Terms in this set (89)
HPV vaccine scheduleFirst dose: 11-12 yearsMeningococcal vaccine scheduleFirst dose: 11-12 years; second dose: 16 yearsBreastfeeding maternal contraindications-HIV, human T cell lymphotropic virus I or II -Active TB (safe after 14 days tx) -Herpes lesions on nipple -Active varicella (VZIG to infant; feed when no breast lesions and no longer contagious) -Drugs of abuse and alcohol abuse -Maternal medications (few)Breastfeeding infant contraindications-Galactosemia and tyrosinemia -PKUFEE breastfeeding signs for successFrequent: 7-10x/24 hours; full and satisfied; soft breasts after Effective: swallowing; 1 void and stool per day of age; yellow stool by 4-6 days; weight loss then gain; 15-30 g/day; back to birth weight by 14 days Exclusive: avoid formulaSupplementation in breastfeeding jaundice-Rarely (first choice is expressed milk) -Poor intake despite intervention -Bili levels >20-25 -Diagnostic interruption of breastfeeding may be helpfulPhysiological jaundice-after 24 hours and up to 2 weeks -caused by ABO/Rh incompatibility, breastfeeding, asian, dehydration, G6PDPathological jaundice-occurs before 24 hours -anatomy (liver) or infection (GBS) -levels increase rapidlyInfant length growth-Average at birth: 50cm or 20 in -Increases 2.5 cm or 1 in monthly during first 6 mo -Average at 6 mo: 65 cm or 26 in -Increases by 50% at 1 year old (avg: 72 cm or 29 in) -Doubles by 4 years -Triples by 13 years -Average yearly growth is 5cm or 2inInfant head circumference-1.5 cm per month for first 6 mo -0.5 cm per month for months 6-12 -Average: 43 cm at 6 mo and 46 cm at 12 mo -33% increase from birth to 12 moInfant chest circumference-2 cm at birth; smaller than head -Equal to head circ at 12 moInfant weight gain-5-7 oz weekly for first 6 mo -Birth weight doubles by 6 mo -Birth weight triples by 12 mo (9.75 kg or 21.5 lbs) -Birth weight quadruples by 24 moPotty training-Should be complete by 4 years -Average 2.5-3.5 yearsPotty training readiness cues-Wakes up from naps dry -Dry for 2 hours -States urge to void/stool -Desire to be clean/dry -Follows directions -Parents ready2 month social development-smiles responsively -makes sounds that show happiness/upset2 month gross motor development-lifts head and chest while prone -holds head up but forward while sitting2 month fine motor development-hands frequently open -briefly brings hands together2 month language development-makes short cooing sounds4 month social development-laughs -looks for parent or caregiver when upset4 month language development-turns to voices -makes extended cooing sounds4 month gross motor development-supports self on elbows and wrists when prone -rolls over from stomach to back4 month fine motor development-keeps hands unfisted -plays with fingers in midline -grasps objects6 month social development-pats or smiles at own reflection -looks when name is called6 month language development-babbles -makes sounds like ga ma or ba6 month gross motor development-rolls over from back to stomach -sits briefly without support6 month fine motor development-passes a toy from one hand to another -rakes small objects with 4 fingers -bangs small objects on surface9 month social development-uses basic gestures (holding arms out to be picked up, waving bye bye) -looks for dropped objects -plays peekaboo and pat-a-cake -turns consistently when name called9 month language development-says dada or mama nonspecifically -looks around when hearing "where's your" -copies sounds that parent makes9 month gross motor development-sits well without support -pulls to stand; transitions well between sitting and lying -crawls on hands and knees9 month fine motor development-picks up food to eat -picks up small objects with 3 fingers and thumb -lets go of objects intentionally -bangs objects together12 month social development-looks for hidden objects -imitates new gestures12 month language development-uses dada or mama specifically -uses 1 word other than names -follows directions with gestures12 month gross motor development-takes first independent steps -stands without support12 month fine motor development-drops an object in a cup -picks up small object with 2 finger pincer grasp -picks up food to eat15 month social development-imitates scribbling -drinks from cup with little spilling -points to ask for something -looks around after hearing "wheres your"15 month language development-uses 3 words other than names -speaks in sounds like an unknown language -follows directions that do not include a gesture15 month gross motor development-squats to pick up objects -crawls up a few steps -runs15 month fine motor development-makes marks with crayon -drops object in and takes object out from container18 month social development-engages with others for play -helps dress and undress self -points to pictures in book or object to draw parent attention to it -turns and looks at adult if something new happens -begins to scoop with spoon -uses words to ask for help18 month language development-identifies at least 2 body parts -names at least 5 familiar objects18 month gross motor development-walks up steps with 2 feet per step with hand held -sits in small chair -carries toy while walking18 month fine motor development-scribbles spontaneously -throws a small ball a few feet while standing2 year old social development-plays alongside other children (parallel) -takes off some clothing -scoops well with spoon2 year old language development-uses 50 words -combines 2 words into short phrase -follows 2 step command -names at least 5 body parts -speaks in words 50% understandable to strangers2 year old gross motor development-kicks a ball -jumps off ground with two feet2 year old fine motor development-stacks objects, turns book pages -uses hands to turn objects -draws lines3 year old social development-potty trained -dresses self -eats independently -engages in imaginative play -cooperative play and sharing3 year old language development-uses 3 word phrases -speaks in words 75% understandable to strangers -tells a story -compares things (bigger/shorter) -understands simple prepositions (on/under)3 year old gross motor development-pedals a tricycle -climbs on and off couch or chair -jumps forward3 year old fine motor development-draws a single circle -draws a person with head and 1 other body part -cuts with child scissors4 year old social development-potty trained -brushes teeth -dresses and undresses self -engages in imaginative play4 year old language development-answers questions -uses 4 word sentences -speaks in words 100% understandable -draws recognizable pictures -follows simple rules when playing -tells a story from book4 year old gross motor development-skips on 1 foot -climbs stairs, alternating feet without support4 year old fine motor development-draws a person with at least 3 body parts -draws simple cross -unbuttons and buttons -grasps pencil with thumb and fingers instead of fist5 year old development-balances on one foot -hops and skips -able to tie a knot -can draw person with at least 6 body parts -prints some letters/numbers -able to copy squares and triangles -good articulation/language skills -can count to ten -can name four or more colors -follow simple directions -dresses with minimal assistanceAtopic dermatitis-erythematous salmon colored patches -cheeks, AC, popliteal fossa -genetic and environmentAtopic dermatitis treatment-bath daily -gentle soap -moisturizer -topical steroids -manage infectionsInfantile hemangioma-benign vascular tumor -grow first year -90% involuted by age 9 -observe, topical propranolol and/or topical steroid -oral propranololMolluscum contagiousum-poxvirus infection -small "waxy" dome shaped flesh colored papules with umbilicated core -observe in 9mo-1 year -tea tree oil, apple cider vinegar, zymaderm and canthiridinAcne-abnormal keratinization -sebum overproduction -bacteria and inflammationAcne treatment-retinoid -BP and retinoid or topical abx -triple therapy: BP and retinoid and topical abx -BP and retinoid and oral abxVerruca vulgaris-exophytic papules with black dot appearance -HPV -resolve within 2 years -salicylic acid and duct tape occlusion -cryotherapyTinea capitis-dermatophytosis affecting scalp -Trichophyton tonsurans -patchy alopecia with scaling and/or erythema or pruritis, may have black dot appearance -systemic management -griseofulvin or terbinifine in children >4 -complications: kerion - fluctuant erythematous plaque often with crust and dischargeImpetigo-staph aureus, GABHS, or both -non bullous: papules or pustules which may evolve into thin walled vesicles -bullous: evolve into vesicles and then larger thin walled bullae with clear to purulent fluid -classic honey colored crust -localized: mupirocin ointment tid x10 days -oral abxHead lice-pediculosis capitis -die within 2-3 days if they don't feed -do not hop or fly -treat and retreat in 7-9 days -permethrin age >2 mo, leave on scalp for 10 min -laundry or seal in plastic bag for 2 weeks -nit removal with fine tooth comb after treatmentMeasles-droplet or airborne transmission -contagious 4 days before and up to 4 days after rash -comp: PNA, bronchitis, gastroenteritis, OM, myocarditis, encephalitis -3 Cs: cough, coryza, conjunctivitis -rash begins on face/behind ears and spreads to trunk/extremities -pink papules and blotchy blanchable macules and patches -koplik spotsRubella-German measles/3 day measles -erythematous rose pink macules and papules -comp: encephalitis, myocarditis, anemia, neutropenia, thrombocytopenia -congenital rubella syndrome -no school for 7 days after rash onset, avoid pregnant womenScarlatina-GABHS -fine rough textured sandpaper like blanchable papules -sore throat, strawberry tongue, petechial macules on palate -comp: rheumatic fever, PNA, pericarditis, meningitis, glomerulonephritis -treatment of GABHS -return to school 24 hrs after abxErythema infectiousum-fifth disease -human parvovirus B19 -prodrome usually absent -slapped cheek appearance -reticular lacey maculopapules on extensor surfaces/trunk with reactivation -not infectious rash onsetRoseola infantum-sixth disease -human herpes virus 6 -high fever (101-105) in otherwise well infant -sudden rash with defervescence -rose pink macules and papules with characteristic faint halo of blanching -trunk and spread to neck and extremitiesHand foot mouth-coxsackie virus A16 -painful vesicles on buccal mucosa and tongue -deep vesiculopustules with gray to white color, surrounded by erythema -return to school after resolution of lesionsVaricella-pruritis rash beginning on trunk as macules evolving to papules and vesicles progressing to face and head -dew drop on a rose petal in different stages of healing -appear as 3 crops on 3 consecutive days -return to school when all lesions are crusted overLyme disease-spirochete borrelia burgdorferi -erythema migrans -comp: neurologic symptoms, arthritis, meningitis, heart block -stage 1: early localized with flu-like s/s and rash -stage 2: early disseminated -stage 3: late disease -doxy 4 mg/kg/d divided bid up to 100 mg bid x3-4 weeks (>8yo)Rocky mountain spotted fever-rickettsia rickettsii -faint macules on wrist/ankles spreading centrally and becoming petechial -pearls: sudden severe HA unrelieved by analgesics with myalgias (calf/thigh) -treat promptly with doxyNightmares-3-6 years -REM sleep -late at night -upset/scared on waking -consolable to parents -difficult to return to sleep -vivid memory of eventNight terrors-4-8 years -NREM sleep -early in night -disoriented on waking -unaware of parents -easy/rapid return to sleep -no memory of eventPuberty in females-thelarche ~10 years -pubic hair 6 months after thelarche -rapid linear growth and peak height 1 year after thelarche -menarche typically 2.5 years after thelarchePuberty in males-testicular enlargement ~11 years -rapid linear growth and peak hight ~12-16 -spermarche typically 2.5 years after testicular enlargement ~13.5 -facial hair in tanner IVADHD DSM5-symptoms present before age 12 -symptoms present in two or more settings -symptoms interfere with or reduce quality of social, school, or work functioning
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