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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

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2
Q

When can BMI started 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.

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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

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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.

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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 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

Premature closing of the coronal or lambdoidal suture

Easiest to evaluate by looking from the top

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

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23
Q

What characterizes tringonocephaly?

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 positioens
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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

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

Wha 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?

39
Q

What supplement is needed for any BFed baby?

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
42
Q

What vaccine at 2 months may cause a slight fever?

A

TDaP (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)

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: point, 2 words, walking, fine pincer
45
Q

When can you introduce solid foods to a child?

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
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
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

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: MCV4 & TdaP
  • HPV series
54
Q

What vaccines are indicated at age 16?

A
  • MCV4
  • Men B
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

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 = Recheck in 48 hours (slide typo?)
  • 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

71
Q

When is dimercaprol given?

A

Symptomatic children

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
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

74
Q

How is each chelating agent administered?

A
  • Succimer: ORAL
  • EDTA: IV
  • Dimercaprol: IM
75
Q

What chelating agent is for copper and mercury?

A

D-penicillamine

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?

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 is fluorosis?

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 (41 decks)

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