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

Infants, Toddlers and Young Children Flashcards

(121 cards)

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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
Expected 15 month milestones
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
26
Expected 18 month milestones
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
27
Expected 2 year milestones
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
28
Expected milestones 2.5 years
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
29
Expected milestones 3 years
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
30
Expected 4 year milestones
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)
31
I can jump and kick a ball- how old am I
2 years
32
I can pull myself up and stand, I can wave bye, I imitate sounds - how old am I
1 year
33
I can hop on one foot and my speech is clear, I can copy a circle- how old am I
4 years
34
Developmental screening
use of standardized tools to identify children at risk for developmental disorder
35
When do you do developmental screening?
Anytime a parent has a concern
36
What developmental screening do you do at the 9 month visit
identify motor issues, visual, hearing issues
37
What developmental screening do you do at the 18 month visit
communication and language delays, mild motor delays
38
What developmental screening do you do at the 30 month visit
most issues can be identified
39
Autism screening is recommended when by the AAP?
18 month visit 24 month visit
40
What category screening is autism screening?
USPSTF Category I
41
Developmental screening tools
Ages and stages questionnaire (ASQ) Parent's evaluation of developmental status (PEDStest) Survey of wellbeing of young children (SWYC)
42
Autism screening tool
Modified checklist for autism in toddlers revised with follow-up (M-CHAT-R/F)
43
What do you measure for the growth chart
head circumference, weight, length
44
When do you do growth chart measurements
every visit
45
When do you stop head circumference measurement?
2 year visit
46
How much weight does a infant lose in the first week of life?
10% of birth weight
47
When should the infant be back to birth weight?
14 days
48
When should an infant have doubled their birth weight
4-6 months
49
When should an infant have tripled their birth weight
1 year
50
Average growth rates
2" and 2kg per year from 2 to puberty
51
How much weight do neonates gain to 3 months
1 once/day (30grams)
52
How much weight do infants gain per day between 3-6 months
0.67 ounce (20 grams)
53
How much weight do infants gain per day between 6-12 months
0.33 ounce (10grams)
54
Average length at birth
~20 inches
55
How much do infants grow in their first year
~10 inches
56
How much do toddlers grow between 12-24 months
~4 inches
57
How much do toddlers grow between 24-48 months
~3 inches
58
When are children half of adult height
24-30 months
59
How much do people grow between 4 years and puberty
~2 inches/year
60
Remember that growth is _________
pulsatile
61
When should you plot growth?
every visit
62
When do you start plotting BMI for age
age 2
63
When do you stop plotting weight for length
age 2
64
Growth is tracked based on
percentile
65
Which growth chart is better for breastfed infants
WHO
66
Growth charts for breastfed infants are different because
slower weight gain between 3 and 4 months
67
What would happen if you plotted a breastfed baby on CDC
may lead to earlier solids and less breast milk
68
When do you use WHO
up to age 2, then CDC from ages 2-19
69
What age does WHO go to
5
70
What do you do if you have no EMR
measure 2-3 times and plot as accurately as possible
71
What is a common recommendation for infant physical exam
use toys for distraction
72
Where should the baby lay during physical exam
in the parent's lap as much as possible during exam
73
When should you do heart and lungs
when the baby is quiet
74
When should you do invasive exams (mouth and ears)
for last
75
Young children physical exam tips
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
Instead of asking for permission for a child what do you do instead
State what you are going to do and do it
77
Who should undress a young child during the physical exam
the parent
78
As children age you need to be sensitive to _______
modesty
79
Spread to the child _______
directly
80
differences in children: head size
larger
81
differences in children: abdomen
"square" until age 2 less muscle
82
differences in children: bladder
at umbilicus at birth
83
differences in children: breathing
obligate nose breathers
84
difference in children: ribs
not very flexible, not as protective
85
differences in children: organs
much larger and more exposed
86
Early childhood is when
1-4 year
87
In early childhood how much does does growth slow
50% of that infancy
88
Early childhood exam sequence
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
When do you start measuring blood pressure
age 3
90
is adenopathy is ______ in children
common
91
Early childhood eye exam
cover and cover/uncover test for position and alignment of eyes
92
Expected eye findings in early childhood exam
normal corneal light reflex
93
Esotropia
eye deviates nasally
94
Exotropia
eye deviates temporally
95
strabismus
eyes are not aligned
96
Cover test you are examining
the uncovered eye
97
Cover/uncover test you are examining
the covered eye Cover for 5 seconds (drifting indicates phoria)
98
When looking for a tympanic membrane in a child it can be _____ to see
hard
99
How can you assist in visualizing tympanic membrane in children
pull up, out and back +/- insufflator
100
Are brachial or radial pulses easier to feel in children
brachial
101
Normal abdominal exam in childhood
protuberant abdomen, liver span 1-2cm below costal margin, spleen edge 1-2cm below costal edge
102
When should you expect the testes to descend into the sac
if not descended by age 1, refer out
103
A normal musculoskeletal finding in children
bowlegged
104
When are children knock-kneed
18 months-4 years of age
105
When do you inspect for scoliosis
any child who can stand
106
When is universal screening recommended
all children
107
When is selective screening recommended
at risk children, risk assessment should be done regularly
108
Who makes pediatric recommendations
American Academy of Pediatrics via Bright Futures United States Preventative Services Task Force Centers for disease control and prevention School requirements
109
Newborn screening
genetic and metabolic screen Critical congenital heart disease (pulse ox) hearing bilirubin
110
When is hearing screening recommended
all newborns and risk assessment for all children up to age 21
111
Audiology screening schedule for all children
age 4,5,6,8,10 years
112
Vision screening under age 5 for
amblyopia, strabismus and decreased visual acuity
113
When do you screen for iron deficiency
H&H at 12 months
114
What is being removed from universal screening
lead
115
Misc screening for young children
iron, lead, oral health, blood pressure, cholesterol
116
When do you start screening for cholesterol
age 9-11 and again at 17-21
117
What is anticipatory guidance
identify upcoming issues that a child and family face, give advice that is developmentally consistent
118
Anticipatory guidelines must be 3 things:
Timely: given at the right age Appropriate: for this child and family Relevant: so that families will adopt them
119
What domains do anticipatory guidance fall into
social determinants of health behavior and development discipline nutrition and feeding safety
120
Surveillance is ______ Screening is ________
every single visit, if a parent has a concern
121
If a child +/- 2 lines on growth chart
concern for failure to thrive or metabolic disorder

ME 536- Patient Care II (8 decks)

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