Peds: Infant Health & Issues

Question 1

Infant Health Assessment:
Stage Appropriate Screening
newborn - 1 to 2 mos
infancy- 1 mos to 12 yrs

Answer 1

• *well child checks (WCC)- for age 2 weeks to 1 yr @ ( 2 wks, then 2, 4, 6, 9, & 12 mos);
• *if d/c from hospital prior to 48 hrs- 1st visit should be 3-5 days;
• *interview - hx, problems since last visit, immuniz, injury prevention, guidance;
• *physical exam- assess wt, length, head circum (up to age 2);
• *TB (based on risk);
• *Developmental Screening (Denver < 6 yrs of age);
• *Bili (if indicated);
• *HCT (between 6, 9, & 12 mos unless otherwise indicated)

Question 2

Infant Health Assessment: Physical Exam Elements

Answer 2

• • wt, length, head circum;
• *growth chart- sequential measurements;
• *dental development- tooth eruption (6-7.5 mos), fissures (vit def- cheilosis), symmetrical tonsils (asym- abscess);
• *voice-nasal/voice quality (high pitch- Edwards, ICP);
• *vitals;
• *head-size/shape/fontanels, control- by 4 mos, no head lad when pulled to sitting postiion - 6 mos (may indicate palsy if present);
• *neck- masses;
• *periorbital dedema (CV), heart sounds;
• *flattened/flaring nose-Downs/respiratory status; chest-gynecomastia/galactorhea up to 3 mos (maternal hormones); chest wall, diaph. breathers,
• *skin variations;
• *nasal discharge;
• *hip dysplasia- Barlow’s/Ortolani’s sign, Alli’s sign- (unequal leg length), Galeazzi’s sign- unequal knee length, skin fold- asymmetry (dislocation); scoliosis;
• *lymph nodes- 1 cm inguinal and 2 cm cervical (enlargement may be normal), shotty nodes- past infection, supraclavicular nodes- requires further investigation

Question 3

Infant Health Assessment: Development Monitoring

Answer 3

• *visual acuity- blink reflex & pupil constriction (indicate newborn vision);
• *hearing- high risk infants, loss of 20-30 decibels (indicate hearing loss);
• *sensorimotor- adapts to environ,, simple problem solving;
• *psychosocial- temperaments (easy, slow to warm, difficult/cycles), fears (strangers by 6 mos, separation by 8 mos), attachment (bond develops 1sst year and diffs to emotions later)- secure/insecure (insecure detachment issues- avoidance, anxiety, disorganization)’
• *warning signs of development- not raise head by 3 mos, not pick up items by 6 mos, no reaction to voice/noise, no laugh, no sitting up, no interest in interpersonal contact, visual delay

Question 4

Infant Health Assessment: Anticipatory Guidance

Answer 4

• *breast/bottle feeding, weaning, introduction of new foods, monitor for allergies, supplementation of vitamins;
• *dental health- brushing, fluoride, cleaning schedule (1st visit by 12 mos), bottle tooth decay;
• *sleep- 2mos to 12 mos- sleep 8-12 hrs/night, 2-3 naps daily, avoid sleeping with infant, do not pick up during night after night feedings

Question 5

Infant Health Assessment: Fever (1st 2 mos of life)

Answer 5

• *rectal > 100.4 F (38 C) indicates fever;
• *very young- temp subnormal with infection- unable to thermoregulate;
• • temp > 101.8 F (38.9 C)- serious bacterial infection;
• *40% occur in infants < 4 wks of age;
• *40% result from viral infection;
• *common bacterial infections- 1st mos- Group B strep and gram-neg organisms; 2nd mos- S. pneumoniae (30% of AOM) and H. influenzae (20% of AOM);
• *mild fever- behavior is active, smile, feeding well;
• *moderate fever- behavior is irritable but smiling and feeding well;
• *severe fever- temp > 104 F, listless, cannot console, poorly feeding, hospital admission required;
• *when source cannot be found with fever- check for UTI;
• *TX- tylenol (1st line)- 10-15 mg/kg q4-6 hrs, Ibuprofen- approved after 6 mos of age- 10 mg/kg q6 hrs, DO NOT ALTERNATE (RISK FOR OVERDOSING)

Question 6

Key Infant Health Factors:

Physical, Cognitive, Psychosocial Development

Answer 6

• *physical- gross motor (cephalocaudal);
• *fine motor- (proximal > distal);
• *sensorimotor stage (adapting reflexes to environment, simple problem solving, object permanence, etc.);
• *developing trust (trust vs mistrust);
• *survival reflexes- breathing, temp control, and feeding

Question 7

Infant Health: Developmental Monitoring Standardized Tests

Answer 7

• *Denver II;
• *Bayley Scales of INfant Development (BSID-II);
• *Newborn Behavioral Assessment Scale (NBAS);
• *Bayley Infant Neurodevelopment Screener (BINS);
• *Ages and Stages Questionairre (ASQ);
• *need results from @ least 2 tests for any abnormalities– then refer to psych.