Notes Flashcards
2 ways we track baby growth
Denver and growth chart
What is involved in the growth chart?
Height
Weight
Head circumference
What is in the denver developmental chart II?
Gross motor
Fine motor
Personal-social
Language
Normal child development marker at 3 months
Hold head up
Normal child development marker at 4 months
Rolls over
Normal child development marker at 6 months
Sits up
Normal child development marker at 9 months
Crawl/sit
Normal child development marker at 11 months
Stands/throws
Normal child development marker at 1 year
Walk/crawls freely
What is most common loss of point in appearance of APGAR?
Acrocyanosis
G in APGAR?
Grimace: are they reacting to noxious stimuli?
Second A in APGAR
Activity = are they moving both limbs equally? 0 = floppy
How will you check for developmental lag warning signs at 6-8 weeks old?
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.
T/F: can still be a head lag at 4 months
False. Should be no head lag at 4 months.
At what age do babies begin to get very social?
4-6 months
When would you see readiness signs for solid foods?
6-7 months
When should you see truncal control?
6 months
At what age should you see teeth growth?
7-9 months
What is a readiness sign for eating?
When teeth grow
When should you see hand to hand transfer? (Denver)
7-9 months
When will you see lumbar and sacral curve beginning to develop?
7-9 months
When will you hear sounds to first word? Nonspecific
7-9 months
When is object permanence developed?
8-10 months
What are some questions you would as a 7-9 month old baby?
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?
What age has a child tripled their birth weight?
10-12 months
When do you see a child speak 2-4 words?
10-12 months
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.
When should babies be walking?
16 months
When should you expect to hear two word phrases?
18-24 months
When should you expect 1000 words? >3 word phrases
Age 3
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
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?
Congenital infant conditions to watch for
CP Feet Clubfoot CHD Hearing Vision Brain Fetal alcohol
Birth trauma conditions to watch for
Torticollis Brachial plexus Clavicle fx Brain injury Head injury
Genetic conditions to watch for
Downs
Muscular dystrophy
Other conditions besides congenital, birth trauma or genetic to watch out for
Colic
Nursing difficulties
GER
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)
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
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
APGAR scoring for color
0 = all blue/pale
1 = pink body, blue ext
2 - all pink
APGAR score for HR
0 = absent 1 = <100 bpm 2 = >100 bpm
APGAR score for respiration
0 = absent 1 = irregular, slow, cry 2 = good, cryin
APGAR score for reflex, stim
0 = none 1 = grimace 2 = sneeze/cough
APGAR score for muscle tone
0 = limp 1 = some flexion 2 = active
APGAR Scoring
8-10 = good to excellent 5-7 = fair <5 = neuro sequelae. Poor condition. Maybe immediate lifesaving mesasure such as o2 mask
Head/face exam (3)
Size, smmetry, alignment of skull, face, eyes, ears and nose, swelling?
Palpate sutures and fontanelles (should be open. Ant/post)
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
When do sutures clos?
2-6 months
When does ant fontanelle close?
18-24 months.
Psot closes birth - 6 weeks
Plagiocephaly
Craniofacial asymmetry due to sustained pressure usually disappears by 2 years.
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
Caput succedaneum
Crosses suture lines
Benign and usually goes away in first weeks of life
Squishy and soft.
In newborn/infantn eval, how should infant be postured?
Extremities flexed and fists clenched
What is lanugo?
Fine body hair on shoulders, forehead and back
Milia
Small white papules on nose, cheeks and chin
Erythema toxicum
Maacular eruption common in light skin newobrn that resolves in 1 week
What are petechia and lesions a sign of?
Meningitis
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
Heart murmurs
Birth - 1 week
10% association with congenital heart disease
Should be evaluated
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
Where should liver be palpable?
2-3 cm below right costal margin
When should you hear bowel soudns
Within 2 hours of birth
When should you see meconium
Within i24-48 hours of birth
Abominal signs of distress
Absent bowel sounds Visible peristalsis Abdominal distention Palpable masses Red base of cord Cord with only two vessels
Neurmuscular system signs of distress
Hypotonia Quivering Limp extremities Spasticity Straightening of extremities Clonic jerking Paralysis
Neck signs of distress
Torticollis
Resistance to flexion
Neck webbing
Palpable crepitus in SC/AC joint
Two orthos to check for hip dislocation
Ortolanis
Barlows
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
What is CHD
Flattening of acetabulum so hip slides in and out. Laxity of hip area in newborn
CHD is MC in what gender babies
Girls.
MC orthopedic conditions you’ll see in this age group.