Growth and Development Flashcards

Question

developmental milestones: 3-4 years

Answer 1

-Climbs stairs with alternating feet -Begins to button and unbutton -“What do you like to do for fun?” (Answers using plurals, personal pronouns, and verbs) -Responds to place toy in, on, or under table -Draws circle when asked to draw person -Knows own sex -Gives full name -Parent reported: -Feeds self at mealtime -Takes off shoes and jacket

Answer 2

-Runs and turns without losing balance -Stands on 1 leg for at least 10 seconds -Copies circle/+ sign -Draws a person (head, 2 appendages, 2 eyes) -Buttons clothes and laces shoes -Gives appropriate answers to: “What must you do if you are sleepy, hungry, cold? -Knows the days of the week -school age -Parent reported: -Self care at toilet -Plays outside for at least 30 minutes

Answer 3

-Can catch a ball -Skips smoothly, heel-to-toe walks -Copies a square -Draws recognizable person with at least 6-8 details -Counts -Knows L/R hand -Can describe favorite TV program in some detail -Parent reported: -Tells age -Performs simple home chores -Goes to school unattended or meets school bus

Answer 4

-Copies triangle -Knows morning/afternoon, time -Draws person with 12 details -Reads several 1-syllable printed words -Defines words

Answer 5

-Ties shoes -Copies a diamond -Draws person with 16 details -Enhanced reading -Counts by 2s and 5s -Adds and subtracts 1-digit numbers

Answer 6

-Defines words better than by use (an orange is a fruit) -Enhanced reading -Borrowing and carrying processes in addition and subtraction

Answer 7

-Knows month, day, and year – names months in order (15 seconds, 1 error) -Enhanced reading, sentence construction -Simple multiplication

Answer 8

-Enhanced reading, comprehension -Multiplication and simple division

Answer 9

-Enhanced reading, comprehension -Reduce fractions, long division, adds/subtracts fractions

Answer 10

-Only recommended are newborn metabolic screening with hemoglobin electrophoresis, hearing and vision evaluation, anemia and lead screening, TB testing, and dyslipidemia screening -Metabolic Screening -Mandated in every state -Includes phenylketonuria, galactosemia, congenital hypothyroidism, maple sugar urine disease, and organic aciduria (some states screen for CF) -prevent develop delays -Hemoglobin Electrophoresis -Higher risk for infections/complications -sickle cell -risk to encapsulated bacteria -prophylaxis with PCN until 5yo -vaccines -Critical Congenital Heart Disease Screening -AAP now mandates screening with pulse oximetry of R hand and foot (pass if > 95% and difference is < 3% points; fail if < 90%) -coarctation of the aorta if difference is found -Hearing Evaluation -Performed before discharge from newborn nursery -Screen by 1 month, follow-up (if abnormal) by 3 months, intervention by 6 months -prevent speech delay

Answer 11

-Infants and Toddlers: -Inferences from asking parents about response to sound, speech/examining speech, and language development closely -Screened by auditory evoked responses or behavioral audiology (sounds of varying frequencies/intensities filtered into soundproof room) -Inferences about vision made by examining gross motor milestones and PE of eye -Screened by visual evoked responses and/or referral to ophthalmologist -3yo +: -Snellen eye chart (standard or shapes) -Audiologic testing with headphones should begin at 4 yo

Answer 12

talk, walk, crawling (6-7 months), vocab, mama, dada, 4-20 words

Answer 13

-All infants screened at 12 months -> when iron deficiency is greatest (bc of diet change away from formula) -Infants at risk (low birthweight/premature) screened at birth and 4 months -Therapeutic trial of iron may be used when deficiency strongly suspected (no testing required)

Answer 14

-Screened at 1 month, 6 months, 12 months, then annually -Standard PPD intradermal test used with evaluation 48-72 hours following placement -15 mm induration is positive, 10 mm in high-risk, 5 mm in HIV pts, recent TB contact, healed TB CXR, or immunosuppressed -QuantiFERON-TB Gold blood test is a newer test – single office visit, but pricey

Answer 15

-CDC recommends routine blood lead screening at 12 and 24 months -Lead intoxication (plumbism) may cause developmental and behavioral abnormalities -Risk factors: living in older homes with cracked/peeling lead-based paint, industrial exposure, use of foreign remedies, and use of pottery with lead paint glaze -affects the CNS -vague symptoms: -Early: Weakness, irritability, weight loss, vomiting, personality changes, ataxia, constipation, headache, and colicky abdominal pain -Late: Developmental delays, convulsions, and coma associated with increased intracranial pressure

Answer 16

-Investigation warranted if levels of 20 mcg/dL on 1 time test or persistent 15 mcg/dL over 3-month period (decontamination techniques used once source identified) -Succimer is an oral chelator recommended in asymptomatic children with levels > 45 mcg/dL -IM dimercaprol/BAL and IV calcium sodium edetate in symptomatic children with encephalopathy or levels > 70 mcg/dL

Answer 17

-AAP recommends dyslipidemia screening for at-risk populations by obtaining a fasting lipid profile -Screening levels are the same for 2-18 years of age (170 mg/dL normal, 170-199 mg/dL borderline, 200 mg/dL is elevated)

Answer 18

-Sexually experienced adolescents should be screened for STIs and have an HIV test at least once between 16 and 18 -at least an annual evaluation for STIs by physical (genital warts, genital herpes, pediculosis) and lab testing (chlamydia, gonorrhea, syphilis, HIV) -Pap smears at 21 years of age

Answer 19

All adolescents, starting at age 11, should have annual screening (PHQ2/PHQ9)

Answer 20

-Checked at each visit and appropriate ones administered -Live-attenuated: Measles/Mumps/Rubella, Varicella, Influenza (nasal), Polio (PO), Rotavirus!!!!!! -Inactivated/killed viruses: Polio (IM), Hepatitis A, Influenza (IM) -Recombinant: Hepatitis B, HPV -Immunogeneic components of bacteria: Pertussis, H. influenzae type b, N. meningitidis, and S. pneumoniae; including toxoids (Diphtheria, Tetanus) -Schedule includes up to 23 injections in 4-5 visits by 18 months of age -Children behind on immunizations should receive catch-up as rapidly as possible -Infants premature should be vaccinated based on chronological age (same schedule) -Administered following informed consent from parents -he said the main thing to know is the live vaccines -know the chart- ex. 12mo pt presents assuming they are up to date with vaccines -> Which vaccine would you now recommend -passive immunity- breast feeding -active immunity- vaccine

Answer 21

just know this exists

Answer 22

-Information conveyed to parents verbally, in written materials, or online resources to assist them in facilitating optimal growth and development for their children -burns

Answer 23

-swim -poisoning- safety locks -2-3 potty training

Answer 24

-sexual development -goals

Answer 25

-MCC of death for infants 1 month to 1 year of age is MVA -Most states have laws mandating use of safety seats until 4yo or at least 40 pounds: -Infants and toddlers in !rear-facing safety! seat until at least 2 years old -Toddlers and preschoolers over age 2 should use forward-facing car seat with harness -School-aged children should use !belt-positioning booster! seat until vehicle seat belt fits properly (4 ft 9 in and between 8-12 year of age) -Older children should always wear lap and shoulder seat belts (protects from air bags)

Answer 26

-Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than 1 year that remains unexplained after a thorough case investigation -Sudden unexpected infant death syndrome (SUID) is a sudden and unexpected infant death (explained or unexplained) – now the preferred term -Includes deaths due to infection, ingestions, metabolic diseases, cardiac arrhythmias, and trauma -Incidence peaks between ages 2 and 4 months -Most deaths occur at night -Risk factors: Socioeconomically disadvantaged populations (continued prone positioning, sharing beds), preterm birth, low birth weight, recent infection, young maternal age, high maternal parity, maternal tobacco or drug use, and crowded living conditions -Pathological findings most common for SUID deaths from unknown cause (SIDS): Intrathoracic petechiae, mild inflammation/congestion of the respiratory tract, findings consistent with chronic hypoxia prior to death

Answer 27

-Back to Sleep initiative has resulted in a 60% decline in SIDS rates since 1990 -Supine positioning -Sleep in parents’ room, close to parents’ bed but on a separate surface designed for infants at least for the first 6 months of life -Remove soft objects/loose bedding, stuffed animals, or wedge positioners from infant’s sleep area -Breastfeeding is recommended -Pacifier at naptime and bedtime -Avoiding cigarette smoking during pregnancy and after birth -Avoid car seats, swings, and baby slings for sleep -Avoid use of adult beds and bed rails (increases risk of suffocation)

Answer 28

-can mimic ear infection -Remedies for teething pain: -OTC teething gels or liquids that contain benzocaine -Systemic analgesics -Chewing on teething object (distraction) -Eruption Cysts: Localized, red/purple, round, raised, and smooth lesion, resolved with eruption of tooth (NORMAL) -All children 1yo+ should have dental exam by dentist at least annually and cleaning every 6 months -Preventative measures: Brushing, flossing, concentrated fluoride topical treatments (dental varnish) and acrylic sealants on molars -Recommended PCPs apply dental fluoride varnish to infants and children every 3-6 months between 9 months and 5yo -Fluoridation of water or fluoride supplements in communities that do not have fluoridation are important in prevention of caries

Answer 29

-Episodes of uncontrollable crying or fussing in an otherwise healthy infant -Paroxysmal, characterized by facial grimacing, leg flexion, and passing flatus -Wessel rule of threes: -Crying for > 3 hours/day -At least 3 days/week -> 3 weeks -Etiology: Unknown, likely multifactorial -Cow’s milk intolerance -Change in fecal flora -Increase in serotonin secretion -Poor feeding technique -Maternal smoking may be associated

Answer 30

-Techniques for calming infants (Dr. Harvey Karp’s “5 Ss”): -Swaddling -Side/stomach holding -Soothing noises -Swinging/slow rhythmic movement -Sucking on pacifier -Educating parents on hunger cues, avoiding excessive caffeine and use of alcohol in nursing mothers, ensuring adequate bottle/nipple flow, and cautioning overfeeding Effectiveness of dietary changes, herbal supplements, and/or medications very limited -Prognosis -No evidence of long-term adverse outcomes for patient or parents -Most serious complication of colic is nonaccidental trauma

Answer 31

-Brief episodes of extreme unpleasant behavior disproportionate to situation, in response to frustration or anger -whining, crying, screaming, stomping, flailing, head banging, hitting, throwing objects, and biting -Etiology -Normal human developmental behavior -1-4 yo have increasing desire for independence and are often unable to effectively communicate physical needs and emotions -Triggers include fatigue, hunger, discomfort, and frustration

Answer 32

-History: Evaluate for other behavioral, psychologic, or physiologic conditions -Important to differentiate between typical and atypical tantrums -Physical examination: -Focus on identifying signs of underlying illness and include vision, hearing, and developmental exams -Behavioral observations -Dysmorphic features may reveal a genetic syndrome, skin exam (anemia, nonaccidental trauma), neurologic exam -Laboratory studies: Screening for iron deficiency anemia and lead exposure

Answer 33

-Communicate clear, consistent, and developmentally appropriate expectations and consequences -Provide positive reinforcements for good behavior -Maintain routine and structure in a child’s environment -Use distraction techniques -Avoid known triggers -Help children learn to communicate desires, needs, and emotions -Provide children with choices among acceptable alternatives (support autonomy) -Parents should remain calm and meet physical/safety needs without complying to child’s demands, do not punish for tantrum

Answer 34

-Behavioral sleep disorders most prevalent from infancy through preschool age -Affect 30% of children, with bedtime resistance in 10-15% of toddlers and difficulty falling/staying asleep in 20-30% of school-age children and 10% in adolescents -Behavioral Insomnia of Childhood -Sleep-onset association subtype: Frequent, prolonged nighttime awakenings that occur in infants/children -Limit-setting subtype: Bedtime resistance or refusal that stems from caregiver’s unwillingness or inability to enforce bedtime rules/expectations

Answer 35

-History -Sleep habits, typical bedtime, sleep onset/wake times, and schedule variation from day to day -Description of sleep environment (type of bed, sharing bed, ambient noise, and temperature) -Dietary practices and household routines -Physical examination to rule out organic causes of sleep disturbances -Prevention and Treatment -Consistent and appropriate bedtime routine/close attention to sleep hygiene -Behavioral interventions mainstay of treatment -Systematic ignoring: Not responding to a child’s demands for parental attention at bedtime -Strategic napping -Positive reinforcement -Behavioral therapy (nighttime fears) -No FDA approved medications for treating insomnia in children

Growth and Development Flashcards

(61 cards)