Pediatrics Screening for Referral

Question 1

What is considered a fever for a young infant

Answer 1

• Fever is 100.4º (38º C)

Question 2

Define a fever without source (FWS)

Answer 2

• Last 7 days or less
• Usually resolves spontaneously
• May be a minor infection

Question 3

Red flags in a newborn

Answer 3

• Difficulty in arousing
• Newborn/infant who does not display sucking
• Birth weight (low or high)
• Small or large for gestational age
• Low APGAR at 5 minutes
• Cardiovascular/pulmonary abnormalities
• Infant cannot be comforted
• Umbilical defects
• Persistent asymmetry of posture
• Persistent extension of extremities
• Head maintained to one side
• Severe flaccidity
• Lack of normal, spontaneous movements
• Failure to thrive
• Abnormal growth: head, height, weight
• Premature closing of the sutures
• Misshapen head/face
• Microcephaly/hydrocephaly
• Abnormalities of the eyes or ears or nose
• Abnormalities of the mouth
• Neck masses
• Abnormal skin texture, pigmentation, hair, turgor

Question 4

Red flags in toddlers

Answer 4

• Failure to reach developmental milestones
• Abnormal growth: head, height, weight
• Irritability
• Vision or hearing impairments
• Impaired general health
• Seizures

Question 5

Red flags in preschoolers

Answer 5

• Signs of chronic disease
• Developmental delay in any area
• Disturbances in growth
• Vaginal discharge
• Scoliosis
• Sex maturity inconsistent with age

Question 6

Red flags at any age

Answer 6

• Signs of abuse
• Excessive crying
• Difficulty breathing
• Cyanosis
• Projectile vomiting
• Failure to make eye contact
• Repetitive motor mannerisms

Question 7

Social emotional red flags in preschoolers

Answer 7

• Inability to get along in groups
• Child with excessively aggressive behaviors
• Inability to get along with family members, particularly siblings
• Aggression which is beyond instrumental aggression

Question 8

Cognitive red flags in infant/toddler/preschoolers

Answer 8

• Passive affect, lack initiative
• No creative, imaginative play
• Decreased associative play
• Decreased self awareness
• Decreased understanding of cause & effect

Question 9

Communication red flags in preschoolers

Answer 9

• Speech of a 3-4 year old cannot be understood
• Has difficulty with many sounds
• Repeats syllables and words when talking
• Does not use grammar of family
• Childhood Apraxia of Speech
• Orofacial Myofunctional Disorders
• Language-based learning disability
• Dyslexia

Question 10

Fine motor red flags in infants

Answer 10

• Persistent palmar grasp
• Asymmetry of hand use (arm use)
• Thumb grasped inside of palm
• Failure to reach
• Using primitive reflexes to grasp or release

Question 11

Fine motor red flags in toddler/preschoolers

Answer 11

• Poor crossing midline
• Poor in-hand manipulation
• Poor disassociation of digits

Question 12

Feeding red flags in infants

Answer 12

• Choking on breast or bottle
• Leakage around the mouth
• GERD
• Ineffective oral motor activities (tongue, lips, cheek)
• Failure to regain birth weight
• Failure to thrive

Question 13

Sensory processing red flags

Answer 13

• Limited speech (delays in speech)
• Regulation difficulties
• Loss of previously known words
• Repeating what is said (echolalia)
• Robotic speech or different sounding speech
• Poor eye contact
• Inappropriate affective skills
• Dislike of being touched or held
• Self-stimulating movements
• Difficulty changing routines
• Unusual attachment to objects
• Feeding difficulties
• Presence of other diagnoses (Tourette’s or Fragile X syndromes)

Question 14

Normal vitals signs in newborns

Answer 14

• Heart rate: 120-180 bpm
• Blood pressure: 60-90/30-60 mmHg
• Respiratory rate: 35-55
• Weight in pounds: 4.5-7 lbs

Question 15

Normal vital signs ion infants (1-12 months)

Answer 15

• Heart rate: 80-140 bpm
• Blood pressure: 70-100/45-90 mmHg
• Respiratory rate: 20-30
• Weight in pounds: 9-22 lbs

Question 16

Normal vitals signs in toddlers (1-3 years old)

Answer 16

• Heart rate: 80-130 bpm
• Blood pressure: 80-110/45-90 mmHg
• Respiratory rate: 20-30
• Weight in pounds: 22-31 lbs

Question 17

Normal vital signs of preschoolers (3-5 years old)

Answer 17

• Heart rate: 80-120 bpm
• Blood pressure: 80-110/50-80 mmHg
• Respiratory rate: 15-25
• Weight in pounds: 31-40 lbs

Question 18

Elements of a cardiopulmonary examination

Answer 18

• Nutritional status
• Color
• Chest deformities
• Unusual pulsations
• Respiratory excursion
• Clubbing of the fingers
• Breathing pattern/dyspnea

Question 19

Cardiopulmonary red flags in toddlers

Answer 19

• Abnormal heart rhythms
• Weak or bounding peripheral pulses
• Dyspnea
• Exercise intolerance
• Cough
• Cyanosis
• Abnormal breath sounds
• Dullness with percussion over lungs
• Restlessness
• Fever

Question 20

Integumentary red flags in toddler/preschoolers

Answer 20

• Abnormal skin turgor
• Abnormal skin temperature
• Abnormal mole appearance
• Presence of skin lesions
• Area of unusual swelling
• Peeling or scaling skin
• Abnormal skin pigmentation

Question 21

Urogenital red flags in toddlers/preschoolers

Answer 21

• Presence of edema
• Signs of dehydration
• Irritability
• Decreased urination
• HTN
• Fever
• Presence of hernia
• Anorexia
• Slow weight gain over days or weeks
• Abdominal discomfort
• Not toilet trained when age appropriate
• Signs of sexual abuse
• Presence of pubic hair

Question 22

Gastrointestinal system red flags for any age

Answer 22

• Dehydration
• Weight loss or no gain
• Irritable or lethargic
• Chronic hunger
• Skin turgor
• Crying w/o tears
• Depressed anterior fontanel
• Abdominal pain
• Vomiting: color, sign just before choke/gag (elevated eyebrows & wrinkle forehead), describes nausea, projectile, bile stained or non-bilious

Question 23

MSK red flags in infants

Answer 23

• Obvious deformity
• Area of tenderness
• Swollen area in soft tissue
• Swollen joint
• Leg length difference
• Limited cervical ROM
• Bruises
• Frequent or multiple fractures
• Presence of contractures

Question 24

MSK red flags in toddlers/preschoolers

Answer 24

• Obvious deformity
• Area of tenderness
• Swollen area in soft tissue
• Swollen joint
• Leg length difference
• Limited cervical ROM
• Bruises
• Frequent or multiple fractures
• Presence of contractures
• Antalgic gait
• Decreased activity level
• Pain with activities
• Night pain
• Decreased functional strength

Question 25

Neurological system red flags for any age

Answer 25

- Loss of consciousness - Amnesia - Crying for more than a few minutes after injury - Vomiting - Swelling - Difficult to arouse - HA - Unsteady movements - Pupil/eye changes - Full or bulging fontanel (skull) - Seizure - Alteration in temperament - Fluid leak from ears or nose - Continued primitive reflexes - Palmar grasp - Abnormal tone - DTRs - Babinski sign - Lack of interest in people/toys - Unaware of environmental stimuli

Question 26

General red flags at any age

Answer 26

- Signs of abuse - Excessive crying - Difficulty breathing - Cyanosis - Projectile vomiting - Failure to make eye contact - Repetitive motor mannerisms