Week 2: Principles of Growth and Development Flashcards

1
Q

normal growth parameters for the infant at 3 months

A

lift head (no head lags), clasp hands, coo

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2
Q

What are normal growth parameters for early childhood (1-4 yrs old) development

A

15 mo: walk

2 yrs: run

4 yrs: tricycle and jump

sensorimotor learning (touching/looking)

impulsive, poor self regulation

preoperational: no sustained logical thought process

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3
Q

What are normal growth parameters for the middle child (5-10 yrs)?

A

Concrete operational: capable of limited logic and more complex learning

Limited logic, complex learning

School, family, environment influence

Self efficacy

More independent

Guilt, self-esteem

Wrong vs right

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4
Q

What are normal growth parameters for the adolescent (11-20yrs)?

A

formal operational thinking: abstract thinking, manipulating ideas in head

Reason logically, abstractly

From family dominated influences to more autonomy and peer influence

Brain development til 20’s

Struggle for identity, independence, intimacy = stress, health related problems, high risk behaviors

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5
Q

In considering abnormal growth, which children should be prioritized for evaluation?

A

Variations b/t 2 standard deviations for age or Kids above 95% or below 5%

Drop in height % on growth curve

Drop > 2 quartiles in 6 months (goes from 25% - 50% - 75%), each 25%, so if drops more than that!

Weight for length < 5% (Use height if < 2 yo; if over 2 yrs, use BMI)

Head circumference above 95% or < 5%

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6
Q

What are the five domains of infant/child development?

A

Gross motor

Fine motor

cognitive development (problem solving)

Communication

Personal/social domains of development

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7
Q

For babies born prematurely, how do you adjust expected developmental milestones for the gestational age? And up to what age do we do this?

A

Correct prematurity til 24 months. if don’t adjust, we will have abnormal findings on developmental screening if expected milestones are not adjusted.

if premature 32 weeks, it’s 8 weeks/2 months early. If baby comes in at 12 month visit, we expect them to attain milestones appropriate for a 10 months old. (subtract how early he/she is by the month visit)

if premature 28 weeks, 28-40= 12 weeks/3 months. if comes in at 9 month check up, 9 - 3 months, expect the baby to be 6 months

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8
Q

What are the various cognitive stages that children progress through?

A

Sensorimotor stage 0-2

Child interacts with environment

touching/looking to symbolic thinking, solving simple problems, remembering songs , engaging in imitative plays

Preoperational stage 2-7

Represent events

Uses symbols, gestures

Concrete operational 5-10 yrs

Limited logic and more complex learning

Formal operational stage 11 yrs

Systematic and reasonable

Reason with tangible objects and events

Abstract thinking

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9
Q

What is the difference between active and passive immunity?

A

active immunity: protection that is made by person’s own immune system
Lasts yrs to lifetime
Vaccines, or being exposed to disease

passive immunity: protection by products produced by an animal or human and transferred to another human, usually by injection

Immunity wanes

Mother to infant

Blood products (IVIg, antitoxin)

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10
Q

What are the two types of vaccines and how do they work?

A

Live attenuated vaccines

Made by modified disease producing virus (“wild) or bacterium in lab

Can replicate/grow but DOESN’T cause illness

If does cause “disease”, its milder than natural disease and known as adverse reaction

Small % of ppl don’t respond to 1st dose (ie MMR or varicella) and need 2nd dose

MMR, vaccinia, varicella, zoster, yellow fever, rotavirus, influenza

NO immunocompromised pt’s (Uncontrolled replication (growth) of vaccine virus , Pregnant pts, < 1 years old)

Inactivated vaccines

Can’t replicate

Less effective than live

Need multiple doses

1st dose = “primes” immune system

Need booster

Antibody titers diminish with time

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11
Q

What special consideration should you make about the interval between most live virus vaccines?

A

Can give injection/intranasal live vaccines SAME visit or else have to wait at least 4 weeks in between each one

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12
Q

What are the various types of adverse vaccine reactions?

A

any medical event that occurs after vaccination

Local reaction (80% of vaccine doses; w/in few hrs; Mild, self limited; Pain, welling, redness at injection site)

Systemic (Generalized, Fever, malaise, h/a, LOA)

Allergic (d/t vaccine or component)

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13
Q

What are the only contraindications to receiving a vaccine?

A

Severe allergic reaction to a vaccine component or following a prior dose

Encephalopathy NOT due to another identifiable cause happening w/in 7 days of pertussis vaccination

Severe combined immunodeficiency (rota virus)

History of intussusception (rotavirus vaccine)

Pregnant (No live vaccines, MMRV, HPV vaccine)

Immunosuppressed

Moderate or severe illness

Delay BOTH live and dead vaccine til recovered

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14
Q

Contraindications in pregnancy

A
  • no live vaccines
  • inactivated vaccines administered if indicated
  • HPV vaccine should be deferred during pregnancy
  • MMRV
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15
Q

Diptheria

pathogen:

sx:

complications:

vaccine schedule:

A

Bacteria
Sx’s: Mucous membranes, Insidious onset pharyngitis, within 2-3 days, membrane forms = respiratory obstruction
Complications:
Myocarditis
Neuritis
Paralysis of soft palate
Eyes & limbs
Death (5-10%, 40% if <5 yo and >40)
Vaccine:
5 childhood doses, 1 adolescent dose then every 10 years
DTAP - children 6 wks - 6 yrs
2, 4, 6, 15-18 months, 4-6 years, 11-12 yrs (TDAP)
Every 10 yrs with TD or TDAP

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16
Q

Haemophilus influenzae type B (Hib)

sx, complications, vaccine schedule

A

Bacteria

Sx’s: Meningitis

Epiglottis

Pneumonia

Arthritis

Cellulitis (buccal cellulitis in the pic)

Complications:

Hearing impairment

Neurologic sequelae

Death (3-6%)

Vaccine:

3 or 4 doses given at:

2, 4, 12-15 months

OR

2, 4, 6, 12-15months

17
Q

Hepatitis A

sx, complications, vaccine schedule

A

Virus

Transmission: fecal-oral transmission

Sx’s:

Abrupt fever

Malaise

Anorexia

Nausea

Abdominal discomfort

Dark urine

Jaundice

Complications:

Immunologic

Neurologic

Hematologic

Pancreatic

Renal extrahepatic manifestations

Vaccine:

2 doses: 1st dose minimum 12 months, 2nd dose min 6 months apart

18
Q

Hepatitis B

sx’s, complications, vaccine schedule

A

Virus

Transmission: parental, mucosal to body fluids

Sx’s

Preicteric:

Insidious malaise, anorexia, nausea, vomiting, RUQ abd pain

Fever, h/a, myalgia, skin rashes, arthralgia, arthritis, dark urine

Icteric: 1-3 weeks

Jaundice, light or gray stools

Hepatic tenderness, hepatomegaly

Splenomegaly less common

Complications:

Fulminant hepatitis (fatality 63%-93%), hospitalization, cirrhosis, hepatocellular carcinoma death

Vaccine:

3 doses; but 4 doses okay!

Birth

1-2 months

6-18 months

19
Q

Human papillomavirus (HPV)

sx’s, complication’s, vaccine schedule

A

Virus

Transmission: direct contact, usu sexual

Sx’s/complications:

Anogenital warts

Respiratory papillomatosis

Cervical, anal, vaginal, vulvar and penile cancer

Vaccines:

Routine schedule 9-11 years, can give up to 26 years old

Gardasil licensed to give thru age 45, catch up HPV NOT recc for all adults > 26 yo, since public health benefit of vaccination in this age range is minimal

2 doses if 9-15yrs old, 2nd dose 6-12 months (min 5 months in between)

If get vaccinated after 15 years old: 3 doses: 0, 1-2 months, and 6 months

Don’t need to restarted if schedule is interrupted

Can’t treat HPV infxn, genital warts, or cervical lesions

20
Q

Influenza

sx, complications, vaccine schedule

A

Virus

Sx’s:

Abrupt fever, myalgia

Sore throat

Nonproductive cough

h/a

Complications:

Pneumonia

Secondary bacterial infections

Reye syndrome

Myocardidits

Deaths < 1 per 1000

Vaccine:

Live (flumist)

inactive: from 6 months + (2 doses, 4 wks apart; 1st year the child gets it thru 8 yrs); then 2-50 yrs annual

Healthy non preg 2-49 years old

21
Q

Measles

sx, complications, vaccine schedule

A

Virus

Sx’s

Fever, incr temp 103-105F

Onset cough, coryza (runny nose), conjunctivitis

Koplik spots - rash on mucous membranes

Confluent Maculopapular eruption lasting 5-6 days

Hairline to face to upper neck then down to hands/feet

Discrete then confluent in upper body

Complications:

Diarrhea

AOM (acute otitis media)

Pneumonia

Encephalitis

Seizures

Death

Vaccine:

2 doses (4 wks apart)

12 mo - 15 mo MMR (MMR first then MMRV)

4-6 yrs

22
Q

Meningococcal disease “college dorms”

sx’s, complications, vaccine schedule

A

Bacterial

Sx’s:

Sudden fever

h/a

Stiff neck / nuchal rigidity

n/v/ photophobia

Altered mental status

Complications:

Petechial or purpuric rash

Hypotension

Shock

Acute adrenal hemorrhage

Multiorgan failure

*think of college daughter that had a sudden fever and died next day even tho mom said to take tylenol**

Vaccine: Men ACWY

2 doses: 11-12 yrs, booster at 16

Men B: (shared clinical decision making) at 16 yo and may repeat 2nd dose in 1 month

23
Q

mumps

sx’s, complications, vaccine schedule

A

Viral

Sx’s:

Myalgia

Malaise

h/a

Low grade fever

Complications:

Orchitis (testicular inflammation)

Parotitis (enlargment of parotid glands)

long term: infertility

Vaccine:

1st dose after 12 months-15 months

Min interval 4 weeks (4-6 yrs)

24
Q

Pertussis

sx, complications, vaccine schedule

A

Bacteria

Sx:

Coryza, sneezing, low grade fever, mild occasional cough, similar to cold

Cough gradually becomes severe after 1-2 weeks,

Then 2nd paroxysmal stage beings

Numerous rapid coughs, bc can’t expel out thick mucous

At end of paroxysm, long inspiratory effort “whoop”

Complications:

Secondary bacterial pneumonia (most common)

Neurologic complication

Seizures, encephalopathy, otitis media, anorexia, dehydration, pneumothorax

Epistaxis, subdural hematoma, hernias, rectal prolapse

Vaccine: 6 doses:

4 doses: 2, 4, 6, 15-18 months

5th dose 4-6 yrs

Tdap: 1 dose 11-18 yrs

25
Q

Pneumococcal Disease

pathogen, sx’s, complications,

A

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 and death

26
Q

pneumococcal vaccine schedule

A

PCV13 - 3 doses age 2,4,6 months, booster at age 12-15 months

for adults age 65+:

PPSV23 - 1 dose, 12 months from PCV13, revaccinate at least 5 years after 1st dose

If not vaccinated during childhood, give PCV13 first

then PPSV23, 12 months later

Never give them together

If PPSV23 given before age 65, revaccinate in 5+ years

In chronic medical conditions/smokers: PCV13 followed in 8 weeks with PPSV23, then PPSV23 in 5 years, after age 65, PPSV23 at least 5 years from last dose

In asplenia/functional asplenia - don’t give with meningococcal vaccine at the same time, give only after the youth series is finished

27
Q

Poliomyelitis

pathogen, sx’s, complications, vaccines

A

virus

sx’s: 72% asymptomatic

24% nonspecific, minor illness w/o clinical or lab evidence of CNS invasion

nonparalytic aseptic meningitis (stiff neck, back, and/or legs)

<1 % flaccid paralysis

complications: paralytic polio, death in 2-5% cases

vaccine:

4 doses: 2, 4, 6-18, 1 dose after 4 yrs

28
Q

Rotavirus

pathogen, sx, complications, vaccine schedule

A

Viral

sx’s: watery diarrhea, severe dehydration

fever (> 102F) , vomiting

complications:

severe diarrhea, dehydration, electrolyte imbalance, and metabolic acidosis

vaccine: (oral)

○ Rotateq: 3 doses, 2, 4, 6 months 14

○ Rotarix: 2 doses, 2 and 4 months

○ Maximum age for first dose is 14 weeks 6 days

29
Q

rubella

pathogen, sx’s, complications, vaccine schedule

A

viral

Sx’s: 1-5 prodrome low grade fever, malaise, lymphadenopathy, upper respiratory symptoms, preceding the rash

rash is maculopapular appearing 14-17 days after exposure (face first then head/foot); lasts 3 days; pruritic

Complications:

Arthralgia, encephalitis, hemorrhagic complications
○ Congenital rubella: fetal death, prematurity, deafness, eye and cardiac defects, microcephaly

vaccine:

First dose after 12 months

Second dose usually 4-6 years

Given as MMR or MMRV

Ensure non-pregnant women of childbearing age are immune

30
Q

tetanus

pathogen, sx’s, complications, vaccine

A

bacteria

sx’s: trismus/lock jaw, stiffness of neck, difficulty swallowing, rigidity of abdominal muscles

elevated temp, sweating, elevated BP, episodic rapid HR

spasms (freq/several mins) x 3-4 weeks

vaccine:

DTaP (5 doses): 2, 4, 6, 15-18 months, 4-6 years

○ Tdap: 11-12 years and then every 10 years (TD or Tdap)

○ Tdap: given during 3rd trimester of pregnancy to protect baby from pertussis through passive immunity

31
Q

varicella zoster

pathogen, sx’s, complications, vaccine schedule

A

viral

sx’s:

varicella: mild prodrome before onset of rash
- rash on head then trunk, extremities; vesicular 1-4mm, may rupture and crust; form in crops; “dewdrop on a rose petal”
shingles: vesicular eruption of zoster unilaterally in distribution of sensory nerve; involves turnk or 5th cranial nerve; 2-4 days before eruption there is pain and parethesia in area; few systemic areas

postherpetic neuralgia

vaccine:

MMRV - 2 doses age 12-15 months, 4-6 years

in person w/o proof of immunity, 2 doses separated by 4 weeks

adults age 50+: (shingrix) 2 doses of zoster recombinant vaccine (2-6 months apart

age 60+ : 1 dose live zoster vaccine

32
Q

Weight and height at 12 months

A

infant: 1 yo (3x weight, ht increase by 50% ie: 8 lb 20 inches, then in 1 yr, 24 lbs, 30 inches)

33
Q

Infant at 6 months

A

able to roll over

reach for objects

turn to voices

babble

sit with support

34
Q

Infant at 9 months

A

neat pincer grasp

indicate wants

developed “stranger danger”