Pediatrics Screening for Referral Flashcards
What is considered a fever for a young infant
- Fever is 100.4º (38º C)
Define a fever without source (FWS)
- Last 7 days or less
- Usually resolves spontaneously
- May be a minor infection
Red flags in a newborn
- 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
Red flags in toddlers
- Failure to reach developmental milestones
- Abnormal growth: head, height, weight
- Irritability
- Vision or hearing impairments
- Impaired general health
- Seizures
Red flags in preschoolers
- Signs of chronic disease
- Developmental delay in any area
- Disturbances in growth
- Vaginal discharge
- Scoliosis
- Sex maturity inconsistent with age
Red flags at any age
- Signs of abuse
- Excessive crying
- Difficulty breathing
- Cyanosis
- Projectile vomiting
- Failure to make eye contact
- Repetitive motor mannerisms
Social emotional red flags in preschoolers
- 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
Cognitive red flags in infant/toddler/preschoolers
- Passive affect, lack initiative
- No creative, imaginative play
- Decreased associative play
- Decreased self awareness
- Decreased understanding of cause & effect
Communication red flags in preschoolers
- 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
Fine motor red flags in infants
- Persistent palmar grasp
- Asymmetry of hand use (arm use)
- Thumb grasped inside of palm
- Failure to reach
- Using primitive reflexes to grasp or release
Fine motor red flags in toddler/preschoolers
- Poor crossing midline
- Poor in-hand manipulation
- Poor disassociation of digits
Feeding red flags in infants
- 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
Sensory processing red flags
- 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)
Normal vitals signs in newborns
- Heart rate: 120-180 bpm
- Blood pressure: 60-90/30-60 mmHg
- Respiratory rate: 35-55
- Weight in pounds: 4.5-7 lbs
Normal vital signs ion infants (1-12 months)
- Heart rate: 80-140 bpm
- Blood pressure: 70-100/45-90 mmHg
- Respiratory rate: 20-30
- Weight in pounds: 9-22 lbs
Normal vitals signs in toddlers (1-3 years old)
- Heart rate: 80-130 bpm
- Blood pressure: 80-110/45-90 mmHg
- Respiratory rate: 20-30
- Weight in pounds: 22-31 lbs
Normal vital signs of preschoolers (3-5 years old)
- Heart rate: 80-120 bpm
- Blood pressure: 80-110/50-80 mmHg
- Respiratory rate: 15-25
- Weight in pounds: 31-40 lbs
Elements of a cardiopulmonary examination
- Nutritional status
- Color
- Chest deformities
- Unusual pulsations
- Respiratory excursion
- Clubbing of the fingers
- Breathing pattern/dyspnea
Cardiopulmonary red flags in toddlers
- Abnormal heart rhythms
- Weak or bounding peripheral pulses
- Dyspnea
- Exercise intolerance
- Cough
- Cyanosis
- Abnormal breath sounds
- Dullness with percussion over lungs
- Restlessness
- Fever
Integumentary red flags in toddler/preschoolers
- Abnormal skin turgor
- Abnormal skin temperature
- Abnormal mole appearance
- Presence of skin lesions
- Area of unusual swelling
- Peeling or scaling skin
- Abnormal skin pigmentation
Urogenital red flags in toddlers/preschoolers
- 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
Gastrointestinal system red flags for any age
- 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
MSK red flags in infants
- 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
MSK red flags in toddlers/preschoolers
- 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
Neurological system red flags for any age
- 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
General red flags at any age
- Signs of abuse
- Excessive crying
- Difficulty breathing
- Cyanosis
- Projectile vomiting
- Failure to make eye contact
- Repetitive motor mannerisms