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Opisthotonic "Death pose" - hyperextension, spasticity; ween in CNS Infection, tetanus, phenothiazide intoxication
weak cry seriously ill child
hoarse cry laryngitis, epiglottis, foreign body, croup
high pitched cry increased intracranial pressure
moaning cry meningitis, toxic infant; **ER
Grunting cry respiratory distress & heart failure; pneumonia; intestinal obstruction, sickle cell, skull fx, intussusception
infrequent cry mental retardation, downs syndrome, hypothyoidism
excessive cry colic, parental anxiety, maladjustment
how often do they cry an hour? 10-15min
how often do they cry in a day 2.5 hrs
colic rule of threes
colic onset/duration begins at 3 weeks of age, stops at 3 months
colic presentation cry 3 hrs of nonstop crying at lease 3 days per week
folic acid deficiency increases neural tube defects
bioenvironmental factors drugs, alcohol, diet, heat
bioenvironmental factor histone modifications
histone modifications opens DNA making it available to turn genes on or off; only occurs at cytosine/guanosine locations
socioenvironmental emotional/sensory deprivation may lead to decreased intellectual development
which motor skills correlate with intelligence fine, not gross motor
"normal" within 2 std dev of the mean of the population studied**
weight doubles by 3-5 months
weight triples by 1 year
breast fed babies 1st month gain very rapidly
breast fed babies 6th month slowed weight gain
do large babies follow the standard weight gains no
which is the most important measurement HC
HC during first 3 months increases by 2cm/month
HC during months 3-6 increases by 1 cm/month
HC during 2nd half of the first year increases by 0.5cm/month
If baby starts with 13cm head, what will it be when the baby is 8 months? 23 cm
when does the skull stop growing? when the fontanelles close
when does the posterior fontanelle close by 3-4months
when does the anterior fontanelle close by 12-15 months
Length during 1st 3 months increases 2in/month
length during months 3-6 increases by 1 in/month
length during 2nd half of 1st yr increases by 0.5in/month
what will the length of a 10 month old be if he started at 17inches? 28 inches
growth rate of 1st year of life grow about half the birth length
growth rate of 2nd year of life grow half the 1st year
growth rate of 3rd year of life grow half the 2nd year
growth rate of 4th year to puberty same as 3rd year of life
growth of 1st yr of life about 10 in
growth of 2nd yr of life grow 5 in
growth of 3rd yr of life grow 2.5 in
growth of 4th yr to puberty grow about 2.5 in per year
predicted girl height - double at 2 yrs
predicted boy height - double at 18 months
moro reflex primary
moro reflex startle; eyes open, fingers spread and cry
moro disappears by 5-6 months
rooting reflex primary
rooting stroke mouth and turns head toward the stroked side
rooting disappears by 9months
palmar grasp primary
asymmetric tonic neck primary
palmar grasp hand in palm or sole of foot and baby closes around it
palmar grasp disappears by 5 months
asymmetric tonic neck baby looks right, right arm sticks out and cant roll over
asymmetric tonic neck disappears by 9 months
babinski reflex disappears by 2 yrs
neck righting secondary
parachute secondary
neck righting while supine, baby rotates trunk in the direction in which the head is turned to roll onto stomach
parachute anterior 1st, then lateral then posterior parachute develops
anterior parachute develops at 4-5 months
anterior parachute can sit like gorilla with arms out but only until turns head and then falls over because no lateral parachute yet
6-17 weeks holds head up
2-5 months rolls over
which way to roll over is better front to back
5-8 months sits unsupported
5-10 months stands
7-10 months creeps
11-15 months walks unassisted
24-30 months toilet trained
4 months reaches for object
7 months transfers object hand to hand
9-10 months thumbs and finger grasp (pincer)
begins by 12 months and all by 18 scribbles spontaneously
9-13 months 1st word
14-24 months 1st phrase
18-30 months 1st sentence
1 month begins to mimic your mouth movements
3-6 months babbling
9 months babbling sounds like a language
12 months has own jargon, gestures, understands simple phrases like no, bye, bottle
18 months uses 6 meaningful words
18 months follows 1 step commands
24 months 50 word vocab
24 months uses simple 2 word phrases
24 months uses negative and possessives
24 months points to body parts
30-36 months names pictures
30-36 months follows 2 step commands
36 months uses 4 word sentences
36 months asks questions
36 months uses past and future tenses
48 months uses full sentences and has adult grammar
48 months differentiates and answers simple question
rear facing car seat until 3 yrs
booster seat if after 7 years and still under 4ft 9 in
allowed to sit in front of car 13 yrs
2nd overall cause of unintentional death drowning
drowning peaks in preschool and ten years
infants drown in bath tubs
preschoolers drown in swimming pools
preteens/adolescents drown in natural bodies of water
cause of death due to fire due to smoke inhalation or asphyxiation
suicide 1 million children come home to a loaded gun unsupervised
highest suicide rates race american indians
1st cause of death in <1yr inhalation/ aspiration
2nd cause of death in <1 mechanical suffocation
3rd cause of death in <1 MVA
1st cause of death in preschool 1-4 MVA
2nd cause of death in preschool 1-4 drowning
3rd cause of death in preschool 1-4 fire and burns
1st cause of death in school age MVA
2nd cause of death in school age drowning
3rd cause of death in school age fire and burns (5-9)
4th cause of death in school age firearms & homicide (10-14)
1st cause of death in teens MVA
2nd cause of death in teens firearms and homicide
3rd cause of death in teens suicide
hot water temp should be 120 degrees
embryonic phase 8-12 weeks of growth (gestation)
fetal phase last 2 trimesters
circulatory development begins at 4 weeks gestation
circulatory development attains final form at 8-12 weeks gestation
1st blood forming organ connective tissue (then liver, spleen & bone marrow)
Fetal Hb at birth 80%
fetal Hb at 20 weeks old 5%
all primordial upper airway present 5-6 weeks gestation
surfactant production begins 22-24 weeks gestation
lung maturity permits survival 27-28 weeks
bile formation & digestive enzymes 12 weeks gestation
swallowing movements begin 14 weeks gestation
meconium formation seen 16 weeks gestation
weak active sucking & swallowing 28-29 weeks gestation
neural tube development 4 weeks gestation
cerebral hemispheres and ventricle form 8-12 weeks gestation
palms and soles become reflexogenic 9 weeks gestation
fetal movement aware to mom 13-14 weeks gestation
fetal activity decreases & sluggish until birth 15-16 weeks gestation
frontal, temporal, parietal, occipatal lobe development 16 weeks gestation
grasp reflex formed 17 weeks gestation
moro response begins 25 weeks gestation
risk autism advanced paternal age
risk schizophrenia advanced paternal age
risk achondroplasia advanced paternal age
risk neurofibromatosis advanced paternal age
risk marfan syndrome advance paternal age
risk hemophilia A & b advanced paternal age
risk deuschends muscular dystrophy advanced paternal age
risk neural tube defects obese mother
risk ASD, VSD, cardiac abnormalities obese mother
risk cleft lip obese mother
risk anal rectal atresia obese mother
risk limb abnormalities obese mom
risk hydrocephalis obese mom
risk neural tube defects diabetic mom
diabetic mom inhibits PAX3 gene
diabetic mom large babies
risk asthma AA mom who takes alot of acetaminophen during preg
risk ADHD smoking mom
risk ADHD mercury
TORCH toxoplasmosis, other, rubella, cytomegalovirus, herpes
risk of Type II DM & obesity smoking mom
PROM premature rupture of membranes
when is a baby considered infected? if PROM for >24 hrs
C section if <39 weeks, increase risk of resp distress, infection, neonatal unit admission
toxemia may lead to HTN and proteinuria - at risk for seizures
When do you do APGAR score at 1 min and 5 min after delivery
A appearance
p pulse
g grimace
a activity
r respirations
blue pale appearance 0
body pink extremity blue 1
all pink appearance 2
absent pulse 0
<100 bpm, irreg 1
>100 2
normal HR 140
no grimace to nasal catheter 0
grimace to nasal catheter 1
sneeze to nasal catheter 2
limp tome 0
some tome 1
active motion 2
absent respirations 0
slow gasping 1
good cry 2
If APGAR almost all 1s, score is 5
premature delivered normally
premature develop on time for age
small for gest age never catch up while developing
small for gest age big head
risk for small for gest age HTN mom
risk for small for gest age smoking mom
small for gest age vasoconstriction from old mom with HTN or smoking cause decrease blood flow and decrease nutrition
large for gest age very sick
large for gest age needs to be on monitors, nasal O2 and IV
large for gest age when cord cut, cuts off sugar supply but baby has too much insulin and seizes
post mature decreased subcutaneous tissue, dry baby due to low nutrition due to placenta quitting
Skin exam color, rashes, nevi
hemangiomas most not present at birth
sucking baby eyes open!
epicanthal folds (nasal side) - seen in Downs Syndrome
Conjunctivitis on day 1 m/c cause chemical (due to silver nitrates on skin around eye)
conjunctivitis on day 2 m/c cause gonorrhea
conjunctivitis on day 3 or later due to chlamydia **watch out for pneumonia!
Head exam shape, fontanelles, swelling, lesions, face
frontal bossing prominence of frontal bones seen with congenital syphilis
cephalohematoma blood between the skull and periosteum - at risk for jaundice
caput succadeneum fluid extraperiosteal below scalp and above periosteum
unilateral lacrimal duct obstruction another cause of conjunctivities
what happens if pressure at inner canthus doesnt open lacrimal duct and the baby is <1 yr? the optho will not probe it because too young
mouth exam palate, tongue, ebsteins pearls, supernummerary teeth
palate feel to make sure its intact - may have submucosal cleft
submucosal cleft looks intact but isnt and will create speech problemes
high arched palates associated with developmental and congenital anomalies
ebsteins pearls occlusion cysts midline palate or on gum, look like teeth, benign, rupture and go away
supernummerary teeth babys permanent teeth - no problem
neck exam masses, sinus tracts, clavicles
clavicle fractures many miss this! palpate for crepitus, heal spontaneously
masses SCM lesions, branchial cleft rests; goiter - mom may be hypothyroidism
cystic hygroma seen laterally
sinus tracts remnants of fetal development - dont cause major problems
thyroglossal ducts normally travels down but may not finish and may find mass/ draining sinus midline - dont remove until you know if it is the thyroid since they are small in newborns!
newborn breast engorgement may leak milk as mom breast feeds - normal due to moms hormones
normal resp rate of newborn 40
tachypnea of newborn >60
Only congenital anomaly you can rule out with a stethoscope coarctation of aorta
coarctation of aorta decreased pules in LE femoral pulses
Umbilicus vessels 3
umbilical arteries 2
umbilical veins 1
umbilical artery carries blood to placenta
umbilical vein carries O2 blood to fetus!
single umbilical artery possible malformation in Cardiovascular, CNS, GI, Renal, Karyotypic syndromes
Male genital exam make sure testes are down, look for hydrocele, hernia, hypospadius
hypospadius opening of urethra is any place other than tip; if severe, cant have circumscision because you need the skin to repair it
female genital exam normal to have mucoid or bloody discharge in breast fed babies due to maternal hormones
Back exam look for any skin abnormality overlying the cord because the skin and NS are derived from the same germ layer (neurocutaneous disorders)
hips dislocation, especially in breech deliveries - make sure you call it developmental dysplasia of hips (not congenital dislocation of hips because not always found at birth)
m/c finding with dysplastic hip abduction
Galazzi sign knees bent with feet on mattress - is one knee higher than the other? the lower knee is the subluxed hip
barlow maneuver attempt to dislocate the hip - you abduct and push up and feel it slip out the glenoid
ortolani sign when you bring the leg back down and hear the thud when it goes back - relocating the hip
developmental dysplasia of hips evaluate the hips every visit until they walk
when will the cord fall off around? 2-6 weeks
bowel movements normal can be 7/8 per day due to gastrocolic reflex or 1 per week when breast feeding because it is mostly water
baby doesnt cry because has gas passing gas because right before they cry they take a deep breath in and bear down
when do you do a spinal tap and check for sepsis? if baby is <1 month and has 101 F; <2 months and has 102 F; <3 months and has 103 F
elevated bili 1.increased production - due to increased hemolysis 2.impaired handling - due to immaturity or liver disease 3.increased reabsorption from intestine
Normal adult Hb 12-15
normal baby Hb 20 HbF (more Hb) because placental O2 is lower therefore once born, air O2 is higher and they break down the extra blood
septic jaundice high direct bili
polycythemia due to delayed cord clamping (increases blood volume) can cause jaundice
Jaundice of term infants begins 2-3 days and gone by day 7
premies jaundice begins day 4-5 and gone by day 14
c-section <38 weeks increase bili and jaundice because more immature liver
when do we worry about bili? if it rises >7mg/day, >12mg by 48 hrs or >15 by 72 hours
Jaundice starts at head and works down so check soles to see how far along they are
kernicteris yellow staining of brain
high direct bili very bad!
high direct bili caused by sepsis, infection, hemolytic disease, cystic fibrosis
Increased indirect bili most are fine; it is physiologic but look at Coombs test
Coombs test isoimmunization; if positive have Rh or ABO incompatablility
ABO incompatability mom is O because has anti a and anti b and baby is either a or b
If coombs was negative measure Hb next - if Hb high, baby is polycythemic (tomato)
causes of high Hb twin transfusion, maternal-fetal transfusion, delayed cord clamping, small for gest age
If Hb low look at reticulocyte count - if normal, there is nothing wrong with the RBC and high bili due to cephalohematoma, high enterohepatic circulation, infreq stool, bowel obstr, neonatal asphyxia (no heart beat)
If reticulcytes high ask hematologist to look at smear
characteristic smear cells spherocytosis (abnormal, rupture in spleen)
how is spherocytosis dx? family hx of anemia
nonspecific smear cells G6PD deficiency (causing the increased indirect bili)
risks for hyperbili -born before 38 wks -sibling w/jaundice -mother exclusively breastfeeding - causes excess hormones to be metabolized by immature liver -visibly jaundice at <24 hrs
risk for hypoglycemia small for gest age
risk for hypoglycemia diabetic moms
risk for hypoglycemia premie, postmatures, stressed infants
hypoglycemia symptoms may be asymptomatic
lumbar puncture differentiates between sepsis and meningitis
transplacental bacterial infections syphilis, lyme, TORCH
m/c cause of cerebral palsy maternal infections while preg due to cytokines
number 1 etiology of sepsis group B strep (women are colonized in vag flora)
early onset sepsis types I and II; prevented by IV ABX to mom & screenings
late onset sepsis type III; presents as pneumonia and you die
respiratory distress syndrome most freq cause of resp distress in newborn; results from lack of surfactant
xray of respiratory distress syndrome ground glass appearance
tx resp distress syndrome tx like baby has GroupB strep because the xray looks the same
most common pneumonia Group B strep
Crack/cocaine use 3rd leading cause of birth defects assoc with mental retardation
Crack cocaine use clinical findings microcephaly, short palpebral fissures, flat philtrum, thin vermillian border, migcrognathia, low set ears
crack cocaine assoc findings intrauterine growth retardation, prematurity, lethargic, hypertonic, tremors,increased CNS injuries
Heroin&Methadone infants go through withdrawal; with methadone symptoms are more severe and longer - irritable, tremors, seizures, high-pitched cry
barbiturates symptoms delayed; due to the slow metabolism & excretion by the immature liver
opiods increased risk for resp distress & seizures
leading cause of death in 1st yr of life after newborn period SIDS; most common between 2-6mos
cows milk based formula brands enfamil, similac, goodstart
cows milk based formula protein source skim milk (cow)
cows milk based formula fat source soy, coconut, safflower oils
cows milk based formula carb source lactose
Lactose the sugar in breastmilk is lactose so you cant be lactose intolerant at birth
1 kg 2.2lbs
1 meter 39.37 in
greatest factor correlating with the development of obesity presence of a TV in a childs bedroom
marasmus severe state of caloric deprivation
marasmus exam failure to gain weight; distended or flat ab, muscle atrophy, hypotonia, edema, hypothermia
kwashiorkor inadequate protein intake with almost normal caloric intake
kwashiorkor exam **edema, diarrhea -lethargy, hyperactivity, distended ab, skin rash, decrease hair coloration, anemia
most common type of dehydrations isotonic dehydration
mild dehydration 3-5%
dont look sick mild dehydration
normal physical mild dehydration
normal or increased pulse mild dehydration
increased thirst mild dehydration
decreased urine output mild dehydration
moderate dehydration 7-10%
tachycardia mod dehyd
little to no urine output mod dehyd
irritable or lethargic mod dehyd
sunken eyes mod dehyd
depressed anterior fontanelle mod dehyd
decreased tears, dry mucous membranes mod dehyd
mild loss of skin turgor, delayed cap fill, skin cool and pale mod dehyd
severe dehydration 10-15%
rapid weak pulse sev dehyd
low BP sev dehyd
no urine output sev dehyd
very sunken eyes, markedly sunken anterior fontanelle sev dehyd
absence of tears, parched & dry mucous membranes sev dehyd
marked loss of skin turgor, very delayed cap refill, skin cold & mottled sev dehyd
shock >15%
to restore shock/sever dehydration blood volume 20 ml/kg every 20 min until bp normal
hypertonic dehydration deficit over 48hrs Na 158-170
hypertonic dehydration deficit over 72 hrs Na 171-183
hypertonic dehydration deficit over 96 hrs Na181-196
hypertonic dehydration maintenance keep same
renal failure/no urine output deficit remains same
maintenance is oliguric half normal maintenance
K replacement cant give until urine output has been established
m/c cause cerebral palsy outside of the neonatal period head injuries secondary to abuse
2-3 yr old sexual abuse if play takes on aspects of shame, secrecy and obsession
3-4 yr old sexual abuse if have a clear focus on sexual intercourse red flag
masturbation normal in 2-4 yrs
5-9 yr old sex abuse red flag if sex play with different ages, or includes force, threats, harm or secrecy
parvovirus 19 5th disease
RNA virus rubeola
rubeola measles
rna virus rubella
rubella german measles
RNA virus - paramyxovirus mumps
GAS scarlet fever
GAS bacterial pharyngitis/tonsilitis
GBS meningitis <2yrs
pseudomonas otitis externa
viral disease sinusitis
adenovirus pink eye
adenovirus parhyngitis/tonsilitis
s. aureus periorbital cellulitis
s. aureus osteomyelitis
s. aureus septic arthritis
s. pneumoniae meningitis >2yrs
s. pneumoniae bacterial sinusitis
s. pneumoniae acute otitis media
eustacian tube dysfunction/allergies otitis media w/effusion
Created by: jjohrden16