Pediatric Health Supervision Flashcards
Failure to thrive? Most common cause?
Less than expected growth rate (usually weight) which crosses 2 percentile isobars
Reduced calorie intake
Purpose of routine well child visit?
- Anticipatory guidance
- Prevention (immunizations)
- Screening (vision, hearing, metabolic screening, TB)
- Growth and development assessment
- Prevention of disability (in chronic disease)
Expected weight, height and head circumference increases?
Double birthweight by 5 months
Triple birthweight by 12 months
Double length by 4 years
Triple length by 13 years
25% of normal adult had size at birth
75% of normal adult size by one year (12 cm increase since birth )
Cephalohematoma?
Subperiosteal hemorrhage of newborn cranium after traumatic delivery
Microcephaly? Types? Clinical features?
Head circumference 2 to 3 standard deviations below mean
CONGENITAL (abnormal migration of brain tissue) versus ACQUIRED (cerebral insult)
- Small brain
- Developmental delay/intellectual impairment
- Cerebral palsy/seizures
Craniosynostosis? Causes?
Premature closure of cranial sutures
90% SPORADIC
GENETIC (Alpert/Crouzon syndromes)
METABOLIC (hyperthyroid, hypercalcemia)
Craniosynostosis Clinical features?
Sagittal suture – Dolichocephaly (elongated skull)
Coronal suture – Brachycephaly (shortened skull) and Optic nerve atrophy
Metopic suture - trigonocephaly (triangle head)
Causes of congenital versus acquired microcephaly?
- Early prenatal infection (HIV/TORCH)
- Toxins (fetal alcohol)
- Chromosomal (Trison the 13, 18, 21)
- Familial
- Maternal phenoketouria
- Played third trimester/perineal infections
- Meningitis/meningoencephalitis during first year
- Ischemic cerebral insult
- Metabolic (hypothyroidism, inborn errors of metabolism)
TORCH?
Toxoplasmosis, other (syphilis), rubella, CMV, HSV
Plagiocephaly? Main cause? Associated with? Management?
Asymmetry of head not associated with premature suture closure
Positional – associated with Congenital muscular torticollis
Motion stretching exercises, repositioning the head during sleep, increased time in prone position
Macrocephaly? Does not reflect? Management?
Head circumference >95% for age
Does not reflect brain size
Look for signs of high ICP
CT scan to rule out hydrocephalus
Genetic evaluation if suspectedp
Causes of macrocephaly?
- Familial
- Overgrowth (Sotos syndrome)
- Metabolic storage disorders (gangliosidosis, Canavan)
- Neurofibromatosis
- Achrondroplasia
- Hydrocephalus
- Space occupying lesions (cysts/tumors
Live vaccines?
Dead vaccines?
Polio, Varcella, MMR
DTaP, hepatitis A/B, polio, H. influenzae, influenza, pneumococcal/meningococcal
Give passive immunization for these diseases?
- Varicella (if immunocompromised or at higher risk)
- Hepatitis B (if mother is positive)
- Hepatitis A (before travel)
Types of hearing tests?
- Brainstem auditory evoked response – EEG waves generated in response to clicks
- Evoked otoacoustic emission – measures sounds generated by cochlear hair cells
Circumcision required if?
- Phimosis – inability to retract foreskin (ballooning of the foreskin after age 6)
- Paraphimosis – foreskin cannot be returned to normal position and ask as tourniquet
- Balanitis – inflammation of glans penis (associated with candida and gram-negative infections in children)
Contraindications to circumcision?
Hypospadias, prematurity, bleeding diaphysis
Average age of tooth eruption? Type of tooth? Primary teeth established by what age? Secondary tooth eruption by when?
Six months
Lower central incisor
Two years
Seven years
Delayed dental eruption? Causes?
Eruption after 16 months
Hypothyroidism, hypopituitarism, down syndrome, ectodermal dysplasia
Early dental eruption? Causes?
Before three months
Hyperthyroidism, precocious puberty, growth hormone excess
Patients who need flourine supplementation?
- Exclusively breast-fed children older than six months
2. Order contains <.3 ppm fluoride
The most common cause of nursing/bottle caries? Mech?
Streptococcus mutans
Any liquid other than water can serve as a substrate for infection
Signs of hydrocephalus in infant?
Bulging fontanelle and split cranial sutures
Patient less than 9 months with iron deficiency anemia – possible cause?
Early cows milk – less bioavailable iron (Compared to breast milk or formula)
One month milestones?
Formed stools
At 2 months parents should?
Encourage vocalizations
Be wary of small object aspiration
At four months parents should?
Introduce iron fortified cereal and solid food
Introduce transitional object
At six months?
Sleeping through the night
Sunscreen use
No infant Walker
At nine months?
Drinks from cup/eats appropriate finger foods
Anxiety separation
Sleep disturbances
At 12 months?
Three meals a day plus snacks
Toddler car seat facing forward
Whole milk
Discipline with distraction
At 18 months?
Toilet training
Nightmares
Two years?
Change to bed from crib
Change to 2% milk
Parallel play/sibling rivalry
Three years?
Tricycle
Private parts
Four years?
Swimming lessons
Scissor/pencil use
Imitates peers
Imaginative play
Earliest to begin vitamin D supplementation?
Nine months
