Peds Exam 1

Increased risks for children with disabilities 

• Increased risk for child abuse 

• Increased risk of harm (safety concerns) 

Intellectual disabilities 

• Many potential causes, genetics, environment, substances, unknown, etc. 

• Many medical comorbidities 

• Psychiatric comorbidities 

• The rate is increasing for unknown reasons 

Downs Syndrome  

• Trisomy 21 = 95% of Down Syndrome cases 

• Incidence is higher in boys and the Caucasian population  

• Maternal age is the biggest risk factor  

• Most are mild to moderately intellectually impaired 

• Many comorbidities such as cardiac defects, vision, and hearing impairments, leukemia, umbilical hernia, TEF & imperforate anus, premature aging + Alzheimer's  

Fragile X 

• Common inherited cause of cognitive impairment 

• Known genetic cause of autism 

• Physical characteristics such as large prominent ears and narrow face 

• The mother carries the gene 

• Boys are more typically affected than girls  

Fetal Alcohol Syndrome 

• There is no cure, prevention is key 

• No amount of alcohol is ok during pregnancy 

• Causes physical and mental stunting 

• Symptoms range from mild to severe 

Autism – 3 Questions 

• Ranges from mild to severe 

• Symptoms usually noticed by 3, and can be gradual or sudden 

• Many potential causes, no cure 

• Lack of attachment or socialization 

• Tx. Focuses on symptoms and behavior management  

Failure to Thrive – 2 Questions 

• Children whose weight or weight gain is significantly below normal 

• Organic: Causes within the child (chromosome abnormalities, heart/lung defects, toxins) 

• Inorganic: Familial issues (socioeconomic issues, parental relationship, parental emotional state)

ADHD – 1 Question 

• More common in boys than girls 

Drug Abuse – 2 Questions 

• Opiate usage is trending upwards 

• Pharmaceutical parties (Risky, random drug parties consisting of raided pills) 

• Vaping is a big concern 

• Marijuana and Alcohol usage 35% of 12th graders, very concerning and damaging to development of adolescents 

General Growth & Development – 7 Questions 

Infant-Specific Milestones/Behaviors/Concerns – 13 Questions 

Fontanelles: A: 18 Months P: 2 Months 

Growth:  

2 Months: Move head, Verbal noises babbling, Smiles, Holds head up on stomach 

4 Months: Babbles, reaches for toys, remembers faces, rolls over, likes to play 

6 Months: Sits up without support, recognizes name, stranger anxiety, early vowels babbling 

5-7 Months: Hand to hand  

8-9 Months: Crawling, Stands up holding onto objects, Pincer Grasp, object permanence 

10-12 Months: Begin walking, Simple commands, Putting objects in containers / smacking things, simple words, Separation anxiety

Toddler-Specific Milestones/Behaviors/Concerns – 12 Questions 

1-3 years 

Skills: Running, Throwing, Drawing, 3 word sentences,  

2-3 4x body weight 

T: Tantrums, Erikson Autonomy,  

O(OTM): Safety concerns, carseat rear facing if under 2 years 20lbs,  

D(Diaper): 18-24yo potty training, most trained by 4-5 yo, 3yo night time 

Development: Egocentric, parallel play, symbolic play, Push-pull toys, pretend

Preschool Specific Milestones/Behaviors/Concerns – 2 Question 

• Initiative vs. Guilt 

• Magical thinking 

• Separation anxiety 

• Open choices for preschoolers  

School Age Specific Milestones/Behaviors/Concerns – 2 Questions 

• Puberty becomes a topic of concern, with girls developing sooner than boys and sexual maturation in boys being less apparent. 

• Children should increase their ability to think and consider the intention of rules rather than the punishments/rewards involved in them. 

• Conformity and social pressures increase. 

Adolescent Specific Milestones/Behaviors/Concerns – 8 Questions 

Animism, centration, egocentrism, irreversibility, & magical thought – 5 Questions 

• Animism: Child believes that nonliving things are alive  or have living qualities (Teddy bear) 

• Centration: The child can only think about one aspect of an object, like it’s color but not it’s volume 

• Egocentrism: The child can only think about themselves and their needs 

• Irreversibility: Difficulties in a child reversing the order of events in their minds 

• Magical Thought: I think something bad will happen and it happens, must have something to do with my thoughts 

• Erikson – 2 

• Piaget – 2 Questions 

• Kholberg – 1 Question 

Infectious Diseases:

What is diphtheria? S/S? Assessment and management?

• S/S: Sore throat, fever, difficulty swallowing, airway obstruction

• Administer abx, immunization status, closely observe respiratory status, droplet precautions for a child, no longer infectious 9 days following parotid swelling

• What is pertussis? S/S? Assessment and management?

• “Whooping cough” paroxysmal coughing spells (difficulty breathing)

• Lack of immunization is a big risk factor

• Humidity, suctioning of the nose, fluids, antibiotics, droplet precautions

• Often misdiagnosed as RSV

What is tetanus? S/S? Assessment and management?

• S/S: lockjaw, trouble swallowing, muscle spasms, change to bp and hr, PE, pneumonia

• Lack of immunization (go figure)

• Wound care, TIG (human tetanus immune globulin), tetanus vaccine, drugs for muscle spasms, antibiotics, ventilation possible

What is Haemophilus influenzae Type B? (Hib) S/S? Assessment and management?

S/S: Fever, confusion, headache/stiff nech, light sensitivity, nausea, poor reflexes (meningitis), 

Mostly affects children less than 5

Can cause meningitis, pneumonia, swelling of the throat, infection to joints, bones, and heart, sepsis, otis media, conjunctivitis

Antibiotics, respiratory support, meds to treat symptoms, droplet precautions

What is measles? S/S? Assessment and management?

Highly contagious, 

S/S: Fever, cough, coryza(cold symptoms), conjunctivitis, rash, koplik spots

Treated with bedrest, fluids, antipyretics, cool mist

Airborne precautions

What is Mumps? S/S? Assessment and management?

Fever, swelling of parotid (cheeks), orchitis in boys (can result in sterility in boys), meningitis/encephalitis, 

Supportive tx, airway, icepack for testicles if orchitis present

Droplet precautions

Rubella (German measles)

• Can be transmitted mother to fetus

• Spread up to a week before rash appears

• Facial rash that spreads to other areas of the body

• Supportive tx.

• Maternal rubella can result in miscarriage, fetal demise, or congenital malformations

• Screen for pt contact with pregnant women and notify them of possible exposure

• Vaccines :/ 

Chicken Pox

• Highly contagious, airborne + Contact precautions

• Approx 90% not immune will become infected with close contact

• Supportive tx, vaccine!!!

• Symptoms can take 10-21 days to develop. It can spread 1-2 days before appearance.

Poliomyelitis 

• Vaccines!!!

• There is no cure for polio

• Flu like symptoms and possible paralysis / permanent disability

• Manage respiratory, contact precautions

• Limit contact with saliva and feces, VERY GOOD HAND HYGIENE

• Flu-like symptoms, paralysis 

Parasite Diseases: Pinworms (helminthic)

• Fecal oral route of transmission

• Anal itching 

• Dx tape worms and microscope

• Vermox med

• Keep fingernails short and hand washing!This helps prevent the spread of infection and reduces irritation.