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Pediatrics > Well Child Care and Developmental Assessment > Flashcards

Well Child Care and Developmental Assessment Flashcards

1
Q

Frequency of Well Child Care Visit for the following ages:

  1. Age 5-7 days?
  2. After that?
  3. Until age 6?
  4. Until age 12?
  5. Yearly ages 13 through 18?
A
  1. Age 5-7 days, 2 weeks
  2. Ages 2, 4, 6, 9, l2, l5, l8 and 24 mos
  3. Then yearly till age 6
  4. Then every 2 years till age l2
  5. Yearly ages 13 through 18
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2
Q

What should be in the visit?

7

A
  1. Growth measurements
  2. Interval Hx (assess family)
  3. PE (find abnormalities)
  4. Developmental Assessment
  5. Anticipatory Guidance (Prevention and Nutrition)
  6. Immunizations
  7. Answer questions
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3
Q

Growth Measurements
When to worry?
3

A
  1. Weight falls 2 percentile lines
  2. Weightt below 5%
  3. Head size passing 2 percentile lines
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4
Q

Development Assessment
Areas to be assessed include?
6

A
  1. Gross Motor
  2. Fine Motor
  3. Language
  4. Personal-social
  5. Vision
  6. Hearing
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5
Q 
Developmental Delays
Tend to present in an age-related manner. State when the following occur:
1. Motor delays?
2. Language delays?
3. Learning disabilities?
A
  1. Motor delays tend to manifest in the first year of life
  2. Language delays tend to manifest in the toddler and preschool years of life
  3. Learning disabilities manifest during the school years
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6
Q

Variety of types of standardized instruments for developmental assessment including?
4

A
  1. Denver II
  2. ASQ (Ages and Stages Questionnaire)
  3. Brigance Screening
  4. PEDS (Parents’ Evaluation of Developmental Status)
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7
Q
  1. What age is the Denver II a screening to for?
  2. At what well child visits should the Denver II be used?
  3. What are we looking to identify here?
  4. What four areas are screenedd?
  5. How do we correct it for childern born before 38 weeks?
  6. How is each item scored? 4
A
  1. Screening tool for the apparently normal child between the ages of 0 and 6 years
  2. Use is suggested at every well child visit
  3. Objective measure which allows provider to identify those children who may have developmental delay, and thus would benefit from further evaluation
  4. Four areas screened include: gross motor, fine motor, personal-social, and language
  5. Children born before 38 weeks gestation must have their age corrected for prematurity, up to 2 years of age
  6. Items should be scored as:
    - pass,
    - fail,
    - no opportunity, or
    - refused to cooperate
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8
Q

What are the scoring classifications for the Denver II tests?
4

A
  1. Advanced: Child passes item that falls completely to the right of the age line
  2. Normal: Child passes, fails, or refuses item on which the age line falls between the 25th and 75th percentile
  3. Caution: Child fails or refuses item on which the age line falls between the 75th and 90th percentile
  4. Delayed: Child fails or refuses item that falls completely to the left of the age line
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9
Q

Criticisms of the Denver II?

5

A
  1. Can take a while to administer the test (How long do you have with the child, really?)
  2. Norms established not necessarily representative of the population as a whole, may not compare appropriately with other populations
  3. Some items are difficult to test
  4. Requires a number of items to administer test thoroughly
    5 .High over-referral rate (why do you think this would be?)
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10
Q 
ASQ
Ages and Stages Questionnaire
1. Relies on what information?
2. Screens for what?
3. Where is this test done?
4. Can be used in what ages of pts?
A
  1. Relies on information from parents
  2. Screens for developmental problems
  3. Takes 10-15 minutes to complete (but this is done at home, not in your office!)
  4. Can be used in patients 4 months to 5 years
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11
Q

Brigance Screening

  1. Relies primarily on what?
  2. Can be used in what aged pts?
  3. Takes how long?
A
  1. Relies primarily on observation and elicitation of skills (0-2 year age range can be administered by parent report)
  2. Can be used in patients 0-90 months
  3. Takes 10-15 minutes to administer
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12
Q

PEDS: Parents’ Evaluation of Developmental Status

  1. Relies solely on what information?
  2. What aged pts?
A
  1. Relies solely on information from parents

2. Can be used in patients birth to 8 years

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13
Q

In a potential language problem what should we check first?

A

Check hearing first

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14
Q

The ASQ relies on information from parents but… instead of it just relying on memory, it forces the parents to go through the testing with their child. This is good for several reasons:
3

A
  1. Gets parents involved in their child’s care
  2. Helps them to become more aware of their child’s abilities/limitations
  3. Saves a ton of time as the test is already complete by the time they come to the office
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15
Q

High Impact Anticipatory Guidance

2 things to discuss

A
  1. **NO SMOKING

2. **Reading to the child

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16
Q

Describe the risks/benefits of the following:

  1. **NO SMOKING
  2. **Reading to the child
A
  • *NO SMOKING
    1. Increases risk of SIDS, AOM, Asthma, Cough, URI, and children of smokers SMOKE!
    2. **Reading to the child: proven to increase school performance (what else does this do?)
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17
Q

Anticipatory Guidance: Newborn?

8

A
  1. Review feeding method
  2. Proper sleep position and environment
  3. Care of skin, cord, circumcision
  4. Breast engorgement, vaginal discharge
  5. Jaundice
  6. Injury prevention
  7. When and why to call doctor
  8. Individuality of infant
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18
Q

What things should we educate about injury prevention for the newborn?
9

A
  1. Microwave safety (heating bottles can be dangerous),
  2. car seat safety,
  3. crib safety,
  4. siblings,
  5. pets,
  6. smoke detectors,
  7. hot water heater temperature setting (set at 120F),
  8. UV protection,
  9. smoke free home
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19
Q

Anticipatory Guidance

Two-week visit?

A
  1. Answer questions about breast or formula feeding
  2. Sleep patterns (encourage mom to sleep when baby sleeps)
  3. Social interaction with family
  4. Injury prevention
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20
Q

Injury prevention for the two week visit includes?

9

A
  1. Car safety seats,
  2. smoke detectors,
  3. hot water temp,
  4. reinforce “back to sleep”,
  5. violence prevention,
  6. education about colic,
  7. educate about shaken baby syndrome,
  8. UV Protection,
  9. smoke free home
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21
Q

Why shouldn’t we give a little child honey?

A

Clostridium botulinum

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22
Q

Anticipatory Guidance
Two month visit?
6

A
  1. Nutrition
  2. Sleeping issues
  3. Play with, talk to, cuddle infant, **never too early to read to a child, **educate about time alone with siblings
  4. Signs of maternal depression? 5. Screen for this!
  5. Injury Prevention
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23
Q

Two month visit nutrition guide?

3

A
  1. Vitamin D, iron, fluoride as indicated
  2. No honey or corn syrup
  3. Defer solids until 4-6 months
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24
Q

Four month visit?

4

A
  1. Expect about 6 URIs per year, more if in daycare; most will NOT need antibiotics, unnecessary antibiotics may be harmful
  2. Elimination
  3. Nutrition
  4. Injury prevention (Safe toys and none too small)
25
Q

Six-month visit

4

A
  1. Nutrition
  2. Discuss sleep patterns
  3. Development
  4. Injury Prevention
26
Q

Nutrition for the six month?

A

Offer sips from cup, start solids if haven’t started already

27
Q

Nine-month visit

4

A
  1. Nutrition
  2. Sleep patterns (regular bedtime routine)
  3. Interaction with child
  4. Injury prevention (childproof home)
28
Q

Injury prevention for nine month visit?

6

A
  1. Avoid foods (peanuts, popcorn kernels) that can be aspirated,
  2. poison control number,
  3. no infant walkers,
  4. car safety seat height and weight requirements,
  5. heating food in microwave,
  6. never leave infant alone in bathtub
29
Q

Nutrition for 9 month visit education?

3

A
  1. Regular mealtimes, soft table foods, use of cup

2. Educate about waiting until one year before using cow’s whole milk

30
Q

Anticipatory Guidance
12 month visit:

Nutrition? 4
Behavioral Development? 2
Injury prevention? 6

A
  1. Appetite may be decreased, don’t force feed (growth velocity slows at this time, many parents are concerned that the child isn’t eating as much)
  2. Wean to cup,
  3. transition from baby foods to all table foods
  4. Educate about limiting use of cow’s whole milk
  5. Infant will seek increased autonomy over next several months
  6. Interact heavily with child, show mutual interest in environment
  7. Window and stair safety
  8. Childproof home
  9. Never leave child alone in bathtub
  10. Use of appropriate car seat
  11. Hot stoves, heaters, irons
  12. UV protection
31
Q

Anticipatory Guidance
15 month visit

Nutrition? 2
Behavioral? 7
Injury prevention? 5

A

Nutrition

  1. Regular meals
  2. Sits still to eat (attempts!!)
  3. Don’t expect potty training until past 18 months

Behavioral:

  1. Drive for autonomy is normal, don’t punish exploration!
  2. More “yes” than “no” messages
  3. State “no” clearly with emotional congruence
  4. Use lots of distraction
  5. Participate in games such as hide and go seek
  6. Temper tantrum management
  7. Limit amount of TV
  8. Use of appropriate car seat
  9. Door, window, stairwell safety
  10. Hot stoves, pots, pans, heaters, irons
  11. Water safety
  12. UV protection
32
Q

Anticipatory Guidance
18 month visit

Nutrition? 3
What starts about this time? 1
Behvioral? 4
Injury prevention? 1

A

Nutrition

  1. Balanced diet,
  2. allow toddler to decide how much to eat
  3. Encourage cup, discourage bottle
  4. Toilet training techniques

Behavioral

  1. Parallel play, not interactive
  2. Self-comforting behaviors
  3. Time-out
  4. Allow decision making

Injury prevention
1. Durable toys without small parts, reinforce others

33
Q

Anticipatory Guidance
2 year visit

Nutrition 2
TT?
Behavioral?4
Injury prevention? 1

A

Nutrition

  1. Discontinue bottle-feeding (if not done yet)
  2. Balanced diet
  3. Note signs of toilet training readiness

Behavioral

  1. Offer choices between acceptable alternatives,
  2. read to child,
  3. limit TV,
  4. positive outcomes for desired behaviors

Injury prevention
1. Reinforce all other teachings, gun safety

34
Q

Anticipatory Guidance
3 year visit

  1. Nurition? 2
  2. Naps?
  3. Injury prevention? 3
A
  1. Nutrition
    - Encourage self-feeding (with utensils),
    - dental referral
  2. May discontinue naps if desired
  3. Injury prevention
    - **Gun safety,
    - stranger danger,
    - water safety

Interact appropriately with child, give honest answers

35
Q

Anticipatory Guidance

What should we talk about at the 4 yr visit?

A
  1. Regular Dental care
  2. Nocturnal enuresis
  3. Opportunities to play with peers
  4. Chores
  5. Clear limits and consequences
  6. Praise desired behavior
  7. Injury prevention
36
Q

Injury prevention at 4 years?

4

A
  1. Bicycle helmets,
  2. stranger danger,
  3. animal danger,
  4. water safety
37
Q

Anticipatory Guidance
5 year visit
4

A
  1. **Regular physical activity
  2. Increasing autonomy
  3. Praise liberally
  4. Injury prevention
38
Q

Injury prevention for 5 year old?

5

A
  1. Bicycle helmets
  2. Pedestrian, bicycle safety
  3. Dealing with strangers
  4. Poisons, tools, guns
  5. Water Safety
39
Q 
Variations in Vitals-review
State the HR for the following ages:
1. New born?
2. 2 weeks to 6 months?
3. 6-12 yrs?
4. 1-3 yrs?
5. 4-5 yrs?
6. 6-8 yrs?
7. 9-16 yrs?
8. > 16 yrs?
A
  1. Newborn 120-160
  2. 2 weeks to 6mo 145
  3. 6-12 mo 135
  4. 1-3yr 120
  5. 4-5yr 110
  6. 6-8yr 100
  7. 9-16yr 85
  8. > 16yr 80
40
Q 
Variations in Vitals-review
State the RR for the following ages:
1. 0-1 yrs?
2. 1-3 yrs?
3. 4-6 yrs?
4. 7-9yrs?
5. 10-14 yrs?
6. 14-18 yrs?
A
  1. 0-1yr* 24-38
  2. 1-3yr 22-30
  3. 4-6yr 20-24
  4. 7-9yr 18-24
  5. 10-14yr 16-22
  6. 14-18yr 14-20
    * Slightly higher respiratory rates in neonatal period (as high as 40-50) may be normal in the absence of other signs or symptoms
41
Q

Variation in Vitals?

  1. One year old?
  2. 8 years old?
  3. 17?
  4. How does it change by height?
A
  1. One year old 85/40
  2. Incrementally increases to about 100/60 at age 8 and
  3. then to 110/65 as a 17 year old
  4. Height will change norms: shorter children will have lower blood pressures, taller will have higher
42
Q

Circumcision may be beneficial when it comes to what?

2

A
  1. STDs and
  2. preventing cervical CA in sexual partners but…
    there is no definitive literature to indicate a clear medical recommendation to circumcise every male infant
43
Q

High impact anticipatory guidance includes:

4

A
  1. no smoking
  2. reading to child
  3. Never leave child alone in tub
  4. Childproofing home
44
Q

Normal Development: What are the 5 critical areas?

5

A
  1. Physical Growth
  2. Gross Motor Control
  3. Fine Motor Control
  4. Language
  5. Personal-Social
45
Q

The First Year:

Physical Growth: Average child ______ birth weight by one year of age

46
Q 
The first year
Gross Motor Control: 
1. One month?
2. 4?
3. 6?
4. 9?
5. 12?
A
  1. 1 month: Lift head while prone
  2. 4 months: Rolls over
  3. 6 months: Sit independently
  4. 9 months: Crawl
  5. 12 months: Walk
47
Q 
The first year
Fine Motor Control:
1. 3-4 months?
2. 5 months?
3. 6?
4. 9?
5. 12?
A
  1. 3-4 months: Ulnar grasp
  2. 5 months: Thumb joins the party
  3. 6 months: Uses raking grasp, transfers objects
  4. 9 months: Pincer grasp (immature), holds bottle, throws object
  5. 12 months: Fine pincer grasp
48
Q 
The first year
Language:
1. 2 months?
2. 3?
3. 4?
4. 6?
5. 9?
6. 12?
A

Language:

  1. 2 months: Smiles socially
  2. 3 months: Coos
  3. 4 months: Laughs, orients to voice
  4. 6 months: Babbles
  5. 9 months: Says “Mama/Dada” indiscriminantly, waves bye-bye
  6. 12 months: Uses two words other than mama and dada, jargoning
49
Q 
The first year
Personal-Social:
1. 2 months?
2. 6?
3. 9?
4. 12?
A
  1. 2 months: Recognizes parent
  2. 6 months: Recognizes that someone is a stranger
  3. 9 months: Starts exploring, plays gesture games
  4. 12 months: Imitates actions, comes when called
50
Q 
The second year
Gross Motor:
1. 15 months?
2. 18 months?
3. 24 months?
A
  1. 15 months: Creeps upstairs, walks backwards independently
  2. 18 months: Runs, throws objects from standing without falling
  3. 24 months: Walks up and down steps without help
51
Q 
The second year 
Fine motor:
1. 15 months?
2. 18 months?
3. 24 months?
A
  1. 15 months: Scribbles in imitation, builds tower of two blocks
  2. 18 months: Scribbles spontaneously, three-block tower, turns 2-3 pages at a time
  3. 24 months: Imitates stroke with pencil, seven-block tower, turns one page at a time, removes shoes, pants
52
Q 
The Second Year:
Language:
1. 15 months?
2. 18?
3. 24?
A
  1. 15 months: 4-6 words, one-step command without gesture
  2. 18 months: Mature jargoning (including intelligible words), 7-10 word vocabulary, knows 5 body parts
  3. 24 months: Uses pronouns (I, you, me) inappropriately, follows two-step commands, 50-word vocabulary, uses two word sentences
53
Q 
The Second Year
Personal-Social:
1. 15-18 months?
2. 18?
3. 24?
A
  1. 15-18 months: uses spoon and cup
  2. 18 months: Copies parent in tasks (sweeping, dusting), plays in company of other children
  3. 24 months: Parallel play
54
Q 
Three Years:
Describe the following at this age:
1. Gross motor?
2. Fine motor?
3. Language?
4. Personal-Social?
A
  1. Gross Motor: Can alternate feet when going up steps, pedals tricycle
  2. Fine Motor: Copies a circle, undresses completely, dresses partially, dries hands if reminded, unbuttons
  3. Language: 250 word minimum, 3-word sentences, uses plurals, knows all pronouns
  4. Personal-Social: Group play, shares toys, takes turns, plays well with others, knows full name, age, gender
55
Q 
Four years
Describe the following at this age:
1. Gross motor?
2. Fine motor?
3. Language?
4. Personal-Social?
A
  1. Gross Motor: Hops, skips, alternates feet going down steps
  2. Fine Motor: Copies a square, buttons clothing, dresses self completely, catches ball
  3. Language: Knows colors, says song or poem from memory, asks questions
  4. Personal-Social: Tells “tall tales,” plays cooperatively with a group of children
56
Q 
Five years
Describe the following at this age:
1. Gross motor?
2. Fine motor?
3. Language?
4. Personal-Social?
A
  1. Gross Motor: Skips alternating feet, jumps over low obstacles
  2. Fine Motor: Copies triangle, ties shoes, spreads with knife
  3. Language: Prints first name, asks what a word means
  4. Personal-Social: Plays competitive games, abides by rules, likes helping in household tasks
57
Q

Changes in years 5-7?

4

A
  1. Acceleration of the separation-individuation theme initiated in the preschool years
  2. Go from being able to deal with one variable cognitively to dealing with more than one
  3. Magical thinking diminishes
  4. Reality of cause-effect relationships better understood
58
Q

Changes in years 7-11?

3

A
  1. Devotion of energy to school and peers
  2. Progressive interaction with opposite sex
  3. Expectations for behavior and academics intensifies
    - —This is where children with learning disabilities and attention deficit problems can really begin to struggle
59
Q
  1. The majority of the time short stature, which is defined what? usually has a normal cause.
  2. What helps to differentiate the child with constitutional delay from the child with familial short stature (it also helps to take the parents’ height and history into account)?
A
  1. as being two standard deviations below the mean, has a normal cause.
  2. Radiograph of the wrist for bone age

Pediatrics (18 decks)

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