehydration
Anterior fontanell
Chapped lips
Tenting
Skin with decreased turgor remains elevated after being pulled up and released
Dehydration
Brachial plexus injury
Arm at side, fist facing backward
Upper extremity reflex
Palmar grasp
Negative palmar grasp
Ortalani
Palpable click or clunk
Inguinal and gluteal folds
Should be symmetric, if not check hips
Lower extremity reflexes
Placing
Stepping
Parachute
Frank breech
Legs in splits high V
Placing reflex
0-6 weeks
Hold infant under arms and touch the dorsum of the infant’s foot to the examining table
Normal = infant should flex the knee and bring foot up onto surface followed by the other foot
Abnormal = paresis to breech delivery or hip abnormalities
Stepping reflex
0-6 weeks
Hold infant under arms and touches the soles of infant’s feet onto table
Normal = infant flexes both knees followed by extension of the knees
Abnormal = paresis to breech delivery or hip abnormalities
Gallants: AKA trunk incurvation reflex
0-8 weeks
Hold infant in prone position supported securely under abdomen. Examiner strokes one side of paravertebral muscles from occiput to base of sacrum bilaterally
Normal = infant should extend and laterally flex head and trunk to the side of stimulus
Abnormal = lower motor neuron lesion
Moro AKA startle reflex
0-4 months
Hold infant supine and abruptly changes head position of infant 1-2cm
Normal = initially the infant should symmetrically extend and full abduct the arms bilateral concomitant with extension of the trunk and flexion of the knees and hips, then followed by an embrace response
Abnormal = hemi paresis of upper or lower extermity is asymmetrical response is produced, brachial plexus injury, spinal cord injury
Rooting reflex
0-4 months while awake; 0-7 months while asleep
Firmly strokes above the ramus of the mandible towards the mouth, bilaterally
Normal = infant moves towards side of stimulus
Abnormal = CN V or CN VII lesion or general CNS disorder
Sucking reflex
0-4 months
Inserts clean finger into infant’s mouth and lightly strokes the hard palate
Normal = infant starts to suckle
Abnormal = general CNS disorder
Vertical suspension
0-6 months
Supports the upright infant around the torso, then raises the infant suddenly upwards
Normal = the infant should bilaterally flex his hips and knees
Abnormal = hip joint abnormalitis, or spastic paraplegia
Palmar/plantar grasp
0-6 months
Places finger on the infant’s palm
Normal = infant grasp examiner’s finger
Abnormal = cerebral dysfunction. A persistent fist presentation during waking hours after 2 months of age may suggest CNS disorder like CP
Blink aka Dazzle reflex
0-1 year
Shine pen light into infant’s eyes
Normal = infant blinks
Abnormal = blindness or decreased visual acuity
Acoustic blink AKA cochleopalpebral
0-gradually disappears
Make a loud noise away from infant’s visual gaze
Normal = infant should blink eyes
Abnormal = decreased or total hearing loss
ATNR: Asymmetrical tonic neck reflex
2 weeks - 6 months
Infant is supine. Examiner rotates infant’s head for 30 seconds, bilaterally
Normal = infant takes on a fencing type posture. The infant should extend the upper and lower extremity on the side of head rotation and flex the upper and lower extrmeity on the contralateral side.
Abnormal = a persistent ATNR is abnormal and may indicate ipsilateral hemi paresis or CNS damage
.Landau reflex
2 weeks-2 years
Hold baby under belly, the back arches
Normal = neck extends and back arche while extremities extend. When the head is passively flexed the child will flex hips and torso.
Abnormal = present after 2 years may indicate poor motor development
Neck righting reflex
0-10 months
Infant is lying supine. Examiner rotates infant’s head to one side
Normal = infant should rotated trunk to the side of head rotation
Abnormal = cerebral damage
Parachute reflex
6 months-1 year
With infant suspended in the prone position, the examiner quickly changes head posiitoining of infant mimicking a fall
Normal = the infant should extend arms down as to brace the fall
Abnormal = assess upper extremity function and asymmetry may indicate paresis
Digital response reflex
0-6 months
Stroke the ulnar side of the infant’s hand
Normal = infant extends thumb and fingers followed by grasp
Abnormal = cerebral dysfunction
Babinski reflex
0-1 year
Stroke plantar surface of the foot from the heel towards the toes but not across the ball of the foot
Normal = extension and fanning of the toes with flexor response of the first toe
Abnormal = possible CNS dysfunction
Otolith righting reflex
0-?
Hold infant under arms then tilts infant to one side
Normal = the infant should try to laterally flex head to maintain horizon
Abnormal = general CNS damage
Anal aka anal wink reflex
0-?
Stroke the perianal region
Normal = contraction of the external sphincter
Abnormal = dysfunction of lower sacral segment
Corneal reflex
0-…
Tough infant’s cornea with cotton wisp
Normal = blinking and tearing
Abnormal = brain or CNS damage
Suck/swallow reflex
As liquid moves into the mouth, the tongue moves it back into the mouth
Tongue thrust reflex
When lips are touched, baby moves tongue out of mouth
Cross extensor
Stroke sole of one foot causes extension of contralateral leg
Brudzinski test
Tuck chin to chest
Positive resistance, pain and/or hip flexion
Indicates might be meningeal irritation
Kernig
Supine-bring knee and hip to 90 degrees then extend leg
Positive and/or pain
Indicates might be meningeal irritation
Ortolani
Supine, place chiro index on greater trochanter and thumb on lesser trochanter, move hip into flexion then externally rotate
Positive palpable clunk
Indicates instability or dislocation of hip
Barlow
Hand placement same as above distract and internally rotate
Positive palpable clunk
Indicates instability or dislocation of hip
CN I
Pulls away from strong odor
CN II
Blink reflex
CN III, IV, VI
Tracking not reliable
CN V
Sucking
Rooting
CN VII
Moro crying
CN VIII
Acoustic blink
CN IX, X, XII
Swallowing, gag reflex
CN XI
Rotating baby’s head via sound or light
Leopolds first maneuver
Fundal grip
Locate the fetal part at the lower uterine segment, then apply slight counter pressure at the uterine fundus with your opposite hand, feeling for movement of the fetus. This movement is called balottement
Leopald second maneuver
Umbilical grip
Locate the fetal part at the uterine fundus, then apply slight counter pressure to the lower uterine segment with your opposite hand, feeling for movement of the fetus. This movement is called ballottment
Third maneuver leopold
Pawlick’s grip
Palpate down the lateral walls of the uterus moving toward the cervical area, this is to determine the side the spine is on versus the side of the extremities
Fourth leopold maneuver
Pelvic grip
Locate the cephalic prominence, this will determine if the presenting portion of the head is the occiput or the sinciput
Occiput = palpates on the side opposite the spine
Sinciput = palpates on the same side of the spine
Fetal auscultation
Utilizing a fetal stethoscope may assist you in confirming the fetal position.
The fetal heartbeat is fast and easy to differentiate from the mothers.
A strong fetal heartbeat above the umbilicus indicates the head is up, breech.
A strong fetal heartbeat below the umbilicus indicates the head is down.
Vertex
Longitudinal lie, caudal presentation with head in slight flexion
Facial or brow position
With the face up toward the mother’s abdomen and in the longitudinal position with head down
Frank breech position
The head is located near the top of the uterus and buttocks facing the birth canal with both hips in flexion and knees in extension
Complete breech
The head will be located near the top of the uterus, legs folded at the knees and crossed, and feet near the buttocks
Incomplete breech
This presentation has the baby in the head position with one leg in extension and both hips in flexion
Transverse lie
The baby will be in the horizontal position
Footling breech
The baby is head up with one hip in extension and one hip in flexion
Webster’s technique
- Check for leg lag
- Adjust on the sacrum on the side of leg lag
- Re-check the leg lag
- Hold abdominal trigger points in the lower quadrant opposite leg lag
- Repeat every other day - adjust nothing else that day
- Continue for up to 3 weeks
Facial brow presentation technique
- Check for leg lag
- Adjust on the sacrum on the side of leg lag
- Re-check the leg lag
- Hold abdominal trigger points in the lower quadrant on the ipsilateral side of leg lag
- Repeat every other day - adjust nothing else that day
- Continue for up to 3 weeks
Transverse lie presentation technique
- Check for leg lag
- Adjust on the sacrum as a BP
- Re-check the leg lag
- Hold abdominal trigger points in the lower quadrant on bilaterally
- Repeat every other day - adjust nothing else that day
- Continue for up to 3 weeks
- If there is leg lag and the baby has moved around, begin with basic turning procedure
