Pediatrics Flashcards
What grows in a predictable pattern? Children’s…
a) growth
b) behaviour
c) both
c) both
What is a primary goal during pediatric assessment?
increase comfort as much as possible
What is the first step in a pediatric assessment?
observation
very important***
General Considerations for Infant Assessment
goal: establishing trust
parent should be present, in full view
young infant: place infant in supine on table, or parent’s chest
older infant: as much in parent’s lap
1-2 hours after the infant is fed
don’t have to be in clothes
warmth, eye contact, smile
How to sequence infant assessment
least distressing steps first
FIRST: heart, lung, abdominal sounds
LAST: eye, ear, nose, throat, Moro/startle reflex
General Considerations for Toddler Assessment
goal: developing autonomy
greet child and parent, but focus more on parent initially
position: parent’s lap
dislike being restrained
get parent to help you hold child still
security object - blanket, toy
wearing clothes for as much as possible
How to sequence toddler assessment
Some objective data as you collect the history
Begin with “game” - e.g. cranial nerve testing
Start with non threatening areas
LAST: eye, ear, nose, throat
What is the best way to pose a question to a toddler?
a) Can I listen to your heart?
b) Would you like me to listen to your heart or tummy first?
b) Would you like me to listen to your heart or tummy first?
give limited options
do not offer a choice when there is none - child will respond “no”
General Considerations for Preschool Assessment
goal: developing initiative
Position:
parent present, may be on parent’s lap
older - on table, with parent present
can talk - use simple, short explanations
leave clothes on
offer limited options
have them help you
use games
feedback, reassurance
How to sequence preschool assessment
FIRST: thorax, abdomen, extremities, and genitalia
LAST: head, eye, ear, nose, and throat
General Considerations for School-Age Assessment
goal: developing industry
developing social competence, desiring approval
Position:
sitting on exam table
decide whether parent, sibling should be present
small talk
undress on their own, drape
demonstrate equipment
How to sequence school-age assessment
head-to-toe
same as adult
General Considerations for Adolescent Assessment
goal: self-identity
PRIVACY
self-conscious, introspective
peer values and acceptance
sitting on exam table, NO parents
feedback - body is healthy and developing normally, wide variation
treat them like a teenager - not a child, not an adult
health teaching
How to sequence adolescent assessment
head-to-toe
genitalia last, quickly
Signs of Child Abuse (4)
1) child avoids eye contact
2) no separation anxiety, expected for age
3) parent disgusting by child’s odour, sounds, drooling, stools
4) deprivation of physical or emotional care
What is the best indicator of a child’s general health?
physical growth
Concerning aspects of growth (4)
1) below 5th, above 95th percentile with no genetic explanation
2) wide percentile difference between height and weight
3) steady growth then stops
4) no growth spurts during infancy, adolescence
Order of vitals in infants
REVERSE order
respiration –> pulse –> temperature (may have to take rectally)
Infants and young children have _____ variations in normal temperature
a) narrower
b) wider
b) wider
a result of less effective heat control mechanisms
Children get higher fevers up to _____°C
40.5°C
Assessing pain in child
assess subjectively and objectively
non-verbal behaviours
vital signs (changes from baseline)
Wong-Baker Faces Scale
other paediatric pain scales as appropriate
Landmark for infant and toddler pulse
apical pulse (chest)
4th intercostal space
FULL minute
Is sinus arrhythmia normal in children and adolescents?
yes
What is an especially important indicator during a pediatric cardiovascular assessment
cap refill
< 3 seconds
What is an important indicator of hydration status in children?
mucous membranes
children can become dehydrated very easily*
When assessing an infant’s respirations, where should you watch?
abdomen
do more diaphragmatic breathing
FULL minute
Examples of respiratory distress in children
nasal flaring
head bobbing
tracheal tug
clavicular indrawing
During an assessment of a newborn, you note that they have a lusty cry. What should your next step be?
a) document and proceed with the rest of the assessment
b) notify the physician
a) document and proceed with the rest of the assessment
normal
cry full of strength and energy
Bad kind of cry
hypertonic
high-pitched, don’t settle easily, e.g. withdrawal
When does the anterior fontanelle close?
12 - 18 months
When does the posterior fontanelle close?
2 - 3 months
Which of the following fontanelle characteristics is normal?
a) tense
b) sunken
c) soft
d) firm
c) soft
and flat
anything else = bad
Infant measurements to take (4)
1) weight (without diaper)
2) length
3) head circumference
4) chest circumference
1st year of life: head = chest circumference
Moro/Startle Reflex
hold baby, support neck, kinda drop them quickly
startled look
arms will fling out sideways with the palms up and the thumbs flexed
until 4 months
Rooting Reflex
tickle cheek
head should turn to the side that you tickle
up to 4 months
Sucking Reflex
with gloved hand, should suck finger
up to 12 months
Palmer Grasp Reflex
will wrap hands around finger
up to 4 months
Tonic Neck Reflex
baby supine, relaxed, or sleeping, turn the head to one side with the chin over the shoulder
note ipsilateral extension of the arm and leg, and flexion of the opposite arm and leg
up to 6 months
Babinski Reflex
bottom of foot
toes should splay out
up until 24 months
Stepping Reflex
hold infant upright under the arms, with the feet on a flat surface
note regular alternating steps
disappears before voluntary walking begins
When examining the ear in the children, pull the pinna
a) up
b) down and back
b) down and back
