Pediatric preventative care

Question 1

Newborn evaluation

Answer 1

Promote breastfeeding
History including pregnancy histories, labor and delivery
Length height weight head circumference
Sensory screening (vision if at risk, hearing always)
Milestones

Question 2

When to get bp at newborn screening

Answer 2

Premature
Vlbw
Congenital heart disease
Urinary or renal problems

Question 3

Apgars

Answer 3

1 minutes for intrauterine environment and birth process

5 minutes for success at transitioning

Score >/=7 ok

Question 4

Newborn screenings

Answer 4

PKU
Congenital hypothyroidism
Hemoglobinopathoes
Galactisemia

Pulse ox for congenital heart defect after 24 hours and before hospital discharge

Question 5

Frequency of visits

Answer 5

1-2 weeks
1, 2, 4, 6, 9, 12, 15, 18, 24 months

Annually from age 3-10

Question 6

Growth measurement frequency

Answer 6

Length 
weight 
head circumference 
weight for length 
Through 18 months 

Then just weight and height

BMI starting at age 2

Question 7

Sensory screening frequency

Answer 7

Visual: 3-8, 10, 12, 15, 18

Hearing: 4-6, 8, 10 and then if at risk

Question 8

Autism screening

Answer 8

18 and 24 months

Using validated instruments eg M-CHAT-R

Question 9

2 wk milestones

Answer 9

Gross motor:
Side to side head movement

Fine (visual) motor:
Follow with eyes to midline only, tightly fisted hands

Language:
Startles with noise

Social:
Fixes on faces

Question 10

2 mo milestones

Answer 10

Gross motor:
Lift shoulder/head in prime position

Fine (visual) motor:
Follows object or tracks past midline

Language:
Coos

Social:
Smiles. Recognizes parents

Question 11

4 mo milestones

Answer 11

Gross motor:
Lifts on hands in prone position
Rolls front to back
Good head control

Fine (visual) motor:
Reaches for and grasps object

Language:
Laughs, squeals

Social:
Looks at hands, begins to interact

Question 12

6 mo milestones

Answer 12

Gross motor:
Sits alone but may need support

Fine (visual) motor:
Transfers objects from hand to hand
Feeds self

Language:
Babbles

Social:
Recognizes unfamiliar persons

Question 13

9 mo milestones

Answer 13

Gross motor:
Sits without support, crawls, pulls to stand

Fine (visual) motor:
Pincer grasp

Language:
Nonspecific mama and dada

Social:
Waves bye, stranger anxiety

Question 14

12 mo milestones

Answer 14

Gross motor:
Cruises, stands alone, may walk

Fine (visual) motor:
Can release items, drinks from cup

Language:
Specific use of mama and dada, one to four other words

Social:
Imitates, cooperates

Question 15

15 mo milestones

Answer 15

Gross motor:
Walks well including backward

Fine (visual) motor:
Stacks two blocks, uses spoon

Language:
Up to six words

Social:
Follows commands

Question 16

18 month milestones

Answer 16

Gross motor:
Runs

Fine (visual) motor:
Stacks four blocks

Language:
10-25 words usually, at least 6

Social:
Removes garment, uses words to communicate

Question 17

2 yr milestones

Answer 17

Gross motor:
Walks up and down stairs without assistance, kicks ball

Fine (visual) motor:
Stacks six blocks, copies a straight line

Language:
Two and three word phrases, 50% of speech understandable to stranger

Social:
Parallel play

Question 18

3 yr milestones

Answer 18

Gross motor:
Pedals tricycle and broad jumps

Fine (visual) motor:
Copies circle, stacks 8 blocks

Language:
75% understandable to stranger

Social:
Group play
Knows age and gender

Question 19

4 year milestones

Answer 19

Gross motor:
Balanced and good on one foot

Fine (visual) motor:
Copies cross, draws person with three parts

Language:
Speech understandable to strangers

Social:
Brushes teeth without help, dresses self

Question 20

5 year milestones

Answer 20

Gross motor:
Skips

Fine (visual) motor:
Draws a person with six body parts

Language:
Counts, asks meaning of words

Social:
Names four colors
Understands rules

Question 21

6 year milestones

Answer 21

Gross motor:
Rides a bike
Balances on each foot for 6 seconds

Fine (visual) motor:
Writes name

Language:
Defines words

Social:
Knows colors, knows right and left

Question 22

Apgar scores

Answer 22

Give 0, 1, or 2 points

Heart rate: absent, <100, >100

Respiratory effort: absent, weak irregular cry, string cry

Color: pale/cyanosis, extremities cyanotic, pink

Muscle tone: absent, weak slightly flexed extremities, active

Reflex irritability: absent, grimace, active cry and avoidance

Question 23

Bo screening

Answer 23

Start at 3 years

Question 24

Anemia screening

Answer 24

12 months and at discretion for high-risk infants

Question 25

Lead screening

Answer 25

12 months or as dictated by risk

Question 26

Tb screening

Answer 26

Did josh rush patients periodically and then annually

Those with known contact or housemate with tb, hiv infection, illicit drug use, or in a high tb prevalent area

Question 27

Oral health pedi

Answer 27

Counsel against bottle pricing feeding and taking bottles to bed

Fl at 6 mo if needed

Start brushing teeth at 6 mo

Wean to cup by 12 months

Question 28

Adolescent growth

Answer 28

Take height, weight, BMI

Counsel on diet and exercise

If BMI over 85th percentile counsel in weight loss

Screen for eating disorders starting in middle school

Question 29

Phq-2

Answer 29

Over the past two weeks how often have you been bothered by any of the following problems?

1: little interest or pleasure in doing things
2: feeling down, depressed, or hopeless

Scoring:
0 = not at all
1 = several days
2= more than half the days
3= nearly every day

Question 30

Screenings during adolescence

Answer 30

Alcohol and drug use
Depression
Eating disorders 
Bp
Anemia if needed
Tb if needed
Lipid once between 18-21
HIV between 16-18
Chlamydia and gonorrhea annually for sexually active 
Syphilis if high risk