Flashcards in General Principles Deck (79):
Age for social smile
Age for cooing
Age for while prone, lifts head up 90 degrees
Age for rolls front to back
Age for voluntary grasp (no release)
Age for stranger anxiety
Age for sits with no support
Age for pulls to stand
Age for waves "bye-bye"
Age for voluntary grasp with voluntary release
Age for plays pat-a-cake
Age for first words
Age for imitates others' sounds
Age for separation anxiety
Age for walks without help
Age for build tower of 2 cubes
Age understands 1-step commands (no gesture)
Age for good use of cup and spoon
Age for build tower of 6 cubes
Age runs well
Age ties shoelaces
Which is more important, the age at which individual milestones are reached or the overall pattern of development?
Overall pattern of development
Screening done at every pediatric visit (5)
3. Blood pressure
4. Developmental/ behavioral assessment
5. Anticipatory guidance
Most common cause of death in children 1-12 mo
Testable Anticipatory Guidance (8)
1. Water Heater <120F
2. Proper car restraints
3. Infant sleep on side or back
4. No baby walkers
5. No small objects - aspiration
6. No honey or cow's milk before 1 yr
7. Solids start at 6 mo
8. Supervise around water
When is head circumference measured?
Every visit for first 2 years
Failure to Thrive
- Head circumference, height, or weight < 5th percentile
- Weight < 80% of ideal weight for age
- Weight loss causes a decrease of 2 or more major percentage lines
Organic causes of childhood obesity
< 5% of cases
Conditions with abnormal head circumference
Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus (CMV), and Herpes infections
Initial Hearing and Vision Screening
At least once by 4 yrs of age
Normal age for strabismus
Until 3 mo of age
H&H Screening for Anemia
at 12 months of age
Risk factors for anemia during infancy (5)
2. Low birth weight
3. Ingestion of cow's milk before 1 yr of age
4. Low dietary intake
5. Low socioeconomic status
When should iron supplementation start?
What children should be screened for lead exposure?
all Medicaid-eligible children
Risk factors for TB Testing in Children 2 yr or older (4)
1. Family with TB or pos TB test
2. Born in high-risk country
3. Traveled to high-risk country
4. Consumed unpasteurized milk or cheese
How test for vesicoureteral reflux?
Ultrasound scan and either voiding cystourethrogram (VCUG) or radionuclide cystogram (RNC)
When test for vesicoureteral reflux?
febrile UTI in children 2 mo to 2 yr old
Which special patient populations require pneumococcal vaccine?
Which vaccine is contraindicated in egg-allergic patients?
When not give live vaccines?
What are the live vaccines? (3)
When should a child see a dentist for the first time?
When does the anterior fontanelle usually close?
18 months of age
What disorder should you suspect if it fails to close? (4)
hypothyroidism, hydrocephalus, rickets, or intrauterine growth retardation.
Is milky-white and possibly blood-tinged vaginal discharge usually abnormal in the first week of life for a female newborn?
This discharge is usually physiologic and due to maternal hormone withdrawal
When should the Moro reflex and palmar grasp reflex disappear?
6 months of age.
When can dx of encopresis or enuresis be made?
Encopresis is normal until age 4 years and enuresis is normal until age 5 years
Tanner Stage 1
Tanner Stage 5
Definition of puberty
when someone first has changes from Tanner Stage 1
Average age for puberty
Girls - 10.5 yrs
Boys - 11.5 yrs
First event for puberty in boys
First event for puberty in girls
True precocious puberty
premature activation of the hypothalamic-pituitary axis with sexual maturation
When does true precocious puberty occur in males and females?
Males < 9 yrs
Females < 8 yrs
Secondary sex characteristics develop prematurely because of high circulating levels of androgens or estrogen
What happens in precocious puberty that does not occur in pseudoprecocious puberty?
Testicular or ovarian enlargement
Tests for precocious puberty
GnRH stimulation test
If increased FSH and LH, precocious puberty
What causes pseudoprecocious puberty? (5)
1. Exogenous hormones
2. Adrenal tumors
3. Congenital adrenal hyperplasia (e.g. 21-hydroxylase def)
4. Hormone-secreting tumors
5. McCune-Albright syndrome
McCune-Albright Syndrome (4)
1. Ovarian cysts
2. Pseudoprecocious puberty
3. Polyostotic fibrous dysplasia of bone
4. Cafe au lait spots
What causes precocious puberty? (7)
1. Usually idiopathic
2. McCune-Albright Syndrome
3. Ovarian tumors (granulosa, theca cell or gonadoblastoma)
4. Testicular tumors (Leydig)
5. CNS disease or trauma
6. Adrenal neoplasm
Congenital adrenal hyperplasia
21-hydroxylase deficiency (95% of the time)
Males - precocious puberty or salt-wasting crisis
Females - ambiguous genitalia
Treatment for idiopathic precocious puberty
long-acting GnRH agonists
Why is it important to treat precocious puberty?
Prevent premature epiphyseal closure and short stature
Boys - lack of testicular enlargement by age 14 yrs
Girls - lack of breast development by age 12 yrs
Most common cause of delayed puberty
constitutional delay (normal variant)
What are other causes of delayed puberty?
1. Primary testicular failure (Klinefelter syndrome, cryptorchidism, hx of chemo, gonadal dysgenesis)
2. Ovarian failure (Turner syndrome, gonadal dysgenesis)
3. Hypothalamic or pituitary defect (Kallmann syndrome or tumor)
Three leading causes of death in adolescents
Accidents, homicide, suicide
People who should get the flu vaccine yearly (6)
1. Children 6mo - 18yrs
2. Women who will be pregnant during flu season
4. 50 yrs or older
5. Chronic medical conditions (pulm, CV, renal, hepatic, hematologic, metabolic including DM)
6. Healthcare professionals
What age should adults start getting pneumococcal vaccine?
What special populations should get pneumococcal vaccine?
For age 2 yrs and older
1. Chronic CV, pulm, or liver disease
3. Functional or anatomic asplenia
Who should get rubella vaccine if haven't had in childhood?
1. All women of child-bearing age
2. Healthcare workers
3. HIV-positive patients
Can MMR vaccine be given to pregnant women or immunocompromised patients?
No, it's a live vaccine
How long should women avoid getting pregnant after getting the MMR vaccine?
Can pregnant women receive Tdap vaccine?
When should people receive Tdap vaccine?
Once, 11 yrs old or older, in place of Td vaccine