Pediatrics Flashcards
When does the anterior fontanelle close?
2 years
When does the posterior fontanelle close?
2 months
When does the metopic suture begin closing?
2 months
When does the sagittal suture begin closing?
22 months
When does the coronal suture begin closing?
24 months
When does the lamboid suture begin closing?
26 months
Craniosynostosis
- Occurs when one or more sutures closes (fuses) early
- The fusion restricts the growth of the skull
- In order to accommodate the growing the brain, compensatory skull growth occurs across sutures that have not closed
Scaphocephaly
- Closure of the sagittal suture
- Causes elongated head
- Most common cause of craniosynostosis
Brachycephaly
- The head flattens uniformly, causing a wider and shorter shape.
- Increased head height is also common
- Can be positional or a result of closure of the coronal, metopic sutures
Plagiocephaly
- Plagiocephaly means “oblique head”
- It’s called a parallelogram deformity because if you look down on the infant’s head (bird’s-eye-view), this is the shape you will see.
- Misalignment of the ears
- Can be positional or due to unilateral closure of the coronal or lambdoid sutures
Average head circumference at birth?
35cm
How much does the head circumference increase?
- first 3 months
- 3-12 months
- 1 year+
- Head circumference increases 2 cm/month for the first 3 months of life
- Then decreases to 1cm per month from 3-12 mths of age
- After one year growth slows for a total of 10cm for rest of life
How is abnormal head growth defined?
a head circumference greater than 2 standard deviations above or below the mean for a given age, gender and gestation
- either micro or macrocephaly
Microcephaly
2 SD below mean
Macrocephaly
2 SD above mean
Respiratory rate of infant (birth to 1 year)
30-60
Respiratory rate of 1-3 year old
24-40
Respiratory rate of 3-6 year old
22-34
Respiratory rate of 6-12 year old
18-30
Respiratory rate of 12-18 year old
12-16
What are signs of respiratory distress?
- tachypnea
- retractions
- tripod
- grunting
- nasal flaring
- cyanosis
Bronchiolitis
Respiratory Syncytial Virus (most common)
Causes acute respiratory disease in children
“Happy wheezer”- inflammation of the bronchioles
Most common in winter months
Symptoms of Bronchiolitis
Rhinorrhea
Pharyngitis
Cough
Tachypnea
Wheeze
Laryngomalacia
Stridor beginning at birth, up to a week
Collapse of the epiglottis during inspiration
Self-limiting, and no tx unless hypoxic
Inspiratory stridor and with feeding
Aspiration of a foreign object
Common in children under the age of 4
Usually clear cut history of choking
Unwitnessed or no choking, symptoms usually present with:
- Unilateral absence of breath sounds (right side)
- Localized wheezing
- Stridor
- Bloody Sputum
Untreated aspiration could lead to pneumonia
Internal Femoral Torsion
- Patella turns inward and In-toeing
- On exam, gently rotate the patella so that they face forward
- If femoral torsion is the problem the feet suddenly point forward.
Internal Tibia Torsion
- Common 6-18mths
- Patella and feet point directly forward, but in-toeing present
- Worse when they start to walk, but resolves by age 2
Genu Varnum
- Bow legged
- Internal tibia torsion often accompanies physiologic bowed appearance
Spontaneous correction by age 2
What are pathologic causes of Genu Varnum?
Blount disease
Rickets
Skeletal dysplasia
Asymmetric growth
Genu Valgum
- Knock knees
- May occur after genu varnum and/or after the age of 2
- Spontaneously disappear by age 8
- Associate with obese children
What are pathologic causes of Genu Valgum?
Rickets
Post traumatic
Skeletal dysplasia
What is toeing out?
Eversion of legs
Spontaneously corrects 6-12 mths
External rotation of the hips
What is toe walking?
Favor their toes in the early months of walking, prior to developing heal to toe gait
- Intermittent
- At rest will stand flat footed on the floor
What is toe walking associated with?
- cerebral palsy,
- tethered spinal cord
- muscular dystrophy
What are risk factors for developmental hip dysplasia?
Breech positioning at >34 weeks
Family history of dysplasia
Female
First born
Developmental dysplasia?
Abnormal development of the acetabulum and proximal femur leading to mechanical instability of the hip joint
Barlow test
- “dislocation test,” used to discover hip instability
- The thigh is flexed and adducted with gentle downward pressure
- Dislocation is palpable as the femoral head slips out of the acetabulum
- Dx confirmed with Ortolani
Ortolani test
- “reduction test,” used to reduce a recently dislocated hip
- Infant thigh is flexed and abducted and the femoral head is lifted anteriorly toward the acetabulum
- A positive test is a “clunk” or a “click” as the femoral head is reduced into the acetabulum
Galeazzi Sign
- While the infant is supine, Feet are placed together with hips and knees flexed (Use after 3-4 months)
- Uneven knee length is a positive Galeazzi sign
Trendelenburg Pelvic Tilt Test
- Have the patient stand and raise leg, to 90 degrees with knee flexed
- Should be able to hold position
- If unable to hold position or there is a tilt of the pelvis that is a positive sign
Nursemaids Elbow
- Subluxation of the annular ligament of the radial head
- Occurs when there is longitudinal traction on the arm
- The child will present with the arm flexed or at their side with the palm down and refuse to move their arm or reach for items
- Treatment is reduction of the ligament
When should palmar grasp occur?
birth to 3-4 months
When should plantar grasp occur?
Birth to 6-8 months
When should the stepping reflex occur?
Birth to 3 months (variable)
When should the rooting reflex occur?
Birth to 3-4 months
When should the moro reflex occur?
Birth to 4 months
startle reflex
When should the tonic clonic reflex occur?
Birth to 2 months
What are examples of concerning behaviors of a 1 month old baby?
Sucks poorly and feeds slowly
Doesn’t blink when shown a bright light
Doesn’t focus and follow a nearby object moving side to side
Rarely moves arms and legs; seems stiff
Seems excessively loose in the limbs, or floppy
Lower jaw trembles constantly, even when not crying or excited
Doesn’t respond to loud sounds
What are examples of concerning behaviors of a 3 month old baby?
Doesn’t notice her hands by two months
Doesn’t smile at the sound of your voice by two months
Doesn’t follow moving objects with her eyes by two to three months
Doesn’t grasp and hold objects by three months
Doesn’t smile at people by three months
Cannot support her head well at three months
Doesn’t reach for and grasp toys by three to four months
Doesn’t babble by three to four months
Doesn’t bring objects to her mouth by four months
Begins babbling, but doesn’t try to imitate any of your sounds by four months
Doesn’t push down with her legs when her feet are placed on a firm surface by four month
What are examples of concerning behaviors of a 1 year old?
Does not crawl
Drags one side of body while crawling (for over one month)
Cannot stand when supported
Does not search for objects that are hidden while he watches
Says no single words (“mama” or “dada”)
Does not learn to use gestures, such as waving or shaking head
Does not point to objects or pictures
What are examples of concerning behaviors of a 2 year old?
Cannot walk by eighteen months
Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
Does not speak at least fifteen words by eighteen months
Does not use two-word sentences by age two
Does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon) by fifteen months
Does not imitate actions or words by the end of this period
Does not follow simple instructions by age two
Cannot push a wheeled toy by age two
