Peds Flashcards
Fontanelles -
Normal closure times: Posterior ?
1-3 mo
Fontanelles -
Normal closure times: Sphenoid ?
6 mo
Fontanelles -
Normal closure times: Mastoid ?
6-18 mo
Fontanelles -
Normal closure times: Anterior ?
9-18 mo
First offie visit - Less than 48 hours at hospital ?
: first visit within 2 days (quick)
First offie visit - more than 48 hours at hospital ?
3-5 days after discharge (longer)
First offie visit - complications at birth at hospital ?
within 24 hours (alot sooner)
BM protect against ?
Diarrhea URI NEC Otitis media UTI Type 1 and 2 DM Lymphoma and leukemia
Obesity
Decrease maternal bleeding
Decrease risk of breast and ovarian cancers (mom)
Allergies at least through adolescence (Grasky, 1982)
** 7x less likely to have a cows milk allergy later on if BF **
Baby blues ?
Up to 80% new moms Overwhelmed Frustration Crying/weepy Trouble falling asleep Exhaustion *Resolves within two weeks post partum
PPD ?
10-20% new moms Flat affect Persistent sadness Anxiety with occasional bizarre thoughts; hurting the baby Thoughts of death Somatic complaints *Over 14 days
At one week after birth:
Stools should be _______________ and seedy now, about ____ a day. Green stools should be ending(meconium)
mustard colored
2-3
At one week after birth:____ wet diapers a day =adequate _________
Check color if there is a concern of not getting enough
4-6
hydration
Infants usually lose weight initially and they should be back to first weight in ?
2 weeks
1st visit: temp: infants: _________ add 1°,
axillary
1st visit: temp: toddlers: ______ subtract 1°
rectal
When do you check BP before 3 years old infant ?
neonatal cuff but only if cardiac or renal disease suspected or being monitored
Starting at 3 year old visit, do yearly
The fronto-occipital head circumference should be measured at its _______
maximum
Chest circumference can also be measured if concern about _________.
lung growth
It is usually within 2 cm of head circumference.
Chest circumference
measure until 2-3 years of age
1 visit milestone ?
Can suck and swallow and breathe easily
otherwise think cleft
*Can follow your face
Turns and calms to your voice
After the infants first visit when should the next one be ?
Next visit at one month or two months of age( 2 typically)
Infants and toddlers until __ years should ride in rear-facing seats (no air bag), once __ years then ?
2
2
forward facing seat
Car seats until at least ___ years and __ pounds, then booster
4
40
Until __ years – rear seat of car
13
fever in an infant is considered ?
100.4 (38)
101 go to the ER immediately
2 mo WCC: sleep: ______ daytime naps normal with approximately _____ total hours asleep. Most 2 month olds are up every 3-4 hours to eat
Three
15.5
2 mo WCC physical development ?
Lifts head in prone position
Holds head erect when upright (briefly)
Symmetrical movement
2 mo WCC social. emotional ?
Reciprocal smile
Coos
2 mo WCC: fine motor ?
Hands un-fisted (50%)
Retains rattle if placed
2 mo WCC: cognitive ?
Recognizes mother
Follows large highly contrasting objects
Opens mouth at sight of bottle or breast
2 mo WCC: anticipatory guidance ?
Discuss immunizations and normal reactions
Reinforce breast feeding & supplements of Vitamin D
No solid food until at LEAST next visit at 4 months
Tummy time
for neck movement and eye muscle movement
Back to sleep
No bottle in bed and no propping of bottle
- Burn injuries
- Cigarette smoke, second hand smoke
Fire and burn injury ?
Lower water heater temps to avoid scalding (120°)
Smoke detectors
Fire evacuation plan
Sunscreen, sun avoidance, SPF>30 apply 30 min before sun and reapply every 2 hours
By next visit infants can be reaching for hot beverages
Inquire about starting infants that are bottle fed on any solid foods ?
4 mo
Iron supplements *1-2mg/kg/day until solids
4 mo
4 mo sleep ?
More regular sleep pattern
15 hours about average
Less night time feedings
Starting to stay awake longer daytime hours
Three naps
Set more routine times for nap and bedtime
4 mo development milestones ?
Good head control (no head lag when pull to sit)
Begin to reach for objects
Sit with trunk support
Holds hands predominantly open
LOL
Vocalizes when alone
Turns head to voice
Shakes rattle (gross motor)
Neuro-Moro and rooting reflexes suppressed ?
4 mo
Neck: Torticollis, may take 2-3 months to appear after delivery ( maybe a lump along the muscle)
Neuro: stepping reflex disappears
2 mo
4 mo anticipatory guidance ?
Solid foods and when to start
Breastfeeding
Weight gain and spurts
*Keep drugs out of reach (4mo till grown)
Fears and phobias
Social development
Stranger anxiety soon
Drowning
choking
4 mo WCC when is the next visit ?
6 mo
Choking ?
Food, small objects
Especially under 3 years
Foods associated with choking ?
Hot dogs, hard candy, nuts, popcorn, raw vegetables, chunks of meat, fruit, cheese, peanut butter
Nonfoods
for choking ?
Coins, latex balloons, button batteries, marbles, small toys and parts
Drowning ?
Second leading cause of injury-related death, especially 1-3 years
10% survivors have brain damage
Bathtub, pools
Close supervision
Swimming lessons
Parents trained in CPR
what is the 6 mo ROS mainly focused on ?
feeding and elimination, sleep and activity (no TV)
6 mo feeding information ?
Infants that are breast and/or bottle fed can begin on solid foods. Milk intake will decline
Shows signs of readiness for solids
Introduce one food at a time. Wait a few days in between in case of allergies
When can you introduce cup ?
6mo
6 mo elimination ?
Usually only about two stools a day
More foul smelling
Undigested bits of food normal
Unusual colors normal depending on what was eaten last
6 mo sleeping ?
90% of 6 month olds can sleep through the night without feeding (6 hour span at least)
Sleeps about 10 hours per night
2-3 daytime naps (individual)
Total sleep is 14-15 hours in a
24 hour span
6 mo milestones ?
Sits without support but may be unsteady (gross)
Transfers hand-hand (fine)
Feeds self (cheerios)
Bangs and shakes toys
Stranger anxiety
Rolls over both ways
Starts to recognize name, enjoys vocal turn taking
Raking grasp - cant pick up things but they can rake things towards them (fine motor)
raking graps ?
6 mo
Legs: Genu varus still normal
by
6 mo
What reflex disappears at 6 mo ?
palmar reflex - grasp
baby proof house by ?
6 mo
at 6 mo WCC when is the next app ?
9 mo
9 mo typically eat how much BM ?
Feeding-typically eating 24-32oz of breast milk/formula in a 24 hour period plus solid foods three times a day
Self feeding
Using sippy cup
When is it more common to see more C ?
9 mo -12
as they get more solid foods
Identify not just by straining but what it looks like (hard pellets that look like small marbles)
Big players in constipation-favorites ?
Bananas
cheese
cows milk
*miralax - cause it doesn’t mess with the babies , they dont get used to it
When do sleep regression begin ?
9 mo
and teething
9 mo WCC milestones ?
Cruising - assisted walking (coffee table - gross)
Pull to stand
Three finger grasp-two fingers and thumb (fine motor)
Separation anxiety
Waves bye bye/Pat-a-cake
Mama/dada non specific (sometimes dada is specific?)
Neuro: Parachute reflex should be observed ?
9 mo
Anterior fontanelle may be just starting to close ?
9 mo
9 mo WCC anticipatory changes ?
Transition to cup
Self feeding
Child to be walking soon- prepare house!
Shaken baby syndrome Next visit at 1 year Sleep practices Reading Stranger awareness Sibling interaction Toothpaste Posion control
12 mo PE ?
make sure eyes are no longer crossed
12 mo WVV ROS ?
Feeding
Three meals and two snacks
Picky eating may start (limit sugary snacks)
Switch from formula to cow’s milk (whole)
Sippy cup now?
at 12 mo sleep decreased to what ?
Typically 11 ½ hours at night and two naps for approximately 14 hours total in 24 hours
12 mo screening ?
Daily tooth brushing now
Lead level taken
Hemoglobin and Hematocrit
*TB risk assessment
12 mo WCC developmental milestones ?
Says first words (mama/dada specific)
2 finger grasp (pincer grasp)
Stands well, independent steps
Scribbles, holds crayon
Uncovers toy under cloth (10 months)
Imitates parents
12 mo WCC anticipatory guidance ?
Talk about milk change and amount
*Whole milk unless risk for obesity
Limit to 24 ounces daily
No need for Vitamin D supplements now
Cow’s milk allergy is rare
Little awareness of others
Not sharing and physical responses normal
Great imitator-beware!!
Next visit in 3 months
Prepare house for a walking child
15 mo WCC ?
none unless catching up
15 mo milestones ?
3-5 words
points to body part
turn book pages
creeps up stairs
walks carrying toy
15 mo AG ?
Nutrition/exercise
Fire safety
*Risk assessment for H/H
Most common hematological condition affecting millions of children worldwide ?
IDA
____ in cow milk has lower bioavailability than human breast milk (5%-10% vs. 50%)
Iron
Start Fe 1-2mg/kg/d in all __ month old infants who are exclusively breastfed until iron enriched cereal started
4
Check Babinski reflex-should be gone / decreasing ?
18 mo
Answer questions about toilet training ?
Ask about speech and if there are any concerns (about a dozen words)
Inquire about colds, illnesses
Breast or whole milk?
18 mo
sleep is how long at 18 mo?
11-12
18 mo AG ?
Violence prevention
*Gun safety
Setting limits
Discuss concerns of autism-screening
Next appointment at 2 years old
**time out - once they are calm they sit there for 1 minutes for however old they are **
24 mo Hx/SocHx. ?
Tantrums/discipline
Toilet training readiness
Preschool or playgroups-colds and flu?
Picky eating started?
Ask about concerns of speech and social interactions (eye contact) Screen for ASD - autism spectrum
Dyslipidemia screening starts-ask about risks
When do you start to plot BMI ?
24 mo
**10% of weight they should be 10% of height **
when should all the fontanelles be closed ?
24 mo
Bowing of legs should be straighter now that child is walking ?
24
24 mo milestones ?
50-300 words are within normal range
2-step commands understood
2 word sentences (most can do 3)
Go down stairs two feet on each step
Parallel play
Stack about 6 cubes
Suck through straw
24 mo AG ?
stop pacificier
toilet training readiness
TV is okay
burns
fears and phobias
self control
dont push them to eat
24 mo when is the next visit ?
6 mo from now so when they are 2.5
2.5 years WCC is mainly for what ?
screening for delays
Speech
Developmental
Parental concerns
If child is seen during that year for sick visits, then may not be necessary
**skip , they can wash hands , use stairs **
3 yo sleep how long now ?
11.5 hrs
3 yo eat how much now ?
3 meals and 2 snacks
*Potty trained during day but accidents common and diaper needed at night
primary enuresis ?
3 yo.
BP measurements start, vision screening, check teeth (pea sized toothpaste now) ?
3 yo
3 yo milestones ?
String three or more words together
Pedal tricycle (gross)
Copy a circle-360’ (fine)
Play make believe
Dress and undress with little
help
Brush teeth
Understandable most of the time when speaking
3 yo AG ?
helmet saftey
gun safety
nightmares
social interactions
read to them every day
time out instead of spanking
Helmet safety ?
75% of bike related fatalities could
have been prevented by using a helmet
About 20% of children in Ohio wear bike helmets, though > 70% ride regularly -AAP
Bill is being considered to mandate helmet use in children under 16 in Ohio
Can reduce the risk of head injury by 85% and brain injury by 88%
Educate parents
Gun safety ?
Keep guns locked up with ammunition locked up in separate location
For every one intentional shooting for self defense, 4 accidental shootings occur
Gun in the home triples the likelihood of a lethal suicide attempt, double homicide
Adolescents with a history of depression or violence at higher risk
4 yo milestones ?
copies cross
draws stick figure
hops
use scissors
plays with others
5 yo WCC H and P - toilet habits ?
Constipation due to being in school bathroom and “holding it” common
5 yo WCC H and P - sleep ?
10-11 hours per night, no naps usually
5 yo PE ?
Hearing and vision screen before entering school using standard equipment
5 yo milestones ?
Hops on one foot, may skip
Speaks clearly
Count to 10, knows 10 colors, reads 25 words
Draws at least 6 body parts on a person
Knows right and left on self
Knows his or her gender
writes first name
walks down stairs alternating feet, no rial
when is the pre adolescent visit ?
10-11 y.o.
Pre-adolescent visit ? talk about ?
Showering daily, use of deodorant
Undiagnosed learning disabilities, bullying
Puberty (menses usually 2 years after breast development)
Out of booster at 4 feet 9 inches, backseat >13
Drug and alcohol use (cigarettes, *e-cigarettes)
Depression screening (starting at 11)
E-cigarettes ?
Battery operated products designed to turn nicotine and other chemicals into vapor (“vaping”)
Contains nicotine which is highly addictive and some contain carcinogens and toxic chemicals such as formaldehyde, as well as heavy metals
Increasingly popular among adolescents (2 million kids have tried e cigarettes already-web MD)
Ohio banned sales to minors but easily available on the internet
Concern that they may be a “gateway” or introductory product to youth trying tobacco
Tanner staging pre - adolescent: female breast 1 ?
preadolescent
Tanner staging pre - adolescent: female breast 2 ?
breast bud
Tanner staging pre - adolescent: female 3 breast ?
areolar diameter enlarges
Tanner staging pre - adolescent: female 4 breast ?
secondary mound
separation of contours
Tanner staging pre - adolescent: female 5 breast ?
mature female
Tanner staging pre - adolescent: male genitalia 1 ?
childhood size
Tanner staging pre - adolescent: male genitalia 2 ?
enlargement of scrotum/testes
Tanner staging pre - adolescent: male genitalia 3 ?
penis grows in length
testes continue to enlarge
Tanner staging pre - adolescent: male genitalia 4 ?
penis grows in length/breadth
scrotum darkens
testes enlarge
Tanner staging pre - adolescent: male genitalia 5 ?
adult shape and size
Tanner staging pre - adolescent: male and female pubic hair 1 ?
none
Tanner staging pre - adolescent: male and female pubic hair 2 ?
sparse, long, straight
Tanner staging pre - adolescent: male and female pubic hair 3 ?
darker, curling, increased amount
Tanner staging pre - adolescent: male and female pubic hair 4 ?
coarse
curly
adult type
Tanner staging pre - adolescent: male and female pubic hair 5 ?
adult
extends to thighs
Adolescent WCC basics: confidentiality ?
conditional vs. unconditional
Talk with patient & parent on first visit and document
Adolescent WCC basics:
Screen for alcohol, drugs, smoking
Depression
HIV (16-18 years old)
STD screening
*Teen pregnancy (condoms least effective for pregnancy but must be used every time
for STD protection!)
*Sleep-changes in puberty
Teenage pregnancy: talk about OCP ?
most effective are implants like nexplanon and IUD
worse are condoms
5 P’s of taking a sexual history ?
Partners,
sexual Practices,
Protection from STD,
Past history of Pregnancy and STD,
Prevention pregnancy
History and PE, height and weight done ?
every visit
Psychosocial screening done ?
every visit
*Congenital Heart disease- done ?
NB before discharge
H/H for anemia- done ?
12 month
Head circumference - done ?q
birth to 24 months
BMI - done at ?
24 mo
BP - done at ?
3 years
Vision- done ?
3-4 years old (visual acuity)
Hearing- done ?
birth then again at 4 years
Developmental screening- done ?
9,18,30 months
Autism screening- done ?
18 and 24 months
Lead level- done?
12 months if at risk
TB- done ?
if at risk can start as early as 1 month
*Dyslipidemia- done ?
9-11 then 17-21 years
*Cervical dysplasia- done ?
21 years old
*H/H risk assesment added at ?
15-30 months
*HIV- screening at ?
16-18 years
*Depression - done at ?
11-21 years with suggested tools
