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PoM II Peds Med
Terms in this set (73)
Down syndrome facies
flat nasal bridge, epicanthal folds, upslanting palpebral fissures, lowset ears, open mouth, protruding tongue (should see cardiologist, increased risk of leukemia), transverse palmar crease
webbed neck, wide spaced breasts, coarctation of aorta, lymphedema
causes of low head circumference
fetal alcohol syndrome, toxo, plasmo
bulging fontanel DD
hydrocephalus, tumor, meningitis
within periosteum, doesnt cross fontalles, could become infected (e coli common)
commonly seen with vaginal births - spontaneously resolves
neonatal chlamydia conjunctivitis
(looks similar to gonococcal but presents later), at 5-15 days of life, more serosanguinous than GC, obligate intracellular, oral and topical antibiotics
normal optic disc
cup:disc ration 0.2
hazy, optic disk isn't sharp, more prominent vein, vit A intoxication
flat nasal bridge, looks like eso/exotropia but is maybe just covered by epicanthal fold
autosomal dominant mutation, sometimes mistaken as child abuse
bilateral periorbital ecchymoses w/ basilar skull fracture (child abuse)
part of malleus projection on eardrum
using tubing and an insufflator bulb generating negative and positive pressures
light reflex on ear drum
anterior and inferior
painful vesicles on eardrum
asymptomatic whitish plaques
nose is plugged up anatomically
abnormal cilia, CF, allergies?
CFTR chrom 7, prevents Cl- transport, treat with nebulized saline
unilateral purulent, fowl smelling
foreign body (most often right - bc rand handed)
acute cutaneous lupus erythematosus
fetal alcohol syndrome
smooth philtrum, thin upper lip, short palpebral fissures
whitish elevations patholgnomic of measles?
branchial cleft cysts
thyroglossal duct cyst
3 ways to measure growth
weight, height, Fronto-Occipital Circumference (FOC)
avg birth weight in Americans
Birth weight in Americans is ~3.5 kg. (~7.5 lbs.).
Plot weight on growth curves every visit.
A newborn may normally lose up to 10% of birth
weight in first week of life, but should regain birth
weight by the second week of life.
Doubles birth weight by ~4-6 months.
Triples birth weight by ~1 year.
Weight gain slows after 1 year.
Avg birth length
35 cm (14in)
Congenital Zika infections
Fetal Alcohol Syndrome (FAS)
2-3 standard deviations (SD) below the mean
Toxoplasmosis (Cat feces, Generalized calcifications)
Rubella (Congenital cataracts)
CMV (Periventricular calcifications)
Herpes, HIV, HSV
familial, hydrocephalus, neoplasm
Unusually rapid head enlargement (upwardly crossing percentiles)
large fontanelle, hoarse cry, bradycardia, constipation, jaundice
routinely recorded after 3 yrs of age
By age of visit: cross sectional
By domain: longitudinal
Denver Developmental Screening Test II: Most commonly used
Brazelton: Newborn behavior/neurologic function
Bayley: More extensive evaluation
Denver Developmental Achievement Charts
2 mo old normal devt
can follow 180 degrees, smiles socially, turns to sound
4 mo old normal devt
laughs, rolls from front to back
6 mo old normal devt
stranger anxiety, transfers objects, uses whole hand, sits alone without support, supports weight while standing, babbles consonants
9 mo old normal devt
says "dada" first, then "mama", has pincer grasp (using 2 fingers), walks holding on (cruising)
12 mo old normal devt
says "dada"/"mama", stands alone, walks with one hand, points with one finger
15 mo old normal devt
gibberish (jargon), independently drinks from cup, walks independently
2 yrs old normal devt
oppositional behavior, 2-3 word phrases, name pictures and objects, runs, walks up and down stairs alone, copies vertical lines
3 yrs old normal devt
rides tricycle (3 wheels), copies circle (360 degrees), 75% (3/4) understandable speech
4 yrs old normal devt
alternates feet down stairs, balance on 1 foot, throws ball overhead, copies squares, dressees self, asks ~400 questions/day
5 yr old normal devt
skips, copies triangle, plays cooperatively
1-2 days and 1-2 weeks of age
sickle cell disease
measure hemoglobin electrophoresis (1:2000 births)
measure TSH and/or T4 (1:2500 births)
congenital adrenal hyperplasia
measure 17 and 21 OH Progesterone (1:9000 births)
measure phenylalanine (1:12000 births)
measure galactose (1:23000 births)
Symmetrical light reflex
Symmetrical red reflex
Generally subjective until ~4-5 years of age
Refer to optometry/ophthalmology/pediatric ophthalmology if any concerns.
State of Texas law mandates hearing screening on all neonates.
Follow-up screening is generally subjective.
Refer to audiology if any concerns. American Academy of Pediatrics (AAP) recommends universal hearing screening for all newborns by one month of age.
Hearing screening risk factors
risk of permanent congenital, delayed-onset, or
progressive hearing loss in childhood include:
Family history of permanent childhood hearing loss
Neonatal intensive care unit (NICU) stay
Exchange transfusion for hyperbilirubinemia,
Exposure to ototoxic drugs (e.g. gentamicin) or loop diuretics
Congenital head and neck deformities
Syndromes associated with hearing loss
Congenital or central nervous system infections
Ototoxic drug exposure, including chemotherapy
Anatomic deformities and other disorders that affect Eustachian tube function
Chronic or recurrent otitis media with effusion
syndromes associated with hearing loss
achondroplasia, CHARGE, Craniofacial anomolies, Kartagener syndrome, Klippel-Feil syndrome, Marfan Syndromw, Mucopolysaccharidosis, Hurler, Hunter, Ostegenesis imperfecta, Pierre-Robin, Treacher-Collins, Waardenburg
Hemoglobin/hematocrit evaluation and lead screening begins at 12 months of age.
Lipid panel (cholesterol and triglyceride) is recommended for children at risk for atherosclerosis.
Glucose and HgbA1C screening is recommended for children at risk for diabetes mellitus.
Risk assessment for iron deficiency includes
History of prematurity or low birth weight and
Diet (i.e., not receiving iron-fortified formula).
Risk assessment after 1 year of age includes
Questions about socioeconomic status (particularly children of Mexican American descent)
Limited access to food, diets low in iron (e.g., vegetarian diet)
Exposure to lead and
Excessive menstrual bleeding (for post-menarchal females)
age 12-24 mo, Does your child live in or regularly visit a house or child care facility built before 1950?
Does your child live in or regularly visit a house or child care facility built before 1978 that is being or within the last 6 months has been renovated or remodeled?
Does your child have a sibling or playmate who has or did have lead poisoning?
Does your child play in or put dirt in his/her mouth?
Do you use pottery or ceramic vessels or plates for cooking, eating, or drinking?
Do you live within one block of a freeway?
Has your child ever been to Mexico, Central and/or South America?
Have you ever given your child any culturally recommended home remedies?
Health effects of lead toxicity:acute
potent neurotoxin, cumulative and may be irreversible, encephalopathy
chronic health effects of lead toxicity
High blood lead levels
Tuberculosis risk assessment screening should be performed at 1, 6, 12, 18, and 24 months, and annually thereafter.
However, tuberculosis screening of all patients via a purified protein derivative (PPD) skin test is no longer recommended.
The AAP no longer recommends a screening urinalysis for children.
9 and 18 months, and at 2, 3, and 4 years utilizing
AAP recommends: Routine childhood immunizations
Currently approved child car restraints
Safe hot water temperatures at tap
Window, stairway, swimming pool and Jacuzzi fences/gates/guards
rear-facing car seats: until age 2,
forward-facing car seat with harness should occur after the rider is ≥2 years.
Booster seat: 4'9" tall and between 8-12 years old.
back seat: until 13 yrs
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