PEDS exam 1 Flashcards
Why shouldn’t an infant drink water?
- Can cause fullness so baby doesn’t drink milk and will be nutrient deficient
- can cause electrolyte imbalances (leading to potential seizure)
what is the correct way to measure length in an infant?
- infant should should lay supine, fully extend body holding head in midline, grasping knees together gently and pushing down on the knees
- top of head to heels of feet (feet with toes pointing towards ceiling)
How to weigh an infant?
• Use an infant scale
• Balance the scale before each weight (with clean sheet of paper)
• Infant should be weighed NUDE (diaper off) and in a lying position
-We need to measure exactly to the OUNCE
What is typically included in an infant well child visit?
o Height, weight, head circumference and plotting o Vital signs o Developmental screening o Nutritional assessment o Physical examination o Anticipatory guidance o Immunizations
How to obtain head circumference for an infant?
- Measure the head at its greatest circumference (usually slightly above the eyebrows and pinna of the ears and around the occipital prominence at the back of the skull)
- Repeat measurement for accuracy
Until what age do we measure head circumference?
from birth to 3 years
Why do we measure head circumference in infants and toddlers?
To make sure the skull and brain are growing adequately
All growth in brain occurs during what time frame?
birth to 3 years
Between birth to 6 months, what is the AVG weight gain?
5-7 oz/week
At what age should an infant’s birth weight be doubled?
by 5-6 months
Best way to take an infants temp?
axillary (rectal is more accurate but not necessary!)
Between birth to 6 months, what is the AVG head circumference growth?
1.5cm increase per month
Between 6 months to 1 yr, what is the AVG weight gain?
3-5 oz/week
At what age should an infant’s birth weight be tripled?
by 1 year
Between 6 months to 1 yr, what is the AVG height growth?
1/2 inch/month
Between birth to 6 months, what is the AVG height growth?
1 inch/month
Correct way to measure an infants temp?
o Place tip under arm in center of axilla and keep close to skin (not clothing); hold infant’s arm firmly against side
Normal axillary temp in an infant
99-99.7f
How to take heart rate in an infant?
- Apically
- Heard through the stethoscope held to the chest at the apex of the heart (4th intercostal space midclavicular); count the pulse for 1 full minute because of irregularities
Normal heart rate in an infant
80-150 (up to 200 with excitement/fever)
normal respiratory rate in an infant
24-50
How to measure RR in an infant?
o Observe ABDOMINAL movements; count for 1 full minute due to irregular respirations
what is the most widely used developmental screening tool?
The Denver II test
What is the Denver II test?
4 areas of focus are: Gross Motor, Language, Fine Motor and Personal-Social. (from birth to 6 yrs)
• The examiner should be trained by a master instructor
• In general: Mostly used to screen for developmental delays
• Child is expected to perform every item to the left of the line and items that intersect the line that are in the 75-90th % (shaded box)
• The best source of info about child is the PARENT(S)
what happens to BP, HR, and RR as kids get older?
BP: increases
RR: decreases
HR: decreases
developmental milestones for a 1 month old?
• 1 month: can turn head from side to side, grasp reflex is strong, follows to midline, makes comfort sounds during feeding
developmental milestones for a 2 month old?
• 2 months: when prone can lift head to 45 degrees, hands often open, when supine follows to beyond midline, gurgles, holds placed rattle, smiles spontaneously
developmental milestones for a 4 month old?
• 4 months: raises head and chest with arm support, sits head steady, inspects and plays with hand, reaches and grasps rattle, makes consonant sounds “b” , watches hand, calms when spoken to/picked up/sucking/or looking, self-soothes to sleep
developmental milestones for a 6 month old?
• 6 months: primitive refelxes GONE! no head lag, pulls to sit and sits tripod, holds bottle, reaches and shakes rattle, passes cube, looks for yarn, will turn head to side when hears voice, imitates sounds, babbles, LAUGHS, shows interest in other infants, **foot to mouth when supine
developmental milestones for a 9 month old?
• 9 months: postural reflexes present, ROLLS BOTH WAYS, sits well- no support, raking pincer grasp (touches cheerio w/ finger), bangs two cubes together, understands no, may say “Mama”, “Dada”, waves bye bye
developmental milestones for a 12 month old?
• 12 months: crawls, pulls to stand, stands alone, walks with help, can sit down from standing position, puts block in a cup, pincer grasp, can turn pages in a book, holds bottle, says 1 word other than mama and dada understands simple commands, waves bye bye, uses “cause and effect toys”
AAP recommends that women breastfeed exclusively for how long?
first 6 months at least
AAP
american academy of pediatrics
recommended breast milk or formula for a NEWBORN TO 3 MONTH OLD
1-6 oz every 2-4 hours (varies with age and weight)
recommended breast milk or formula for a 4 TO 6 MONTH OLD
6-8 oz every 4-6 hours
recommended breast milk or formula for a 7 TO 11 MONTH OLD
6-8 oz every 6-8 hours (with a maximum of 32 oz per day
infants should stay away from cow’s milk until what age?
at least 1 year
Rules about mixing water with baby formula
- Can be mixed with tap water (or bottled water)
- Use only COLD H20 from tap & run tap for 2 minutes before using (minimizes lead)
- Must refrigerate formula once mixed (decreases bacteria)
- Formula that baby does not drink (left in the bottle) must be discarded (bacteria)
- To minimize waste, parents should prepare only as much as infant will consume
Why is it recommended to mix fruit with iron-fortified baby cereal?
vitamin C helps the iron absorb
when does a baby start to produce tears?
after 3 months
when does the posterior fontanel close?
by 2 months
when does the anterior fontanel close?
by 12-18 months
Approx how many teeth should an infant have by 1 year?
4-8 teeth
It’s normal for an infant to appear bowed until…?
until lower back and leg muscles are well-developed (usually until they are actively crawling and walking)
-Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African American children.
How can we check for dislocated hips in an infant?
look for uneven gluteal folds or do Ortolani’s test and listen for click/clunk (infants feel no pain during this test)
foreskin in infant boys is not retractable until what age?
until 1-2 years of age
babies are obligate nose breathers until what age?
~5 months
Between birth to 3 months of age, how much should a baby sleep?
10-16 hr/day
Between 3 to 6 months, how much should a baby sleep?
14 hrs/day
Between 6 to 12 months, how much should a baby sleep?
12-14 hours/day
name two methods to help with teething pain
cool objects and tyelenol
3 indications of an infant’s mental health
- good growth & development
- child & parents interactions (eye contact, secure holding & cuddling, comforting)
- Infant’s ability to self-comfort
How often is tummy time recommended for infants?
Parents should do it after every time they change a diaper for 5-10 minutes
What is the recommended at home mngt post immunizations?
o Mild pain/fever: analgesic (acetaminophen)
o Local redness and swelling: ice/benadryl
o Fever for more than 3 days; or high fevers (105 or >), or high-pitched cry, or seizures: are RARE side effects and need immediate medical mngt (these are very rare, they happen in 1 out of 3 million children but are still possible)
how long is required by law that a child should be in a rear-facing car seat? How long does AAP recommend?
law: until 1 year
AAP: until 2 years
At what age do you start to measure a child’s BMI?
2 years
Normal heart rate range for toddler
70-110
Normal respiration rate for toddler
20-30
Normal temp for toddler
99F
Normal BP for toddler
90-105SBP/55-70DBP
Normal growth for a toddler
3 inches per year (4-6 lbs/year)
What is the leading cause of death in 1 to 4 year olds
unintentional injury
_______ is the leading cause of injury death in toddlers
motor vehicle injury
What are some causes of developmental delays in children?
- Genetic syndromes
- Prematurity
- Perinatal infections/toxin exposures (fetal alcohol syndrome)/hypoxia
- Hypoxia during delivery
- Vision impairments
- Hearing impairments
- Lead exposure
On average, an 18-month-old can speak how many words?
15 words
On average, a 24-month-old can speak how many words?
50 words or more
Developmental milestones for 4 years old
hops, speech all understandable with complete sentences, follows 3-step commands, copy cross, draw person 2-4 parts, brush teeth no help, dress no help, can count 4 objects, walks down stairs alternating feet, walks backward, indicates need to void, complex sentences/jokes/teasing, creates imaginary roles, preferred friend, offers sympathy to peers
Developmental milestones for 3 years old
pedals tricycle, broad jump, 3 to 4 word sentences, follows 2-step commands, speech 75% understandable, build tower of 10 cubes, thumb wiggle, imitates horizontal line, put on T shirt, uses spoon and fork well and drinks from open cup,
Developmental milestones for 2 years old
walks up and downstairs WITHOUT help, can kick a ball forward, builds tower 6 cubes, feeds doll, names 1 picture, says about **50 words or more, uses 2 word phrases, uses pronouns “I”, “me”, PARALLEL PLAY, brush teeth with help, helps dress , uses SPOON to self feed, speech is 50% intelligible
Developmental milestones for 18 months
WALKS ALONE, walks up and down stairs holding on, runs, builds tower of 2-3 cubes, says **15 or more words, scribbles, self feeds (fingers), follows one step commands, points to 6 body parts
Why can too much milk be bad for toddlers?
Can cause them to be iron deficient (too much calcium doesn’t allow the iron to be absorbed)
At what age can kids start to drink cow’s milk?
1 year
At what age can kids start to drink water
6 months
Do toddlers need more or less calories than infants?
Less!
How much milk per day is recommended for toddlers?
No more than 2 cups
How many calories do preschoolers need in a day?
Preschoolers need 90 cal/kg: average 1800 cal/day
Primary dentition should be completed by what age
30 months
how much sleep per day is healthy for a toddler?
8-13 hours
toddler age
1-3 years
preschooler age
3-6 years
Avg age for potty training?
Boys: 2.5-3yrs
Girls: 2-2.5yrs
lead paint was banned in what year
1978
at what age can we start teaching kids about dialing 911?
preschool age (starting at age 3)
1 gm of wet diaper equals ___ ml of urine
1 ml
avg urine output for children
1-2mg/kg/hr
what is the antidote for acetaminophen?
mucomyst
pediatric dose of acetaminophen
10-15mg/kg/dose (q4-6hrs)
at what age can kids stat to be able to swallow pills and capsules?
5 years old
proper eye medication administration for toddler
gently press lower lid down and have the child look up as the drop is instilled into the lower conjunctival sac.
Proper ear medication administration for toddler
pull pinna down and back (3yo)
proper nasal drop administration for toddler
hyperextend the head and place the tip of the dropper just at the nasal opening
proper nasal spray administration for toddler
upright position, place tip of spray bottle just inside the nasal opening and squeeze container
Avg heart rate for school age child
60-110
avg respiration rate for school age child
20-25
avg temp for a school age child
98-98.5
avg BP for school age child
SBP 95 – 110 / DBP60 – 75
Avg growth for school age child
2.5 inches/year and 7 lbs/year
Developmental milestones for 5 year old
• 5 years old: catches ball, skips, balance on one foot 10 seconds, names 4 colors, recalls parts of a story, counts 10 blocks, copy square, draws 10-part person, play board games, speech 100% intelligible, washes and dries hands thoroughly
Physical assessment for school age child
- ***Explain what’s going to be done before it’s done
- Respect need for privacy
- Talk to child during exam and explain findings
- Use words child will understand
- Proceed from head – to – toe
- Permanent teeth begin to come in
- Assess for scoliosis
- Begin to see secondary sex characteristics (Also need to look at Tanner stages)
amt of sleep needed for school age child
8-12 hrs (depending on child and activity level)
most children loose their first tooth at what age?
6 years old
how is “overweight” categorized in a child?
85-95 BMI percentile
how is “obese” categorized in a child?
95 or higher BMI percentile
how is “healthy weight” categorized in a child?
5-85% BMI
Overweight children are at higher risk for developing:
o Diabetes Mellitus Type 2 o Hypertension o Asthma o Obstructive sleep apnea o Non-alcoholic liver disease o Early puberty or menstruation o Anorexia/bulimia o Depression o Low self esteem o anxiety
the most predictive indicator of childhood obesity is:
parental obesity
To sit in a regular car seat with lap belt and shoulder seat belt, you must be how tall?
at least 4’9”
kids over ____lbs should use a belt positioning forward facing booster seat located in back seat
40lbs (4-8 years old)
for kids, height is taking laying down until typically what age?
2 years
What is the earliest age at which a satisfactory radial pulse can be taken in children?
2 years
-Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children, the apical pulse is more reliable.
