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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
Q

What is the rule of thumb for normal weight gain /loss in newborns?

A

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

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26
Q

Helmet therapy for plagiocephaly

A

worn 23 hours a day for 6 weeks to 4 months (ideally started before 18 months)

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27
Q

What is the treatment for craniosynostosis?

A

has to go to surgery to normalize ICP

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28
Q

What are the components of developmental surveillance?

A

eliciting and attending to parents concerns
obtaining relevant developmental history
skillfully observing children’s development
sharing opinions with other professionals

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29
Q

When is formal testing (developmental screening) done?

A

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)

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30
Q

What are the 5 different domains of developmental milestones?

A 
Language 
Motor (fine and gross) 
Cognitive
Social 
Play
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31
Q

What gross motor milestones do we need to know?

A 
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)
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32
Q

What self help milestones do we need to know?

A

holds own bottle (8 months)
fusses to be changed (15 months)
uses a spoon well (22 months)
pulls pants off (24 months)

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33
Q

What problem solving milestones do we need to know?

A

seeking object after it falls silent to floor (8 months) - demonstrates object permanence

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34
Q

What social/emotional milestones do we have to know?

A 
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
Q

Which language milestones do we need to know?

A

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
Q

When should you expect a child to say their first word?

A

11 months

37
Q

How old was Ben in Friends when he waved “Bye-bye” for the first time?

A

10 months

38
Q

When can you expect a baby to start crawling?

A

9 months

39
Q

Proto-imperative pointing

A

points at an object because they want it

12 months

40
Q

Proto-declarative pointing

A

points at something because they want to share the experience with that person
14 months

41
Q

Joint Attention

A

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
Q

When does affective reciprocity occur?

A

3 - 6 months

43
Q

When does joint attention occur?

A

12-18 months

44
Q

When does theory of mind occur?

A

30 months

this is the not everyone thinks and feels the way I do

45
Q

When is screening for anemia recommended?

A

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
Q

What things put an infant at risk of anemia?

A
  • 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
Q

What is the recommended screening guideline for Lead levels?

A

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
Q

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?

A

risk assessment 15, 18, 24 months, and 3 and 5 years of age, and at any time if they meet these criteria

49
Q

Why are kids at greater risk than adults for lead toxicity?

A 
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
Q

How does a pt with elevated BLL present?

A

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
Q

What is the management for lead poisoning?

A

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
Q

When do we do lipid screening?

A

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
Q

Which pts are at risk for dyslipidemia and need extra screening?

A 
obesity 
family hx of MI, stroke <65 years of age
DM
HTN
PCOD
Hypothyroidism 
Smoker
54
Q

When do we do BP screenings?

A

annual start at age 3

55
Q

With what pts do we need to check BP at every visit?

A

obese
take meds known to increase BP
have renal dz, history of aortic arch obstruction or coaractation
DM

56
Q

For taking BP of a child, bladder length should be ____% of arm circumference

A

80-100% of arm circumference

width at least 40%

57
Q

What position should infants be in when you obtain BP reading?

A

supine

children should be seated

58
Q

How do you determine if a child has HTN?

A

based on their height

59
Q

When do we screen for visual acuity?

A

annually once >4 y/o

or cooperative 3 year olds

60
Q

When do we screen for amblyopia?

A

between age 3-5

61
Q

When do we do hearing screenings?

A

universal newborn screening
screen at 4, 5, 6, 8, and 10 years

screen once between
11-14
15-17
18-21

62
Q

When do we expect to see the first teeth come in? Where are they?

A

lower front teeth (incisor) - 6-10 months

upper front teeth (incisor) - 8-12 months

63
Q

What is the most common chronic illness in children?

A

dental carries

Strep mutans

64
Q

How can you help prevent dental carries?

A

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
Q

What is the appropriate size of toothpaste for a <3year old?

A

rice sized

66
Q

What is the appropriate size of toothpaste for a >3year old?

A

pea size

67
Q

HEADDSSS

A

adolescence age-based safety counseling

home 
education 
activities 
diet 
drugs
safety 
sex 
suicide
68
Q

What height is appropriate to no longer use a booster seat?

A

4 foot 9 inches

69
Q

How long should children been in a rear facing car seat?

A

until 2 years

ideally longer

70
Q

How many hours of sleep should a newborn get?

A

16-18 hours

71
Q

How many hours of sleep should a 1 year old get?

A

14 hours

72
Q

How many hours of sleep should a 3 year old get?

A

12 hours

73
Q

How many hours of sleep should a 5 year old get?

A

11 hours

74
Q

How many hours of sleep should a 9 year old get?

A

10 hours

75
Q

When are naps appropriate?

A

2 naps until 1 year

1 afternoon nap until 3-4 years

76
Q

When should children be learning to self sooth and sleep on their own?

A

6 - 8 months –before separation anxiety starts

77
Q

When do you normally start the topic of toilet training during well visits?

A

18 - 24 month visits

78
Q

What are signs that a child is ready to toilet train?

A

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
Q

BMI increases every ___ hour of media consumed per week

A

1

there should be a 2 hour per day limit on TV watching

80
Q

Children under the age of 18months can use what kind of media?

A

face time only

81
Q

Children 2-5 years of age should be limited to how many hours of TV/day?

A

1

82
Q

What are the different types of discipline?

A

natural consequences
logical consequences
withholding privileges
time out

83
Q

What is the rule for how long time outs should be?

A

1 minute for every year of age

3 year old gets 3 minute time out

Pediatrics Exam 1 (6 decks)

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