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Well Child for PAs


parent discussion, developmental assessment, physical exam, screening tests, immunizations, anticipatory guidance goals of the well child visit
frequency of the well child visit irth, within the first week of birth, then months 1,2,4,6,9,12,15,18,24,30 then annually for years 3 to 18
What are the consequences of poor parent/child interactions? Developmental delays, language delays, hearing deficits, and parental detachment may stem from maternal depression or inadequate social support. Inappropriate parental discipline or “difficult temperament” may indicate risk for abuse or neglect.
What patient population is easier to examine after meals? Infants
What technique is helpful for examining a child? First examine the child's toy, then the child.
When does the order of examination begin to follow that used for adults? Late childhood.
How old should a child be before standing for measurement instead of supine on a measuring board? 2 years
How long should you follow a child's head circumference? 24 mo unless a genetic or CNS disorder is suspected
Why take serial measurements of somatic growth during childhood? detect growth abnormalities, differentiate endocrine disorder causes of short stature, eval caloric intake, detect exogenous obesity
When should head circumference be taken? Throughout the first two years of life
When does the anterior fontanelle close? between 4 and 26 mo, but most close between 7-19 mo
How large is the anterior fontanelle at birth? 4 to 6 cm
How large is the posterior fontanelle at birth? 1 to 2 cm
When does the posterior fontanelle close? by 2 mo old
When should you begin to measure a child's BP? 3 years old
How do you measure visual acuity in infancy? check for red reflex, rotate baby and look for eye deviation in the direction you are turning as well as, upon stopping, a few nystagmoid movements and deviation to the opposite side.
How do you measure visual acuity in early childhood? use an eye chart with symbols or characters
How do you measure visual acuity in late childhood? same as an adult
When does visual acuity reach the adult level? Less than 4 years
What is the most common cause of amblyopia? refractive errors or poor transmission from image to brain caused by disuse
Define amblyopia. the loss of one eye's ability to see details
misalignment of the eyes strabismus
Name two methods to test for strabismus corneal light reflex test, cover uncover
How should you examine an infant's ears? in the parent's lap, pull the auricle down
How should yo examine a child's ears? sitting or lying down, pull the auricle down
Why insufflate on ear examination for infants or children? assess for TM movement that will be absent with an inner ear effusion
Why screen hearing for children? prevent speech delays
How prevalent is hearing loss in children? up to 15% have mild hearing loss
If a child is reluctant to open their mouth for an exam, what techniques should be employed? -may want to leave this part to the end of the exam, don't show a tongue blade necessary, demonstrate on an older sibling, may need to have parent restrain the child, slip tongue depressor between teeth and elicit a gag reflex
What should one look for on genitalia and rectal exams on boys? Hernias
What should one look for on genitalia and rectal exams on girls? intact hymen
Why is congenital hip dysplasia is important to detect? early treatment has excellent outcomes
What is the Ortolani test for? posterior hip displacement
Wha is the Barlow test for? hip laxity from hip dysplasia
How do you test for hip problems in children? have the child stand straight and palpate the iliac crests from behind, and compare to make sure they are even
what is a positive Trendelenberg's sign? the pelvis does not remain level when the child shifts weight from one leg to the other, this indicates severe hip dz
Name the four domains of the Denver developmental screening test gross motor, personal-social, fine-motor adaptive, language
What are the two types of speech disorders? expressive and receptive
Why is it important to detect growth or developmental disorders at young age? can result in improved health outcomes for decades, and deviations can be important indicators for serious and chronic medical disorders
T or F- a child should be encouraged to "think about what they have done" in timeout. F- timeout is simply a punishment
Name some sources of lead for lead poisoning in children. Paint in buildings before 1960, hobbies, environment (living near a lead smelter, battery recycling plant, radiator repair shop), home remedies, foreign pottery
developmental red flags include <5th percentiles in height, weight, head circumference, discrepant percentiles, declining percentiles
<5th percentile could mean: familial short stature, constitutional short stature, intrauterine insult, genetic abnormality
discrepant percentiles could mean normal familial variant, endocrine growth factors, caloric insufficiency
declining percentiles could mean catch down growth
key assessment of the newborn immediately after birth. Apgar score
estimates gestational age to within 2 weeks, even in extremely premature infants. Ballard Scoring System
An increasing weight percentile in the face of a falling height percentile suggests hypothyroidism. hypothyroidism
head circumference is at less than the 3rd percentile A child is considered microcephalic
the weight percentile falls first, then the height, and finally the head circumference When caloric intake is inadequate
Created by: cwyatt13
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