Pediatrics Flashcards
what are general s/sx of abuse and neglect in children (3)
frightened/cries when time to go home
sudden unexplained difficulty walking or sitting
injuries that don’t match explanations of changing history
what is physical abuse
intentional bodily/physical injury inflicted upon child, or puts them at harm
what are sx of physical abuse in children (4)
unexplained bruises, lacerations or welts
suspicious patterns of bruising
unexplained fx
unexplained scalding or burns
what is sexual abuse in children
any sexual activity or assisting any other person in sexual activity with a child
what are sx of sexual abuse in a child (6)
unexplained difficulty walking/sitting
unexplained pain in groin
unexplained STIs
pregnancy
behavior or knowledge inappropriate for child’s age
inappropriate sexual contact w other children
what is emotional abuse in children
any behavior that impairs child’s emotional development or self-esteem
what are sx of emotional abuse (5)
delayed or inappropriate emotional development
social withdrawal
non-communicative
avoidance and nervousness
loss of previously acquired skills
what is neglect
failure to provide necessary care
what are sx of neglect in children (6)
poor/improper hygiene
malnutrition/dehydration
poor growth
lack of clothing/supplies
hiding food (to save it)
unsanitary/unsafe living conditions
what is medical abuse
intentional refusal of needed care, giving false info, or insisting on unnecessary care
- do they follow up on POC
- are they going to a lot of medical providers
HR in infants-1yo and where to take it
120-160bpm
brachial a.
HR in 1-10yo
70-120bpm
HR in >10yo (adolescents)
60-100bpm (adult values)
when should respiratory rate be taken in infants and why
observe while awake and calm, or sleeping
crying will change respiratory rate
RR in preterm infants
40-70/min
RR in infants-1yo
24-40/min
RR in 1-3yo
20-30/min
RR in 4-9yo
20-24/min
RR in >10yo
14-20/min (adult values)
when is BP starting to be assessed
3yo
when is BP taken <3yo (4)
only if needed:
- premature
- congenital heart dz
- low birth weight
- ICP issues
usually in inpatient settings
preterm SBP and DBP
SBP: 55-75
DBP: 35-45
infants-1yo SBP and DBP
SBP: 60-90
DBP: 30-60
1-3yo SBP and DBP
SBP: 80-130
DBP: 45-90
> 3yo SBP and DBP
SBP: 90-140
DBP: 50-80
how is temp taken <3mo
digital rectal
how is temp taken 3mo-3yo
rectal or axillary
how is temp taken 4-5yo
oral or axillary
what is a fever in rectal temp
> 100.4 deg F
what is hypothermia in rectal temp
<95 deg F
oral vs axillary vs rectal temp conversions
oral is 0.5F< rectal
axillary 1F < rectal
when does posterior fontanel close
6-8wks
when does anterior fontanel close
12-18mo
what can the fontanel tell you if it is sunk in or bulging
can assess hydration status
- sinking = dehydration
bulging = inc intracranial pressure
from newborn to 6mo, how does head circumference inc
0.6in/mo
from 6mo-1yo, how does head circumference inc
0.2in/mo
what is the avg head circumference at 6mo vs 12mo
6mo = 17in
12mo = 18in
how does wt inc from birth to 6mo
doubles
how does wt inc from 6mo-3yo
inc 4-6lb/yr
how does wt inc from 3-5yo
inc 5lb/yr
how does height inc from birth to 6mo
inc 1in/mo
what is the relevance of the height of child at 2yo
~1/2 of adult final height
from 2-5yo, where is the inc in height see mostly in
LE height
what scale is used for assessing pain in pre-verbal children and what does it look like
FLACC scale
physiologic parameters (HR, BP), crying, facial expressions, and observational parameters
for children older than 4yo, what measure is used to assess the amt of pain child is in
self report scales w faces
- bieri faces pain scale
- wong-baker pain scale
for children >7yo, what assessment(s) are used to measure amt of pain
numeric rating scales
- VAS
- numeric pain intensity scale
what are the categories of the FLACC
Face
Legs
Activity
Cry
Consolability
developmental activity benchmark at 3mo
reaching to grasp toy
developmental activity benchmark at 4mo
rolling from back to side
developmental activity benchmark at 9mo (2)
sitting w/o support
pull to stand
developmental activity benchmark at 12mo (2)
pincer grasp
limited number of clear words
developmental activity benchmark at 2yo (2)
climbing stairs
walking on tip toes
developmental activity benchmark at 3yo (2)
couple word sentences
hopping on one foot
what is a common congenital MSK deformity/issue in children
congenital hip dysplasia
what are common acquired MSK deformities/issues in children (2)
legg calve perthes dz
slipped capital femoral epiphysis
what are 3 sx of slipped capital femoral epiphysis
limp
limited hip flex, IR, ABD
pain from hip down ant to knee
what are 3 risk factors of slipped capital femoral epiphysis
7-12yo
overweight
active
what are 2 delivery issues in children
erb’s palsy (brachial plexus injury)
congenital hip dysplasia
what are s/sx of erb’s palsy in children
difficulty w shoulder movement:
- ant brachium
- delt
- rotator cuff
what are 4 signs in abuse screen of children
bruising
fx
multiple healthcare practitioners
moving around a lot
when is a leg length discrepancy more significant and why
if also limping
- true leg length vs something at hip causing leg length (ie SCFE)
what are head abnormalities that need NM referral (3)
microcephaly
macrocephaly
fontanels change
what are muscle tone changes that need NM referral (3)
tremors
fasciculations
lack of coordination
what are bulbar signs originating from and what are 2 examples
CN9-12
swallowing, clearing throat
what are gait changes that need NM referral (3)
ataxia
hemi gait
(+) Gower’s sign
where can fine motor changes be seen that need NM referral (3)
tremors
handwriting
self care
what are 2 abnormal eye movements that need a NM referral
nystagmus
upward gaze
where will cerebrospinal fluid leak from
ear or nose
what are 6 signs of inc ICP
bulging fontanel
HA
lethargy
projectile vomiting
irritability
distended scalp v.
what are 2 tests and measures for CP screening
breathing pattern assessment
chest deformities
what is a chest deformity seen and what is the significance of this
pectus excavatus
lower sternum dips in
can affect heart function and dec vital capacity if significant enough
what are 4 clinical sx of a congenital heart defect
tachypnea
cyanosis
fatigue
poor circulation
- cold hands/feet, weak pedal pulses
what are signs of GI distress in babies
knees to chest
crying
what are signs of dehydration in babies
sunken fontanels
dry skin/lips
crying w/o tears
turgot test
- on lower arm or abdomen
what is the concern w an infant who has diarrhea
rapid loss of electrolytes and dehydration
what are normal BMs for infants
typically soft, frequent stools
what is GER
reflux, spit up
immaturity in ms tone of GI tract
s/sx of GER in infants
uncomfortable after feeding
not gaining wt or growing regularly
treatment for GER ?
resolves on its own by 12-18mo
what is GERD in infants
chronic form of GER
what is GERD associated with in infants
respiratory issues
what infants is GERD more common in
premies
what is an aggravating factor for GERD in infants
rear facing car seats
what is colic
crying that lasts longer than 3hr/day on >3days/wk, >3wks
will usually pass before official dx
etiology of colic
unknown
- can be affected by GI dysfunciton
why should a cleft lip or palate be treated
affects ability to eat and gain weight effectively
why should an umbilical hernia be addressed soon
colon can enter hernia and get stuck
- tissues can become necrotic
what is the importance of treating UTIs in children
prevent renal injury and scarring
who are more susceptible to UTIs
children w NM disorders
upon integ screen, what may indicate a referral for further assessment
moles >6mm
cafe au lait
hyper pigmented lesions varying from light to dark brown
how common is newborn jaundice
60%
why is newborn jaundice a red flag if detected and undiagnosed
can lead to brain damage if left untreated
- need immediate blood tests to eval serum bilirubin levels
what should be looked for in cafe au lait spots and why
5 spots that are >1/2’’
may mean possible neurofibromatosis
- progress to bone deformities, learning disabilities, elevated bp, tumors on brain/SC
what is juvenile idiopathic arthritis
chronic inflammatory disorder
dx criteria for juvenile idiopathic arthritis
arthritis in 1+ joints for >6wks in <16yo
what tools can be utilized to dx juvenile idiopathic arthritis (7)
WBC count
ESR
Hgb
Hct
urinalysis
RF assay
CRP
what is a common hx for juvenile idiopathic arthritis (6)
of joints involved
small joint involvement
symmetrical involvement
uveitis risk
systemic sx
family hx
treatment for juvenile idiopathic arthritis?
aggressive treatment w new meds shows improved outcomes
- immunosuppressive and biologic side effects to monitor
triage suspected juvenile idiopathic arthritis
yellow flag
- refer back to PCP
