Well Child 2 Flashcards
Abdomen
- What are the vessels of the umbilical cord?
- Definition: develops at base of navel, pink granulation tissue formed during the healing process
- Cord: 2 umbilical arteries, 1 umb vein
- Umbilical granuloma
What is this?
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Umbilical Granuloma
- develops at base of navel
- pink granulation tissue formed during healing process
Male GU
- Presence of testes, size of penis, appearance of scrotum
- 30% of pre term male infants are born w/ what?
- Definition: abnormal ventral placement (check before what?)
- Definition: abnormal dorsal placement (uncommon)
- 30%: undescended testicle
- Hypospadias (Hypo-below)
- Epispadias (Epi-eye)
Male GU
- What are 2 common scrotal masses in newborns?
- What side are they most common on?
- hydroceles & inguinal hernias
- RIGHT
Which mass?
- Overlie the testes & spermatic cord
- Not reducible
- Can be transilluminated
- Usually resolves by __ months
- Refer to urology to r/o what?
Hydrocele
- 18
- hernia
Which mass?
- Separate from the testes
- Usually reducible
- Often DO NOT transilluminate
- Do not resolve
Hernias
Female GU
- Often a milky white discharge present, but what may be present?
- Labial adhesions
- What may be noted at birth?
- Blood tinged
- imperforate hymen
Anus / Spine
- Imperforate anus is not always obvious. Cannot assume until baby passes what? Usually passes within how many hours?
- If there is a sacral dimple, must get what test?
- Meconium / 48 hours
- US (to check for spina bifida)
Extremities
- Count fingers/toes
- Check for what 2 things?
- Syndactyly (webbed or conjoined fingers or toes)
- Palmar crease (single palmar crease - simian crease associated w/ trisomy 21)
Hip
- Evaluation for what condition?
Developmental dysplasia of the hips (DDH)
5 risk factors for Developmental Dysplasia of the Hips (DDH)
- breech
- caucasian
- 1st born female
- family hx
- prematurity
Hip
- What would prompt a further work up of DDH?
- Which tests for ability to sublux or dislocate an intact, but unstable hip? (IN)
- Which tests for posteriorly discolated hip? (OUT)
- What other finding is suggestive of DDH?
- Audible “click” heard w/ maneuvers
- In: Barlow
- Out: Ortolani
- Asymmetry of leg creases
Tx for DDH?
- Ortho eval & pavlik harness
- If untreated can lead to degenerative hip disease
Palmar Grasp
- Primitive Reflex
- Place your finger into baby’s hand and press (baby will flex all fingers to grasp your finger)
- What age?
- Birth - 3/4 months
Plantar Grasp Reflex
- Primitive Reflex
- Touch sole at base of toes
- Toes will curl
- Age?
- Birth - 6/8 months
What reflex?
- Hold baby supine while supporting head, back, legs
- Abruptly lower entire body about 2 feet
- –> arms should abduct & extend
- –> hands open & legs flex (baby may cry)
- Age?
- Persistence beyond what age suggests what?
- Asymmetric response indicates what?
Moro Reflex (Startle Reflex)
- birth - 4 months
- 6 months –> neurological dz: CP
- Fx of clavicle or brachial plexus injury
Which primitive reflex?
- with baby supine, turn head to one side, holding jaw over shoulder
- the arms/legs on side to which head is turned extend (think bow & arrow)
- the opposite arm/leg flex
- What age?
- Persistence beyond this age suggests what?
Asymmetric Tonic Neck Reflex
- Birth - 2 months
- asymmetric central nervous system development
Which reflex?
- Hold the baby around the trunk & lower until the feet touch a flat surface
- the hips, knees & ankles extend & baby stands up, partially bearing weight, sags after 20-30sec
- What age?
- Lack of reflex = hypotonia or flaccidity
Positive Support Reflex
- Birth - 2/6 months
Which reflex?
- stroke the perioral skin at the corners of the mouth
- the mouth will open & baby will turn the head toward the stimulated side
- Age?
Rooting Reflex
- Birth - 3/4 months
Which reflex?
- Support the baby prone w/ one hand
- stroke one side of the back 1cm from midline, from shoulder to buttocks
- the spine will curve TOWARD the stimulated side
- Age?
- Absence suggests what?
Trunk Incurvation (Galant’s Reflex)
- Birth - 2 months
- Transverse spinal cord lesion or injury
Which reflexes?
- hold baby upright from behind (as in positive support reflex)
- have one sole touch the tabletop
- the hip & knee of that foot will flex & the other foot will step forward
- alternate stepping will occur
- What age?
Placing & Stepping
- Birth (best after 4 days) - variable age to disappear
Vision
- Always check for what?
- Ages 3-5: 20/40
- Ages 6+: 20/30
- The AAP recommends annual photo screening between what ages?
- What is the MC cause of childhood blindness?
- Red reflex
- 1 - 3 yrs
- Amblyopia
Hearing Screening
- AAP recommends universal hearing screening before when?
Before leaving the hospital
Blood Pressure
- Start checking at what age?
-
Check before this age if pt has risk factors:
- Kidney disease, prematurity, congenital heart disease, recurrent UTIs, hematuria, proteinuria
- Other conditions associated w/ HTN: neurofibromatosis, tuberous sclerosis)
- 3 yrs
Additional Screening
- Check what level to screen for iron deficiency at 9 months or 12 months?
- CDC recommends universal screening of what for children age 1-2 yrs old?
- Autism screening at what ages?
- STI testing for high risk adolescents
- Iron def: Hemoglobin
- 1-2 yrs: Lead (targeted screening for those in communities w/ high risk = homes before 1950)
- Autism: 18mo & 24mo
Lipid Panel
- Fasting lipid screening is recommended for children between what ages?
- (if what 6 certain RF are present?)
- Controversial if need to screen if pt/adolescent has no RF or Fam hx
- 2 - 10 yrs
- Fam hx of HLD
- Fam hx of early CV disease
- Obesity
- Overweight
- HTN
- DM
Dental
- Wash gums/teeth prior to 1st dental visit
- 1st dental visit between what ages?
- Brush 2x/day
- Floss 1x/day
- Dental visit how often?
- 1st: 12mo - 3yrs
- Every 6 months
Dental: Baby Teeth eruption ages: UPPER
- Central incisor
- Lateral incisor
- Canine
- Central: 8-12 months
- Lateral: 9-13 months
- Canine: 16-22 months
Dental: Baby Teeth eruption ages: UPPER
- 1st molar:
- Second molar:
- 1st: 13-19 months
- 2nd: 25-33 months
Dental: Baby Teeth eruption ages: LOWER
- 1st molar:
- 2nd molar:
- Canine:
- Lateral incisor:
- Central incisor:
- 1st molar: 14 - 18 mo
- 2nd molar: 23 - 31 mo
- Canine: 17-23 mo
- Lateral incisor: 10 - 16 mo
- Central incisor: 6 - 10 mo
Permanent Teeth Eruption - UPPER
- Central incisor
- Lateral incisor
- Canine
- 1st premolar
- 2nd premolar
- Central incisor: 7-8 yrs
- Lateral incisor: 8-9 yrs
- Canine: 11-12 yrs
- 1st premolar: 10-11 yrs
- 2nd premolar: 10-12 yrs
Permanent Teeth Eruption - UPPER
- 1st molar:
- 2nd molar:
- 3rd molar:
- 1st molar: 6-7 yrs
- 2nd molar: 12-13 yrs
- 3rd molar: 17-21 yrs
Permanent Teeth Eruption - LOWER
- Central incisor
- Lateral incisor
- Canine
- 1st premolar
- 2nd premolar
- Central incisor: 6-7 yrs
- Lateral incisor: 7-8 yrs
- Canine: 9-10 yrs
- 1st premolar: 10-12 yrs
- 2nd premolar: 11-12 yrs
Permanent Teeth Eruption - LOWER
- 1st molar:
- 2nd molar:
- 3rd molar:
- 1st molar: 6-7 yrs
- 2nd molar: 11-13 yrs
- 3rd molar: 17-21 yrs
Car Safety
- Rear facing car seat until how old?
- Booster seat until how tall?
- No front seat until what age?
- Rear facing: 2 yrs
- Booster: 4’9”
- Front seat: 13 yrs
Safety at Home
- Keep what 3 things away from kids in the house?
- What number should you have on hand?
- Button batteries
- Laundry pods
- cleaning products
- Poison control
Milestones of what age?
- fixes/follows on face
- some head control
- responds to sounds/noises
- spontaneous smile
1 month
Milestones of what age?
- Responsive smile
- coos/vocalizes
- lifts head when prone
- follows to midline
2 months
Milestones of what age?
- rolls from tummy to back
- good head control
- laughs, squeals
- follows past midline
- grasps toys/objects
4 months
Milestones of what age?
- sits w/ support
- bears weight on legs
- vocalizes “ba, da-da”
- reaches out for toys
- follows 180 degrees
- stranger danger/separation anxiety
6 months
Milestones of what age?
- crawls
- pulls up to stand & cruises on furniture
- says mama/dada
- immature pincer grasp
- responds to name
9 months
Milestones of what age?
- walks (however, may be delayed up until __ months)
- waves bye-bye
- says mama/dad
- points w/ index finger
- self feeds w/ fingers
12 months
- 18 mo
Milestones of what age?
- 3-6 words
- walks well
- climbs stairs
- imitates actions
15 months
Milestones of what age?
- 5-15 words
- some 2 word phrases
- uses spoon/fork
- scribbes
- follows simple commands
- runs, walks backward
18 months
Milestones of what age?
- 20-50 words or more
- 2 word phrases
- kicks ball
- builds 3-4 block tower
- 50% speech understandable
24 months