Pediatrics Flashcards
What year of life has most rapid physical growth?
year 1
How does height and weight change in infancy
Ht: increased 50%
Wt: triples
What is infancy
first year of life
Infancy physical development
body proportions change
neuro development of infancy?
progresses central to peripheral
cognitive development in infants
-increase understanding of self and environment
-cause and effect (rattle=sount)
object permanence
strangers
language in infants
cooing 2mo
babbling 6 mo
1-3 words 1 yr
Social and emotional development of infants
Bonding, attachment and trust varied with temperments depending on environment
Rate of physical growth in early childhood
slows, about 1/2 of infancy
growth in spurts
early childhood
1-4 years
physical development in early childhood
walk: 15 mo
run: 2 yr
pedal and jump: 3 yrs
fine motor skills develop
sequence of exam
noninvasive nonthreatening first, painful last
neonatal age
first 28 days of life
When do you asses a newborn
immediately after birth and several hours later
What is APGAR used for
to asses adaption to extrauterine life at 1 min and 5 minutes after birth
-max points is 10, low score indicates medical emergency
what does APGAR stand for
Appearance skin color (blue/gray, acrocyanosis, normal)
Pulse (absent, below, above 100)
Grimace (reflexes)
Activity (muscle activity)- absent, arms/legs flexed, normal
Respiration absent, slow, crying
Ballard Scoring system
determine gestational age to see if size is consistent with dates
What age children should stay in parent’s lap for beginning of exam?
infancy and early childhood
At what age can you ask parents to leave
13, but make sure you get chaperone
how do you distract early childhood patients
simple conversation, engage mom in conversation and exam
what’s most important about assessing adolescents
comfortable and confidentiality
Best clue of illness in child
appearance
goals of observation
- sick or not sick (mood, activity level)
- family integrity (mom-child)
- age in yrs vs. demonstrates
how to measure somatic growth
height, weight, head circumference
compare with normal values, previous readings, patterns
-MEASURE CONSISTENTLY
most common cause of deviant measurement
technical errors
-REPEAT!!!
How do you measure height >2 yo
have patient stand bare foot against the wall with heels, back and shoulders against wall
-make sure head straight forward and midline!!!
how do you measure height <2 yo
supine on measuring board with legs fully extended
Rule of thumb average weight at birth, 1 year, 5 year and 10 year
Birth: 3.5 kg
1 yr: 10 kg
5 yr: 20 kg
10 yr: 30 kg
How do you measure head circumference
paper tape around eyebrows back to occipital prominence, then plot on chart
how long do you measure head circumference
until 2yo
causes of microencephaly
congenital, familial, chromosomal disorders
causes of macroencephaly
subdural hematoma, tumor, familial, hydrocephalus
When do you determine BMI
2 yo
BMI in children with percentils
underweight: 85%
overweight: >95%
infant blood pressure
80/60
preschool BP
90/75
adolescent BP
100/75
diastolic BP in children
60 in infants increases to 75 in childhood
Respirations in newborns
30-60
Respiration in early childhood
20-40
late childhood respiration
15-25
At what age is rectal temperature recommended
<2 mo
What is considered a fever?
rectal >100.4 F, 37 C
head inspection
sutures, symmetry, fontanelles, facies
neck exam
nodes masses mobility nuchal rigidity assess clavicles in newborns
Important eye exam in infants
Gaze, EOM, red reflex, fundoscopic exam
Normal variants for eye in infants
nystagmus for first few days cross gaze for 3 mo edema after birth subconjunctival hemorrhage common pupilllary asymmetry
infant cloudines of cornea
congenital glaucoma
dark light reflex in infants
cataracts
retinopathy of premie
white light reflex in infant
cataract
retinal detachment
chorioretinitis
retinoblastoma
eye exam early childhood
acuity
gaze
late childhood/adolescent eye exam
annual acuity
same exam as adults
infant ear exam
patency
gross hearing
inspect position, size, shape
ear indication of defect
low set, small, deformed may indicated defects
Early childhood ear exam
examine drum
>4yo need acoustic screening
late childhood and adolescent ear exam
same as adult
Nose and paranasal infant exam
patency
nasal septum
which sinuses are only present at birth?
ethmoid
Nasal exam for early/late childhood
inspect nose and mucosa
development of sinuses
Ethmoid: birth
Maxillary 4yo
Sphenoids: 6 yo
Frontal 6-7
by what age do you have all of your sinuses?
6-7
which sinus develops last?
frontal
at age 4 which sinuses do you have?
ethmoid and maxillary
Mouth and pharynx exam
Infant: inspect, palpate and note cry quality
Childhood: inspect uvula, tonsils, teeth, gums, note voice quality and breath odor
Heart exam in children
inspect
palpate
auscultate
Which cyanosis in newborns is normal? abnormal?
acrocyanosis normal
central cyanosis abnormal
what pulses do you evaluate in infants
brachial
femoral
at what age do you take BP
3 yo
PMI in infant
unreliable
normal variant in children heart rhythm
sinus dysrhthmia, common
Which is split S1 or S2
S2
Breasts in newborn children
often enlarged “witch’s milk”
common onset of puberty in breast development
8-13 yo, average of 11
may develop asymmetrically at first
-males can have gynecomastia during puberty
protuberance in newborn
normal
inspecting the umbilical cord in newborns
2 thick wall arteries and 1 large thin walled vein at 12:00
-look for hernias
childhood abdominal exam
inspect
palpate
percuss
What are you asessing for male genitalia exam in newborn and infants
hypospadias, chordee
foreskin not usually retratable
testes in scrotum, hernias, hydroceles
size of the penis in childhood
not important unless enlarged
Male genitalia tanner stages
- prepubertal testes 2mL, no hair
- enlargement of testes >4mL, redenned scrotum, few hairs at base of penis
- lengthening of penis, enlarge to 6-10mL, curly hair across pubes
- broadening of glans penis, growth 10-15mL, small adult hair
Puberty in males onset and termination
onset: 10-13 yrs
complete 14-18
inspection of female genetalia infants
size of clitoris color, size of labia majora (rashes, lesions) urethral orifice and labia minora hymen d/c?
what position do you perform childhood female genital exam
parents lap or knee, chest to examine external structurs, d/c or lesions
NOT IN STIRRUPS
Female Tanner stages
- Prepubertal: no breast tissue or PH
- areolar enlargement with bud, few dark hairs on labia
- single mound areolar, breast with curly ph
- projection of areola, double mound, small adult ph
- adult single contour breast with adult PH
Rectal exam
not apart of routine peds PE
done when intra-abdominal, pelvic or perirectal dz
Two tests done in infants to test for hip sublux
ortolani’s and barlow’s
Ortolani’s
tests for presence of posterior dislocation
-hip, knees flexed at 90 degrees, ABduct both until lateral leg hits exam table
Barlow’s
same position as ortolani’s but tests for ability of unstable hip to sublux
-pul one leg forward and ADduct with a posterior force, no movement means stable hip
Most common congenital foot disorder
club foot
Neuro exam in infants
infantile refleces
childhood neuro exam
modified glassgow
Rooting
stroke perioral skin with hand, infant will turn head twd stimulus, open mouth and suck
when does rooting disappear
3-4 month
When does sucking diappear
10-12 months
when does palmar grasp and plantar grasp disappear
palmar: 3-4 mo
plantar: 6-8 mo
tonic neck (fencing)
turn head and hold head and shoulder down, ipsalateral arm will extned, other will flex
when does fencing diappear
2 months
moro (startle)
support supine and drop about two feet, arms will extend and abduct, hands open, legs flex, cry
when does moro diappear
4 months
when does babinski disappear
2 years
when does stepping reflex diappear
2-6 mo
