week 6 Flashcards
musculoskeletal, lymphatics and abdominal
bones grow for how many years? no fully ossified (firm and calcified) until when?
19-20 years, adulthood
fractures that are uncommon in children
rib fractures
lordosis and curve of spine is normal at what ages?
lordosis (toddler) , curve of spine (3-4 mo) to help with head control
bow legs is called what and normal for kids what age? knock knees is called what and normal for kids what age? What happens if bow leg persists beyond this age?
genu valgum (infants and toddlers), genum varum (2-8years)
genum varum it is termed at tibial torsion which can be caused by rickets, JRA, osteomyelitis, neoplasia or trauma
flat feet is called what and is normal at what age?
pes planus (infants)
there is a growth spurt that peaks at what age for girls and what age for boys?
13 (g) , 14 (b)
Blounts disease
- common in scandinavian and african american children
-bow legs with ONLY TIBIAL involvement. bow legs is both tibial and femur involvment
Hip dysplasia (developmental dysplasia of the hips) common in, exams, etc
- common in caucasian and indiginous north americans
- common when keeping tight swaddle, keeping hips adducted
- common in breech presentation
- NEEDS to be checked every well-child visit for the first YEAR of life to initiate treatment and prevent hip dislocation
- one hip at a time, diaper off
- EXAMS: ortalani, and barlow
club feet- what the actual name for it and who is it common in
- talipes equinovasus
- Polynesian group and genetic complications
why do we want to the know the onset of puberty?
- know the remaining musculoskeletal growth years
what is positional clubfoot?
metatarsus adducts
what is torticollis? how to treat
contracted sternocleidomastoid muscle.
- put a toy on the opposite side of the crib, doesnt work - PT!
obese children are at risk for suffering from
Slipped Capital Femoral Epiphysis (SCFE) which happes when excessive wt happens on a hip and results in ripped hip muscles and tearing through the vascularity which can be very dangerous. if notice unstable hip, they need a referral and non wt bearing until evaluation
what age do we send for PT refferal if the child is not walking?
15 mo. want to know what the patient is doing all day (daycare, pack and play, laying) etc.
infant joint eval:
done when the patient is passivly moving in the exam room since the patinet cannot follow commands
infant cannot sit without support until what age
8 months
W sitting is a sign of what childhood condition
Cerebral Palsy
things that have made posture an issue for older children
- phone use
- heavy backpacks
- obesity
6 or more cafe-au-lait spots can indicate what
neurofibromatosis
head circ is collected and plotted until age what
2 years
fontanelle closures
anterior: 12-18 months
Posterior: BY age 2 months (sometimes closes at birth)
flat head technical age
plagiocephaly
what could a lack of spontaneous movment of the upper extremity in a newborn mean?
erbs palsy which is a birth injury to cranial nerves V and V1
inspect palm of newborn for what
palmar creses, whorls, finger loops and ridges
- transverse (simian) crease occurs in childrens w down syndrome
nursemaid elbow is what
subluxation of the radial head
symetrical painful swelling of the hands can be cuased by
sickle cell disease
joint deformity can occur with some syndromes and
juvenile RA
marfan syndrome
long slender fingers with hyper extendable joints
EXAMS for DDH
barlow: if the hip is dislocated, a clunk is palpable but not audible as the hip dislocates out of the acetabulum
Ortolani: a palpable but not audible clunk is felt when the hip dislocation is reduced
Galeazzi: knee height is compared (shorting of the limb on the affected side that is dislocated)
signs of scoliosis
uneven hip or shoulder height, lateral curvature of the spine or rasied scapula on one side
Adams forward bending test
ask child to stand and reach for toes folding voer legs.
inspecting for lumps, curves, etc.
tool to measure degree of curvature. what degree requires treatment?
scoliometer, 25 degrees or more requires treatment
Gaits associated with CP
scissor walk and toe walking (also caused by kids in walkers for a long time)
depth of assessment in a well child visit is determined by what
health history and family history
types of moveable joints (4)
-pivot- neck
- hinge elbow and knee
- ball and socket- shoulder
- condyloid- fingers and wrists
active vs passive ROM
active is what the patient can do for themselves, passive is what motion can be done with assistance.
muscle grade assessment
- grades 0-5
- 0 no activation
-5 full ROM against full resistance - grade 3 or lower indicates a disability (full ROM against gravity but not against resistance)
TMJ ROM
- should be a gap of 3-6 CM between upper and lower teeth (back by the joint)
- side to side, should move about 1-2 cm both sides
- should be able to move it forward and backwards
- clench teeth to feel contracted muscle
pregnancy changes MSK and why does this happen?
- lordosis or inward curvature of the lumbar spine
- relaxing of the pelvic muscles and ligaments to change the pelvic angle
- happens for the body to naturally re-establish its center line of gravity as the abdomen grows in size and wt.
- carpal tunnel syndrome from swelling of the extremities from fluid retention (usually goes away after 6 mo post baby)
older adults MSK considerations
- takes more time to examine
- need to assess motor skills for functional abilities
- posture changes (kyphosis)
- bones are more spread apart on hands and feet and more pressed together vertically (height)
-muscle mass production
specialized tests for adult musculoskelatal
Phalen:
- Carpal tunnel syndrome
Tinel:
- Carpal tunnel syndrome
Bulge:
- knee effusion
Ballottement/Patella
Mcmurrey:
- meniscus injury (torn)
Straight leg raise
- lumbar disk herniation
stomach capacity at neonate, toddler and adolecents
60,500,1000 ML
abdominal muscles in neonates and toddlers are..? what does this not help with?
neonates: protuberant
toddler: prominent
protecting the liver and the spleen
abdomen is larger than the chest in age what to what
brith to 4 years
pancreatic enzyme activity is decreased at birth until what age? what does this effect?
4-6 mo… varied bioavailility that may depend on specific enzymes to aid in drug absorption
liver is immature from age what to what? what age does it reach full SIZE?
birth to age 1 years. size: adolecents
decreased hepatic enzyme functions in kids result in what? what ages?
longer half lifes of drugs from birth to age 3-4
from birth to age 1 the liver synthesizes and stores glycogen less effectivly. what does this make infants prone to?
hypoglycemia
length of sm intestine for a infant is what? what does this allow for?
proportionatly longer relative to body size. which provides greater surface area for absorbtion until they are toddlers.
what age does a baby have prolonged gastric emptying?
age 6-8mo
what is the gastrocolic reflex?
food entering the stomch stimulates the need for a bowel movement
when can we start potty training? why can we NOT do it earlier?
we don’t start until 18-24 months because the spinal cord mylenates and the musculature of the anus develops before then and that’s when the child can begin controlling their bowel movements.
when can you palpate the R kidney?
what does this put at risk for?
- palpation can happen with a child less than preschool age (because of increased proportional size of kidney), on the right posterior side when the patient is inhaling (chest wall lifts up)
- trauma susceptibility with kidney exposure
kidney maturity at birth until what age and what does it mean for kids
-birth to age 2
- increased vascular resistance and incomplete glomerular and tubular development which means decreased renal blood flow, glomerular filtration rate and tubular function
- risk for hypovolemia and dehydration
- until preschool age, the kidneys are proportionally larger and surrounded by less fat.
where does the bladder sit ages birth to 3? when does it descend into the pelvis?
between the symphysis and the umbillicus, decends during puberty
bladder capacity: newborns, calculation for older infants/children
20-30 ml, (age in years)+2=(# of ounces) x 30= # ml capacity
umibical hernia is common for what population
- 8x more common in african american children
lactose intolerance is highest in what population
- hispanic, african, asian and mediteratian
cystic fibrosis is most common in what population
- white children
polyhydramnios can be associated with what
TEF, intestinal atresia
oligohydramnios can be associated with what
- urinary obstructive lesions, polycistic kidneys, renal agenesis, and gastrointestinal atresias
what should be notes about children’s ears? related to the GI tract
low set pinna can be associated with renal disease
what type of stool could indicate intussusception?
currant jelly stools
abdominal assessment order
inspection auscultation percussion palpation
scaphoid abdomen in infant and older child can indicate (transverse view of the abdomen when the patient is lying supine)
infant: congenital diaphragmatic hernia
older child: malnoursihment
begin bowel sounds in what quadrant
RLQ
area of pain should be assessed
last
bowel sounds are considered absent when what
sounds are auscultated and NOT heard for 2 full minutes
why would you hear tympany in the abdominal areas when purcussing a child?
gas in the stomach
what is light palpation used for?
finding areas of tenderness or rigidity
what is deep palpation used for?
evaluate underlying structures
when palpating the spleen, what is important?
GENTLE palpation
what is iliopsoas test used for?
- identify intra-abdominal inflammation
- commonly used in appendicitis
- positined on the affected side, asked to extend the other leg at the hip against resistance (abdominal pain is illicited )
what is the obturator test used for?
- identify intra-abdominal inflammation
- supine, flexes each leg at the hop and rotates internally and externally
when do you start calculating BMI
2 years
what is the ballottment test
assessing for knee effusion
older adults GI considerations
- decreased intestinal mobility
- thinner abdominal wall
- obstruction
- rounded abdominal contour
- fecal incontinence
infant nutrition assessment… what to ask?
- formula or bf?
- how much/long of each
- wet diapers
- stool patterns
- solids?
- cows milk?
- feeding relationship with parents
weight expectations for infants
- lose initially about 6% of their birth weight and regain it within the first 10-14 days
- by 6 months, they should DOUBLE, by year 1, they should TRIPLE, by 2 years, QUADRUPLE
Length for infants
- increase by 50% in the first year
- averaging 1 inch a month in the first 6 months
young children eating habits
- 12-18 mo: pincaer grasp, hold a spoon and cup, wants other peoples food
- 2-3 yrs hold a cup, chew food well, express likes and dislikes
- 4 years: use fork, hold handle of cup, pour liquids from small containers, request fav foods, begin being influenced by media
young children what to ask? (1-5years)
- type/amount of milk
- type/amount of juice (no more than 4oz is reccomended/day)
- meat, fruit/veggies
- snacks
FAT SHOULD NOT BE RESTRICTED younger than 2 years
screentime recommendation for school age kids
no more than 2 hrs/day
dental health
- first dental visit at 6 mo
- semi annual visits start at 3 yrs
what do you do if there appears to be a problem with nutrition?
consult for a nutritionist to be seen
