Modules 1-3 Flashcards
neonate age
0-28 days
Infant age
1 month - 1 year
Toddler age
1 -3 years
School age range
4-11 years
Adolescent age
12-18 years
Define pediatrics
Branch of medicine concerned with the physical, mental, and social health of children from birth to young adulthood
Top 5 causes of infant death in US
- congenital malformations/chromosome abnormalities/ 2. Short gestation/low birthweight
- Maternal complications
- SIDS
- Accidents
Top 5 causes of death ages 1-4
- Accidents
- Congenital abnormalities
- Cancer
- Homicide
- Heart disease
Top 5 causes of death ages 5-9
- Accidents
- Cancer
- Congenital abnormalities
- Homicide
- Heart disease
Top 5 causes of death ages 10-14
- Accidents
- Suicide
- Cancer
- Congenital abnormalities
- Homicide
Top 5 causes of death ages 15-24
- Accidents
- Suicide
- Homicide
- Cancer
- Heart disease
Define beneficence
Maximizing benefit and minimizing burden; acting in the patient’s best interest
Define informed consent
Full disclosure to the patient of the facts necessary to make reasonable consent for intervention
What age does assent start?
About 7
Elements of informed consent
nature of illness, proposed intervention and probability of success, risks/benefits/uncertainties, assess understanding, question/answer, voluntary agreement
Elements of assent
help patient achieve awareness of condition, give patient expectations, assessment of understanding and influencing factors, solicit expression of patient’s willingness
Limits of parental autonomy
Parents usually cannot refuse life-saving treatment for a child, expected to make decisions in the child’s best interest
Limits of provider authority in pediatrics
Providers generally defer to parental preference, but can seek to override parents’ decision if in the child’s best interest
Components of neonatal history
Maternal hx, family hx, previous pregnancies and outcomes, labor and delivery, history of pt since birth, history of mother since birth
Components of history for infants and toddlers
birth hx, medical hx, family hx, social hx, milestones, feeding, sleeping, stooling/urination, vaccinations
Components of history for school-aged children
birth hx if relevant, medical hx, family hx, social hx, milestones, feeding, sleeping, vaccination
Components of history for adolescents
medical history, social history, sexual development, family history, vaccinations
Components of neonatal evaluation
APGAR, vitals, age and weight, sex, physical exam
Components of APGAR
appearance, pulse, grimace, activity, respirations
Appearance scoring
central cyanosis 0, acrocyanosis 1, pink 2
Pulse scoring
0=no pulse, 1=less than 100, 2=more than 100
Grimace scoring
0=none, 1=grimace, 2=cries
Activity
0=limp, 1=some, 2=active
Respirations
0=none, 1=slow/irregular, 2=strong cry
what score at 5 minutes means high risk?
0-7
what is normal birthweight in grams
2500
what is normal birthweight in pounds
5.5
what is the % range for large for gestational age?
> 90
what is the % range for appropriate for gestational age?
10-90
what is the % range for small for gestational age?
<10
what is the Ballard score
Determines gestational age by neuromuscular activity and physical maturity
posterior fontanelle size
1 cm or less
when the sutures close prematurely
craniosynostosis
anterior fontanelle size
1-4 cm
infants are obligate nose breathers until when
about 1 month
significance of low-set ears for the purposes of this class
Turners Syndrome
signs of congenital heart disease in a newborn
increased work of breathing with cyanosis
Primitive reflexes to be checked in a newborn
Rooting, sucking, Moro, palmar grasp, Babinski
Babinski reflex disappears at
1-2 y/o
Hip examination maneuvers
Barlow (adducting) and Ortolani (abducting)
categories of disorders tested for in NM Newborn Screening
Amino acids, organic acids, fatty acids, endocrine disorder, hemoglobin, other
When does newborn screening occur for healthy infant
24-48 hours or at discharge and then 10-14 days later
When does newborn screening occur for NICU infants
on admission, 2-3 days later, then one month or discharge
What is timeframe for hearing test?
Prior to leaving hospital or within first month, then 3 months if needed, intervention by 6 months if needed
screening for congenital heart disease
pulse oximetry
how many genetic screening test for healthy newborn?
2
how many genetic screening tests for NICU
3
when does the perinatal period start
22 weeks
when does the perinatal period end
7 days
what counts as premature
less than 38 weeks
what do the first trimester screenings look for
trisomy 18 and 21
when does the quad screen occur
2nd trimester
what does the quad screen test for
trisomy 18 and 21
what does the cell free fetal DNA test for
trisomy 13, 18, 21 and sex chromosomes
what fetal analysis can occur during the first trimester
chorionic villus sampling
what fetal analysis can occur during the second trimester
amniocentesis
what fetal analysis can occur during late gestation
fetal blood/tissue/urine
is a maternal blood analysis screening or diagnostic
screening
normal HR range for neonate
120-160
normal RR for neonate
40-60
normal BP for neonate
60-80/30-45
when does neonate physical exam occur
several hours after birth, after feeding and resting
what can usually be felt in the abdomen of a neonate
spleen and liver
how many babies have birth defects
1 in 33
what is the most common type of birth defect
congenital heart defects
how often are serious disease detected through newborn screening
about once per week
how late can specimens be collected for newborn screening
up to 6 months
what are signs and symptoms of an emergent condition in neonates
cardiac arrest, lethargy, poor feeding, weight loss
what lab abnormalities may be present in a newborn with an emergent condition
abnormal ammonia, low glucose, acidosis, electrolyte abnormalities, reducing substances in urine
what percentage of conditions does the first newborn screening detect
90%
what is physiologic jaundice
benign, transient elevated bilirubin that appears at more than 24 hours after birth due to increased metabolism. Visible jaundice resolves by 1 week in the term infant and 2 weeks in the preterm infant. Peak bilirubin measurement occurs at 3-5 days of age but does not rise by more than 5 mg/dl
what is pathologic jaundice
jaundice that appears within 24 hours of birth
what is the most common infection in utero
cytomegalovirus
what is hypoglycemia in a newborn less than 4 hours old
less than 40
what is hypoglycemia in a newborn between 4 and 24 hours old
less than 45
when should hypoglycemia return to normal
within 3 hours
what counts as tachypnea in a newborn
over 60 breaths/min
what comprises the majority of high-risk newborns
prematurity
what level of prematurity is associated with low levels of surfactant
younger than 26 weeks
when is the ability to coordinate sucking, breathing, and swallowing developed
34-36 weeks
what happens if a baby is born before 34 weeks
gavage feedings
what heart problem is common among premature infants
patent ductus arteriosus
what are the consequences of immature cerebral vasculature in premature infants
subempendymal and intraventricular hemorrhage and periventricular leukomalacia
what factors contribute to calculating BSA
height, weight, age and sex
skin of a baby is ___ than an adult’s
thinner
increased permeability of blood brain barrier contributes to what in infants
increased CNS receptivity
gastric pH is what after birth
elevated
gastric transit times and metabolism are what in infants
faster
when does gastric pH normalize
1-2 months after birth
shape of infant thorax is
cylindrical
what do ribs run in an infant
horizontal
why do infants have an increased respiratory rate
limited chest expansion
characteristics of infant head
large with short neck and prominent occiput and tongue
why do infants have increased heart rate
ventricles are less compliant leading to decreased output
why do some medications have longer duration of action in infant
immature liver
psychology less than 6 months
usually accept strangers
psychology 6 months to 4 years
stranger danger
psychology school age
worry about pain, procedure, how will affect them
at what age can children start providing some of their own history
4
up to when is the WHO growth chart used
24 months
what are signs of acute bilirubin encephalopathy
lethargy, poor feeding, irritability, highpitched cry, arching of the neck and trunk, apnea, seizures, coma
what is chronic bilirubin encephalopathy
extrapyramidal movement disorder. Gaze abnormality, auditory disturbances, dysplasia of enamel of deciduous teeth
who is at risk for hypoglycemia
LGA, SGA, preterm, stressed
hypoglycemia ssx
asymptomatic, lethargy, poor feeding, irritability, seizures
what triad is present with cocaine and meth use
no prenatal care, premature delivery, placental abruption
what ssx of cocaine and meth use
possible iugr, irritability
ssx of newboard opiate withdrawal
CNS excitement: irritability, hyperactivity, hypertonicity, high-pitched cry, tremors, seizures. GI: Vomiting, diarrhea, weight loss, poor feeding, incessant hunger, salivation
Metabolic/respiratory: Nasal stuffiness, sneezing, yawning, sweating, hyperthermia. Often IUGR
monochorial twins characteristics
always monozygotic and same sex but can be diamniotic or monoamniotic. Risk for twin to twin transfusion and birth abnormalities like CP
dichorial twins
can be either dizygous or monozygous of either sex. Can have growth restriction but is less likely to have twin-to-twin transfusion and anomalies
what is one treatment for apnea in an infant
caffeine
definition of enuresis and encopresis
a child who does not achieve urine and bowel continence by 5-6 years of age and has no underlying implicated pathology
2 core features of autism spectrum disorders
persistent deficits in social communication and social interaction across multiple contexts, restricted, repetitive patterns of behavior, interests, or activities
4 principles of child development
development is predictable, range of norms is wide, multiple factors affecting development, H&P is variable
intervals for use of standardized screening tools
9 month, 18 month, 24/30 month
1 month gross motor
lift up chin from prone
2 month gross motor
left chest up from prone
4 month gross motor
no head lag when pulled to sti
6 month gross motor
sits briefly
8 month gross motor
can get into sit position
12 month gross motor
can stand assisted
how much weight does an infant drop in the first week
5-10%
when will the weight dropped in the first week be regained
7-10 days
brain weight does what by 4-6 months
doubles
average head circumference at birth
35 cm
age for boys puberty
12-16
age for girls puberty
10-14
first sign of girls puberty
breast development
first sign of boys puberty
testicle enlargement
stage 1 tanner
pre-pubescent, no pubic hair
stage 2 tanner
boys have testicle enlargement, girls have breast enlargement, slight pubic hair
stage 5 tanner
adult features
