Pediatrics Flashcards
Voluntary grasp ( no release )
Rolls front to back
5 mo
Sits with no support
7 mo
Voluntary grasp with voluntary release
Waves “ bye- bye”
Plays pat-a-cake
10 mo
Can built tower of 6 cubes
Runs well
2 yr
Age at milestones are reached
Or
Overall patten of development
The overall pattern of development is more important than the age at which individual milestones are reached.
Preventive care measures at pediatric visit;
Height, weight, blood pressure, developmental/ behavioral assessment, and anticipatory guidance!
Screening and preventive care are important part of every encounter with patient.
eg. Mother complains about her child sleeps 11 hours a day! ( 4 yo) . That is normal behavior.
What should you do next?
Give a objective hearing exam , which is routine screening procedure in a 4 yo!
Screening for metabolic and congenial disorders. First month.
All states : hypothyroidism & phenylketonuria
Most states: galactosemia & sickle cell disease
If any is + 1 st step= order A CONFIRMATORY TEST.
Anticipatory guidance for parents:
- keep the water heater < 110-120 * F
- use car restraints
- infant sleeps on his back, to prevent ( SIDS) the most common cause of death in 1-2 mo
- no walkers
- watch small objects
- no cow milk before 1 yo
- introduce solid foods gradually starting at 6 mo
- supervise swimming pools
Head circumference should be measured
At every visit in the first 2 years
First words
Imitates other’s sounds
9-12 mo
Growth curve always low are more benign than
A patient who goes from normal to abnormal curve. That is worrisome!
Failure to thrive is defined as head circumference, height and or weight less than 50 percentile of age.
Due most commonly to psychosocial or functional problems.
Look for signs of neglect/ or child abuse.
Obesity is due to overheating and too little activity ( > 95 % cases)
Less than ( 5%) of cases are due to organic causes (USA)
Cushing’s syndrome , Prader- Willi Syndrome
Abnormal head circumference ;
INCREASED : hydrocephalus or tumor
DECREASED : microcephaly ( from TORCH)
Hearing and vision may be measured objectively at least once by 4 years of age.
After every few years until adulthood
Worried about hearing loss
After MENINGITIS(hearing loss is the most common complication)
With ( TORCH)
With measles or mumps
With chronic middle effusions or chronic otitis media
With ototoxic drugs ( aminoglycosides)
TORCH
Toxoplmosis Other- Syphilis,HIV Rubella Cytomegalovirus Herpes simplex
Red reflex?
Penlight shined at the pupil you usually se red because of the underlying fundus.
If CATARACT or TUMOR the red reflex disappears.. you see
If CATARACT = black
If TUMOR = white -“Leucocoria” ( Retinoblastoma )
Strabismus ( ocular misalignment ) is normal until..
3 mo
After 3 month strabismus should be evaluated by ophthalmologist.
Screening for anemia routine
Once in the first year ( 8-12 mo)
Once between 4-6 years
Once during adolescence
Risk factors for iron deficiency : Should screening with; complete blood count or hemoglobin and hematocrit
- Prematurity
- Low birth weight
- Cow milk before 1 year age.
- low dietary intake
- Low socioeconomic status
Exclusively breast-feed infants do not require supplementation!
All other children should recive IRON
at
4-6 mo
2 mo, in preterm
Screen for LEAD expousure:
High risk ( old buildings, eat paint chips, live near battery recycling plant or parent works there)
Low risk: at 12 mo if normal rescreen at 24 mo.
High risk: at 6 mo if normal, rescreen at 12 mo.
And annually!
First step: stop the expousure!
Most Children do not need fluoride supplements ( Fluor)
Only those that lives in areas were the water is not fluoridated (rare)
Or eat only ready-to-eat formulas ( which use non fluorated water)
Breast-fed infants are more likely to require Vitamin D supplements than formula-fed infants.
True! High risk children;
Exclusively breast-fed beyond 6 mo.
Little sun light expousure or dark skin
All formulas contain Vit. D!
Screen TBC?
Universal screen is not recommended.
Only high risk factors ( HIV/ institutionalization) screen annually!
If the only risk factor is living in an area or immigrant parents,
Screen once between 4-6 yo. And once between 11-16 yo.
Screening children for renal disease, for congenital/ anatomic abnormalities ( vesico ureteral reflux) after ;
Male < 6 yo. Urinary tract infection.
Female < 6 yo. Repeated urinary tract infection.
VOIDING CYSTOURETHROGRAM & RENAL ULTRASOUND!
Vaccination
-PNEUMOCOCCAL VACCINE to sickle cell disease/ splenectomy
-NO MEASLES-MUMPS-RUBELLA OR INFLUENZA VACCINES
for egg-allergic patients
- NO LIVE VACCINES for inmunocompromised!
Sexual active teenaged girls need annual Pap smears and screening for;
Chlamydial and Gonorrhea