Notes Flashcards
1
Q
2 ways we track baby growth
A
Denver and growth chart
2
Q
What is involved in the growth chart?
A
Height
Weight
Head circumference
3
Q
What is in the denver developmental chart II?
A
Gross motor
Fine motor
Personal-social
Language
4
Q
Normal child development marker at 3 months
A
Hold head up
5
Q
Normal child development marker at 4 months
A
Rolls over
6
Q
Normal child development marker at 6 months
A
Sits up
7
Q
Normal child development marker at 9 months
A
Crawl/sit
8
Q
Normal child development marker at 11 months
A
Stands/throws
9
Q
Normal child development marker at 1 year
A
Walk/crawls freely
10
Q
What is most common loss of point in appearance of APGAR?
A
Acrocyanosis
11
Q
G in APGAR?
A
Grimace: are they reacting to noxious stimuli?
12
Q
Second A in APGAR
A
Activity = are they moving both limbs equally? 0 = floppy
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.
14
Q
T/F: can still be a head lag at 4 months
A
False. Should be no head lag at 4 months.
15
Q
At what age do babies begin to get very social?
A
4-6 months
16
Q
When would you see readiness signs for solid foods?
A
6-7 months
17
Q
When should you see truncal control?
A
6 months
18
Q
At what age should you see teeth growth?
A
7-9 months
19
Q
What is a readiness sign for eating?
A
When teeth grow
20
Q
When should you see hand to hand transfer? (Denver)
A
7-9 months
21
Q
When will you see lumbar and sacral curve beginning to develop?
A
7-9 months
22
Q
When will you hear sounds to first word? Nonspecific
A
7-9 months
23
Q
When is object permanence developed?
A
8-10 months
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?
25
What age has a child tripled their birth weight?
10-12 months
26
When do you see a child speak 2-4 words?
10-12 months
27
Which babies tend to develop slower?
Premature and low birth weight babies. As long as there is a reason they develop slower, then don't worry so much.
28
When should babies be walking?
16 months
29
When should you expect to hear two word phrases?
18-24 months
30
When should you expect 1000 words? >3 word phrases
Age 3
31
Pediatric history
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
32
What are 5 important questions about habits?
```
Change in attitude/personality?
Appetite/feeding?
Sleep? Night terrors?
Bowel/bladder habits?
Question to ask if child was injured from trauma/is ill?
```
33
Congenital infant conditions to watch for
```
CP
Feet
Clubfoot
CHD
Hearing
Vision
Brain
Fetal alcohol
```
34
Birth trauma conditions to watch for
```
Torticollis
Brachial plexus
Clavicle fx
Brain injury
Head injury
```
35
Genetic conditions to watch for
Downs
| Muscular dystrophy
36
Other conditions besides congenital, birth trauma or genetic to watch out for
Colic
Nursing difficulties
GER
37
Does infant seem ill? Look for:
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)
38
History taking tips (5)
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
39
Newborn/infant PE (11)
```
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
```
40
APGAR scoring for color
0 = all blue/pale
1 = pink body, blue ext
2 - all pink
41
APGAR score for HR
```
0 = absent
1 = <100 bpm
2 = >100 bpm
```
42
APGAR score for respiration
```
0 = absent
1 = irregular, slow, cry
2 = good, cryin
```
43
APGAR score for reflex, stim
```
0 = none
1 = grimace
2 = sneeze/cough
```
44
APGAR score for muscle tone
```
0 = limp
1 = some flexion
2 = active
```
45
APGAR Scoring
```
8-10 = good to excellent
5-7 = fair
<5 = neuro sequelae. Poor condition. Maybe immediate lifesaving mesasure such as o2 mask
```
46
Head/face exam (3)
Size, smmetry, alignment of skull, face, eyes, ears and nose, swelling?
Palpate sutures and fontanelles (should be open. Ant/post)
47
Fontanelles should be... (ant, post)
Ant: large diamond shape; open 1-4 cm at midline. Closes 18-24 months
Post: smaller; may be closed at birth = 6 weeks
48
When do sutures clos?
2-6 months
49
When does ant fontanelle close?
18-24 months.
| Psot closes birth - 6 weeks
50
Plagiocephaly
Craniofacial asymmetry due to sustained pressure usually disappears by 2 years.
51
Cephalhematoma
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
52
Caput succedaneum
Crosses suture lines
Benign and usually goes away in first weeks of life
Squishy and soft.
53
In newborn/infantn eval, how should infant be postured?
Extremities flexed and fists clenched
54
What is lanugo?
Fine body hair on shoulders, forehead and back
55
Milia
Small white papules on nose, cheeks and chin
56
Erythema toxicum
Maacular eruption common in light skin newobrn that resolves in 1 week
57
What are petechia and lesions a sign of?
Meningitis
58
Birth marks
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
59
Heart murmurs
Birth - 1 week
10% association with congenital heart disease
Should be evaluated
60
Signs of distress
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
61
Where should liver be palpable?
2-3 cm below right costal margin
62
When should you hear bowel soudns
Within 2 hours of birth
63
When should you see meconium
Within i24-48 hours of birth
64
Abominal signs of distress
```
Absent bowel sounds
Visible peristalsis
Abdominal distention
Palpable masses
Red base of cord
Cord with only two vessels
```
65
Neurmuscular system signs of distress
```
Hypotonia
Quivering
Limp extremities
Spasticity
Straightening of extremities
Clonic jerking
Paralysis
```
66
Neck signs of distress
Torticollis
Resistance to flexion
Neck webbing
Palpable crepitus in SC/AC joint
67
Two orthos to check for hip dislocation
Ortolanis
| Barlows
68
Things we'll see in a child who had untreated CHD
```
Assymetry of gluteal and thigh folds
Limited hip abduction
Apparent shortening of femu
Positive trendelenburg sign
Ortolani click
Short leg side = CHD
```
69
What is CHD
Flattening of acetabulum so hip slides in and out. Laxity of hip area in newborn
70
CHD is MC in what gender babies
Girls.
| MC orthopedic conditions you'll see in this age group.
71
Barlow maneuver - how to perform
Adduct hip, apply light pressure on knee. Direct force posteriorly
If disolcates = positive.
Confirm with ortolani
72
Ortolani maneuver
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
Moro reflex? And when you would see it
Birth - 4 months
Aka startle or parachute
Sudden extension and abduction of extremities and fanning of fingers
74
Tonic neck
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
Palmar grasp
Birth to 3-4 months
76
Plantar grasp
Birth to 8-10 months
77
Steps in place
Birth to 3 months
78
Babinski
Birth to 18 months
79
Clonus
Birth to 4 months
80
Rooting awake
Response birth to 3-4 months
81
Rooting asleep
Response birth to 7-8 months
82
Blink reflex
Bright light towards eyes. Should be symmetrical. Damage to CN II, VII
Present 3-6 months
83
Dolls eye reflex
As head is moved slowly, eyes do not move. Disappears as fixation develops (3 months)
84
Rooting reflex
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
Sucking
Birth to 10-12 months
| Place nipple of finger in infants mouth.
86
Birth to 28 days =
Neonatal
87
PKU
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
Galactosemia
Can't convert galactose (in milk) to glucose = blind (Cataracts), mental retardation, growth and developmental problems, nursing problems, decrease IQ, seizures
89
Congenital hypothyroid
1 in 4000
| Retards growth and brain developmental
90
Biotinidase deficiency
Biotinidase Recycles biotin. Deficiency = seixures, skin abnormalities, death.
91
SEARCH
```
Socially interacting
Energy state
Apperance (color, tone)
Reaction to parent (consolibility)
Cry (strength, type)
Hydration status
```
92
Leading cause of death in infants 1 month to 1 year
SIDS
93
Highest risk of SIDS
African american
| Asian/hispanic = lowest risks
94
SIDS
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
Considerations of SIDS
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
Recommendations for SIDS
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
Craniosynostosis
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
Hydrocephalus
Abnormal enlargement of ventricles d/t increased pressure = compression of brain!
Obstruction of CSF drainage/excess CSF production/decreased resorption into circulation
99
S&S of hydrocephalus
Macrocephaly, setting sun eyes, bulging fontanelles, abducens palsy, ataxia, increased ICP (pupil asymmetry, papilledema, bradycardia, HTN, focal neuro)
Seizures
100
Eval & Tx of hydrocephaly
```
CT/MRI of brain
Lx puncture
Surgical shunting of excess CSF
Meds
Underlying brain disease
```
101
Subdural hematoma
```
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&s as hydrocephalus
```
102
Cerebral palsy
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
CP presentation
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
CP management
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
Other disorders of infancy (2)
```
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
Common causes of recurrent infant crying
```
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
Infant colic syndrome
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
Cry and pull up legs, hard abdomen, relief with gas passing
Infant colic syndrome
109
When does infant colic syndrome work
1 month of age and resolves by 3 months or 6 months
110
Somatovisceral theory of infant colic syndrome
Upper cervical subluxations can cause interference with vagus nerve which controls gastric function
111
Infantile colic syndrome diagnosis
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
Ill child treatment protocol
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
4 S's
Swaddle, swing, shushing, sucking
114
Positive features of breast feeding
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
Breast milk firist 3-4 days
Colostrum (high in protein and immunoglob) helping with immunity and prepares GI tract to receive and make use of milk.
116
Crosses boob barrier
Alcohol
Drugs
Nicotine
117
Contraindications for breast feeding
TB
Hep B
Acute varicella, herpetic, syphilitic lesions
118
Not contraindications
Boob infections, UTI, group b strep or cytomegalovirus
| Caution = alcohol, drugs, nicotine
119
When is the iron stored in babes body depleted by?
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
First foods
```
Rice
Cereal
Bananas
Applesauce
Pear
Mild vegetables
Fruits
```
121
Nonspecific allergy symptoms
```
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
Allergenic foods = do not feed them these things
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
Do not feed any fruit juice in great amounts of ?
4 oz
124
Regurgitation/vomiting DDX
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
Regurigtation/vomiting hx
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
Ppaas
```
Poop
Pee
Attitude
Appetite
Sleep
```
127
Red flags for referral
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
GER in infants. Why?
Immature sphincter
50-67% <4 months common
Episodic vomiting/spitting up in 1st 1-2 weeks of life
Resolves as baby grows up
129
GER treatment
Upright position post feeding
Burp 2x during feeding and after
Keep feeding to 20 mins or less
130
What is pyloric stenosis
Congenital stenosis of valve between ST and SI
| Linked to neuromuscular control and poor breastfeeding
131
What begins as projectile vomiting in 1st week to month of life
Pyloric stenosis.
Feeding/nursing difficulties and failure to thrive. GROWTH CHART.
IMMEDIATE REFERRAL INDICATED.
132
Intussusception
Intestines are more mobile in infancy and can fold i on itself causing obstruction. MC CAUSE OF BOWEL OBSTRUCTION IN FIRST 2 YEARS
133
Symptoms of intussusception
```
Unctrollable crying (colic), irratibility, vomiting, constipation, tender palpable mass (RUQ0
URGENT REFERRAL INDICATED (air enema or surgery needed
```
134
Diarrhea in infants
```
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
Ddx for infant diarrhea
```
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
Red flags for infant diarrhea/constipation
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
Acute abdomen signs
```
Blood in stool
Rigid abdomen
Rebound tenderness
Loss of bowel sounds
Any masses
```
138
Treatment for diarrhea
Moderate - severe : IV
| Mild = pedialyte and increase fluid intake
139
Gastroenteritis often caused by
Stomach flu (viral = rotovirus MC) d/t bacteria, food poisoning, parasite
Usually lasts 24 hrs - 5 days
R.o serious problem (stool sample)
140
Infant has persistent vomiting after nursing
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
Vomiting after nursing/eating and a rash
Allergy
If difficiulty breathing = anaphylactic rxn
If mild = explore diet
142
Vibrant green-yellow vomit
Color = bile (liver or GI obstruction which could be d/t birth defect, meconium blockage or twisted intestuine aka volvulus)
Bile stain = emergency
143
Recurrent vomiting with no obvious cause in otherwise healthy child
Cyclic vomiting syndrome; brain gut disorder (w/ migraine HA) often in cycles
Misdiagnosed and mistreated
144
Vomiting and fever and piercing cry or stiff neck
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
Vomiting and severe abdominal pain
Appendicitis (MC over 10)
Pain around belly that gets worse and moves to RLQ
Medical emergency
146
Constipation
1Bm every 2-3 days
147
Constipation ddx
Bowel/gi obsturction, anal stenosis, intussuception, impaction, hypothyroidism, botulism, other gi, hirschsprung, meds, dehydration
148
Tx of constipation
```
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
Stool hardening foods
Brat, dairy, sweets, yogurt, cheese, cereal, change formula
150
Persistent vomting after nursing
Pyloric stenosis
151
Vomiting and rash around mouth or face
Allergy
152
Bloody vomit/stools
Bacterial infection
Ulcer
Aspirin
153
Greeh-yellow vomit
Bile obstruction
154
Vomiting and diarrhea and fever
Gastroenteritis (viral or bacterial)
155
Vomiting and severe abdominal pain (rlq0
Appendicitis (esp >10 years)
| Signs of acute abdomen 1) blood 2) rigid abdomen 3) rebound tenderness = peritonitis 911. ER
156
Vomiting and fever and piercing screaming cry and or rash and or stiff neck
Meningitis 911 ER
157
Vomting and constipation
Obsturction, intussusception
158
3 MC reported pediatric orthopedic problems during infancy
1. Clubfeet
2. DHD
3. Congenital torticollis
159
Craniofacial asymmetry may result if contracture is not corrected in what condition
Congenital torticollis
160
If tumor on ddx of torticollis, should you adjust?
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
Ddx for torticollis
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
Congenital torticollis
```
Congenital muscular torticollis
Birth trauma
Klippel-feil syndrome
Arnold chiari malformation
Spina bifida
```
163
Acquired torticollis
Trauma
Infection (RA, retropharyngeal abscess, TB)
Neoplasm (posterior fossa, SC, BS, vestibular, vertebral column tumor, osteoid osteoma)
Neurogenic (syringomyelia, bulbar palsies)
Idiopathic
164
If negative x-ray, what next for treatment of torticollis?
Trial tx = 2x/week for 2 weeks and reeval (CMT and STM)
165
If SCM mass, more likely biomechanic. Tyus do what
SCM TP and C/S ISD
166
No SCM mass =
Bigger concern for serious pathology
167
Benign causes of torticollis
Muscular
Joint dysfunction
Resolve quickly with appropriate treatment
168
Large baby small framed mother force needed for birth, breech
```
Brachial plexus stretch injury
Neuropraxia
3-6 months for healing
Start tx 3-4 weeks old
Surgery option if incomplete healing
```
169
Infantile erb-duchenne's palsy
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
Waiter tip deformity
Infantile erb duchene palsy
| Infant can't abduct or flex shoulder or flex elbow
171
Arm in adduction, elbow extension and internally rotated
Erb's palsy c5-7 nerve
172
Damage wrist drop; assocaigted with birth trauma
Klumpke's palsy c7-t1
173
Ortlani's sign
DHD/CHD
174
Diagnostic criteria for CHD: perinatal risk factors
Breech, female, low amniotic fluid, quick discharge from hospital, primiparity, large weight, rural birth
175
Diagnostic criteria for CHD
Ultrasound
| Ortlani's and barlow tests
176
Signs and symptoms = CHD
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
Treatment CHD
Early dx and tx = pavlik harness
Von rosen splint, spica casting or surgery
Prevention: webster! Change breech, proper swaddling (free hips
