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Flashcards in Pediatric Health Supervision Deck (123)
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1

What are the 7 steps of the well child visit?



  1. History

  2. Developmental surveillance

  3. Observation of parent-child interaction

  4. Physical examination

  5. Additional screening tests

  6. Immunizations

  7. Anticipatory guidance


2

What are the 6 components of well child care?



  • Anticipatory guidance (diet, healthy lifestyle promotion)

  • Specific preventative measures (immunizations)

  • Screening tests to detect a symptomatic diseases (vision, hearing, newborn metabolic screening, tuberculosis screening)

  • Early detection and treatment of symptomatic acute illness to prevent complications

  • Prevention of disability in chronic disease

  • Assessment of growth and development


3

What is routinely monitored for normal growth?



  • Weight

  • Height

  • Head circumference (until age 2)

  • Sexual maturity


4

Standardized Growth Curves



  • Represent normal values for age for 95% of children

  • Used to plot weight, height, BMI, head circumference

  • Special growth curves exist for children w/ particular genetic conditions (Down syndrome, achondroplasia)


5

Growth disturbances



Definition



Types



  • Growth outside of the usual pattern

  • Types

    • Failure to thrive

    • Head growth abnormalities




6

Failure to Thrive 



definition 



growth parameters 



weight vs. length



  • Growth rate of less than expected for a child

  • Concerning when child's weight crosses 2 major %ile isobars

  • May involve all growth parameters, but WEIGHT GAIN is the most abnormal

  • Weight affected before length before head circumference


7

Rules of Thumb for Expected Increase in Weight




  • Birth-3 mo

  • 3-6 mo

  • 6-12 mo

  • 1-2 yrs

  • 2 yrs-adolescence



  • Birth-3 mo: 30 g/day (regain birth weight by 2 wks)

  • 3-6 mo: 20 g/day (double birth weight by 4-6 mo)

  • 6-12 mo: 10 g/day (triple birth weight by 12 mo)

  • 1-2 yrs: 250 g/mo

  • 2 yrs-adolescence: 2.3 kg/yr


8

Rules of Thumb for Expected Increase in Height




  • 0-12 mo

  • 13-24 mo

  • 2 yrs-adolescence



  • 0-12 mo: 25 cm/yr

    • birth length increases by 50% at 12 mo



  • 12-24 mo: 12.5 cm/yr

  • 2 yrs-adolescence: 6.25 cm/yr

    • birth length doubles by age 4

    • birth length triples by age 13




9

What are the 2 etiologies of failure to thrive?



Which is the most common?



  • Inorganic FTT


    • a disturbed parent-child bond that results in inadequate caloric intake or retention (most common)



  • Organic FTT

    • suggest underlying organ system pathology, infection, chromosomal disorders or systemic illness




10

How do you evaluate FTT?



  • Careful history & physical

  • Complete dietary history

  • Observation of parent-child interaction

  • Routine screening tests usually not useful

  • Evaluation of organic etiology directed at timing/onset


11

What are the 4 main head growth abnormalities?



  • Microcephaly

  • Craniosynostosis

  • Deformational plagiocephaly

  • Macrocephaly


12

Almost all head growth occurs prenatally & during the first ____ years of life.
Head circumference at birth is __% of the normal adult head size, and it increases to __% of the normal adult head size by 1 yr of age.

2 years
25%, 75%

13

What is a cephalohematoma?



  • Subperiosteal hemorrhage of the newborn cranium after a traumatic delivery

  • May interfere w/ accurate head circumference measurement (as well as scalp edema)


14

Rules of Thumb for Expected Increase in Head Circumference




  • 0-2 mo

  • 2-6 mo

  • By 12 mo



  • 0-2 mo: 0.5 cm/wk

  • 2-6 mo: 0.25 cm/wk

  • By 12 mo: total increase = 12 cm since birth


15

What are the inorganic causes of failure to thrive?



  • Poor formula preparation

  • Poor feeding techniques

  • Child abuse & neglect

  • Parental immaturity

  • Maternal depression

  • Alcohol or drug use

  • Marital discord

  • Mental illness

  • Family violence

  • Poverty

  • Isolation from support systems


16

Microcephaly 



definition 



incidence



  • Head circumference 2-3 standard deviations below the mean for age

  • 1-2/1,000 children


17

What are the etiologies of microcephaly?



  • Congenital 


    • associated w/ abnormal induction & migration of brain tissue



  • Acquired

    • caused by a cerebral insult in the late 3rd trimester, perinatal period, or 1st yr of life 

    • affected children are born w/ a normal head circumference that does not growth after the cerebral insult




18

What are the clinical features of microcephaly?



  • Small brain

  • Developmental delay

  • Intellectual impairment

  • Cerebral palsy or seizures


19

Craniosynostosis 



definition 



etiology



  • Premature closure of one or more of the cranial sutures

  • Unknown etiology 

    • 80-90% sporadic  

    • 10-20% familial or part of a genetic syndrome (Crouzon, Apert)




20

Risk factors for craniosynostosis



  • Intrauterine constraint or crowding

  • Metabolic abnormalities

    • hyperthyroidism, hypercalcemia




21

What are the clinical features of craniosynostosis? What is the most common form?



  • Cranial sutures remain open until cessation of brain growth

    • 90% completed by age 2

    • complete by age 5



  • Head shape is based on which suture closes prematurely


22

5 congenital causes of microcephaly



  • Early prenatal infection (HIV, TORCH)

  • Maternal exposure to drugs & toxins (fetal alcohol syndrome)

  • Chromosomal abnormality (trisomy 13, 18, 21)

  • Familial microcephaly (autosomal dominant or autosomal recessive)

  • Maternal PKU


23

4 acquired causes of microcephaly



  • Late 3rd trimester or perinatal infections

  • Meningitis or meningoencephalitis during 1st yr of life

  • Hypoxic or ischemic cerebral insult

  • Metabolic derangements (hypothyroidism, inborn errors of metabolism)


24

What is dolichocephaly or scaphocephaly?



  • Premature closure of the sagittal suture

  • Results in an elongated skull

  • Most common form of craniosynostosis


25

What is brachycephaly?



  • Premature closure of the coronal suture

  • Results in a shortened skull

  • More common in boys

  • May be associated w/ neurological complications (optic nerve atrophy)


26

What is trigonocephaly?



  • Premature closure of the metopic suture

  • Leads to a triangular-shaped head


27

What happens with premature closure of MULTIPLE sutures?



  • Rare

  • Associated w/ severe neurologic compromise


28

Craniosynostosis 



diagnosis 



treatment



  • Physical exam of the head

  • Note by 6 mo of age

  • Confirmation by skull radiographs & head CT

  • Surgical repair (esp when significant cosmetic concerns)


29

What is the definition of plagiocephaly?


Asymmetry of the infant head shape NOT associated with premature suture closure


30

What is the most common type of plagiocephaly?


Positional plagiocephaly



Flattening of the occiput



Prominence of the ipsilateral frontal area



Viewed from the top, skull shaped like parallelogram