Week 1 Flashcards
History taking in pediatrics
Chief complaint, past history including birth history - prenatal, natal, postnatal. Allergies. Accidents, broken bones. Illnesses. Operations/Hospitalizations. Immunizations. Lab tests. Family hx of siblings, family health, family social hx
ROS
Question each system, measure growth chart, weight, head circumference, BMI. Nutrition: breast fed, formula, eating habits. Patterns of elimination. Sleep patterns, naps. G&D.
Not urinated in >6 hours worry about
dehydration
Well child exam times
Newborn after discharge or 2 weeks later.. Then 1, 2, 4, 6 months then every 3 months until 2 years then 2.5y, 3y, 4y and annual
Nutrition
What do they eat, how much formula, how often are they being breast fed. Solid food; 4-6 months. 1 year – how much whole milk versus solid foods. 2 year – type of milk? 2%. Variety of foods? Veggies, fruits.
Elimination
Normal bowel pattern, how often wet diapers, toilet trained? Accidents day or night – may indicate Type 1 DM, Issues w constipation? When sick get hypermetabolic and can get loose stools leading to dehydration
Sleep
Normal sleep pattern? Naps? Where do they sleep? Where do they wake up? Problem falling asleep or staying asleep
When to assess respirations
When child is asleep count breaths for 1 minute
Height
Record on growth chart, gain 1 inch per month, deviation may be endocrine problem
Red flags
Weight parameters w change of 2% or greater, height below or above average, head circumference off the established curve, abnormal vital signs
Measure height
Standing in socks or bare feet with heels back and shoulders touching wall
Weight
Record on growth chart, newborn lose 10 percent of BW in 3-4 days, gains 1 ounce per day after that. Goal is to gain the 10 percent lost by dc in 2 weeks
Weight norms
double birth weight by 6 months, triple by 1 year
Head circumference
Done every visit up to 2 years, post font take 4 weeks to close triangle shape, anterior take 12-18 months diamond shape. Wrap tape over eyebrows and occipital prominence
breast and genitalia scale
tanner
this can fx during birth
clavicle
musculoskeletal exam hips
ortaloni and barlows
Neurological exam
Glasgow coma scale, observe natural state play games with them, CN 2-12
Screening tests
NJ: PKU, Sickle cell, thyroid, galacftosemia. Billirubin, h&h at 1 year visit, lead 6-12 mos,
Mantoux test
9-12mo, 4years, adolescence. 0 - negative, 3-5 + w close contact w TB patient, abnormal CXR, HIV, or
Infant exam
Diaper on, wrap in blanket for warmth, pacifier to comfort, talk softly
Head exam
until age 2, plot on growth curve, check fonatelles 12-18 mo anterior, post 2-5 months. Flat head babies need to do back to back sleep position.
Toddler
examine on parents lap, talk w parent first, play therapy, distract w stories, let toddler play w equipment, call by name, praise, do exam quickly
Preschool
have parent within eye contact, explain what you are doing
School age child
Allow child to have choice of having parent present
School age exam
privacy, explain procedure, explain equipment, interact during exam, matter of fact about genital exam
Adolescent
ask about parent in room, private interview time for difficult questions, privacy
headss exam
Home environment, Education, Activities, Drugs/Drinking, Safety, Sexuality
Early autism screening tools
Infant/toddler checklist behavior scale, Modified checklist for autism in Toddlers (M-CHAT)
