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Med > Pediatric 1 > Flashcards

Pediatric 1 Flashcards

1
Q

At which age the normal HR range is similar to that of adults?

A

12

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2
Q

Infant visit schedule

A 
Within 1 wk post-discharge
1mo
2mo
4mo
6mo
9mo
12mo
15mo
18mo
24mo
Annually between 2-5 yr
Every 1-2 y between 6-12 yr
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3
Q

Publicly funded immunization schedule for:

DTaP-IPV-Hib

A

2mo
4mo
6mo
18mo

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4
Q

Publicly funded immunization schedule for:

dTaP-IPV

A

4-6 y

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5
Q

Publicly funded immunization schedule for:

Pneu-C-13

A

2mo
4mo
12mo

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6
Q

Publicly funded immunization schedule for:

Rot-1

A

2mo

4mo

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7
Q

Publicly funded immunization schedule for:
Men-C-C
Men-C-ACYW

A

Men-C-C: 12mo

Men-C-ACYW: Grade7

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8
Q

Publicly funded immunization schedule for:
MMR
Var
MMRV

A

MMR: 12 SC
Var:15 mo
MMRV: 4-6 yr

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9
Q

Publicly funded immunization schedule for:

HepB

A

0-1-6 mo

Grade 7

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10
Q

Publicly funded immunization schedule for:

HPV-4

A

Grade 7

0-2-6 mo

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11
Q

Publicly funded immunization schedule for:

Tdap

A

14-16 y

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12
Q

Publicly funded immunization schedule for:

Inf

A

Yearly, every autumn

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13
Q

Contraindications to DTaP-IPV

A

Evolving unstable neurologic disease

Hyporesponsive/hypotonic following previous vaccine

Anaphylactic reaction to neomycin, streptomycin

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14
Q

Contraindications to Rot-1

A

Hx of intussusception

ImComp

Abdominal disorder (Meckel…)

Received blood products within 42d

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15
Q

MMR contraindications

A

Pregnancy

ImComp

Anaphylactic reaction to gelatin

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16
Q

MMR for HIV + children

A

Allowed if healthy

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17
Q

Var vaccine contraindications

A

Pregnant
Planning to get pregnant within 3 mo
Anaphylactic reaction to gelatin

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18
Q

Hep B contraindication

A

Anaphylaxis to baker’s yeast

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19
Q

dTaP contra

A

1st trimester of pregnancy

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20
Q

Contraindications to flu vaccine

A

<6mo

ImComp

Egg-allergic (live attenuated)

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21
Q

Egg allergy and flu vaccine

A

Live attenuated vaccine not recommended

Trivalent/quadrivalent vaccine can be given in environment where anaphylaxis can be managed

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22
Q

MenB

A 
Publicly funded only for selected groups:
Asplenia
Ab/Compliment deficiencies
Cochlear implant recipients
HIV
Close contacts with infected individuals

Contra: anaphylactic reaction to components

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23
Q

Vaccination in case of asplenia/hyposplenia

A

All routine vaccines

Yearly flu (among routines)

Men-C-C at age 2 or older
Men-P-ACYW at least 2 wk later, booster q 2-5y

Pneu-P-23: 2y or older
Pneu-P-23: single booster, at age 3 yr or older

Hib: single booster at age 5 or older

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24
Q

Organisms causing infection more frequently in asplenia

A 
Hib
Pneumococ
Meningococ
E.coli
Klebsiella
Salmonella
GBS
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25
Q

Vaccine injection site in infants

A

Anterolateral thigh

All IM

Except:
SQ: MMR, Var, MMRV
Oral: rota

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26
Q

Corrected GA for premature infants is used up to age

A

2 yr

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27
Q

Most lymphatic, gonad, CNS growth time period

A

CNS: first 2 years

Lymphoid: mid-childhood

Gonads: puberty

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28
Q

Upper/lower body proportion

A

Newborn: 1.7

Adult:
0.9 male
1 female

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29
Q

When does newborn lose and regain weight?

A

Wt loss, 10%, in first 7 days

Regain by 10-14 d of age

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30
Q

Infant wt

A

Birth: 3250

x2: 4-5 mo
x3: 1y
x4: 2y

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31
Q

Height of infant

A

Birth: 50 cm

Growth during 1st yr: 25 cm

2nd yr: 12 cm

3rd yr: 8 cm

Then: 4-7 cm/y until puberty

Measurement:
Supine until 2
Then standing

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32
Q

Head circumference

A

Birth: 35cm

2 cm/mo x 3mo (0-3 mo)

1 cm/mo x 3mo (3-6mo)

0.5 cm/mo x 6 mo (6-12mo)

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33
Q

Upgoing plantar reflex in infants

A

Normal until 2 yr

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34
Q

Age of disappearance of moro reflex

A

4-6 mo

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35
Q

Galant reflex

A

Infant held in ventral suspension and one side of back is stroked along paravertebral line

Pelvis moves in the direction of stimulated side

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36
Q

Age of disappearance of galant reflex

A

2-3 mo

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37
Q

Age of disappearance of grasp reflex

A

3-4 mo

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38
Q

ANTR reflex (asymmetric tonic neck reflex)

A

Turn infant’s head to one site

Response: fencing posture

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39
Q

Age of disappearance of ATNR reflex

A

4-6 mo

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40
Q

Age of disappearance of placing reflex

A

Variable

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41
Q

Age of disappearance of sucking reflex

A

2-3 mo

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42
Q

Age of disappearance of parachute reflex

A

Never

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43
Q

Developmental red flags

A

Not walking at 18 mo
Rolling too early at < 3 mo

Hand preference at < 18 mo

Speech < 10 words at 18 mo

Not smiling at 3 mo
Not pointing at 15-18mo

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44
Q

Growth motor at 1 mo

A

Turns head from side to side when supine

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45
Q

Fine motor at 1 mo

A

Hands fisted

Thumb in fist

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46
Q

Speech/language at 1 mo

A

Cries

Startles to loud noise

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47
Q

Adaptive/social skills at 1 mo

A

Calms when comforted

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48
Q

Gross motor at 2 mo

A

Briefly raises head when prone

Holds head erect when upright

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49
Q

Fine motor at 2 mo

A

Pulls at cloths

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50
Q

Speech/language at 2 mo

A

Coos

Gurgles

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51
Q

Adaptive and social skills at 2 mo

A

Smiles responsively

Recognizes/calms down to familiar voice

Follows movements with eyes

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52
Q

Gross motor at 4 mo

A

Lifts head and chest when prone

Holds head steady when supported sitting

Rolls prone to supine

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53
Q

Fine motor at 4 mo

A

Briefly holds object when placed in hand

Reaches for midline objects

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54
Q

Speech/language at 4 mo

A

Turns head towards sounds

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55
Q

Adaptive/social skills at 4 mo

A

Laughs responsively

Follows with eyes

Responds to people with excitement

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56
Q

Gross motor at 6 mo

A

Tripod sit

Pivots in prone position

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57
Q

Fine motor at 6 mo

A

Transfers objects from hand to hand

Bring objects to mouth

Ulnar or raking grasp

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58
Q

Speech and language at 6 mo

A

Babbles

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59
Q

Adaptive/social at 6 mo

A

Stranger anxiety

Beginning of object permanence

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60
Q

Gross motor at 9 mo

A

Sits well without support

Crawls

Pulls to stand

Stands with support

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61
Q

Fine motor at 9 mo

A

Early pincer grasp with straight wrist

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62
Q

Speech/language at 9

A

Mama, dada

Imitates 1 word

Responds to no regardless of tone

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63
Q

Adaptive/social at 9 mo

A

Plays games (peek-a-boo)

Reaches to be picked up

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64
Q

Gross motor at 12 mo

A

Gets into sitting without help

Stands without support

Walks while holding on

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65
Q

Fine motor at 12 mo

A

Neat pincer grasp

Releases ball with throw

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66
Q

Speech and language at 12 mo

A

2 words

Follows 1 step commands

Uses facial expression, sounds, actions to make needs known

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67
Q

Gross motor at 15 mo

A

Walks without support

Crawls upstairs/steps

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68
Q

Fine motor at 15 mo

A

Picks up and eats finger foods

Scribbles

Stacks 2 blocks

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69
Q

Speech at 15 mo

A

4-5 words

Points to needs/wants

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70
Q

Adaptive/social at 15

A

Looks to see how others react (after falling…)

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71
Q

Adaptive/social at 12 mo

A

Responds to own name

Separation anxiety begins

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72
Q

Gross motor at 18 mo

A

Runs

Walks forward pulling toys/objects

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73
Q

Fine motor at 18 mo

A

Tower of 3 cubes

Scribbling

Eats with spoon

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74
Q

Speech at 18 mo

A

10 words

Follows simple commands

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75
Q

Adaptive/social at 18 mo

A

Shows affection towards others

Points to show interest in something

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76
Q

Gross motor at 24 mo

A

Climb up and down steps with 2 feet per step

Runs

Kicks ball

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77
Q

Fine motor at age 24

A

Tower of 6 cubes

Undresses

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78
Q

Speech at 24 mo

A

2-3 word phrases

50% intelligible

I, me, you

Understands 2-step commands

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79
Q

Adaptive/social at 24 mo

A

Parallel play

Helps to dress

80
Q

Gross at 36 mo

A

Rides tricycle

Climbs 1 foot per step

Down 2 feet per step

Stands on one foot briefly

81
Q

Fine motor at 36 mo

A

Copies a circle

Turns pages one at a time

Puts on shoes

Dress/undress fully, except bottoms

82
Q

Language/speech at 36 mo

A

Combines 3 or more words into sentence

Recognizes colors, prepositions, plurals, counts to 10

75% intelligible

83
Q

Adaptive/social at 36 mo

A

Knows sex and age

Shares some of the time

Plays make-believe games

84
Q

Gross at 4 yr

A

Hops on 1 foot

Climbs down 1 foot per step

85
Q

Fine motor at age 4 yr

A

Copies a cross

Uses scissors

Buttons cloths

86
Q

Speech/language at 4 yr

A

100% intelligible

Uses past tense

Understands 3 part directions

87
Q

Adaptive/social skills at age 4

A

Cooperative play

Fully toilet trained by day

Tries to comfort someone who is upset

88
Q

Gross motor at 5 y

A

Skips

Rides bicycle

89
Q

Fine motor at age 4

A

Copies of triangle and square

Prints name

Ties shoelaces

90
Q

Speech at 5 y

A

Fluent speech

Future tense

Alphabet

Retells sequence of a story

91
Q

Adaptive skills at age 5

A

Cooperates with adult requests most of the time

Separate easily from caregiver

92
Q

Baby daily calorie needs

A

<10 kg: 100 kcal/kg/d

10-20: 1000 + 50 kcal/kg/d for each kg above 10

> 20: 1500 + 20 kcal/kg/d for each kg above 20

100-50-20

93
Q

Supplements in BF infants

A

Vit D 400 IU/d

Iron (6-12 mo if not receiving fortified cereals/meat/meat alternatives) CDC: start at 4 mo

Fluoride (if not sufficient in water)

94
Q

How to introduce solid food?

A

At 6 mo (don’t delay beyond 9 mo)

2-3 new foods/w

At least 2 day in between each food

95
Q

When to introduce highly allergenic foods?

A

Early

96
Q

Most common allergenic foods

A 
Egg
Milk
Mustard
Sesame 
Wheat
See food
Tree nuts
Soy
Peanut
97
Q

When to introduce vegetables, fruits, grains, full-fat milk?

A

After iron-rich foods are given

98
Q

When and how to switch to cow milk?

A

9-24 mo:

Homogenized, 3.25% milk

16 oz/d to NBF infants

No more than 24 oz (750 cc) after 1 yr

2-6 yr:

2% milk

500 ml/d

99
Q

Amount of feeding meals

A

Up to 3 large meals

1-2 smaller snacks

100
Q

When to encourage self-feeding?

A

By 18 mo

101
Q

Foods to avoid

A

Honey until past 12 mo

Added salt/sugar

Excessive milk

Limit juice (max: 4-6 oz: 1/2 cup daily)

Anything with choking hazard

102
Q

Role of dietary restrictions during pregnancy and breast-feeding in reducing allergy rate in infants

A

No role

103
Q

Colostrum properties

A

High protein

Low fat

High Ig content

104
Q

Mature breast milk content

A

Whey/casein : 70/30

Fat: dietary butterfat

Carb: lactose

105
Q

Advantages of breastmilk

A

Easily digested

Low renal solute load

IgA

Macrophage

Lymphocyte

Lysozymes

Lactoferrin (inhibits E. Coli growth in intestine)

Lower pH (promotes growth of lactobacillus in GI)

Parent child bonding

Economical

Convenient

106
Q

Contraindications to breast-feeding

A 
Maternal:
Chemo
Radioactive compounds
HIV
Active untreated TB
Herpes in breast region
Illicit drugs
Alcohol > 0.5 g/kg/d
Certain meds
107
Q

Breast feeding jaundice time

A

1-2 wk

108
Q

Cause of breastfeeding jaundice

A

Infant dehydration due to low milk production

109
Q

Breast milk jaundice time

A

Persists up to 4-6 mo

Glucuronyl transferase inhibitor in breast milk

Decrease Bil conjugation
Increased enterohepatic circulation of Bil

Healthy, thriving baby

Jaundice resolves

110
Q

Signs of inadequate intake

A

Jaundice

Wt loss > 10%

<6 wet diapers/d after 1st week

<7 feeds/d

Sleepy/lethargic

Sleeping throughout the night < 6 wk

111
Q

Normal number of wet diapers/stools in newborn

A

1 wet diaper/d of age for first wk

1-2 black or dark green stools/d on day 1-2

3+ brown/green/yellow stool/d on day 3-4

3+ yellow, seedy stools/d on day 5+

112
Q

Soy protein milk indications

A

Galactosemia

Desire for vegetarian/vegan diet

(Sucrose instead of lactose)

113
Q

Indications for aa formula

A

Short gut

Food allergy

(No lactose)

114
Q

Indications for protein hydrolysate formula

A

Food allergy

Malabsorption

(100% casein, no lactose)

115
Q

Partially hyrolyzed proteins formula indications

A

Delayed gastric emptying

Cow milk protein allergy

(100% whey)

116
Q

Fortified formula indications

A

LBW
Prematurity

(Higher calories and vit A, C, D, K)

Mainly used in hospital (risk of fat-soluble vit toxicity)

117
Q

Indications for cow’s milk-based formula

A

Prematurity

Transition into breastfeeding

Contra to breastfeeding

(Lower whey/casein, plant fat)

118
Q

Allergy rate to soy protein in cow’s milk protein allergic children

A

10-35%

119
Q

Appropriate age for swimming lessons

A

> 4 yr

120
Q

Age of sunscreen use

A

From 6 mo

121
Q

Age of breath holding spells

A

6mo-4yr

Usually starts during first year of life

122
Q

Trigger of breath holding spells

A

Anger, injury, fear

Holds breath and becomes silent

Spontaneously resolves or loses consciousness

123
Q

Breath holding spell types

A

Cyanotic
Following anger/frustration

Less commonly pallid
Following pain/surprise

124
Q

Mx of breath holding spells

A

Help child control response to frustration

Avoid drawing attention to spell

My be associated with IDA (improves with supplemental iron)

Usually resolves spontaneously (rarely progresses to seizure)

125
Q

Benefits of circumcision

A 
Slightly decreased:
UTI
STI
Balanitis
Cancer of the penis
126
Q

Contraindications to circumcision

A

Genital abnormalities

Bleeding disorders

127
Q

Definition of infantile colic

A

Paroxysms of irritability and crying

> 3h/d
3d/w
3w

Healthy, well-fed infant

128
Q

Onset and duration of infantile colin

A

Onset: 10d- 3 mo

Peak: 6-8 wk

Duration: all resolve, mostly by 3-6 mo

129
Q

Mx of infantile colic

A

Parental relief, rest, reassurrance

Hold baby
Soother
Car ride
Music
Vacuum
Check diaper

Probiotics

Maintain breastfeeding but eliminate allergens from mother’s diet (cow’s milk protein, eggs, wheat, nuts)
Try casein hydrolysate formula

130
Q

Time of first dentition

A

5-9 mo
Lower incisors

Then 1/mo

131
Q

1st assessment by dentist

A

6 mo after 1st tooth

Definitely by 1 yr of age

132
Q

Secondary dentition time and first tooth

A

6 yr

1st molar then lower incisors

133
Q

Cause of milk caries

A

Prolonged feeding

Superior front teeth and back molars in first 4 yr

134
Q

Prevention of milk caries

A

No bottle at bedtime

Clean teeth after last feed

Minimize juice/sweetened pacifier

Clean teeth with soft damp cloth or toothbrush and water

Water fluoridation

135
Q

Definition of enuresis

A

Involuntary urinary incontinence by day and/or night in child > 5

136
Q

When to evaluate enuresis?

A 
If:
Dysuria
Change in urine color, odor, stream
Secondary
Diurnal
Change in gait
Stool incontinence
137
Q

Primary nocturnal enuresis etiology

A

Boys>

Developmental disorder

Maturational lag in bladder control while asleep

138
Q

Mx of primary nocturnal enuresis

A

Time and reassurance

Limiting fluid

Voiding prior to sleep

Bladder retention exercises

Scheduled toileting overnight (limited effectiveness)

Conditioning wet alarm (70% success rate)

2nd line:

medications: oral DDAVP, imipramine

Children > 7 y

For sleepovers/camps

139
Q

DDAVP vs Conditioning alarm for nocturnal enuresis

A

Similar effectiveness

Higher relapse rate for DDAVP

140
Q

Secondary enuresis definition

A

After a period of bladder control >6 mo

141
Q

Etiology of secondary enuresis

A

Inorganic regression due to anxiety/stress

Or

Organic causes: UTI, DM, DI, sleep apnea, neurogenic bladder, CP, seizure, pinworm

Tx: underlying

142
Q

Diurnal enuresis definition and etiology

A

Day time wetting

Mostly also have night time wetting

Etiology:
Micturition deferral

Structural anomalies: ectopic ureteral site, neurogenic bladder

UTI, constipation, CNS disorders, DM

143
Q

Tx of diurnal enuresis

A

Treat underlying

Behavioral (scheduled toileting, double voiding, good bowel program, sitting backwards on toilet, charting/incentive system, relaxation/biofeedback), pharmacotherapy

144
Q

Definition of encopresis

A

Fecal incontinence in child > 4 yr

At least once/mo

For 3 mo

M>F

145
Q

causes of encopresis

A

Chronic constipation

Hirschprung

Hypothyroidism

Hypercalcemia

Spinal cord lesions

Anorectal malformations

Bowel obstruction

146
Q

Etiology of retentive encopresis

A

Painful stooling secondary to constipation

Disturbed paren-child relationship

Coercive toilet training

147
Q

Mx of encopresis

A

Complete bowel clean-out:
PEG 3350, oral
(2nd line: enema, supp)

Regular bowel movements

Assessing psychosocial stressors

Behavioral modification

148
Q

Complications of encopresis

A

Recurrence

Toxic megacolon

Bowel perforation

149
Q

Toilet training

A

Girls earlier than boys

Bladder before bowel

98% daytime bladder control by 3 yr

150
Q

Signs of toilet readiness

A

Ambulating independently

Stable on potty

Desire to be independent or to please caregiver

Sufficient expressive and receptive language skill (2-step command level)

Can stay dry for several h

Can recognize need to go

Able to remove clothing

151
Q

Definition of failure to thrive

A

Wt < 3rd percentile
Or
Falls across two major percentile curves,
Or
< 80% of expected weight for height and age

152
Q

Most common factor in poor wt gain

A

Inadequate calorie intake

153
Q

Inv for FTT

A 
CBC, 
Blood smear
Electrolytes
T4,TSH
Bone Xray
Chromosome, karyotype
Chronic illness: CXR, sweat Cl-, ECG, echo, celiac, inflammation, malabsorption, U/A, liver enzymes, alb
154
Q

Calculation of mid-parental height

A

Boys: (Father ht + Mother ht + 13)/2
Girls: (Father ht + Mother ht -13 13)/2

155
Q

FTT with decreased Wt but normal Ht and HC

A

Insufficient calorie intake

Hypermetabolic state

156
Q

FTT with decreased Wt and Ht but normal HC

A

Structural dystrophy

Endocrine disorder

Constitutional growth delay (bone age < chronological age)

Familial short stature (BA=CA)

157
Q

FTT with decreased Wt, Ht, HC

A

Intrauterine insult

Genetic abnormalities

158
Q

Mx of FTT

A

Multidisciplinary

Treating underlying

Educate about:
Age-appropriate foods
Calorie boosting
Mealtime schedules and environment

Goal: to reach 90-110% IBW

Correct nutritional deficiencies
Promote catch up growth and development

159
Q

Increased upper/lower segment ration DDx

A

Achondroplasia

Short limb syndrome

Hypothyroidism

Storage diseases

160
Q

Decreased upper/lower segment DDx

A

Marfan
Kleinfelter
Kallman
Testosterone deficiency

161
Q

Obesity definition

A

Overweight: BMI > 85th percentile

Obesity: BMI >95th for age and Ht

162
Q

Organic causes of obesity

A

Rare (5%)

Prader-Willi

Carpenter

Turner

Cushing

Hypothyroidism

163
Q

Complications of obesity

A 
HTN
Dyslipidemia
SCFE
DM2
Asthma
Obstructive sleep apnea
Gynecomastia
PCOS
Early menarche
Irregular menses
Psychological trauma
164
Q

Inv for obesity

A

BP
Pulse
Lipid profile

165
Q

Mx of obesity

A

Long-term gial: maintain BMI <85th percentile

Encouragement
Reassurance
Engagement of family
Diet:
Quantitative changes
DO NOT ENCOURAGE WEIGHT LOSS (allow linear growth to catchup with wt)
DO NOT ENCOURAGE ADULT DIETS OR VERY LOW CALORIE DIET.

Behavioral modification:
Increase activity
Change eating habit/meal patterns
Limit juice/sugary drinks
Adequate sleep
Increase physical activity (1h/d)
Reduce screen time (<2h/d)
166
Q

Extra management in obese children who have RFs or complications

A

AST/ALT

DM screening

Small changes in energy expenditure and intake (lose 1 lb/mo)

167
Q

factors affecting Child wt

A

Associated with obesity:
Maternal smoking during pregnancy,
Birth wt

Factors negatively associated with obesity:
Exclusive breast-feeding for six months,
Adequate sleep hours,
Being physically active

168
Q

Recommended screen time for children

A

Not recommended for children under 2 yr

<1h for 2-5 yr

<2g for 5-17

169
Q

CS in diaper dermatitis

A

Short-term, low-potency, for severe ICD and SD

170
Q

Limit setting sleep disorder

A

Bedtime resistance

Preschool and older children

Exacerbated by child’s oppositional behavior

Due to caregiver’s inability to set consistent bedtime rules and routines

171
Q

Sleep-onset association disorder

A

Infants and toddlers

Child learns to fall asleep only under certain conditions or associations

During the normal brief arousals of sleep, child cannot fall back sleep because same conditions are not present

172
Q

First-line Tx for OSA

A

1st line:
Adenotonsillectomy
Wt Mx

CPAP:
If adenotonsillectomy is contraindicated
Minimal adenotonsillar tissue
Residual OSA

Mild-mod:
Watchful waiting

Avoid pollutants, smoke, allergens
Avoid CS, AB

173
Q

Effects of adenotonsillectomy on OSA

A

Improved behavior
Improved QOL
Improved polysomnographic findings

No improvement in:
Attention
Executive function

174
Q

Mx of sleep disturbances

A

Set strict bedtimes and wind-down routines

Do not send child to bed hungry

Positive reinforcement for limit setting sleep disorder

Always sleep in own bed, in a dark, quiet, and comfortable room

Do not use bedroom for timeouts

Systematic ignoring and gradual extinction for: sleep onset association disorder

175
Q

Nightmares

A

Boys 4-7 yr

REM

Upon awakening, child is alert and clearly recalls frightening dream.

+/- daytime anxiety

Mx: reassurance

176
Q

Night terrors

A

Early hours of sleep, stage 4 sleep

Abrupt sitting up, eyes open, screaming. Inconsolable

Signs of panic and autonomic arousal

No memory of event

Stress/anxiety can aggravate them

Remits spontaneously at puberty

177
Q

Mx of night terror

A

Reassurance of parents

Ensure child is safe

178
Q

Leading cause of death between 1 to 12 months of age

A

SIDS

179
Q

Sudden infant death syndrome

A

M>F

Prone position>

Peak age (in term infant): 2-4 mo

Increased during RSV peak

Midnight-8 am

180
Q

RFs for SIDS

A

Prematurity

Early bed sharing (<12 wk)

Alcohol during pregnancy

Soft bedding

LBW

Aboriginal

Male

No prenatal care

Smoking in household

Prone sleep position

Poverty

Sibling of infant with SIDS

Sleeping on a surface with a fixed wall

Sleeping with an infant after consumption of alcohol/drugs or extreme fatigue

Infant sleeping with someone other than the primary caregiver

181
Q

Prevention of SIDS

A

Place infant on back when sleeping

Avoid sharing bed

Allow supervised tummy time

Avoid overheating, overdressing

Appropriate infant bedding

No smoking

Exclusive BF in first month

Pacifier

NO ALARMS/MONITORS

182
Q

Appropriate bedding for infant

A

Firm mattress

No loose bedding

No pillows

No stuffed animals

No crib bumper pad

183
Q

RFs for child abuse

A

Social isolation
Poverty
Domestic violence

Caregiver:
Personal history of abuse
Psychiatrist illness
Postpartum depression
Substance abuse
Single parent family
Poor social and vocational skills
Below average intelligence
Child
Difficult temperament
Disability
Special needs
Prematurity
184
Q

Mx of child abuse/neglect

A

Report all suspicions to CAS: request emergency visit if imminent risk to child/siblings

Acute medical care

Arrange consultation to social work, appropriate F/U

May need to discharge child directly to CAS supervision

185
Q

Bruises suspicious if child abuse

A

Not explained by accidental injury or child development level

Locations:
Abdomen, buttocks, genitalia, fleshy part of cheek, ears, neck or feet

Baby not yet cruising

Bruising not on the front of the body and/or overlying bones

Large/numerous, clustered/patterned

186
Q

Fx suspicious of abuse

A

Not explain why history or child’s development level

Posterior rib
Metaphyseal
Scapular
Vertebral
Sternal
187
Q

The most common cause of death and child abuse

A

Head trauma

188
Q

Inv for child abuse

A

Document all injuries

Photography of skin injuries is ideal (with police or hospital photography)

Rule out medical causes:
If fx: Ca, Mg, PO4, ALP, PTH, vitD, alb
If bruising: CBC, INR, PTT, vWF, F VIII/IX

Screen for abd trauma:
AST, ALT, amylase
CT if required
Lytes, U/A

Toxicity screen

Skeletal survey if <2yr
Imaging based on Hx in child > 5yr

Neuroimaging (if subdural hemorrhage detected, eye exam by ophthalmologist)

189
Q

Peak age of sexual abuse

A

2-6y

12-16y

190
Q

Complications of sexual abuse

A

As adults:
Obesity, sexual problems, IBS, fibromyalgia, STI, substance use disorder

More likely to experience intimate partner violence and sexual assault

191
Q

Order of sexual abuse committers

A

Family member>
Non-relative known to victim
Stranger

192
Q

Hx taking in sexual abuse

A

DO NOT TAKE Hx FROM A YOUNG CHILD

MUST BE DONE BY TRAINED PERSONNEL

193
Q

PEx findings suggestive of sexual abuse

A

Recurrent UTI

Pregnancy

STI

Vaginitis

Vaginal bleeding

Pain

Genital injury

Enuresis

SPECULUM CONTRAINDICATED IN PREPUBERTAL GIRLS

194
Q

Inv for sexual assault

A

Sexual assault examination kit:
Within 24 h if prepubertal
Within 72h if pubertal

R/O:
STI, pregnancy, UTI

Consider STI prophylaxis, emergency contraception

R/O other injuries

R/O drug, alcohol screen

195
Q

Adolescence Hx

A

HEEADSSS

Home
Education/Employment
Eating
Activities
Drugs
Sexuality
Suicide and depression
Safety/violence
196
Q

Clues to beglect

A 
FTT
developmental delay
Inadequate/dirty clothing
Poor hygiene
Poor attachment to parents
No stranger anxiety
197
Q

Findings suggestive of physical abuse

A 
Retinal hemorrhage
Frenulum tear
Patchy hair loss
Immersion burns
Altered mental status

Med (25 decks)

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