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
2
Q
When can BMI started being measured?
A
2
3
Q
How long do we measure head circumference until?
A
Up to age 3
4
Q
When do we start measuring BP in a kid?
A
At age 3
Unless cardiorenal anormality, then check all the time.
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.
6
Q
When is an echo indicated for BP eval?
A
When you are ready to start tx
7
Q
When does formal VA testing begin?
A
Age 3
Prior to age 3 is based on fixation and tracking.
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
9
Q
What is the MCC of hearing loss in a newborn?
A
Congenital abnormality
10
Q
What is the gold standard for hearing screening up to age 3?
A
Behavioral and language response
11
Q
When is audiometry used for hearing checks?
A
Starting at age 4.
Generally they just do it at school.
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
13
Q
What two innate responses disappear by 2 months in children?
A
- Placing response
- Stepping response
14
Q
When is strabismus NOT abnormal?
A
Intermittent is normal up to 6 months of age.
15
Q
What is leukocoria?
A
Absence of red reflex
16
Q
What are the palpable sutures at birth? (4)
A
- Frontal
- Coronal
- Sagittal
- Lambdoid
17
Q
Which fontanelle closes later?
A
Anterior
18
Q
What position should a baby be in for fontanelle assessment?
A
Sitting upright
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
20
Q
What characterizes anterior plagiocephaly?
A
- Flattened forehead
- Elevated eye on affected side
21
Q
What is scaphocephaly?
A
Premature closure of saggital sinus, resulting in a long and narrow head
Stop growing wide
Saggital Scapho
22
Q
What characterizes acrocephaly?
A
Closure of coronal, lambdoidal, and sagittal sutures
Cone shaped
23
Q
What characterizes tringonocephaly?
A
- Premature closing of frontal/metopic suture
- Narrow triangular shaped forehead with prominent midline ridge
24
Q
How do you prevent positional plagiocephaly?
A
- Frequent position changes
- Tummy time
- Change crib positioens
25
How do you treat all the suture cephalys?
Maxillofacial or neurosurgeon
26
Which cephaly can be corrected endoscopically?
Scaphocephaly
| Sagittal
## Footnote
All can be corrected with an open approach.
27
How do you treat positional plagiocephaly (occipital)?
* Positional changes
* Skull shaping helmet
28
When do dental examinations begin?
Eruption of first tooth, around 5-8 months
| Can also just do it at around 1st bday per AAP
29
What is the issue with non-nutritive sucking past age 4-5?
Malocclusion of teeth
30
When do you begin flossing in a child?
Too small to clean adequately with a toothbrush
31
Until what age should a parent monitor brushing/flossing?
Age 8
32
When do you check anemia and what is the MC anemia?
* Check at age 1 and 2
* Iron deficiency anemia is MC
| Iron def anemia is bimodal: 12-24m and adolescence
33
When is UA indicated for WCC?
Only in symptomatic pts or those at risk for renal disease
34
Why are sputum cultures an issue with TB in children?
Children requires less bacteria to infect and often cannot produce enough sputum, resulting in higher incidence of false negatives.
| Prefer PPD or Quantiferon
35
What is the HEADSS assessment for teens?
* Home
* Education
* Activities/Employment
* Drugs
* Suicidality
* Sex
36
Wha occurs to a baby's weight over their first week?
Tend to lose weight, up to 8-10% for BFed babies
37
What do you do with the umbilical cord to infants?
Sponge bath until it falls off on its own in 1-2 weeks.
38
When does a baby return to its original BW?
2 weeks
39
What supplement is needed for any BFed baby?
Vitamin D
40
What vaccines are indicated at month 1?
None unless you didn't give Hep B at birth
41
What vaccines are given at 2 months?
* DTaP
* IPV
* Hep B
* Hib
* Pneumococcal
* Rota
42
What vaccine at 2 months may cause a slight fever?
TDaP (recommended to call doctor before giving tylenol)
43
What vaccines are indicated at 4 months?
Same as month 2 (DTaP, IPV, Hep B, Hib, pneumococcal, Rota)
44
What are the age specific milestones? (2,4,6,9,12)
* 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
When can you introduce solid foods to a child?
6 months
46
What vaccines are indicated at 6 months?
* DTaP
* IPV
* Hep B
* Hib (maybe)
* Pneumococcal
* Rota (maybe)
* **First flu shot & schedule 2nd 1 month later**
47
What vaccines are indicated at 12 months?
* MMR (live)
* Varicella (live)
* Hep A
48
What vaccines are indicated at 15 months?
* DTaP
* Hib
* Pneumococcal
49
What vaccine is indicated at 18 months?
Hep A
| Final routine vaccine
50
When can you begin autism screening?
18 months
| ASQ/MCHAT
51
What vaccines are required for a 4 year old to attend preschool usually?
* DtaP
* IPV
* MMR
* Varicella
52
What significant milestone should occur at around 4 years?
Kid becomes aware of genital differences
53
What boosters and vaccines are indicated at age 11?
* Boosters: MCV4 & TdaP
* HPV series
54
What vaccines are indicated at age 16?
* MCV4
* Men B
55
When is the ASQ given?
| Ages and Stages Questionnaire
1 month to 5.5 years
56
When is diagnostic referral indicated with ASQ testing?
Below cutoff in 1 or more areas
| Cutoff is 2 SDs below the mean
57
What is the M-CHAT?
Modified checklist for Autism in Toddlers
| 2 stage report to check autism spectrum disorder (ASD)
## Footnote
Recommended to do at 18 and 30 months.
58
What RFs are alarming for Lead Poisoning?
* Home built prior to **1950**
* Parents work at **battery mills, pottery, painting, printing, demo sites**
59
When is lead screening performed?
Ages 1 & 2
60
What would suggest a child has lead poisoning? (S/S)
* **Vague symptoms: weakness, irritability, wt loss, vomiting**
* Personality changes
* **Late symptoms: retardation, convulsions, coma, lower IQ**
61
Is it worse to ingest small amts of lead over time or a single large dose?
Small amts over time
62
What is the preferred method of checking for lead poisoning?
Venous blood sample > 10 mcg/dl
| Can do fingerstick, but confirm with venous
63
For a venous blood reading of lead of 10-19 mcg/dl, what is the recommendation?
Recommend parents to diminish exposure
| Retest in 3 months
## Footnote
Replace old windows
Cover leaded paint that is chipping
Mop floors, clean windows
**Cold water for cooking**
64
For a venous blood reading of 20-44 mcg/dl, what is the recommendation for treatment?
Full medical eval of nutrition, development, and environment
| Repeat tests weekly!
## Footnote
Check iron
ABD XR for ingestion
65
In lead poisonings of 45 mcg/dl or higher, when do you recheck in 48 hrs? 24 hrs?
* 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
What does normal FEP/ZPP with elevated blood lead levels suggest about exposure?
Acute
| No time for lead to have had persistent effects yet
67
At what blood lead level do you hospitalize?
70+
| Call poison control @ 1-800-222-1222
68
When is succimer used to chelate lead?
| DMSA dimercaptosuccinic acid
Once lead levels reach **45 mcg/dl**
69
What is the second agent given to assist in lead chelation?
Calcium Disodium EDTA
| 2 hours after 1st dose of succimer
70
MOA of calcium disodium EDTA
* Displacement of lead by calcium
* Formation of water soluble complex excreted in urine
| CI: Renal, Hepatitis
## Footnote
SEs:
Nephrotoxicity, EKG changes, N/V, Sneezing, etc
71
When is dimercaprol given?
Symptomatic children
| Adjunct to EDTA, **general reversal of metallic binding**
## Footnote
works on mercury, gold, and arsenic as well.
72
Who cannot take dimercaprol?
* HSR to **peanuts**
* Lactating
* Liver failure
73
What is the MOA of succimer?
Binds with lead ions to form a water soluble complex excretable in urine
| Very similar to EDTA
74
How is each chelating agent administered?
* Succimer: ORAL
* EDTA: IV
* Dimercaprol: IM
75
What chelating agent is for **copper** and mercury?
D-penicillamine
76
Primary uses of D-penicillamine
* Wilson's disease
* Cystinuria
* RA
77
CIs of D-penicillamine
* Nephro
* Hepatitis
* BFeeding
* Pregnancy
| She just wrote same as others + BFeeding & preggo
78
What chemical is important in preventing early childhood caries and dental tooth decay?
Fluoride
79
What are the 3 MOAs of fluoride?
1. Inhibit bacterial metabolism
2. Inhibits demineralization of teeth
3. Promotes remineralization of teeth
80
When do you start supplementing fluoride and how much?
* 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
What is fluorosis?
* Superficial
* White flecked/lacy appearance
* Severe would be brown
82
How do you prevent fluorosis?
* Limit fluoride consumption
* Limit toothpaste swallowing and mouth rinses
83
