Newborn Assessment & Well Child Exams Flashcards
New Ballard Score: Fetal maturation of newly born infants: Takes into consideration? (6)
Posture
square window (wrist→ flexibility-less flexible when term) arm recoiled (how far back it recoils determines how close to term they are)
popliteal angle
scarf sign
heel to ear (more likely to be able to pull heel up to ear if premature)
Auditory Brainstem Response Screening
introduces soft clicking sound to each ear→ electrodes record auditory response→ testing integrity of auditory pathway
Caput Succedaneum
Serosanguinous, subcutaneous, extraperiosteal fluid collection with poorly defined margins caused be the pressure of the scalp against the cervix. May get bruising over vertex, DOES cross suture line
Cephalohematoma
membrane on skull bone gets elevated up and there is a hemorrhage underneath. Blood tumor under the periosteum causing it to lift, d/t rupture of blood vessels crossing the periosteum. Do NOT cross suture lines
Subgaleal Hemorrhage
Bleeding in the potential space between the skull periostium and the aponeurosis
Male GU abnormalities (6)
- Normal Neonatal phimosis
- Hypospadias→ urethral meatus not at tip of head
- Hydrocele
- Inguinal Hernia
- Imperforate Anus
- Ambiguous genitalis
Extremity Abnormalities (2)
- Simian Crease→ crease goes all the way across palm (could be downs or bradydactly (small hands))
- Polydactyly→ extra digit→ Pre axial (on thumb side), post axial (pinky side). Need to decide if there is a bone or not→ refer to ortho
2 Exams for Hips
• Barlow Test→ will feel snap, dislocates hip
• Ortolani→ allowing the hip to relocate
Hip problems can be from breech position (head of femur may not sit in acetabulum correctly)→ do Hip U/S
2 Verterbral Abnormalities
- Sacral sinus/Dimple→ can be sign of dysraphysm of sacral spine
- Hair tuft→ can cause tethered cords- can eventually cause weakness in legs→ U/S and release cord if tethered
4 newborn reflexes
useful to see if they are symmetrically bilateral
• Moro reflex: drop them back and watch for arms to flail
• Stepping reflex: hold under arms and they try to step
• Palmar & Plantar Grasp
• Rooting Reflex→ stimulation around mouth–turn head towards something to suck on
How Feces may present from infants
- If breast fed→ non oderous, seedy, yellowish
- Melena→ digestive & abdominal wall cells broken down into blood
- Meconeum→ seen when babies are first born, will diminish over a few weeks
7 skin findings on infants
- Mongolian spots
- Erythema toxicum neonatorum
- Transient pustular melanosis→ sterile, not infective, benign, goes away
- Sebaceous Gland Hyperplasia→ “milia”- plugged sebaceous glands—goes away
- Neonatal Acne→ T zone area of face, hormonal, benign & transient
- Cradle Cap (seborrheic dermatitis)
- Salmon Patch Hemangioma
Mongolian Spots
congenital dermal melanocytosis
o MC in Mediterranean, blacks, often over sacrym, back, arms, wrists, ankles→ disappear over time
Erythema toxicum neonatorum
small pustules w/red base, often post term babies
Salmon Patch Hemangioma
(Stork bite)—looks like acne, don’t tx like ance (will get worse if you do)
Tanners height Predictions & BMI
• Predicted adult height→ (Mother Ht+ Father Ht)/2
o + 6.5 cm for male, - 6.5 cm for female
• BMI→ Kg/Ht (cm)2
Weight Gain by Age
• Typically takes 2 weeks to get back to birth weight, then from that point should gain 1oz/day
Piaget’s Stages of Cognitive Development (5)
- 0-2 → Sensory/motor: action intelligence only
- 2-4 → Pre-operational: Pre-conceptual: symbolic
- 4-7 → Pre-operational: Intuitive: influenced by own perception
- 7-11 → Concrete operation: Logical reasoning to real/seen objects
- 12+ → Formal Operations: Abstract thinking
What are some causes of speech delay
MR
hearing loss
maturation delay
expressive language disorder (expressive aphesia), bilingualism, psychosocial deprivation (ppl who don’t read/interact w/ their children)
autism (screen at 18-14 mo), elective mutis
Cerebral Palsy
Static lesions (pre-natal), swelling in ventricles, the leg will be the first one that are affected
• Sx
o Over 2 mo→ difficulty controlling head, stiff legs that scissor when picked up
o Over 6 mo→ previous plus: reach with only one hand while keeping the other in a fist
o Over 10 mo→ not sit by them self, crawl using only one side (hemipalegic, one side may be spastic)
o Over 12 mo→ not crawl, not be able to stand w/support
o Over 24 mo→ not able to walk, not able to push toy w/wheels
3 signs of hearing loss
- Does not turn to source of sound
- Does not say single words
- Does not startle w/loud sounds out of sight
4 signs of vision loss
- Close/cover one eye
- Squint
- Have trouble reading or doing close up work
- Blink more than usual
6 things a child on the autism spectrum could demonstrate
- Not play pretend games
- Not point
- Not look when other ppl point
- Have trouble relating to others/no interest in other ppl
- Prefer not to be held
- Loose skills they once had
Child with Asperger’s Syndrome might have? (6)
- Have trouble understanding feelings, body language,
- Avoid contact
- Talk about themselves
- Narrow, obsessive interests
- Speak in unusual ways or with an odd tone of voice
- Be clumsy or awk
