Peds COPY Flashcards
T/F there is no evidence that screening for suicidal ideation in teens reduces suicides
true, suicidal patterns can be identified but there is little effect on outcomes
beri-beri
risks
solution
thiamin deficiency
polished rice or other cereal diet
whole or parboiled rice, legumes, protein sources
indications to pump and bottle feed
materanl varicella, occuring 5 days before throigh 2 days after
active herpes on the nipple
active H1N1 flue
nupple issues with breastfeeding
nipple or breast infections
dermatitis or psoriasis
inverted nipples
four issues that would inactivate surfactant
pulmonary hemorrhage
pulmonary edema
alveolar capillary leak
meconium
what percent of high school students exercise for 60 minutes daily
35%
4-5 month milestone
gross: head steady in supported position
fine: hands together
social: shows displeasure through vocalization
language: looks for the source of sound
suckle reflex
new born sucks when something is placed in the mouth
14 weeks
PSYCH primary care providers screen for socio-emotional problems
Parent child interaction: how are things going with your parents
school: how are things in school
youth: how are things with friends
casa: how are things at home
happiness: how would you describe your modd
diagnosing ID in children under 3.5
over 3
developmental testing
developmental testing, standardized tests, psych eval, vision and hearing test
how do most kids learn to roll over
front to back accidently as they look around and fall over
OCD defined
upsetting, recurrent thoughts leading to repetitive actions
feeling to urge to do repitive actions to soothe anxiety
difficulty stopping the reccurent thoughts until ritual is complete
T/F breast milk is lacking in vitamin D
true
signs that infants can hear
6-7 months
turning to listen to voices and conversation
issues with breast reduction that can decrease milk production
interruption of ducts
decreased blood flow
nerve damage that decreases reflex arc
gross motor development milestones
running
jumping & climbing stairs (2 feet)
tricycle & climbing stairs (alternating feet)
18 months
2 years
3 years
what is the action of phototherapy for jaundice in neonates
to formation of lumirubin that will bind with water and does not need to conjugated to be excreted
mammogenesis
development of breasts to a functional state
T/F electroconvulsive therapy has been show to have no positive effect in treating pediatric depression
false
treatment for ID
speech therapy
OT/PT
special education
behavior therapy
counseling
medical therapy if needed
DDx for pediatric depression
adjustment disorder with depressed mood
bipolar
sadness
24 month milestones
gross: throws ball overhead, jumps
fine: turns door knobs, builds a 7 block tower
social: washes and ries hands, little spilling during feeding
language: two or three words combined, points to body parts
what is the standard of care for suicide attempts
other options?
hospitalization, though it is not proven to prevent future suicide
outpatient treatment for low risk pts with intensive home therapy
risk factors for pediatric depression
FHx of depression
family dysfunction
exposure to early difficulty (neglect, abuse)
low birth weight
TBI
gender dysphoria
substance abuse
why can iron and zinc defiency be an issue in pediatrics
because meat is a major source of both and kids don’t necessarily like the taste/texture of them
when should head lag go away in an infant
between two months and 6 months they should have the strength and recognition to tuck their chin
what does a gestational age assessment look at
neuromuscular and physical maturity
how would a preterm baby present posturally
full extension and no flexion
treatment for a plugged duct related to breastfeeding
check latch
warm compress
expression
analgesics
signs that infants can hear
3-4 months
turning eyes and head to sound
arm recoil test
how will this differ pretime to term
pull the arms down and se if the naturally recoil
a full term baby will naturally bring their arms back to less than 90, a preterm wont
symptoms of ODD
frequent temper tantrums
excessive arguing with adults
active defiance of adults
deliberate attempts to annoy upset people
frequent anger and resentment
intrauterine growth retardation
a conditions where a baby does not grow to a normal size
comorbid conditions with ASD
ADHD
depression
anxiety
frequent diarrhea
colitis
asthma
eczema
barriers to breastfeeding
african americans
adolescent, <25 years
single mothers
smokers
less than high school education
participation in WIC
early return to work
unwatnted pregnancy
examples of executive functioning issues associated with FASD
repeatedly break rules
doesn’t learn from mistakes
issues with time and money
susceptible to peer pressure
acute or chronic hypoxia is indicative of what
meconium aspiration
tips on how to initiate a latch
bring baby to breast
infant facing mother
wide gape for nipple and areola
lower lip out
full cheeks
tongue extended
T/F gross motor development progresses from the bottom up
false, it progresses from the head down
rooting: defined
touch a neonates cheek, head turns towards stimulus with an open mouth
language development milestones
9 months
12 months
15 months
wave bye
jargoning (intonation), performing 1 step commands with gesture
1 step commands
failure to thrive
weight curve fallen by two percentile channels from previously established rate
acrocyanosis
cyanosis of the hands and feet
risk factors for childhood obesity
genetics
behaviors
environment
5 A’s for smoking cessation
ask
advise
assess
assist
arrange
two contraindications for breastfeeding
infants with classic galactosemia (galactose 1-phosphate uridyltransferase deficiency)
mother who have HIV
possible explanations why suicide rates are increasing
increased drug and alcohol abuse
depression
family/social disorganization
access to firearms
social media
how will the ear look on a preterm baby
cartilage looks more firm on a term than a preterm baby
what is the rationale for using the WHO growth charts until age 2 then the CDC charts after
breastfed infants regardless of background are generally the same
after age 2 the diet and health care availible in the US will cause us to have larger children
klumpke palsy
paralysis of the forearm muscles
calculating ideal birth weight for men
for women
what are the flaws
110 for 5’ then 5 lbs every inch
100 for 5’ then 5lbs for every inch
only works for people >5ft tall, estimates too low for women, usually for calculating doses and assessing severity of anorexia
T/F the decrease in ovulation from breastfeeding can be considered contraceptive
false, there is still a change to get pregnant
T/F most infants with kernicterus has show some sign of acute bilirubin encephalopathyq
true, but there are some with few clinical signs as well
what is the role of amniotic fluid
fetal breathing of amniotic fluid stimulates lung growth
if there isn;t enough fluid the baby gets pulmonaryt hypoplasia
erbs palsy
brachial plexus injury of C5-6, makes a claw hand, related to birth trauma from shoulder dystocia
risk factors for ASD
down syndrome, fragile X, rett syndrome
older parents
having a sibling with ASD
low birth weight
clinically significant brain abnormalities associated with FAS
changes in the corpus callosum, cerebellum, basal ganglia
T/F babies have excellent vision
false, very poor 20/400 in black and white with a fixed focal length of 12 inches
lactogenesis
stages
synthesis and secretion of milk from the breast alveoli
Stage I: colosutrum production starting at week 16
Stage II: sharp increase in production due to decreased progesterone after delivery of the placenta
mongolian spots
flat blue grey spots that can be confused for bruises
what is the most common psychiatric condition across developmental stages
anxiety
T/F animal studies show that continous drinking is more damaging than binge drinking
false, other way around
social development milestones
15-18 months
independent
copies parents (18months)
rooting: duration
32 wks (incomplete gestation) or 36 wks (complete)
to 4 monts
oppositional defiant disorder
ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that interfere with daily function
ADHD symptoms
inattention
hyperactivity
impulsivity
what is more important for pediatric growth before 4 years, TH or GH
after 4
TH before 4, GH after 4
T/F the etiology is intellectual disability is usually known
false, it is only known in 1/3 of patients
short term maternal benefits of breastfeeding
less postpartum bleeding
easier postpartum weight loss
delays ovulation
allows for mother/infant bonding
15-17 month milestones
gross: stoops and recovers, walks well
fine: builds 2-3 cube tower
social: attempts to use sppon
language: waves bye, uses 4-5 words
DDx of ASD
childhood psychoses
fragile X
hearing loss
pharmacotherapy for suicide
no proven treatment, SSRIs might be used during initial therapy or if underlying psych disorders are present
12-14 month milestones
gross: stands alone for 2 seconds
fine: bangs object together, places pellet in bottle
social: hugs dolls, uses gestures to indicate needs
language: uses one or two words with meaning
etiology of ASD
unknown, possible genetic or enviromental factors
social development milestones
1
2
6 months
regards face
recognize parents
likes looking around
biological factors associated with ODD
parent with ADHD, ODD, CD
parent with depression or bipolar
parent substance abuse
chemical imbalance
exposure to toxins
when should babies be tranisitioned to solid food
indications a child is ready for solids
4-6 months
does the baby hold up their head, open their mouth at the sight of food, at least double their body weight from birth
signs of hunger to indicate breastfeeding should start
increased alertness
mouthing or rooting
bringing hands to mouth
crying is the last one
how to treat reynauds associated with breastfeeding
warm the whole body
what is the best way to maximize milk production
infant feeding or pumping (not as effective)
9-11 month milestones
gross stands while holding on
fine: passes object from hand to hand
social: feeds self, imitates waving
language: undestands no, says mama
when is it ok the start breastfeeding after general anesthesia
when the mother is alert
conditions associated with excessive bilirubin production in neonates
blood group incompatibility
spherocytosis
G6PD deficiency
sepsis
neonate PE eyes, nose, jaw
eyes should be 2-3cm apart
nose flattened bridge
pierre robin small jaw
etiology of OCD
precise cause is unknown
some genetic correlation
dysregulation of serotonin
describe the evolution in fine motor skills in terms of grasping
6 months they should rake
9 months they should do an inferior pincher grasp
12 months the should do a fine pincher grasp
signs of advanced phase acute bilirubin encephalopathy
pronouced retrocollis-opisthotonos
shrill cry
no feeding
apnea
fever
stupor into coma
sz
death
when should supplemental feeding be considered
dehydration
<3 stools/day
loss of 7% birth weight
limited maternal milk supply
preventable causes of intellectual disability
FAS
maternal drug use
maternal malnutrition
infection
decreased risk factors for RDS
chronic inttrauterine stress
maternal HTN
IUGR or SGA
corticosteroids
thyroid homone
tocolytic agents
when is the period of most rapid head growth
0-2 months
four reflexs to note on neonate PE
root
suck
moro
grasp
0-2 month milestones
gross
fine
social
language
gross: turns head to side
fine: clenched fist with eye contact
social: recognizes human face
language: vocalizes in play
indications for bariatric surgery of obesity
severely obese adolscents who are mature with a BMI over 50 or over 40 with comorbid conditions
AND
failed a structured weight loss program for six months
AND
are psychologically ready for major lifestyle changes
abnormalities of functional skills of the CNS related to FAS
decreased cognition
motor delays
ADHD
social skill issues
language problems
others
why is breastfeeding preventative for uterine bleeding postpartum
it causes smooth muscle contraction and involution of the uterus
two symtom categories for ADHD
inattention or hyperactivity/impulsiveness
function of prolactin in breastfeeding
oxytocin
increases milk production
stimulates let down from the breast
reccomendations to decrease SIDs risk
sleep on back
firm surface
no bedding or pillows
share room, not bed
don’t smoke
offer pacifier
avoid overwrapping, overheating, head coverings
encourage tummy time while awake
neonate PE spine and extremities
curvatures, dimpling, bulging, exposed spinal cord
symmetry in appearance in movement, ROM, positioning
typical breastfeeding schedule during the first week
wake every four hours to feed
follow urine and stool
strategies to avoid memory issues associated with FASD
provide direction one rule at time
review rules regularly
repetition
underlying causes of failure to thrive
inadequate nutrition
GI reflux
neglect
poverty
ignorance
contraindications of breastfeeding
infant with galactosemia
HIV+
human T cell lymphotrophic virus
active TB
cytotoxic chemo
illicit drugs/alcohol
treatment of nipple yeat infections
topical antifungal
combination of antifungal
gentian violet
maternal fluconazole
infant nystatin
at what stage of acute bilirubin encephalopathy is the damage likely reversible
the intermediate stage if there is a blood transfusion
inattention ADHD symptoms
often fails to give close attention to details
trouble holding attention on tasks
doesn’t listen when spoken to
doesn’t follow thoruh with instruction or fails to finish tasks
trouble organizing tasks
what is the dosing schedule for reglan for breastmilk production
is it proven successful
how long should the course be
10mg/8hrs
limited evidence, some anecdotal
limit to 1-3 weeks unless it works really wel
what does the skin of an immatue baby look like
red, shiny, tacky
if 24028 weeks there will be venous patterns on the trunk, head, and neck
DDx for ID
ASD
developmental delay
FAS
communication disorders
spoken language disorders
hearing loss
growth deficits related to FAS
prenatal or post natal and or weight below 10th percetile at one point in time adjusted for age, sex, race
when is formula used
if breastfeeding isn’t possible or desired
physical factors that contribute to SIDS
brain abnormalities
low birth weight
respiratory infeciton
6-8 month milestones
gross: rolls over, sits foward on arms
fine: reaching and raking
personal: responsed to own name, holds bottle
language: imitates speech and voice
6 month old girl presents with mom for Well Child Visit.
Mom states that baby is eating well.
Baby has social smile and is cooing.
On physical exam baby has head lag. Not able to push up on hands. Has not started rolling over yet. Can not keep head steady when held in sitting position.
Growth chart demonstrates less than optimal growth
why might this be considered normal
if the baby is premature, comparisions to growth and development are made to their gestational age until2 years
positive barlow manuver
hip dislocation brought on by adduction of a flexed hip while pushing down on the thigh
symptoms of yeast infection in the breast
pain out of proportion with findings on exam
history of infant oral or diaper candidal infection
maternal vaginal yeast
shiny, flaky nipple skin
risk factors for recurrence of pediatric depression
presence of residual Sx
enviromental stressors
limited social support
DSM diagnostic criteria for ASD
presistant social communication and social interaction deficits
restrictive, repetative behaviors behaviors
symptoms present in early development
symptoms cause clincally signifcant impairment to function
disturbances are not explained by an intellectual disability
treatment of non-severe, low risk MRSA mastitis
dicloxacillin
keflex
clindamycin
misc SIDS risk factors
sex
age
race
FHx
2nd hand smoke
gestational age
boys > girls
most vulerable during the 2nd and 3rd month
black, native american, eskimo increased risk
FHx increases risk
2nd hand smoke increases risk
preature babies have a higher risk
infant benefits of breast feeding
decreased rate of ear infections, respiratory illness, allergies, diarrhea, childhood obesity, SIDS
palmar grasp: duration
28 weeks gestation to 4 months
ways to decrease milk production
stress (inhibits milk let down)
smoking
supplementation with formula
engorgment
36 month milestones
gross: stands on one foot for 2 seconds
fine: copies circle
social: takes turns, toliet trained
language: uses pronouns, gives names
omphalocele
intestines and abdominal organs are formed out side the body
involution
regression and atrophy post lactation
when would you put a patient on a 24 hour hold
when would you refer to psych
if there is imminent risk of suicide
if there is a plan but not imminent risk of suicide
galactokinesis
galactopoiesis
ejection of milk
maintenance of lactation
diastasis recti
separation of the rectus
poplital angle
try to draw leg up to the ear, a preterm baby will allow more extension of the knee
memory issues with FASD
information recall (learning, test taking, directions)
putting things from memory in sequential order
6 topics for a well child visit
- Interval history since last appointment
- Parent concerns
- Child care
- Review medical history
- Review medications / allergies
- Sleep issues
- Dietary issues
- Family risk factors
- Nutrition evaluation
- Anticipatory guidance (aka stuff you teach the parents)
- Immunizations
- Screening labs if indicated
- Developmental and Mental Health
- Fine motor / Gross motor
- Hearing
- Vision
- Dental
positve barlow, ortolani, or hip click lasting more than one month should be referred
true
factors that indicate decreased risk for jaundice after discharge
TSB in the low risk zone
gestational age 41 weeks
exclusive bottle feeding
black
discharge after 72 hrs
treatment of severe mastitis
inpatient IV vancomycin
ortolani manuver
PE of a new born that checks for hips dysplasia
where do boys hit their highest growth velocity
girls
what accounts for this difference
14
12
girls growth plates fuse faster during their growth spurt, boys stay open longer and allow for more gradual growth before the growth spurt
what are the two main periods of increasing length
infant and adolescence
kerion
abscess from a fungal infection
how much weight should a baby gain
15-30 (.5-1 oz) everyday
social development milestones
6
8
12 months
strangers
expoloring+pat a cake
imitation, comes when called
hyperoxia challenge test
giving a neonate with RDS supplmental oxygen resolves cyanosis, indicative of pulmonary or noncardiovascular origin
when should a baby start eating finger foods
7-8 months, or when they can sit up and bring objects to their mouth
presentation vs diagnosis of symptoms in ASD
symptoms usually present in the first 2 years but no diagnosed until age 4
differentiate length vs height
length is laying down
height it standing
gastroschisis
baby’s intestines are out side of the abdominal cavity
root reflex
stroking the cheek will cause the baby to turn their head to ward the stimulus
scarf sign
when the preterm babies arm is pulled across their neck they wont fight
what is the probability that pediatric obestity will progress into adulthood
20% at 4 years
80% at adolescence
factors that can delay progression to stage II lactogenesis
materanl pre-pregnancy obesity
gestational hyertension/preeclampsia
PCOS
retained placenta fragments
pituitary insufficiency (sheehans syndrome)
T/F prenatal alcohol is the leading cause of birth defects and development disabilities
T/F alcohol causes worse neurobehavioral effects than other drugs
true to both
moro (startle) reflex: duration
28wks to 3 onths
gross motor development milestones
rolling
sitting
crawling
4 months
6 months
9 months
capur succeduaneum
swelling of the scap of a neonate brought on by pressure of the being forced out of the vagina
crosses midline
pierre robin
issues with transport and intubation
babies with no lower jaw or very small one, commonly have stridor and tongue obstruction
easiest to transport prone and hard to intubate
comorbid conditions for ODD
ADHD
learning disabilities
mood disorders (depression, bipolar)
anxiety
meconium
the first newborn stool made of epithelium, hair, mucus, bile
what should cause an increased (bad) score on scarf test
obesity, chest wall edema, short humerus, shoulder girdle hypertonicity
key issues for school aged nutrition
getting enough fruit, veggies, calcium, vit d
avoiding junk food
developing a healthy body image
moro (startle) reflex: defined
hold the baby supine, allow a head dropof 1-2 cm. arms will abduct and elbows flex with fingers spread
follwed by adduction with flexion
masitis
incidence
causes
organism
local inflammation of the breast that causes fever, myalgia, pain, firmness
5-10%
ineffective feeding/incomplete emptying, plugged ducts, nipple damage
usually from staph
guidelines for phototherapy in neonatal jaundice
500-1000g
1000-1500g
1500-2500g
>2500g
bilirubin 12-15 mg/dL
15-18
18-20
>20
hyperactive ADHD symptoms
fidgets a lot
leaves seat often
unable to play quietly
talks alot
how much weight should a child gain between age 2 and adolescence
5lbs
PE findings that indicate RDS
cyanosis on room air
RR +60
grunting
sternal and intercostal retractions
T/F parents should fed children snack food if they won’t eat normal food
false, don’t let them eat food with no nutritional value just to get them calories
fine motor milestones
15-18 months
use a spoon and cup
2 block tower
scribbles
what is the most common chronic disease of childhood
dental caries
fine motor development milestones
2 months
3 months
4 months
follow past midline
follow 180 deg
reach with two hands
sideffects of SSRI (pediatric depression)
abdominal pain
diarrhea
nausea
headache
sleep changes
cardiac events
suicidal thoughts
fine motor development milestones
6 months
9 months
12 months
transfer object and raking
immature pincher
matuer pincer
what is the maximum amount of weight loss reccomended for BMI over 95th percentile before age 11
lose 1 lb per month
three parts of pubertal cognitive development
change in secondary sex characteristics and development of reproductive ability
cognitive recognition of the previous
moral determination of right and wrong in shade of grey
galactogogues
two types
medications that can increase milk supply
reglan, fenugreek
treatment for failure to thrive
correct underlying cause (usualyl inadequate intake)
look at social environment for poor eating or learned behavior
how should the ears line up in relation to the eyes
the eye and the ear should be on a horizontal line, if the ear is low set it can be indicative of a chromosomal problem
reasons for inadequate milk production
insufficient breast development (rare)
previous breast surgery (augmentation or reduction)
delay in progression to stage II lactogenesis
maternal drugs that decrease milk production
types of breast milk
colostrum: late pregnancy until 4 days after delivery (antibodies)
transitional milk: day 4-10, lower in protein than colostrum
mature: produced from day 1o through completion of breastfeeding
describe these pictures in terms of infant development
at four months a baby will lay on its back and grasp something at th midline
at 6 months a baby can sit up, listen, see, hear
at 1 year they can stand, talk, and pincer grasp
three reasons why newborns are predisposed to jaundice
increased bilirubin load
increase entreoheaptic recirculation
immature hepatic metabolism
lab tests for obese childten based on BMI 84-94th percentile with and without risk factors (FHx, HTN, high lipd levels, tobacco)
what if BMI is +95th
fasting lipids
fasting lipids with AST, ALT, fasting glucose
same as the ones with risk factors
eye fusing
eyes fused suggested a gestational of 26 weeks
hypospadias
opening of the urethra on the dorsal surface of the glans
categorize these from top to bottom
1 month no head up
2 months about 45 deg
4 months head up and rolling
RDS chest xray
ground glass appearance, hazy, air bronchograms
describe the positive feedback mechanism that regulates milk production
sensory stimulus of suckling triggers a release of prolaction from the anterior pituitary and oxytocin from the posterior pituitary
why is fiber very important for toddler nutrition
prevention of constipation
comorbid condition associated with OCD
other anxiety disorders
tic disorders
depression
ADHD
oppositional defiant disorder
IURG (intrauterine growth restricted)
two types
what does this put them at risk for
assymterical: head too big for their body
what is the most important indicator of gestational age
how accurate is it
posture
accurate with in one week
how will DTRs in an infant appear
brisk, possibly with clonus
how much formula should be given when using formula
2-2.5 oz per lbs in 24 hours
2-3 oz ever 3 hours
4-6 every 3-4 hours
max 32oz at 24 hours before eating solid foods
guidlines for school aged nutrition
consume 3 meals with 2-3 snacks as dicated by appetite, growth, activity
limit grazing
avoid automatic eating
avoid junk food
favor fresh foods
when should you be concerned a baby was not getting fed enough
weight loss beyond 3 days of life
weight loss of >7% of birth weight
failure to regain birthweight by day 10 of life
language development milestones
18 months
2 years
know 5 body parts
2 word sentances, “what”, 50 word vocab
typically difficulties with information processing with FASD
may feign understanding
poor judgement in decision making
don’t ask questions because they want to fit in
BMI in pediatrics is based on the number or their percentile
percentile
progression of cognitive ability associated with adolescents
formal operational thought (development of logic, deduction, planning)
use of abstract thought to consider possible outcomes and consequences
increased self awareness
what is preferred method of infant nutrition
breast feeding up to 6 months, try to main tain for 12 months
ADHD treatment (school aged)
types of medication
start with medication plus behavior therapy
methylphenidate
amphetamine
dextroamphetamine
causes of nipple and breast pain
breast pump use
nipple vasoconstriction from reynauds
engorgment
plugged duct
nipple issues
what causes breast milk jaundice in health infants
what is the treatment
familial tendency
active reabsorption of bilirubin
withhold breast feeding for 24 hours then resume
management of RDS
antenatal steroids
surfactant replacement
CPAP
mechanical ventiliation
ABx
sedation
Dx of OCD
SCARED screen
childrens yale-brown obsessive compulsive scale
infant
birth to one year
AAP reccomendation for TV
no tv before 2, max 2 hrs after 2
signs that infants can hear
at 0-2 months
startle response and blink to sudden noise
calming down with soothing voice or music
neonate PE thorax
symettry, retractions, precordial activity
contour of the abdomen and number of vessels in the cord
intellectual disability involved impairment in what two areas
intellectual ability (IQ <75)
lack of adaptive behaviors (hard time learning but can communicate)
what is the leading cause of morbidity/mortality in adolescents
MVA, frequently involving alcohol or texting
behavior therapy for teachers and parents to implement with ADHD kids
keeping a schedule
keeping distractions to a minimum
having a place for all their things (toys, books, etc)
setting small, reachable goals
rewarding positive behavior)
CNS or neurobehavior deficits related to FAS
head circumference below 10th percentile
clinically significant brain abnormalities observed through imaging
abnormalities in function skills of the CNS
typical onset of OCD
10, but can start as early as 6
acrocynanosis
constriction of small arterioles that leads to cyanosis in the hands
mongolian spots
why is it important to document
skin discoloation
can be mistaken for a bruise and lead someone to think there is abuse
ADHD treatment (pre school)
start with behavior therapy with positive reinforcement
add stimulants if therapy is ineffective
when is a newborn hearing screen done
when should it be repeated
when should signs of hearing loss be assessed
at discharge
at age 4
with each visit
neurochemical etiology of ADHD
deficiency of dopamine and norepinephrine
signs of kernicterus
cerebral palsy
auditory dysfunction
dental enamel dysplasia
paralysis of upward gaze
intellectual handicaps
lanugo
what does it mean in term of prognosis
fine hair on the baby
more lanugo means the baby is more viable
why are newborns predisposed to jaundice due to increased bilirubin load
decreased life span of RBCs
increased RBC volume
small amount of internal bleeding
what is OFC in regards to pediatric growth measurements
what is the concern if it is large
what is the concern if it is small
occipital-frontal circumference
hydrocephalus
poss poor brain development
pathophysiology of FASD
alcohol quickly crosses the placenta
the fetal liver lacks alcohol dehydrogenase or gluthiaone to break down alcohol
amniotic sac holds alcohol
pharmacotherapy treatment for obese children
orlistat (lipase inhibitor) approved for >12 yrs old
neonate PE color
cyanosis of hands an feet is normal, jaundice is abnormal
potential complications of childhood obesity
HTN
dyslipidemia
DMII
sleep apnea
mental health problems
orthro issue
nenonate
less than 4 weeks old
48 month milestones
gross: hops on one foot
fine: wiggles thumb, copies cross
social: dresses self
lanuage: knows colors, asks questions
typical pattern for failure to thrive
decreased weight with normal height and head circumference, progressing to height and head slowing
differentiate between stages of obesity treatment (prevention plus, structured management, comprehensive multidisciplinary, tertiary care)
counselling with emphasis on lifestyle changes
meal planning, exercise, behavior goals with dietician or therapist
multidisciplinary team with weekly meetings
mutlidisciplinary team that might involve medications or surgery
why is sharing difficult to learn at age 3
because children lack empathy to understand that not everything is theirs
baby presents saying hi to receptionist, asking for juice, tries to give her doll a drink, knows her mouth, imitates mother, and knows mama
what age would you expect this child to be
18 months
what can we do to prevent suicide
recognize disrders
screen
anticipatory guidance on drug use, firearms etc
be tehre
reduce stigma of mental healt conditions
polydactyly
multiple fingers and toes
failure to thrive
decline in weight curse by two percentile channels from a previously established rate
TORCH infections
Toxoplasmosis
Other (syphylis, chicken pox, parovirus)
Rubella
Cytomegalovirus
Herpes
comorbid conditions associated with ADHD
any mental, emotional, behavior disorders
behavior issues
anxiety
depression
autism spectrum
tourettes
treatment for engorgement related to breast feeding
empty breast, pump if needed, check latch, take nsaids
kernicterus
at what level of hyperbilirubinemia will this occur
what will it cause
a conditon where bilirubin passes the blood brain barrier
20-25 mg/dL
encephalopathy
facial dysmorphia related to FAS
smooth philitrum
thin vermilion border
small palpebral fissures
micrognathia
epicanthal folds
minor ear abnormalities
treatment for OCD
cognitive behavior therapy
medications (SSRIs, tricyclics)
suck reflex
issues with develipment
when the roof of the babies mouth is touched they wil begin to suck
usually doens;t present until 32 weeks and not fully developed until 36 weeks
lanugo
thin soft hair found on newborns
palmar grasp: defined
newborn closes fingers around object placed in hand
what is acnthosis nigricans indicative of
high levels of insulin
why add 13 or minus 13 from the parental heights when calculating height
it takes into account the genetic potential the mother had or the growth the father experienced before the growth spurt
how long after drinking should breastfeeding be allowed
2 hours after a single drink
what is the economic benefit of breast feeding
saves $1200/yr on formula
lower healthcare issues due to fewer illnesses
fine motor milestones
2 years
3
4
6 block tower
draw circle, clothes off
draw a cross
post mortem finding most consistent with SIDs
intraothoracic petiechiae with mild inflammation and congestion of the respiratory tract
language development milestones
2 months
4 months
6 months
smile
laugh
babble
heel to ear
take both letgs to the ears without lifting the hips off the table, preterm will allow rhis
how long should fruit juice be withheld
whats the maximum amount of fruit juice
should it be put into a bottle
1 year
4oz/day max up to half the daily reccs for fruit
no, only from a cup
what is the issue with fenugreek supplmentation for breast feeding
it can help increase production but it isn’t welll proven
pharmacotheraputic treatment of depression in adolescents
SSRIs are useful and 30% of patients don’t remit after initial treatment
second and third line treatments are available
third line treatment should involve referral
when should toddlers transition from breast milk/whole mile to low fat milk
2
causes of pediatric malnutrition
inadequate intake from eating disorders or limited access
celiac disease
crohns
chonic liver disease
galactosemia
symptoms
inborn error of metablism that leads to accumulation of galactose
failure to thrive, liver dysfunction, mental retardation
treatment for pediatric depression
SSRI/SNRI (fluoxetine)
common issues with breast feeding
inadequate milk supply (most common reason for termination)
nipple or breast pain
breast infections (mastitis/yeast)
maternal medication use
comorbid conditions associated with intellectual disability
CP
epilepsy
ADHD
ASD
depression
specific symptoms of ASD
little to no eye contact
abnormal response when someone tries to get their attention
unusual tone of voice
flat affect
echolalia
extreme focus
hyper/hyposensitive to sensory input
what constitutes a pre term baby
three conditions to be manage
<37 weeks
sepsis, thermoregulation, RDS
how long should depression be treated with SSRIs
why is it important to have adherence
6-12 months
relapse is more common with patients who stop taking drugs once symptoms remit
T/F school and community based suicide prevention programs are effective
false, there is some evidence for school based support
what is the best way to support breastfeeding after birth
skin to skin contact increases breastfeeding by 42.6 days
how much does length increase in the first year
by four years
by 13years
on average how much does high increase between age 2 and teenage years
50%
2x
3x
2” per year
around when will children begin to show imagination
3-5 years
ear tags/ear pits are possibly indicative of what
kidney malformation because they are formed at the same time
what demographics have increased risk of depression
teenage girls and minorities
maternal risk factors for SIDS
younger than 20
smokes
drugs or alcohol
inadequate prenatal care
what is the CDC’s reccomendation on which growth chart to use
WHO growth charts up to 2
CDC/NCHS from 2-19
describe these from top to bottom
rake, thumbs aducted, proximal and distal thumb joints flexed, happens at 6 months
inferior grasp between the thumb and the index finger beginning opposition, 9 months
fine pincher between fingertips, 12 months
general screening questions for suicide
depression
substance abuse
hx of violence, victimization, or witnessing violence
blood gas workup for RDS
high CO2, low O2
common features of fetal alcohol syndrome
craniofacial dysmortpholgy
growth deficits
neurological abnormalities or deficits
what is the most important part of a apgar score
the progression or lack thereof (apgar 4 to 9 is ok, 4 to 4 is worrisome)
four growth parameters to measure
head circumference
length
weight
BMI
questions to ask during a nutritional interview
who buys and makes food
who does feedings
are they on a consistent schedule
aer you offering good portions
do you eat out
special psych risk for post partum women who are having difficulty breast feeding
postpartum depression
incidence in hearing loss in babies
when is intervention most crucial
2-4 out of 1000 babies
intervention is critical before 6 years
etiology of intellectual disability
problems during pregnancy or child birth
genetic conditions
illnesses
injuries
staged approach to treating obesity
prevention plus
structured weight management
comprehensive multidisciplinary
tertiary care intervention
T/F you can have an obese child who is malnourished
true
preventing secondary disabilities associated woith FAS/FASD
get early diagnosis and help
family education
increase supervision in adolescence and early adulthood
proactive adult support and mental health services
what is the lag time in SSRI treatment
4-6 weeks before there is an appreciable effect
clinical course for depression in children
adolescents
most end in 8-13 months with a 30-70% relapse
most end in 4-9 months, 90% within 2 years, 20-70% relapse
treatment for childhood obesity
eat less do more
clincal diagnosis of pediatric anxiety
HP
anxiety screen (screen for anxiety related emotional disorders)
labs
T/F studies show that low to moderate drinking does not cause FAS/FASD
true, but many disorders might not be come evident until after age 5
social development milestones
2
3
4 years
parallel play
group play, sharing, taking turns
associate gender specific categories, competition
pateitn presents tolerating solid food, brings feet to her mouth, being distracted by a mirror and pats her image
which of the following developmental milestones are most typical for in infant whose age is what
A) 2 months
B) 4
C) 6
D) 9
E) 12
c, 6 months. tolerating solid food, placing feet in mouth, and reaching for a mirror while patting the image are all typical 6 onths milestones
depression standardized tools for pediatrics
mood and feelings questionaire
beck depression inventory
child depression inventory (7-17)
reynolds adolescent depression (grades 7-12)
maturity of male genitalia
female
presence of testis, degree of descent, developemtn of rugea on the scrotum
prominence of the clitoris, develpment of labia minora/majora
signs of early phase acute bilirubin encephalopathy
severe jaundice
lethargy
hypotonic
poor nursing
T/F you have to have confirmed prenatal alcohol use to make a diagnosis of FAS
false
pellegra
risk factor
solution
a niacin deficiency
maize based diet
foods rich in protein and whole grains
2-3 month milestones
gross
fine
social
language
gross: lifts head
fine: tracks objects past midline, opens hands
social: smiles responsively
language: vocalizes in play
sheehands syndrome
a loss of pituitary function from episodes of extremely high blood pressure
citalopram is associated with what risk for what (used to treat depression)
long QT syndrome and sudden cardiac death
contributing factors of teenage smoking
low SSE
use or approval from peers/siblings/parents
availabilty and price
no parental support
low self esteem
18-21 month milestones
gross: runs well, kicks ball, walks backwards
fine: scribbles, turns book pages
social: drinks from cup, uses spoon, feeds self
language: follows simple commands, has 20-50 words
why are most others induced at 41-42 weeks
because the placent doesn’t function as well at this point and can injure the baby
environmental contributors to SIDS
side or stomach sleeping
sleeping on a soft surface
cosleeping
big change between school age kids vs toddlers
decrease from 50 to 35% total cals from fat
45-65% carbs less than 10% simple sugar
once suicidal ideation with planning has been identified what is the goal
work with family to address safety issues
removing access to means
constant monitoring
overall management of breast and nipple pain from breast feeding
get a good latch
be aware that is is normal
nurse on the unaffected side first
avoid excess moisture/air dry
psychological etiology of ODD
poor relationship with parents
neglectful or absent parents
difficultly forming social relationships
three phases of acute bilirubin encephalopathy
early, intermediate, advanced
four centers in the brain associated with ADHD
frontal cortex (attention, organization, executive function)
limbic system (emotions)
basal ganglia (inattention, impulsivity)
reticular activating system (inattention, impulsiviity, hyperactivity)
five types of anxiety disorders
generalized anxiety
social anxiety
separation anxiety
OCD
phobias
treatment for parents and care givers
positve reinforcement
be a good role model
pick your battles
set up age appropriate limits with consequences
maintain a life away from your kid
cephalohemotoma
traumatic subperiosteal hemotoma that occurs under the skin
patient presents able tos tand, take a few steps independently, and uses a two finger grasp
what age would you expect this patient to be
12 months
BMI standard for peds
underweight <5%
healthy 5-84%
overweight 85-94%
obese >95%
what is the most common reason why a baby is born prematurely
signs of this
sepsis from infection
cloudy or smelly amniotic fluid
syndactyl
fingers or toes that are attached to each other
what typically causes jaundice ina neonate
infection or hemolytic process
symptoms of ID
deficieits in intellectual functions (language development, reasoning, problem solving, planning, judgement)
deficits in adaptive learning (fails to become independent, limited functioning in daily activities)
what usually preceeds a breast abscess
symptoms
evaluation
treatment
usually preceded by mastitis
breast pain, fever, myalgias, fluctuant, tender mass
evaluate by ultrasound, treat with I&D
what is considered small for gestational age
large
10th percentile or less
90th perctile or more
when do infants develop full color vision
7 months
what nutritional factor will cause a vitamin A deficiency
how can it be resolved
a diet without enough fresh fruit
dark orange fuirt and veggies, yellow corn, dark green veggies
estimate adult height based on parents height for boys
girls
boys: Mom height + 13 + Dad height/2 +-5
girls: mom height + dad height - 13/2 +-5
ankyloglossia
baby born with a short frenulum that limits tongue extension
when will primary teeth erupt
what factors can change this by one month
7 months
gestational age <37 weeks or birthweight <2500g increases that by one month
genetic correlation of ADHD
prevalence
70-80% genetic
5 %
intellectual disability prevalence and gendrer bias
1% have it, 85% of those are mild
males affected more than females
who diagnoses ASD
general practitioner makes initial screen
specialized evaluation by psych, speech pathology, pediatricians
hearing screens or lab tests to rule out other causes
neotnate PE vital signs
HR 120-140 preterm 140-160
heart sounds split s2 normal with no murmurs
RR 40-60
SIDs demographic bias and risk factors
more likley among minorities and low SES
RFs: low birth weight, teen mothers, drug addiction, multiparity, FHx
nonstimulant treatment for ADHD in school aged children
atomexetine (strattera)
buproprion (wellbutrin)
guanfacine
moro reflex
how long is it present
a loud sound will cause the baby to throw back their head, extend their arms, cry, then pull the limbs back in
lasts about 5-6 months
why are newborns predisposed to jaundice due to immature hepatic circulation
decreased bilirubin uptake
decreased conjugation
two ways to gather infromation that will help early recognition of high-risk patterns of weight gain
dietary history
activity log
what is the square window
how sshould this change as the baby gets older
the angle between the palm and the flexor surface of the arm when the hand is flexed
the angle should decreased as gestational age increases
pulmonary air leaks found with meconium aspiration
pneumothorax
pneumomediastinum
pneumopericardium
pulmonary interstitial emphysema
reasons parents should avoid juice
cavities
malnutrition
short stature
perioral rash
diarrhea
GI symptoms
signs of intermediate phase acute bilirubin encephalopathy
stupor
irritability
hypertonia of the neck and back
fever with high pitched cry
treatment of ASD
early treatment is important
involves therapy and medication
social service programs
life style modification
combined presentation of ADHD vs predominantly inattentive or hyperactive
allows for inattentive and impulsive criteria if there are enough present for six months
symptoms of pediatric anxiety
overly tense and uptight
constant fears of safety
refusal to goto school
extreme worries about sleeping away from home
clingy
difficulty sleeping
what would cause a spuriously low (good) score on scarf sign
brachial plexus injury or general hypertonicity
how often should a baby be breastfed
8-12 x in 24 hours in the first month
7-9x 1-2 months
6-8x 2-12 months
DDX for ADHD
age approproate activity
mood disorders
anxiety disorders
ASD
substance abuse
primary disabilities related to FASD
lower IQ
impaired abilites in reading or math
lower level of adaptive functioning
commonly diagnosed with ADHD
T/F phototherapy bleaches the skin and makes jaundice more prominent
false, it makes it harder to see and makes visual assessment of jaundice unreliable
fetal erythroblastosis
hemolytic anemia in the fetus caused by antibody incompatibility between the mother and fetus
reccomendations for HIV breastfeeding
formula in developed countries
breastfeeding in poor countries
what is the function of surfactant
decreases surface tension
maintains functions residual capacty
gross motor development milestones
hops on 1 foot, go down stairs alternating feet
jumps over things
4 years
5 years
when should the transition to cup and utensil feeding happen
as soon as possible
12 month old presents with mom for Well Child Visit.
Mom concerned that baby is smaller than his 9 month old cousin.
Mom is worried she is not feeding him well enough. He drinks 30 ounces of whole milk per day with 3 meals and 3 snacks.
Mom’s height: 5’2 (157cm)
She is the tallest girl in her family, but the men in her family are close to 6 foot tall
Dad’s height: 5’4” (162cm)
He has siblings that are shorter than him
should they be concerned
no, there is a strong possiblity based on CDC charts that the child will just be short
how will the plantar surface of a preterm bbaby look like
preterm will have a more smooth foot
when is autism evident in toddlers
15-18 months, they can’t speak but they can interact by pointing and should want to do that
may also point with a thumb instead of forefinger
fetal alcohol syndrome
mental, physiolofgical, neurological, and behavior birth defects caused solely by expsoure to alcohol during pregnancy
Dx of pediatric depression
HP
PE
mental status exam
labs (CBC, CMP, TSH, Urine)
components of neuromuscular maturity
posture
square window
arm recoil
popliteal angle
scarf sign
heel to ear
treatment for ODD
therapy
medication at trating some of the more severe symptoms
treatment of comorbid conditions
Risks of insufficent feeding
dehydration
elevated bilirubin
re-hospitalizxation
acute renal failure -> shock, sz
social etiology of ODD
poverty
chaotic environment
abuse
neglect
lack of supervision
describe 2/4, 3/4, 4/4 as it relates to language development
2 yeasr should be 50% intelligible language
3 years is 75%
4 years is 100% intelligible
how many vessesls hould be in the umbilical cord
two veins and one artery
what is fetal alcohol specturm disorder
the rangle of effects that can occur in an individual who is exposd to alcohol during the nine month prenatal period before birth
T/F childten may up to 10% of their birth weight
what would you expect to happen at week 2
true
they shuld have gained their weight back
OCD cycle
obesseion, anxiety, compulsions, relief
sensory integration issues with FASD
strategies to overcome
overly sensitive to stimulus, problems with kinesthetic awareness, loss of social cue recogition
simplifiy environment, take steps to avoid sensory triggers, OT/PT interventions
what demographics are most likely to be obese
hispanic boys and black females
fine motor milestones
4.5
5
draw square, clothes on, buttons, catch ball
tie shoes
do exercise or contraception have an effect on lactation
little if any
what makes breast milk superior nutritionally to formula
contains a species specific amount of fat, sugar, and minerals
antibodies
changes to adapt to what the baby needs
protoIMPERATIVE vs protoDECLARATIVE
at 15 months they can’t speak but they can point to what they want (imperitive)
18 months can point something out as interesting (declaritive)
myths about alcohol and FASD
less than one drink a day is ok
drinking late in pregnancy is ok
drinking is good for breastfeeding
the health benefits of red wine make it ok
FASD is curable
5 yr milestones
skips using alternating feet
fine: holds a pencil correctly
social: brushes teeth without help
language: easily carries convestaion, counts, does ABCs
treatment for breast feeding jaundice
nursing as soon as possible after delivery
frequent nursing for the first few days
do no limit nursing time
problems that can least to milk extraction issues
insufficient nursing and poor feeding schedule
problems with latch
ankyloglossia
treatment for anxiety
therapy (cognitive behavioral therapy)
medications (SSRI)
language development milestones
3 years
4 years
5 years
3 word sentances, why, temporal orientation, 250 words
4 colors, songs or poems from memory
print first name
how do you know if a baby is breastfeeding well
are they gaining weight
content/active/alert
wet or dirty diapers regularly
specialized tests for diagnosing intellectual disability
genetic testing
brain imaging (micro/macrocephaly)
metabolic screen
gross motor development milestones
cruising
walking
walking backward
running
10-11 months
12 months
15 months
18 months
questions to ask if you think there is a suicide risk
content, nature, chronicity of thoughts
planning
details of the plan
hallmark features of ASD
altered communiations/interactions with others
repetitive movements
restricted interests
all these symptoms interfere with functioning at home/school/etc
scurvy
risks
solution
vitamin C defiency
diet without fresh fruit and a low fat intake
more fruit, veggies, liver, animal milk
positive ortolani
dislocation of the hip by abducting the thigh that will elict a clunk or a spasm
treatment of mastitis
nsaids, cold compressess
continue breast feeding
ABx
conditions sequelae to pediatric malnutrition
illness
stunted growth
hyperactivity
aggression
anxiety
mental disabilities
how to estimate adult heigh based on height at age 2
take the height and double it
three most common causes of hyperbilirubinemia in infants
physiologic jaundice, prematurity, breastfeeding jaundice
how many women start breast feeding
how many continue breast feeding until 6 months
81%
50%
risk factors for OCD
family Hx
stress
prevalence of ODD
gender, age, SE bias
up to 16%
no gender or SE bias
cognitive difficulties for a person with FASD
taking and retaining infrmation (sensory integration)
recollection
using informaiton in a specific situation
what would abnormal red reflex indicate
glaucoma or cataracts
goals of a well child check
assess growth and development
identify problems to provide education and early intervention
teach parents childcare and parent care
Suicide-Screening Questionare questions
- In the past few weeks, have you wished you were dead?
- In the past few weeks, have you felt that you or your family would be better off if you were dead?
- In the past week, have you been having thoughts about killing yourself?
- Have you ever tried to kill yourself?
what is the calorie need of toddlers
how much of that is fat
1000, half from fat
lab tests for suicide attempts
toxicology screen
pregnancy test
drug and alcohol screen
test for medical conditions that can lead to psychiatric disorders (thyroid, SLE, IBS)
measurements and observations to help dectect pediatric obesity
plot trend on ht, wt, bmi
blood pressure
note on adiposity
labs
signs of satiety after breast feeding
relaxation of arms and elgs
eyes close
falling asleep
specific causes that lead to failure to thrive
lack of appetite (anemia, CNS issues)
difficulty swallowing
unable to get food
vomitting
malabsorption
diarrhea
inadequate absorption of calories
increased metabolism
grasp reflex
how long is this present
stroking the palm causes the babies hand to close
5-6 months
why would SSRI treatment be considered for longer than 6-12 months
if the depression episode includes psychosis, suicidal behavior or ideation, functional impairment, resistance to treatment, previous failure to reduce medication
reccomdations for infant cereal
baby food
start with 1-2 teaspons of a single grain cereal mixed with breast milk, formula, or water, then advance to 1-2 table spoons twice daily
give a new food each day, start with 1 tsp working up to a full jar
PANDAs related to strep
some patients don’t show signs of OCD until they have a strep infection
decreased conjugation of bilirubin in neonates is related to wha conditions
physiologic jaundice
gilbery syndrome
crigler-najar syndrome
what are the effects of ethanol/acetaldehyde in FASD
disrupt cell differentiation
DNA and protein synthesis
inhibition of cell migration
altered fat/protein/carb metabolism
decrease movement of amino acids, protein, folic acid, minerals across the placenta
CDC criteria for diagnosis of FAS.
how amany are needed for diagnosis
facial dysmorphia
growth deficits
CNS abnormalities or behavior deficits
all three
what constitutes a term baby
four conditions to manage
37-42 weeks
sepsis, pneumonia, birth asphyxia, meconium aspiration
how long should a baby get back to birth weight after birth
when should they have doubled their weight
tripled
quadrupled
2 weeks
4 months
1 year
2 years
post term baby
two conditions to manage
>42 weeks
asphyxia related complications and sepsis
common diseases that are NOT contraindications for breastfeeding
HepB (if the infant is immunized at delivery)
HepC
maternal fever
chorioamnioitis
materanl CMV if the baby is term and mother hasnt converted
risk factors for development of hyperbilirubinemia in infants older than 35 weeks gestation
predischarge TSB in the high risk zone
jaundice in the first 24 hours
blood group incompatibility
known hemolytic disease
gestational age 35-36 weeks
treatment of non-severe, moderate MRSA mastitis
trimetoprim-sulfamethoxazole
clindamycin
increased risk factors for RDS
prematurity
male
familial dispositon
c section
chorioamnionitis
hydrops
maternal diabetes
two causes of neonatal jaundice
excess production of bilirubin
decreased rate of conjugation
what is the gender bias in ADHD
how do they present differently
males more than females
men more hyperactive
women more inattentive
T/F the use of homephototherapy or sunlight exposure in the treatment of jaundice in neonates is effective
false, it is reserved for those with optional phototherapy needs or excluded all together as a theraputic tool (sunlight)
what are the gender or racial bias of pediatric OCD
none in either category
the five steps of lactation physiology
mammaogenesis
lactogenesis
galactokinesis
galactopoiesis
involution
secondary disabilities associated with FAS/FASD
mental health issues
school issues
trouble with the law
inappropriate sexual behavior
substance abuse
what is the peak time for SIDs
2-4 months in age, between 12am and 8 am
diagnostic conditions for ADHD
6+ symptoms under 16, 5+ symptoms over 17
present for at least 6 months
symptoms inappropriate or disruptive
symptoms are present in two or more settings
clear evidence that the symptoms interfere with social functioning
symptoms are not better explained by another condition (anxiety, dissociative disorder, schizophrenia)
stragegies to deal with executive functioning in FASD
use short term consequences
establish achievable goals
provide skill training that uses role play
how many/how long symptoms need to be present to diagnose ODD
>4 symptoms for >6months
DDx for OCD
depression
bipolar
eating disorders
body dysmorphic disorder
hoarding disorder
symptoms of pediatric depression
depressed
decreased interest
change in appetite weight
sleep issues
psychomotor agitiation or retardation
fatigue
risks of meconium aspiration
air leak of ball valving (atelectasis, pneumothorax)
chemical pneumonitis
pulmonary HTN
T/F abnormal flucuations in appetite are abnormal
false, they are normal and should be expected
comorbid consitions for depression related to CV issues
diabetes
obesity
sedentary lifestyle
smoking
management of meconium aspiration
pulmonary toliet
umbilical lines
oxygen monitoring with mechanical ventilation
chest xray to rule out air leaks
ABx
surfactant
ECMO
forms for ADHD
vanderbitl form
conners scale
long term maternal benefits of breastfeeding
reduced risk of breast and ovarian cancer
decreased risk of CV disease, HTN, hyperlipidemia
decreased risk of DM II
drugs that can decrease milk production
decongestants, antihistamines
pulmonary causes of respiratory distress
choanal atresia
transient tachypnea ofthe newborn
fluid aspiration (blood or meconium)
hyaline membrane disease
congenital pnemonia from rectal flora
two conditions that might cause surfactant deficiency
prematurity
infant of a diabetic mother
signs that infants can hear
2-3 months
change in body movements in response to sound
change in facial expression to familiar sounds
