Module 6: Infancy, Plagiocephaly, Torticollis & Developmental Hip Dysplasiaia

Question 1

What is the average (50th Percentile) head circumference of a newborn

Answer 1

= 34 cm
- If child has normal weight & length, measurement < 31 cm is disproportionately small
- Head circ’ > 1 to 2 SD above height & weight on growth should be evaluated

Question 2

What can Microcephaly be indicative of?

Answer 2

• SGA =small for gestational infant
• IUGR = Intrauterine growth retardation
• Premature closure of sutures (craniosynostosis) = Requires immediate referral

Question 3

What is Cranial Molding? What is expected?

Answer 3

= Temporary skull asymmetry d/t compression during labour & ridges develop when one bone slightly overlaps the adjacent one during delivery.
- Complete resolution is expected with time without intervention

Question 4

What is Caput Succedaneum?

Answer 4

= Scalp Edema, not confined by sutures.
- Most prominent after birth
- How to test = firm constant pressure in one spot = elicit characteristic Pitting Edema, visible when finger released.
- often predominantly/ entirely UL
- Should naturally resolve

Question 5

What is Cephalohematoma?

Answer 5

= Collection of blood/ fluid under the periosteum of skull & on top of bone. Soft swelling that can increase in size over first 24-72hr
- Primarily ass’ w assisted deliveries
- cannot cross / confined by suture lines
- on palp = feels unstable/ fluctuating

Question 6

What is a subgaleal Hemorrhage?

Answer 6

-Accumulation of blood between scalp & skin of scalp.
= Boggy, shifting mass that extends over cranial surface to neck/ behind ears
- Referral

Question 7

Complications associated with Sacral Dimple:

Answer 7

• Tethered SC = tissue attached to SC that limits its movement
• Dermal Sinus Tract = abnormal connection between skin & spine that can lead to infection
• Spina bifida Occulta = Spine doesn’t close correctly around SC

Question 8

Slate Grey Patches (previously Mongolian Spots)

Answer 8

• MC seen in darker skinned Infants
• MC over sacrum
• Tend to fade over years
• Not serious- no need for referral/ further evaluation

Question 9

What is Milia?

Answer 9

• Keratin filled epithelial cysts
• Present at birth
• Spontaneous resolution expected within few weeks
• VS Acne (caused by maternal hormones) not generally appear until after 2 weeks old

Question 10

Sebaceous Hyperplasia

Answer 10

• raised/ yellowish lesions
• Result of maternal androgen exposure in utero
• spontaneously resolves
• Maternal hormone exposure may also cause vaginal withdrawl bleeding in infant girls & neonatal acne

Question 11

Signs of facial nerve Palsy:

Answer 11

• Ptosis (eyelid doesn’t close on affected side)
• lower face uneven during crying
• paralysis on affected side of face.

Question 12

Causes of Bulging Fontanelles

Answer 12

• crying, coughing, vomiting
• Increased ICP
• Hydrocephalus
• Meningitis or Encephalitis
• Hypoxic
  -Trauma
• Intracranial hemorrage