Pediatric Evaluation

what are the components of a pediatric evaluation?

• subjective

• medical history

  • maternal

  • patient

• social history

• objective measures

• assessment

what should be gathered in the subjective history?

• why doctor referred them

• caregiver's main concern

  • use this to make a goal

  • or educate on why this goal is not yet appropriate

what are common complications during pregnancy?

• high BP

• gestational diabetes

• pre-eclampsia

• infections

• mental health

why is high blood pressure a concern during pregnancy?

at risk for pre-term labor

why is gestational diabetes a concern for pregnancy?

• if uncontrolled, increases risk for large infant which increases risk for C-section delivery

what is pre-eclampsia?

• high blood pressure

• protein in urine

• developed after 20th week

what are risk factors for pre-eclampsia?

• first pregnancy

• existing conditions (high BP, diabetes, autoimmune disorders, kidney disease)

• older than 35

• carry multiples

• obesity

why are infections a concern for pregnancy?

• may pass to child during birth or pregnancy

• preterm labor

• low birth weight

• birth defects

• maternal health complications

what percentage of women report anxiety and depression during pregnancy?

• anxiety: 43%

• depression: 15%

what is considered full term pregnancy?

39-40 weeks

what is considered early term?

37-38 weeks

what is considered late term?

41-42 weeks

when does corrected age start?

36 weeks or earlier

what is age of viability?

24 weeks

when do you stop using corrected age?

2 years old

what are possible concerns for labor and delivery?

• labor does not progress

• umbilical cord issues

• abnormal heart rate of baby or mother

• water breaking early

what are tests done during pregnancy on baby?

• ultrasounds

• blood tests

  • genetic carrier screenings

• amniocentesis

• chorionic villus sampling (CVS)

when do you get ultrasounds?

• 8-13 weeks

• 18-21 weeks

• possibly near end term

what is the purpose of the 8-13 week ultrasound?

• establish viability

• determine due date

• number of fetuses

• assess pelvic anatomy

what is the purpose of the 18-21 week anatomy scan?

• measure the baby’s weight and length

• baby’s gender

• assess organs

• placenta health

what is PAPP-A and what do abnormal levels mean?

• pregnancy associated plasma protein screening

• tests for protein made by placenta in early pregnancy

• abnormal levels linked to higher risk of chromosome problems

what is hCG test and what does abnormal mean?

• human chorionic gonadotropin

• tests for hormone made by the placenta in early pregnancy

• abnormal levels linked to a higher risk for chromosome problems

what is AFP test and what does it suggest?

• alpha-fetoprotein screening

• measures the amount of AFP in the mother’s blood

• may suggest twins, ONTD, and chromosomal problems

what is an amniocentesis and when is it done?

• small sample of amniotic fluid taken by putting a long needle through the abdomen into the amniotic sac

• offered between 16th and 22nd week of gestation

what does an amniocentesis test for?

• chromosomal abnormalities

• neural tube defects

• other genetic diagnoses if at risk d/t family history

what is CVS and when is it done?

• chorionic villus sampling

• prenatal genetic testing done between 10 and 13 weeks gestation

• requires small sample of placental tissue

what does CVS test for?

• chromosomal abnormalities

  • down syndrome

  • Edward’s syndrome

• genetic conditions

  • cystic fibrosis

  • sickle cell anemia

• DOES NOT diagnose neural tube defects

what are risks associated with CVS?

• miscarriage in 1/100 pregnancies

• rare or mild side effects

  • dizziness

  • infection

  • abdominal cramps

  • Rh incompatibility

what are the categories for APGAR score?

• appearance

• pulse

• grimace

• activity

• respiration

what score is considered normal for APGAR?

8-10

what is scoring for appearance for APGAR?

2- all pink

1- body pink, limbs blue

0- blue and pale

what is scoring for pulse for APGAR?

2- >100

1- <100

0- absent

what is scoring for grimace for APGAR?

2- coughing and crying

1- grimace

0- no response

what is scoring for activity for APGAR?

2- strong

1- weak

0- limp

what is scoring for respiration for APGAR?

2- good, crying

1- irregular, slow

0- absent

what objectives should we look at during an evaluation?

• pain

• strength/ROM

• tone

• visual appearance

• reflex integration

• posture

• gross motor skills

  • transitions

  • balance

  • gait

what is the FLACC pain rating scale?

• face, legs, activity, cry, consolability

• used for non-verbal or pre-verbal pts

• ages 2 months to 3 years

• score 0-10

what is the scoring for face on FLACC?

0- disinterested

1- occasional grimace, withdrawn

2- frequent frown, clenched jaw

what is the scoring for legs on FLACC?

0- no position or relaxed

1- uneasy, restless, tense

2- kicking or legs drawn up

what is scoring for activity for FLACC?

0- normal position

1- squirming, tense

2- arched, rigid, or jerking

what is scoring for cry on FLACC?

0- no crying

1- moans or whimpers

2- constant crying, screams, or sobs

what is scoring for consolability on FLACC?

0- content, relaxed

1- distractible

2- inconsolable

what is Wong Baker Faces Scale?

• used for pts 3 and older

• not limited to children

• cartoon faces to quantify pain

what is Faces Pain Scale - Revised?

• self-report measure for pain intensity in children

• 4-16 years old

• more realistic faces

at what age does the numeric pain rating scale become reliable?

used for children over the age of 7

when can you use MMT?

• as early as 3 years old, but has increased reliability at 5 and up

• best used for yearly measurements such as after surgery, injury, or casting

how do you test advanced strength?

• sit ups

• push ups

• wall sits (60 seconds)

• V-ups (60 seconds)

• supine flexion (90 seconds)

what is tone?

• amount of resting tension or resistance to movement in a muscle

• assists in maintaining posture

• usually does not change from birth

  • normalizes by 12-15 months

when does flexor tone develop in the legs?

30-32 weeks gestation

when does flexor tone develop in the arms?

36 weeks gestation

what are disorders of muscle tone cause by?

• dysfunction in the brain

• spinal cord

• muscle spindles

• neural circuits of these structures

what is hypotonia?

• diminished resting tone

• decreased ability to generate muscle force

what is hypertonia?

• abnormal increase in resistance to an external force

• typically increased resting tone

what are common causes of hypotonia?

• pre-term birth

• prenatal drug exposure

• neurological disorders

• genetics

what does hypotonia cause?

• decreased gross motor skills

  • sitting

  • crawling

  • walking

what does the modified ashworth scale measure?

tone

what is 0 on Modified Ashworth Scale?

no increase in muscle tone

what is 1 on Modified Ashworth Scale?

• slight increase in muscle tone

• catch and release or minimal resistance at the end of ROM

what is 1+ on Modified Ashworth Scale?

• slight increase in muscle tone

• catch followed by minimal resistance through less than half ROM

what is 2 on Modified Ashworth Scale?

marked increase in muscle tone through most ROM, but still easily moved

what is 3 on Modified Ashworth Scale?

• considerable increase in muscle tone

• passive movement difficult

what is 4 on Modified Ashworth Scale?

affected part rigid in flexion or extension

when assessing appearance of a child, what should you look for?

• torticollis visual assessment

  • eyes, ears, jaw, cheek, head shape

• skin integrity

  • under braces

  • in high-tone areas

• redness

• swelling

• creases

  • torticollis

  • Galaezzi “Allis” test

• wounds

what are yellow flags?

• significant lack of motor skills without physician referral

• night pain without known diagnosis

• integumentary concerns

  • bites

  • unexplained bumps

  • significant swelling

what is a red flag?

projectile vomiting and headache with known history of a shunt