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Pediatrics Clerkship > Well Child Visits, Vaccination, and Nutrition > Flashcards

Well Child Visits, Vaccination, and Nutrition Flashcards

1
Q

Basic measurements in terms of clinical importance

A
  1. Head circumference
  2. Height
  3. Weight
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2
Q

Progressive “falling off the curve” in failure to thrive

A

First, the child will fall off the curve for weight. Then, for height. Then, for head circumference.

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3
Q

Infants should not eat honey until. . .

A

. . . after 1 year of age

To protect against botulism

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4
Q

Screening for childhood autism

A

Occurs at the 18 month and 24 month visits

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5
Q

Three F’s of non-organic failure to thrive

A
  1. Formula
  2. Feeds
  3. Frequency
  • ie, are they getting enough of the right stuff at the right frequency
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6
Q

Major safety topics to cover in well child visit

A
  1. Smoking cessation
  2. Seat belts and car seats
  3. Gun safety
  4. Swimming / pools
  5. Trampolines
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7
Q

By __ a baby should be roughly able to walk

A

By 1 year a baby should be roughly able to walk

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8
Q

By __ a child should be able to ride a tricycle

A

By 3 years a child should be able to ride a tricycle

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9
Q

2-6-12 rule of social development

A

2 months: Social smile

6 months: Stranger danger

12 months: Separation anxiety

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10
Q

Rule of thumb for how many words a child should be able to say

A

of years is the # of words in a phrase the baby knows.

1 year, baby knows 1 word

2 years, 2 word phrases

. . .

5 years, 5 word sentences

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11
Q

All you need to know about shapes in development

A

3 years – rough circle

4 years – cross

5 years – triangle

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12
Q

Contraindications for vaccination

A
  • Egg allergy is a contraindication to vaccines made with eggs (ie, the Yellow fever vaccine)
  • Profound immunocompromise (AIDS, transplant, pregnant, on biologics) is a contraindication to live attenuated strain vaccines (MMR, VZV, intranasal flu)
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13
Q

A normal reaction to a vaccine is normal if. . .

A

. . . temperature is < 104F or inconsolable baby

Low fever is okay. Erythema is okay. Crying is okay.

But, they shouldn’t be inconsolable.

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14
Q

An abnormal vaccine reaction is characterized by. . .

A

. . . temperature > 104F, inconsolable child, or frank anaphylaxis

Frank anaphylaxis is NOT A CONTRAINDICATION TO OTHER VACCINES, just the one that they are allergic to.

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15
Q

If a child is sick, can they still get a vaccine?

A

Yes.

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16
Q

If someone in the family had a family history of X, can you give a vaccine?

A

Yes.

Only personal history of abnormal reaction or known allergy are contraindications to vaccination. There is no family history of any disease or reaction that is a contraindication to receiving the vaccine in a related individual.

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17
Q

Hepatitis B vaccine schedule

A
  • If born to HBV + mother:
    • Hep B Ig AND Hep B vaccine at birth
  • If born to HBV - mother:
    • Hep B vaccine within 2 months
  • If born to HBV ? mother:
    • Hep B vaccine NOW and check mom’s HBsAg. If positive, give Hep B Ig too.
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18
Q

DTaP / Tdap vaccine schedule

A
  • DTaP (for kids)
    • 3 doses in 1st year, 2 doses between age 1-4
    • Td booster at age 11, then every 10 years OR every 5 years if wounded
  • Tdap (for adults)
    • Smaller dose
    • Everyone over age of 11 should get this at least once. EVERYONE.
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19
Q

H. infleunzae B vaccine schedule

A
  • Give to those < 2 years of age
  • Protects against H. influenzae epiglottitis, meningitis, otitis media
  • This is crucial, as being infected with H. influenzae B does not create an anamnestic immune response, like Norovirus. Only the vaccine will confer an amnestic immunity.
  • Note: Does not cover non-typable H. influenzae
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20
Q

MMRV vaccine schedule

A

Give vaccine AND booster before school starts (before age 5)

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21
Q

Pneumococcal vaccine schedule

A
  • 13 valent: As infant
  • Add 23 valent if risk factors are present (immunocompromise or asplenia)
    • Otherwise, 23-valent as adult
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22
Q

Meningococcal vaccine schedule

A
  • Everyone should get it
  • Anyone who goes into shared dormitory space (college or military) must get it
23
Q

HPV vaccine schedule

A

All boys and girls ages 9 to 26

24
Q

Hep A and B vaccine schedules

A
  • 2 doses for A
  • 3 doses for B
  • No matter where you are in the series, pick up where you left off
25
Q

Rotavirus vaccine schedule

A
  • Give to all infants, optional for later in life
  • Series of 2-3 oral doses in first 6 months of life
  • Contraindicated in anyone with history of intussusception (part of the intestine slides into an adjacent part of the intestine)
26
Q

Add-ons to the standard Well-Child visit for Down’s patients

A
  • Thyroid exam and TSH
  • Hearing test
  • Vision screening
27
Q

Feeding exclusively goat’s milk

A

Not uncommon for some ethnicities

These individuals are at risk for folate and B12 deficiency and subsequent megaloblastic anemia. They are also at risk for iron deficiency.

They are also at risk for Brucellosis if the milk is unpasteurized

28
Q

Breastfeeding vegan mothers should take an additional ___ supplement to prevent ___

A

Breastfeeding vegan mothers should take an additional B12 supplement to prevent neonatal methylmalonic acidemia

Methylmalonic acidemia is characterized by failure to thrive, megaloblastic anemia, seizure, encephalopathy, stroke, and other neurologic manifestations.

29
Q

Failure to thrive, decreased infantile fat reserves and presence of one or more vitamin deficiencies is suggestive of. . .

A

. . . pancreatic insufficiency from cystic fibrosis

30
Q

Thrombophilia is suggestive of ___ as an etiology of anemia in kids

A

Thrombophilia is suggestive of iron deficiency as an etiology of anemia in kids

Weirdly, iron deficiency can also be associated with elevated platelets. In an adult, this constellation might make you worried for essential thrombasthenia, but of course kids too young for this diagnosis - it would be extraordinarily unlikely.

31
Q

Kids with biliary atresia or other liver disease are at significant risk for. . .

A

. . . fat soluble vitamin deficiencies and associated syndromes

Especially ricketts.

Remember, bile salts are necessary to absorb the fat soluble vitamins.

32
Q

Most common form of non-nutritional ricketts

A
  • Familial X-linked hypophosphatemic ricketts
  • Phosphate reabsorption is defective due to excessive FGF23 activity
    • Poor 1-alpha hydroxylase activity
    • Phosphaturia
33
Q

Schmid metaphyseal dysplasia

A
  • Autosomal dominant heritable condition
  • Presents similarly to ricketts, with short stature, leg bowing, and waddling gate
  • Radiographs show irregular long bone mineralization
  • Calcium, phosphate, and ALKP will be normal
34
Q

The H. influenzae B vaccine is not recommended for children over age ___

A

The H. influenzae B vaccine is not recommended for children over age 5

35
Q

An infant should be able to fix on another person’s face and track it starting at. . .

A

. . . BIRTH

All children and infants should have this capacity. Whenever any child does not track anyone, ever, this is a sign for concern.

36
Q

When should a pediatric provider start providing pelvic exams as routine screening for sexually active females?

A

At the age of sexual activity or by age 18-21 . . .

. . . is what the book says.

But, this can potentially be traumatic, especially performing it on someone who is 18 but has never had a sexual encounter. Also, Pap smears are not indicated until age 21 anyway, even for young women who are sexually active. So, in the real world, use your sense. Even in the case of apparent cervicitis, urine NAAT is probably preferable.

37
Q

Pharmacologic and chemical exposures that may cause sensorineural hearing loss (in utero or ex utero)

A
  • Aminoglycosides
  • Loop diuretics
  • Chemotherapeutics (especially cisplatin)
  • Lead
  • Arsenic
  • Quinine
38
Q

Testing hearing in an infant

A
  • Goal is detection by 3 months of age and intervention by 6 months of age
  • Auditory-brainstem evoked responses measure electrophysiologic response to sound and do not require cooperation, so this testing is ideal for an infant. The one problem is that this cannot determine the laterality of hearing impairment.
    • Otoacoustic emissions are considered to be absent if the threshold for responses is above 30 to 40 dB
  • Visual reinforcement audiometry, behavioral audiometry, or play audiometry may be utilized to reveal information specific to each ear
39
Q

Testing hearing in a child old enough to cooperate

A
  • Air conduction audiometry is the gold standard in these individuals
  • Using headphones, lateralized tones between 250 and 8000 Hz are played
    • The same sounds are repeated via an oscillator on the mastoid bone to assess bone conduction
40
Q

Treatment for sensorineural hearing loss

A
  • Depends on age:
    • Children as young as 2 months may have hearing aids placed
    • Cochlear implantation is a treatment option for selected children older than 2 years
    • With severe and profound hearing loss, a combination of hearing aids, sign language, lip reading, and attention to appropriate education surroundings is utilized
41
Q

Groups of children that require audiologic evaluation

A
  • Those with syndromic features of syndromes including hearing loss (including Down’s)
  • Infants born with Apgars of <4 and <6 at 1 and 5 minutes
  • Those with family history of childhood SNHL
  • Those with CMV, rubella, syphilis, herpes, or toxoplasmosis infection
  • Those with craniofacial anomalies
  • Those with birth weight < 1500 g
  • Those with hyperbilirubinemia at a level requiring exchange transfusion
  • Those with bacterial meingitis
  • Those with mechanical ventilation > 5 days
42
Q

Most common cause of thrombocytopenia in an otherwise healthy child

A

Immune thrombocytopenic purpura

Peak is 2-5 years

43
Q

When is bone marrow evaluation warranted in a child presenting with thrombocytopenia?

A
  1. If the peripheral blood smear is abnormal
  2. If the WBC count is abnormal
  3. If lymphadenopathy or organomegaly are present

It may still be ITP, in which case the bone marrow will demonstrate increased megakaryocytes in response to platelet destruction

44
Q

Course of ITP

A

Usually resolves on its own within 6 months.

If platelets are >20,000 there is no need to treat at all, just advise close monitoring and avoidance of trauma.

45
Q

Accidental injuries vs abusive injuries

A
  • Accidental: Typically found over bony areas (knee, shin, elbow, forehead). Appropriate for child’s developmental milestones.Nursemaid’s elbow is common and occurs when the child falls while holding an adult’s hand.
  • Abbusive:Abdomen, buttocks, thights, inner arm.Shaped or patternedmarks. Intentional hot water immersion will leave asharply demarkated lineand often occurs inglove-and-stocking distribution.
    • A note should be made that some traditional or folk healing remedies may leave patterned marks, such as cupping or coin-rubbing
46
Q

Most common form of abuse

A

Neglect

47
Q

Next steps when child abuse is suspected

A
  • Physicians are mandated reporters. We must report all cases of suspected child abuse to child protective services or law enforcement.
  • Skeletal survey is often indicated to determine the extent of traumatic damage, especially in a child younger than 3 years of age
    • ​Recent fractures may not be detectable on plain radiographs until 1-2 weeks after injury
    • Bone scans demonstrate fractures within 24-48 hours and are more useful acutely
  • Photographic documentation of nonpermanent lesions, such as bruises
  • Careful interviewing and assessment of the child’s developmental history
  • If bruising, blood count and coagulation studies to rule out hematologic disorder
48
Q

Differentiating epidural hematoma, subdural hematoma, and contusion

A
  • Epidural hematoma:
    • Usually due to rupture of middle meningeal artery
    • Strike to the head, often ball sports or skiing
    • Brief LOC, then “walk, talk, and die”
    • CT scan: “lens shaped” hematoma
  • Subdural hematoma:
    • Struck by car, MVA, or shaken baby syndrome (abuse)
    • Sustained LOC
    • CT scan: “crescent shaped” hematoma
    • A subdural hematoma in any kid under 3 is highly likely to be abuse
  • Contusion:
    • Decceleration injury, usually sports (helmet-to-helmet)
    • Sustained LOC
    • CT: Punctate intraparenchymal hemorrhages
49
Q

Child car safety

A
  • Age 0-2: Car seat (back seat, rear-facing, seatbelt on)
  • Age >2, height < 4”9’ : Booster seat
  • Height > 4”9’ : Car seat
50
Q

Concussion

A
  • Head trauma w/o bleeding
  • Almost always a sports injury
  • Mild:
    • No focal neurologic deficits
    • LOC < 60 sec
    • No headache or mild headache that is improving
    • No amnesia
      • No CT scan, no treatment. Return to play slowly in stepwise fashion.
  • Severe:
    • Focal neurologic deficit
    • LOC > 60 sec
    • Headache present and worsening, may be N/V
    • Retrograde or anterograde amnesia
      • CT scan to r/o brain bleed, admit for observation regardless of result.Return to play slowly in stepwise fashion.
51
Q

Swimming aids for kids

A

Floaties = bad

Life jackets = good

52
Q

What type of drowning is most dangerous? What type is least dangerous (but still very dangerous)?

A

Most: Hot, salty water

Least: Cold, fresh water

53
Q

APA’s recommendations for guns in the home

A

Don’t have them. Eliminate.

However, since we live in America and people are gun happy, when thay say no, here is how you counsel them: Keep on a high shelf in a gun safe and with a gun lock, and with weapon separate from ammo.

Same goes for chemicals.

Pediatrics Clerkship (23 decks)

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