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General Peds Boards > Preventative Pediatrics / Well Child Care > Flashcards

Preventative Pediatrics / Well Child Care Flashcards

1
Q

Causes of delayed dental eruption

A
  • Infants born before 30 weeks, birth weight < 1000 g

- Delay is mostly in primary teeth

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2
Q

HPV vaccine facts

A
  • Provides protection against cervical and noncervical HPV-associated cancers
  • Includes HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58
  • For ages 9-14: 2 dose schedule
  • For ages 15-26: 3 dose schedule
  • Adverse effects: injection site pain, erythema, edema, headache, dizziness, fever, fatigue
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3
Q

Weight changes in 1st year of life

A
  • Lose 10% at birth, regain by 2 weeks (some may be delayed to 3 weeks)
  • Birth weight doubles by 5 months
  • Birth weight triples by 1 year
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4
Q

Length changes in young kids

A
  • Average birth length is 50 cm
  • Birth length is doubled by age 4
  • Growth rate is 20 cm/year
  • Okay to cross percentiles in first 12-18 months
  • Shifts across 2 or more percentile lines after age 2 should be worked up
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5
Q

Head circumference changes

A
  • Normal at birth is 35 cm

- Grow 1 cm/month in first 6 months then 1/2 cm/month for 6-12 months

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6
Q

Macrocephaly definition and differential

A
  • > 97th percentile
  • Big head but normal development - measure parent’s heads (familial macrocephaly)
  • Hydrocephalus: irritability, vomiting, impaired upward gaze, bulging fontanelle
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7
Q

Microcephaly definition/workup

A
  • < 3rd percentile for age
  • Primary: born with small heads and stay small (genetic conditions and in utero infections)
  • Acquired: normal at birth and then decrease (perinatal or postnatal insults, genetic, infectious)
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8
Q

Growth changes in inadequate caloric intake

A

Weight drops initially followed by decreased length, spares head circumference

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9
Q

Growth changes in endocrine disorders

A

Presents with short stature with normal or elevated weight

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10
Q

Growth changes in chromosomal abnormalities

A

Microcephalic and dysmorphic features

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11
Q

Growth changes in chronic medical conditions

A

Weight and height fall together

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12
Q

Failure to thrive definitions

A
  • Weight < 5th percentile
  • Weight that drops down two major percentile channels
  • Weight less than 80% of ideal weight for age
  • Weight below 5th percentile on weight for length curve
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13
Q

2 month milestones

A
  • Track to both sides (2 sides)
  • Lift head and chest while prone
  • Coo
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14
Q

4 month milestones

A
  • Grab clothes
  • Clutch/hold onto a rattle
  • Put objects in mouth
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15
Q

6 month milestones

A
  • Sit up on own

- Transfer a cube from one hand to another

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16
Q

9 month milestones

A
  • Crawling
  • Stranger danger
  • Babbling with syllables
  • Pulls to stand, cruising
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17
Q

12 month milestones

A
  • Walk holding onto one hand
  • Point with ONE finger (ONE year of age)
  • Say ONE word besides mama and dada
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18
Q

18 month milestones

A
  • Walks fast, falls occasionally
  • Stairs with hand held
  • Climbs onto a chair and sits in it
  • Feed themselves
  • 4 cube tower
  • Throw a ball standing (but not overhand)
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19
Q

2 year milestones

A
  • Single line train of cubes
  • Copies a circle
  • Can understand 50% of what they say
  • Throws ball overhand
  • Walks down steps holding rail with both feet on each step
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20
Q

3 year milestones

A
  • Walk up stairs alternating feet
  • Ride a tricycle (3 wheels)
  • Hop 3 times
  • Draw a triangle
  • 3 word sentences
  • Knows name, sex, age (3 things)
  • Understand 3/4 of what they say
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21
Q

4 year milestones

A
  • Identify opposites
  • Can draw 4 body parts
  • 4 word sentences, can say first and last name, asks why a lot
  • Identify 5-6 primary colors
  • Copies a square (4 sides)
  • Cuts on a line
  • Understand everything they say
  • Balances on 1 foot for 4 seconds
  • Dresses self but can’t tie shoes
  • Potty trained, brushes teeth
  • Shows increased cooperativity
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22
Q

5 year milestones

A
  • Tie a knot
  • Correctly grab a pen
  • Print letters
  • Walk backward heel to toe
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23
Q

When does stuttering need worked up

A
  • Normal up to age 3 or 4
  • Persistence beyond preschool age will require a workup or if it persists for more than 6-8 weeks or associated with facial tics
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24
Q

Workup for language deficits

A
  • Bilingual home is not an acceptable reason for language delay
  • Hearing evaluation is often the first thing to do
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25
Q

Developmental screening tests

A
  • 9, 18, 24 (or 30) month need developmental screening
  • ASD screening at 18 and 24 months
  • Kindergarten readiness at 4 years
  • Social/emotional, mental health at every visit from 5-18 years
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26
Q

Potty training by what age

A

75% of kids have bladder and bowel control by age 3

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27
Q

Nocturnal enuresis age and workup

A
  • Primary nocturnal enuresis is a child who has never been dry on consecutive nights for 6 months - only after age 5
  • Secondary is when they start wetting after being dry for 6 months
  • Workup: urinalysis
  • Primary Causes (SUDS): Sickle cell trait, Urinary tract infection, Diabetes, Seizure
  • Secondary causes: UTI, diabetes, stress, sleep disruption, constipation
  • Treatment: enuresis alarms are the most effective, limiting nighttime fluids 2 hours before bed, double voiding before bed
  • Can try DDAVP (desmopressin) but only in tablet form - take nightly for 6 months and then stop for 2 weeks to see if it has improved
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28
Q

Daytime enuresis organic causes

A
  • Uti, diabetes mellitus or DI, kidney disease
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29
Q

Screen time recommendations

A
  • 2 hours per day

- Younger than 2 should not watch TV

30
Q

At what age is day/night schedule established

A
  • 2 months
31
Q

How much sleep does a 1 year old need

A

13-14 hours per day

32
Q

What age is appropriate to start sleep training

A

4-6 months of age

33
Q

Night terrors

A
  • Occur in the first third of the night
  • More common in boys
  • Don’t remember the episode
  • Tx: keep surrounding environment safe, don’t wake them during it because it can worsen the agitation, but can try pre-waking the child before the episode usually happens
34
Q

Nightmares

A
  • Last third of the night

- Can easily be woken up and they remember the nightmare

35
Q

International adoption screenings

A
  • Developmental assessment every 3-4 months during the first year
  • Hearing/vision at first visit
  • Immunizations
  • CBC, lead level, hepatitis B, HIV, TB testing, and syphilis are all recommended (hepatitis C if from endemic area)
  • TB testing is indicated regardless of whether or not they received BCG vaccination
36
Q

DTap vs Tdap

A
  • Little d has less diphtheria toxoid in it (Tdap is the booster)
  • DTap up through kindergarten, never over age 7
37
Q

DTap/Tdap vaccination schedule

A
  • DTap at 2, 4, 6, 15-18 months, and kindergarten (D for diapers)
  • Tdap at age 11-12 (T for teens)
  • Catch up: Tdap should be substituted for a single dose of Td in the catch-up series but it then counts as the booster so don’t need another one at age 11-12
38
Q

DTap/Tdap contraindications

A
  • Serious allergic reaction
  • Encephalopathy within 7 days of receiving pertussis-containing vaccine
  • Things that are NOT contraindications: extensive limb swelling after vaccine, stable neurologic conditions, brachial neuritis, pregnancy/breast feeding, immunosuppression
39
Q

Tetanus vaccine in clean wounds

A
  • Give it if kid has < 3 tetanus vaccines or if it has been more than 10 years since the last one
40
Q

Tetanus management in dirty wounds

A
  • If less than 3 tetanus vaccines or history is unknown, give tetanus vaccine and tetanus immune globulin
  • If more than 5 years since last vaccine given a booster
  • If adolescent has already received the Tdap then just give Td (but if they haven’t then give Tdap)
41
Q

Haemophilus influenza B vaccine

A
  • Reduced incidence of invasive Hib including meningitis and epiglottitis
  • 3 doses at 2, 4, and 6 months with a booster at 12-15 months
42
Q

Hepatitis B vaccine

A
  • In 1/3 of cases of hepatitis B, no identifiable risk factors are found
  • Children are at risk of hepatitis B: intrapartum, early childhood (household contacts), or adolescence (STDs and IV drugs)
  • Vaccine schedule: at birth, 2 months, third dose 6-18 months after the first dose
  • Preemies less than 2kg: give at 30 days of life or before discharge (if given at less than 2kg it doesn’t count towards the series)
  • If any child hasn’t been fully immunized you should complete the 3 part series
  • Only absolute contraindication is severe allergic reaction to prior dose
43
Q

Mother infected with hepatitis B (HBsAg) positive or unknown hepatitis status, baby should receive what

A

Hepatitis B immunoglobulin in the first 12 hours of life in addition to the regular vaccine

44
Q

What high risk groups need hepatitis B serologic testing after vaccine

A
  • Infants born to positive mothers (at 9-18 months of age)

- High risk groups: immunocompromised patients, hemodialysis patients, health care workers

45
Q

Hepatitis B post-exposure prophylaxis

A
  • Infants/unvaccinated people: hepatitis B immunoglobulin and start the vaccine series
  • If fully vaccinated and antibody positive: nothing
  • If fully vaccinated and antibody negative: HBIG and full revaccination
46
Q

Hepatitis A vaccine

A
  • Give at 12 and 18 months
  • Contraindications: allergy to aluminum hydroxide and phenoxyehtanol
  • If traveling to endemic area: give immune globulin if < 1 year old or vaccine if > 1 year old
47
Q

Meningococcal vaccine

A
  • Protection against A, C, Y, and W-135 strains
  • Vaccine series: at 11-12 year visit, booster at age 16, when entering college dorm if previously unvaccinated
  • If immunodeficient or traveling to prevalent areas need vaccine series
48
Q

MMR vaccine

A
  • Vaccine at 12-15 months and then again 4-6 years of age
  • Second dose enhances immunity among nonresponders, it does not serve as a booster
  • Vaccines given before 12 months of age for travel don’t count toward completion of the series
49
Q

MMR vaccine with other live vaccines

A

Okay to give on same day or in a combined vaccine but can’t be given within 4 weeks of each other (varicella and intranasal influenza)
- Similarly, can place a PPD with MMR vaccine but not for 4-6 weeks after vaccine

50
Q

MMR side effects

A
  • 15% of kids develop high fever within 12 days of vaccine and lasts 1-2 days, 5% can also get a rash
51
Q

MMR absolute contraindications

A
  • Severe allergic reaction to vaccine component, neomycin, or gelatin
  • Pregnancy
  • Severely immunocompromised
52
Q

MMRV side effect

A

Increased risk of febrile seizures when given to kids 12-23 months of age

53
Q

Live vaccines in HIV positive patients

A
  • Measles vaccine is indicated for those who are symptomatic but not severely immunocompromised or asymptomatic (no MMRV vaccine)
  • Varicella vaccine if CD4 counts are high enough
  • Give only inactivated influenza vaccine
54
Q

Varicella vaccine

A
  • Give at 12-15 months and then again at 4-6 years

- Contraindications: pregnancy, prior allergic reaction, substantial suppression of cellular immunity

55
Q

Varicella post-exposure prophylaxis

A
  • Give vaccine within 3-5 days of exposure if healthy and over 12 months of age (at least 3 months after first vaccine dose)

Give immunoglobulin and acyclovir if:

  • immunocompromised child with no prior varicella infection/immunization
  • pregnant woman without immunity
  • hospitalized preemies of 28 or more weeks if mom doesn’t have immunity
  • hospitalized preemies of < 28 weeks
  • newborns if mom had varicella 5 days before up to 2 days after birth
56
Q

Varicella vaccine and aspirin

A
  • Stop aspirin for 6 weeks after vaccine due to risk of Reye syndrome
57
Q

Chemotherapy and vaccines

A
  • No live vaccines for 3-6 months after chemo has ended

- Except varicella vaccine is given to children in ALL remission because of risk of varicella

58
Q

Pneumococcal vaccine

A
  • PCV13 or conjugate vaccine (prevnar) given at 2, 4, 6, and 12-15 months
  • PPSV23 or polysaccharide is not recommended for healthy kids because it is less immunogenic but it does cover more strains
  • Give 23 valent to any chronic disease/asplenic kid at or after age 2 and at least 8 weeks after 13 valent
  • Also give polysaccharide vaccine to kids at risk for invasive pneumoccal disease including CSF leaks, chronic heart/lung disease, diabetes, or cochlear implants
  • Asplenia, sickle cell, HIV infection, malignancy, transplants, or immunodeficient patients need a second 23 valent after 5 years
59
Q

Polio vaccine

A
  • Given at 2, 4, 6 month, and age 4-6
  • Technical rules: first two given at 2 month intervals beginning no earlier than 6 weeks, 3rd dose is 6-18 months of age, 4th dose after age 4 but at least 6 months after 3rd dose
  • Can give on accelerated schedule 4 weeks apart
60
Q

Rotavirus vaccine

A
  • RV5 vaccine given at 2, 4, 6 months but RV1 vaccine given at 2 and 4 months
  • First dose of rotavirus should not be given after 15 weeks of age
  • Once it’s started the series needs to be completed by 8 months of age
  • Contraindications: SCID or history of intussusception
  • Preemies should still get the vaccine as long as they are 6 weeks of age old
61
Q

Vaccines in solid organ transplant patients

A
  • Inactivated vaccines should be given at least 2 weeks before transplantation and live should be given at least 1 month before for best immune response
62
Q

Influenza vaccine

A
  • Annually for everyone over 6 months of age

- Nasal spray is live and approved for kids over 2 years of age

63
Q

Egg allergy and vaccines

A
  • Yellow fever is the only vaccine that has enough egg protein to cause an allergic reaction
  • MMR does not
  • Influenza does not in most cases but it is contraindicated in kids with ANAPHYLACTIC reaction to egg
64
Q

Cholesterol screening guidelines

A
  • Universal screening for kids age 9-11
  • Children age 5-9 if family history or risk factors: BMI > 85th percentile, poor diet, chronic steroid medications, anticonvulsants, beta blockers, alcohol abuse, anorexia
65
Q

Car seat guidelines

A
  • Infants < 2 and weighing < 20 lbs: infant or rear facing car seat
  • Toddlers > 2 and more than 20 lbs: convertible car seat forward facing in back seat
  • School age children up to 4’9” tall: booster seat forward facing in back seat
  • Older children until age 13: back seat with seatbelt
66
Q

Bicycle safety facts

A
  • Most bicycle deaths are in kids < age 15
  • Helmets are worn by < 10% of kids
  • Helmets reduce serious injury by 85%
  • 75% of deaths are due to head injury
  • Reflectors are required on pedals, tire sidewalls or rims, and front/rear of bicycle
67
Q

Water heater temperature

A
  • 120 degrees F

- Hot liquid burns are the most common in the house (pay attention to demarcation burns)

68
Q

Drowning facts

A
  • Infants are most likely to drown in a bathtub
  • Kids < 5 are most likely to drown in a residential pool
  • Adolescents are most likely to drown in fresh water
  • Higher rates in african american males
  • MCC of death in kids with epilepsy
  • AAP recommendations: 4 sided fence around the pool with a self locking and slef latching gate
69
Q

Tobacco use in adolescents

A
  • School based eduation programs are effective if they focus on role playing refusal skills and the health impact
  • Nicotine replacement therapy is not FDA approved in adolescents
  • Buproprion with counseling is another option
70
Q

Workup for abnormal head shape/growth

A
  • HUS if anterior fontnaelle is open, MRI if not
  • Head CT with 3D reconstruction for craniosynostosis
  • Helmet orthosis/PT for positional plagiocephaly if > 6 months

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