What 3 specific areas should be addressed at each well child exam?
- physical development
- cognitive development
- social and emotional development
When are kids called the following?
•Adolescence (11-20 years)
•Adolescence (11-20 years)
Early, middle, & late
What are the components of the APGAR scoring?
•A: Appearance (color)
•G: Grimace (reflex irritability)
•A: Activity (muscle tone)
•R: Respiratory effort
Most babies start out at what apgar score?
9 - due to aprocynosis (spelling?)
In APGAR, what does activitys stand for?
What are three things given shortly after delivery?
- –Erythromycin ointment in eyes to prevent infection (prevent STD infection)
- –Vitamin K injection to prevent bleeding
- –Full bath
What is the ballard scoring system for?
What are the subranges?
To determine gestational age in weeks.
-1 to 5
-1 to 5
what defines a pre-term baby?
less than 37 weeks
What is post term baby time fram?
more than 42 weeks
How often should neonates feed?
Every three hours
In first week of life, what should happen to a childs weight?
Normal to lose up to 10% of birth weight over first week.
Elevated bilirubin prior to first 24 hours of life indicate it is more than physiological jaundice.
What are common causes of pathological jaundice of the newborn?
What is a cephalohematoma?
Large bruise that doesn't cross suture lines
What is done prior to discrharge from the hospital?
–Hepatitis B immunization
–Newborn Screening blood test
When should there be PCP follow up after discharge?
What components are used for assessment of developmental milestone?
How does neurologic development progress?
Centrally to peripherally
- –Head control
- –Trunk control
- –Use of arms
- –Use of legs
- –Use of hands then fingers
What are the normal language milestones up to 1 yr?
–1 year-1-3 words
At 9 months and older, how should you examine the child?
On parent's lap
Until when should you measure head circumference?
At each visit until 36 months
At what age would you begin checking BP at a well child exam?
What are the primitive reflexes to test?
- Palmar grasp
- Plantar grasp
- Moro (startle reflex)
- Asymmetric Tonic Neck
- Positive support
How do you test the palmar grasp
finger in hand and press against palmar surface --> grasps finger
How do you check plantar grasp?
Touch sole at base toes --> toes curl
How do you test the Moro reflex?
Hold supine support head, back, legs; abruptly lower 2 feet --> arms abduct& extend, hands open, & legs flex, +/-cry
What do you use Barlow and Ortolani maneuvers to test for?
Signs of hip dislocation
Can indicated developmental hip dysplasia (DHD)
If positive, imaging
What does ortolani test look for?
presence of posteriorly dislocated hip
What does the barlow test reveal?
ability to sublux or dislocate intact but unstable hip
When does the anterior fontanelle close?
When does posterior fontanelle close?
At what age should a toddler be understandable to all?
By 4 years of age
Where should you examine a toddler?
On parents lap
Where should you examine a school age child?
What are new topics to discuss for school age children?
–Performance, bullying, special ed, behavioral issues?
–Does your child have a place to do homework?
•Start talking about body changes of puberty/age appropriate
•Remember that health and development is heavily influenced by physical, social, environmental factors and disease (child abuse, chronic illness, socioeconomic status)
When does puberty begin for females?
When does puberty begin for males?
What is adrenarche?
–Activation of adrenal medulla for production of adrenal androgens
–Occurs before the onset of puberty
What is gonadarche?
What are the hormonal changes for boys and girls respectively?
–Earliest gonadal changes of puberty-GnRH released
•Boys-LH stimulates testosterone production and FSH stimulates sperm maturation
•Girls-FSH stimulates estrogen & follicle formation and LH stimulates corpus luteum after ovulation
What is Thelarche?
Beginning of breast development at puberty
What is pubarche?
beginning of pubic hair
What is Tanner 1 for breasts?
elevation of nipple only, preadolescent
What is tanner 2 for breasts?
2-elevation breast/nipple as small mound (breast buds)
What is tanner 3 for breasts?
further enlargement breast/areola, no separation of contour
What is tanner 4 for breast development?
Projection areola/nipple to form secondary mound
What is tanner 5 for breasts?
mature stage, projection of nipple only
What is tanner 1 for boys?
preadolescent-no pubic hair (fine body hair only); penis/testes same size as childhood
What is tanner 2 for boys?
Pubic hair-sparse slightly pigmented, straight. Penis-slight or no enlargement. Testes/scrotum-larger, slightly reddened
What is tanner 3 for male?
Pubic hair-darker, coarser, curlier, sparsely over pubic sym; Penis-larger in length. Testes/scrotum-further enlargement
Tanner 4 for boys?
Coarse/curly greater than stg 3 but not as great as adult; not on thighs. Penis-further enlargement length/breadth w/ dev. of glans. Testes/scrotum-further enlarged, scrotal skin darkened
What is tanner 5 for males?
Pubic hair-adult quantity & quality, spread to medial thighs. Penis-adult size &shape. Testes/scrotum-adult size & shape.
What is the acronym for how to approach topics with teens?
H- Home how are things?
E - Education, how is school?
A - Alcohol, are your friends drinking?
D - Drugs - do your friends try drugs?
S - Sex: Do you have a boyfriend/girlfriend? Sexually active?
When do you kick parents out of the room?
When a child ilooks mature enough that someone might mistake them for an adult.
What is the typical order of changes in males during puberty?
-Growth spurt peaks (age 14)
What is the typical order of changes in females during puberty?
-Growth spurt peaks (age 12)