L PD PEDS

infant crying patterns: boisterous hardy cry

reassuring

weak and listless cry, you suspect?

seriously ill infant

high-pitched cry, you suspect?

increased ICP,

painful injury,

strangulated hernia,

other serious conditions

child makes no eye contact or lacks animation*

neglect

psychosocial issue

child laying completely still, verbally responsive, noticeable winces with position change = ? and big sx?

acute abdomen (peritonitis)

best detected by rebound tenderness

a dyspneic pt who is sitting uprgiht and leaning forward with arms extended*

exacerbation of asthma

other cause of respiratory distress

child and parent have minimal/no social connection (eye contact, smile, animation), suspect*

neglect

where infants >6m vs. <6m are placed at office

>6 m / anxious toddlers = caregiver lap

<6 m or > 30m = exam table

order of exam for infants/toddlers*

easy part first (skin, heart, lungs)

→ invasive (HEENT, abdomen, genitalia)

examiner should always evaluate the _____ before touching the child*

developmental status

growth measurements in peds*

height (length)

weight

head circumference

ht, wt, hc plotted on standardized graphs, reassess if growth is crossing percentile lines

when do you start to measure BP in kids? _ WCC

3yr WCC

macrocephaly in an infant may indicate*

hydrocephalus

microcephaly in an infant may indicate*

neurological deficit

when is strabismus normal*

normal 0-4months in infant

should be evaluated is it persists >4mos

vision screening in newborn

red reflex, pupil constriction, blink

vision screening infant and toddler

photo screener

vision screening 3-6yrs

annually w picture/letter chart

unilateral foul smelling d/c from one nostril is suspicious for

FB

when kid has articulation issues and/or breastfeeing problems, evaluate the _____

frenulum

first tooth eruption occurs*

4-6months

→ gum swelling

peds populations that may have gynecomastia

neonates breastfeeding (d/t maternal estrogen stimulation)

males in early puberty

HTN in peds definition

BP >95 perceentile

Heart murmurs of childhood (list)

innocent (still's murmur)

benign venous hum

peripheral pulmonic stenosis

patent ductus arteriosus

ventricular septal defect

atrial septal defect

Innocent (still's murmur) definition, heard best and disappears when?

grade </2 systolic murmur, short

heard best when supine, disappears when standing

benign venous hum definition

• where does it come from?

• disappears when?

continuous murmur at supraclavicular area

-comes from normal venous flow leading to heart

-disappears when supine or when kid turns head to right side

peripheral pulmonic stenosis definition

• heard where

• radiates where?

• what causes it?

• disappears when?

systolic ejection murmur L/R USB,

radiates to back and axilla

from turbulent flow in proximal pulmonary arteries

-disappears 3-4months

patent ductus arteriosis (PDA) definition

• does position change this?

• heard best where?

• when do majority close?

continuous murmur,

no change w position

heard best at LUSB

90% close by 48hrs of life

ventricular septal defect (VSD) definition

• may _ spontaneously in 1st year

• if large, what is a finding?

short systolic murmur

may close spontaneously in 1st yr

large VSD: holosystolic murmur at LLSB

ASD and location

fixed, widely split S2, systolic murmur at LUSB

sacral dimple above the gluteal cleft

spina pifida or tethered cord

scoliometer >5-7derees

order spine XR w Cobb angle (gold standard)

scoliometer >20degrees

ortho referral

when to do hip examination for joint laxity/dislocation

from birth to 2-3 months after walking

large and small for gestational age

large: >90 percentile wt for gestational age

small: <10 percentile wt for gestational age

complications of large gestational age baby

hypoglycemia

birth injury

perinatal asphyxia

respiratory distress

polycythemia

congenital anomalies

central cyanosis in newborn

blue tongue, lips, etc. indicates hypoxemia

indications of respiratory distress newborn

Rapid RR,

nasal flaring,

grunting,

retractions,

accessory muscle use,

stridor

pallor in newborn → suspect?

anemia

ruddy color in newborn = ?

polycythemia

yellow color in newborn

jaundice

when is jaundice abnormal in a newborn

first 24hrs

facial dysmorphology from genetic syndrome or fetal alcohol syndrome

unusual shape of nose or ears

wide spaced eyes

long philtrum

when is asymmetric eye movement normal

first month of life

Peirre Robin Syndrome

recessed jaw

glossoptosis (falling backwards tongue)

cleft palate

Epstein Pearls

benign inclusion cysts in midline btwn hard and soft palate

Mucous retention cysts

benign cysts on gums, inside lips or floor of mouth

frenulum lingae

band of tissue from floor of mouth to tongue

finding associated w cleft palate

bifid uvula

dimpling

cystic hygromas

painless transilluminated cyst above clavicles

brachial cleft cyst

anterior margine of SCM

thyroglossal duct cyst or enlarged thyroid, when does it move?

midline

moves up when tongue is out/swallow

torticollis and cause

head tipped to one side

injury to SCM/muscular birth injury

excess skin - webbing of neck

turner syndrome

excess skin - folds

Downs

sx clavicle fx from birth trauma

irritability

decreased mobility of arm after birth

asymmetric moro reflex

T/F in both males and females, breasts in infants may be hypertrophied and asymmetrical from maternal hormones

T

widely spaced/laterally displaced nipples

turner syndrome

supranumerary nipples (“third nipple”) are common where?

along the milk line

T/F rales can be normal a few hrs after birth and why

T

(d/t remnants of amniotic fluid in lungs)

pyogenic granuloma

overgrowth of blood vessels →raised, bright red bump

keratosis pilaris

excess keratin clogs hair follicles

cafe au lait spots

flat, light-to-dark brown birthmarks

d/t overproduction of melanin

tinea versicolor

non-contagious fungal skin infection caused by an overgrowth of yeast

facial hemangioma

benign, non-cancerous clusters of extra blood vessels

positional plagiocephaly

"flat head syndrome," occurs when an infant's soft skull develops a persistent flat spot from being in one position too long

aplasia cutis

absence of a portion of skin

tinea capitus and sx

contagious fungal infection that affects the scalp and hair shafts

sx: itchy, scaly, and circular bald patches

seborrheic dermatitis

non-contagious inflammatory skin condition

causes scaly, itchy patches and stubborn dandruff

dermoid cyst

benign, fluid-filled sac

fetal alcohol syndrome

small eye opening

thin upper lip

smooth ridge between nose and upper lip

slower growth

poor coordination

infant w diminished pulses

coarctation of the aorta

Dextrocardia

prominent heart sounds on R chest (heart on R side)

scaphoid abdomen in newbord

diaphragmatic hernia

(organs herniated into chest, so abdomen is empty)

abdominal wall defects in newborn

omphalocele (abdominal organs outside of body FROM belly button, has a sac covering)

gastrochisis (intestines out of body near belly button, no sac)

most abdominal masses in newborns are ___

kidney hydronephrosis

cystic renal disease

imphalitis

redness around umbilical stump or odorous discharge

how long does umbilical cord remnants last

2-3 wks before falling off

what may be the only finding in VACTERL Syndrome (collection of birth defects)

imperforate anus (rectum/anus missing or blocked)

(vertebral, anal atresia, cardiac, tracheo/esophageal, renal, and limb defects)

when is perforate anus (normal) assumed

only after meconium is passed

hypospadias and where can it be

abnormal development of urethral opening ventrally

can be on glans, penis shaft, scrotum or perineum

abnormal genitalia in phenotypical female

clitoromegaly,

fused labia,

palpable gonads

abnormal genitalia in phenotypical male

bifid scrotum,

micro-penis,

severe hypospadias,

cryptorchidism

Signs of neural tube defect on back of infant

soft tissue mass (lipoma or meningocele)

sacral dimple or asymmetrical gluteal cleft (dimple can be benign)

Hemangioma or skin discoloration over spine

Tuff of hair

Syndactyly

fused finger

polydactyly

extra digits

RF for developmental dysplasia of hips

female

family hx

breech position

findings consistent w neuro condition newborn

hypopigmented spots: tuberos sclerosis

hemangioma trigeminal nerve region: sturge webber syndrome

petechia and hepatosplenomegaly: CMV infx

facial dysmorphic features

Moro reflex

drop head, arms extend

stepping reflex

a neonatal reflex in which an infant lifts first one leg and then the other in a coordinated pattern like walking

palmar and plantar grasp reflex

Elicited by the examiner placing his finger on the palmar surface of the infant's hand and the infant's hand grasps the finger. Attempts to remove the finger result in the infant tightening the grasp.

Asymmetric tonic neck reflex

turn baby's head to one side - "on gaurd"

Rooting reflex

touched on the cheek, to turn +open the mouth, and search for the nipple

contraindications to breastfeeding

galactosemia in infant

maternal meds

drug use in mother

mother w Ebola

mother w HIV (not being immunosuppressed)

mother has monkeypox

mother has HSV w lesion on breast

how much weight is normal to see a baby lose in first few days of life

up to 10% birth weight

2 month WCC anticipatory guidance

sleep on back

small amounts of spit up

when prone, lift head up

smiles responsively

watches ppl as they move

looks at toy for secs

what age is appropriate to start giving ibuprofen instead of tyelnol

>6months

4 month WCC anticipatory guidance

safety w rolling

start food btwn 4-6months

holds head unsupported

bats at swinging toys

brings hand → mouth

when prone, pushes up to elbow/forearm

chuckles

if hungry, opens mouth when sees breast/bottle

6 month WCC anticipatory guidance

lock areas w poisons, meds, cleaning products

outlet covers

gates for stairwells

don't use walkers

begin fluoride

rolls, leans on hands, blows raspberry, looks at self, reaches for stuff, closes lips when full

9 month WCC anticipatory guidance

avoid foods that can lead to choking

lower crib mattress to lowest level