Peds Flashcards
Pharmacodynamics
knows no age. The way a medication works in an infant is the same way it works in an older adult.
Pharmacokinetics
Pharmacokinetics vary over the lifespan, with most healthy children being in effective drug biotransformers and eliminators
Changes through the lifespan
Defining times of early childhood
Neonate - 0-28 days Infancy the first year of life Toddler ages 1 to 2 years Preschool ages 3 to 4 years School aged ages 5 to 12 years
Term
37 weeks = early term
40 weeks = term
41 weeks = late term
42 weeks= post term
Remember: Adjusted age for preterm infants*
Positional plagiocephaly
Alternation of shape of the skull due to position.
Tummy time important to avoid
Treatment helmet
Proper latch in breastfeeding
During breast-feeding with proper latch, no dimpling other babies cheeks, no clicking sound with sucking.
The cheeks should be round, and the nose should be on the breast.
Physiological jaundice
Any jaundice after the first 24 hours of birth
Any jaundice before the first 24 hours of birth is almost always pathologic.
Encourage breast-feeding at minimum every 2 to 3 hours while avoiding dextrose in water feelings will help minimize the newborns risk of hyperbilirubemia
Chlamydial conjunctivitis
Signs and symptoms present between 5 to 14 days post exposure
examination will reveal bilateral eyelid swelling conjunctival edema and Mucoid discharge.
Ocular erythromycin at birth would minimize the risk of gonococcal conjunctivitis but not chlamydial conjunctivitis.
Treatment: IV or IM ceftriaxone and oral erythromycin for two weeks also protects the respiratory track risk of pneumonia.
Coinfection with gonoccoal common
Moro reflex
Aka startle reflex
Throwing out arms and legs followed by pulling them back to the body following a sudden movement or loud noise.
No longer seen by 4 months
Palmer grasp
Grasping at Object when placed in the palm.
No longer seen by 2 to 3 months.
Babinski reflex
Stroking the soul of the foot elicits fanning of the toes.
No longer seen by six months
Stepping reflex
Walking motion made with legs and feet when held upright and feet touching the ground.
Appears in the first 3 to 4 months, then disappears at 12 to 24 months
Rooting reflex
Turning up head and sucking one cheek is stroked.
No longer seen by 2-3 months
2 month milestones
From tummy, can lift self up on 2 arms Response 2 sound
smiles when smiled 2
4 month milestones
Reaches 4 a toy or other object.
Smiles 4 fun (spontaneously no trigger needed)
Rolls from tummy to back
Six month milestones
Looks like a number six when SITTING UP unassisted.
Rolls from back to tummy and back.
6 to 8 months milestone
Once able to sit up, able to pass object from one hand to the other. Brain is mature enough to recognize body as one.
Babbles, & ah/oh sounds
12 months milestones or 1 year
Stands tall like a number one and walks on two legs
18 month milestones
Can name single word objects.
Says “no” a lot also like an 18-year-old.
Acts like an 18-year-old by copying work that adults do.
Two or 24 months milestones
Speaks in 2 word sentences.
Follows 2-step commands.
Can walk up to the 2nd floor with help.
Builds a 2 block tower with ease
Three year milestones
Can draw a circle.
Can ride a tricycle.
Build a three block tower with ease. Speaks in three word sentences.
Four year milestones
Can speak in 4 word sentences.
Can build a 4 block tower with ease.
Can draw a cross
Time out
Time out should be introduced at 18 months (learning concept). At 24 months came out is more effective. The child should remain in time out for 1 minute per year of age. Ex) 2 mins for a 2 year old
Intellectual speech by which age
By 3 1/2 nearly 100% of speech should be easily understood to others other than parents
Rule of sixes with teeth
The first tooth eruption should be the upper and lower central incisors around 6 to 10 months.
Permanent teeth begin to irrupt at 6 years. They are usually the molars first
6 months for baby teeth and 6 years for adult teeth
Adjusted age of preterm babies should be used to assess developmental age until what age?
2 years
micropreemies will take full two years but most babies will grow out of status before two years.
Non-communicating hydrocele
A painless, tense, nonreducible, relatively symmetric scrotal enlargement that brightly and evenly transilluminates. With the position change there is no change in scrotal size.
Very common in the first year of life, will self resolved.
Caused by the ceiling of the abdominal cavity during gestation with residual trapped peritoneal fluid in the scrotal sac
Communicating hydrocele
Caused by incomplete ceiling of the peritoneal cavity at the inguinal area during gestation leaving a space between the abdominal cavity and the scrotum.
Only difference in presentation from non communicating hydrocele - Size of the scrotum sack but increase or decrease with position change.
Due to communication, and infant is more at risk for herniation of the abdominal contents. Refer to pediatric urologist.
Pyloric stenosis
Caused by thickening of the pylorus muscle, preventing food from moving from the stomach into the small intestines.
Post fed projectile vomiting is present, with the baby eager to eat again immediately post emesis.
More common in males
Olive shaped right upper quadrant abdominal mass occasionally noted.
Most common time for symptoms of onset are approximately at 3weeks - 6weeks of age.
US for diagnosis
Sent to ER - surgery correction required & iv hydration
Intussusception
Caused when a secretion of intestines invaginate into the adjoined intestinal lumen, causing bowel destruction.
More common in males
Sudden onset colicky severe and intermittent abdominal pain. Often with these drawn to chest during most intense discomfort. Accompanied by a sausage shaped of abdominal mass.
Usually occurs between ages 6 to 12 months
Us for diagnosis
Sent to ER - hydrostatic or pneumatic enemas or surgical correction
Developmental red flags in young children
By 6 month: no big smile or other warm, joyful expressions
By 9 months: no back-and-forth sharing of sounds smiles or other facial expressions
By 12 months: lack of response to name, no babbling or baby talk, and or no back-and-forth gestures, such as pointing, showing, reaching or waving
By 16 months: no spoken words
By 24 months: no meaningful two word phrases that don’t involve imitating or repeating
Infant weight change
Neonate lose up to 7% of body weight but should regain it by two weeks of age. They doubled her birthweight by six months and triple their birthweight in 12 months.
Acute URI should be treated with antibiotics when
Persistent illness or daytime cough more than 10 days without improvement
Worsening course or new onset of nasal drainage, daytime cough, or fever after initial improvement
Severe onset/concurrent fever of greater than 102.2F and purulent nasal drainage more than three consecutive days
ABRS abx treatment
Amoxicillin 80 to 90 mg per kilogram per day
Or HD Augmentin PO
Course of therapy 10-14 days (differed from 5-10 day therapy recommended for adults)
