Pediatric Patient PD I

neonate age

0-28 days

post-neonatal period

29 days to 1 year

young child age

1-4 years

middle child age

5-10 years

adolescent age

11-20 years

name same factors that can affect development

physical, social, environmental, disease

health promotion

the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions

health literacy

the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions

what is the schedule for well child checks?

Birth

First week of life

1, 2, 4, 6, 9 and 12 months

Annually

the AAP recommends use of a standardized tool for development milestones. it measures 4 domains of development, what are they?

Personal- social

Fine motor- adaptive

Language

Gross motor

what developmental milestones for 1 mo?

Head control

Spontaneous smile

what developmental milestones for 2 mo?

Head up when prone

Eyes follow object to midline

Responsive smile

what developmental milestones for 4 mo?

Rolls over

Eyes follow object past midline

Laughs

Preferential social smile

what developmental milestones for 6 mo?

Sits unsupported

Transfer objects between hands

Babbles

Stranger anxiety

what developmental milestones for 9 mo?

Stands with help

Pincher grasp

Repetitive sounds

Social games (peek-a-boo)

what developmental milestones for 12 mo?

Walks

Stacks cubes

10 words

Separation anxiety

what developmental milestones for 2 yr?

Walks backwards

Copies a line

Use of pronouns

Self centered

what developmental milestones for 3 yr?

Rides a tricycle

Copies a circle

Complete sentences

Group play

what developmental milestones for 4 yr?

Hops on one foot

Copies a cross

Tell stories

Imitates adults

what developmental milestones for 5 yr?

Partially dresses self

Copies a square

Asks for word meaning

Conforms to peers

what developmental milestones for 6 yr?

Skips

Copies a triangle

Expanding vocab

Rules are important

what is the number of immunizations recommended as of 2024?

37-42 doses + annual flu and COVID-19 vaccines

when are APGAR scores accessed? whats the max score?

assessed at 1 minute and 5 minutes of life, and every 5 minutes after until > 7 or intervention is initiated. Max score 10.

Ballard Scoring System

standardized method used to estimate gestational age and is based on neuromuscular and physical maturity

by year 1 birth weight and height should increase by?

weight should triple

height should increase by 50%

what is the average heart rate for

0-2 mo

0-6 mo

6-12 mo

140

130

115

what is the average respiratory rate range for an infant?

30-60 rpm

Cutis marmorata

common to see, due to cold - will disappear with warmth

Acrocyanosis

blue skin, typically the extremeites

Mongolian spots

bluish purple spots of pigmentation

Café-au-lait spots

birthmarks

>6 - consider neurofibromatosis

Lanugo

peach fuzz hair that sheds on its own, common in premature kiddos

Desquamation

peeling/flaking skin, more common in post term kiddos

Milia

tiny epidermal cysts that occur in half of babies and will go away on their own

Erythema toxicum

blotchy red macules seen on the chest, back, and face in full term babies

Physiologic jaundice is seen in half of all newborns and is more common in breastfed babies t/f

true

1 multiple choice option

Nevus simplex

flat pink area that can be seen on the nape of neck (stork bite), upper eyelids, forehead (salmon patch)

Capillary hemangioma

raised, red rubbery texture mark; appear in 2-4 weeks as a red nodule and typically resolves by age 9 - benign, best to wait it out

fontanelles

soft spots

Caput succedaneum

crosses suture lines

Cephalohematoma

does not cross suture lines

Plagiocephaly

flattening of the head

what is the visual milestone for birth?

blinks, may regard

what is the visual milestone for 1 mo?

fixes on object

what is the visual milestone for 1.5-2 mo?

coordinated eye movement

what is the visual milestone for 3 mo?

eyes converge, baby reaches

what is the visual milestone for 12 mo?

20/60 - 20/80 acuity

you are doing an ophthalmoscopic exam on an infant and they have a dark reflex, what could that indicate?

cataract, retinopathy of prematurity

you are doing an ophthalmoscopic exam on an infant and they have a white reflex, what could that indicate?

cataract, retinal detachment (separation of the retina from underlying layer), chorioretinitis or retinoblastoma

what are signs in a 0-2 mo year old that they can hear?

Startle response/blink; Calm with soothing voice

what are signs in a 2-3 mo year old that they can hear?

Change in body mvmt or facial expression in response to sound Turn eyes/head to sound

what are signs in a 3-4 mo year old that they can hear?

Turn to listen to voices/conversation

what are signs in a 6-7 mo year old that they can hear?

Appropriate language development

retention cyst

fluid-filled sac on the soft palate

Epstein pearls

white/yellow cysts on hard palate

Ankyloglossia

tongue tied

Macroglossia

enlarged tongue

what could a raspberry tongue indicate in an infant?

desaturation

describe the heart sounds that might be heard during an infant heart exam

S1 and S2 should be crisp

Splitting of S2 heard with quiet or sleeping infant

S3 is low pitched, early diastolic, heard best at the apex

name 3 acyanotic heart murmurs seen in infants

ventricular septal defect (VSD)

patent ductus arteriosus (PDA)

atrial septal defect (ASD)

ventricular septal defect (VSD)

Defect in septum

Blood goes from left ventricle to right ventricle

patent ductis arteriosus (PDA)

Ductus arteriosus does not close at birth

Blood flows from aorta to pulmonary artery

Machinery sounding

atrial septal defect (ASD)

Opening in atrial septum

Blood shunts from left to right atria

Splitting of S2

name 2 cyanotic heart murmurs seen in infants

transposition of the great vessels

tetralogy of fallot

transposition of the great vessels

Aorta rises from the right ventricle

Pulmonary artery rises from the left ventricle

what are the 4 defects tetralogy of fallot?

Ventricular septal defect

Malposition of the aorta

Pulmonic stenosis

Right ventricular hypertrophy

amniotic portion of the umbilical cord

dries up and falls off by 2 weeks

cutaneous portion of the umbilical cord

retracts to abdominal wall

Diastasis recti

separation of rectus abdominis muscles

what are major and minor defects of spina bifida occulta?

Major defects- meningomyelocele

Minor defects-Pigmented spots, hairy patches, pits

what are the 2 tests to test for congenital hip dysplasia?

barlow and ortolani test

Barlow test

Tests for hip instability

Adduct both hips simultaneously while applying posterior pressure

Ortolani test

Confirm hip dislocation

Abduct both hips simultaneously

Metatarsus adductus

adduction without inversion of whole forefoot

Talipes equinovarus

(clubfoot) full inversion, cannot recorrect it

Hypertonia

Spasticity

Increase resistance

Stiff limps

Lack of flexibility

Hypotonia

Floppy" baby

Decreased resistance

Pronation

Increased flexibility

what result would the babinski reflex be in an infant?

positive

Moro reflex

Fight or Flight

Birth to 2-4 mo

Baby is lowered rapidly, head is thrown back, arms extend, cries

Rooting reflex

Locate food

Birth to 3-6 mo

Stroking corner of the mouth, the mouth will open and head will turn toward stimulus

Palmar grasp

Grasping

Birth to 6 mo

Fingers close around an object placed in the palm

Plantar grasp

Protect the foot

Birth to 6 mo

Toes curl downward when sole is gently pressed

Asymmetric tonic neck reflex

Passage through birth canal

Birth to 3-9 mo

Supine turn head to one side, arms and legs on that side extend

Stepping reflex

Instinct for walking

Birth to 2 mo

Appear to walk when held upright with feet on flat surface

Landau reflex

Postural stability

4-5 mo to 1 yr

Holding baby prone, head will lift up and spine will straighten

Parachute reflex

Instinct for catching oneself

8-9 mo through life

Holding baby prone and tipping head down, arms and legs extend

what is a normal pulse in early childhood?

110 bpm (1-2 years old)

103 bpm ( 2-6 years old)

95 bpm (6-10 years old)

what is a normal respiratory rate in early childhood?

20-40 rpm early childhood, 15- 25 late childhood, 14-20 from 15yr+

a toddler comes in with a hyper nasal voice. what do you suspect?

Submucosal cleft palate

a toddler comes in with a nasal voice and snoring. what do you suspect?

Adenoid hypertrophy mouth

a toddler comes in with a hoarse voice and cough. what do you suspect?

Viral infection

a toddler comes in with "rocks in their mouth". what do you suspect?

Tonsillitis

a toddler comes in with a "hot potato voice". what do you suspect?

Peritonsillar abscess

still's murmur

grade I-II/IV musical/vibratory, early-midsystolic, mid-lower LSB, radiates to carotids, may be eliminated with carotid compression

venous hum

soft, hollow, continuous. Louder in diastole, below the right clavicle, eliminated with jugular compression