Amublatory Office

What are the most important components of the comprehnsive pediatirc medical history?

birth history and developmental history

What is the biggest focus on the genital/anus exam?

tanner staging

What is the biggest focus during the musculoskelatal exam?

scoliosis checks

What are the expected weight changes from birth to 6 months?

• should be back to birth weight by 2 weeks, because it’s normal for the newborn to lose up to 10% of birth weight in the first few days after birth

• gain 5-7 oz/week (1 oz/day)

• should double birth weight by 4-6 months

What is the expected weight change from 6 to 12 months?

should triple birth weight by 1 yr

When does assessment of BP begin?

3 years of age, unless RFs exist

What is the best way to assess BP in peds patients?

auscultation

What is the Tanner staging of the female breasts?

1. prepubertal

2. breast buds

3. growth of breasts and areola

4. separation of nipple and areola from mound of breast aka “secondary mound”

5. areola rejoins breast (complete development)

What is the Tanner staging of female genitalia?

1. prepubertal

2. straight/fine pubic hair initially on mons pubis; sparse

3. hair increases in amount and is darker, curlier, more coarse and spreads to labia

4. adult type hair but limited in amount; no hair on thights

5. complete development

What is the Tanner staging of male genitalia?

1. prepubertal

2. sparse growth of straight long, slightly pigmented hair at the base of the penis; testes increase in size, scrotal skin reddens

3. hair becomes curly, coarse, and dark; penis grows in length

4. hair is full, limited in area; penis grows in width; scrotal skin darkens

5. complete development

What do we want to see at the 2-week exam?

re-attainment of birth weight

What do we want to see at the 4-6 months exam in males?

bilateral descent of testes

What do we want to see at the school-age/adolescence exam?

tanner staging

What % of kids experience delays that aren’t truly concerning?

18%

What ages is the denver II used for, and how long does it take?

ages 0-6 y/o; 30 minutes

How is the Denver II test administered?

office-administered

What ages is the ASQ used for, and how long does it take?

ages 4-60 months; 15 minutes

How is the ASQ administered?

parent administered

What test is best for a language and cognitive screen?

M-ChAT

What ages is the M-ChAT used for, and how long does it take?

ages 16-48 months; 5-10 minutes

What does the ASQ-3 provide?

provides reliable, accurate developmental and social-emotional screening birth to age 5

When do you stop the ASQ-3?

when the child fails at 3 tasks in that domain

What do you do if a child is unable to perform tasks at age level?

move backwards to the left until 3 tasks are passed successfully

What are the 4 domains of the Denver II?

1. personal-social

2. fine motor-adaptive

3. language

4. gross motor skill

What is considered a failure in the Denver II?

If a child is not performing a task, but 90% of children are meeting that same milestone at the same age

What is considered a caution in the Denver II?

if a child is not performing a task, but 75% of children are meeting that same milestone at that same age

What is a developmental red flag for communication/socialization/engagement at 36-48 months?

75% of speech should be intelligible at 3 years of age

What should be screened for when there are abnormal results?

assess for hearing loss, lead poisoning, and autism screen

When is an anemia screening done (H/H)?

12 months via finger or heel stick

When is lead (PB) screening done?

12 months and 24 months

When are lead levels chelation therapy recommended for?

>45 mcg/dL

When is visual acuity assessed?

ages 3-6 years, 8, 10, 12 and 15 y/o

When is full credit given during the VA?

>50% of line correct

When is conventional audiometry done?

at age 4

What can hearing issues lead to?

speech and behavioral problems

What is SHNL?

most common congenital sensory impairment

What is the #1 cause of conductive hearing loss?

AOM & OME/MEE

When do babies start seeing a dentist?

12 months (or within 6 months of first tooth)

What is given if the water source is deficient?

fluoride supplementation

When does the anxiety (USPSTF) test start?

at 8 years of age

When is annual depression testing started?

at 12 years of age

When do you start screening for lipids?

9-11 y/o and again 17-21 y/o

When do you begin PAP/HPV testing?

begin at 21

When do you do GC and CT testing?

anually if sexually active female <25 years

When is HIV tested for?

once between 15-21 years, anually if high risk

When is hepatitis C screened?

> 18 years of age

When is TB screened for?

only if high-risk