PEDS QUIZ 2 MS. MAY

Developmental Milestones

  • Earliest Stage of Sitting

    • Infants can independently sit alone around 8 months.

    • At 5 months, infants can only sit for a few seconds and need propping.

Child Safety and Car Seat Regulations

  • Car Seat Usage

    • Always use a rear-facing car seat to minimize injuries during collisions.

    • Rear-facing positions help protect the head and neck of the infant.

Infant Growth and Development

  • 6 Month Old Milestones

    • Weight gain: 4 to 7 ounces per week.

    • Length increase: 1 inch every 2 months.

    • Can sit alone for a few seconds.

Congenital Cardiac Defects

  • Defects Increasing Pulmonary Blood Flow

    • Patent Ductus Arteriosus (PDA)

    • Ventricular Septal Defect (VSD)

    • Atrial Septal Defect (ASD)

Rheumatic Fever and Related Conditions

  • Involuntary Movements

    • Known as Saint Vitus Dance or Sydenham Chorea.

Specific Congenital Heart Conditions

  • Hypoplastic Left Heart Syndrome

    • Requires shunting of oxygenated blood from the left atrium to the right atrium through an atrial septal defect.

    • Essential for oxygenation.

  • Tetralogy of Fallot

    • Chronic hypoxia results in digital clubbing as a latent sign.

  • Kawasaki Disease

    • Affects arterioles, venules, and capillaries, leading to aneurysms due to inflammation.

  • Congenital Heart Defects Observations

    • Notable observation: feeding fatigue in infants indicates congenital heart issues.

Rheumatic Heart Fever

  • Areas Affected by Carditis

    • Affects the heart muscle and mitral valve.

Clinical Manifestations of Heart Defects

  • PDA Characteristics

    • Oxygenated blood flows back to the lungs, causing circulatory congestion.

    • Notable sign: machine-like murmur in large PDA.

  • Ventricular Septal Defect (VSD) Characteristics

    • Characterized by a loud, harsh murmur with a systolic thrill.

  • Tetralogy of Fallot Defects

    • Four defects:

    1. VSD

    2. Pulmonary artery stenosis

    3. Right ventricular hypertrophy

    4. Dextroposition of the aorta

Congestive Heart Failure (CHF) in Pediatric Patients

  • Child exhibits normal weight for age if they follow the medication regimen.

    • Lack of weight gain indicates signs of CHF: cyanosis, rapid respiration, rapid pulse, feeding difficulties, poor weight gain, edema, respiratory infections.

  • Cyanotic vs. Acyanotic Defects

    • Cyanotic: Blood with low oxygen enters systemic circulation (e.g., Tetralogy of Fallot).

    • Acyanotic: No poorly oxygenated blood enters systemic circulation (e.g., PDA, coarctation of aorta, atrial stenosis).

Tet Spells in Tetralogy of Fallot

  • Defined as paroxysmal hypercyanotic episodes.

    • Occurs during the first 2 years of life.

    • Signs include spontaneous cyanosis, respiratory distress, weakness, and syncope lasting for minutes to hours.

    • Recovery is facilitated in a knee-chest position to improve blood flow to the heart.

Kawasaki Disease Diagnosis

  • Key manifestations include erythematous skin rash, swollen hands, and desquamation (peeling) of palms and soles.

Feeding Guidelines for Infants

  • Transition to whole milk should occur at 1 year old for nutritional adequacy.

  • Rooting Reflex

    • Elicited by stroking the newborn's cheek, causing the newborn to turn the head and make sucking motions.

Developmental Milestones

  • 10 Months Old

    • Should be able to sit independently without support by 8 months.

  • 7 Month Old

    • Should be able to babble with multiple syllables.

    • Exhibits fear of strangers and separation anxiety.

    • Can sit leaning forward using both hands to support.

    • Should have a unidextrous grasp.

Recommended Toys for Infants

  • 7 Months Old

    • Best toys are light, soft, and respond to manipulation (e.g., squeaky toys).

Medication Monitoring for Patients

  • Chlorothiazide

    • Monitor serum electrolytes and daily weight to avoid potassium depletion.

  • Lanoxin (Digoxin) Toxicity Symptoms

    • Symptoms include nausea, vomiting, anorexia, irregular pulse, and sudden changes in pulse.

Observational Questions for Diagnosing Rheumatic Fever

  • Important question: Has the child had a recent sore throat?

Coarctation of the Aorta

  • Expected physical findings:

    • Increased pressure in arms and decreased pressure in legs due to coarctation.

Introduction of Solid Foods to Infants

  • Solid foods can be introduced around 4 to 6 months, with iron-fortified cereals being the first recommendation due to lower allergenic potential.

Infant Weight Expectations

  • Infants typically double their weight by 6 months and triple their weight by 1 year.