Chapter 18: Assessing Children Flashcards
(85 cards)
1
Q
What is the typical sequence of examination for a newborn
A
- Careful observation
- Head, neck, heart, lungs, abdomen, GU
- Lower extremities and back
- Ears and mouth
- Eyes (whenever they spontaneously open)\
- Skin (as you go)
- Neuro
- Hips
2
Q
What is an Apgar score (definition)?
A
an assessment of the newborn immediately after birth to classify the newborn’s neurologic recovery from birth and adaptation to extrauterine life. Score once at 1 minute and again at 5 minutes.
Score 0-2 for:
Heart rate
Respiratory effort
Muscle tone
Reflex irritability (reaction to suction of nares with bulb syringe)
Color
3
Q
Apgar: heart rate categories
A
0= absent 1= less than 100 2= greater than 100
4
Q
Apgar: Respiratory effort categories
A
0= Absent 1= slow and irregular 2= good; strong
5
Q
Apgar: Muscle tone categories
A
0= flaccid 1= some flexion of the arms and legs 2= active movement
6
Q
Apgar: Reflex irritability categories
A
0= no response 1= grimace 2= crying vigorously, sneeze, or cough
7
Q
Apgar: Color
A
0=blue, pale
1= pink body, blue extremities
2= pink all over
8
Q
Apgar score categories at 1 minute
A
8-10=Normal
5-7= Some nervous system depression
0-4= Severe depression, requiring immediate resuscitation
9
Q
Apgar score categories at 5 minutes
A
8-10= Normal 0-7= High risk for subsequent central nervous system and other organ system dysfunction
10
Q
Preterm (classification)
A
<34 weeks
11
Q
Late preterm (classification)
A
34-36 weeks
12
Q
Term (classification)
A
37-42 weeks
13
Q
Post-term (classification)
A
> 42 weeks
14
Q
Heart rate (birth to 1 mo)
A
Avg= 140 Range= 90-190
15
Q
Heart rate (1-6 months)
A
Avg= 130 Range= 80-180
16
Q
Heart rate (6-12 months)
A
Avg= 115 Range= 75-155
17
Q
Respiratory rate in newborn
A
30-60
18
Q
Temp in newborn
A
> 99 (rectal), may fluctuate by up to 3 degrees in a day, as high as 101 in afternoon or after exercise. This is the case up to 3 months of age.
19
Q
Blood pressure in newborn
A
70-90mmHg systolic
20
Q
Size for gestational age categries
A
Small for gestational age: less thank 10th percentile (large is greater than 90th)
21
Q
Average birth weight
A
7.7 lbs (3400g)
22
Q
Weight change after 1st week
A
10% weight loss
23
Q
Weight change after 2nd week
A
Regain birth weight (no change from birth)
24
Q
Weight change in 4-6 months
A
Double birth weight
25
Weight change in 12 months
Triple birth weight
26
Avg length at birth
20 inches
27
Avg length at 12 months
~30 inches (should be 50% increase from birth length)
28
Avg growth from 13-24 months
~+5 inches
29
Age of growth spurt in girls and boys
10-12 years in girls
14-16 years in boys
(4-5 inches/year)
30
Avg head circumference at birth
13.5-14 inches
31
Increase in head circumference after 12 months
4-5 inch increase
32
Increase in head circumference at 13-24 months
2-3 inches
33
Increase in head size from 13 months on
3 inches
34
At what ages to the anterior and posterior fontanelles close?
Anterior: 4-26 months
Posterior: by 2 months
35
Placing/stepping reflex
birth (best after 4 days) until variable
36
Rooting reflex
Stroking perioral skin at corners of mouth will cause baby to turn toward the stimulus and suck
Birth until 3-4 months
37
Moro reflex
Holding baby supine with head supported, abruptly simulate dropping baby about 2 feet. The arms should abduct and extend, hands open, and legs flex. Crying is normal.
Birth until 4 months
38
Asymmetric tonic neck reflex
With baby supine, turn head to one side, holding jaw over shoulder. The arm/leg on the side to which head is turned extend, while the opposite arm/leg flex.
Birth until 2 months
39
Trunk incurvation (Galant's reflex)
Supporting prone baby with one hand, stroke one side of the back 1 cm from midline, from shoulder to buttocks. Spine will curve toward the stimulated side.
Birth to 2 months.
40
Acrocyanosis
Bluish discoloration of the hands and feet (sometimes lips). It is frequent during the early hours of life and usually resolves in 48 hours.
41
Milia
Tiny sebaceous cysts that appear as pearly white or yellow papules about 1mm in size, mainly on and around the nose. They self-resolve in a few weeks.
42
Jaundice within 24 hours of birth
suggests hemolytic disease
43
Jaundice on second or third day after birth
normal "physiologic" jaundice. Should peak around day 5 and resolve on its own within 1 week. If it persists beyond 2 or 3 weeks it could suggest biliary obstruction or liver disease.
44
How does infection present in infants?
Respiratory distress: RR>60, apnea, expiratory grunting, nasal flaring, inspiratory crackes/rales.
Increased/depressed neutrophil and band count
Hypotension
mottled skin
thrombocytopenia
45
How to diagnose failing to thrive
1) growth: drops >2 quartiles in 6 months
| 3) weight for length <5th percentile
46
3 basic mechanisms of failure to thrive
1) Insufficient nutrition available because the child cannot feed properly
2) Inadequate absorption
3) A disease process creating added metabolic requirements (eg asthma, cardiac failure, thyroiditis
47
Denver Developmental Screening Test
Designed to detect developmental delays in four domains of development from birth through 6 years:
Social, gross motor, fine motor, and language. Highly specific, but not very sensitive.
48
DDST: Gross motor landmarks
```
Birth-2 months: lifts head posteriorly
4 months: holds head up anteriorly
2-3 months: can roll over, grasp rattle
7-8 months: can stand
9-10 months: crawls, cruises
12 months: walks
3 years: jumps in place
4 years: pedals tricycle
5 years: skips
```
49
DDST: Fine motor landmarks
1 month: involuntary grasp (cannot release)
2 months: hands to midline
3 months: voluntary grasp, thumb sucking, raking
6 months: transfers items, can hold bottle
Complex fine motor skills: dropping, throwing, stacking, use of cup/spoon, drawing
50
DDST: language landmarks
2 years: 2 word sentences, 25% intelligible, verbs and adjectives. dysfluency common. Talks about current action
3 years: 3-4 word sentences, 75% intelligible. Can tell own age, sex, counts to 3. Dysfluency common
4 years: >5 word sentences. 100% intelligible. Can describe experiences and sing songs. Some dysfluency.
5 years: can define words. Counts to 10, knows letters, telephone #. No dysfluency.
51
Hearing development landmarks
0-2 mo: reacts to sound with startle
2-3 months: turns toward sounds
3-4 mo: turns eyes and head toward sounds
6-7 mo: turns to listen to voices and conversation
52
Visual development landmarks
1 mo: fixes on object
9 mo: neat pincer grasp
12 mo: stacks blocks, peg in hole, acuity~ 20/50
53
Well-child visit schedule
0; 3-5 days, 2 weeks, 1 mo, 2, 4, 6, 9, 12, 15, 18, 24 mo. Annually after 2 yrs.
54
Prevalence of childhood obesity
15% in 6-9 year olds; additional 14% at risk
55
Risk factors for childhood obesity
```
Genetic: 3 fold increase if 1 parent obese. 10 fold increase of both parents obese
Low activity
Absence of family meals
Over consumption of sweetened beverages
Large portions
```
56
Clinical morbidities of childhood obesity
```
Insulin resistance
Hyperglycemia
Accelerated growth
Early menses
Polycystic ovarian disease
Increased cortisol production
```
57
Lab recommendations for kids with BMI> 85 percentile
```
Fasting glc
Fasting insulin
Hg A1c
Lipid profile
TSH
```
58
Development milestones: 24 months
Walks up and down stairs; stacks 6 blocks, knows 50+ words (inc pronouns), parallel play
59
Development milestones: 3 yrs
Pedals tricycle, copies circle, 250+ words, group play
60
Development milestones: 4 yrs
Balances on 1 foot, copies square, dresses self, colors, cooperative play
61
Development milestones: 5 yrs
Skips (alternating feet), copies triangle, ties laces, writes names, competitive play
62
Tanner stages: breast
stage 1: immature
stage 2: 8.9-12.9 yrs (mean 10.9). Elevation of breast/nipple
stage 3: 9.9-13.9 yrs (mean 11.9). breast/areola enlargement
stage 4: 10.5-15.3 yrs (mean 12.9 yrs). Areolae and nipples project. secondary mound visible
stage 5: mean 14.5 yrs. Mature breast. Projection of nipple only, no secondary mound.
63
Tanner stages: female pubic
stage 1: no pubic hair
stage 2: sparse hair growth
stage 3: darker, courser, curlier
stage 4: course and curly as adult, but less
stage 5: adult in quantity and distribution
64
Tanner stages: male
stage 1: no pubic hair
stage 2: sparse hair growth, no penile growth
stage 3: darker, courser hair spread over junction of pubes. Some penile enlargement & lengthening
stage 4: Course, curly hair (adult type) covers smaller area than adult (does not extend to thighs). Development of glans.
stage 5: Adult hair, adult penis size and shape. testes/scrotum adult size/shape.
65
HepB
Dose 1: Birth
Dose 2: 1-2 months
Dose 3: 6-18 months
66
Rotavirus
Dose 1: 2 mos
Dose 2: 4 mos
Dose 3 (rotaTEQ only): 6 mos
67
DTaP
```
Dose 1: 2 mos
Dose 2: 4 mos
Dose 3: 6 mos
Dose 4: 15-18 mos
Dose 5: 4-6 years
```
68
Tdap
Dose 1: 11-12 yrs
69
Hib
Dose 1: 2 mos
Dose 2: 4 mos
Dose 3 (If 3 dose type): 6 mos
Booster: 12-15 mos
70
Pneumococcal conjugate
Dose 1: 2 mos
Dose 2: 4 mos
Dose 3: 6 mos
Dose 4: 12-15 mos
71
IPV
Dose 1: 2 mos
Dose 2: 4 mos
Dose 3: 6-18 mos
Dose 4: 4-6 yrs
72
MMR
Dose 1: 12-15 mos
| Dose 2: 4-6 yrs
73
Varicella
Dose 1: 12-15 mos
| Dose 2: 4-6 yrs
74
HepA
2 doses: 12-23 mos, min 6 mos apart
75
HPV
3 dose series 11-12 yrs
76
Meningococcal
Dose 1: 11-12 yrs
| Booster: 16-17 yrs
77
Erythema toxicum
Small areas of redness, varying in diameter from a few mm to 2 cm, in the center of which is a small raised yellowish-white wheal.
Appear in first 24 hours of life, on trunk and diaper area.
Persist 7-10 days
Self resolve.
Occur in 70% of infants.
78
Moulding
Movement of skull bones during birth process is a common cause of temporary head asymmetry. Overlapping is common. This resolves by the end of the first week of life.
79
Caput succedaneum
Diffuse, edematous swelling of the soft tissues of the scalp involving areas that presented first during labor and delivery. Swelling extends across skull sutures.
Self-resolves during first few days of life.
80
Pseudostrabismus
Upper eyelids of newborn have epicanthal folds running medially downward and obscuring inner canthus. This gives the illusion of strabismus.
Find symmetrical points of reflected light centered on infants pupils to dispel illusion.
81
Port wine stain
Observed at birth. Comprised of plexus of newly formed capillaries. Flat, red to purple in color. Will not blanch or disappear spontaneously.
82
Capillary hemangiomata (2 types)
1. Stork's beak mark- seen on eyelids, glabella, and occipital areas. Blanch on pressure and fade within 1 year. Found in 33% of newborns. NORMAL.
2. Cavernous hemangioma- Communicating network of interconnected venules in subcutaneous tissue. Enlarge before they regress. May require surgical removal if they grow rapidly or bleed.
83
Mongolian spots
Dark blue, bruise-like macular spots over sacrum (usually). Easily confused with bruise. Document size and location. Bruises will disappear in 1 week, these will not change.
84
Congenital nevomelanocytic nevi (CNN)
Pigmented plaques often associated with hair growth. Large cnns (>20cm) are associated with a 2-15% lifetime risk of progression to melanoma and may require excision. Observe them for progression.
85
Social developmental milestones
```
1 year: plays games (peek-a-boo)
2 yrs: imitates activities
3 yrs: feeds self
4 yrs: imagination. sings
5 yrs: dresses self. plays games.
```
