Notes Flashcards

1
Q

2 ways we track baby growth

A

Denver and growth chart

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2
Q

What is involved in the growth chart?

A

Height
Weight
Head circumference

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3
Q

What is in the denver developmental chart II?

A

Gross motor
Fine motor
Personal-social
Language

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4
Q

Normal child development marker at 3 months

A

Hold head up

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5
Q

Normal child development marker at 4 months

A

Rolls over

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6
Q

Normal child development marker at 6 months

A

Sits up

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7
Q

Normal child development marker at 9 months

A

Crawl/sit

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8
Q

Normal child development marker at 11 months

A

Stands/throws

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9
Q

Normal child development marker at 1 year

A

Walk/crawls freely

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10
Q

What is most common loss of point in appearance of APGAR?

A

Acrocyanosis

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11
Q

G in APGAR?

A

Grimace: are they reacting to noxious stimuli?

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12
Q

Second A in APGAR

A

Activity = are they moving both limbs equally? 0 = floppy

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13
Q

How will you check for developmental lag warning signs at 6-8 weeks old?

A

Flex hip, see if returns to normal position.
UE = usually in flexed position with spasticity.
LE = extended with toes pointed with spasticity.
Parents usually explain with difficulty changing a diaper.

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14
Q

T/F: can still be a head lag at 4 months

A

False. Should be no head lag at 4 months.

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15
Q

At what age do babies begin to get very social?

A

4-6 months

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16
Q

When would you see readiness signs for solid foods?

A

6-7 months

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17
Q

When should you see truncal control?

A

6 months

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18
Q

At what age should you see teeth growth?

A

7-9 months

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19
Q

What is a readiness sign for eating?

A

When teeth grow

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20
Q

When should you see hand to hand transfer? (Denver)

A

7-9 months

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21
Q

When will you see lumbar and sacral curve beginning to develop?

A

7-9 months

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22
Q

When will you hear sounds to first word? Nonspecific

A

7-9 months

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23
Q

When is object permanence developed?

A

8-10 months

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24
Q

What are some questions you would as a 7-9 month old baby?

A

Are they crawling? What’s the diet like? Have they introduced solid foods yet? What solid foods are they being introduced to? Have they spoken yet?

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25
Q

What age has a child tripled their birth weight?

A

10-12 months

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26
Q

When do you see a child speak 2-4 words?

A

10-12 months

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27
Q

Which babies tend to develop slower?

A

Premature and low birth weight babies. As long as there is a reason they develop slower, then don’t worry so much.

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28
Q

When should babies be walking?

A

16 months

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29
Q

When should you expect to hear two word phrases?

A

18-24 months

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30
Q

When should you expect 1000 words? >3 word phrases

A

Age 3

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31
Q

Pediatric history

A

Chief complaint (Well baby exam, new injury, special concerns)
Growht and developmental history
Obstetric history (in utero, delivery, post birth)
Nutrition/diet history (nursing, foods)
Habits (attitude, appetite, sleeping, bowel, bladder)
Past health history and family health history

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32
Q

What are 5 important questions about habits?

A
Change in attitude/personality?
Appetite/feeding?
Sleep? Night terrors?
Bowel/bladder habits?
Question to ask if child was injured from trauma/is ill?
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33
Q

Congenital infant conditions to watch for

A
CP
Feet
Clubfoot
CHD
Hearing
Vision
Brain
Fetal alcohol
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34
Q

Birth trauma conditions to watch for

A
Torticollis
Brachial plexus
Clavicle fx
Brain injury
Head injury
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35
Q

Genetic conditions to watch for

A

Downs

Muscular dystrophy

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36
Q

Other conditions besides congenital, birth trauma or genetic to watch out for

A

Colic
Nursing difficulties
GER

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37
Q

Does infant seem ill? Look for:

A

Fever, normal vitals, rashes (SEARCH), mental status
Growth normal
Developmental delays
Personality/attitude changes
Sleep changes
Bodily functions WNL (change from normal. 1/2 to 3-6 day; 6-8 wet diapers/day; feedings 2-4 hours; normal appetite)

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38
Q

History taking tips (5)

A

Assume a position that puts you at eye level
Play before exam
Allow child to sit in parents lap
Begin with least invasive and move quickly
Involve child as much as possible

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39
Q

Newborn/infant PE (11)

A
W/in 12 hours of birth
Pregnancy/birth history
Growth measurements (ht, wt, head)
Developmental evals
Vitals
HEENT
Skin
Cardioresp
MSK
nervous system
Abdomen and genetalia
Posture (extremities flexed and fists clenched - 2 months)
Skin (lanugo, milia, erythema toxicum)
Lungs
Heart
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40
Q

APGAR scoring for color

A

0 = all blue/pale
1 = pink body, blue ext
2 - all pink

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41
Q

APGAR score for HR

A
0 = absent
1 = <100 bpm
2 = >100 bpm
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42
Q

APGAR score for respiration

A
0 = absent
1 = irregular, slow, cry
2 = good, cryin
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43
Q

APGAR score for reflex, stim

A
0 = none
1 = grimace
2 = sneeze/cough
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44
Q

APGAR score for muscle tone

A
0 = limp
1 = some flexion
2 = active
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45
Q

APGAR Scoring

A
8-10 = good to excellent
5-7 = fair
<5 = neuro sequelae. Poor condition. Maybe immediate lifesaving mesasure such as o2 mask
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46
Q

Head/face exam (3)

A

Size, smmetry, alignment of skull, face, eyes, ears and nose, swelling?
Palpate sutures and fontanelles (should be open. Ant/post)

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47
Q

Fontanelles should be… (ant, post)

A

Ant: large diamond shape; open 1-4 cm at midline. Closes 18-24 months
Post: smaller; may be closed at birth = 6 weeks

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48
Q

When do sutures clos?

A

2-6 months

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49
Q

When does ant fontanelle close?

A

18-24 months.

Psot closes birth - 6 weeks

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50
Q

Plagiocephaly

A

Craniofacial asymmetry due to sustained pressure usually disappears by 2 years.

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51
Q

Cephalhematoma

A

Outlined by the bone. Boney and hard because it is under the periosteum.
This is more serious than caput succedaneum.
Subperiosteal hemorrhage doesn’t cross suture lines. Visible swelling might not be visible for few hours - 1 week and usually disappears in about 6 weeks

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52
Q

Caput succedaneum

A

Crosses suture lines
Benign and usually goes away in first weeks of life
Squishy and soft.

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53
Q

In newborn/infantn eval, how should infant be postured?

A

Extremities flexed and fists clenched

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54
Q

What is lanugo?

A

Fine body hair on shoulders, forehead and back

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55
Q

Milia

A

Small white papules on nose, cheeks and chin

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56
Q

Erythema toxicum

A

Maacular eruption common in light skin newobrn that resolves in 1 week

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57
Q

What are petechia and lesions a sign of?

A

Meningitis

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58
Q

Birth marks

A

Port wine stain (doesn’t blanch)
stork’s bite: upper eyelids, forehead, nape of neck, disappear by one year
Mongolion spots: dark blue/purple bruise on back/bottom in darker complexioned infants within first four years
Accessory supernumerary nipples

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59
Q

Heart murmurs

A

Birth - 1 week
10% association with congenital heart disease
Should be evaluated

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60
Q

Signs of distress

A

Include asymmetric chest movement, depressed sternum, absent breast tissue, flattened chest, nipples widely spaced, bowel sounds auscultated in chest

Cyanosis, grunting on expirations, nasal flaring, tachypnea, intercostal retractions

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61
Q

Where should liver be palpable?

A

2-3 cm below right costal margin

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62
Q

When should you hear bowel soudns

A

Within 2 hours of birth

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63
Q

When should you see meconium

A

Within i24-48 hours of birth

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64
Q

Abominal signs of distress

A
Absent bowel sounds 
Visible peristalsis
Abdominal distention
Palpable masses
Red base of cord
Cord with only two vessels
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65
Q

Neurmuscular system signs of distress

A
Hypotonia
Quivering
Limp extremities
Spasticity
Straightening of extremities
Clonic jerking
Paralysis
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66
Q

Neck signs of distress

A

Torticollis
Resistance to flexion
Neck webbing
Palpable crepitus in SC/AC joint

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67
Q

Two orthos to check for hip dislocation

A

Ortolanis

Barlows

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68
Q

Things we’ll see in a child who had untreated CHD

A
Assymetry of gluteal and thigh folds
Limited hip abduction
Apparent shortening of femu
Positive trendelenburg sign
Ortolani click
Short leg side = CHD
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69
Q

What is CHD

A

Flattening of acetabulum so hip slides in and out. Laxity of hip area in newborn

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70
Q

CHD is MC in what gender babies

A

Girls.

MC orthopedic conditions you’ll see in this age group.

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71
Q

Barlow maneuver - how to perform

A

Adduct hip, apply light pressure on knee. Direct force posteriorly
If disolcates = positive.
Confirm with ortolani

72
Q

Ortolani maneuver

A

Flex hips and knees of supine infant to 90 degrees. Examiner’s index finger places anterior pressure on greater trochanter, gently and smoothly abducting infants legs and examiner’s thumb.
Positive = clunk as femoral head relocates anteriorly in acetabulum.
POSTERIOR DISLOCATION test
Usually becomes negative after 2 months.

73
Q

Moro reflex? And when you would see it

A

Birth - 4 months
Aka startle or parachute
Sudden extension and abduction of extremities and fanning of fingers

74
Q

Tonic neck

A

Birth to 4-6 months

Infants head is turned to one side, arm and leg will extend on that side while opposite arm and leg may flex

75
Q

Palmar grasp

A

Birth to 3-4 months

76
Q

Plantar grasp

A

Birth to 8-10 months

77
Q

Steps in place

A

Birth to 3 months

78
Q

Babinski

A

Birth to 18 months

79
Q

Clonus

A

Birth to 4 months

80
Q

Rooting awake

A

Response birth to 3-4 months

81
Q

Rooting asleep

A

Response birth to 7-8 months

82
Q

Blink reflex

A

Bright light towards eyes. Should be symmetrical. Damage to CN II, VII
Present 3-6 months

83
Q

Dolls eye reflex

A

As head is moved slowly, eyes do not move. Disappears as fixation develops (3 months)

84
Q

Rooting reflex

A

Touching or stroking cheek by mouth = makes head turn toward that side
May disappear at 3-4 months or persist up to 12 months

85
Q

Sucking

A

Birth to 10-12 months

Place nipple of finger in infants mouth.

86
Q

Birth to 28 days =

A

Neonatal

87
Q

PKU

A

Both parents have gene (1 in 4 chance)
First newborn screening test (since 1960s)
Cannot process phenylalanine which would build up in bloodstream and cause brain damage and mental retardation.
Sx’s start 1-3 months old.

88
Q

Galactosemia

A

Can’t convert galactose (in milk) to glucose = blind (Cataracts), mental retardation, growth and developmental problems, nursing problems, decrease IQ, seizures

89
Q

Congenital hypothyroid

A

1 in 4000

Retards growth and brain developmental

90
Q

Biotinidase deficiency

A

Biotinidase Recycles biotin. Deficiency = seixures, skin abnormalities, death.

91
Q

SEARCH

A
Socially interacting
Energy state
Apperance (color, tone)
Reaction to parent (consolibility)
Cry (strength, type)
Hydration status
92
Q

Leading cause of death in infants 1 month to 1 year

A

SIDS

93
Q

Highest risk of SIDS

A

African american

Asian/hispanic = lowest risks

94
Q

SIDS

A

No identifiable cause
1 month - 1 year leading cause of death
2-4 months of age, at night
Baby with more of a traumatic birth may have inflammation of foramen magnum area thus disrupting respiratory centers and causing death this way.

95
Q

Considerations of SIDS

A

Premature/low birth weight babies
Mom ill during pregnancy (alcohol or any drugs)
Infants exposed to second hand smoke or toxins/irritants
Hx of difficult labor/delivery
Sleep positions
Apnea spells, bradycardia, cyanosis

96
Q

Recommendations for SIDS

A

Place baby on back on firm surface and fitted sheets
Remove pillows, quilts and comforters from crib
Babys head must remain uncovered
Have baby share your room but not your bed
No smoke!

97
Q

Craniosynostosis

A

Premture closing of sutures
Developmental disorder
Increased intracranial pressure and deformed head results. Affects brain development (IQ). Abnormal facial features.
May need surgery, sometimes in first 6 weeks

98
Q

Hydrocephalus

A

Abnormal enlargement of ventricles d/t increased pressure = compression of brain!
Obstruction of CSF drainage/excess CSF production/decreased resorption into circulation

99
Q

S&S of hydrocephalus

A

Macrocephaly, setting sun eyes, bulging fontanelles, abducens palsy, ataxia, increased ICP (pupil asymmetry, papilledema, bradycardia, HTN, focal neuro)
Seizures

100
Q

Eval & Tx of hydrocephaly

A
CT/MRI of brain
Lx puncture
Surgical shunting of excess CSF
Meds
Underlying brain disease
101
Q

Subdural hematoma

A
Immediate referral
Dx via skull xray, CT scan, MRI
Consider child abuse (shaken baby syndrome)
Sx'al removal of blood clot or meds.
Similar s&amp;s as hydrocephalus
102
Q

Cerebral palsy

A

Brain damage during gestation, birth process or in months after birth d/t hypoxia
CNS motor impairments - 75% spastic (pyramidal) spasticity, rigidity, dyskinesia, ataxia.

103
Q

CP presentation

A

Clumsy (lack of balance & control)
Failure to achieve developmental milestones)
Limb spasticity = MC first sign
Leg spasticity in adduction, extension and IR = scissor gait pattern

104
Q

CP management

A

Motor and movement abnormalities; difficulty with speech and movement
CT/MRI of brain, EEG, blood work, hearing/vision/cognitive testing
Tx: chiro, PT, counseling

105
Q

Other disorders of infancy (2)

A
Conjunctivitis (referral)
Cradle cap (ddx - seborrhea, psoriasis, eczema) top of head only. Daily wash with baby shampoo, gentle brushing with oil to loosen crusts
106
Q

Common causes of recurrent infant crying

A
Feeding problems
GI (GERD, constipation, allergy to milk, diseases)
Abdomen problems (hernia, fissures)
Head or nec kproblems (otitis media, strains/sprains, abrasions)
Extremities (fx's, ingrown toe)
UTI, obstruction
Other: meningitis
Trauma = birth
107
Q

Infant colic syndrome

A

Excessive inconsolable crying episodes in an otherwise healthy infant.
0-3 months, >3 hrs/d, 3 d/wk for 3 weeks or more. Usually same time each day.

108
Q

Cry and pull up legs, hard abdomen, relief with gas passing

A

Infant colic syndrome

109
Q

When does infant colic syndrome work

A

1 month of age and resolves by 3 months or 6 months

110
Q

Somatovisceral theory of infant colic syndrome

A

Upper cervical subluxations can cause interference with vagus nerve which controls gastric function

111
Q

Infantile colic syndrome diagnosis

A

Of exclusion.
First rule out serious illness as cause for crying (intussusception/bowel obstruction’ Gi disease, pyloric stenosis, child abuse, drug rxn, OM, UTI, GI, URI, meningitis, GERD, allergy, lactose intolerance, nursing technique, parenting errors)

112
Q

Ill child treatment protocol

A

Treatment trial - 2x/week for 2-3 weeks then re-evaluate
Crying diary
Usually children respond within 2-4 treatments; if no improvement within 4 treatments, consider other contributors (food sensitivites, nursing techniques)
Current research: upper cervical complex, t8-12 and cranial

113
Q

4 S’s

A

Swaddle, swing, shushing, sucking

114
Q

Positive features of breast feeding

A

Reduces infant mortality and morbidity from sepsis, gastroenteritis, RTI, asthma, SIDS, DM
Redsuce frequency of OM and food allergies, other GI symptoms
Less likely to be obese
Enhance mother-infant bonding

115
Q

Breast milk firist 3-4 days

A

Colostrum (high in protein and immunoglob) helping with immunity and prepares GI tract to receive and make use of milk.

116
Q

Crosses boob barrier

A

Alcohol
Drugs
Nicotine

117
Q

Contraindications for breast feeding

A

TB
Hep B
Acute varicella, herpetic, syphilitic lesions

118
Q

Not contraindications

A

Boob infections, UTI, group b strep or cytomegalovirus

Caution = alcohol, drugs, nicotine

119
Q

When is the iron stored in babes body depleted by?

A

6 months. Little in boob milk. Thus may need supplementation of vit D.
Signs of readiness between 4-10 months = teething or tooth eruption

120
Q

First foods

A
Rice
Cereal
Bananas
Applesauce
Pear
Mild vegetables
Fruits
121
Q

Nonspecific allergy symptoms

A
Irritability, colic
Rash around mouth, pruritis
Red nose, ears, cheeks or buttocks
Wrinkles under eyes, pallor
Mouth uulcers
Sleep distrubrances
Flatulance, diarrhea, constipation, bloating, spitting up
Fatigue
Unpleasant body odors
Infants with chronic recurrent ear infections, congestion, asthma = consider allergy
122
Q

Allergenic foods = do not feed them these things

A

Honey, corn syrup, molasses to babies <1 year old because they may contain botulinum spores not neutralized by high pH of the gastric secretions in infants

123
Q

Do not feed any fruit juice in great amounts of ?

A

4 oz

124
Q

Regurgitation/vomiting DDX

A

Normal spititng up: GERD, excess feeding, air swallowing, nursing issues, food allergy/sensitivity, new drug, migraine, HA
GI dz: obstruction/blockage, appendicitis, GI, infection, pyloric stenosis (congenital), fistulas, duodenal atresia, IBS, accidental ingestion
Nonspecific: OM, UTI, URI, meningitis

125
Q

Regurigtation/vomiting hx

A

New? Related to feeding? Normal appetite? Color/volue of vomit? Child = ill? Pain? Fever? New drugs or foods? Changes in habits (ppaas)? Diet? Normal BM and urinatino

126
Q

Ppaas

A
Poop
Pee
Attitude
Appetite
Sleep
127
Q

Red flags for referral

A

Blood in vomit or persistent vomiting (3/4 events)
Spitting up causes infant to choke/cough (PNA)
Abnormalities of exam (infection, obstruction, acute abdomen)
Underweight babies gaining weight or no appetite
Fever
Vomiting and diarrhea (infection, dehydration)
Vomiting and constipation (obstruction)

128
Q

GER in infants. Why?

A

Immature sphincter
50-67% <4 months common
Episodic vomiting/spitting up in 1st 1-2 weeks of life
Resolves as baby grows up

129
Q

GER treatment

A

Upright position post feeding
Burp 2x during feeding and after
Keep feeding to 20 mins or less

130
Q

What is pyloric stenosis

A

Congenital stenosis of valve between ST and SI

Linked to neuromuscular control and poor breastfeeding

131
Q

What begins as projectile vomiting in 1st week to month of life

A

Pyloric stenosis.
Feeding/nursing difficulties and failure to thrive. GROWTH CHART.
IMMEDIATE REFERRAL INDICATED.

132
Q

Intussusception

A

Intestines are more mobile in infancy and can fold i on itself causing obstruction. MC CAUSE OF BOWEL OBSTRUCTION IN FIRST 2 YEARS

133
Q

Symptoms of intussusception

A
Unctrollable crying (colic), irratibility, vomiting, constipation, tender palpable mass (RUQ0
URGENT REFERRAL INDICATED (air enema or surgery needed
134
Q

Diarrhea in infants

A
Loose stools = normal in boob fed infants.
# of BM's vary greatly
Consider diarrhea if >8-10 BM/day and # or fluid content of stool has changed.
If more than 8 watery stools per day and vomiting = danger of dehydration and loss of electrolytes.
135
Q

Ddx for infant diarrhea

A
gastroenteritis (bacterial/viral). Viral = MC but must rule out bacterial (shigella, salmonelle, e.coli, campylobactor (blood) - need stool sample
UTI, OM, URI (PNA), meningitis
Food alergies
Drug reaction
Stress
Too much juice
136
Q

Red flags for infant diarrhea/constipation

A

Bloody stools
Abdominal pain and crying for more than 2 hours
Signs of illness = SEARCH
Dehydartion = lack of turgor, depression on anterior fontanelle, dry mucous membranes
Acute abdomen

137
Q

Acute abdomen signs

A
Blood in stool
Rigid abdomen
Rebound tenderness
Loss of bowel sounds
Any masses
138
Q

Treatment for diarrhea

A

Moderate - severe : IV

Mild = pedialyte and increase fluid intake

139
Q

Gastroenteritis often caused by

A

Stomach flu (viral = rotovirus MC) d/t bacteria, food poisoning, parasite
Usually lasts 24 hrs - 5 days
R.o serious problem (stool sample)

140
Q

Infant has persistent vomiting after nursing

A

Projectile = pyloric stenosis
MC in 1st born boys 3-8 weeks old
Triad: 1) projectile vomit 2)visible peristalsis 3) palpable olive mass
Diagnose = abdominal ultrasound
Urgent referral to MD for surgery: laparoscopic pylorotomy. Home in 2 days

141
Q

Vomiting after nursing/eating and a rash

A

Allergy
If difficiulty breathing = anaphylactic rxn
If mild = explore diet

142
Q

Vibrant green-yellow vomit

A

Color = bile (liver or GI obstruction which could be d/t birth defect, meconium blockage or twisted intestuine aka volvulus)
Bile stain = emergency

143
Q

Recurrent vomiting with no obvious cause in otherwise healthy child

A

Cyclic vomiting syndrome; brain gut disorder (w/ migraine HA) often in cycles
Misdiagnosed and mistreated

144
Q

Vomiting and fever and piercing cry or stiff neck

A

Ddx: bacterial meningitis; other signs HA, neck pain, lethargy/confusion/disorientation, seizures; nuchal rigidity/bruzinski’s >6 mo (not very reliable)
Medical emergency. Lx puncture needed to ddx viral from bacterial.
Vaccine

145
Q

Vomiting and severe abdominal pain

A

Appendicitis (MC over 10)
Pain around belly that gets worse and moves to RLQ
Medical emergency

146
Q

Constipation

A

1Bm every 2-3 days

147
Q

Constipation ddx

A

Bowel/gi obsturction, anal stenosis, intussuception, impaction, hypothyroidism, botulism, other gi, hirschsprung, meds, dehydration

148
Q

Tx of constipation

A
Co treat
Over 6 months = increase water, fruits, veggies (prunes, apricots, pears), prune juice, veggie soup.broth, smoothie
Increase fiber, fruits, veggies (psylium seed or flaxseed)
Decrease stool hardening foods 
Abdominal massage
Exercise
OTC mulk of magnesium
CMT (lx and sacral if abnormalities)
149
Q

Stool hardening foods

A

Brat, dairy, sweets, yogurt, cheese, cereal, change formula

150
Q

Persistent vomting after nursing

A

Pyloric stenosis

151
Q

Vomiting and rash around mouth or face

A

Allergy

152
Q

Bloody vomit/stools

A

Bacterial infection
Ulcer
Aspirin

153
Q

Greeh-yellow vomit

A

Bile obstruction

154
Q

Vomiting and diarrhea and fever

A

Gastroenteritis (viral or bacterial)

155
Q

Vomiting and severe abdominal pain (rlq0

A

Appendicitis (esp >10 years)

Signs of acute abdomen 1) blood 2) rigid abdomen 3) rebound tenderness = peritonitis 911. ER

156
Q

Vomiting and fever and piercing screaming cry and or rash and or stiff neck

A

Meningitis 911 ER

157
Q

Vomting and constipation

A

Obsturction, intussusception

158
Q

3 MC reported pediatric orthopedic problems during infancy

A
  1. Clubfeet
  2. DHD
  3. Congenital torticollis
159
Q

Craniofacial asymmetry may result if contracture is not corrected in what condition

A

Congenital torticollis

160
Q

If tumor on ddx of torticollis, should you adjust?

A

No. SCM innervated by CN Xi, also integrated with upper cervical nerves. Sometimes could be brain tumor. 3-4 adjustmetns should take care of it. If doesn’t get better, refer! With babies if it’s going to work it’s going to work quickly.

161
Q

Ddx for torticollis

A

Pseudotumor of SCm - myofascial; congenital muscular torticollis
Upper cervical trauma/dislocation
Spinal cord tumor or othro tumor (bs)
Vertebral dislocation or fracture
2-% of infants with congenital torticollis have congenital/degenerative hip displasia

162
Q

Congenital torticollis

A
Congenital muscular torticollis
Birth trauma
Klippel-feil syndrome
Arnold chiari malformation
Spina bifida
163
Q

Acquired torticollis

A

Trauma
Infection (RA, retropharyngeal abscess, TB)
Neoplasm (posterior fossa, SC, BS, vestibular, vertebral column tumor, osteoid osteoma)
Neurogenic (syringomyelia, bulbar palsies)
Idiopathic

164
Q

If negative x-ray, what next for treatment of torticollis?

A

Trial tx = 2x/week for 2 weeks and reeval (CMT and STM)

165
Q

If SCM mass, more likely biomechanic. Tyus do what

A

SCM TP and C/S ISD

166
Q

No SCM mass =

A

Bigger concern for serious pathology

167
Q

Benign causes of torticollis

A

Muscular
Joint dysfunction
Resolve quickly with appropriate treatment

168
Q

Large baby small framed mother force needed for birth, breech

A
Brachial plexus stretch injury
Neuropraxia
3-6 months for healing
Start tx 3-4 weeks old
Surgery option if incomplete healing
169
Q

Infantile erb-duchenne’s palsy

A

Unilateral traction injury to brachial plexus (c5-6) during delivery
Mild cases = self limiting
Severe =residual paralysis
LMN paralysis of deltoid, biceps, brachialis and brachioradialis over c5/6 dermatomes.

170
Q

Waiter tip deformity

A

Infantile erb duchene palsy

Infant can’t abduct or flex shoulder or flex elbow

171
Q

Arm in adduction, elbow extension and internally rotated

A

Erb’s palsy c5-7 nerve

172
Q

Damage wrist drop; assocaigted with birth trauma

A

Klumpke’s palsy c7-t1

173
Q

Ortlani’s sign

A

DHD/CHD

174
Q

Diagnostic criteria for CHD: perinatal risk factors

A

Breech, female, low amniotic fluid, quick discharge from hospital, primiparity, large weight, rural birth

175
Q

Diagnostic criteria for CHD

A

Ultrasound

Ortlani’s and barlow tests

176
Q

Signs and symptoms = CHD

A

0-3 months = parent may notice decreased abduction (diaper changes); babies hips should abduct enough to lay flat on exam table or notice short leg
4-11 month = trouble crawling
Once walking = limp or waddle

177
Q

Treatment CHD

A

Early dx and tx = pavlik harness
Von rosen splint, spica casting or surgery
Prevention: webster! Change breech, proper swaddling (free hips