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Pediatrics > Lecture 13: Well-Child Care > Flashcards

Lecture 13: Well-Child Care Flashcards

1
Q

What is the description of Failure to Thrive?

A
  • Wt curve growth dropping by 2 major percentiles in < 6 months
  • Wt to length decreases below 5th percentile

Trend is most important

Your wt gain is impaired
You weigh way too little

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2
Q

When can BMI start being measured?

A

2

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3
Q

How long do we measure head circumference until?

A

Up to age 3

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4
Q

When do we start measuring BP in a kid?

A

At age 3

Unless cardiorenal anormality, then check all the time.

Also when you stop measuring head circumference
Also start VAs

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5
Q

What is considered HTN in a kid? (2)

A
  • > 95th percentile based on age/ht
  • > 130/80 on 3 occasions

After age 13, use adult guidelines.

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6
Q

When is an echo indicated for BP eval?

A

When you are ready to start tx

Part of the radiographs for BP eval

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7
Q

When does formal VA testing begin?

A

Age 3

Prior to age 3 is based on fixation and tracking.

Same time you stop measuring head circumference

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8
Q

When to refer regarding vision in a child? (4)

A
  • Age 3-4: worse than 20/40
  • Age 5: worse than 20/30
  • Age 6: worse than 20/20
  • Abnormal/asymmetric red reflex
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9
Q

What is the MCC of hearing loss in a newborn?

A

Congenital abnormality

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10
Q

What is the gold standard for hearing screening up to age 3?

A

Behavioral and language response

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11
Q

When is audiometry used for hearing checks?

A

Starting at age 4.

Generally they just do it at school.

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12
Q

When do the innate reflexes tend to go away in children?

A

Around month 4

Sucking, Rooting, Grasping, Moro, Tonic (fencing)

Traction around 6 months

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13
Q

What two innate responses disappear by 2 months in children?

A
  • Placing response
  • Stepping response
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14
Q

When is strabismus NOT abnormal?

A

Intermittent is normal up to 6 months of age.

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15
Q

What is leukocoria?

A

Absence or abnormality of red reflex

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16
Q

What are the palpable sutures at birth? (4)

A
  1. Frontal
  2. Coronal
  3. Sagittal
  4. Lambdoid
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17
Q

Which fontanelle closes later?

A

Anterior

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18
Q

What position should a baby be in for fontanelle assessment?

A

Sitting upright

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19
Q

What is plagiocephaly?

A

Misshapen head, either due to position or to craniosynostosis (fusing of suture)

Easiest to evaluate by looking from the top. Primarily cosmetic.

A crown plate of lamb

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20
Q

What characterizes anterior plagiocephaly?

A
  • Flattened forehead
  • Elevated eye on affected side
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21
Q

What is scaphocephaly?

A

Premature closure of saggital sinus, resulting in a long and narrow head

Stop growing wide

Saggital Scapho

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22
Q

What characterizes acrocephaly?

A

Closure of coronal, lambdoidal, and sagittal sutures

Cone shaped

No frontal closure

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23
Q

What characterizes trigonocephaly?

A
  • Premature closing of frontal/metopic suture
  • Narrow triangular shaped forehead with prominent midline ridge
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24
Q

How do you prevent positional plagiocephaly?

A
  • Frequent position changes
  • Tummy time
  • Change crib positions
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25
Q

How do you treat all the suture cephalys?

A

Maxillofacial or neurosurgeon

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26
Q

Which cephaly can be corrected endoscopically?

A

Scaphocephaly

Sagittal

Scope scapho saggital
All can be corrected with an open approach.

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27
Q

How do you treat positional plagiocephaly (occipital)?

A
  • Positional changes
  • Skull shaping helmet
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28
Q

When do dental examinations begin?

A

Eruption of first tooth, around 5-8 months

Can also just do it at around 1st bday per AAP

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29
Q

What is the issue with non-nutritive sucking past age 4-5?

A

Malocclusion of teeth

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30
Q

When do you begin flossing in a child?

A

Too small to clean adequately with a toothbrush

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31
Q

Until what age should a parent monitor brushing/flossing?

A

Age 8

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32
Q

When do you check anemia and what is the MC anemia?

A
  • Check at age 1 and 2
  • Iron deficiency anemia is MC

Iron def anemia is bimodal: 12-24m and adolescence

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33
Q

When is UA indicated for WCC?

A

Only in symptomatic pts or those at risk for renal disease

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34
Q

Why are sputum cultures an issue with TB in children?

A

Children requires less bacteria to infect and often cannot produce enough sputum, resulting in higher incidence of false negatives.

Prefer PPD or Quantiferon

35
Q

What is the HEADSS assessment for teens?

A
  • Home
  • Education
  • Activities/Employment
  • Drugs
  • Suicidality
  • Sex
36
Q

What occurs to a baby’s weight over their first week?

A

Tend to lose weight, up to 8-10% for BFed babies

37
Q

What do you do with the umbilical cord to infants?

A

Sponge bath until it falls off on its own in 1-2 weeks.

38
Q

When does a baby return to its original BW?

A

2 weeks

39
Q

What supplement is needed for any BFed baby?

A

Vitamin D

40
Q

What vaccines are indicated at month 1?

A

None unless you didn’t give Hep B at birth

41
Q

What vaccines are given at 2 months?

A
  • DTaP
  • IPV
  • Hep B
  • Hib
  • Pneumococcal
  • Rota

Be DR HIP

42
Q

What vaccine at 2 months may cause a slight fever?

A

DtaP (recommended to call doctor before giving tylenol)

43
Q

What vaccines are indicated at 4 months?

A

Same as month 2 (DTaP, IPV, Hep B, Hib, pneumococcal, Rota)

4 DR HIP

Although both lectures say HBV is months 2,4,6, so the mnemonic is kinda off ):

44
Q

What are the age specific milestones? (2,4,6,9,12)

A
  • 2 months: moves head to sound
  • 4 months: controls head & neck
  • 6 months: 6 stunts at 6 mo (sit, stand, speak, swipe, slobber, switch)
  • 9 months: “ma & da”, raspberry, pulls to stand, gross pincer
  • 12 months: 1 point, 2 words, walking, fine pincer
45
Q

When can you introduce solid foods to a child?

A

6 months

Complementary Feeding

46
Q

What vaccines are indicated at 6 months?

A
  • DTaP
  • IPV
  • Hep B
  • Hib (maybe)
  • Pneumococcal
  • Rota (maybe)
  • First flu shot & schedule 2nd 1 month later

Be DR HIP IN 6 months

47
Q

What vaccines are indicated at 12 months?

A
  • MMR (live)
  • Varicella (live)
  • Hep A
48
Q

What vaccines are indicated at 15 months?

A
  • DTaP
  • Hib
  • Pneumococcal

1 Very MAD HIPster

49
Q

What vaccine is indicated at 18 months?

A

Hep A

Final routine vaccine

50
Q

When can you begin autism screening?

A

18 months

ASQ/MCHAT

Same time as Hep A shot
Earliest you give MCHAT

51
Q

What vaccines are required for a 4 year old to attend preschool usually?

A
  • DtaP
  • IPV
  • MMR
  • Varicella
52
Q

What significant milestone should occur at around 4 years?

A

Kid becomes aware of genital differences

53
Q

What boosters and vaccines are indicated at age 11?

A
  • Boosters: Men ACWY & TdaP
  • HPV series
54
Q

What vaccines are indicated at age 16?

A
  • Men ACWY
  • Men B
55
Q

CDC Vaccine Schedule

A
55
Q

When is the ASQ given?

Ages and Stages Questionnaire

A

1 month to 5.5 years

56
Q

When is diagnostic referral indicated with ASQ testing?

A

Below cutoff in 1 or more areas

Cutoff is 2 SDs below the mean

57
Q

What is the M-CHAT?

A

Modified CHecklist for Autism in Toddlers

2 stage report to check autism spectrum disorder (ASD)

Recommended to do at 18 and 30 months.

58
Q

What RFs are alarming for Lead Poisoning?

A
  • Home built prior to 1950
  • Parents work at battery mills, pottery, painting, printing, demo sites
59
Q

When is lead screening performed?

A

Ages 1 & 2

Same time as anemia screening

60
Q

What would suggest a child has lead poisoning? (S/S)

A
  • Vague symptoms: weakness, irritability, wt loss, vomiting
  • Personality changes
  • Late symptoms: retardation, convulsions, coma, lower IQ
61
Q

Is it worse to ingest small amts of lead over time or a single large dose?

A

Small amts over time

62
Q

What is the preferred method of checking for lead poisoning?

A

Venous blood sample > 10 mcg/dl

Can do fingerstick, but confirm with venous

63
Q

For a venous blood reading of lead of 10-19 mcg/dl, what is the recommendation?

A

Recommend parents to diminish exposure

Retest in 3 months

Replace old windows
Cover leaded paint that is chipping
Mop floors, clean windows
Cold water for cooking

64
Q

For a venous blood reading of 20-44 mcg/dl, what is the recommendation for treatment?

A

Full medical eval of nutrition, development, and environment

Repeat tests weekly!

Check iron
ABD XR for ingestion

65
Q

In lead poisonings of 45 mcg/dl or higher, when do you recheck in 48 hrs? 24 hrs?

A
  • Between 45-69(slide typo?) = Recheck in 48 hours
  • Between 60-69= recheck in 24 hours

Measuring FEP & ZPP (checks biologic effects of lead/Pb)

66
Q

What does normal FEP/ZPP with elevated blood lead levels suggest about exposure?

A

Acute

No time for lead to have had persistent effects yet

67
Q

At what blood lead level do you hospitalize?

A

70+

Call poison control @ 1-800-222-1222

68
Q

When is succimer used to chelate lead?

DMSA dimercaptosuccinic acid

A

Once lead levels reach 45 mcg/dl

69
Q

What is the second agent given to assist in lead chelation?

A

Calcium Disodium EDTA

2 hours after 1st dose of succimer

70
Q

MOA of calcium disodium EDTA

A
  • Displacement of lead by calcium
  • Formation of water soluble complex excreted in urine

CI: Renal, Hepatitis

SEs:
Nephrotoxicity, EKG changes, N/V, Sneezing, etc

Calcium DIsplaces (Ca DIsodium)

71
Q

When is dimercaprol given?

A

Symptomatic children with lead poisoning

Adjunct to EDTA, general reversal of metallic binding

works on mercury, gold, and arsenic as well.

72
Q

Who cannot take dimercaprol?

A
  • HSR to peanuts
  • Lactating
  • Liver failure

A dime for peanuts

73
Q

What is the MOA of succimer?

A

Binds with lead ions to form a water soluble complex excretable in urine

Very similar to EDTA

The primary chelating agent for lead poisoning.

First, get rid of the free lead ions via succimer, then displace the sticky ones with calcium disodium EDTA

74
Q

How is each chelating agent administered?

A
  • Succimer/DMSA: ORAL
  • EDTA: IV/IM
  • Dimercaprol/BAL: IM
75
Q

What chelating agent is for copper and mercury?

A

D-penicillamine

Copper D-pen

76
Q

Primary uses of D-penicillamine

A
  • Wilson’s disease
  • Cystinuria
  • RA
77
Q

CIs of D-penicillamine

A
  • Nephro
  • Hepatitis
  • BFeeding
  • Pregnancy

She just wrote same as others + BFeeding & preggo

78
Q

What chemical is important in preventing early childhood caries and dental tooth decay?

A

Fluoride

79
Q

What are the 3 MOAs of fluoride?

A
  1. Inhibit bacterial metabolism
  2. Inhibits demineralization of teeth
  3. Promotes remineralization of teeth
80
Q

When do you start supplementing fluoride and how much?

A
  • If 0.3-0.6ppm: 0.25mg supplement for ages 3-6. 0.5mg for 6-16
  • If < 0.3ppm: 0.25mg for 6mo to 3y, 0.5mg for 3-6y, 1mg for 6-16y
81
Q

What characterizes fluorosis? (Excess fluoride)

A
  • Superficial
  • White flecked/lacy appearance
  • Severe would be brown
82
Q

How do you prevent fluorosis?

A
  • Limit fluoride consumption
  • Limit toothpaste swallowing and mouth rinses

Pediatrics (23 decks)

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