Peds Health Supervision Flashcards
FTT
Less than 2nd percentile weight
Weight down first, then length, then head circ
Expected weight increases
Birth-3 mo: 30g/day, regain bw by 2 weeks 3-6 mo: 20g/day, double bw by 4-6 mo 6-12 mo: 10g/day, triple bw by 12 mo 1-2 years: 250g/month 2-adolescence: 2.3 kg/year
Expected height increases
0-12 mo: 25 cm/ year, BL up by 50% at 1 year
13-24 mo: 12.5 cm/year
2yrs-adolesence- 6.25 cm/ year, birth length 2x by age 4, 3x by 13
FTT etiologies
Inorganic (disturbed parent/child bond), MOST COMMOn
Organic = underlying pathology/chromo systemic illness
Eval of FTT
hx/pe, diet hx, obs, routine tests NOT useful, focused lab eval. Look for IUGR vs. postnatal.
Head growth abnormal
Almost all head growth prental, during first 2 years. At birth 25% of adult head, 75% adult by 1 year age. cephalohematoma can screw up head circ measure
Expected head circ increase
0-2 mo- .5 cm/wk
2-6 mo- .25 cm/ wk
by 1 year, 12 cm increase since birth!
Inorganic FTT?
Bad formula, bad feeding, neglect, young mom/sad mom, alcohol/drugs, marital discord, mental illness, fam violence, poverty, isolation
Microcephaly
Head cir 2-3 STDs below mean, incidence 1-2/1000
congen = abnormal induction/migration of brain tissue
acquired = cerebral insult in late third tri/perinatal/first year. head stops growing too soon
clin fx= SMALL brain! developmental delay/intellectual impair/CP/seizures
Craniosynostosis
Premature closure of 1+ sutures
Why? unknown/sporadic 80-90%, few = genetic syndrome (Crouzon/Apert), or IU constraint, hyperthy or hypercalcemia
Clin fx- normal sutures open until brain growht stops…90% done at 2, done at 5. Head shape depend on which suture closes early.
dx = phys exam, by 6 months noted, confirm w/ head CT + skull XR
MGMT = surgical repair, esp for cosmetics
Which suture closes early?
Sag suture => elongated skull (dolicho/scaphoceph) = most common
Coronal suture => shortened skull (brachyceph), bos, neuro complications like optic nerve atrophy
Metopic suture => hey arnold! trignocephaly
Multiple sutures => severe neuro compromise
Organic FTT
Think about all of the systems. Many infectious diseases, naemia, kidney failure, GI abnormalities, immunodef, etc
Plagiocephaly
Asymmetry not assoc with suture closure. Positional plagio = flattened occiput + prominence of ipsi frontal area, skull = parallelogram
Assoc w/ congen musc torticollis, increased b/c infants told to sleep on backs
MGMT = ROM exercise for torticolis, tummy time, helment, reposition head
Macroceph
head circ > 95%, not necessariily big brain
Why? Familial, overgrowth sotos syndrome, mets issues (canavan/gangliosidoses), NFM, achondroplasia, hydroceph, SOL (tumor)
Eval- measure parents heads, obs for bulging fontanelle/vom/irritable/split sutures b/c ICP concern. R/o hydroceph w/ CT/head u/s. genetic eval maybe
Active immunization
Live vaccine = more likely long-lasting immunity, avoid if immunocomp. Varicella, oral polio, MMR
Non-live: not infectious, need boosters- DTaP, hep A and B, IPV, HIB, flu, pneumococ/meningococ
Passive immunization
Delivery of preformed abs if no active immunity…
VZIG for immunocomp pts, newborns to hepB+ mommas get HBIG. Travel to high risk area, HepAIG
HBV
Hep B hits 300 mil worldwide, give as recombo vaccine in us with HBsAg. 3 shots in first year of life
DTaP
Diph, tet, pertussis, inactivated vaccine. DTP = whole cell bordetella, now replaced w/ DTaP w/ acellular bits, less s/e. Give at 2,4,6, mo w/ boost at 12-18 mo and 4-6 yrs. dT = 1/10 dose of dipth toxoid, give at 11-12 years and ever 10 years after. dT not DTaP if >= 7 y/o
OPV/IPV
OPV = good b/c host immunity + secondary (comes out in stool, may immunize others), but maybe => polio IPV = subq/IM, give at 2 and 4 mo, boost 6-18 mo and 4-6 years
HIB
H flu => invasive bac infection, meningitis, epiglot, sepsis before vaccine
Conjugate vaccine- h flu polysach + protein antigens (diph toxoid/tetanus). Give at 2,4,6 mo w/ 12-15 mo boos, or 2,4,12 (dep on conjugate)
MMR
Measles = pneumonia+ mortality, mumps = parotitis + meningoenceph + orchitis. Rubella = mild viral, but birth defects
Live attenated, give at 12-15 mo w/ boost at 4-6 years or 11-12 years
Varicella
Chicken pox! Severe in very young/old. Live attenu, give at 12-18 mo
Hep A
Most common viral hep, though 70% asx, severe in older kids/adults, rare fulm hep
Inactive, give at 2 y/o or older, boost 6 mo later if high incidence in area or risk fx (liver, homo sexula/bisexual, IVD, clotting factor/blood products, occupational)
Pneumococcal vaccine (Pneumovax/Prevnarr)
Most common cause of OM/invasive bacterial if younger than 3
Pneumovax = polysach antigen from 23 serotypes, cover everything, but little immunogen under 2 y/o, use for older kids/adults w/ high risk (aspelnic ppl, Chronic Liver, immuno def, nephrotic snydnrome)
Prevnar = 7 serotypes, immunogenic in kids under two, not as broad, give it to all kids under 2, some kids older, 2,4,6, mo and 12-15 booster
Why immunizations bad?
Most s/e mild/mod, local inflamm/low-grade. MMR/Varicella might => fever/rash 1-2 weeks post shot, serious s/e RARE.
DONT give if…anaphylaxis, encephalo within 1 week of DTaP, pts w/ progressive neuro disorders shouldnt get dTaP,
Immunodef? no give live guys
Precautions for immunizations
Be careful givin shots w/ mod/severe illness.
w/ DTaP, careful if temp of 40.5, collapse/shocklike, or inconsolable crying for > 3 hour within 48 hours, seizures within 3 days
Hearing screening
Universal newborn hearing screening b/c hearing loss => impaired language
Brainstem aud evoked response measures EEG waves in response to clicks, most accurate but $$
Evoked otoacoustic emission measures sound made by choclear cells detected by microphone in external aud canal…may be messed up by debris/fluid
Most effective = use both tests
Metabolic Screening
all states screen hypothy, PKU, many do galactosemia
Sickle cell + other hemoglob issues- penicillin prophylaxis => down mort/morbid
Some states do CAH too
Cholesterol/Lipid Screen?
Not recommended for routine. IF kids > 2 have fam hx, do cholesterol if either parent w/ hyperchol, or fasting lipid if either parents/gpas have hx of CVD or sudden death < 55 y/o
kids with elevated chol 75-90th percentile do fasting LP with total chol, tg, HDL, LDL
Iron Def Anemia screen
Most common under 6 y/o, peak 9-15 mo, risks = premature, low bw, early cows milk pre 9 mo, insufficient diet iron, low SES
Universal hb screen at 9-15 mo and 4-6 years
UA- recc by some docs, but lil evidence. only if school needs it
TB Screen
For at risk kids- contacts w/ tb or high risk (jail, insitutionalized, HIV, homeless, IVD). For kids w/ XR findings, immigration, HIV, high prev areas
Skin test analyzed 48-72 hrs after plaement, interpret on basis of level for risk
Lead Toxicity
Plumbism = risk for kids arex, apathy, lethargy, amemia, irritable, vom, maybe enceh
Chronic => asx, maybe neuro isues (delay, mr, learning probs)
Lead Screen
For all kids 9mo-6years in old housing, for same age kids w/ contacts who are intoxicated w/ lead, same age if near smelters, any age kids w/ old house being renovated, all kids if >12% 1-2y/o with elevated lead
Lead levels <10ug/dL still bad, MGMT based on levels, decrease exposure, chelate if very high
Circumcise
60% males circ, unclear health benefits, maybe good for penile cancer/cervical cancer, not recommended. UTI more common in uncirc. 10% uncirc eventually need it for Phimosis (normal up to age 6, can’t retract foreskin), or paraphimosis- retracted skin gets stuck and tourniquets, or balanitis- inflamm of penis glans (candida or g neg infections or STI)
Use anesthesia/analgesia in circ, can have bleeding compx, phimosis or injury, dont do it w/ penile abnormal/prematurity or bleeding diatheses
Tooth eruption
Inital between 3-16 mo, avg 6 mo, usually lower central incisor first
20 primary teeth by age 2, secondary eruption w/ lower incisor between 6-8, 32 teeth
Delayed eruption if after 16 mo, familiar, hypothy, hypopit, genetics like downs/ectodermal dysplasia (con teeth, less sweat glands)
Early teeth = before 3 mo- familia, hyperthy, precocious pub, growth hormone too much
Dental Hygiene
Brush as soon as teeth erupt, at 2-3 years kiddos can help, use floss, get fluoride, but too much = flurosis, abnormal brown-gray fugly teeth. vulnerable at 2-4 years. Make sure you give fluoride fi kids are only getting bf, or kids with bad tap water
Dental weird things
Natal teeth = at birth they’re there! Neonatal = in first month! Most common = mandibu central incisors, more than 90% erupt early. Why = unclear, mgmt = nbd unless teeth are hypermobile, cause bf issues or trauma to baby’s tongue. aspiration risk pretty low
Nursing/bottle caries
3-6% kids, often at 2-30 mo age, especially if fall asleep w/ nipple in mouth or kids that carry around bottle, or any other liquid given. Strepto mutans = most common agent. Max incisors, canines, primary molars. MGMT = dental crowns/extraction
Dental Trauma
Perm tooth that is avulsed can be reimplanted if you place it back quick! Extraoral time = biggest prog factor, best if avulsed tooth kept in milk (WEIRD), dry tooth doesnt do so hot. Avulsed primary teeth just leave em
Feeding schedule
Newborm= on demand 8-12x/day for 4-6 weeks
2 mo- feed every 3-4 hours
4 mo- 4-5 hours
6 mo- feedings spaced out!
