Pediatrics Flashcards
What are the cues indicate that a new board is not be fed enough?
HUNGRY
H- Hypoglycemia- characterized by protracted, high-pitched cry, jitteriness, seizures
U- unsatisfied nursing, feeding more frequently than every two hours with hunger cues
N- not waking for feeding every 2 to 3 hours, not latching appropriately (especially if latched appropriately in the past), limpness, lethargy, findings indicate low blood sugar, dehydration, or electrolyte disorder
G- growth or weight loss greater than 7% at any given time, especially outside the first week of life, which increases the risk of neonatal jaundice in hypernatremia
R- reduce number in frequency of wet and or soil diapers, especially if no wet diapers for more than six hours, dry, Brit, colored stools, especially if a newborn has evidence of a dry mouth or crying without tears
Y- yellowing of the skin and eyes, indicating hyper bilirubinemia and jaundice, noted, particularly in the first few weeks of life when feeding and fluid intake are in adequate.
When should we be concerned about weight loss or growth in a newborn?
7% weight loss or close
How often should a newborn feed regardless, if their breast or formula, fed
Every 2 to 3 hours
What are the risks of underfeeding a newborn
Jaundice
Dehydration
Hypernatremia
At what age should solid foods be introduced to infants
No sooner than 4 to 6 months of age
What is considered the neonatal period?
Birth to 28 days
How much growth should occur in the neonate period
 Two or more pounds and grows about 1 to 1.5 inches in length.
How much fluid should you instruct a breast-feeding mother to drink with each feeding?
16 ounces of water
When does the transformation from colostrum to mature breastmilk occur?
2 to 5 days after birth
What are some signs of an inappropriate latch when breast-feeding?
 Dimpling of the babies cheeks, and or clicking noise with attempts at suck and swallow 
What does inappropriate latch look like in breast-feeding?
The babies, chin and stomach should be comfortably resting against the mothers, body, babies, mouth, wide open, the lips flange at work, and the areola, minimally visible
Your mother should be able to hear the baby swallowing and see the babies ears move slightly with each suck and swallow 
When does physiologic jaundice typically start? And what causes it?
Usually starts 3 to 5 days of life or within the first few weeks. A result of normal breakdown of fetal, hemoglobin, immature, liver, metabolism.
No underlying liver disease is involved in this condition
In adequate feedings can trigger this response
How does physiologic jaundice usually spread?
From the head, then spreads to the body
How much of a drug does does a breast-fed baby get from the mother?
One percent or less
What antibiotics are considered safe during breast-feeding?
Beta lactam, such as penicillin in cephalosporins
If a mother takes a problematic drug that is harmful to the infant how should she proceed?
Pump and dump for at least 3 to 5 half-life of the medication
What two substances pass easily into the breast, milk and reduce milk supply
Nicotine and EtOH
What is the recommended feeding frequency during the first and second months of life
Breast-feeding: a minimum of 10 minutes on each breast every one and a half to three hours
Bottle-fed: 2 to 3 ounces every 2 to 3 hours
What supplement is recommended for breast fed in infants?
Fluoride
What supplement is recommended for breast-fed infants? And at what age do they speak in?
Iron supplementation
Begin at four months of age
Dose 1 mg per kilogram
What are some signs that an infant is ready for solid food?
Double their birth weight, and at least 4 to 6 months of age
Taking more than 32 ounces of formula per day, or more than 8 to 10 feedings per day
Describe the Moro reflex, when it should be present in when it should dissipate
Set an loud noise, causes also known as startle reflex: symmetric, abduction, and extension of the arms, followed by adduction in flexion of the arms over the body
Present at birth
Should disappear by 3 to 4 months of age
A strong moro reflects in an infant older than six months of age is indicative of what
Brain damage
Describe the tonic neck reflects
A.k.a. fencing, reflex: Turning head to one side with a jar over shoulder, causes the arm and leg on that same side to extend the arm and leg on the opposite side will flex
What is the Moro reflex is absent on one side?
Rule out brachial, plexus injury, fracture, or shoulder dystocia
What is the Moro reflex is absent on both sides?
Rule out a spinal cord or brain lesion
What is the rooting reflex? When is it present? And when should it disappear? should it disappear?
Stroking the corner of a a baby’s mouth causes the baby to turn towards the stimulus and suck
Should disappear by 3 to 4 months
What is the step reflects? When is it present? And when should it disappear?
When, holding the baby upright, allow the dorsal surface of the foot to touch the edge of the table. Baby will flex the hip and knee and placed the simulated foot on the table top in a stepping motion.
Should disappear by six weeks
When is the stepping reflects absent?
In breech births
Paresis
What are the primitive reflexes?
Tonic neck
Palmar grasp
Babinski
Routing, awake, and asleep
Sucking
What are the anticipated, developmental milestones at one to two months?
Lifts head with TWO arms
Responds TWO sounds
Smiles when smiled Two
Regards face
Follows objects in visual field
Moro and palmar grasp reflex receding
Social smile
Recognize his parents
Pneumonic: at two months, the baby has two eyes and two arms they can hold themselves up and see follow and recognize their parents
What are the anticipated, developmental milestones for a four month old?
Reaches FOR objects
Smiles FOR fun
Grasps cube
Brings objects to mouth
Makes raspberry sounds
Laughs, squeals, vocalizes in response to others
Recognizes food by sight
Rolls back to side
Imitates others
Repeat, interesting actions 
Pneumonic:
Reaches FOUR things, holds a FOUR sided cube. I like raspberries in my wine but by my FOURTH glass I’m laughing, squealing, playing charades,
, and looking for food. Then I roll from my back to side all night.
At what age is stranger in separation anxiety begin
Six months
When should a child be able to sit without support?
6-8months
When should a child be able to transfer objects from hand to hand?
6-8 months
When should a child be able to roll back to stomach and stomach to back?
6-8 months
When should a child be able to babble things like mama papa?
6-8 months
Pneumonic: mama, papa= 8 letters
When does a child begin to recognize the word no
6-8 months
Pneumonic: sideways 8 looks like NOO
What should a child be doing at 9 to 11 months?
Crawling
Stands initially holding onto furniture and then independently
Imitates, peekaboo, and Patticake
Picks up small object with thumb and finger
Follow simple commands
Connects meaning to words like mama Papa
Pneumonic: 11
Stand tall like an 11
11 looks like tweezers for pincher grasp
11 two hands to play pat-a-cake
11 letters in “understands”
When should a child scoop of small objects with rake grip
Six months
Pneumonic: there are six prongs on a rake
What should a child be able to do developmentally at age 12 to 15 months?
Walk with help then solo
Pincher grasp fully developed
Can place a cube in a cup
Hands over objects on request
Build a tower of two bricks
Says one to two words
Indicates once by pointing
Scribble spontaneously
Imitates animal sounds
Pneumonic: think of playing corn coffee with Coop. He could put the corn in the bowl hand it back to me, say corn coffee, which is two words.
What period of time is considered infancy
The first year of life
What period of time is considered a toddler
1-2 yo
What period of time is considered preschool age
3-4 years
What period of time is considered school-age
5 to 12 years
What is the vision range for a newborn?
8 to 12 inches. Think of distance from baby to mothers face while breast-feeding.
Is a bluish scleral tint normal in a newborn? If so, when is it abnormal?
Bluish clear all tent is normal in the first months of life
If it persist, it could be a sign of osteogenesis imperfecta
Other than loud noise, what can trigger the startle reflex in a newborn?
Bright lights
What is considered a term pregnancy?
37 to 41 weeks +6 days in duration
When does the rooting reflex disappear?
6 to 12 months
When should the Moro reflex disappear?
By 16 weeks
When should the palmar grasp disappear?
2-3 months
When should the Babinski reflex disappear?
By six months
When is a baby’s hearing typically checked
Prior to discharge from the hospital
What should the provider recommend regarding tummy time?
Start tummy time immediately after birth building absolutely to a total of 30 minutes a day until the child can roll tummy to back and back to tummy- this should occur around six months of age
When should a newborn be back to its original birth weight
By 3 to 4 weeks of age
What type of jaundice is typically seen in a newborn less than 24 hours old?
Pathologic
When should phototherapy be initiated for a child with pathologic jaundice?
If total serum bilirubin is greater than 25
When does chlamydial conjunctivitis typically appear and what is the most common symptom?
5 to 14 days post exposure
Chemosis (conjunctival edema) is the most common symptom
What developmental milestones are expected in an 18 month old
Think of an 18-year-old
Says no like an 18 year old
Can copy things adults do like an 18-year-old
Speaks and single word sentences like an 18-year-old
What developmental milestones are expected in a two-year-old
Speaks in TWO word sentences
Follows TWO word
Build a TWO block tower
Can walk up to the second floor with help
What are the expected developmental milestones of a three year old
Build a three block tower
Rides a three wheeled bike
Draws a circle like a three ring circus
What developmental milestones are expected of a four-year-old
Build a FOUR block tower
SPEAKS IN FOUR word sentences
Can draw a cross with four points
When should 100% of a toddler speech be recognizable by strangers?
3 to four years