Peds Flashcards
Childhood ages
- neonate 0-28 days
- infancy 1st year of life
- Toddler 1-2
- preschool 3-4
- school age 5-12
2 week old
- visual prefrerence for human face - vision range 8-12”
- hear high pitch voices best
- reacts to crys of othe neonates
- well-developed snse of smell
stepping reflex
- walking motion made with legs and feet when heald upright
- appears for the 1st 3-4 months then reappears at 12-24 months
rooting reflex
- turning head and sucking when cheek stroked
- no longer seen by 6-12 months
Moro/startle reflex
- throwing out arms and legs followed by pulling them back to the body following sudden movement or loud noise
- no longer seen after 16 weeks
Palmar grasp
- grasping object placed in the hand
- no longer seen by 2-3 months
Babinski reflex
- stoking the sole of the foot elicits fanning of the toes
- no longer seen by 6 months
neonate stomach size
day1 cherry size
day 7 apricot
day 30 egg
Infant feeding
- exclusively breast fed for first 6 months
- introduce compplementry foods no sooner than 4 months
- continue breast feeding for 1 year or longer
- if not breast feeding infant formula 1st year as major caloric source
baby should be back to birth weight by 2 weeks
Hyperbilirubinemia in newborn
- immature intestinal tract cannot reduce bilirubin to urobilinogen for excretion
Onset >24
* Pathologic jaundice - less common
* caused by metabolic disorders, hmeolytic disorder, sepsis …
* Intervention: treat underlying illness, ensure adequate fluid intake, Phototherapy if total serum bili >25
Onset <24 - 2 wks
* physiologic jaundice - most common reason, usually in the first 4-5 days of life
*Breast milk jaundice - usually after 1 wk
* Intervention: ensure adequate fluid intake, phototherapy if t. billi > 25
Hyperbilirubinemia in newborn
labs
- jaundice starts in the face and works its way down the body
- labs are required to dx degree of jaundice
Direct (conjugated) bili: hemolyzed RBC able to be excreted; elevated due to: sepsis, intrauterine infection, severe hymolytic disease, biliary atresia…
Indirect (unconjugated) bili: hemolyzed RBC not able to be excreted; uaually related to positive Coombs test (Blood groups Rh, ABO incompatibility)
Chemosis - conjuntival edema
- chemical irritation from neonatal chemoprophylaxis
- chlamydial (inclusion) conjunctivitis - s/s 5-14 days post exposure, chemosis common. prevent via maternal screen. confirm with culture, treat with oral erythromycin x2weeks
- Gonococcal conjunctivitis - incubation beriod after exposure 2-7 days . Ocular chemoprophylaxis at birth with erythromycin opthalmic ointment or silver nitrate minimizes risk
- Neonatal adenovirus - common cold pathogen- causitive organism of viral conjunctivitis, usually with ecessive tearing, mildly red conjuntiva and URI symotoms
2 month milestones
- from tummy can lift selft with 2 arms
- resonds 2 sounds
- smiles when smiled 2
4 month milestone
- reaches 4 a toy or object
- smiles 4 fun (spontaneously)
- rolls from tummy to back
6 month milestone
- looks like number 6 when sitting
- rolls from back to tummy and back
6 to 8 months
- able to sit up unsupported
- transferrs objects from hand to hand
12 months
beging to walk
18 months
canname single word objects
copys adults
says no alot
2 years
- 2 word sentences
- follows 2 step commands
- walk up steps with help
- bultds a tower with 2 blocks
3 years
- bulids 3 block tower
- speaks in 3 word sentance
- trides a trike
- draw a circle
Speech milestones
- percent of words understadable by adult not in daily contact with child
- 16-18 months 25%
- 19-21 months 50%
- 2-2.5 yrs 75%
- 3-4 years nearly 100%
develpomental redflags
- 6 months: no big smiles or other warm joyful expressions
- 9 months: no back and forth sharing of sounds, smiles, or other expressions
- 12 months: lack of response to name, no babbleing, and/or no back and forth gestures, shuch as pointing, reaching, showing, or waving
- 16 months: no spoken words
- 24 months: no meaningful two-word phrases that don’t involve repeating
Childhood anemia
- most common type IDA - microcytic, hypochromic, elevated RDW
- most common in children 12-30 months
- depletion of birth iron stores (usually lasts till 6 months), initiation of lower-iron diet in later infancy, early todler stage
- most calories in 1sy year should be from breast milk with iron supplementation statring at 4- 6 months unless iron fortified formula or foods
- > 12 months, most potent risk factor for IDA is cows milk >16 oz/day
- in <9 months, most potent risk is maternal iron depletion or preterm infant
Diagnosis of AOM in children
- moderate or severe buldging of TM OR new onset of otorrhea not related to otitis externa, and Otalgia
- mild buldging of TM and recent (<48 hrs) onset of ear pain ( tugging, holding, rubbing) or Intense TM erythema with otalgia
Management of AOM
- treat ear pain - alagesics: acetaminophen or ibuprofen
watchfull waiting for AOM
in otherwise well child may not need to immediately start abx:
* low risk of adverse outcome without ABx, high rate of spontaneous resolution without abx
analgesia without abx is acceptable if
* >6 months and unilateral infection with non severe illness based on joint decision with provider and parent. follow up in 48-72 hours with ability to start abx if no improvement or worsening
severe vs nonsevere AOM in children
nonsevere
* mild otalgia for <48hours or
* fever < 39/102.2 in the past 24 hours
Severe
* moderate to sever otalgia or
* otalgia >48 hours or
* fever>39/102.2
ABX tx for AOM at time of diagnosis
- reguradless of severity or laterality if <6 months
- severe illness with unilateral or bilateral in >6 months
- nonsevere illness with bilateral AOM in young children 6-24 months
1st line tx for AOM
- amoxicillin 80-90mg/kg/d
- amioxicillin-clavulante
length of therapy
* <2 yrs : 10 days
* 2-6 yrs: 7 days
* >6 yrs 5-7 days
AOM with PCN allergy
cefdinir, cefuroxime, cefpodoxime
Otitis media with effusion
- fluid in middle ear without s/s of infection (anticipated finding after AOM)
- 1st line: watful waiting - 75-90% resolve in 3 months without specific treatment (abx, oral antihistamines, decongestants not indicated)
- consider audiologic eval if persists more than 3 months, or concers for hearing, speech, or language concerns after prior audiologic test - referal to ENT and/or speach therapy
scarlet fever
- S. pyogenes pharyngitis with sanpaper like rash
- exudative pharangytis, fever, HA, tender localized anterior cervicle lymphadenopathy
- rash usually reeupts on day 2 of pharyngitis and often peels away a few days later
Roseola
- human herpesvirus -6
- yonger child with peack at 6-24 months
- fever spike
- discrete rosy-pink macular or maculopapular rash lasting hours to 3-days, follws a 3-7 dya period of fever, often quite high
Rubella/3 day measles/german measles
- mild symptoms - fever sore throat, malaise, diffuse maculopapular rash lasting about 3 days
- Posterior cervicle and postauricular lymphadenopathy begining 5-10 days prior to onset and present during rash
- Arthralgia in about 25% (most common in women)
- risk in pregnancy to the fetus
- vaccine preventable
Rebeola/10 day measles/hard measles/measles
- usually acute presentation
- fever nasal discharge, cough, generalized lymphadenopathy, conjunctivitis (copious clear discharge), photophobia
- Koplik spots - appearing 2 days prior to onset of rash as white spots with blue rings held within red spots in oral mucosa
- pharyngitits is usually mild without exudate
- maculopapular rash onset 3-4 days after onset of symptoms, my coalesc
- vaccine preventable
