Flashcards in Jarvis Quiz 4 Deck (170):
During which week does the primitive lung bud emerge in utero?
By which week in utero does the conducting airways of the respiratory system reach the same number as the adult
At what week does surfactant form in utero? What is the purpose of surfactant?
32 weeks gestation. Surfactant is the complex liquid substance needed for sustained inflation of the air sacs.
How many alveoli are there at birth? What significance does this have on the respiratory system?
70 million alveoli, ready to start the job of respiration.
When is the first breath taken? Why should a baby have a lusty cry when it is born?
At birth; the baby should have a lusty cry when it is born to reassure it is okay and that it’s respiratory system is working properly. Birth demands the instant performance of the respiratory system.
What happens when the umbilical cord is cut at birth?
The blood is cut off from the placenta and it gushes into the pulmonary circulation.
The respiratory system continues to develop throughout childhood. How so?
Airways increase in diameter and length. Number and size in alveoli increase. Adolescents have about 300million by adolescence.
What puts the baby at risk for respiratory distress? How does smoking harm the fetus and baby?
Having a smaller size and immature pulmonary system. The presence of smoking can cause chronic hypoxia, premature delivery, and low birth weight. It also sensitizes the fetal brain to nicotine. Prenatal and postnatal exposure to secondhand smoke can cause SIDS, lower respiratory illness, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood. Prenatal nicotine exposure can increase the risk for ADHD and depression in kids and teens.
What is the most common chronic disease in childhood? How many kids does it effect?
Asthma; it effects 9.5% of kids aged 0-17yo. African Americans and Hispanics have more indicators of poorly controlled asthma: more ER visits, more resuscitation equipment use, and lower use of inhalers.
What is the limit to the number of uncomplicated upper respiratory infections a young child can have before it becomes a concern
Limit of 4-6/year is expected
What are some possible allergies when discussing infant allergies
New foods or formula
What reduces the risk for respiratory tract infections and otitis media in babies?
Full breastfeeding for 6mos or more
Why would you assess if the child has a cough or seems congested, or has wheezing with noisy breathing?
May indicate chronic asthma or bronchitis
How would you position an infant while assessing their respiratory system?
Have the parent hold the infant, supported against their chest or shoulder. Ignore the usual sequence.
How should you assess a baby’s respiratory system when they are sleeping, vs. when they are crying?
Sleeping: inspect and then listens to lung sounds
Awake: enhances palpation of tactile Freitas and auscultation of breath sounds
How should you assess a child’s respiratory system?
Allow them to sit on the parent’s lap, if they want. Offer the stethoscope and let them handle it. Promote their participation. While listening to the lung sounds, have the child breath in deeply and blow out your penlight or have them “pant like a dog”.
What is the AP-to transverse ratio on an infant? When does it reach the adult ratio? What is the adult ratio?
The infant has a rounded thorax with an equal AP-transverse ratio. It reaches the adult ratio of 1:2 by age 6yo.
What should a newborn’s chest circumference be? What should it be in comparison to the head?
Chest circumference should be 30-36cm. It should be 2cm smaller than the head until 2yrs of age.
Describe the features of the infant’s chest
Ribs and xiphoid process are prominent. You should be able to see and feel the sharp tip of the xiphoid process. The thoracic cage is soft and flexible. The chest wall is thin with little musculature.
What would a barrel shape chest indicate if the child is already 6yrs old and still has one?
Cystic fibrosis or chronic asthma.
What does the APGAR scoring system measure? What times are they scored? What is a good score?
The successful transition to extrauterine life. They are scored at 1 and 5 minutes. APGAR total of 7-10 indicates good condition, needing only suctioning of the nose and mouth and otherwise routine care.
What causes respiratory depression in the immediate newborn period?
Maternal drugs, interruption of uterine blood supply, or obstruction of the tracheobronchial tree with mucus or fluid.
What does a 1minute APGAR score of 3-6 indicate in a newborn? What would a score of 0-2 indicate?
3-6 would be Moderately depressed. Needing more resuscitation and subsequent close observation. 0-2 would indicate severe respiratory depression indicating the need for full resuscitation, ventilatory assistance, and subsequent intensive care
What are the five categories on the APGAR scoring system? How can they be scored.
Heart rate, respiratory effort, muscle tone, reflex irritability, and color. Scored as 0,1, or 2 (0 being the worst).
How does the infant breathe during the first 3mos of life? What are normal findings of respirations?
Though the nose. Slight flaring of lower costal margins may occur with respirations, but normally no flaring of the nostrils and no sternal or intercostal retractions. Abdominal bulge with each inspiration is. Normal because intercostal muscles are not well developed. Count respirations while the infant is sleeping. Should be between 30-40. Brief periods of apnea less than 10-15 seconds are common, especially in premies.
What should you feel in palpating the infants respiratory system
Equal chest expansion, no lumps or masses or crepitus. You may feel costochondral junctions
What do marked retractions of the sternum and intercostal muscles indicate in a baby
Increased respiratory effort, atelectasis, pneumonia, and acute airway obstruction
What is accompanied with rapid respiratory rates in infants
Pneumonia, fever, asthma, and acute airway obstruction. An infant breathing 50-100bpm may be an early sign of heart failure.
What does asymmetric expansion indicate in a baby? What about crepitus? How about diminished breath sounds?
Asymmetric expansion: diaphragmatic hernia or pneumothorax
Crepitus: palpable around a fractured clavicle, may occur with forceps delivery
Diminished breath sounds: pneumonia, atelectasis, pleural effusion, or pneumothorax
What should auscultation sound like in a baby’s lungs?
Bronchovesicular breath sounds until 5-6yo. r/t their thin chest walls with underdeveloped musculature. This does not damp off the sound as do the thicker walls of adults. Breath sounds are louder and more harsh.
Describe crackles if heard in a newborn or infant
Fine crackles are commonly found in a fresh newborn. Bowel sounds may even be heard in the chest. Persistent fine crackles may occur with pneumonia, bronchiolitis, or atelectasis. Crackles in only the upper lung field occur with CF. Crackles in only the lower lung field occur with heart failure. Expiratory wheezing occurs with lower airway obstruction (asthma or bronchiolitis) and unilateral with foreign body aspiration.
What might persistent peristaltic sounds with diminished breath sound on the same side indicate?
What does stridor indicate in an infant?
Upper airway obstruction (croup, foreign body aspiration, or acute epiglottitis)
When does the fetal heart start to beat? How does the baby get oxygen in utero?
3 weeks. Compensates for nonfunctional lungs. Oxygen comes from the placenta and arterial blood is returned to the right side of the fetal heart.
There is no point in pumping all the freshly oxygenated blood through the lungs of the fetus in utero. Where is it rerouted to?
2/3rds of it is shunted through the foramen ovale (opening in atrial septum) into the left side of the heart where it is pumped through the aorta. The rest of the oxygenated blood is pumped by the right side of the heart out of the pulmonary artery, but it is detoured through the ductus arteriousus to the aorta.
When does the foramen ovale close? What about the ductus arteriosis?
Foramen ovale: closes within an hour after birth
Ductus arteriosis: closes usually within 10-15hrs of birth
Mass of the ventricles are no longer equal at 1yr of age. The left is heavier by a 2:1 ratio
Describe the fetal heart position compared to that of an adults
The fetal heart is more horizontal in the infant than the adult. The apex is higher, located in the 4th left intercostal space. It reaches the adult position when the child reaches age 7.
How do you assess for heart disease in an infant?
Fatigue during feeding, takes fewer ounces while feeding, becomes dyspneic with sucking, may be diaphoretic, falls asleep during feeding and awakens shortly, hungry again.
What does cyanosis in a kid indicate (other than hypoxia or respiratory depression)?
Tetralogy of Fallot or transposition of the great arteries
What might cause chest pain in a child?
Not common, usually musculoskeletal pain or respiratory causes such as asthma. May also be a psychogenic thing or a GI problem. Families usually freak out about it.
When do the fetal shunts of the heart close normally? When should you assess the baby’s CV system?
Within 10-15 hours, but may take 2 days. Assess during the first day and again in 2-3days
What does cyanosis just after birth indicate if it is not a respiratory issue?
Congenital heart disease and o2 desaturation
What are the most important signs of heart failure in a newborn?
Persistent tachycardia, tachypnea, liver enlargement, engorged veins, gallop rhythm, pulses alternans, respiration crackles (rales)
Where should you palpate the infant’s heart?
4th intercostal space just lateral to the midclavicular line
What would cause a displaced apex in a baby’s heart?
Cardiac enlargement=shifts to the left
Pneumothorax=shifts to opposite side of pneumo
Diaphragmatic hernia=most often shifts heart to the right
Dextrocardia is a rare anomaly which the heart is located on the right side of the chest
What is the normal HR for babies? Include ranges during rest with activity and just after birth
Just after birth= 100-180bpm
Stabilizes to 120-140bpm
70-90bpm with sleeping
170+ beats while crying
What is considered persistent tachycardia in newborns? What about in infants?
Newborns= more than 200bpm
Infants= more than 150bpm
What is considered bradycardia in newborns? What about in infants?What is a result of bradycardia?
Newborns= less than 90bpm
Infants= less than 60bpm
Causes a serious drop in cardiac output because the small muscle mass of their hearts cannot increase stroke volume significantly.
Why are infant’s heart sounds louder than an adults heart sounds?
The infant has a thinner chest wall, and S2 has a higher pitch than S1. Splitting of S2 with inspiration is common after a few hours of birth
Are murmurs normal in a newborn? What is associated with congenital heart defects?
YEs, they can be for the first 2-3 days r/t to the shunts being open. However, no murmurs doesn’t necessarily indicate the absence of a heart defect. Congenital defects are associated with harsh murmur quality, location, and timing.
What can indicate heart disease in a kid?
Poor weight gain, developmental delay, persistent tachycardia, tachypnea, DOE, cyanosis, and clubbing
What does a precordial bulge to the left of the sternum with a hyper dynamic precordium signal in a child?
Cardiac enlargement, because the cartilaginous rib cage is more compliant
Where should you auscultate the heart in kids, based on their age?
4th intercostal space, left of midclavicular until 4yo
4th intercostal space, midclavicular from 4-6yo
5th intercostal space, right of midclavicular at 7yo
What would a substernal heave indicate in kids? What about an apical heave?
Right ventricular enlargement with a substernal heave.
Ventricular hypertrophy with an apical heave.
What is a thrill?
Palpable vibration: not normal
Talk about the heart rate and auscultation sounds of a child’s heart
Heart rate slows as child grows. Sinus arrhythmia is often present. S3 is common and occurs in early diastole just after S2, best heard in apex.
What is a venous hum?
Caused by turbulence of blood flow in the jugular venous system. Common in healthy children. No pathological significance. Loudest in diastole, heart throughout the entire cycle. Not usually effected by respiration. May sound louder with standing. Obliterated by occluding jugular veins, this latter maneuver helps r/o venous hum from other cardiac murmurs such as PDA.
Talk about a carotid bruit
Benign murmur heard just above the clavicles. Slightly harsh, early or midsystolic, louder on the left and will disappear completely by carotid artery compression.
What are still’s murmur?
Innocent (functional) in origin . Soft, relatively short, early or midsystolic ejection murmur, medium pitch, vibratory, best heard at the left lower eternal or midsternal border, with no radiation.
Persistence of the channel joining left pulmonary artery to the aorta. There are usually no symptoms in early childhood, but BP is widened with bounding peripheral pulses. Thrill is often palpable at left upper sternal border. Heard in systole and diastole. “Machinery murmur”
Arterial septal defect. Abnormal opening in the atrial septum, resulting usually in the left to right shunt and pausing a large increase in pulmonary blood flow. Symptoms are rare, but kids may have fatigue and DOE. A sternal shift is often present. S2 has a fixed split with P2 louder than A2. Murmur is systolic, medium pitch, best heard in left 2nd space.
Talk about VSD
Ventricular septal defect; abnormal opening in the septum between the ventricles, usually subaortic area. Small defects are asymptomatic by may have poor growth, slow weight gain, pale, thin, delicate, feeding problems, DOE, frequent respiratory infections, and heart failure (severe cases). Loud, harsh systolic murmur, best heard over the left lower sternal border, may have a thrill. Might have a diastolic murmur at apex with large defects.
Describe tetralogy of fallot
Four parts: right ventricular outflow stenosis, VSD, right ventricular hypertrophy, and overriding aorta.
A lot of venous blood is shunted directly into the aorta away from the pulmonary system. BLood never gets oxygenated. SEvere cyanosis present, squatting posture, DOE, slowed development. Palpable thrill at L lower sternal border. S1 is normal. S2 has A2 loud and P2 diminished or absent. Murmur is systolic, loud and crescendo-decrescendo.
Describe coarctation of the aorta.
Severe narrowing of the descending aorta, usually at the junction of the ductus arteriosis and the aortic arch. Distal of the left subclavian artery. increased workload of the left ventricle. Associated with aortic valve in most cases, PDA or VSD. Abnormal BP findings, Teens may c/o of lower extremity cramping, worse with exercise. Arm HTN 20mmHg higher than leg. Absent or greatly diminished femoral pulse. Systolic murmur best heard at L sternal border, radiating to the back.
Describe lymphoid tissue development in infants and children.
Developed at birth and quickly grows until ate 10/11yo. By 6yo, it reaches adult size and surpasses adult size by puberty. Then, it slowly atrophies.
Describe lymph nodes in children
Relatively large and often palpable in a healthy child. They should be small, firm (shotty), mobile and non tender. With infection, excessive swelling and hyperplasia occur. Enlarged tonsils are early signs of resp. Infection. They may also be the sequel of diaper rash or vaccinations.
What may be the cause of abdominal pain in kids r/t the lymphatic system?
The inflammation of the mesenteric lymph nodes and their rapid growth
What would you correlate weak pulses with in kids and babies? What about bounding pulses? Diminished/absent femoral pulses?
Weak pulse: vasoconstriction of diminished C.O.
Bounding pulse: PDA from the large L to R shunting
Diminished/absent femoral pulse: coarctation of aorta
Describe the infant’s liver
Takes up more space at birth than later on in life. May be palpated at .5 to 2.5 cm below the right costal margin.
Where should the infant’s bladder be palpated in comparison to an adult
Higher in the abdomen, between the symphysis pubis and the belly button. Organs should be easier to palpate r/t less musculature.
What is oftentimes the common cause of irregular eating habits in babies?
Parental anxiety; as long as growth and development is on track, reassure the parents
What are some common causes of abdominal pain in kids?
Anxiety, bowel inflammation, UTI, constipation, otitis media
How many calories should teenagers get? (Boys vs. girls)
Boys: 4000/day (more with exercise)
Girls: 20% less than boys, but same amount of nutrients
What is fast food mostly consisted of?
High fat, calories, and salt with no fiber.
What are some s/s of anorexia?
Disturbed body image, extreme weight loss, purging, amenorrhea, psychosocial problems, using laxatives
What should the baby’s abdomen look like? talk about the abnormals
Protuberant r/t decreased musculature (scaphoid shape would indicate dehydration). Fine skins with superficial veins. Veins should not be dilated. AVA with white umbilical cord and Wharton’s jelly. Only one artery would indicate congenital defect risk
How long before the umbilical cord falls off? When does skin cover the area?
10-14 days. Skin covers the area by 2-3wks. No drainage should be present when the cord falls off.
Describe the baby’s abdomen as far as umbilical hernias
The abdomen should be symmetrical. Two bulges are common. Umbilical hernia may appear at 2-3weeks and is prominent during crying. REaches max size by 1month and disappears by 1 year. Refer any hernia bigger than 2.5cm, if it grows even after a month, or if lasts more than 2yrs in a white baby or 7yrs in a black child.
What is diastasis recti
Common; a separation of the rectus muscles with a visible bulge along the midline. More common in black infants. Disappears during early childhood. Refer if it lasts more than 6yrs
What should auscultation of the abdomen sound like in a baby?
Bowel sounds only. No vascular sounds should be heard. Marked peristalsis would indicate pyloric stenosis. No bruit or venous hum should be heard.
What should percussion sounds like in a baby’s abdomen?
Tympanic, with dullness over the liver. The spleen is not percussed. Dullness over the bladder is also normal
How should you position the baby to palpate the abdomen
Flex the baby’s knees. Or hold the upper back and flex the neck slightly. Offer a pacifier to a crying babe.
What may be palpated in the baby;s abdomen?
Liver in the RUQ. Spleen, kidneys, and bladder. Cecum in the RLQ and the sigmoid colon in the left inguinal area.
What should a baby’s stool be like?
First stool: sticky, green-black meconium within first 24hrs. By day 4, stools of breastfed babies are yellow, pasty, and smell like sour milk. Formula fed babes will have brown-yellow, firmer, more fecal smelling stool.
What should the child’s abdomen look like? What are the abnormal findings/
Potbelly until about 4yo. Abdominal respirations until 7yo. Abnormal findings are scaphoid abdomen with dehydration or abdominal respirations offer 7yo may indicate peritoneal inflammation.
How should you position the child to palpate the child’s abdomen?
Position them on the parent’s lap as you sit knee to knee with the parent. FLex the knees up and elevate the head slightly. The child may pant like a dog to further relax muscles. Place flat palm on the kid’s belly before palpating. Use their hand with yours to palpate if they are ticklish.
How should percussion of the liver span measure in kids?
What should a parent avoid doing to their baby that has an umbilical hernia and why?
They should avoid affixing a belt or coin at the hernia because this wont help the closure and may cause contact dermatitis
What is a succussion splash?
A loud splash auscultate when the infant is rocked side to side. Indicates increased air and fluid in the stomach as seen with pyloric obstruction or large hiatus hernia
Talked about marked peristalsis
Together with projectile vomiting, it indicates pyloric stenosis. This is a congenital defect that appears in the 2nd or 3rd week. AFter feeding, waves move from L to R leading to projectile vomiting. An olive-sized mass in the RUQ midway between the the R costal margins and the umbilicus may be felt. Refer promptly to avoid weight loss.
At which age of gestation does the fetus form a scale model of the skeleton? What is the skeleton made of in the fetus? Talk about its development
3mos, made of cartilage. Turns into true bone and begins to grow. It also grows after birth, rapidly during childhood and steadily til adolescence. (Rapid growth spurt)
Describe the development of long bones
They grow into two dimensions. They increase and width and diameter. Lengthening occurs at the epiphyses (growth plates)
Talk about growth plates/epiphyses
They are transverse disks located at the ends of long bones. Any trauma or infection at this location puts the child at risk for deformity. This longitudinal growth occurs until about 20yrs old.
Describe the vertebral column in a baby
At birth, the spine has a single C-shaped curve.
3-4months: raising the baby’s head from prone position develops the anterior curve in the cervical neck region. From 1 yr to 8months, standing erect develops the anterior curve in the lumbar region
Talk about muscle development in youngsters.
They grow throughout childhood, but marked with the growth spurt in adolescence. They respond to increased segregation of growth hormone to adrenal androgens and in boys to further stimulation by testosterone.
How do you prevent osteoporosis and obesity in kids?
Diets rich in dark leafy greens and deep yellow veggies and low intake of fried foods help promote bone mass accrual and prevent obesity.
How may anoxia or traumatic delivery harm the baby’s musculoskeletal system?
Anoxia can cause hypotonia of muscles
Traumatic delivery can cause fractures (clavicle & humerus)
Talk about which considerations should be made for a kid that plays sports in regards to their musculoskeletal system.
They may fail to report injury in the fear of not being able to play their favorite sports. Stress the importance to them of using the proper safety equipment (helmets/padding). Make sure they are height and weight ready for the given sport (football).
How should you examine the infant (in general)
Supine, naked, on a warming table.
How do you check for a foot deformity in a baby?
Scratch the outside of the bottom of the foot. A true deformity is fixed and assumes a right angle only with forced manipulation, or not at all. Or you can immobilize the heel with one hand and gently push the forefoot to the neutral position with the other. If you can move the foot, all is well.
What is metatarsus Varus?
Adduction and inversion of the forefoot
What should the relationship be in a baby between the hind foot and forefoot?
The hind foot is in alignment with the lower leg an the forefoot angles inward. This is called metatarsus adductus and resolves by yo.
What is tibial torsion? How do you assess for it? What causes it?
Twisting of the tibia. Place both feet flat on the table and flex up the knees. With the patella and the tibial tubercle in a straight line, place your fingers on the malleoli. A line connecting the four malleoli is parallel to the table.Can be from intrauterine placement or TV squat (reverse tailor position) More than 20 degrees of deviation is abnormal.
How do you check for developmental congenital dislocation dysplasia in a baby? How would you know there is a dislocation?
Ortolani maneuver; should be done at every visit until 1yo. A dislocated hip would have a femur not cupped in the acetabulum, but rests posterior to it. Hip instability feels like a clunk as the head of the femur pops back into place. (Ortolani sign).
The Allis test is also used by laying the baby supine and flexing the knees up: they should be of equal elevation. Unequal gluteal folds may also indicate hip dislocation.
What is the difference between polydactyl and syndactyly?
Polydactyly: extra fingers or toes
Syndactyly: webbing of fingers/toes
What does a baby’s hand look like if they have Downs?
Simian crease, short broad fingers, incurring fingers and low-set thumbs.
At which age can the infant lift the head while prone on a flat surface?
What would be an abnormal finding on the baby’s back?
Tuft of hair or dimple: could be spina bifida.
Small dimple in the midline from head to coccyx could be Dermoid sinus.
Mass/meningocele is also abnormal.
How do you test upper body muscle strength in a baby?
Hold them under the pits, they should not slip between your hands.
Name creative ways to examine normal gait and such on a toddler?
By observing them as they crawl and walk. Hop on one foot, jump, walk to Mom, climb the step stool.
Talk about lordosis in kids.
Common in childhood, especially if they have a rounded belly. More visible from the side. Lordosis is oftentimes marked with muscular dystrophy and rickets.
Talk about Genu Varum and genu valgum.
Genu varum : bow-legged. 2.5cm or more between the knees when malleoli are together. Severe bowing may occur with rickets.
Genu valgum: knocked knees. 2.5cm or more between malleoli when knees are together.is normal for a year after the kid begins to walk. They may have a wobbling gait. This requires no treatment. May occur with rickets, poliomyelitis, or syphillis.
Describe flat footing in kids
Pes Plantus; pronation or turning in of the medial side of the foot. Normal for first 30mos only.
Describe pigeon toes
When the child walks on the lateral side of the foot and the longitudinal arch looks higher than normal. Starts as forefoot adduction. Should not last more than 3 yrs.
How will you observe gait in a kid?
While they walk to and from you, allow them to wear socks on the tile floor. A broad based gait from 1-2 years with arms out for balance is normal. From 3yrs, arms should be closer to sides and base of gait should narrow. Limp should not occur.
Once you have the child sitting, which part of the body should you assess first with musculoskeletal system?
Feet and hands if they are 2-6yo.
How should you assess the kid’s upper extremeties?
Full ROM and if pain is present. Look for elbow subluxation (unable to supinate hand while arm is flexed and pain in the elbow), which is common between 2-4yrs if as a result of forceful removal of clothing or dangling while hold child from hands. Palpate joints bones and muscles.
What might be indicated if enlargement of tibial tubercles with tenderness is present?
Osgood-Schlatter disease; more common in males or during a rapid growth spurt. Pain increases with kicking, running, bike riding, stair climbing, or kneeling. Symptoms resolve with rest
What special things should you assess for in a teen’s musculoskeletal system?
Kyphosis r/t poor chronic posture, sports related injuries,scoliosis with bend forward test r/t preadolescent growth spurt. Scoliosis would show marked asymmetry of the spine, ribs may hump on one side as the child bends forward.
What is club foot also called? Explain it.
Talipes equinovarus; includes foot inversion, forefoot adduction, and foot pointing downward (equinus). Common in 1-3:1000 live births. Males are effective twice more than females.
What is the worst type of spina bifida?
Myelomeningocele; paralysis below site of lesion occurs. Spinal fluid and malformed spinal cord are present.
What is coxa plana?
“Legg- Calve Perthes Syndrome”. Avascular necrosis occurs at the femoral head. Often in males between 3-12yo with a peak age of 6yo. Interruption of blood supply to femoral epiphysis and halting growth occurs. REvascularization and healing occur later but severe deformity and dysfunction may be present.
What controls motor activity in the newborn? Talk about their primitive reflexes
The medulla and spinal cord. Movements are directed primarily by primitive reflexes. As the cerebral cortex develops during year one, these reflexes are inhibited. CNS dysfunction would cause persistence of primitive reflexes
Discuss myelination during infancy
Neurons not myelinated at birth. Myelin conducts most impulses. It forms in a cehpalocaudal and proximodistal order AEB head lift, shoulder lift, rolling over, moving entire arms, using hands, walking.
Discuss an infants sensation
Rudimentary at birth. Needs a strong stimulus and responds by crying and with whole body movements. As this develops, the infant is able to localize the stimulus more precisely and make more accurate motor responses.
Why might a seizure occur in an infant/child?
High fever or a sign of a neurological disease
At what age is a child tested for lead? What can lead exposure cause?
Tested at year one; may cause a developmental delay or a loss of newly acquired skill (may be asymptomatic)
Why are teens more prone to concussion?
Thinner cranial bones, larger head-to-body ratio, and larger subarachnoid space, participation in sports or vigorous activities
What does smoothness and symmetry of motor activity indicate in a baby, in addition to sucking and swallowing?
Proper cerebellar functioning
What would a delay in motor activity indicate?
Brain damage, mental disability, peripheral neuromuscular damage, prolonged illness, and paternal neglect.
What would a frog position indicate in a baby?
Abnormal posture, unless its a breeched baby
What wouldn’t a breech baby display with posture?
Flexion of the lower extremeties
What does the Denver II test measure?
Screens gross and fine motor coordination with age-specific developmental milestones.
What should resting posture look like in a baby?
Flexed position, extremities symmetrically folded inward, slight abducted hips, fists tightly flexed.
What is opisthotonos and what does it indicate?
Head arched back with stiffness of neck and extended arms and legs occurs with meninges or brain stem irritation and kernicterus.
What may extension of the limbs indicate?
What might cause continual asymmetry such as is in the limbs?
Brachial plexus palsy
At which month does the baby begin to move from flexion to extension?
2mos (moving in a cephalocaudal direction)
What should spasticity be like in a baby? How is it tested?
Bring the baby’s knees to chest, and let them go. They should extend slowly.Spasticity is an early sign of cerebral palsy. Scissoring of legs or quick extension would be present. Baby would resist head flexion and extend head back against your hand if you pushed it forward.
When does the tight fist of a baby open up?
When will a baby begin to reach for objects? When can they move objects from one hand to the other? When will they grasp with fingers and an opposing thumb? When will they have purposeful release of their hands?
HOw long are babies usually ambidextrous for? What may be indicated if a baby seems to prefer the use of one hand only?
18mos; one hand use may indicate a motor deficit on the other side
What would head lag indicate?
How do you test for head control in a baby?
Pull baby’s wrist and up into a sittting position: head should stay Aline with body or flop forward. Forward flop should not occur by 4mos.
Also, you can lift the baby prone and they should have their head at a 45degree angle with back straight or slightly arched
By which age should you be considered if the baby can’t hold its head midline while sitting
What is called when the baby raises the head and arches the back like a swan dive? How long does this last?
Landau reflex....until 1.5yrs
At which age can a baby localize stimuli?
If a baby has rapid withdrawal with reflexes, what is it called and what does it indicate?
Hyperesthesia with CNS infection, spinal cord lesions, increased ICP, peritonitis
What if a baby has decreased sensations, what is that called? Is this normal? What if a baby has no sensations?
Decreased sensation is normal during first 7mos, hypoesthesia.
No sensations would indicate decreased consciousness, mental deficiency, spinal cord/peripheral nerve lesions
What are infantile automatisms? Name some of them
Reflexes that have predictable timetable of appearance and departure. (Rooting, grasping, Moro, tonic neck)
When should the rooting reflex go away? What about the sucking reflex?
When is a palmar grasp strongest? When does it disappear?
PALMAR: strongest at 1-2mos, disappears at 3-4mos
When does the plantar grasp disappear?
When should the Babinski sign disappear? What if it doesn’t?
Toes should not fan out after 24mos.... may indicate pyramidal tract disease
What if the palmar grasp is absent, what does it indicate? What about if it persists after 4mos?
Absent palmar grasp: brain damage and local muscle/nerve injury
Persistence after 4mos: frontal lobe lesion
When does the tonic neck reflex appear/disappear? What does it indicate if it remains later?
Appears at 2-3mos, disappears 4-6mos, indicates brain damage if longer
When is the Moro reflex present? When does it go away? What if it isnt present
Birth until 1-4mos, absence or persistence would indicate CNS injury
What if only one side of the Moro reflex occurs
Fracture of humerus, or clavicle with brachial plexus palsy in ARM
LEG would be lower spinal cord problem or dislocated hip
What would a hyperactive Moro reflex indicate
Tetany or CNS infection
If you hold a baby in a standing position, what should they do?
Step, flex hip, extend hip, occurs within first 4days.
Baby’s legs should not thrust or scissor
What can you assess by having a child dress themselves, especially with buttons on their clothes?
Muscle strength, symmetry, joint ROM, fine motor skills
How long should a child be able to balance on one foot based on their age? AT which age should they be able to hop
5seconds at 4yrs
8-10seconds at 5yrs
Hop at 4rs (otherwise gross motor skill issue)
What is the Gowers sign?
NOT normal: kid will roll to one side, bend forward to all four extremeties, and crawl their way up to a standing position (common with muscular dystrophy)
How do you assess fine coordination in kids. At which age should it be present
Finger to nose test. Should be developed by 4-6yrs
You don’t normally test DTRs in kids because they cant relax, but when is the knee jerk present? What about the other reflexes?
Knee jerk present at birth
Remaining reflexes present at 6mos
Which cranial nerves are being tested with a babies eyes?
2,3,4,5,8 (8:eyes follow sound)
How do you assess cranial nerve 5 in a baby?
Rooting and sucking reflex
How do you test cranial nerve 7 in a baby
Facial movements (wrinkling, smiling)
How do you test cranial nerve 9 and 10 in a baby?
Swallowing, gag, sucking and swallowing coordination