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Peds Exam 1



Hepatitus B vaccine; monovalent=all newborns; if mom=HBsAg-(+) then HepB+HBIG= 12hrs; mom=HBs Ag- (unknown)= only HepB= 12hrs and test mom (HBIG no later than 1wk); Second dose=1-2mths; Final >24wks then test HBs-Ag= 9-18mths; => cirrhosis or liver cancer; deltoid and vastus lateralis, NOT dorsogluteal; Contra= Yeast preservatives reactivity, pregnancy, preterm birth;


Rotavirus Vaccine; >6-12wks NO later; Final dose by 32wks No later; Contra= analphylaxis, HIV, immuniodeficiency (radiation, drugs, leukemia, blood disorders, cancer), gastroenteritis, ferile, intussusception, pregnancy, hx of rota, intussusception, fever;


Diptheria, tetanus toxoids and acellular pertussis vaccine; >6wks; 4th as early as 12months if 6mths from 3rd; Final @4-6yrs; diptheria=> respiratory nasopharyngitis or obstructive paryngotracheitis, vaginal otic conjunctival or cutaneous lesions; pertussis=neurologic contraindications (encephalopathy), inconsolable crying, fam hx for seizures, SIDS;


Haemophilus influenza type b conjugate vaccine; >6wks; If PRP-OMP at 2-4mths then 6mths not req.; TriHIBit= booster@>12mths not for primary; => menengitis, epiglottitis, pneumonia, septic arthritis and sepsis; Contra= none;


Pneumoccocal Vaccine; >6wks; => seticemia, meningitis, otitis media, sinusitis and pneumonia; Contra= LBWI, anaphylaxis, PPV within 2mths; minor illness, Upper respiratory inf., allergic rhinitis;


Pneumoccocal Vaccine; >2yrs;


trivalent inactivated influenza; >6mths; Contra= analphylaxis (eggs), GBS within 6wks, Pregnancy


live, attenuated influenza vaccine; >2yrs;


measles, mumps, rubella; >12mths; 2nd @4-6yrs; contraindication= pregnancy, recent immunoglobulin, simultaneous PPD, altered immunodeficiency, Breastfeeding, HIV, reaction to eggs or neomycin, thrombocytopenia;


Varicella Vaccine; >12mths; 2nd@ 4-6yrs; (live attenuated); together or 1 month apart from MMR; Contra= pregnancy, breastfeeding, anaphylaxis (neomycin/gelatin), recent immunoglobulin, HIV, immunodeficiency, corticosteroids;


Hepatitus A; >12mths; 2nd @6mths apart; fecal-oral route= abrupt, fever, malaise, anorexia, nausea, abdominal discomfort, dark urine, and jaundice;

MCV4 and MPSV4

Meningococcal Vaccine; >2yrs; => amputations, skin scarring, hearing loss, and neurologic disabilities; Contra= Hx encephalopathy, GBS (6wks), progressive neuropathy (epilepsy), fever, Rx's to Dtap, Brachial neuritis, immunosuppresion, HIV, Antibiotic use, minor illness;


inactivated poliovius vaccine; contraindication= anaphylaxis, pregnancy, breastfeeding, diarrhea;

HPV (Gardisil)

Human papilloma vaccine; Contra= pregnancy, yeast Rx, immunosuppressed female, minor acute illness, lactation,









School Age


Late Childhood/Adolescent


Factors for Growth and Development

Genetics, Nutrition, Prenatal, Environmental Factors, Family and community, Cultural Factors, Socioeconomic status

Trust vs Mistrust

Infancy- Birth-1y.

Autonomy vs. shame and doubt

Toddler- 1y-3y

Initiative vs. Guilt

Preschooler- 3y-6y; plays and lives life to the fullest, sense of accomplishment; rivalry with same sex parent.

Industry vs. Inferiority

School Age- 6y-12y; child identifies with same sex parent.

Identity vs. Role Confusion

Adolescence- 13y-18y


in the world for infant mortality

Childhood mortality

>1y= car seats, cooking accidents and guns

Growth and Development= 1st year

weight and head circumference always growing... never down.

Nutrition= 1m-4m


Nutrition= 4m-5m

BM/Formula + cereal; 1st solid food= juice, strained fruits, strained veg, meats, yogurts (soy 1st). 1 new item 3-5days.

Nutrition= 4m-6m

iron fortified formula is very important as fetal hemoglobin drops.

Nutrition 8m-9m

junior foods, cheerios, crackers, small pieces of fruit; NO grapes, carrots, raisins, marshmallows, hot dogs or honey.

Vomiting and Diarrhea in the newborn

very dangerous; body comp. 75-80% water mostly ECF=> rapid dehydration.


regular formula.

Injury Prevention=

Aspiration, suffocation, burn/sunburn, drowning, ingestions, overdoses.

Development Benchmarks- 3m

some head lag, regards hand, pulling motion, interest in environment, recognition to objects and faces, vocalization= cooing, babble, chuckles;

Development Benchmarks- 4m

↓ head lag, grasping both hands, drooling, constant sound, teething;

Development Benchmarks- 5m

palmer graps, sitting, rolls side to side, teeth, BW dbl, Smiles, fam from strangers, playful, vowels.

Development Benchmarks- 6m

Pincer grasp small object and manipulations, Tripod position, rolls back to abdomen, stranger anxiety, arms out, likes and dislikes, peek a boo, vocal imitation.

Development Benchmarks- 7m

Hand to hand tranfer, bears weight on feet, imitates acts, chained syllables (dada),

Development Benchmarks- 8m

Stands holding on, regular bowel pattern, responds to "NO"

Development Benchmarks- 9m

Pulls to standing, Comprehends "NO"

Development Benchmarks- 10m

demontrates independence= dressing, feeding; locomotion, prone to supine position, sits by falling on butt, follows picture books, stops behavior to "NO"

Development Benchmarks- 11m

Explores, walks holding furniture, plays games, shakes head to "NO", imitates speech;

Development Benchmarks- 12m

Turns pages in book, walks w/ 1 hand, determined walking, BW 3x, Ant Fon closes, Name recognition, Meaning comprehension, imitates animal sounds, comprehends simple commands;

Posterior Fontanels

close at 2m


never put to sleep with.


failure to thrive= inadequate weight gains= below 5th percentile on growth charts

Organice FTT

identifiable cause; common= CHD, DF, HIV, Metabolic Syndrome; less common= endocrine, neurologic condition or lesions and GERD malabsorption syndrome.

Non-Organic FTT

Non-Identifiable medical causes; maybe Psychological= Accidental, Neglectful, Deliberate;

Physical Assessments in FTT

weight falls below 5th%, decline in growth curve, delays in developmental milestones, language delays, decreased muscle mass, abdominal distention, hypotonic, weakness, feeding and dietary hx;

Behavioral Assessment in FTT

Avoidant eye contact, Sleep disturbance, Cranky;

Diagnostic Testing in FTT

Comprehensive hx, Developmental Sx, Nutritional Sx, Growth Curve, Urinalysis, Swerat CL Test, Stool specimen, T4;


Sudden infant death syndrome; leading cause of death in infants 90% of cases >6m; More common= M, 2-4m, in winter or spring.

Factors of SIDS

ALTE, cyanosis, respiratory distress, preemie, multiple births, exposure to smoking, poor prenatal care, poor weight gain of mom, brainstem defect, prone sleeping, sibling with SIDS, irish twins, soft bleeding, use of pillows;


Apparent Life Threatening Event; apnea, change in color (pallor, cyanosis, redness), change in muscle tone (usually hypotonia), choking, gagging, or coughing, and which usually involves a significant intervention and even cardiopulmonary resuscitation (CPR) by the caregiver who witnesses the event

Back to sleep


SIDS Prevention

back to sleep, educate parents, no pillow, no quilts, firm approved bedding.

Post SIDS interventions

contact fam, friends, clergy; SIDS support group referral; Compassionate/Empathetic Care; Fam advocacy in ER, Allow time, take hand/foot prints, locks of hair and photos;

Leading causes of Infants Death

Congenital anomalies, Complications of prematurity, shaken baby syndrome, neonatal infections, Accidental (MVA, drowning);

Car Seat Faces Back...

til 1yo and 20lbs.

Corrosive Poisoning

lye, acid, strong cleaning products; assess and manage airway, do not induce vomiting; gastric lavage and NS.

Non-Corrosive Poisoning

OTC, Rx meds, simple cleaners, plants, alcohol; Do Not induce vomiting, administer activated charcoal, manage effects of substance ingested.


#1 ingested poison; administer mucomyst and monitor liver function.

Rat Poison

coumadin; monitor PT and give Vit K.

Dish Washer Detergent

very toxic, contains bleach; assess GI irritations, needs gastric lavage.

Vitamins containing Fe-

gastric lavage; Assess for GI bleeding;

Prevention of Poisoning

keep out of reach, discard old medications, do no buy large size OTC drugs, store things in original containers, never tell children that medication is "candy"

Sources of Lead poisoning

pipes, paint, soil, dust near industries and roadways, ceramic ware, leaded gas, folk remedies, candy from mexico.

Effects of Lead poisoning

interferes with making hemoglogin, anemia; damages proximal tubules= glucosuria, proteinuria, ketonuria, chelating agents; Nuerologic= blocks calcium= impulsive, hyperactive, clumsy, speech.

BLL <10mcg/dl

reassess or rescreen in 1 year.

BLL 10-14mcg/dl

provide family with lead poisoning education, follow-up testing, and social service referral if necessary.

BLL 15-19mcg/dl

Provide family with lead poisoning education (dietary and environmental), follow-up testing, and social service referral as needed; if BLL persists, initiate actions for BLL of 20 to 44mcg/dl.

BLL 20-44mcg/dl

provide coordination of care, clinical management, environmental investigation and lead hazard control.

BLL 45-69mcg/dl

within 48 hours, provide coordination of care and clinical management, including treatment, environmental investigation and lead hazard control. The child must not remain in a lead-hazardous environment if resolution is to occur.

BLL >70mcg/dl

Immediately provide medical treatment and begin coordination of care, clinical management, environmental investigation, and lead hazard control.


treatment for heavy metal poisoning; IV or IM; may take several tx's; follow up required.

Lead poisoning interventions

prevention= identifying sources, remove or corrective actions.

Toddlers 20-40lbs...

front facing car seat.

Children 40-80lbs...

car booster seat.

Until 100lbs...

back seat with neck above airbag level.

MVA safety

always in back seat, disable airbags for small children, flat seat belts and straps, appropriate clothing.

Physical growth rate by weight...


Age 3- Gross Motor Skills

rid a trike, going upstairs alternating feet but come down step by step.

Age 4- Gross Motor Skills

skip/hop on one foot, catch a ball, throw a ball overhand, and walk down stairs alternating.

Age 5- Gross Motor Skills

preschooler skips on alternating feet, jumps rope, skates with good balance.

Age 3- Fine Motor Skills

uses scissors, draw, copy a diamond and triangle, tie shoelaces.

Age 5- Fine Motor Skills

dresses completely.

Use Questions, plurals, pronouns and past tense of verbs?

between 3-4yrs.

associative play

preschoolers- imitates adults behaviors with a lack of organized rules.

Imaginary playmates...


Stage of Industry...

attitude's towards work, skill development, independence, goal achievement, peer approval is important.

Independent Exams start at...



home life, education, alcohol, drugs, sexual activity/suicide.

Pulse on children under 1y...

always apical


rectal only.

Measurements at every visit until 2y...

Height, weight and head circumference.

Altered by pain, anxiety, fear, crying, medications, disease, fever...

pulses, respirations

RR in Neonate


RR in Infant


RR in 2-6y


RR in 10y


RR in 18y



barking, seal like.

Startle to sound...


Straight line from eyes


Neurologic Assessment...

glascow, cranial nerves, natural state, LOC, spontaneous movement and reactions. = playful, irritable, cranky.


developmental dysplasia of the hip- use Ortolani and Barlow tests- abducting the thighs to test the hip for subluxation or dislocation. [other signs= shortening of limb asymmetric thigh and gluteal folds, or broadening of perineum]


spotted or blotchy with different shades of colors.

Crying improves pallor...

valve issue= more likely pulmonic

Restless and Irritable=


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