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Flashcards in Peds Health Supervision Deck (40):
1

FTT

Less than 2nd percentile weight
Weight down first, then length, then head circ

2

Expected weight increases

Birth-3 mo: 30g/day, regain bw by 2 weeks
3-6 mo: 20g/day, double bw by 4-6 mo
6-12 mo: 10g/day, triple bw by 12 mo
1-2 years: 250g/month
2-adolescence: 2.3 kg/year

3

Expected height increases

0-12 mo: 25 cm/ year, BL up by 50% at 1 year
13-24 mo: 12.5 cm/year
2yrs-adolesence- 6.25 cm/ year, birth length 2x by age 4, 3x by 13

4

FTT etiologies

Inorganic (disturbed parent/child bond), MOST COMMOn
Organic = underlying pathology/chromo systemic illness

5

Eval of FTT

hx/pe, diet hx, obs, routine tests NOT useful, focused lab eval. Look for IUGR vs. postnatal.

6

Head growth abnormal

Almost all head growth prental, during first 2 years. At birth 25% of adult head, 75% adult by 1 year age. cephalohematoma can screw up head circ measure

7

Expected head circ increase

0-2 mo- .5 cm/wk
2-6 mo- .25 cm/ wk
by 1 year, 12 cm increase since birth!

8

Inorganic FTT?

Bad formula, bad feeding, neglect, young mom/sad mom, alcohol/drugs, marital discord, mental illness, fam violence, poverty, isolation

9

Microcephaly

Head cir 2-3 STDs below mean, incidence 1-2/1000
congen = abnormal induction/migration of brain tissue
acquired = cerebral insult in late third tri/perinatal/first year. head stops growing too soon
clin fx= SMALL brain! developmental delay/intellectual impair/CP/seizures

10

Craniosynostosis

Premature closure of 1+ sutures
Why? unknown/sporadic 80-90%, few = genetic syndrome (Crouzon/Apert), or IU constraint, hyperthy or hypercalcemia
Clin fx- normal sutures open until brain growht stops...90% done at 2, done at 5. Head shape depend on which suture closes early.
dx = phys exam, by 6 months noted, confirm w/ head CT + skull XR
MGMT = surgical repair, esp for cosmetics

11

Which suture closes early?

Sag suture => elongated skull (dolicho/scaphoceph) = most common
Coronal suture => shortened skull (brachyceph), bos, neuro complications like optic nerve atrophy
Metopic suture => hey arnold! trignocephaly
Multiple sutures => severe neuro compromise

12

Organic FTT

Think about all of the systems. Many infectious diseases, naemia, kidney failure, GI abnormalities, immunodef, etc

13

Plagiocephaly

Asymmetry not assoc with suture closure. Positional plagio = flattened occiput + prominence of ipsi frontal area, skull = parallelogram
Assoc w/ congen musc torticollis, increased b/c infants told to sleep on backs
MGMT = ROM exercise for torticolis, tummy time, helment, reposition head

14

Macroceph

head circ > 95%, not necessariily big brain
Why? Familial, overgrowth sotos syndrome, mets issues (canavan/gangliosidoses), NFM, achondroplasia, hydroceph, SOL (tumor)
Eval- measure parents heads, obs for bulging fontanelle/vom/irritable/split sutures b/c ICP concern. R/o hydroceph w/ CT/head u/s. genetic eval maybe

15

Active immunization

Live vaccine = more likely long-lasting immunity, avoid if immunocomp. Varicella, oral polio, MMR
Non-live: not infectious, need boosters- DTaP, hep A and B, IPV, HIB, flu, pneumococ/meningococ

16

Passive immunization

Delivery of preformed abs if no active immunity...
VZIG for immunocomp pts, newborns to hepB+ mommas get HBIG. Travel to high risk area, HepAIG

17

HBV

Hep B hits 300 mil worldwide, give as recombo vaccine in us with HBsAg. 3 shots in first year of life

18

DTaP

Diph, tet, pertussis, inactivated vaccine. DTP = whole cell bordetella, now replaced w/ DTaP w/ acellular bits, less s/e. Give at 2,4,6, mo w/ boost at 12-18 mo and 4-6 yrs. dT = 1/10 dose of dipth toxoid, give at 11-12 years and ever 10 years after. dT not DTaP if >= 7 y/o

19

OPV/IPV

OPV = good b/c host immunity + secondary (comes out in stool, may immunize others), but maybe => polio
IPV = subq/IM, give at 2 and 4 mo, boost 6-18 mo and 4-6 years

20

HIB

H flu => invasive bac infection, meningitis, epiglot, sepsis before vaccine
Conjugate vaccine- h flu polysach + protein antigens (diph toxoid/tetanus). Give at 2,4,6 mo w/ 12-15 mo boos, or 2,4,12 (dep on conjugate)

21

MMR

Measles = pneumonia+ mortality, mumps = parotitis + meningoenceph + orchitis. Rubella = mild viral, but birth defects
Live attenated, give at 12-15 mo w/ boost at 4-6 years or 11-12 years

22

Varicella

Chicken pox! Severe in very young/old. Live attenu, give at 12-18 mo

23

Hep A

Most common viral hep, though 70% asx, severe in older kids/adults, rare fulm hep
Inactive, give at 2 y/o or older, boost 6 mo later if high incidence in area or risk fx (liver, homo sexula/bisexual, IVD, clotting factor/blood products, occupational)

24

Pneumococcal vaccine (Pneumovax/Prevnarr)

Most common cause of OM/invasive bacterial if younger than 3
Pneumovax = polysach antigen from 23 serotypes, cover everything, but little immunogen under 2 y/o, use for older kids/adults w/ high risk (aspelnic ppl, Chronic Liver, immuno def, nephrotic snydnrome)
Prevnar = 7 serotypes, immunogenic in kids under two, not as broad, give it to all kids under 2, some kids older, 2,4,6, mo and 12-15 booster

25

Why immunizations bad?

Most s/e mild/mod, local inflamm/low-grade. MMR/Varicella might => fever/rash 1-2 weeks post shot, serious s/e RARE.
DONT give if...anaphylaxis, encephalo within 1 week of DTaP, pts w/ progressive neuro disorders shouldnt get dTaP,
Immunodef? no give live guys

26

Precautions for immunizations

Be careful givin shots w/ mod/severe illness.
w/ DTaP, careful if temp of 40.5, collapse/shocklike, or inconsolable crying for > 3 hour within 48 hours, seizures within 3 days

27

Hearing screening

Universal newborn hearing screening b/c hearing loss => impaired language
Brainstem aud evoked response measures EEG waves in response to clicks, most accurate but $$
Evoked otoacoustic emission measures sound made by choclear cells detected by microphone in external aud canal...may be messed up by debris/fluid
Most effective = use both tests

28

Metabolic Screening

all states screen hypothy, PKU, many do galactosemia
Sickle cell + other hemoglob issues- penicillin prophylaxis => down mort/morbid
Some states do CAH too

29

Cholesterol/Lipid Screen?

Not recommended for routine. IF kids > 2 have fam hx, do cholesterol if either parent w/ hyperchol, or fasting lipid if either parents/gpas have hx of CVD or sudden death < 55 y/o
kids with elevated chol 75-90th percentile do fasting LP with total chol, tg, HDL, LDL

30

Iron Def Anemia screen

Most common under 6 y/o, peak 9-15 mo, risks = premature, low bw, early cows milk pre 9 mo, insufficient diet iron, low SES
Universal hb screen at 9-15 mo and 4-6 years
UA- recc by some docs, but lil evidence. only if school needs it

31

TB Screen

For at risk kids- contacts w/ tb or high risk (jail, insitutionalized, HIV, homeless, IVD). For kids w/ XR findings, immigration, HIV, high prev areas
Skin test analyzed 48-72 hrs after plaement, interpret on basis of level for risk

32

Lead Toxicity

Plumbism = risk for kids arex, apathy, lethargy, amemia, irritable, vom, maybe enceh
Chronic => asx, maybe neuro isues (delay, mr, learning probs)

33

Lead Screen

For all kids 9mo-6years in old housing, for same age kids w/ contacts who are intoxicated w/ lead, same age if near smelters, any age kids w/ old house being renovated, all kids if >12% 1-2y/o with elevated lead
Lead levels <10ug/dL still bad, MGMT based on levels, decrease exposure, chelate if very high

34

Circumcise

60% males circ, unclear health benefits, maybe good for penile cancer/cervical cancer, not recommended. UTI more common in uncirc. 10% uncirc eventually need it for Phimosis (normal up to age 6, can't retract foreskin), or paraphimosis- retracted skin gets stuck and tourniquets, or balanitis- inflamm of penis glans (candida or g neg infections or STI)
Use anesthesia/analgesia in circ, can have bleeding compx, phimosis or injury, dont do it w/ penile abnormal/prematurity or bleeding diatheses

35

Tooth eruption

Inital between 3-16 mo, avg 6 mo, usually lower central incisor first
20 primary teeth by age 2, secondary eruption w/ lower incisor between 6-8, 32 teeth
Delayed eruption if after 16 mo, familiar, hypothy, hypopit, genetics like downs/ectodermal dysplasia (con teeth, less sweat glands)
Early teeth = before 3 mo- familia, hyperthy, precocious pub, growth hormone too much

36

Dental Hygiene

Brush as soon as teeth erupt, at 2-3 years kiddos can help, use floss, get fluoride, but too much = flurosis, abnormal brown-gray fugly teeth. vulnerable at 2-4 years. Make sure you give fluoride fi kids are only getting bf, or kids with bad tap water

37

Dental weird things

Natal teeth = at birth they're there! Neonatal = in first month! Most common = mandibu central incisors, more than 90% erupt early. Why = unclear, mgmt = nbd unless teeth are hypermobile, cause bf issues or trauma to baby's tongue. aspiration risk pretty low

38

Nursing/bottle caries

3-6% kids, often at 2-30 mo age, especially if fall asleep w/ nipple in mouth or kids that carry around bottle, or any other liquid given. Strepto mutans = most common agent. Max incisors, canines, primary molars. MGMT = dental crowns/extraction

39

Dental Trauma

Perm tooth that is avulsed can be reimplanted if you place it back quick! Extraoral time = biggest prog factor, best if avulsed tooth kept in milk (WEIRD), dry tooth doesnt do so hot. Avulsed primary teeth just leave em

40

Feeding schedule

Newborm= on demand 8-12x/day for 4-6 weeks
2 mo- feed every 3-4 hours
4 mo- 4-5 hours
6 mo- feedings spaced out!