Pediactric Exam 1 - Birth to Infancy Flashcards
well child exams
physical development
cognitive development
social/emotional development
newborn
0-28 days
infancy
0-12 months
toddler/early childhood
1-4 years
school-aged/middle childhood
5-10 years
adolescence
11-20 years
further separated to early, middle, and late
development and health of child
affected by physical, social, emotional factors, and disease
APGAR
appearance pulse grimace activity respiratory effort
measured at birth - looks at neurologic recovery
-at 1 minute and 5 minutes
appearance score?
blue, pale = 0
pink body, blue extremities = 1
pink all over = 2
pulse score
absent = 0 100 = 2
grimace score
aka reflex irritability
no response = 0
grimace = 1
crying, sneezing, coughing,
4 principles of child development
1 predictable pathway
2 wide range of normalcy
3 physical, social, environmental, disease all affect
4 childs level determines how you H and P
activity score
flaccid = 0
flexion of arms/legs = 1
active movement = 2
respiratory effort score
absent = 0 slow/irregular = 1 good/strong = 2
levels at 1 minute
0-4 - severe depression
5-7 - some NS depression
8-10 - normal
levels at 5 minutes
0-7 - high risk for CNS and other organ system dysfunction
8-10 - normal
hospital evaluation
within 24 hours of delivery
- review moms hx
- review delivery record
- full head-to-toe exam
given after delivery
erythromycin - eyes prevent infection
vitamin K - injection to prevent bleeding
full bath
gestational age and birth weight
help preduct medical problems in future
gestational age
neuromuscular sign and physical characteristics that change with gestational age
ballard scoring system
ballard scoring system
neuromuscular maturity
-1 to 5
physical maturity
-1 to 5
add numbers together to determine gestational age
preterm
< 37 weeks
term
37-42 weeks
post term
> 42 weeks
extremely low birth weight
<1000 grams
very low birth weight
<1500 grams
low birth weight
< 2500 grams
normal birth weight
> or = 2500 grams
small for gestation age
SGA
<10th percentile
appropriate for gestational age
AGA
10-90th precentile
large for gestational age
LGA
>90th percentile
neonate feeding
every 3 hours
- breast feeding - initial colostrum
- milk come in after 2-3 days
colostrum
initial small volume of breast milk
formula
15-30 ml (0.5-1 ounce)
weight change
normal to lose up to 10% of body weight
-should regain after 10-14 days
voiding regularity?
3-4 /day in 1-3 days
day 4-5 - should see 6-8/day
meconium
initial stool
-first 24 hours
dark, black, tarry
breast fed stool
yellow, seedy
formula fed stool
green/yellow
initiate phototherapy
levels high or rising quickly
>5mg/dl per day
jaundice
elevated bilirubin prior to 24 hours no good
-more than just physiologic jaundice
high risk bilirubin zone
repeated 4-8 hours
high intermediate bilirubin risk zone
repeated 8-12 hours
low-intermediate bilirubin risk zone
repeated within 48 hours
low risk bilirubin zone
3-5 days
hospital discharge
vaginal 48 hours
c section 3 days
prior to discharge of newborn
hep B
hearing screen
newborn screening blood test
circumcision, if desired
follow up care after delivery
24-48 hours after discharge
well child visits
continued assessment of growth as infant ages
- immunizations
- parent information
- parent questions
components of well child visit
HPI -feeding, stooling, voiding, sleeping, development, safety, parental concerns PMH -med problems, injuries, hosp, surgery Meds Allergies Fam Hx Social Hx
well visit intervals
3-4 days of life - growth only 2 weeks (with screen #2) 1 month 2 month 4 month 6 month 9 month - Hg 1 year
all look at growth and development
growth review
weight
length
head circumference
growth chart
need 3 points
-look at trend
development through infancy
physical - fine/gross motor
language/cognitive
personal/social
physical development
central to peripheral
gross to fine motor
head control > trunk control > arms > legs > hands and fingers
language development
2 month cooing
6 months babbling
1 year 1-3 words
cognitive development
cause/effect, object permanence, use of tools
9 months - recognize strangers, seek comfort from parent during exam, actively manipulate object
personal social development
understanding self and family matures
bonding/attachment to caregivers
temperament - adaptability to changes, variable
gross motor milestones
large groups to sit
stand, walk run, balance
fine motor milestones
drawing, eating, dressing, playing, writing
language milestones
speaking, body language and gestures, communicating, understanding
cognitive milestones
problem solving, reasoning, remembering
social milestones
interacting with others, friends, family, teachers, cooperating
at 9 months
no more exam on table - do it on parent lap
exam sequence for infant
heart/lung first
HEENT last
head circumference
measured up to 3 years (36 months)
shape, symmetry, tilt, lesions, hair
respiratory infant exam
signs of distress - nasal flaring, retractions, accessory muscles
auscultate lung fields
blood pressure in child
not measured in child < 3 years
pulse in infant
brachial and femoral
-compare B/L
CV don’t miss
benign murmurs
GI don’t miss
normal: no spleen palpable can feel kidney anal fissures liver tip palpable below costal margin
GU infant exam
descended testicles B/L
swelling of testicles normal
inguinal or femoral hernias
don’t miss labial adhesions
neuro exam infant
cranial nerves
strength/muscle tone
deep tendon reflexes
primitive reflexes
palmar grasp reflex
birth to 4 months
-grasp finger
plantar grasp reflex
birth to 9 months
-toes curl
moro reflex
birth to 4 months
startle reflex
-lower quickly - arms abduct and extend, hands open, legs flex, maybe cry
asymmeric tonic neck reflex
birth to 4 months
supine, turn head to one side with jaw over shoulder
arm/leg same side extend opposite side flex
positive support reflex
birth to 2 month or 6 months
feet touch surface
-hip, knee, ankle extend, partial weight bearing
rooting reflex
birth to 3-4 months
stroke corner of mouth - turns head toward stimuli
galants reflex
birth to 3 months
galants
stoke one side of back - spine curves toward stimuli
placing/stepping reflex
one foot on surface
-hip/knee that foot flex and other foot step forward
birth to variable disappear
landau reflex
suspend prone
-head up and spine straigten
birth to 6 months
parachute reflex
suspend prone, slowly lower head
arms/legs extend in protective fashion
4-6 months - doesn’t disappear
infant hip exam
barlow and ortolani maneuvers
-for signs of dislpcation
can indicate developmental hip dysplasia
effective until around 3 months
-look for other signs - galeazzi
ortolani test
test for posteriorly dislocated hip
will relocate the hip
finger anterior pressure
barlow test
test for ability to sublux or dislocate hip
-indicates intact but unstable hip
press hip posteriorly, to dislocate hip
galeazzi test
flex knees, feet to butt
measure heights of knees
lower is posterior dislocated hip
HEENT exam in infant
big difference - sutures and fontanelles
red reflex in eyes
fontanelles
anterior - closes later (18 mo - 2 yr)
posterior - closes early (1-2 mo)
should be soft and flat
red reflex
light on retina
- should reflect red light
- symmetrical reflection with light 18 inches away
epstein pearls
mucus cyst in mouth
-normal
immunizations 0 - 6 years
hospital - hep B
office - RV, DTaP, HIB, PCV, IPV, influenza, MMR< varicella, Hep A
lots 2 months, 4 months, 6 months - RV, DTaP, HIB, PCV, IPV
