Lecture 10/1 Flashcards
when can kids become front facing in a car seat?
2 years old
when can you screen for ADHD well?
School aged, particularly 2nd and 3rd grade
what is the most common type of deaths for children?
- motor vehicle accidents
2. drownings/ smoke or fire
what ages have the highest risk of drowning?
ages 1-3
when should children start getting teeth?
7-12 months
they should have them by 15 months old
What teeth usually fall out first?
Fall out in pairs
bottom front teeth usually come out at same time
What is the main appropriate test to evaluate cognition. Usually done by a developmental psychologist.
Bayley scores
what is used for intelligence testing?
Standford Binet
when is colic common?
First few weeks of life up to 6 months. Predictable pattern
What type babies is colic common in?
Formula-fed babies
severe and paroxysmal crying that occurs mainly in the late afternoon. Difficult to console.
Colic
What can you do for colic?
Reassure the parents
rule out other issues
preventative, try to stop it before it starts
when does colic peak?
2-3 months
what is the rule of 3s for colic?
Healthy and well fed but cries > 3 hours/day for > 3 days a week, for > 3 weeks
What drugs helps to reduce gas? Doesn’t really help prevent colic
Simethicone
what is commonly used for reflex, but may not be helpful.
Zantac
What is one of the most common reasons for shaken baby syndrome?
colic
Who is food refusal common in?
Toddlers/ school aged children
what can food refusal be an underlying sign of?
thrush
esophageal dysmotility
infection (ear infection, etc)
pyloric stenosis (only in infancy)
what’s the first thing you should do when you see food refusal?
Look at growth chart to make sure they aren’t falling off of it
what is a way to increase calorie intake for children doing food refusal?
have them butter all their foods
avoid fruit juices (excessive juice)
fortify with high calorie drinks (pediasure drinks)
What study can show constipation?
radiographic studies
when do most babies start to sleep through the night?
6 months
when is sleeping disorders a problem due to separation anxiety
9 months
2hrs after sleeping, during NREM, screaming thrashing, tachycardia, sweating… ends after 30min… no memory of it.
Night terrors
– during REM, later in the night, typically followed by awakening. Typically 3-5yr old. 25-50%
night mares
when are temper tantrums common
12 months- 4 years
how do you avoid temper tantrums?
chid-proof the environment
pick your battles
distraction
what can you do to stop breath-holding?
nothing really
what can breath holding lead to rarely?
seizure
when are temper tantrums the highest?
2 years of age
what is a function problem?
Not related to a physical problem
ex- holding stool, eating low fiber diet
what is an organic issue?
Related to anatomic or neurologic problems
incontinence beyond “maturity” - typically age 4
Enuresis
when is nighttime dryness usually achieved?
6 years old
Never been contient
primary enuresis
Dry at least 6 months but now have incontinence episodes again
secondary enuresis
what is the ddx for enuresis
developmental difficulties
organic illness
psychological distress
what type of nocturnal enuresis is most likely to have a family history and no identified problem
up to 6-8 years old
primary nocturnal enuresis
type of enuresis that is more likely to have an organic etiology: UTI, DM, DI
happens in day and night
secondary diurnal and nocturnal
More likely to have a neurodevelopmental disorder or bladder problem
primary diurnal and nocturnal enuresis
type of enuresis that is more likely to have psychosocial stressor or sleep disorder
secondary nocturnal
what labs do you get for enuresis?
Clean catch urinalysis
urine culture (if indicated)
RUS (renal US)
VCUG (voiding cystourogram)
3 was to treat enuresis
conditioning (bladder training) go on scheduled basis
imipramine (tricyclic antidepressant, nocturnal enuresis)
desmopressin (drug- good for diabetes insipidus)
decreased BM frequency, hard stools
constipation
regular voluntary or involuntary passage of feces somewhere other than the toilet after 4 yrs : often occurs with constipation
encorperesis
involuntary passage of feces ; typically associated with fecal impaction
soiling
when should you only use drug therapy for enuresis
primary enuresis
when will you do a rectal exam for constipation?
For chronic constipation
check to see if they can willingly contract
what is a cremaster reflex?
scrotum lifts up if inner thigh stroked
Will most constipation resolve?
Yes 50-60% resolve with proper education, diet, behavioral therapy + laxative
How long will treatment for constipation last?
Lots of times over 6 months
sometimes have to give them diarrhea to teach them it won’t hurt to poop
what are the 3 major nutritional components accounting for calories in all food?
Protein
Fatty Acids
Carbohydrates
What are other nutritional components not accounting for calories?
Vitamins
Minerals
trace elements
what nutrient has the highest requirement in infancy and is necessary for physical growth and development.
protein
are there body stores of protein in infancy?
no, all must be supplemented and synthesized
essential amino acids
can’t be synthesized in body, but be injested
what is the main infant dietary source (but not main energy source) needed for cellular respiration, energy to maintain normal body processes.
fatty acids, main caloric content
where are fatty acids stored well and used for long term energy?
adipose tissue
what is the majority of breast milk?
Fat
what is brain development mostly reliant on?
Fatty acids and carbs
what type fat is the majority in breast milk?
Poly-unsaturated fats
when are the requirements for calcium increased
from infancy to age 1-3 and again at age 8
when does most bone density develop
8-10 years of life
when is potassium intake not encouraged?
renal failure
what can potassium deficiency cause?
muscle weakness
mental confusion
cardiac arrhythmias
are deficiencies in trace elements common?
No, most foods are fortified w/ these
where is potassium found
readily available in most unprocessed foods
What vitamin do infants need to be supplement with?
Vitamin D (breast-fed babies) formula already fortified
when do you get vitamin A and E deficiencies
malabsorption issues
prematurity
what are the water soluble vitamins
B and C
What are the fat soluble vitamins
A D E K
this vitamin play role in fat and carbohydrate metabolism, immune development. Folic acid prevents intrauterine neural tube defects
B vitamins
acts at antioxidant, has role in collagen synthesis.
Ascorbic Acid (vitamin C)
what is the primary source of carbs?
Lactose
what is the predominate source of energy in childhood?
carbs
when is the most rapid growth in an infant?
first month of life then decreases
a healthy baby from birth to one year old should ____ their birth weight.
triple
main dietary energy source in infancy, accounts for up to 50% of caloric energy in breast milk
Fats
is the second most abundant energy source followed by protein
Carbs
Caloric needs ______ as the infant ages.
decreases
Does breast milk or formula have more protein.
Formula, but it is less bioavailable, so that is why there is more
protein from breast milk is more efficient
what is the biggest benefit of breast milk?
Passive immunity through first 6 months of life
what is the normal number of feedings per day?
8-10 feedings on demand schedule (every 2-3 hours)
becomes less as they get older
when can you start supplementing w/ cereals and baby foods?
6 months
can be ready as soon as baby can support then head w/o bobbling
how many new foods should you add per week?
1 new food (good to make sure they don’t have a food allergy)
when do you start table and solid foods?
not until a year, allergy is the highest risk until then
when can a baby receive cows milk?
Not until 1 year old, can prevent binding of iron and cause allergies
when can a baby drink water?
infants shouldn’t have free water before 6 months of age. Don’t real need water- getting it from their formula/ breast milk
what babies may require higher calorie formulas? 24-26 kcal/oz
under 1500 grams
prematurity or SGA
how long do you use these higher calorie formulas?
Get them above 3rd percentile and see which growth curve percentile they stabilize on and normalize on.
Once you have 2-3 data points on that curve you can switch to normal sources
what causes nonprojectile emesis that is usually a result of weakness in the lower esophageal sphincter.
GER (gastroesophageal reflux)
what can help with GER?
formulas fortified with rice carbohydrate to thicken or may partially break down milk proteins to avoid emesis
If a baby presents with FTT, vomiting, acidosis, seizures, hepatomegaly what should you suspect?
Metabolic disease/ malabsorption
Can GER be present with breastfed moms?
Yes, mom’s diet could be the source (high acid)
what babies are you more likely to see a milk protein allergy?
formula-fed babies
what are some common symptoms with milk protein allergy?
fussiness/ flatus
diarrhea- bloody or mucousy
FTT
What do you do for milk protein allergy?
Give a different formula- the more processed though the least the infant will like it
what is the order of nutrients that an older child should intake be?
carbs
proteins
fats
what is obesity in kids?
> 95%
what are the most common allergies in children?
peanuts tree nuts fish eggs (might also have a poultry allergy) dairy (might also have a beef allergy) soy
