Lecture 10/1 Flashcards by Meg Dolohanty

when can kids become front facing in a car seat?

2 years old

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when can you screen for ADHD well?

School aged, particularly 2nd and 3rd grade

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what is the most common type of deaths for children?

motor vehicle accidents

2. drownings/ smoke or fire

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what ages have the highest risk of drowning?

ages 1-3

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when should children start getting teeth?

7-12 months

they should have them by 15 months old

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What teeth usually fall out first?

Fall out in pairs

bottom front teeth usually come out at same time

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What is the main appropriate test to evaluate cognition. Usually done by a developmental psychologist.

Bayley scores

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what is used for intelligence testing?

Standford Binet

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when is colic common?

First few weeks of life up to 6 months. Predictable pattern

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What type babies is colic common in?

Formula-fed babies

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severe and paroxysmal crying that occurs mainly in the late afternoon. Difficult to console.

Colic

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What can you do for colic?

Reassure the parents
rule out other issues
preventative, try to stop it before it starts

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when does colic peak?

2-3 months

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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

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What drugs helps to reduce gas? Doesn’t really help prevent colic

Simethicone

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what is commonly used for reflex, but may not be helpful.

Zantac

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What is one of the most common reasons for shaken baby syndrome?

colic

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Who is food refusal common in?

Toddlers/ school aged children

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what can food refusal be an underlying sign of?

thrush
esophageal dysmotility
infection (ear infection, etc)
pyloric stenosis (only in infancy)

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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

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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)

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What study can show constipation?

radiographic studies

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when do most babies start to sleep through the night?

6 months

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when is sleeping disorders a problem due to separation anxiety

9 months

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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 ```