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Flashcards in Newborn Assessment & Well Child Exams Deck (31)
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1

New Ballard Score: Fetal maturation of newly born infants: Takes into consideration? (6)

Posture
square window (wrist→ flexibility-less flexible when term) arm recoiled (how far back it recoils determines how close to term they are)
popliteal angle
scarf sign
heel to ear (more likely to be able to pull heel up to ear if premature)

2

Auditory Brainstem Response Screening

introduces soft clicking sound to each ear→ electrodes record auditory response→ testing integrity of auditory pathway

3

Caput Succedaneum

Serosanguinous, subcutaneous, extraperiosteal fluid collection with poorly defined margins caused be the pressure of the scalp against the cervix. May get bruising over vertex, DOES cross suture line

4

Cephalohematoma

membrane on skull bone gets elevated up and there is a hemorrhage underneath. Blood tumor under the periosteum causing it to lift, d/t rupture of blood vessels crossing the periosteum. Do NOT cross suture lines

5

Subgaleal Hemorrhage

Bleeding in the potential space between the skull periostium and the aponeurosis

6

Male GU abnormalities (6)

• Normal Neonatal phimosis
• Hypospadias→ urethral meatus not at tip of head
• Hydrocele
• Inguinal Hernia
• Imperforate Anus
• Ambiguous genitalis

7

Extremity Abnormalities (2)

• Simian Crease→ crease goes all the way across palm (could be downs or bradydactly (small hands))
• Polydactyly→ extra digit→ Pre axial (on thumb side), post axial (pinky side). Need to decide if there is a bone or not→ refer to ortho

8

2 Exams for Hips

• Barlow Test→ will feel snap, dislocates hip
• Ortolani→ allowing the hip to relocate
Hip problems can be from breech position (head of femur may not sit in acetabulum correctly)→ do Hip U/S

9

2 Verterbral Abnormalities

• Sacral sinus/Dimple→ can be sign of dysraphysm of sacral spine
• Hair tuft→ can cause tethered cords- can eventually cause weakness in legs→ U/S and release cord if tethered

10

4 newborn reflexes

useful to see if they are symmetrically bilateral
• Moro reflex: drop them back and watch for arms to flail
• Stepping reflex: hold under arms and they try to step
• Palmar & Plantar Grasp
• Rooting Reflex→ stimulation around mouth--turn head towards something to suck on

11

How Feces may present from infants

• If breast fed→ non oderous, seedy, yellowish
• Melena→ digestive & abdominal wall cells broken down into blood
• Meconeum→ seen when babies are first born, will diminish over a few weeks

12

7 skin findings on infants

• Mongolian spots
• Erythema toxicum neonatorum
• Transient pustular melanosis→ sterile, not infective, benign, goes away
• Sebaceous Gland Hyperplasia→ “milia”- plugged sebaceous glands—goes away
• Neonatal Acne→ T zone area of face, hormonal, benign & transient
• Cradle Cap (seborrheic dermatitis)
• Salmon Patch Hemangioma

13

Mongolian Spots

congenital dermal melanocytosis
o MC in Mediterranean, blacks, often over sacrym, back, arms, wrists, ankles→ disappear over time

14

Erythema toxicum neonatorum

small pustules w/red base, often post term babies

15

Salmon Patch Hemangioma

(Stork bite)—looks like acne, don’t tx like ance (will get worse if you do)

16

Tanners height Predictions & BMI

• Predicted adult height→ (Mother Ht+ Father Ht)/2
o + 6.5 cm for male, - 6.5 cm for female
• BMI→ Kg/Ht (cm)2

17

Weight Gain by Age

• Typically takes 2 weeks to get back to birth weight, then from that point should gain 1oz/day

18

Piaget’s Stages of Cognitive Development (5)

• 0-2 → Sensory/motor: action intelligence only
• 2-4 → Pre-operational: Pre-conceptual: symbolic
• 4-7 → Pre-operational: Intuitive: influenced by own perception
• 7-11 → Concrete operation: Logical reasoning to real/seen objects
• 12+ → Formal Operations: Abstract thinking

19

What are some causes of speech delay

MR
hearing loss
maturation delay
expressive language disorder (expressive aphesia), bilingualism, psychosocial deprivation (ppl who don’t read/interact w/ their children)
autism (screen at 18-14 mo), elective mutis

20

Cerebral Palsy

Static lesions (pre-natal), swelling in ventricles, the leg will be the first one that are affected
• Sx
o Over 2 mo→ difficulty controlling head, stiff legs that scissor when picked up
o Over 6 mo→ previous plus: reach with only one hand while keeping the other in a fist
o Over 10 mo→ not sit by them self, crawl using only one side (hemipalegic, one side may be spastic)
o Over 12 mo→ not crawl, not be able to stand w/support
o Over 24 mo→ not able to walk, not able to push toy w/wheels

21

3 signs of hearing loss

• Does not turn to source of sound
• Does not say single words
• Does not startle w/loud sounds out of sight

22

4 signs of vision loss

• Close/cover one eye
• Squint
• Have trouble reading or doing close up work
• Blink more than usual

23

6 things a child on the autism spectrum could demonstrate

• Not play pretend games
• Not point
• Not look when other ppl point
• Have trouble relating to others/no interest in other ppl
• Prefer not to be held
• Loose skills they once had

24

Child with Asperger’s Syndrome might have? (6)

• Have trouble understanding feelings, body language,
• Avoid contact
• Talk about themselves
• Narrow, obsessive interests
• Speak in unusual ways or with an odd tone of voice
• Be clumsy or awk

25

Signs of Adolescent Depression

• Decline in school, absences
• Psychosomatic complains
• Changes in sleeping habits
• Diff concentrating, boredom
• Withdrawal from friends/fam, or forming new group of friends
• Violence, rebellious, radical personality changes
• Conflict w/parents and or law
• Suicidal thoughts
• Drug and ETOH abuse
• Running away

26

Symptoms of major depressive episodes

• Depressed mood most of the day, nearly every day (observed by others) –anhedonia
• Diminished pleasure
• Weight loss or weight gain
• Insomnia or hypersomnia nearly every day
• Psychomotor agitation or retardations
• Fatigue
• Feeling worthless
• Difficulty thinking/concentrating
• Recurrent thoughts of death

27

Counseling & Anticipatory Guidance should be aimed at

diet
sleep
stools
voiding
psychosocial
screening

28

Diet includes?

• Solids (no benefit before 4-6 mo)
• Colic, substitution, growth and velocity, appetite
• Milk intake: calcium, constipation, anemia

29

Sleep

separation anxiety, parental response, bottles & pacifiers in bed
• Enuresis→ normal until 5
• Night terrors

30

Stools

• Diarrhea→ common from drinking lots oj juice
• Constipation
• Toilet training