Week 2: Principles of Growth and Development Flashcards
normal growth parameters for the infant at 3 months
lift head (no head lags), clasp hands, coo
What are normal growth parameters for early childhood (1-4 yrs old) development
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
What are normal growth parameters for the middle child (5-10 yrs)?
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
What are normal growth parameters for the adolescent (11-20yrs)?
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
In considering abnormal growth, which children should be prioritized for evaluation?
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%
What are the five domains of infant/child development?
Gross motor
Fine motor
cognitive development (problem solving)
Communication
Personal/social domains of development
For babies born prematurely, how do you adjust expected developmental milestones for the gestational age? And up to what age do we do this?
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
What are the various cognitive stages that children progress through?
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
What is the difference between active and passive immunity?
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)
What are the two types of vaccines and how do they work?
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
What special consideration should you make about the interval between most live virus vaccines?
Can give injection/intranasal live vaccines SAME visit or else have to wait at least 4 weeks in between each one
What are the various types of adverse vaccine reactions?
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)
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 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
Contraindications in pregnancy
- no live vaccines
- inactivated vaccines administered if indicated
- HPV vaccine should be deferred during pregnancy
- MMRV
Diptheria
pathogen:
sx:
complications:
vaccine schedule:
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
Haemophilus influenzae type B (Hib)
sx, complications, vaccine schedule
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
Hepatitis A
sx, complications, vaccine schedule
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
Hepatitis B
sx’s, complications, vaccine schedule
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
Human papillomavirus (HPV)
sx’s, complication’s, vaccine schedule
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
Influenza
sx, complications, vaccine schedule
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
Measles
sx, complications, vaccine schedule
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
Meningococcal disease “college dorms”
sx’s, complications, vaccine schedule
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
mumps
sx’s, complications, vaccine schedule
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)
Pertussis
sx, complications, vaccine schedule
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
Pneumococcal Disease
pathogen, sx’s, complications,
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
pneumococcal vaccine schedule
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
Poliomyelitis
pathogen, sx’s, complications, vaccines
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
Rotavirus
pathogen, sx, complications, vaccine schedule
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
rubella
pathogen, sx’s, complications, vaccine schedule
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
tetanus
pathogen, sx’s, complications, vaccine
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
varicella zoster
pathogen, sx’s, complications, vaccine schedule
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
Weight and height at 12 months
infant: 1 yo (3x weight, ht increase by 50% ie: 8 lb 20 inches, then in 1 yr, 24 lbs, 30 inches)
Infant at 6 months
able to roll over
reach for objects
turn to voices
babble
sit with support
Infant at 9 months
neat pincer grasp
indicate wants
developed “stranger danger”
