Pediatric Well Visits

Question 1

Describe ROWS. What do you measure?

Answer 1

Length/Height and Weight
Head Circumference
Weight for Length
Body Mass Index
Blood Pressure
BMI starts at 2 yo

Question 2

Sensory screening or developmental/behavioral assessment with ROWS?

Answer 2

Sensory Screening:
Vision
Hearing
Developmental/Behavioral Assessment:
Developmental Screening
Autism Screening
Developmental Surveillance
Psychosocial/Behavioral Assessment
Alcohol and Drug Use Assessment
Depression Screening

Question 3

When are newborns screened for the 1st & 2nd time?

Answer 3

1st time in the hospital

2nd time at 2 weeks.

Question 4

Procedures in ROWs?

Answer 4

Newborn Blood Screening
Critical Congenital Heart Defect Screening
Immunization
Hematocrit or Hemoglobin
Lead Screening
Tuberculosis Testing
Dyslipidemia Screening
STI/HIV Screening
Cervical Dysplasia Screening

Question 5

WHen should you have your first oral health exam?

Answer 5

by 1 year of age.

Question 6

What is the screening test for ADHD?

Answer 6

Vanderbilt/Conners

Question 7

What is considered overweight or obese for children?

Answer 7

overweight>85%

obese>95%

Question 8

What is considered hypertensive?

Answer 8

Normal 95%

Question 9

50% of kids are Vit D deficient. When?

Answer 9

breastfed

400 IU Vit D/day recommend.

Question 10

Is there fluoride in the Reno water?

Answer 10

No

Question 11

First vaccine a baby receives in the hospital?

Answer 11

Hep B

Question 12

What are some good nutrition recommendations?

Answer 12

low fat or non fat dairy
more fish
5 fruits & vegetables
whole grains
no sugary beverages
reduce salt intake

Question 13

When can kids start taking solid food?

Answer 13

after 6 months

Question 14

When can kids eat meats & finger foods? Table foods?

Answer 14

9 months–meats, finger food

12 months–table foods

Question 15

How much physical activity should kids get per day?

Answer 15

1 hour of vigorous activity

Question 16

How much screen time is recommended per day?

Answer 16

1-2 hours limit

Question 17

How much should kids sleep per night?

Answer 17

ideally 11 hours/night

Question 18

What is some important safety counseling for kids?

Answer 18

firearm safety
sports safety
traffic safety
water safety

Question 19

What are we worried about the physical exam of a newborn?

Answer 19

1. weight
2. skin–look for jaundice
3. cardiac exam
4. hips
5. umbilicus
6. take care of mom & counsel about stuff
7. cord care

Question 20

What should you think about at 2 weeks old?

Answer 20

should have regained birth weight by this time
GERD
6 wo hip ultrasound if born breech.

Question 21

What do we talk about at 2 months?

Answer 21

tummy time
no solid foods
no propping bottles
look for strabismus: refer by 6 mo if hasn't corrected
check hips
other safety talks
look for smiles
immunizations
vitamin D

Question 22

4 mo check up?

Answer 22

Smiles spontaneously, self-consolation, babbles, rolling over, lifts head/chest, reaches for toys & brings to mouth, no head lag when pulled to sitting, laughs
Quiet and active playtime
Hip time/check folds
Injury prevention
Teething

Question 23

6 mo check up?

Answer 23

Socially interactive with parent, recognizes familiar faces, knows name, visual/oral exploration, sits with support/stands and bounces, may crawl, transfers objects hand to hand, pincer grasp (fine motor)
Start use of high chair/upright seat. DO NOT use a walker.
Reciprocal play
May introduce solids at 6 months
Start cereal, baby foods stage 1. Spoon ONLY (not in a bottle)
One new food per week. Finger foods should be soft. No citric acid products, no whole milk, avoid nuts
Review choking hazards
Solids do not replace breast milk/formula needs.
Begin cup use. Limit juice. May now have water.
Assess for fluoride, clean teeth with wet washcloth or finger brush

Question 24

9 mo check up?

Answer 24

Stranger Danger, separation anxiety, responds to name, waves bye-bye, mama/dada babble, points to objects, interactive games (peek-a-boo, pat-a-cake), exploring environment: crawling/cruising, pulls self up
Use consistent, positive discipline (limit use of the word “no”)
Strangulation/fall risks (stairs, gates, cords from drapes/blinds)
Play with cause-and-effect toys
3 meals, 2 -3 snacks daily, decrease BM/formula
Encourage use of cup
*Put Poison Control number at each telephone

Question 25

What happens at 12 mo?

Answer 25

Interactive games, imitates activities, waves “bye-bye,” speaks 1-2 words, follows simple directions, stands alone, may walk Discipline with time-outs and positive distractions Continue 1 nap per day Establish teeth brushing routine Encourage self-feeding Whole milk! (16-24oz/daily) And mostly table foods. Juice less than 8 oz/day Baby decides quantity of food/parents choose types of food Visit dentist by 12 months or after first tooth Offer only water if still using a bottle/discontinue bottle use Remove guns from home Rear-facing car seat until 2 years per AAP recommendations/1 year AND 20 lbs by law (and even longer if possible!) Check CBC or H/H 9-12 months old (AAP), check lead if at risk

Question 26

15 months old?

Answer 26

Listens to a story, may help in house, brings objects to show, says 2-3 works, scribbles, can walk backwards, climbs stairs, 3 block tower, drinks from cup Check for any speech delay Allow child to choose between 2 acceptable options Consistent bedtime routine Do not give bottle in bed Praise good behavior Injury prevention

Question 27

18 months old?

Answer 27

Laughs in response to others, explores alone, speaks 6-10 words, 4 cube tower, points to 1 body part, walks up steps/runs, stacks 2-3 blocks, uses spoon/cup without spilling MCHAT (18-24 months) autism screen Support emerging independence but reinforce limits Encourage language development by reading and singing Toilet training: wait until child is ready (dry for periods of about 2 hours, knows wet and dry, can pull pants up/down, can indicate bowel movement)

Question 28

2 years?

Answer 28

Imitates adults, refers to self as “I” or “me,” has at least 50 words, uses 2 word phrases, follows 2 step commands, stacks 5-6 blocks, imitates horizontal and circular strokes with crayon, jumps, runs well, throws/catches, 7 cubes Read together daily Encourage interactive play with other children Encourage self-expression Plan for frequent toilet breaks (up to 10 times/daily) Change to 2% milk Check cholesterol screen if + Fam hx/risk factoss Check for obesity with BMI! PLOT it!! Temper tantrums

Question 29

3 years?

Answer 29

``` Feeds self, sentences, jumps in place, balances on one foot, counts 3 objects. Start yearly vision/hearing screen Check growth/nutrition 75% speech comprehended Start BP checks annually ```

Question 30

4 years?

Answer 30

100% speech comprehension, sings, talks about experiences, hops, pedals tricycle Counting/ABCs/Coloring Check vision/hearing Inappropriate touch counseling

Question 31

5 years?

Answer 31

Skips, balances well, copies figures, dresses self, defines words, sense of “right and wrong” Increased strength and coordination

Question 32

Adolescents?

Answer 32

``` CRAFFT screen/HEADSS Menarche/family planning/STD (esp chlamydia) No pap needed Tanner staging Confidentiality issues ```

Question 33

What does HEADSS stand for?

Answer 33

``` Home & Environment Education & Employment Activities Drugs Sexuality Suicide/Depression ```

Question 34

Which are the first teeth to peek out?

Answer 34

lower incisors

Question 35

What are the most effective ways to talk to parents about vaccines who are hesitant?

Answer 35

Talk about Side Effects & be honest, but emphasize that autism isn't one of them. talk about benefits directly to the child, rather than society use anecdotes, rather than numbers.

Question 36

Thimerosal is a preservative in very few vaccines, none of which are used in children under 6...what are parents worried about?

Answer 36

mercury but prob not dangerous not even used anymore

Question 37

Is it a problem to use multiple vaccines in a child?

Answer 37

NO