Pediatric and Newborn Visit Flashcards
How is the age cohort of neonate or newborn defined?
First 28 DOL
How is the age cohort of infant defined?
29 DOL to 1 year
How is the age cohort of early childhood defined?
1-4 years old
How is the age cohort of middle childhood defined?
5-10 years old
How is the age cohort of adolescence defined?
10-20 years old
Age specific milestones are
predictable
Loss/delay of a milestone is always concerning
Is the range of normal wide or narrow in children?
Wide
What are the goals of well child visits?
Disease Detection
Disease Prevention
Health Promotion
Anticipatory guidance (age specific advice)
What is an important component of pediatric visits that are often missed?
Observation of parent/child interactions
What are the components of developmental surveillance?
Ongoing process
Done at every visit
Parental history
Skilled, experienced observation
What are the components of developmental screening?
Formal process
Uses a standardized tool
Universal screening at specified ages
Selective screening when risk assessment raises a concern
What are the main differences in a child HPI compared to the adult visit?
History from parent
Need both parent and patients perspective
Note parent-child interaction
Parental emotions and behaviors
It is important to note what since the last visit?
Any changes
General Status
Other priorities based on age
What are the additional past medical history components to the pediatric visit?
Prenatal history of the mother
Birth history
Newborn history (included in all children < 3 or if pertinent)
What is included in the health maintenance section of the pediatric visit?
Feeding/Nutrition
Growth and Development
Immunizations
Sleep Patterns
Elimination patterns
Dental Care
Safety
What is included in the feeding history/nutrition component of the visit?
Breast vs. bottle fed; how much, how frequently
Weaning
Solid foods: when, what types
Current diet
Food likes/dislikes, appetite, intolerances
Vitamin supplements
What is the immediate care in the evaluation of the newborn at delivery?
drying, clearing, airway, warming
When are APGARs done?
1, and 5 minutes in all newborns
What does the APGAR score at 1 minute assess?
Does the baby need to be resuscitated (0-4 APGAR)
What is a reassuring 5-minute APGARs score?
7-10
Does APGAR’s predict mortality and morbidity?
No, it is only used to assess need for resuscitation
What parts of the exam do you do first when the baby is quiet?
Heart and Lungs
What parts of the exam do you do last?
Spine and hip assessment
What is the normal respiratory rate in a newborn?
35-60 breaths/minute
At what age do we start routinely getting blood pressures?
Age 3
What growth parametric is done at every visit until age 2?
Head circumference
What is lanugo and who is it common in?
Fine downy growth of hair over the entire body, more prominent in preemies
What is vernix caseosa?
Milky chunky white covering present at birth
If there is central cyanosis and cyanosis of mucus membranes what should be evaluated?
Congenital heart disease
What race is pustular melanosis more common?
African Americans
What race is Mongolian spot’s more common?
Asian neonates (85-100%)
What is a Mongolian Spot?
Blue-gray patch, usually in sacral-gluteal region or shoulders. Usually disappear in 1-2 years of life.
What are you concerned for when there is a port wine stain in V1?
Sturge-Weber syndrome (rare, congenital)
Capillary-venous malformations in the brain and eye
When does the Anterior fontanelle close?
4 and 26 months of age (most commonly around 18)
When does the Posterior fontanelle close?
Closes by 2 months of age
What can ear abnormalities be sometimes associated with?
Kidney congenital defects or congenital hearing loss
What is a characteristic finding of Turner’s Syndrome in the neck?
Webbed neck
Why can female genitalia more prominent at birth?
Exposure to mother’s estrogen
What spine findings can be associated with neural tube defects?
Pigmented spots, hairy patches, deep pits
What should be done as part of the neurologic exam?
Note muscle tone
Symmetry of movement
Moving all extremities
Primitive reflexes
What are the primitive reflexes?
Moro reflex (startle reflex)
Grasp reflex
Stepping reflex
Rooting reflex
Babinski
Asymmetrical tonic neck reflex
What is part of preventative care at birth?
Erythromycin ophthalmic ointment to prevent gonococcal conjunctivitis
Vitamin K to prevent vitamin K deficient bleeding
Hepatitis B vaccination
What is done as part of universal newborn screening?
Hearing
Metabolic and genetic disorders, endocrine disorders, and hemoglobinopathies in newborn screen
