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Pediatrics Exam 1 > Lecture 3 - Growth, Development & Preventative Care > Flashcards

Lecture 3 - Growth, Development & Preventative Care Flashcards

1
Q

When are the infancy well visits?

A 
prenatal 
newborn (in hospital) 
3-5 days (post discharge) 
2-4 weeks 
2 months 
4 months
6 months 
9 months
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2
Q

When are the early childhood well visits?

A 
12 months 
15 months
18 months
24 months
30 months 
3 years 
4 years
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3
Q

When are the middle childhood well visits?

A

annually

this is same for adolescence well visits

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4
Q

When are you measuring recumbent length?

A

For children 0-2 years of age

fixed headboard with moveable footboard

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5
Q

What is measured at each well visit?

A

Length/Stature
Weight BMI
Head circumference

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6
Q

What is the best indicator of adiposity in children and adolescents?

A

BMI

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7
Q

When do you measure BMI (age)?

A

Children > 2

BMI > 85th -95th percentile = “overweight”

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8
Q

What is used in children less than 2 to measure adiposity?

A

Weight for length ratio

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9
Q

When is head circumference measured?

A

Through the age of 2-3

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10
Q

What anatomical landmarks are you using for head circumference?

A

Measure just above the supraorbital ridges, passing around head at the same level as the prominence of the occiput

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11
Q

Shifts across ____ percentile lines may indicate abnormality

A

> or = 2

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12
Q

Birth size is a reflection of________

A

Maternal/ in utero factors

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13
Q

Mid-Parental Height

A

correct parents hight by 5 inches based on gender

add 5 to mom for boys
subtract 5 from dad for girls

average corrected heights

target height is +/- 2 inches of mid-parental height

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14
Q

Familial Short Stature

A

height and weight are proportional

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15
Q

Microcephaly

A

Define as head circumference 2 SD below the mean for average
<3rd percentile

Primary vs Secondary

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16
Q

What is the major difference between primary and secondary microcephaly?

A

Secondary microcephaly pts have normal head circumference at birth

This is more concerning

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17
Q

Primary microcephaly

A

head circumference <3rd percentile
head growth remains below normal range

caused by a number of inherited disorders

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18
Q

Macrocephaly

A

HC > 2 standard deviations above the mean (or >97% percentile)

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19
Q

How can you tell the difference between macrocephaly from hydrocephalus?

A

macrocephaly hugs the upper limit of normal

hydrocephally is dilation of the ventricular system so there is an increase in ICP
these cross percentiles and split sutures <12 months old

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20
Q

Plagiocephaly vs Craniosynostosis

A

Plagiocephaly - abnormal head shape

Craniosynososis - early fusion of suture lines

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21
Q

How can you tell the difference between plagiocephaly vs craniosynostosis?

A

With plagiocephaly - positional molding
the ear is displaced forward, and all sutures are open and flattening in the mastoid area

both have frontal protuberance and posterior protuberance

craniosynostosis - lambdoid synostosis - the ear is displaced posteriorly, with closed lambdoid suture, and mastoid protuberance

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22
Q

How can you manage position plagiocephaly?

A

Increase “tummy time” while awake
Repositioning in crib
PT
Helmets therapy

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23
Q

Constitutional delay

A

delay of growth in adolescence
enters puberty late –teens/early 20s

typical story –father will say he graduated high school shortest in his class and then in college grew 7 inches

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24
Q

With a failure to thrive pt, what abnormality will present first?

A

drop in weight curve

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25
What is the rule of thumb for normal weight gain /loss in newborns?
term infants should be back to birth weight by 2 weeks of age and gain 20-30g/day for 3 months can lose up to 12% in first 2 weeks of life by gains in back
26
Helmet therapy for plagiocephaly
worn 23 hours a day for 6 weeks to 4 months (ideally started before 18 months)
27
What is the treatment for craniosynostosis?
has to go to surgery to normalize ICP
28
What are the components of developmental surveillance?
eliciting and attending to parents concerns obtaining relevant developmental history skillfully observing children's development sharing opinions with other professionals
29
When is formal testing (developmental screening) done?
so informally it is done at every visit | but formally it is done at 9, 18, and 30 months (may need to do at 24 months instead of 30 d/t insurance)
30
What are the 5 different domains of developmental milestones?
``` Language Motor (fine and gross) Cognitive Social Play ```
31
What gross motor milestones do we need to know?
``` rolls front to back (4 months) no head lag when pulled to a sit (5 months?) sits without support (7 months) begins creeping (crawling - 9 months) takes independent steps ( 12 months) ```
32
What self help milestones do we need to know?
holds own bottle (8 months) fusses to be changed (15 months) uses a spoon well (22 months) pulls pants off (24 months)
33
What problem solving milestones do we need to know?
seeking object after it falls silent to floor (8 months) - demonstrates object permanence
34
What social/emotional milestones do we have to know?
``` reciprocal smiling (2 months) recognizes caregiver visually (5 months) stranger anxiety (6 months) separation anxiety (9 months) grives objects to adults for action after demonstration ('requests help' - 11 months) proto imperative pointing (12 months) proto declarative pointing (14 months) shows empathy (15 months) ```
35
Which language milestones do we need to know?
Coos ( 2 months) Listens, then vocalizes when adult stops (6 months) Waves bye (10 months) Says first word (11 months) 50+ words, 50% of which are recognized by a stranger (24 months)
36
When should you expect a child to say their first word?
11 months
37
How old was Ben in Friends when he waved "Bye-bye" for the first time?
10 months
38
When can you expect a baby to start crawling?
9 months
39
Proto-imperative pointing
points at an object because they want it 12 months
40
Proto-declarative pointing
points at something because they want to share the experience with that person 14 months
41
Joint Attention
12-18 months of age in social/developmental communication 4 components: - orienting and attending to a social partner - coordinating attention between people and objects - sharing affect and emotional states with people (proto-declerative) - being able to draw others attention to objects or events to indicate need or to share experiences
42
When does affective reciprocity occur?
3 - 6 months
43
When does joint attention occur?
12-18 months
44
When does theory of mind occur?
30 months this is the not everyone thinks and feels the way I do
45
When is screening for anemia recommended?
at age 1 IF: and for those with risk of iron deficiency: -premature infants -exclusive breastfeeding >4 months without supplement -early weaning to cow's milk or non-iron fortified foods -feeding problems, poor growth, low SES
46
What things put an infant at risk of anemia?
- premature infants - exclusive breastfeeding >4 months without supplement - early weaning to cow's milk or non-iron fortified foods - feeding problems, poor growth, low SES risk assessment at 15, 18, 24 months and 3 and 5 years of age
47
What is the recommended screening guideline for Lead levels?
Venous blood lead levels (BLL) at 1 and 2 years of age IF: - children in high-risk environments (populations where more than 12% of children have BLL) - recent immigrants, refugees - homes build before 1978
48
If a child is consuming >24 ox of cows milk/day, or has an iron poor diet, or is a child of special needs, or is of low SES, or is a menstruating female, what are the anemia guidelines?
risk assessment 15, 18, 24 months, and 3 and 5 years of age, and at any time if they meet these criteria
49
Why are kids at greater risk than adults for lead toxicity?
``` hand to mouth behavior concomitant iron deficiency increase lead absorption increased lead consumption (Pica) increased deposition of lead into soft tissues vs bones immature BBB --greater neurotoxicity ```
50
How does a pt with elevated BLL present?
blood lead levels typically asymptomatic may have: abdominal colic, constipation, growth failure, hearing loss, microcytic anemia, dental caries, spontaneous abortions, renal disease, osteopenia, CV disease
51
What is the management for lead poisoning?
chelation if BLL >45 mcg/dL Succimer 10mg/kg PO every 8 hours x 5 days, then every 12 hours for 14 days has SE -- not the easiest to take
52
When do we do lipid screening?
once between 9-11 y/o and once again between 17 and 19 unless they are at high risk then we do screening 2, 4, 6, 8, years and then annually after that
53
Which pts are at risk for dyslipidemia and need extra screening?
``` obesity family hx of MI, stroke <65 years of age DM HTN PCOD Hypothyroidism Smoker ```
54
When do we do BP screenings?
annual start at age 3
55
With what pts do we need to check BP at every visit?
obese take meds known to increase BP have renal dz, history of aortic arch obstruction or coaractation DM
56
For taking BP of a child, bladder length should be ____% of arm circumference
80-100% of arm circumference width at least 40%
57
What position should infants be in when you obtain BP reading?
supine children should be seated
58
How do you determine if a child has HTN?
based on their height
59
When do we screen for visual acuity?
annually once >4 y/o or cooperative 3 year olds
60
When do we screen for amblyopia?
between age 3-5
61
When do we do hearing screenings?
universal newborn screening screen at 4, 5, 6, 8, and 10 years screen once between 11-14 15-17 18-21
62
When do we expect to see the first teeth come in? Where are they?
lower front teeth (incisor) - 6-10 months | upper front teeth (incisor) - 8-12 months
63
What is the most common chronic illness in children?
dental carries Strep mutans
64
How can you help prevent dental carries?
no night-time bottle no juice or soda in bottle or sippy cup encourage parent to use cup at early age limit frequency of startchy/sweet snacks and drinks limit juice and sweets to mealtimes (4-6oz/day) fluoride
65
What is the appropriate size of toothpaste for a <3year old?
rice sized
66
What is the appropriate size of toothpaste for a >3year old?
pea size
67
HEADDSSS
adolescence age-based safety counseling ``` home education activities diet drugs safety sex suicide ```
68
What height is appropriate to no longer use a booster seat?
4 foot 9 inches
69
How long should children been in a rear facing car seat?
until 2 years | ideally longer
70
How many hours of sleep should a newborn get?
16-18 hours
71
How many hours of sleep should a 1 year old get?
14 hours
72
How many hours of sleep should a 3 year old get?
12 hours
73
How many hours of sleep should a 5 year old get?
11 hours
74
How many hours of sleep should a 9 year old get?
10 hours
75
When are naps appropriate?
2 naps until 1 year 1 afternoon nap until 3-4 years
76
When should children be learning to self sooth and sleep on their own?
6 - 8 months --before separation anxiety starts
77
When do you normally start the topic of toilet training during well visits?
18 - 24 month visits
78
What are signs that a child is ready to toilet train?
can put on/take off clothes uses the word no has regular and predictable bowel movements stays dry for two hours at a time reports soiled diapers and wants to be cleaned
79
BMI increases every ___ hour of media consumed per week
1 there should be a 2 hour per day limit on TV watching
80
Children under the age of 18months can use what kind of media?
face time only
81
Children 2-5 years of age should be limited to how many hours of TV/day?
1
82
What are the different types of discipline?
natural consequences logical consequences withholding privileges time out
83
What is the rule for how long time outs should be?
1 minute for every year of age 3 year old gets 3 minute time out

Pediatrics Exam 1 (6 decks)

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