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ME 536- Patient Care II > Infants, Toddlers and Young Children > Flashcards

Infants, Toddlers and Young Children Flashcards

1
Q

Heath supervision visit schedule

A

Birth
3-5 days
1, 2, 4, 6, 9, 12, 15, 18 months
2 years
2.5 years
3 years
annually

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2
Q

Goals of pediatric visits

A

Disease detection, disease prevention, health promotion, anticipatory guidance

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3
Q

Components of pediatric visit

A
  1. interval history
  2. ROS
  3. Surveillance of development
  4. Observation of parent/child interaction
  5. physical exam (measurement of growth)
  6. Screening (universal, risk assessment)
  7. Immunizations
  8. Anticipatory guidance (social determinants of health)
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4
Q

What is one thing you should always ask during interval history?

A

Are there any parental concerns?

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5
Q

What are social aspects of health

A

living situation, family supports, food insecurity, substance use, partner violence

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6
Q

What drives development across a lifespan

A

ecology and biology

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7
Q

Biology

A

physiologic adaptations and disruptions

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8
Q

Ecology

A

The social and physical environment

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9
Q

Development

A

Learning, behavior and health

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10
Q

Child stressors

A

abuse, neglect, chronic fear state, natural disaster, accidents and illness, exposure to violence, disabilities/chronic disease

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11
Q

Parent/family stressors

A

parental dysfunction, substance abuse, domestic violence, mental illness, divorce, poverty

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12
Q

Positive physiologic stress response

A

brief duration, mild/moderate severity, sufficient social/emotional buffering, long-term return to baseline

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13
Q

Tolerable physiologic stress response

A

sustained duration, moderate/severe severity, sufficient social/emotional buffering, long-term return to baseline

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14
Q

Toxic physiologic stress response

A

sustained duration, severe severity, insufficient social-emotional buffering, long term changes to baseline

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15
Q

Surveillance of development are also called

A

milestones

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16
Q

4 main areas of milestones

A
  1. social and emotional
  2. language and communication skills (expressive and receptive)
  3. Gross motor skills
  4. Fine motor skills
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17
Q

When are milestone checks done?

A

Every visit

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18
Q

Expected milestones for a Newborn-1 Week

A

Makes brief eye contact when held, cries with discomfort, calms to adult voice, reflexively moves arms and legs, turns head to side when on stomach, holds fingers closed, reflexive grasp

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19
Q

Expected milestones 1 month

A

calms when picked up or spoken to, looks briefly at objects, alters to unexpected sound, short vowel sounds, holds chin up while prone, holds fingers more open while at rest

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20
Q

Expected 2 month milestones

A

smiles responsively, vocalizes/coos, lifts head and chest when prone, opens and shuts hands

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21
Q

Expected 4 month milestones

A

laughs aloud, turns to voice, vocalizes/extended cooing, rolls over to prone when supine, supports on elbows and wrists while prone, keeps hands unlisted, plays with fingers in midline, grasps objects

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22
Q

Expected 6 month milestones

A

smiles at reflection, turn head with name, babbles, rolls over, sits briefly without support, reaches/transfers objects, rakes small object with 4 fingers, bands objects on surfaces

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23
Q

Expected 9 month milestones

A

uses basic gestures (arms out for pick up), looks for dropped objects, picks up food with fingers, feeds self, turns when name is called, days “dada” or “mama”, sits without support, pulls to stand, transitions between sitting and lying, balances on hands and knees, crawls, picks up small object with 3 fingers and thumb, releases objects intentionally

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24
Q

Expected 12 month milestones

A

looks for hidden objects, imitates new gestures, “dada” or “mama” specifically, 1 other word than parent names, follows verbal commands that include a gesture, first steps, stands without support, drops objects in a cup, picks up small objects 2-finger pincher grasp

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25
Q

Expected 15 month milestones

A

imitates scribbling, drinks from a cup, points to objects, 3 words, jargon, follows verbal commands without a gesture, squats to pick up objects, climbs onto furniture, begins to run, makes mark with crayons

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26
Q

Expected 18 month milestones

A

plays with others, helps with dressing, points to pictures and objets of interest, turns at looks at adults, scoop with spoon, 6-10 words, identify 2 body parts, walks 2 feet with hand held, sits in small chair, carries a toy while walking, scribbles, throws a small ball while standing

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27
Q

Expected 2 year milestones

A

Parallel play, remove clothing, scoops with spoon, 50 words, 2 words into short phrase or sentence, follows 2-step command, words that are 50% unintelligible for strangers, kicks ball, jumps with 2 feet, runs with coordination, stats objects, turns book pages, use hands to turn objects

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28
Q

Expected milestones 2.5 years

A

urinates in a potty, engages in pretend play, spears with a fork, uses pronouns correctly, begins to walk up steps (alternating feet), runs well without falling, grasp crayon with thumb and fingers instead of fist, catches large balls

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29
Q

Expected milestones 3 years

A

Potty by themself, plays in cooperation and shares, puts on coat/shirt, beginning imaginative play, eats independently, 3 word sentences 75% intelligible to strangers, understands simple prepositions (on, under), pedals tricycle, climbs on and off couch, jumps forward, draws a single circle, draws a person with head and 1 other body part, cuts with child scissors

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30
Q

Expected 4 year milestones

A

Uses bathroom/BM alone, brushes teeth, dress/undress, well-developed imaginative play, 4 word sentences, words that are 100% intelligible to strangers, climbs stairs alternating feet without support, skips on 1 foot, draws a person with 3 body parts, draws simple cross, unbutton/button medium buttons, grasps pencil with thumb and fingers (no fist)

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31
Q

I can jump and kick a ball- how old am I

A

2 years

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32
Q

I can pull myself up and stand, I can wave bye, I imitate sounds - how old am I

A

1 year

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33
Q

I can hop on one foot and my speech is clear, I can copy a circle- how old am I

A

4 years

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34
Q

Developmental screening

A

use of standardized tools to identify children at risk for developmental disorder

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35
Q

When do you do developmental screening?

A

Anytime a parent has a concern

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36
Q

What developmental screening do you do at the 9 month visit

A

identify motor issues, visual, hearing issues

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37
Q

What developmental screening do you do at the 18 month visit

A

communication and language delays, mild motor delays

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38
Q

What developmental screening do you do at the 30 month visit

A

most issues can be identified

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39
Q

Autism screening is recommended when by the AAP?

A

18 month visit
24 month visit

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40
Q

What category screening is autism screening?

A

USPSTF Category I

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41
Q

Developmental screening tools

A

Ages and stages questionnaire (ASQ)

Parent’s evaluation of developmental status (PEDStest)

Survey of wellbeing of young children (SWYC)

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42
Q

Autism screening tool

A

Modified checklist for autism in toddlers revised with follow-up (M-CHAT-R/F)

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43
Q

What do you measure for the growth chart

A

head circumference, weight, length

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44
Q

When do you do growth chart measurements

A

every visit

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45
Q

When do you stop head circumference measurement?

A

2 year visit

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46
Q

How much weight does a infant lose in the first week of life?

A

10% of birth weight

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47
Q

When should the infant be back to birth weight?

A

14 days

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48
Q

When should an infant have doubled their birth weight

A

4-6 months

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49
Q

When should an infant have tripled their birth weight

A

1 year

50
Q

Average growth rates

A

2” and 2kg per year from 2 to puberty

51
Q

How much weight do neonates gain to 3 months

A

1 once/day (30grams)

52
Q

How much weight do infants gain per day between 3-6 months

A

0.67 ounce (20 grams)

53
Q

How much weight do infants gain per day between 6-12 months

A

0.33 ounce (10grams)

54
Q

Average length at birth

A

~20 inches

55
Q

How much do infants grow in their first year

A

~10 inches

56
Q

How much do toddlers grow between 12-24 months

A

~4 inches

57
Q

How much do toddlers grow between 24-48 months

A

~3 inches

58
Q

When are children half of adult height

A

24-30 months

59
Q

How much do people grow between 4 years and puberty

A

~2 inches/year

60
Q

Remember that growth is _________

A

pulsatile

61
Q

When should you plot growth?

A

every visit

62
Q

When do you start plotting BMI for age

A

age 2

63
Q

When do you stop plotting weight for length

A

age 2

64
Q

Growth is tracked based on

A

percentile

65
Q

Which growth chart is better for breastfed infants

A

WHO

66
Q

Growth charts for breastfed infants are different because

A

slower weight gain between 3 and 4 months

67
Q

What would happen if you plotted a breastfed baby on CDC

A

may lead to earlier solids and less breast milk

68
Q

When do you use WHO

A

up to age 2, then CDC from ages 2-19

69
Q

What age does WHO go to

A

5

70
Q

What do you do if you have no EMR

A

measure 2-3 times and plot as accurately as possible

71
Q

What is a common recommendation for infant physical exam

A

use toys for distraction

72
Q

Where should the baby lay during physical exam

A

in the parent’s lap as much as possible during exam

73
Q

When should you do heart and lungs

A

when the baby is quiet

74
Q

When should you do invasive exams (mouth and ears)

A

for last

75
Q

Young children physical exam tips

A

use a reassuring voice, let the child see and play with your tools, make it a game, do NOT ask for permission from a child

76
Q

Instead of asking for permission for a child what do you do instead

A

State what you are going to do and do it

77
Q

Who should undress a young child during the physical exam

A

the parent

78
Q

As children age you need to be sensitive to _______

A

modesty

79
Q

Spread to the child _______

A

directly

80
Q

differences in children: head size

A

larger

81
Q

differences in children: abdomen

A

“square” until age 2 less muscle

82
Q

differences in children: bladder

A

at umbilicus at birth

83
Q

differences in children: breathing

A

obligate nose breathers

84
Q

difference in children: ribs

A

not very flexible, not as protective

85
Q

differences in children: organs

A

much larger and more exposed

86
Q

Early childhood is when

A

1-4 year

87
Q

In early childhood how much does does growth slow

A

50% of that infancy

88
Q

Early childhood exam sequence

A

start with seated (eyes, palpate neck, percuss/auscultate), move to supine (abdomen, MSK, nervous system, examine genitalia last), upright (look at throat and ears last

89
Q

When do you start measuring blood pressure

A

age 3

90
Q

is adenopathy is ______ in children

A

common

91
Q

Early childhood eye exam

A

cover and cover/uncover test for position and alignment of eyes

92
Q

Expected eye findings in early childhood exam

A

normal corneal light reflex

93
Q

Esotropia

A

eye deviates nasally

94
Q

Exotropia

A

eye deviates temporally

95
Q

strabismus

A

eyes are not aligned

96
Q

Cover test you are examining

A

the uncovered eye

97
Q

Cover/uncover test you are examining

A

the covered eye
Cover for 5 seconds (drifting indicates phoria)

98
Q

When looking for a tympanic membrane in a child it can be _____ to see

A

hard

99
Q

How can you assist in visualizing tympanic membrane in children

A

pull up, out and back

+/- insufflator

100
Q

Are brachial or radial pulses easier to feel in children

A

brachial

101
Q

Normal abdominal exam in childhood

A

protuberant abdomen, liver span 1-2cm below costal margin, spleen edge 1-2cm below costal edge

102
Q

When should you expect the testes to descend into the sac

A

if not descended by age 1, refer out

103
Q

A normal musculoskeletal finding in children

A

bowlegged

104
Q

When are children knock-kneed

A

18 months-4 years of age

105
Q

When do you inspect for scoliosis

A

any child who can stand

106
Q

When is universal screening recommended

A

all children

107
Q

When is selective screening recommended

A

at risk children, risk assessment should be done regularly

108
Q

Who makes pediatric recommendations

A

American Academy of Pediatrics via Bright Futures

United States Preventative Services Task Force

Centers for disease control and prevention

School requirements

109
Q

Newborn screening

A

genetic and metabolic screen
Critical congenital heart disease (pulse ox)
hearing
bilirubin

110
Q

When is hearing screening recommended

A

all newborns and risk assessment for all children up to age 21

111
Q

Audiology screening schedule for all children

A

age 4,5,6,8,10 years

112
Q

Vision screening under age 5 for

A

amblyopia, strabismus and decreased visual acuity

113
Q

When do you screen for iron deficiency

A

H&H at 12 months

114
Q

What is being removed from universal screening

A

lead

115
Q

Misc screening for young children

A

iron, lead, oral health, blood pressure, cholesterol

116
Q

When do you start screening for cholesterol

A

age 9-11 and again at 17-21

117
Q

What is anticipatory guidance

A

identify upcoming issues that a child and family face, give advice that is developmentally consistent

118
Q

Anticipatory guidelines must be 3 things:

A

Timely: given at the right age
Appropriate: for this child and family
Relevant: so that families will adopt them

119
Q

What domains do anticipatory guidance fall into

A

social determinants of health
behavior and development
discipline
nutrition and feeding
safety

120
Q

Surveillance is ______
Screening is ________

A

every single visit, if a parent has a concern

121
Q

If a child +/- 2 lines on growth chart

A

concern for failure to thrive or metabolic disorder

ME 536- Patient Care II (8 decks)

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