Week 2: Growth, Development, & Vaccines Flashcards
What are normal growth parameters for the infant?
INFANT
- By 1 year: birth-weight should have tripled and height should have increased by 50%
- neurologic development progresses centrally to peripherally
- 3 months: infant should be able to lift their head (no “head-lag”), clasp hands, coo
- 6 months: infant should be able to roll over, reach for objects, turn to voices, babble, and possibly sit with support
- 9 months: infant should have a neat pincer grasp (self-feed), indicate wants; have usually developed “stranger danger:
- 12 months: infants should be able to stand, say 1-3 words
What are normal growth parameters for the child?
EARLY CHILDHOOD (1-4 YEARS)
- rate of growth slows by about half
- preschool years, children grow 3.5 inches and gain 4 lbs on average
- chubby, clumsy toddlers transform into leaner, mroe muscular preschoolers
- almost all children walk by 15 months, run well by 2 years, and pedal a tricycle and jump by 4 years
- toddlers move from sensorimotor learning (through touching and looking) to symbolic thinking, solving simple problems, remembering songs, and engaging in imitative play
- 18 months: 10-20 words
- 2 years: 2-3 words
- 3 years: converses well
- 4 years: complex sentences
- impulsive and have poor self regulation, temper tantrums
- preoperational: WITHOUT sustained, logical thought process
MIDDLE CHILDHOOD (5-10 YEARS)
- grow steadily but slowly
- concrete operational: capable of limited lgoic and more complex learning
- little ability to understand consequences or abstractions
- school, family, and environment greatly influence learning
- major develomental task is self-efficacy
- guilt and self-esteem emerge
- clear sense of wrong and right
What are normal growth parameters for adolescents?
- puberty begins on average at age 10 years in girls and 11 years in boys (sometimes younger for girls, but if younger than 7, work them up for precocious puberty)
- on average, girls end pubertal development with a growth spurt by age 14 years and boys by age 16 years
- age of onset and duration of puberty vary widely, although the stages follow the same sequence in all adolescents
- concrete to formal operational thinking: acquiring an ability to reason logically and abstractly and to consider future implications of current actions
- wide variability in cognitive development
- brain development continues well into twenties
- transition from family-dominated influences to increasing autonomy and peer influence
- struggly for identity, independence, and eventually intimacy leadsto stress, health-related problems, and high-risk behaviors
In considering abnormal growth, which children should be prioritized for evaluation?
- variations beyond 2 standard deviations for age
- children above the 95% or below the 5% are indications for more detailed evaluation
- reduced growth velocity, shown by a drop in height percentile on a growth curve
- drop >2 quartiles in 6 months
- weight for length < 5th percentile
- head circumference above the 95% or below 5%
What are the 5 domains of infant/child development?
- Gross motor
- Fine motor
- Cognitive (or problem-solving)
- Communication
- Personal/social domains of development
How do you correct for prematurity when considering growth and development?
Must correct for prematurity up until 24 months
What are the various cognitive stages that children progress through?
Early childhood: preoperational (without sustained, logical thought process)
Middle childhood: concrete operational (capable of limited logic and more complex learning)
Adolescents: concrete to formal operational thinking (acquiring an ability to reason logically and abstractly and to consider future implications of current actions
What is the difference between active and passive immunity?
Active immunity: protection that is produced by the person’s own immune system
- usually lasts for many years or a lifetime
- vaccines
- obtaining illness itself and develpoping antibodies
Passive immunity: protection by products produced by an animal/human and transferred to another human, usually by injection
- immunity generally wanes
- mother to baby: Tdap during 3rd trimester
- can come from blood products (IVIG, antitoxin)
What are the 2 types of vaccines and how do they work?
Live Attenuated Vaccines
- produced by modifying a disease-producing virus/bacterium in a lab
- vaccine retains ability to replicate and produce immunity but usually does not cause illness (if does produce, illness is usually much milder)
- produce immunity in most recipients with 1 dose, except those administered orally
- may cause severe or fatal reactions in immunocompromised as a result of uncontrolled growth of vaccine
Inactivated Vaccines
- cannot replicate
- less affected by circulating antibody than live vaccine
- always require multiple doses… first “primes the immune system” and often “booster” doses
What special consideration should you make about the interval between most live virus vaccines?
All vaccines can be administered at the same visit as all other vaccines
-except in persons without a spleen (or dysfunctional) for PCV13 and menactra brand meningococcal vaccines should not be given at the same visit; separate by at least 4 weeks
If live injected and/or intranasal vaccines are not administered at the same visit, they should be separated by at least 4 weeks
Live oral vaccines (rotavirus) may be given at any time before or after live parenteral vaccines or LAIV
What are the various types of adverse vaccine reactions?
Adverse reaction: an untoward effect caused by a vaccine that is extraneous to the vaccine’s primary purpose of producing immunity
Local
- occur with up to 80% of vaccine doses
- occur within a few hours and are generally mild and self-limited
- pain, swelling, and redness at the injection site
Systemic
- more generalized events
- fever, malaise, myalgias, headache, loss of appetite, and others
Allergic
- due to vaccine or component
- are rare and risk is minimized by screening
What are the only contraindications to receiving a vaccine?
- severe allergic reaction to a vaccine component or following a prior dose
- encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination
- severe combined immunodeficiency (SCID, genetic disease): rotavirus vaccine
- history of intussusception (rotavirus vaccine)
- live vaccines should not be administered to pregnant women
- live vaccines should not be administered to severely immunosuppressed persons
- if person has moderate-severe illness, vaccination with both live and inactivated vaccines should be delayed until patient recovers
Diphtheria
Pathogen: Bacteria
Symptoms:
- can affect any mucus membrane
- insidious offset of pharyngitis
- within 2-3 days, membrane forms which can cause respiratory obstruction
- fever usually not high but patient appears toxic
Complications:
- myocarditis
- neuritis
- paralysis of the soft palate, eyes, and limbs
- death (5-10%, 40% in persons <5 and >40)
Vaccine:
DTaP: Children 6 weeks - 6 years: 2, 4, 6, 15-18 months, and 4-6 years, 11-12 years (TDap) and then every 10 years with TD or TDaP
Haemophilus influenzae type B (Hib)
Pathogen: bacteria
Symptoms:
- meningitis
- epiglottitis
- pneumonia
- arthritis
- cellulitis
Complications:
- hearing impairment
- neurologic sequelae
- death (3-6%)
Vaccine:
-3 or 4 doses depending on the brand given at 2, 4, 15-18 months OR 2, 4, 6, and 15-18 months
Hepatitis A
Pathogen: virus
Symptoms:
- abrupt onset of fever
- malaise
- anorexia
- nausea
- abdominal discomfort
- dark urine
- jaundice
Complications:
- immunologic, neurologic, hematologic, pancreatic, and renal extrahepatic manifestations
- death rate 0.3-0.6%
Vaccine:
-2 doses 1-18 years (generally given 6 months apart)
Hepatitis B
Pathogen: virus
Symptoms:
- preicteric: insidious onset of malaise, anorexia, nausea, vomiting, RUQ abdominal pain, headache, fever, myalgia, skin rashes, arthralgia and arthritis, dark urine
- icteric: 1-3 weeks and is characterized by jaundice, light/gray stools, hepatic tenderness and hepatomegaly (splenomegaly is less common)
Complications:
- fulminant hepatitis (fatality rate 63-93%)
- hospitalization
- cirrhosis
- hepatocellular carcinoma death
Vaccine:
-3 doses: birth, 1-2 months, 6-18 months
Human Papilloma Virus (HPV)
Pathogen: virus
Symptoms/Complications:
- anogenital warts
- respiratory papillmatosis
- cervical, anal, vaginal, vulvar, and penile cancers
Vaccines:
- routine schedule is 9-11 years: dosing at 0 (today), 1-2 months later, 6 months afterwards
- 2 dose series if started before 15 birthday, 2nd dose 6-12 months later
- series do not need to be restarted if the schedule is interrupted
- no therapeutic effect on HPV infection, genital warts, cervical lesions
Influenza
Pathogen: virus
Symptoms:
-abrupt onset of fever, myalgia, sore throat, nonproductive cough, and HA
Complications:
- PNA
- secondary bacterial infections
- Reye syndrome
- myocarditis
- death is reported than less than 1 per 1,000 cases
Vaccine:
- IIV: annually, 6 month+; 2 doses, 4 weeks apart, the first year the child receives it up through the age of 8
- LAIV: anually for healthy, non-pregnant persons 2-49
Measles
Pathogen: virus
Symptoms:
- Fever, which increases in stepwise fashion, often peaking as high as 103 F - 105 F
- onset of cough, coryza (runny nose), or conjunctivitis
- Koplik spots, a rash present on mucous membranes
- maculopapular eruption that usually lasts 5-6 days: begins at hairline, then face and neck, rash gradually proceeds downwards and outwards during the next 3 days… generally discrete, but may become confluent, particularly on the upper body
Complications:
- diarrhea
- AOM
- PNA
- encephalitis
- seizures
- death (0.2%)
Vaccine: MMR
- minimum age: 12 months
- mimum interval: 4 weeks apart
- CDC: 1st dose at 12-15 months, 2nd dose at 4-6 years (can be MMRV)
Meningococcal disease (high risk in communal groups)
Pathogen: bacteria
Symptoms:
- sudden onset of fever, HA, and nuchal rigidity
- a/b nausea, vomiting, photophobia, and AMS
Complications:
-petechial or purpuric rash a/w hypotension, shock, acute adrenal hemorrhage, and multiorgan failure
Vaccine:
- MenACWY: 2 dose series; 11-12 years, booster at 16 years
- MenB: at 16 yo visit and may repeat 2nd dose in 1 month
Mumps
Pathogen: virus
Symptoms:
- myalgia
- malaise
- HA
- low-grade fever
Complications:
- orchitis (testicular inflammation)
- parotitis (9-94%)
Vaccine:
- first dose after 12 months
- minimum dosing interval: 4 weeks
- CDC schedule: 1st dose at 12-15 months, 2nd dose at 4-6 years
Pertussis
Pathogen: bacteria
Symptoms:
- onset of coryza, sneezing, low-grade fever, and a mild, occasional cough
- cough gradually becomes more severe, and after 1-2 weeks, the paroxysmal stage begins
- paroxysms, numerous rapid coughs, d/t difficulty expelling thick mucus from tracheobronchial tree
- at end of paroxysm, a long inspiratory effort is usually a/b characteristic high pitched whoop
Complications:
- secondary bacterial PNA (most common)
- neurologic complications - seizures, encephalopathy, AOM, anorexia, dehydration, pneumothorax, SDH
- hernias
- rectal prolapse
Vaccines:
- primary series (4 doses): 2, 4, 6, 15-18 months
- 5th dose (when 4th dose before 4th birthday: 4-6 years
- Tdap: single dose 11-18 years
Pneuomococcal Disease
Pathogen: bacteria (streptococcus pneumoniae)
Symptoms:
-abrupt onset of fever and chills or rigors (classically there is a single rigor, and repeated shaking chills are uncommon, pleuritic chest pain)
Complications:
- bacteremia
- meningitis
- death
Vaccines: PCV13 and PPSV23
PCV13
-children: 2, 4, 6, and 12-15 months
-adults 65 years or older who have not received or is unknown should receive a dose… then 6-12 months later, a dose of PPSV23 should be given
PPSV23
- adults 65 and older
- single dose of vaccine is indicated for healthy people 2 years of age and older with a chronic illness
- the 2 vaccines should not be administered simultaneously and minimum acceptable interval is 8 weeks
- adults who previously received a dose of PPSV23 should receive PCV13 no early than 1 year afterwards
Poliomyelitis
Pathogen: viral
Symptoms:
- up to 72% of all polio infections in children are asymptomatic
- approximately 24% of children have minor, nonspecific illness w/o clinical or laboratory evidence of CNS invasion
- nonparalytic aseptic meningitis (symptoms of stiffness of neck, back, and/or legs), usually following several days after a prodrome similar to that of minor illness, occurs in 1-5% of polio infections in children
- fever than 1% of children result in flaccid paralysis
Complications:
- paralytic polio
- death in 2-5% of cases
Vaccine:
-4 doses: 2, 4, 6-18 months, and one dose after 4 yo
