Newborn and Well Child Exams Flashcards
Erythromycin prophylaxis in newborns is to prevent what?
Ophthalmia neonatorum (which can lead to corneal scarring)
What assesses fetal maturation of newly born infants?
New Ballard score
What is ophthalmia neonatorum?
- Untreated gonorrhea causing purulent discharge from the eye in a newborn
- Can lead to corneal scarring
- Erythromycin prophylaxis in newborns to avoid this
What is auditory brainstem response screening?
- Screening to evaluate the integrity of the auditory pathway of a newborn
- Soft clicking sound in each ear, electrodes monitor response
What is caput succedaneum?
- Neonatal condition
- WNL fluid collection causing swelling of head due to pressure against the cervix during delivery
- Resolves in 3-4 days
What is cephalohematoma?
- Hematoma underneath the skin in the periosteum of a newborn’s skull
- Causes unnecessary pooling of blood
- Takes months to resolve
Biggest difference between caput succedaneum and cephalohematoma?
Caput succedaneum will take days to resolve, but cephalohematoma could take months
How to differentiate caput succedaneum vs. cephalohematoma?
- Caput can occur across suture lines
- Cephalohematoma cannot occur across suture lines (periosteum ends there)
What is worse in infants/children: inguinal or umbilicus hernias?
Inguinal
What is a Simian crease?
- Single line that runs across the palm of the hand
- Small hands or Down Syndrome
Barlow and Ortolani tests?
Newborn hip exam (to assess for developmental hip dysplasia)
- Barlow: dislocate hip by pushing down
- Ortolani: relocate hip by pulling up
Newborn exam: potential signs of spina bifida?
- Sacral sinus and dimple
- Hair tuft
What is congenital dermal melanocytosis?
- Skin finding of newborn
- Hyperpigmented
- Fades with time
Why does neonatal acne develop?
Likely due to withdrawal from mother’s hormones
How to treat sebaceous gland hyperplasia vs. neonatal acne?
Don’t treat either one - difficult to do and they’ll just resolve on their own
Why does seborrheic dermatitis in the newborn typically develop in a triangle on the back of the head?
No one wants to scrub/scrape that area (because of the fontanelle)
What is salmon patch hemangioma?
Very superficial blood vessels found on newborns - fade over time
Describe the moro reflex
- The “startle” reflex
- Present in up to 4-5 mos old
- Slightly drop infant
- Infant will spread out arms (abduct), unspread arms (adduct), and cry
Describe the stepping reflex
- Hold newborn upright
- Baby lifts feet as if walking
Describe palmar/plantar grasp
- Newborn reflex
- Place your finger on palm or plantar surface
- Fingers or toes will curl to grasp
Describe the rooting reflex
- Touch anywhere on the face of a newborn
- Head turns to the side
- Present by 28 weeks gestation
Describe meconium
- Early feces of newborn
- Black/dark green
- Heme positive
- Passed from the body prior to any digestion of milk/formula (consists of desquamated GI cells, lanugo, mucus, amniotic fluid, bile, water)
Feces of a newborn once it is being fed milk/formula
- May take a week of feeding to be produced
- Bright yellow, curdled
- Looks like diarrhea
What is considered physiologic jaundice?
- Visible jaundice appearing AFTER 24 hrs of age (anything before that is abnormal)
- Total bilirubin rises slowly (less than 5 mg/dL per day)
What is Tanner’s height prediction formula?
Way to predict adult height
- Mother’s height plus father’s height
- Divide by 2
- Add 6.5 cm for males
- Subtract 6.5 cm for females
- Consider a range of 2 standard deviations (approx 5 cm)
Pediatric BMI
- BMI = kg / cm^2
- Calculate BMI then plot on standardized growth charts (gender/age specific)
- 95th or higher percentile is obese
- 85th to 94th is overweight
- 5th to 84th is healthy wt
- Less than 5th percentile is underweight
Normal weight gain of a newborn?
An ounce per day
When is BMI used in pediatrics?
Not until 2 years old
Causes of hypertension prior to puberty?
Essentially all have an anatomic cause of some sort
Piaget’s stages of cognitive development
0-2 yrs old: sensorimotor
2-7 yrs old: pre-operational
7-11 yrs old: concrete operation
12 yrs and over: formal operations
Developmental warning signs at 2 yo
- Cannot walk by 18 mos
- Does not speak at least 15 words by 18 months
- Does not use 2 word sentences by age 2
Developmental warning signs at 3 yo
- Frequent falling and difficulty w/stairs
- Inability to build tower of more than 4 blocks
- Inability to copy a circle by 3
Developmental warning signs at 4 yo
- Can’t throw a ball overhand
- Can’t grasp a crayon b/w thumb and fingers
- Still clings when parents leave
Developmental warning signs at 5 yo
- Extremely fearful/aggressive behavior
- Easily distracted from any single activity
- Shows little interest in playing w/other children
Define adolescence
- Puberty and somatic growth
- Social, emotional development
- Progress from concrete to abstract thinking
- Establish independent identity
MC causes of adolescent mortality
Unintentional injury (49%)
Homicide (17%)
Suicide (11%)
Describe the sucking reflex
Newborn sucks in response to a nipple in the mouth (observed by 14 wks gestation)
Describe fencing reflex
- Head turned to one side
- Arm and leg on same side are extended
- Arm and leg on OTHER side are flexed
- Normally disappears by 3 months old
Describe Babinski reflex in children
Normal for upgoing toe in children up to 2 yo (due to immature nervous system)
Describe crawling as a developmental milestone for children
NOT considered a milestone - may not develop at all
How long do babies routinely cry?
Crying persists routinely until 3-4 yo
When should a child be able to draw a circle?
36 months
How long does Freud’s oral stage last?
Birth to 18 months
How long does Freud’s anal stage last?
18 months to 3-4 yo
