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Pediatrics > Well Child Exam > Flashcards

Well Child Exam Flashcards

1
Q

Beneficial Things About Well-Child Care

A

Form relationship with parents & child
Vaccinations
Pick up odd things in a child

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2
Q

Approach to a Well Child Visit

A 
Laid-back Attitude
Speak directly to child
Complement the child in some way
Smile
Be non-threatening
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3
Q

What Should be Assessed in a Well-Child Visit?

A 
Growth measurements
Interval History
PE abnormalities
Developmental assessment
Anticipatory Guidance
Immunizations
Answer questions
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4
Q

What types of measurements should we measure?

A

Height
Weight
Head circumfrence

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5
Q

Interval History Questions

A 
How you feeling?
Baby/child doing?
How things going since last visit?
Appropriate follow-up questions
Devote entire time to situation
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6
Q

Areas to be Assessed for a Developmental Assessment

A 
Gross motor
Fine motor
Language
Personal-social
Vision
Hearing
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7
Q

Developmental Delays

A

Motor delays- 1st year
Language delays- toddler-preschool years
Learning disabilities- school years

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8
Q

Reasons for a Motor Delay

A

Neuromuscular
Genetic/Metabolic
Infectious

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9
Q

Reasons for Language Delay

A

Hearing loss

Mental retardation

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10
Q

Importance of Early Detection of Developmental Programs

A

Live independently
Graduate from HS
Contribute to society
Save society $30,000-$100,000 per child

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11
Q

Types of Standardized Instruments for Developmental Assessment

A

Denver II
Ages & Stages Questionnaire (ASQ)
Brigance Screening
Parents’ Evaluation of Developmental Status (PEDS)

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12
Q

Denver II Developmental Assessment Scale

A

Children 0-6 years

Four areas included: gross motor, fine motor, personal-social, and language

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13
Q

Denver II Advanced

A

Child passes item that falls completely to the right of the age line

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14
Q

Denver II Normal

A

Child passes, fails, or refuses item on which the age line falls between the 25th and 75th percentile

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15
Q

Denver II Caution

A

Child fails or refuses item on which the age line falls between the 75th and 90th percentile

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16
Q

Denver II Delayed

A

Child fails or refuses item that falls completely to the left of the age line

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17
Q

Denver II Pass

A

No delays and a maximum of one caution

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18
Q

Denver II Failure

A

Two or more delays noted

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19
Q

Denver II Re-evaluate in 3 months

A

1 Delay and/or 2 or more cautions

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20
Q

Denver II Untestable

A

Significant number of refusal or no opportunity test items

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21
Q

Denver II Criticisms

A

Takes time
Norms established not representative of whole population
Some items difficult to test
Requires a number of items to administer test thoroughly
High over-referral rate

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22
Q

Ages & Stages Questionaire (ASQ)

A 
Info from parents
Developmental problems
10-15 minutes to complete
4 months-5 years
Separate form for each visit
Available in English, Spanish, Korean, & French
Standardized scoring
Photocopied
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23
Q

Brigance Screening

A

Observation & elicitation of skills
Newborn- 8 years
Based on age
10-15 minutes

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24
Q

Parents’ Evaluation of Developmental Status (PEDS)

A 
Info from parents
Newborn- 8 years
10 questions
English, Spanish, & Vietnamese
2 minutes
Standardized scoring
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25
Q

What is one advantage of the ASQ?

A

Gets parents involved in child’s care
More aware of child’s abilities/limitations
Saves time

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26
Q

High Impact Anticipatory Guidance

A

No smoking

Reading to the child

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27
Q

Newborn Anticipatory Guidance

A 
Review feeding method
Sleep position & environment
Care of skin, cord, circumcision
Breast engorgement, vaginal discharge
Jaundice
Injury Prevention
When/why to call Dr.
Individuality of infant
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28
Q

Newborn Injury Prevention

A 
Microwave safety (bottles)
Car seat safety
Crib safety
Siblings
Pets
Smoke detectors
Hot water heater temp setting (120)
UV protection
Smoke free home
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29
Q

Two-week Anticipatory Guidance

A

Answer questions about breast or formula feeding
Sleep patterns
Social Interaction with family
Injury prevention

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30
Q

Two-week Injury Prevention

A 
Car seat safety
Smoke detectors
Hot water temp
"Back to sleep"
Violence prevention
Education about colic
Educate on shaken baby syndrome
UV protection
Smoke free home
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31
Q

Why shouldn’t we give a little child honey?

A

Clostridium botulinum

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32
Q

Two-month Anticipatory Guidance

A 
Nutrition (Vit. D, iron, fluoride, defer solids and honey)
Sleeping issues
Pay with, talk to, cuddle infant
Read to child
Educate about sibling time
Signs of maternal depression
Injury Prevention
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33
Q

Two-month Injury Prevention

A

Smoke free home

Gun safety

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34
Q

Four-month Anticipatory Guidance

A

6 URI’s/year
Elimination
Nutrition (solids, avoid honey)
Injury Prevention

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35
Q

Four-month Injury Prevention

A

Smoke free home
Safe toys
Heating food in microwaves
UV protection

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36
Q

Six-month Anticipatory Guidance

A 
Nutrition (cup sips, solids)
Discuss sleep patterns
"Stranger danger"
Reading to infant
Injury Prevention
37
Q

Six-month Injury Prevention

A 
No smoking
Childproof home
Poison control telephone number
NO infant walkers
Never leave infant alone in bathtub
38
Q

Nine-month Anticipatory Guidance

A

Nutrition (mealtimes, soft foods, cups, no milk)
Sleep patterns (regular bedtime routine)
Interaction with child
Injury prevention

39
Q

Nine-month Injury Prevention

A 
No smoking
Childproof home
Avoid foods to be aspirated
Poison control number
No infant walkers
Car seat safety
Heating food in microwave
Never leave infant in bathtub
40
Q

12-month Anticipatory Guidance

A

Nutrition
Behavioral Development
Injury Prevention

41
Q

12-month Nutrition

A

Appetite may be decreased
Wean to cup
Baby food to table foods
Limiting cow’s milk

42
Q

12-month Behavioral Development

A

Seek increased autonomy

Interact with child

43
Q

12-month Injury Prevention

A 
No smoking
Window & stair safety
Childproof home
Never leave child alone in bathtub
Appropriate car seat
Hot stoves, heaters, irons
UV protection
44
Q

15-month Anticipatory Guidance

A

Nutrition
Don’t expect potty training
Behavioral
Injury Prevention

45
Q

15-month Nutrition

A

Regular meals

Sits still to eat

46
Q

15-month Behavioral

A 
Drive for autonomy
More "yes" than "no" messages
State "no" clearly
Lots of distraction
Participate in games
Temper tantrum management
Limit TV
47
Q

15-month Injury Prevention

A 
No smoking
Appropriate car seat
Door, window, stairwell safety
Hot stoves, pots, pans, heaters, irons
Water safety
UV protection
48
Q

18-month Anticipatory Guidance

A

Nutrition
Toilet training techniques
Behavioral
Injury Prevention

49
Q

18-month Nutrition

A

Balanced diet
Encourage cup
Discourage bottle

50
Q

18-month Behavioral

A

Parallel play, not interactive
Self-conforting behaviors
Time-out
Allow decision making

51
Q

18-month Injury Prevention

A 
Durable toys
No smoking
Appropriate car seat
Door, window, stairwell safety
Hot stoves, pots, pans, heaters, irons
Water safety
UV protection
52
Q

2-year Anticipatory Guidance

A

Nutrition
Note signs of toilet training readiness
Behavioral
Injury Prevention

53
Q

2-year Nutrition

A

Discontinue bottle-feeding

Balanced diet

54
Q

2-year Behavioral

A

Choices between acceptable alternatives
Read to child
Limit TV
Positive outcomes for desired behaviors

55
Q

2-year Injury Prevention

A 
Durable toys
No smoking
Appropriate car seat
Door, window, stairwell safety
Hot stoves, pots, pans, heaters, irons
Water safety
UV protection
Gun safety
56
Q

3-year Anticipatory Guidance

A 
Nutrition
Support toilet training
May discontinue naps
Interact appropriately with child
Injury Prevention
57
Q

3-year Nutrition

A

Encourage self-feeding (utensils)

Dental referral

58
Q

3-year Injury Prevention

A

Gun safety
Stranger danger
Water safety

59
Q

4-year Anticipatory Guidance

A 
Regular dental care
Nocturnal enuresis
Opportunities to play with peers
Chores
Clear limits & consequences
Praise desired behavior
Injury Prevention
60
Q

4-year Injury Prevention

A

Bicycle helmets
Stranger danger
Animal danger
Water safety

61
Q

5-year Anticipatory Guidance

A

Regular physical activity
Increasing autonomy
Praise liberally
Injury prevention

62
Q

5-year Injury Prevention

A 
Bicycle helmets
Pedestrian, bicycle safety
Dealing with strangers
Poisons, tools, guns
Water safety
63
Q

How to close the well-child visit?

A 
Reschedule next appt.
Never appear hurried
Never check watch
Don't cut off parents sentences
Ask "Is there anything else I can do for you today?"
64
Q

Types of Pediatric Visits

A 
Well-child
Acute care
Sports physical
Chronic disease
Counseling
65
Q

Five Critical Areas of Normal Development

A 
Physical growth
Gross motor control
Fine motor control
Language
Personal-social
66
Q

First Year Normal Physical Development

A

Triples birth weight by one year of age

67
Q

First Year Normal Gross Motor Control

A 
Lift head while prone
Rolls over
Sits independently
Crawl
Walk
68
Q

First Year Normal Fine Motor Control

A 
Ulnar grasp
Thumb joins the party
Raking grasp, transfers objects
Pincer grasp, holds bottle, throws object
Fine pincer grasp
69
Q

First Year Normal Language Development

A 
Smiles socially
Coos
Laughs, orients to voice
Babbles
Says "mama/dada" indiscriminately, waves bye-bye
2 words other than mama/dada, jargoning
70
Q

First year Personal-Social Development

A

Recognizes parent
Recognizes strangers
Starts exploring, plays gesture games
Imitates actions, comes when called

71
Q

Second Year Gross Motor Control

A

Creeps upstairs, walks backwards independently
Runs, throws objects from standing without falling
Walks up & down steps without help

72
Q

Second Year Fine Motor Control

A

Scribbles in imitation, builds tower of 2 blocks
Scribbles spontaneously, 3 block tower, turns 2-3 pages at a time
Imitates stroke with pencil, 7 block tower, turns 1 page at a time, removes shoes, pants

73
Q

Second Year Language Development

A

4-6 words, one-step command without gesture
Mature jargoning, 7-10 word vocabulary, knows 5 body parts
Uses pronouns inappropriately, follows 2 step commands, 50 word vocabulary, uses 2 word sentences

74
Q

Second Year Personal-Social Development

A

Uses spoon & cup
Copies parents in tasks, plays in company of other children
Parallel play

75
Q

Three Year Gross Motor Control

A

Alternate feet when going up steps

Pedals tricycle

76
Q

Three Year Fine Motor Control

A 
Copies a circle
Undresses completely
Dresses partially
Dries hands if reminded
Unbuttons
77
Q

Three Year Language Development

A

250 word minimum
3-word sentences
Uses plurals
Knows all pronouns

78
Q

Three Year Personal-Social Development

A 
Group play
Shares toys
Takes turns
Plays well with others
Knows full name
Age
Gender
79
Q

Four Year Gross Motor Control

A

Hops
Skips
Alternates feet going down steps

80
Q

Four Year Fine Motor Control

A

Copies a square
Buttons clothing
Dresses self completely
Catches ball

81
Q

Four Year Language Development

A

Knows colors
Says song or poem from memory
Asks questions

82
Q

Four Year Personal-Social Development

A

Tells “tall tales”

Plays cooperatively with a group of children

83
Q

Five Year Gross Motor Control

A

Skips alternating feet

Jumps over low obstacles

84
Q

Five Year Fine Motor Control

A

Copies triangle
Ties shoes
Spreads with knife

85
Q

Five Year Language Development

A

Prints first name

Asks what a word means

86
Q

Five Year Personal-Social

A

Plays competitive games
Abides by rules
Likes helping in household tasks

87
Q

Years 5-7

A

Move from dealing with one variable to dealing with multiple variables
Magical thinking diminishes
Reality of cause-effect relationships better understood

88
Q

Years 7-11

A

Devotion of energy to school & peers
Progressive interaction with opposite sex
Expectations for behavior and academics intensifies

Pediatrics (23 decks)

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