Well child care Flashcards
components of Growth Parameters during Well child visits
- Measured at every well-child visit
- Ht, and wt are measured at every visit
- Head circumference is measured up through age 3 years
- BMI is measured starting at age 2
purpose of using growth parameters?
how is it measured?
- help recognize growth deficiencies and abnormalities, proper nutrition, CNS issues, neglect, and other forms of abuse
- Measured in percentiles
- want to see a trend, not necessarily what percentile they’re in at that time
term used to describe growth faltering in infants and young children whose wt curve has fallen by two major percentiles in < 6 mo from a previously established rate of growth, or whose wt for length decreases below the 5th percentile
failure to thrive
when should BP be checked during well child visits?
- Starts at age 3
- Any age every visit if renal/cardiac abnormality
diagnostic value for childhood HTN
- SBP or DBP >95th percentile based on age and wt of child OR
- >130/80 on 3 occasions
- > 13 y, use adult guidelines >130/80
labs after diagnosing childhood HTN
UA (renal disease)
BMP
lipids
renal US < 6 y or abnml labs
+/- A1C and LFTs if obese
when to assess vision? how is it tested?
- from birth to three
- ability to fixate and follow an object
- Symmetric red reflex
- if you shine light on eye = blepharospasm response
- At 6 wks - should begin to fixate
- At 3 yrs - formal VA testing
when to refer vision problems?
- 3-4y with vision worse than 20/40
- 5y with vision worse than 20/30
- > 6 (school age) with vision worse than 20/20
- abnml or asymmetric red reflex
- Loss of VA in one eye (amblyopia)
- Test VA in each eye separately
- Strabismus tested at each visit as well
one of the MC congenital abnormality in newborns
Hearing loss
T/f: Even a minimal degree of hearing loss may cause speech and language delay and difficulty in social and educational environments
T
at risk infants for hearing loss - social/language development interventions should be in place by what age?
6 months
All infants with or without risk factors should receive ongoing surveillance of communicative/ language development beginning at what age during well-child visits
2 months
MCC hearing loss in 2-5 y/o?
otitis media
- gold standard of hearing screening for this age group of birth to 3?
- > 4y?
- behavioral and language response
- audiometry
Vision and hearing screened subjectively in office until child is old enough to cooperate
hearing screenings for ages >5y?
- Continue to do at WCC
- screened in school and referred to physician only if they fail the screening.
8 innate reflexes
- Sucking: newborn sucks in response to a nipple in mouth, doesn’t disappear, but by 4 mo becomes voluntary
- Rooting: head turns to side of facial stimulation disappears by 4 mo
- Palmar grasp: placement of examiner’s finger in the newborn’s palm; develops by 28 weeks gestation and disappears by 3-6 months
- Moro (startle): develops by 32 weeks and disappears by 3-6 months
- Tonic neck: “fencing position;” Disappears by 4-6 months
- Traction response: pulled by the arms, head lags, then comes to midline briefly before falling forward. disappears around 6 months, can hold head up
- Placing response: simultaneous flexion of the knees and hip and placement of the stimulated foot on the table, disappears 2 months
- Stepping response: elicits alternating stepping movements with both legs, disappears at 1-2 months
absence of red reflex is called ?
leukocoria
leukocoria is indicative of ?
mgmt?
congenital cataracts, retinoblastoma, glaucoma
- Immediate referral
- Check for strabismus/amblyopia in 6 mo
- Strabismus - intermittent phenomenon in newborns/infants up to 6 mo
The major sutures palpable at birth are ?
frontal, coronal, sagittal, lambdoid
located at junction of sagittal and coronal (closes over 9-18mos, can go to 24 months)
anterior fontanelle
located at junction of sagittal and lambdoid (closes around 2-3 months)
posterior fontanelle
Bulging fontanelle is a sign of ?
depressed fontanelle is a sign of ?
- increased ICP
- dehydration
what is Plagiocephaly
- Premature closure of coronal or lambdoidal suture causes lopsided appearance
- Anterior plagiocephaly - flattens forehead and elevates eyebrow on one side
- the opposite side’s forehead - excessively prominent due to compensatory overgrowth.
what is Scaphocephaly
Premature closure of sagittal suture, resulting in restricted width of the head so that it is abnormally long and narrow
- closure of coronal, lambdoidal, and sagittal sutures, resulting in an upward growth of the head so that it has a pointed, or conical, shape.
- Often associated with rare syndromes
Acrocephaly
- Premature closure of the frontal (also called metopic) suture
- narrow, triangular shaped forehead with a prominent midline ridge
Trigonocephaly
- what is Positional Plagiocephaly (occipital)?
- causes?
- mgmt?
- Mechanical pressure on malleable skull caused by static supine positioning = flattening of occiput in patients
- Supine sleeping position, congenital torticollis, prolonged periods in car seats, and hydrocephalus
- tx: Frequent position changes, tummy time, change crib positions, Skull-molding helmets - all until until 12-16 months
what skull shapes warrant a Referral to Maxillofacial surgeon or neurosurgeon?
what imaging?
Plagiocephaly, Scaphocephaly, Acrocephaly, Trigonocephaly
- Imaging held until specialist visit - CT
mgmt for abnormal head shapes?
-
Open approach surgery - Acro, plagio, and trigonocephaly, scaphocephaly
- large incision across scalp to obtain access to cranial vault
- Delayed until 9-12 months so bones are strong enough to build enduring construct -
Endoscopic approach surgery - Scaphocephaly
- Smaller incisions
- Corrected at 2-3 months of age - Cranial bone easier to remove, less blood loss
