Pediatrics/Growth and Development Flashcards
Hep B schedule
#1 - Birth #2 - 1-2 months - at least one month after first dose #3 - Age 6 months - but at least 2 months after 2nd dose
Tdap for adolescents
Tdap booster Age 11-12
Hib vaccine - when do you no longer give?
after 5 years of age
When is it okay to give live vaccines?
after 1 year of age
When do you give the MCV4 booster
Age 16
What is appropriate spacing for vaccines?
4 days prior is okay, any earlier is invalid and must be repeated.
ADHD characterized by
Hyperactivity
Impulsivity
Inattention
What is a common assessment scale for ADHD
Connors’ - Long and short form
Asthma tx in 0-4 year olds
Use Nebulizer!
Inhaled corticosteroids (only one approved for young children is budesonide)
SABA - albuterol
leukotrine receprot agonist - montelukast
Asthma tx in 5-11 year olds
Can use inhaler as appropriate
Inhaled corticosteroids (fluticasone, budesonide)
SABA - albuterol
leukotrine receprot agonist - montelukast
What type of pneumonia is common in children under 5?
viral, treat empirically
What is the most sensitive sign of pneumonia in children?
Increased resp
Sx RSV
URI 1-3 days which progresses to lower resp tract infection Paroxysmal wheezing Increased RR 40-60 Fever Cough Thick purulent nasal secretions
What is the most common organism for croup?
Parainfluenza types 1,2,3
Adenovirus
Influenza virus
Westley Croup score
Mild disease (can keep with PCP) - barking cough, hoarse cry, no stridor at rest Moderate (ER) - Stridor at rest, mild retractions, sx resp distress Severe (ER) - Significant stridor at rest, retractions are severe.
Tx mild croup
Hydration, cool mist, antipyretics
Single dose of dexamethasone
Organism with epiglottitis
Hib
Cystic fibrosis
Mutation of chromosome 7
Enlarged nodes “rules”
10mm is enlarged unless…
Epitrochlear - >5mm
Inguinal - > 15mm
Cervical - > 20mm
Criteria for febrile seizures
Temp >38C Age < 6yo Absence of CNS infection No metabolic abnormality No hx of febrile seizures
Pyloric stenosis sx
3-6 week old male with projectile vomiting
Olive like mass better palpated after vomiting
GER
frequent regergitation in the absence of pathology
Resolves before 1 year of age
Place supine to sleep
Red flags with reflux in infants
GI bleeding Refusal to feed Forceful vomiting Constipation/Diarrhea Abd tenderness Fever
Intussusception
Vast majoity under 2 yo
Sausage like mass
Classing child crys and pulls legs up to chest
Dx Intussusception
KUB, Abd US
Intussusception classic triad
Intermittant colicky abd pain, vomit, bloody mucus stool (currant jelly)
Encopresis
Involuntary stooling over 4 yo. More common in males. Constipation often underlying problem.
Replacement mild dehydration
5 tsp per pound over 4 hours
Replacement moderate dehydration
10 tsp per pound over 4 hours
Cryptorchifism
testes not in scrotum and can’t be manupulated there (usually found in infants)
Retractile testes
Move between scrotum and inguinal ring (5-6 yo)
When do you refer with undecended testes?
6 months
Most common cause of UTI in children
bowel and bladder dysfunction
What test for first fibrile UTI
renal and bladder ultrasound for all infants 2-24 months
Dx Kawasaki’s disease
Fever for 5 days with (4 of 5): Bilat cunjunctival injection without excudate Polymorphus rash Inflamm changes of lips or oral cavity Changes in extremities Cervical lymphadanopathy
Dx studies with Kawsaki disease
CBC, ESR, CRP, ALT/`AST, UA throat culture
Osgood schlatter disease
Osteochondritis on tibial tubercle
Common cause of adolesant knee pain
More common in athletes
Sx Osgood schlater disease
Swelling affected knee
Bilat symptoms
Prominent tibial tubercle
Trendelenberg sign
Standing on affected side causes pelvic tilt. POsitive in SCFE, Legg-Calve Pertes, ansd Dev Dysplasia
Roseola
Human Herpesvirus 6
Fifth Disease
Parvovirus B19
Rubella
Rubella virus
Rubeola (measles)
Rubeola virus
Chicken pox
Herpes virus
Hermangina
Coxsackie A virus
Hand Foot and mouth disease
Coxsackie virus A16
Measles
Maculopapular brick red rash. Starts on the head and neck and then spreads to trunk and extremities
Fifth disease (Erythema infectiosum)
Slapped cheek rash. Lacy macular rash
Rubella
Maculopapular rash. Looks like measles rask. Remarkable lymphadonopathy, macules on soft palate
Roseola (exanthem subitum)
High fever for 2-4 days then abrupt cessation of fever with appearance of maculopapular rash but not on the face
Chicken pox
vesicular lesions on erythematous case appearing in crops
What are the 3 C’s in Rubeola?
conjunctivitis, coryza, cough
Koplik’s spots
Resemble grains of sand on the oral mucosa and precede rash. Common with measles (rubeola)
When should you have post-partal visit?
2-3 days after birth
Milia
What papules on the nose and cheeks
Mongolian spots
Congenital with indefinite borders. Buttocks and base of spine. Pred. in AA and Asian infants.
Nevus simplex
Stork bite. pink red capillary on face or neck
Nevus flammeus
Port wine stain anywhere on malformation body
Anterior fontanelle closes?
9-12 months
Posterior fontanelle closes?
2 months
Hypertelorism
eyes spaced far apart
When should red reflex be present?
bilat at birth
Normal resp infant
40-60 breaths/min
Murmurs in infants
almost universal
Deep sacral dimples, hemangioma, discoloration of sacrococcygeal area, can indicate
neural tube defect
When finger foods?
8-10 months
Iron needs infant
1mg/kg/day
When start floride baby?
6 months
Who needs vit D
Exclusively breastfed babies
Eye eval newborn-3months
red reflex, inspection
Eye eval 0 3-6 mo
fix and follow, red reflex, inspection
Eye eval - 6-12 months
fix and follow each eye, corneal light reflex, red reflex, inspection
Eye eval > 3 years
visual acuity, corneal light reflex, cover/uncover, red reflex, inspection, attempt ophthalmology
What does the cover/uncover test check for?
Stabismus
Normal HR infant
120-160 with marked sinus arrhythmia
Normal HR 3 yo
80-120
Normal HR 6 yo
70-110
When BP screening children
3yo
Kernicterus
What happens to the infants brain with increased bilirubin. Deposits in brain leading to delay and damage.
POsitive galeizzi test indicates?
hip dysplasia
What is considered scoliosis
> 10 degree curvature
Female Turner stage 1
Prepubertal. Papilla elevated above chest wall.
Female Tanner stage 2
Breast bud stage (8-13yo) Breast and papilla form small mound, areola increases in diameter.
Female Tanner stage 3
Breast and areola enlarge. No seperation of contours
Female Tanner stage 4
Secondary mound formed by areola and papella at level of breast
Female Tanner stage 5
Adult breasts
Male Tanner Stage 1
testes 1cm, scrotum and penis are size seen early childhood
Male Tanner Stage 2
Slight enlargement of testes 2-3cm, scrotum becomes reddened and textured
Male Tanner Stage 3
Further testicular growth (3-4cm) slight enlargement of penis
Male Tanner Stage 4
Penis enlarges in length and diameter. Testes enlarge 4-5cm
Male Tanner Stage 5
Adult genitalia
Adolescence 11-14
Egocentric, moody behavior Eating disorders emerge Focus is on concrete and present Risk taking behaviors Death secondary MVI - think seatbelt
Adolescence 15-17
Peer groups
Seek privacy
Transition from concrete to operational behavior
Risk taking escalates
Adolescence 18-21
Key developmental task focus is achieving
Emotional intimacy
Risky behaviors peak
Death secondary to MVI, suicide, homicide
Development - 2 months
Focuses on face
Grasps rattle if placed in hand
Smiles, coos
Able to lift head 45 degrees
Development - 4 months
Able to hold and control head when held upright No head lag when pulled upright Raises body on hands Rolls prone to supine Follows light 180 degrees
Development - 6 months
Able to place object in opposite hand and in mouth Sits with support Rolls supine to prone Bears weight Recognizes parents Says dada or baba Babbles Smiles, squeals, laughs, imitates sounds
Development - 9 months
Pulls to stand Bangs, shakes, and throws objects Able to feed self with finger foods Says 2-4 words Looks for hidden objects Responds to name and a few words Feeds self and drinks from cup Waves and says bye bye, dada, mama Imitates vocalizations
Development 15 months
Walks well and is able to stoop Can point to body part Says 3-6 words Stacks 2 blocks Follows simple commands POints, grunts, and pulls to show what they want Listens to a story
Development - 18 months
Able to walk backwards Can throw a ball Says 15-20 words Uses 2 word phrases POints to multiple body parts
Development - 2 years
Able to walk up and down stairs one step at a time Can kick a ball Says at least 20 words Imitates adults Follows 2 step commands Stacks 5 blocks
Development - 3 years
Able to jump Can stand on one foot Able to ride a tricycle Says name, age, and gender Knows gender of others Able to copy a circle and cross Able to recognize colors
Development - 4 years
Able to ding a song Able to hop on one foot Able to throw a ball overhand Able to draw a person with 3 parts Able to cut and paste Albe to build a tower with 10 blocks Counts to 5 Able to copy a square Able to dress self with supervision
Development - 5 years
Able to draw a person with body, head, arms, legs
Able to recognize most letters and can print some
PLays make believe
Learns address and phone number
Can define at least one word
Anticipatory guidance - Birth
Feed every 2-3 hours, awaken if more than 4 hours
Does not need Vit D unless no sunlight
Back for sleeping
Do not use baby powder
Anticipatory guidance - One month
Do not place bottle in bed with baby
No solids until 4 months
Discus colic and comfort measures
Anticipatory guidance - 2 months
No solid foods or cereal in bottle
Do not give honey or water in bottle
Anticipatory guidance - 4 months
Childproof home
Introduce solid foods
Have syrup of ipecac available
Anticipatory guidance - 6 months
Solids 2-3 times a day
Avoid choking hazards
Start using a cup
Floride supplements
Anticipatory guidance - 9 months
Mashed foods and finger foods
Wean from bottle
Brush teeth
Anticipatory guidance - 12 months
Start on whole milk
Allow to feed self
Anticipatory guidance - 18 months
Allow to feed self with spoon or hands
Toilet training can start
Anticipatory guidance - 3 years
Time out can start - 1 minute for each year
