Ob/Peds - Final (pediatrics)

____ of bone is ossified at birth

30%

____ of newborn weight is water (note adult is 60%)

80%

Newborns don’t have ______ developed and no spinal curvatures

uncinate processes

Uncinate processes begin to elongate at age

4 and elongate until 9

____ yo are biomechanically equal to adults

8-9

Developmental ranges

infancy = 0-1

toddler = 1-3

early childhood = 3-8

middle childhood = 9-11

adolescence = 12-18

Breastfeeding/formula should remain the primary source of nutrition for up to or past

1 year

Before 6 months, the primary reflex is to push out and is known as the

Note: they lose it around 6-8mo

tongue thrust reflux

When can you tell if the transition to solid foods is coming

unsatisfied after nursing

not sleeping through the night

interested in the parent eating (reaching/watching)

can sit without support

coordinated hand-to-mouth movements

can turn head to refuse food

At ____ you can now add water, but NOT replace milk

9-11mo

What are the two things you have to avoid in the first year of life

honey (botulism)

whole cow’s milk

At ____ they can now grasp foods themselves and are starting to develop a taste for certain foods

12-23mo

At ____ they now have food preferences that may change daily

2-3 yo

Advice for parents of picky eaters

sometimes, it’s all about the calories

Physical activity guidelines for children

at least 60min/day

aerobic + muscle strengthening + bone-strengthening (axial loading)

Sleep requirements

Newborns = 12-18hr

Toddlers = 12-14hr

Preschoolers (3-5yo) = 11-13hrs

Elementary/Middle school = 9-12hrs

Teens = 8-10hrs

Handwashing w/soap can reduce pneumonia in kids by ____ and diarrhea by ____

50%; 40%

Bathing recommendations

infants = every 2-4 days

toddlers = every 2-3 days

school age = all kids are different

adolescents = daily showering

Why should we not bathe babies/kids every day

increases risk of

• disturbing normal skin flora

• dry skin

• rashes

• reactions to chemicals in soaps

Bath order for babies

warm bottom + genitals before filling the tub

fill tub

use towel to line bottom + cover baby

toys

test water temperature w/elbow

Parents can brush their baby’s teeth without toothpaste around age

1 yo

Replace kids’ toothbrushes every ____ or sooner if worn out

4-6mo

Dentist recommendations

infants = first dental visit by age 1

toddlers = every 6 months

school age kids = every 6 months

Four categories of milestones

social engagement

language

cognitive

motor

Red flags at any age

strong parental concerns

significant loss of skills

lack of response to sound/visual stimuli

poor interaction w/adults or other children

lack of/limited eye contact

differences btw R/L sides of body in strength, mvnt, tone

marked low tone or high tone that impacts skills

2 Months - Social/Emotional

calms down when spoken to/picked up

looks at your face

seems happy to see you

smiles when you talk to them

2 Months - Communication

makes sounds other than crying

reacts to loud noises

2 Months - Cognitive

watches you as you move

looks at a toy for several seconds

2 Months - Motor

holds head up during tummy time

moves both arms + legs

opens hands briefly

4 Months - Social/Emotional

smiles on their own to get your attention

chuckles when you make them laugh

moves or makes sounds to get your attention

4 Months - Communication

makes cooing sounds (ooos and ahhhs)

makes sounds back when you talk to them

turns head to the sound of your voice

4 Months - Cognitive

when hungry, opens mouth when seeing breast/bottle

looks at his hands w/interest

4 Months - Motor

holds head steady without support when being held

holds a toy when put into hand

uses arm to swing at toys

brings hands to mouth

pushes up to elbows when on tummy

6 Months - Social/Emotional

knows familiar people

likes to look at themself in a mirror

laughs

6 Months - Communication

takes turns making sounds with you

blows raspberries

makes squealing noises

6 Months - Cognitive

puts things in their mouth to explore them

reaches to grab a new toy they want

closes lips to show they don’t want more food

6 Months - Motor

rolls from tummy to back

pushes up with straight arms when on tummy

leans on hands to support themselves when sitting

9 Months - Social/Emotional

is shy, clingy, or fearful around strangers

shows several facial expressions

looks when you call their name

reacts when you leave the room

smiles or laughs with peek-a-boo

9 Months - Communication

makes different sounds like mama + baba

lifts arms to be picked up

9 Months - Cognitive

looks for objects when dropped out of sight

bands two things together

9 Months - Motor

gets to a sitting position by themselves

moves things from one hand to the other

uses fingers to “rake” food towards themselves

sits without support

12 Months - Social/Emotional

plays games with you (pat-a-cake)

12 Months - Communication

waves bye-bye

calls a parent mama/dada

understands “no”

12 Months - Cognitive

puts something in a container (block in cup)

looks for things he sees you hide (toy under blanket)

12 Months - Motor

pulls up to stand

walks, holding onto furniture

drinks from a cup without a lid as you hold it

picks things up btw thumb + pointer finger

15 Months - Social/Emotional

copies other children while playing, like taking toys out of a container when another child does

shows you an object she likes

claps when excited

hugs stuffed doll or other toy

shows you affection

15 Months - Communication

tries to say one or two words

looks at a familiar object when you name it

follows directions given w/both a gesture + words

points to ask for something or get help

15 Months - Cognitive

tries to use things the right way (phone, cup, book)

stacks at least two small objects

15 Months - Motor

takes a few steps on his own

uses fingers to feed themselves

18 Months - Social/Emotional

moves away from you, but looks to make sure you are close by

points to show you something interesting

puts hands out for you to wash them

looks at a few pages in a book with you

helps you dress them by pushing arms through sleeve

18 Months - Communication

tries to say three or more words

follows 1-step directions without any gestures

18 Months - Cognitive

copies you doing chores (sweeping w/broom)

plays with toys in a simple way (pushing toy car)

18 Months - Motor

walks without holding on to anyone or anything

scribbles

drinks from a cup without a lid

feeds themselves with fingers

tries to use spoon

climbs on and off a cough/chair without help

24 Months/2 yrs - Social/Emotional

notices when others are hurt/upset

looks at your face to see how to react in a new situation

24 Months/2 yrs - Communication

points to things in a book when you ask

says at least two words together

points to at least two body parts when you ask him to show you

uses more gestures than just waving (blowing a kiss)

24 Months/2 yrs - Cognitive

holds something in one hand while using other hand

tries to use switches or knobs or buttons

plays with more than one toy at same time

24 Months/2 yrs - Motor

kicks a ball

runs

walks up a few stairs with/without help

eats with a spoon

30 Months/2.5 yrs - Social/Emotional

plays next to other children + sometimes plays with them

shoes you what they can do by saying “look at me”

follow simple routines when told

30 Months/2.5 yrs - Communication

says about 50 words

says two or more words together with one action word

names things in a book when you point and ask

says words like “I” “me” “we”

30 Months/2.5 yrs - Cognitive

uses things to pretend like feeding a block to a doll as if it were food

shows simple problem solving skills (standing on small stool to reach)

follows two step instructions

shows they know at least one color

30 Months/2.5 yrs - Motor

uses hands to twist things

takes some clothes off by themselves

jumps off the ground with both feet

turns book pages one at a time

36 Months/3 yrs - Social/Emotional

calms down within 10min after you leave

notices other children and joins them to play

36 Months/3 yrs - Communication

talks with you in conversation using at least 2 back and forth exchanges

asks “who” “what”…

says what action is happening in a picture book

says first name when asked

talks well enough for others to understand

36 Months/3 yrs - Cognitive

draws a circle, when you show them how

avoids touching hot objects when warned

36 Months/3 yrs - Motor

string items together

puts on some clothes by themselves

uses a fork

4 Years - Social/Emotional

Pretends to be something else during play

asks to go play with children if none are around

comforts others who are hurt/sad

avoids danger

likes to be a “helper”

changes behavior based on where they are

4 Years - Communication

says sentences with 4+ words

says some words from a song, story, or nursery rhyme

talks about at least one thing that happened during their day

answers simple questions “what is a coat for”

4 Years - Cognitive

names a few colors of items

tells what comes next in a well-known story

draws a person with three or more body parts

4 Years - Motor

catches a large ball most of the time

serves themselves food or pours water

unbuttons some buttons

hold crayon or pencil btw thumb and fingers

5 Years - Social/Emotional

follows rules or takes turns when playing

sings, dances, acts for you

does simple chores at home (clearing table)

5 Years - Communication

tells a story they heard or made up with at least 2 events

answers simple questions about a book/story

keeps a conversation going w/more than three back and forth exchanges

uses/recognizes simple rhymes

5 Years - Cognitive

counts to 10

names some numbers btw 1 and 5 when point to them

uses words about time “yesterday”

pays attention for 5-10min during activities

write some letters in their name

names some letters when you point to them

5 Years - Motor

buttons some buttons

hops on one foot

Fever red flags

infants (<90 days old) = >100.4

children = >104

What is the best location to take a child’s temperature

tympanic

Where is the best pulse going to be found on a child

femoral

What is a normal breathing pattern in an infant

periodic breathing

What three measurements are taken at EVERY pediatricians appt.

weight

height

head circumference (OFC: occipital frontal circumference)

Respiratory rate and heart rate ____ with age

decreases

What is the most important point to make about growth curvatures

kids should stick to their own curve

What is the 3rd leading cause of infant mortality in the US (1st birth defects, 2nd preterm/LBW)

SIDS

When are infants at the highest risk for SIDS

2-4mo

SIDS risk factors

60% are males

poor socioeconomic conditions

young maternal age

smoking

What is the best current recommendation (for first 6mo) for preventing SIDS

same room + separate surface (bassinet)

Colic

3 hrs of unexplained crying

3 times a week

for 3 weeks

Rome IV Criteria

infant <5 months

recurrent, prolonged periods of crying/fusing/irritability

no evidence of infant failure to thrive, fever, illness

Possible causes of colic

GI discomfort

experience of MSK pain or discomfort

overstimulation

What are the 5 S’s for colic

swaddling, side-lying, shushing, swinging, sucking

Milia

multiple white, pinhead-sized papules

resolve on their own

Vascular lesions (Hemangiomas)

irregularly shaped red areas

present at birth or develop weeks after deliver

can enlarge for 1st year

resolves by adolescence or earlier

Port Wine Stains

capillary malformations

present at birth

flat and does NOT resolve over time

lateralized and localized to forehead and upper eyelid

Atopic dermatitis (Eczema)

red and itchy papules associated with crusting

start at 2mo can least 2-3yrs

associated w/allergies or asthma

Diaper dermatitis

arise from diapers not being changed appropriately

Seborrheic dermatitis (Cradle cap)

red scaling on head and face

yellow greasy rash on head

resolves on own

Cafe-au-lait spots

macules vary dark brown to chestnut/yellow

more than 6 well defined over 1.5cm = neurofibromatosis

Urticaria (hives)

multiple macular lesions

acute (<6 wks) = usually allergic reaction

• resolve on own if allergen isn’t reintroduced

chronic (>6 wks) = may be underlying disorder

• will NOT resolve on its own

Impetigo

honey-colored crusts

highly contagious

non-painful but itchy

agent = Staph or Group A strep

Varicella (chickenpox)

start as rash then leads to red macules

lasts for 14-16 days

Hand-Foot-Mouth disease

affects children <10

highly infectious

sores can be all over by typically present on hands, feet, mouth

Scabies

pruritic papules, vesicles, pustules, linear burrows

contagious

intense itching especially at night