WCE, failure to thrive Flashcards
1
Q
List the ages recommended for when a child should get checked for health maintenance
A
- newborn
- 1 month
- 2 months
- 4 months
- 6 months
- 9 months
- 12 months
- 15 months
- 18 months
- 2 years
- 2.5 years
- 3 years
- anual until age 6
- every 2 years from age 6 - adolescence
2
Q
What is the “triad” when taking history of child
A
provider-parent-child
- used to assess developmental stage of child and cognitive stage of child
3
Q
how can you, as a provider, encourage child participation
A
- use child’s name
- have child state his/her problem
- use words child can understand
4
Q
Where should the child be located during the interview at ages (0-2 years); (3-5 yrs); and (6-up)
A
- 0-2 yrs: parent’s lap or arms
- 3-5 yrs: freely moving about room
- 6 and above: exam table
5
Q
What parameters of growth should be obtained at pediatric visits
A
- length/height
- weight
- weight for length
- BMI
- head circumference
6
Q
what growth chart is used for children 0-2 yrs of age
A
WHO growth charts
7
Q
What growth chart is used for children 2 years and older
A
CDC growth chart
8
Q
How should you measure height for a child under 2 yrs? Childen over 2 yrs?
A
- under 2: measure lying down in supine position
- above 2: measure standing
9
Q
How should you weight a infant
A
- in a clean diaper
- weigh infant to the nearest 0.01 kg or 1/2 oz
10
Q
how should you weigh a child 3 years and older
A
without shoes
11
Q
weights between what percentage points are considered normal
A
5%-85%
12
Q
What percentile is considered underweight, overweight for youth (2-18 yrs)
A
- underweight:BMI < 5%
- overweight: BMI = 85%-95%
13
Q
what age range should head circumference be calculated
A
0-3 years
14
Q
what is a good rule of thumb when considering what is normal for head circumference
A
head circumference should correlate with the child’s lenght (if length is 40th percentile; HC should also be 40th percentile)
15
Q
how do you calculate mean parental height for boys and girls to determine if child’s height is normal
A
- girls: (paternal height (in.) + maternal height (in) - 2.5) / 2
- boys: (paternal height (in.) + maternal height (in) + 2.5) / 2
16
Q
What is a patient’s weight concerning
A
drop more than one large percentile or extreme underweight
17
Q
What is the rule of thumb for growth for the first 2 years of life
A
- weight loss in first few days (5-10%)
- return to birth weight by 7-10 days
- double birth weight 4-5 months
- triple birth weight 1 yr
- quadruple birth weight 2 yr
18
Q
average weight at birth, 1 yr, 5 yr and 10 yr
A
- birth: 3.5 kg
- 1 yr: 10 kg
- 5 yr: 20 kg
- 10 yr: 30 kg
19
Q
average daily weight gain for the first 3-4 months? For the rest of the first year?
A
- 20-30 g for first 3-4 months
- 15-20 g for rest of 1st year
20
Q
average length at birth
A
20 in
21
Q
average HC at birth
A
35 cm
22
Q
what parameters show failure to thrive
A
- height or weight drops below 3rd percentile on standarized growth chart
- drop of 2 or more major percentile lines on standarized growth chart
23
Q
caloric intake required for infants
A
100 to 110 kcal/kg/day
24
Q
When can a child be diagnosed with HTN
A
systolic BP and or diastolic BP > or = to 95% for age, sex, and height on 3 or more occasions
25
stages for HTN
* stage 1: BP \> or = 95% but \< (99th percentile + 5 mm Hg)
* stage 2: BP \> (99th percentil + 5 mm Hg)
26
when does annual screening for BP begin
3 yrs old
27
Children younger than 3 y.o should have his/her BP measured under the following circumstances
* premature
* congenital heart disease
* renal disease
* transplant (organ or bone marrow)
* CA
* elevated intracranial pressure
28
what are the 3 most common disorders among children and adults
1. language impairment
2. learning disabilities
3. intellectual disabilities
29
at what visits does the AAP encourage developmental-behavioral surveillance
* 9 mo
* 18 mo
* 2 yr or 2.5 yr
30
Parent report tests
* Parents' evaluations of developmental status (PEDS)
* PEDS: developmental milestones (PEDS:DM)
* Ages and stages questionnaire
* infant-toddler checklist for language and communication
31
direct observation/elicitation tests
* Battelle developmental inventory screening test (BDIST)
* PEDS:DM
* Bayley infant neurodevelopmental screen (BINS
* brigance screens II
* safety word inventory and literacy screener (SWILS)
32
Broad-band tests (involve parent report)
* ages and stages questionnaire: social emotional (ASQ: SE)
* Brief infant-toddler social emotional assesment (BITSEA)
* conners 3rd edition (conners 3)
* Eyberg child behavior inventory/sutter-Eyberg student behavior inventory
33
narrow band tests
* conners 3 attention deficit hyperactivity disorder (ADHD) index (Conners 3AI)
* modified checklist for autism in toddlers (M-CHAT)
* vanderbilt ADHD diagnostic parent and teacher rating scale
34
rule of thumb to calculate average weight in kg
10 + 2(age) or 4 + (mo/2)
35
rule of thumb to calculate max normal HR
170-10 (age)
36
rule of thumb to calculate min normal HR
70 + 2 (age)
37
rule of thumb to calculate max normal RR
50-10 (age)
38
when should you consider a pediatric cardiology referral
* h/o heart disease or murmur
* h/o dyspnea or chest pain on exertion
* irregular HR or palpitations
* syncope
* fam h/o MI, CVA before age 50 yr
39
what 3 things are you concerned with when examing an adolescent
1. progress through puberty
2. obesity
3. orthopedic problems
40
what is common when assessing the neck of people ages 6-20 yrs. What are RED flags
* lymph nodes, tonsils, adenoids are greater in size during this time than adulthood
* asymptomatic cervical lymphadenopathy is common
* RED fLAGS: painful, unilateral solitary adenopathy \> 2 cm diameter, weight loss
41
when should you refer a child who commonly gets pharyngitis to ENT
after 3-4 documented strep infections in one year
42
How do you get a child to take a deep breath
"blow out" a light
43
Where should you auscultate the heart until age 7
* 4th intercostal space until age 7 (then drops to 5th)
* left of mid-clavicular line at 4 years; at MCL at 5-6 years; to right of MCL at 7 years
44
If you detect a systolic, short duration, low intensity murmur in a child, what should you tell parents
50% of children may have an innocent murmur during childhood
45
what is a contraindication to play sports
presence of 1 kidney
46
what should you check for once males start participating in sports or weight lifting
inguinal hernia
47
when should you start doing a pelvic exam on females
sexually active
48
what rating system is used to note development of secondary sexual characteristics
Tanner Sexual Maturity Rating (SMR)
49
what would give a tanner score of 1 in a girl
* nipple elevation only
* no pubic hair
50
what would get a tanner score of 1 in a male
* testicles 1-2 cm
* no pubic hair
51
when does visual acuity check start
3 yo
52
what eye exam scores for preschoolers and children \> 6 warrant referral
* preschoolers less than 20/40
* children \> 6 yo less than 20/30
53
when does infant hearing screening begin
1 month
54
if infant has not passed otoacoustic emissions (OAE), when should comprehensive eval take place
by age 3 mo
55
automated auditory response (AABR)
measures how hearing nerve responds to sound: clicks or tones are played through earphones into baby's ears. 3 electrodes are placed on head that measure nerve response
56
otoacoustic emissions (OAE)
measures sound waves produced in inner ear
57
AAP recommends that children ages (XX) get formal hearing screening
* (2 yr if risk factors for hearing lose) otherwise ..
* 4 yr
* 5 yr
* 6 yr
* 8 yr
* 10 yr
58
AAP recommendation for screening of cholesterol and lipids for peds
do not support universal screening!
* screening is recommended for BMI \> 85th percentile or if children are at high risk for hyperlipidemia
59
congential heart disease puts a child at what risk group category?
Tier III: high setting for accelerated atherosclerosis therefore needs cholesterol and lipid screening
60
medicaid eligibilty to screen for lead
* 9 mo
* 12 mo
* 24 mo
\* lead levels usually peak at 18-24 mo
61
With increased risk of exposure to lead, how long should you do blood tests
up to 6 yrs
62
iron deficiency anemia is how prevalent in 1-3 yr old children
8%
63
when should you iniate hemoglobin and hematocrit testing
between 9-12 mo
* prematurity, low-iron formulas are risk factors
64
poor, or special needs children should get iron deficiency anemia assessments ..
* 18 mon
* 2 yr
* 3 yr
* 4 yr
* 5 yr
65
when shoud you not assess iron deficiency anemia
acute illness or within several weeks of fever/infection
66
when should a UA be performed
routine surveillance not performed
67
AAP recommendation for TB testing
* annual TB testing is not recommended for all children
* selective screening based on risk : homeless shelter; clinical findings suggestive of TB; immunosuppressive therapy; HIV +; incarcerated
68
when should dental screening begin
1 yr
69
median age of SIDS? peak incidence?
* median age: 11 weeks
* peak incidence: 2-4 mo
70
breast feeding has what impact on SIDS
reduces risk
71
AAP recommendation for breast feeding
first 6 months of life
72
if breastfeeding is adequate, how many wet diapers and meconium stool will occur in first 24 hours
* 1 wet diaper
* 1 stool
73
when does urine become light yellow
day 4 of life; 4-6 times in 24 hours
74
when does stool color change from meconium stool
by day 3
75
when does urine become colorless
day 5 +; expect 6-8 times in 24 hours
76
is vit D supplementation recommended after birth
400 IU/day soon after birth with babies that are solely breastfed
77
is fluoride supplementation recommended in infants
after 6 months with children that are solely breastfed
78
standard substitute for breastmilk
enfamil; similac; carnation good start
\* (cows milk with lactose )
