Well Child Visit Flashcards
Developmental age: social smile and eyes follow to midline
2 months
Developmental age: babies aware of caregiver and eyes follow past midline
4 months
Developmental age: roll over, sits upright, grasps/rakes, babbles
6 months (dog)
Developmental age: crawling, grasps with thumb, maybe a word
9 months
Developmental age: 2-5 words, pulls to stand (cruising), walks with help, pincer grasp, 2 block tower, stranger anxeity
12 months (rule of 2s)
Developmental age: runs/walks backwards, uses spoon and cup, 2-word sentence, copies parent, 4-block tower
18 months
Developmental age: walks up and down stairs with help, jumps, 6 block tower, 2-3 word sentences, 50-75 words, follows 2 step commands
2 yrs
Developmental age: rides tricycle, copies a circle
3 yrs
Developmental age: plays with others, draws a “+” and triangle, 250 words, 4 word sentence
4 yr
Developmental age: skipping, draws a stick figure
6yr
Baby should be back to birth weight
2 weeks
Child weighs double their birth weight
4 months
Child weighs triple their birth weight
12 months
Child weighs quadruple the birth weight
24 months
Anticipated weight gain from 2 yr to 13 yrs
5 lbs per year
Causes of inadequate weight gain
poor food intake (including neglect/abuse) chronic V/D malabsorption neoplasms congenital disease - cardiac, endocrine
Childhood obesity risks
rapid growth sleep apnea HTN SCFE Precocious puberty increased skin infections social dysfunction early DM onset
newborn to 3 mo anticipated weight gain
26-31 g per day
age that height increases by 50% from birth length
1 yr
height double the birth length
4yrs
height triple the birth length
13 yrs
Anticipated growth rate from 2y to adolescence
2 inches per year
Greater than normal height causes
Familial tall stature precocious puberty gigantism - elevated growth hormone hyperthyroidism Kleinfelter Sn Marfan Sn Obesity
Lower than normal heath causes
familial short stature neglect Turner sn constitutional growth delay chronic renal failure asthma CF IBD immunologic disease GH deficiency hypothyroidism glucocorticoid excess skeletal dysplasias neoplasm
Failure to thrive definition
wt below 2-3rd percentile, corrected for gestational age
Wt less than 80% of ideal weight for age
Wt crosses 2 major percentile curves downward on the standard growth curve over time
Wt to length ratio less than 10th percentile
rate of daily wt gain less than expected for age
Causes of macrocephaly
TaySachs dz Maple syrup urine disease Neurofibromatosis Tuberous sclerosis Hydrocephalus Increased ICP skeletal dysplasia acromegaly ICH
Causes of microcephaly
fetal toxin exposure (alcohol) Chromosomal trisomies congenital infection (TORCH) Cranial anatomic abnormalities Metabolic disorders Neural tube defects
Normal growth rate that declines after birth
postnatal onset
Growth abnormal from time of birth
prenatal onset
Growth low to normal range but eventually closer to mean
constitutional growth delay
Growth consistently abnormal
genetic short stature
Amblyopia
decreased vision due to disuse/misuse of eye during critical visual development between 3-5 yrs
Treat underlying problem
Patch good eye to let bad eye develop
Strabismus
abnormal eye alignment which impart vision and depth perception
-EOM issue
Risk amblyopia
Esotropia
inward deviation of eye
Exotropia
outward deviation of eye
Retinoblastoma
MC intraocular malignancy in children
MC presentation: leukocoria (white reflex)
also can present with strabismus
Mets within months
Tx: enucleation radiaiton brachytherapy chemotherapy
Lead poisoning
Early sxs: anorexia, decreased activity, irritability, insomnia
Screen children who live in areas where more than 27% of housing built before 1950
Tx for severe toxicity >70 mcg/dL:
Dimercaprol AND calcium disodium edatate
Child abuse - presentation, evaluation
Presentation: FTT multiple fractures of varying ages bruises/burns SDH Retinal hemorrhage Implausible injuries Genital trauma or discharge - suggestive of sexual abuse
Evaluation: PT/PTT LFTs STD testing CBC Skeletal survey CT of head
Always reports suspected child abuse to CPS regardless of how mild the suspicion
Pediatric Hep B vaccination recommendations
Hep B vaccine at birth
If maternal Hep B - give Hep B IG
Immunizations and severely immunosuppressed
avoid live vaccines - varicella, MMR, Rotavirus
Rotavirus still recommended in HIV patients
Risk associated with Rotavirus
risk intussusception
avoid in patient with hx of intussusception and older than 8 mo who are on catch up schedule
Sudden infant death syndrome
Peaks 2-4 months
Risk: exposure to cigarette smoke, maternal age less than 20, prematurity, prone sleeping, soft bedding, overheating
Preventive measures: place on back to sleep, firm sleep surface, no pillows, soft objects or loose bedding, avoid smoking during pregnancy and after delivery
Less effective measures: breastfeeding and use of pacifier when sleeping
Car seat safety - under 2, 2-5, over 5
under 2: rear facing car seat, middle back seat
2-5y: bigger forward facing car seat with chest harness
Over 5: booster seat in back seat until over 4’9”
All under 13 yo in rear seats
