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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
What is one advantage of the ASQ?
Gets parents involved in child's care More aware of child's abilities/limitations Saves time
26
High Impact Anticipatory Guidance
No smoking | Reading to the child
27
Newborn Anticipatory Guidance
``` 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 ```
28
Newborn Injury Prevention
``` Microwave safety (bottles) Car seat safety Crib safety Siblings Pets Smoke detectors Hot water heater temp setting (120) UV protection Smoke free home ```
29
Two-week Anticipatory Guidance
Answer questions about breast or formula feeding Sleep patterns Social Interaction with family Injury prevention
30
Two-week Injury Prevention
``` 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 ```
31
Why shouldn't we give a little child honey?
Clostridium botulinum
32
Two-month Anticipatory Guidance
``` 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 ```
33
Two-month Injury Prevention
Smoke free home | Gun safety
34
Four-month Anticipatory Guidance
6 URI's/year Elimination Nutrition (solids, avoid honey) Injury Prevention
35
Four-month Injury Prevention
Smoke free home Safe toys Heating food in microwaves UV protection
36
Six-month Anticipatory Guidance
``` Nutrition (cup sips, solids) Discuss sleep patterns "Stranger danger" Reading to infant Injury Prevention ```
37
Six-month Injury Prevention
``` No smoking Childproof home Poison control telephone number NO infant walkers Never leave infant alone in bathtub ```
38
Nine-month Anticipatory Guidance
Nutrition (mealtimes, soft foods, cups, no milk) Sleep patterns (regular bedtime routine) Interaction with child Injury prevention
39
Nine-month Injury Prevention
``` 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
12-month Anticipatory Guidance
Nutrition Behavioral Development Injury Prevention
41
12-month Nutrition
Appetite may be decreased Wean to cup Baby food to table foods Limiting cow's milk
42
12-month Behavioral Development
Seek increased autonomy | Interact with child
43
12-month Injury Prevention
``` No smoking Window & stair safety Childproof home Never leave child alone in bathtub Appropriate car seat Hot stoves, heaters, irons UV protection ```
44
15-month Anticipatory Guidance
Nutrition Don't expect potty training Behavioral Injury Prevention
45
15-month Nutrition
Regular meals | Sits still to eat
46
15-month Behavioral
``` Drive for autonomy More "yes" than "no" messages State "no" clearly Lots of distraction Participate in games Temper tantrum management Limit TV ```
47
15-month Injury Prevention
``` No smoking Appropriate car seat Door, window, stairwell safety Hot stoves, pots, pans, heaters, irons Water safety UV protection ```
48
18-month Anticipatory Guidance
Nutrition Toilet training techniques Behavioral Injury Prevention
49
18-month Nutrition
Balanced diet Encourage cup Discourage bottle
50
18-month Behavioral
Parallel play, not interactive Self-conforting behaviors Time-out Allow decision making
51
18-month Injury Prevention
``` Durable toys No smoking Appropriate car seat Door, window, stairwell safety Hot stoves, pots, pans, heaters, irons Water safety UV protection ```
52
2-year Anticipatory Guidance
Nutrition Note signs of toilet training readiness Behavioral Injury Prevention
53
2-year Nutrition
Discontinue bottle-feeding | Balanced diet
54
2-year Behavioral
Choices between acceptable alternatives Read to child Limit TV Positive outcomes for desired behaviors
55
2-year Injury Prevention
``` Durable toys No smoking Appropriate car seat Door, window, stairwell safety Hot stoves, pots, pans, heaters, irons Water safety UV protection Gun safety ```
56
3-year Anticipatory Guidance
``` Nutrition Support toilet training May discontinue naps Interact appropriately with child Injury Prevention ```
57
3-year Nutrition
Encourage self-feeding (utensils) | Dental referral
58
3-year Injury Prevention
Gun safety Stranger danger Water safety
59
4-year Anticipatory Guidance
``` Regular dental care Nocturnal enuresis Opportunities to play with peers Chores Clear limits & consequences Praise desired behavior Injury Prevention ```
60
4-year Injury Prevention
Bicycle helmets Stranger danger Animal danger Water safety
61
5-year Anticipatory Guidance
Regular physical activity Increasing autonomy Praise liberally Injury prevention
62
5-year Injury Prevention
``` Bicycle helmets Pedestrian, bicycle safety Dealing with strangers Poisons, tools, guns Water safety ```
63
How to close the well-child visit?
``` 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
Types of Pediatric Visits
``` Well-child Acute care Sports physical Chronic disease Counseling ```
65
Five Critical Areas of Normal Development
``` Physical growth Gross motor control Fine motor control Language Personal-social ```
66
First Year Normal Physical Development
Triples birth weight by one year of age
67
First Year Normal Gross Motor Control
``` Lift head while prone Rolls over Sits independently Crawl Walk ```
68
First Year Normal Fine Motor Control
``` Ulnar grasp Thumb joins the party Raking grasp, transfers objects Pincer grasp, holds bottle, throws object Fine pincer grasp ```
69
First Year Normal Language Development
``` Smiles socially Coos Laughs, orients to voice Babbles Says "mama/dada" indiscriminately, waves bye-bye 2 words other than mama/dada, jargoning ```
70
First year Personal-Social Development
Recognizes parent Recognizes strangers Starts exploring, plays gesture games Imitates actions, comes when called
71
Second Year Gross Motor Control
Creeps upstairs, walks backwards independently Runs, throws objects from standing without falling Walks up & down steps without help
72
Second Year Fine Motor Control
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
Second Year Language Development
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
Second Year Personal-Social Development
Uses spoon & cup Copies parents in tasks, plays in company of other children Parallel play
75
Three Year Gross Motor Control
Alternate feet when going up steps | Pedals tricycle
76
Three Year Fine Motor Control
``` Copies a circle Undresses completely Dresses partially Dries hands if reminded Unbuttons ```
77
Three Year Language Development
250 word minimum 3-word sentences Uses plurals Knows all pronouns
78
Three Year Personal-Social Development
``` Group play Shares toys Takes turns Plays well with others Knows full name Age Gender ```
79
Four Year Gross Motor Control
Hops Skips Alternates feet going down steps
80
Four Year Fine Motor Control
Copies a square Buttons clothing Dresses self completely Catches ball
81
Four Year Language Development
Knows colors Says song or poem from memory Asks questions
82
Four Year Personal-Social Development
Tells "tall tales" | Plays cooperatively with a group of children
83
Five Year Gross Motor Control
Skips alternating feet | Jumps over low obstacles
84
Five Year Fine Motor Control
Copies triangle Ties shoes Spreads with knife
85
Five Year Language Development
Prints first name | Asks what a word means
86
Five Year Personal-Social
Plays competitive games Abides by rules Likes helping in household tasks
87
Years 5-7
Move from dealing with one variable to dealing with multiple variables Magical thinking diminishes Reality of cause-effect relationships better understood
88
Years 7-11
Devotion of energy to school & peers Progressive interaction with opposite sex Expectations for behavior and academics intensifies

Pediatrics (24 decks)

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