MPA 531 Patient History and Physical Diagnosis - Children & Adolescents

Tachypnea is a RR of ___________ in newborns

>60 breaths/min

What is normal temperature in children?

36.5-37.5 C (97.7-99.5 F)

Where is temperature measured in children?

Axilla

What is a red flag regarding temperature in children?

A temp of >100.4 F in children <3 months is a RED FLAG!!

When is BP routinely taken in pediatrics?

Starting at age 3

What age is considered Newborns/Neonates?

0-2 months old

What is the Apgar scoring system?

A serial perinatal assessment done at 1 and 5 minutes after birth that assesses neurologic recovery and CV adaptation

What is a normal APGAR score?

>7

What is the Ballard score?

Examines neuromuscular and physical maturity and helps confirm the gestational age of the newborn

What is the primary determinant of organ maturity?

Gestational Age

What are predictors of normal behavior and development?

- Gestational Age

- Birth weight

What are preterm infants at risk for developing?

Respiratroy, CV and neuro developmental complications

What is the gestational and weight classification of premature babies?

Gestational - < 37 weeks

Weight - <2500gm (5.5 lbs)

inborn errors of metabolism

Genetic disorders affecting metabolic pathways

What is Phenylketonuria (PKU)?

Disorder of amino acid metabolism with decreased phenylalanine hydroxylase that causes irreversible intellectual disability

When does a full newborn exam/assessment take place?

Within 24 hours, 1-2 hrs after feeding

What are important considerations when taking a Hx for a newborn?

- Pregnancy course (complications, delivery info)

- Perinatal Hx (stools, jaundice)

- Family Hx

- Social Hx - smoking, drinking, stressors

All nutrients, vitamins, minerals, and water are provided by human milk for 1st 6-months of life except in?

Exclusively breast fed infants

What do exclusively breast fed infants need?

- Vitamin D

- Iron

Describe normal stool of newborns and infants

Soft, yellow and frequent

Describe normal urine of a newborn and infant?

6+ wet diapers/day

How much weight does a newborn lose and gain?

- Lose - up to 10% in 1st week of life

- Gain - 1 oz/day during the 1st month

What are important car seat considerations?

Rear facing seat from birth to 12 months OR until height/weight limits of the seat are reached

What is the developmental milestone for language at 2 months

Cooing

What is development milestone for socialization at 2 months?

Smiles responsively

Why may newborns have bilateral breast enlargement?

- Due to estrogen effect

- Will subside over time

What is asked in the MSK system for children?

- Rigidity of extremities

- Symmetry and spontaneous movements

What are abnormal nervous system findings in newborns?

- Sustained Tremors

- Persistent Extension

What is a positive babinski sign in children?

Upgoing and spreading toes, which is normal in this age group

What is the expected age for the sucking reflex?

Involuntary-voluntary

What is the expected age for the rooting reflex?

Birth-4 months

What is the expected age for the palmar reflex?

Birth-4 months

What is the expected age for the Moro (startle) reflex?

birth to 4 months

What is the expected age for asymmetric tonic-neck reflex (fencing)?

Birth-2 month

What is the expected age for the parachute reflex?

8 months

What are the 8 developmental milestones that occur at 2 months?

- Lifts head 45 degrees when prone

- lifts shoulders when prone

- rolls side-to-back

- slow tracking past midline

- recognizes parents

- smiles responsively

- vocalizes (cooing)

- grasps and kicks

When should pediatric patients double birth weight?

By age 4 months

What are the developmental milestones that occur at 3-5 months?

- sit w/ support, head steady

- Lifts up hands when prone

- Reaching/grasping/letting go

- Laughs, vocalizes, listens and explores

What are the developmental milestones that occur in pediatric patients aged 6-8 months?

- Sits alone

- Rolls over

- Babbles

- Grasp objects

- Can sleep 6-8 hrs but easily woken up

What are the developmental milestones that occur in pediatric patients aged 9-11 months?

Objects permanence (peek-a-boo)

Stranger Anxiety

When should a pediatric patient reach triple their birth weight?

12 months

When should pediatric patients be started on whole milk?

12-24 months

What age do pediatric patients tart walking independently?

12 months

When should an autism screening be done for pediatric patients?

18-24 months

What are some development milestones for pediatric patients 12-24 months?

- Intentional use of "mama" and "dada"

- 2-3 other meaningful words

- Points

- Fine Pincer grasp

- Hgb and lead levels

When is it appropriate to start a pediatric patient on low fat milk?

2 years old

When should pediatric patients be almost toilet trained?

3 years old

What exams should be started by 3 y.o.?

- Routine BP checks

- Snellen or visual acuity

When should pediatrics patients experience daytime continence?

4 years old

What exams are important at age 4?

Formal hearing test

What are morbidity and mortality incidences for pediatric groups? (10)

- Pregnancies

- STIs

- Substance Abuse

- Physical Violence

- Obesity

- Dropping out

- Depression

- Delinquency

- Sedentary lifestyle

- Running away

How is adolescence defined?

- Puberty to adulthood

- 10-21 y.o.

What's "HEADSS"?

A acronym used to assess the health Hx of adolescents

H - Home

E - Education, Eating, Exercise

A - Acitivities/hobbies

D - drugs and drinking

S - Sex and sexuality

S - Suicidility and safety

What age range is early adolescence?

10-13 y.o.

What age range is middle adolescence?

14-16 y.o.

What age range is late adolescence?

17+ y.o.

When does puberty begin for males?

Around 12 y.o.

When does puberty begin for females?

Around 10 y.o.

When does menarche begin for females?

Around 12 yo.

What are the Tanner stages of breast development?

Stage 1 - Prepubertal

Stage 2 - breast bud, limited pubic hair

Stage 3 - breast and areola growth, more pubic hair

Stage 4 -nipple and areola separate, adult looking pubic hair

Stage 5 - adult appearance, areola same countour as breast mound

What are Tanner Stages of testicular development?

I - Prepuberty

II - Testicle and scrotal growth, scrotal skin darkens, light pubic hair

III - Increase in penis length; fuller and coarser hair

IV - Increase in penis width; limited adult-looking hair

V - Adult Appearance

In California, what medical services DO NOT require parental consent?

- Pregnancy related services (birth control, abortion)

- Emergency services

- Skeletal surgery

- Dx and Tx of sexual assault or rape