WCE, failure to thrive Flashcards
List the ages recommended for when a child should get checked for health maintenance
- 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
What is the “triad” when taking history of child
provider-parent-child
- used to assess developmental stage of child and cognitive stage of child
how can you, as a provider, encourage child participation
- use child’s name
- have child state his/her problem
- use words child can understand
Where should the child be located during the interview at ages (0-2 years); (3-5 yrs); and (6-up)
- 0-2 yrs: parent’s lap or arms
- 3-5 yrs: freely moving about room
- 6 and above: exam table
What parameters of growth should be obtained at pediatric visits
- length/height
- weight
- weight for length
- BMI
- head circumference
what growth chart is used for children 0-2 yrs of age
WHO growth charts
What growth chart is used for children 2 years and older
CDC growth chart
How should you measure height for a child under 2 yrs? Childen over 2 yrs?
- under 2: measure lying down in supine position
- above 2: measure standing
How should you weight a infant
- in a clean diaper
- weigh infant to the nearest 0.01 kg or 1/2 oz
how should you weigh a child 3 years and older
without shoes
weights between what percentage points are considered normal
5%-85%
What percentile is considered underweight, overweight for youth (2-18 yrs)
- underweight:BMI < 5%
- overweight: BMI = 85%-95%
what age range should head circumference be calculated
0-3 years
what is a good rule of thumb when considering what is normal for head circumference
head circumference should correlate with the child’s lenght (if length is 40th percentile; HC should also be 40th percentile)
how do you calculate mean parental height for boys and girls to determine if child’s height is normal
- girls: (paternal height (in.) + maternal height (in) - 2.5) / 2
- boys: (paternal height (in.) + maternal height (in) + 2.5) / 2
What is a patient’s weight concerning
drop more than one large percentile or extreme underweight
What is the rule of thumb for growth for the first 2 years of life
- 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
average weight at birth, 1 yr, 5 yr and 10 yr
- birth: 3.5 kg
- 1 yr: 10 kg
- 5 yr: 20 kg
- 10 yr: 30 kg
average daily weight gain for the first 3-4 months? For the rest of the first year?
- 20-30 g for first 3-4 months
- 15-20 g for rest of 1st year
average length at birth
20 in
average HC at birth
35 cm
what parameters show failure to thrive
- height or weight drops below 3rd percentile on standarized growth chart
- drop of 2 or more major percentile lines on standarized growth chart
caloric intake required for infants
100 to 110 kcal/kg/day
When can a child be diagnosed with HTN
systolic BP and or diastolic BP > or = to 95% for age, sex, and height on 3 or more occasions
stages for HTN
- stage 1: BP > or = 95% but < (99th percentile + 5 mm Hg)
- stage 2: BP > (99th percentil + 5 mm Hg)
when does annual screening for BP begin
3 yrs old
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
what are the 3 most common disorders among children and adults
- language impairment
- learning disabilities
- intellectual disabilities
at what visits does the AAP encourage developmental-behavioral surveillance
- 9 mo
- 18 mo
- 2 yr or 2.5 yr
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
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)
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
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
rule of thumb to calculate average weight in kg
10 + 2(age) or 4 + (mo/2)
rule of thumb to calculate max normal HR
170-10 (age)
rule of thumb to calculate min normal HR
70 + 2 (age)
rule of thumb to calculate max normal RR
50-10 (age)
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
what 3 things are you concerned with when examing an adolescent
- progress through puberty
- obesity
- orthopedic problems
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
when should you refer a child who commonly gets pharyngitis to ENT
after 3-4 documented strep infections in one year
How do you get a child to take a deep breath
“blow out” a light
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
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
what is a contraindication to play sports
presence of 1 kidney
what should you check for once males start participating in sports or weight lifting
inguinal hernia
when should you start doing a pelvic exam on females
sexually active
what rating system is used to note development of secondary sexual characteristics
Tanner Sexual Maturity Rating (SMR)
what would give a tanner score of 1 in a girl
- nipple elevation only
- no pubic hair
what would get a tanner score of 1 in a male
- testicles 1-2 cm
- no pubic hair
when does visual acuity check start
3 yo
what eye exam scores for preschoolers and children > 6 warrant referral
- preschoolers less than 20/40
- children > 6 yo less than 20/30
when does infant hearing screening begin
1 month
if infant has not passed otoacoustic emissions (OAE), when should comprehensive eval take place
by age 3 mo
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
otoacoustic emissions (OAE)
measures sound waves produced in inner ear
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
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
congential heart disease puts a child at what risk group category?
Tier III: high setting for accelerated atherosclerosis therefore needs cholesterol and lipid screening
medicaid eligibilty to screen for lead
- 9 mo
- 12 mo
- 24 mo
* lead levels usually peak at 18-24 mo
With increased risk of exposure to lead, how long should you do blood tests
up to 6 yrs
iron deficiency anemia is how prevalent in 1-3 yr old children
8%
when should you iniate hemoglobin and hematocrit testing
between 9-12 mo
- prematurity, low-iron formulas are risk factors
poor, or special needs children should get iron deficiency anemia assessments ..
- 18 mon
- 2 yr
- 3 yr
- 4 yr
- 5 yr
when shoud you not assess iron deficiency anemia
acute illness or within several weeks of fever/infection
when should a UA be performed
routine surveillance not performed
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
when should dental screening begin
1 yr
median age of SIDS? peak incidence?
- median age: 11 weeks
- peak incidence: 2-4 mo
breast feeding has what impact on SIDS
reduces risk
AAP recommendation for breast feeding
first 6 months of life
if breastfeeding is adequate, how many wet diapers and meconium stool will occur in first 24 hours
- 1 wet diaper
- 1 stool
when does urine become light yellow
day 4 of life; 4-6 times in 24 hours
when does stool color change from meconium stool
by day 3
when does urine become colorless
day 5 +; expect 6-8 times in 24 hours
is vit D supplementation recommended after birth
400 IU/day soon after birth with babies that are solely breastfed
is fluoride supplementation recommended in infants
after 6 months with children that are solely breastfed
standard substitute for breastmilk
enfamil; similac; carnation good start
* (cows milk with lactose )
