Well child exam Flashcards
1
Q
What are key components of a well child exam
A
- Development achievement (physical, motor, cognitive, emotional, social)
- Health supervision visits (medical and oral health)
- Integrate PE findings with special needs
- Immunizations!!!
- Anticipatory guidance (health habits, nutrition, safety, injury prevention, sexual development, family relationships, emotional/mental health
- Partner w/ child and family member
2
Q
When does AAP recommend well child visits
A
birth 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 2 yr Yearly in adolescence
3
Q
How are vitals different in peds
A
HR higher (110-160 nl in 0-3 mo) BP lower (65-85 / 45-55 nl in 0-3 mo) RR higher (30-60 nl in 0-3 mo)
4
Q
How long do you assess head circumference
A
2 years to assess for brain growth
5
Q
Growth curves can vary based on
A
Gestational age (premature, Down syndrome)
6
Q
What are growth chart results
A
Underweight: <5 percentile
Overweight: 85-95 percentile
Obese >95 percentile
7
Q
How do you classify a newborn
A
Preterm: <37 weeks gestation Term: 37-42 weeks Post-term: >42 weeks First year of life: Infancy Neonatal: 0-28 d Post-natal: after first month of life
8
Q
How do you classify birth weight
A
Extremely low: <1000 g (2.2 lb)
Very low: <1500 gm (3.3 lbs)
Low: <2500, (5.5 lbs)
Normal: >2500 (5.5 lb)
9
Q
How are newborns classified on growth curve (at birth)
A
Small: <10 percentile
Appropriate: 10-90 percentile
Large: >90 percentile
10
Q
What is the APGAR score
A
Key assessment of newborn at birth (1 & 5 minutes after birth)
Scores 0-100 bsed on HR, Resp effort, muscle tone, response to catheter in nostril, and color
Continue q5 min. until score >7
11
Q
What is the newborn screen
A
blood sample (heel stick) collected prior to dc and 7-14 days of life
12
Q
PEARLS for a newborn peds exam
A
Support head
Take PE when convenient
Listen to heart and lungs when baby is sleeping
Look at red reflex when eyes are open
13
Q
General PE should include inspection of
A
Cry
Respiratory effort
Posture (leg & arm flexion when supine=nl)
Color (mild cyanosis @ birth, peripheral for 1-2 days, jaundice can be nl based on race)
14
Q
What is Vernix Caseosa
A
cheesy white covering of lipid matrix (fetal corneocytes and sebaceous glands) that should decrease as term approaches
15
Q
What is milia
A
pinpoint papules of blocked sebaceous glands, W/O erythema
Common to nose, chin, forehead, and cheeks
16
Q
What is a mongolian spot
A
a congenital dermal melanocyte (birth mark) with blue tint that should fade with time, but do not grow or migrate
Common over lumbar, buttocks, or extremities
Common in asian, native american, hispanic, east indian, and african
17
Q
What is erythema toxicum
A
yellow eosinophilic papule W/ red base, likely 2/2 immature pilosebaceous follicles
Usually disappear w/in 1 week of life
Common on trunk and face
-NOT caused by scented lotions, soaps, etc.
18
Q
What are the sutures of the head
A
sagittal, coronal, lambdoid, and frontal
Birthing can mold or cause sutures to override
If widely split, suspect elevated ICP (meningitis, hydroceohalus)
If raised and bony edge, suspect craniosynostosis
19
Q
What are the fontanelles
A
Areas where major sutures intersect; should be soft and flat
Bulgind indicated high ICP (bleed? meningitis?)
Sunken indicates dehydration
20
Q
Large fontanelles can be the first sign of
A
HYPOthyroidism!!
21
Q
When do the fontanelles close
A
Anterior: 9-18 mo
Posterior: 1-2 mo
22
Q
What is Cephalohematoma
A
swelling 2/2 blood collection over one or both parietal bones (more deep)
does NOT cross suture lines
resolves on it’s own in wks to months
23
Q
What is Caput Succedaneum
A
edema of the scalp (more SF)
CAN cross suture lines
resolves in days
24
Q
A pathologic face finding on newborn exam can be
A
Facial palsies from nerve birth injury
check face symmetry
25
Eye findings we should always look out for are
```
Hypertelorism
Subconjunctival hematoma (common from birth)
Red reflexes (should be present and b/l)
```
26
What nose abnormality do we have to look for in newborns
Obstructions!
| Infants <1 mo are nose breathers
27
What should you always screen for in newborns
Hearing loss!
| preauricular pits and tags are common
28
How do you inspect a newborn ear
pull auricle DOWNward gently (at 2-3 y/o, start pulling up)
29
What are Epstein's pearls
small, white, benign inclusion cysts common in 2-4 y/o
common over palate
resolve spontaneously, no Tx needed
30
What are Bohn nodules
similar to Epstein's pearls, but seen on the GINGIVAL ridge
31
What is Ankyloglossia
congenital short lingual frenulum limiting movement of tongue (midline tongue tip puckers
Can make nursing painful
Can cause speech difficulty
32
How do you Tx Ankyloglossia
Frenulectomy in neonatal period (1-28 days)
33
How do you perform a neck exam
Infants: palpate while supine
| Older kids: upright
34
What is congenital torticollis
Firm mass 2/2 bleeding into the SCM during birth, appearing 2-3 weeks after birth
Disappears over months
35
What is plagiocephaly
Flat spot on baby's head
36
What chest abnormalities have we discussed
Clavicle fracture: 2/2 birth, esp w/ difficult arm extraction
Pectus Excavatum: sternal depression
Pectus Carinatum: pigeon chest (associated w/ scoliosis)
37
How do you perform a lung exam on baby
- Observe; RR, color, nasal component, audible breath sounds and work of breathing
- Stethoscope; 30-40 normal. diminished BS on one side indicate unilateral lesion
38
Diminished femoral pulses indicate
Coarcation of the aorta
39
Infants with cardiac disease often present with these symptoms
```
poor feeding
FTT
irritability
tachypnea
hepatomegaly
clubbing
poor overall appearance
weakness
```
40
Why is NS dysrhythmia normal in infants and kids
bc HR increases on inspiration and decreases on expiration
41
What is the MC dysrhythmia in infants
Paroxysmal SVT
| can occur at any age, even in utero
42
What is an umbilical granuloma
pink granulation tissue formed during healing of umbilical cord, at base of navel
**Leave the cord alone! don't submerge in water; should not be oozy**
43
2-5% of full term and 30% of pre-term infant males are born with
cryptorchidism
44
What are the abnormal male urethral openings that can be found
Hypospadias: abnormal VENTRAL placement of urethra; check before circumcision! (hypO=belOw)
What is epispadias: abnormal DORSAL urethra, uncommon. (Epi=Eye)
45
What are the common scrotal masses in newborns
hydrocele (overlie testis and spermatic cord) and inguinal hernia (separate from testes)
can coexist
more common on RIGHT side
46
Hydroceles can be _ on PE
Transilluminated
| resolve by 18 mo, but refer to urology to r/o hernia
47
Hernias are usually
reducible; do NOT transilluminate and don't resolve
48
What are findings that can be found on female GU
Milky white discharge (can be blood tinged) 2/2 estrogen from moms pregnancy
Labial adhesions
imperforate hymen
49
What are the two abnormal anal findings
Imperforate anus: if baby doesn't pass meiconium w/in 48 hours, get US- could be sinus tract or spina bifida
Sacral dimple: If you can see the bottom, normal. if not, get an US
50
A single palmar crease indicates
trisomy 21
| but can also be a normal variant
51
RF for developmental dysplasia of hips include
```
breech
caucasian
first born female
family Hx
prior child born with DDH
premature
```
52
When evaluating for DDH, a "click" with these maneuvers requires further work up
Barlow: tests ability to sublux or dislocate an intact but unstable hip
Ortolani: tests for posteriorly dislocated hip
53
Another DDH test is
evaluate leg creases: they should be symmetric. if not, suspect DDH
54
Tx for DDh is
ortho eval and pavlik harness to prevent progression to degenerative hip disease
55
What are the primative reflexes
- Palmar grasp: when you put your finger into baby's hand, they will grasp you. until 3-4 months
- Plantar grasp: when you touch sole of foot, toes will curl. until 6-8 months
- Moro Reflex: if persistent past 4 mo, indicates cerebral palsy. If asymmetric, indicates clavicle Fx
- Asymmetric tonic neck: if persistent past 2 mo, indicates asymmetric CNS development
- Positive support reflex: If not present indicates hypotonia or flaccidity
- Rooting reflex: stroke perioral skin at mouth corners; mouth opens, baby turns head. until 3-4 mo
- Trunk incurvation: absence suggests transverse spinal cord lesion. until 2 mo.
- Placing and stepping reflexes: hold baby up from behind, let one sole touch table top. that hip and knee will flex, other foot will step forward
56
How do you perform the moro reflex
Hold baby supine (support head, back, and legs)
Abruptly lower baby 2 feet
Arms should ABduct and extend, hands open, and legs flex
baby may cry
57
How do you test asymmetric tonic neck reflex
with baby supine, turn head to one side and hold jaw over shoulder
Arm and leg on the side of the way baby faces= extend
Arm and leg on oppo side= flex
58
How do you perform the positive support reflex
Hold baby around trunk, lower until feet touch flat surface
Hips, knees, and ankles extend and baby partially bears weight for 20-30 seconds
Until 2-6 months old
59
How do you perform trunk incurvation
Support baby prone w/ 1 hand
stroke one side of back, 1cm from midline, shoulder to buttocks
spine will curve toward the stimulated side
60
Absence of red reflex indicates
Retinoblastoma
61
What are age appropriate visual acuities
3-5 y/o: 20/40
| 6+: 20/30
62
AAP recommends this vision screening
Annual photo screen between 1-3 y/o
| Also do cover uncover, and Gocheck vision
63
This is the MC cause of childhood blindness
Amblyopia!
| 2/2 uncorrected strabismus
64
AAp recommends this hearing screen
universal hearing screen before leaving hospital
| **If there is a speech delay in a child, get a hearing screening!!
65
BP checks should start at
3 y/o; Sooner if RF, kidney disease, premature, congenital heart disease, recurrent UTI, hematuria, proteinuria, neurofibromatosis, or tuberous sclerosis
66
Older teens need a BP screen esp if on
birth control
| adderall
67
Screen Hgb at
9-12 mo, checking for iron deficiency
| If low, get iron fortified cereal, eat meat and leafy greens
68
CDC recommends to screen for this at 1-2 y/o
Lead!
| targeted screenings in communities w/ homes built before 1950
69
Screen for autism at
18 mo and 24 mo.
70
IF RF or FHx are present, screen for
Fasting lipids: 2-10 y/o
RF include obese, overweight, HTN, DM, FHx of hyperlipidemia or early CV disease
**If no RF, don't need to screen**
71
Dental visits should occur
First: 12 mo- 2-3 years old, continue every 6 months
Wash gums w/ wash cloth prior to first dental visit
brush teeth 2xday (CAN use fluoride, ok if they swallow a bit)
Floss 1x day
72
Car safety includes
Rear facing car seat until 2 y/o
booster seat until 4'9"
NO front seat until 13 y/o
73
What is the number for poison control
1-800-222-1222
74
1 month milestone is
Fixes and follows face
some head control
responds to sounds and noises
spontaneous smile
75
2 month milestone is
responsive smile
coos/vocalizes
lifts head when prone
follows to midline
76
Is there a 3 month visit
NAHHHHHH
77
4 month milestone is
```
Rolls from tummy to back
good head control
laughs, squeals
follows past midline
grasps objects
```
78
6 month milestone is
```
sits with support
bears weight on legs
vocalizes "ba, da-da"
reaches for toys
follows 180 degrees
stranger danger, separation anxiety
```
79
What meds can babies take
<6 mo. Tylenol only
6+ months, tylenol and ibuprofen
NO honey until 1 y/o (botulinum toxin)
80
9 month milestone is
```
crawls
pulls up to stand
cruises on furniture
says mama dada
immature pincer grasp
responds to name
```
81
12 month milestone is
```
walks (can take up to 18 months)
waves bye-bye
says mama/dad
points with index finger
self feeds w/ fingers
```
82
15 month milestone is
3-6 words
walks well
climbs stairs
imitates actions
83
18 month mile stone is
```
5-15 words
some 2 word phrases
uses spoon/fork
scribbles
follows simple commands
runs, walks backwards
```
84
24 month milestones are
```
20-50 words
2 word phrases
kicks ball
build 3-4 block tower
50% understandable speech
```
85
What we need to know about the hepatitis B vaccine
3 doses; birth, 1-2 mo, 6-18 mo
Contraindication: severe allergy to yeast
ADE: fever, pain at injection site
86
What we need to know about hepatitis B
Spread by contact with blood or body fluids (aka birth)
Sx: asymptomatic, jaundice, HA, weakness, vomiting, joint pain
Complications: chronic liver infection, liver failure, liver cancer
87
What we need to know about Rotavirus vaccine
Live, oral vaccine; give at 2, 4, and 6 mo (MUST start by 4 mo. to be able to receive)
Contraindications: Hx of intussusception, has severe combined immunodeficiency, acute gastroenteritis
ADE: increased risk of intussusception, vomiting, diarrhea, cough, runny nose
88
What we need to know about Rotavirus
Leading cause of hospitalization and death from acute gastroenteritis
Spread by saliva and oral contact
Sx: diarrhea, fever, vomiting
Complications: severe diarrhea/dehydration
89
What we need to know about DTaP vaccine
5 doses; give at 2, 4, 6, 15/18 mo, 4 years
Contraindications: Encaphalopathy w/in 7 days of a previous DTaP dose, progressive neuro d/o, previous high fever, inconsolable crying, or shocked state w/in 48 hours of a DTaP dose
ADE: swelling and redness at site, fever
90
What we need to know about Diphtheria
Spread by air or direct contact
Sx: sore throat, fever, weakness, swollen neck glands
Complications: pericarditis, HF, coma, paralysis, death
91
What we need to know about Tetanus
Spread by exposure through cut skin
Sx: stiffness in neck and abd muscles, difficulty swallowing, muscle spasms, fever
Complications: broken bones, breathing difficulty, death
92
What we need to know about pertussis
Spread by air or direct contact
Sx: severe cough, runny nose, apnea
Complications: PNA, death
93
What we need to know about the HIB vaccine
4 doses; give at 2, 4, 6, and 12 or 15 mo
Contraindications: <6 weeks old, allergic reaction to previous HIB dose
ADE: uncommon, pain and redness at site
94
What we need to know about HIB
Spread by air or direct contact
Used to be the leading cause of invasive bacterial disease in kids <5 y/o
Sx: ASx unless bacteria enter blood (sepsis)
Complications: meningitis, intellectual disability, epiglottitis, PNA, death
95
What we need to know about the PVC-13 vaccine
4 doses; give at 2, 4, 6, and 12 or 15 months
CI: severe previous allergy, defer if sick, rehardless of fever
ADE: fever, local irritation, increased or decreased sleep, risk of febrile seizure if given WITH flu vaccine
96
What we need to know about Pneumococcus
Spread by air or direct contact
Common cause of AOM and sinusitis
Sx: ASx, PNA
Complications: bacteremia, PNA, meningitis, death
97
What we need to know about IPV (polio) vaccine
4 doses; give at 2, 4, 6-18, and 4 years old
NOT a live vaccine anymore
Contraindications: allergic rxn to previous dose, pregnancy, defer when sick
ADE: minor local redness or pain at injection, no serious ADE!
98
What we need to know about polio
Spread by air, direct contact, or through mouth
Sx: ASx, sore throat, fever, nausea, HA
Complications: paralysis, death
99
What we need to know about the MMR vaccine
2 doses; give at 12-15 mo, and 4 years old
CI: pregnant women (or want to be pregnant in 28 days), immunocompromised, egg or neomycin anaphylactic allergy
ADE: fever 6-12 days s/p vaccine, transient morbilliform rash
100
What we need to know about Measles
Spread by air or direct contact
Sx: rash, fever, cough, runny nose, pink eye
Complications: encephalitis, PNA, death
101
What we need to know about mumps
spread by air or direct contact
Sx: swollen salivary glands, fever, HA, fatigue, muscle pain
Complications: meningitis, encaphalitis, testicle/ovary inflammation, deafness
102
What we need to know about Rubella
Spread by air or direct contact
| Complications: miscarriage, stillbirth, premature delivery, and birth defects in pregnant women
103
What we need to know about the varicella vaccine
2 doses; give at 12-15 months, and 4 years
Live vaccine
CI: allergic rxn to previous dose, pregnant women
ADE: minor injection site rxn, sparce varicellaform rash
104
What we need to know about varicella
Spread by air or direct contact
Sx: rash, fever, HA, fatigue
Complications: infected blisters, bleeding disorders, encephalitis, PNA
105
What we need to know about Hepatitis A vaccine
2 doses; give at 12 and 18 mo (second dose has to be at least 6 mo. from first dose)
CI: previous allergic rxn, caution in pregnancy or illness
ADE: Pain, swelling, induration at injection, HA, no appetite
106
What we need to knoe about hepatitis A
Spread by direct contact w/ contaminated food or water
Sx: fever, stomach pain, loss of appetite, fatigue, vomiting, jaundice, dark urine
Complications: liver failure, arthralgia, kidney pancreatic or blood disorders
