School Age Flashcards
Erkison Developmental Theory for school age
Industry v. Inferiority
- Building, creating, accomplishing
Skills:
- Relating to peers, kids want to be together
- Teamwork/ team sports
- Self discipline, mastering reading and arithmetic
Piaget Developmental Theory for school age
Concerte Operational Thinking
- coherent organized thoughts
- conservation of mass and volume
History for school age
Birth hx for patients 0-12 years (prenatal hx & immunizations)
Recurrent illnesses
Hospitalizations- do they use one setting?
Immunizations
Nutrition
Family illnesses
Exercise, activities, after school activities
Safety- poison control, locked guns, smoke alarms, window guards, access to telephones
Substance Use- are they sleepy?
Sexual experimentation
School performance *big one*
Developmental Milestones: Denver + met milestones?
What are common illnesses?
Otitis media/externa
Step
URI
Asthma
Heart murmur
Viral gastroenteritis
Appendicitis
Breaks/fractures in arms and legs
What tanner stage?
Tanner Stage: I
What tanner stage?
Tanner Stage: II
What tanner stage?
Tanner stage III
What tanner stage?
Tanner Stage IV
What tanner stage?
Tanner Stage V
What tanner stage?
Tanner Stage I
What tanner stage?
Tanner Stage II
What tanner stage?
Tanner Stage III
What tanner stage?
Tanner Stage IV
What tanner stage?
Tanner Stage: V
Physical exam componenets for school age
- Vital signs, blood pressure, LMP Hx
- Ht/Wt/BMI
- Tanner staging (precocious puberty might be endocrine issue)
6-7 year old milestones
Stays busy
May loose first tooth
Practices skills to become better
Able to read age-appropriate books
Speaks in complete sentences, understands numbers, differentiates right and left, able to tell time
Cooperates and shares, plays with same gender
Likes to copy adults, jealous of others and siblings
Vision as sharp as an adult
Interest in how things work
Enunciates all sounds, able to use proper tenses, plurals, pronouns
8-9 year old milestones
Dresses and grooms self completely
Comprehends more things: fractions, space, can count backwards
Enjoys competition and games, likes clubs an groups
Begins to mix friends and play with friends of opposite gender
Able to use tools
More graceful with movement and abilities
Likes school and egar to learn
Accepts household chores
10-12 year old milestones
Remainder of adult teeth will develop
More independent
Friends very important and influential, like to talk on the phone
Increased interest in gender of interest
Reads well
Works on confidence and self-esteem
Thinks abstractly and expresses feelings well
Puberty starts
Start to form a sense of community
Cholesterol Screening: when and why in school age?
Universal screen: ages 9-11 and again 17-21 years
- may be fasting or non-fasting depending on clinic
Screen before age 9:
- positive family hx dyslipidemia or premature heart disease
High level risk factors for CVD in school age kids?
- Parent/grandparent hx CVD <55 (M) or <65 (F)
- Coronary artherosclerosis, peripheral vascular disease or cerebrovascular disease
- BMI >97th percentile
- DM Type I or II
- HTN
- Current Smoker
- Chronic renal disease/end-stage renal disease
- s/p any solid organ transplant
- Hx: Kawaskai’s disease w/ coronary aneurysms
PPD placement and MMR
- PPD and MMR can be placed same day
- If MMR given, wait at least a month to give PPD becuase immune system has mild suppression
- MMR- live vaccine, dont give to pregnant or immunocompromised
- PPD- not required in NY public schools, given based on risk factors
Moderate level risk factors for CVD for school age kids
- pre-diabetes
- polycystic ovarian syndrome
- chronic inflammatory disease
- HIV infection
- nephrotic syndrome
Normal Pediatrics Cholesterol Levels
Total Cholesterol: >200
LDL >130
HDL <40
TG >130
What supplements are typically seen in school aged kids?
Vit. D: 400-600 units/day, for bone health and inflammation
May also see flouride- if not in water system
What is the primary treatment for kids who are both:
- over weight or obese
- high TG or low HDL
Weight mgmt
including: improved diet, increased physical activity
Name (4) common childhood illnesses for school age
Otitis externa
Asthma
Step Pharyngitis
Tinea Corporis/Capitus
Otitis Externa
- what is it?
- causes?
What: inflammation of the external auditory canal
Causes: swimming, putting something in the ear
Otitis externa: Signs & Symptoms
- pain in ear, espeically tragus, aggrivated by moving the aurible
- exudate in the ear canal
Otitis Externa: Treatment & Follow up
Treatment:
- first figure our if the infection is above or below the TM
- need TM to be intact to prescribe medication
- Medication: antibiotic/sterioid drops
Follow up:
- f/u in 48-72 hours
- may need to change treatment if it hasn’t gotte better
Asthma: Signs and Symptoms
Note pattern, frequency, precipitating factors and duration
- Coughing, SOB, wheezing on exhalation
- Chest congestion and tightness
- Sputum production
- Insomnia r/t SOB, coughing, or wheezing at night
- Bouts of coughing/ wheezing that increase with respiratory infection
- Delayed recovery after a respiratory infection
- Fatigue & dyspnea upon exertion (exercise-induced asthma)
Asthma: Acute Attack
Tachycardia
Diaphoresis
Chest pain
Use of accessory muscles while breathing
Flaring of nares while breathing
Use of abdominal muscles while breathing
Asthma: Diagnosis
- Tests:
- Spirometry (must be older than 6, taken at rest, after a challange and after med given, measures FVC and FEV-1sec)
- Exhaled Nitric Oxide Tests (increased NO levels in asthma pt.)
- 3 Criteria must be met:
- episodic symptoms of airflow obstruction are present
- airflow obstruction is at least partially reversible
- alternative diagnosis are excluded
- Assess:
- In the fall (must get flu shot and pneumo vax becuase increased risk of URI and pneumonia)
- Family History: Asthma, allergy, sinusitis, rhinitis, or nasal polyps
- Social History: Characteristics of home and living conditions (i.e. age, location, cooling and heating systems, wood-burning stoves, humidifiers, presence of mold and mildew and exposure to tobacco smoke). Find out triggers, schedule a comprehensive home visit/education
Asthma: expected abnormals on physical exam
Skin: Atopic dermatitis/eczema, Manifestations of an allergic skin condition
HEENT: Increased nasal secretions, Mucosal swelling, Nasal polyps
Chest: Hyperexansion of the thorax, Use of accessory muscles, Hunched shoulders, Chest deformity
Respiratory: Adventitious breath sounds- wheezing during normal respirations, Prolonged phase of forced exhalation
Asthma: differential diagnosis
Allergic rhinitis
Allergic Sinusitis
Foreign body in trachea or bronchus
Vocal chord dysfunction
Vascular rings or laryngeal webs
Laryngotracheomalacia
Tracheal stenosis
Bronchostenosis
Enlarged lymph nodes
Tumor in airway
Cystic fibrosis
Bronchopulmonary dysplasia
Heart disease
Aspiration from swallowing mechanism dysfunction
Gastroesophageal reflux
Asthma: Medication
Goal: control chronic symptoms and prevent acute episodes
Long-term control medications
- Inhaled corticosteroids
- Combination inhalers- inhaled corticosteroids and a long-acting bronchodilator
- Leukotriene modifiers
- Cromolyn
- Theophylline
Rescue medications
- Short-acting bronchodilators
Allergy shots- immunotherapy
Asthma: Patient Education
- Never use antihistamines during an acute attack; they dry up respiratory secretions and can create mucous plugs
- Postural drainage: child should lie on bed with head hanging over side
- Side effects of medication
- How to use a metered dose inhaler, dry-powder inhaler, and peak flow meter
- Avoid/minimize exposure to allergens (mold, cigarette smoke, dust mites)
- Notifying child’s school personnel
- Give parent written instructions including medications, use of peak flow meter, use of metered dose inhaler, and indications for returning to office
- Home monitoring: child’s response to medication in the morning and at bedtime yields the best information
Asthma: Follow up
Routine: every 6 months
Immediately call if:
- breathing difficult worsens
- skin or lips turn blue
- restlessness or sleeplessness occurs
- chest pain
- fever develops
Strep Pharyngitis: Signs and Symptoms
Subjective:
- acute onset of sore throat
- fever
- dysphagia
Physical Exam:
- anterior swollen and tender cervical nodes
- fever
- purulent yellowish exudate on tonsils
- tonsils and pharynx erythmatous
If epiglotitis is seen (drooling and tripod position): give steroids and call 9-1-1
Strep Pharyngitis: Diagnostic Test
Rapid Strep test
GABHS- must specify what you are looking for, may treat before results come back
Strep Pharyngitis: Differential Diagnosis
- viral pharyngitis
- infectious mononucleosis (lymphnodes will be huge and splenomegaly)
- epiglottitis (emergency)
Strep Pharyngitis: Treatment
- Antibiotics
- Tylenol- dose is weight dependent
- warm saline gargles
- fluids
Tinea Corporis: Signs & Symptoms
“Ringworm” of the nonhairy skin: Superficial fungal infection on face, trunk, limbs
S&S
- red, patch areas that scale and are oval in shape- well demarcated
- ususally asymptomatic or mildly itchy
Tinea Corporis: Treatment
- Topical antifungal: apply daily for 2 weeks
- Oral antifungal- can lead to drug induced hepititis
- educate patient on dosing and timing
- educate patient on GI symptoms
Tinea Corporis: Patient Education
Caution sharing clothing and towels
Tinea Capitus: Signs & Symptoms
“Ringworm” or Fungal Infection of the scalp
S&S
- red, patch areas that scale and are oval in shape- well demarcated
- CC: “My child has a spot on head without hair”
- ususally asymptomatic or mildly itchy
- may have enlarged anterior/posterior cervial lymphnodes
Tinea Capitus: Treatment
- Antifungal Shampoo
- Oral antifungal- can lead to drug induced hepititis
- educate patient on dosing and timing
- educate patient on GI symptoms
Sexual Abuse: Red flags
- frequent UTOs
- vagina/rectal d/c
- decline in school performance
- change in behavior, affect, appetite
Have a plan, know your resources, know the ER’s
What should be considered if child is having school problems?
- How long has it been going on? Acute, chronic, gradual?
- Does it occur in all settings?
- Birth history: APGAR, complications, term/premie
- Family History: developmental delays, mental illness
- Developmental History: meeting milestones? Drop?
- Medical History: frequent ER visits
- Physical Exam, including: hearing, vision,
- Labs: lead poisioning, blood disorder, nutrition
