1
Q
Vital signs
A
- Pulse: Fast in Newborn and decreases with age Birth ~ 140/min, 1 yr ~ 110/min, 6 years ~ 95/min. Important to know normals to determine tachycardia.
- Respiratory Rate: Newborn: 60/min, 1 year ~ 40/min, 6 years ~ 20/min
2
Q
APGAR Scores
A
- Activity, Pulse, Grimace, Appearance, and Respiration
- Systematic way to assess newborns
- Scored at 1 and 5 minutes (longer if low)
- 1 minute score does not indicate a poor prognosis if 5 minute score is normal
- Good APGAR scores are not a guarantee of a good outcome
3
Q
Vaccinations
A
- at birth: only Hep B vaccine
4
Q
Developmental assessment
A
3 months
- Gross motor: Head up to ninety degrees
- Fine Motor: Grasps rattle
- Language: Laugh
- Social: Smiles spontaneously and responsively
9 months
- Gross motor: pull to stand
- Fine motor: finger grasp
- Language: Dada/mama
- Socia: waves bye-bye
12 months
- Gross motor: walks holding on to furniture
- fine motor: finger feeds
- Language: dada/mama plus other few words
- Social: imitates gestures
2 years
- Gross motor: runs, kicks a ball, carries objects while walking
- Fine motor: scribbles, builds blocks
- Language: 2 to 4 word sentences
- Social: enjoys plauing w other children, demonstrates defiant behaviours
Almost 4
- Gross motor: Hops
- Fine motor: copies a circle, draws a person w 3 parts
- Language: defines 5 words, knows 3 adjectives
- Social: prepares cereal
5
Q
Infant head and neck
A
- Anterior fontanelle: 4 - 6cm at birth closes
- between 4 to 20 months
- Posterior fontanelle: 1-2 cm at birth closed by 2 months
- Sunken fontanelle: dehydration
- Bulging fontanelle: hydrocephalus/tumor/ meningitis
- Fused sutures/premature closure (craniosynostosis)
6
Q
Skin: newborn
A
- Erythema Toxicum: appears 1 to 2 d post-natal and disappears spontaneously
- Milia
- Neonatal Acne Child-
- Eczema (Atopic Dermatitis)
- Tinea (Corporis Capitis)
- Allergy/ Infection
7
Q
Eyes development
A
- Red reflex- absent think of retinoblastoma
- Infants: will open eyes if lights are not two bright
- Tracking to midline
- Visual fields
- Visual acuity At 1 year of age is 20/200)
8
Q
Heart development
A
- Rhythm : Normal Sinus Arrythmia (heart rate increases with inspiration)
- Benign Murmurs:
- Newborn: Closing ductus arteriosus- (disappears after two days)- soft ejection systolic murmur
- School age: Still’s murmur- early/ midsystolic vibratory murmur.
- S3 often heard due to rapid ventricular filling; S4 is abnormal
9
Q
Abdomen
A
- Liver and spleen are palpable in infants and young children
- Other masses: Kidney enlargement, pyloric stenosis, constipation
- Percussion for liver span. May also use the scratch test
- To examine: Hold legs with knees and hips flexed to relax abdomen muscles
- Pyloric stenosis – projectile vomiting, dehydrated, palpable hypertrophied pylorus; usu 1st born male!
10
Q
Tanner stages (male)
A
- Stage 1: preadolescent (9 years and younger)
- Stage 2: sparse hair growth, enlarged testes/scrotum (age 9 to 11)
- Stage 3: more hair/coarser, longer penis, further enlargement of scrotum (age 11 to 12)
- Stage 4: more hair (not yet on thighs) increased breadth and length of glans, scrotal skin darkened (age 12.5 to 14)
- Stage 5: adult but not on ab (age 15+)
11
Q
Tanner stages (female)
A
- Stage 1: preadolescent (10 years and younger)
- Stage 2: sparse growth along labial (age 10 to 11.5)
- Stage 3: darker, coarser hair sparsely over pubic symphysis (age 11.5 to 13)
- Stage 4: darker coarser hair, rhicker not yet on thighs (age 13 to 15)
- Stage 5: adult but not on ab (age 15+)
12
Q
Tanner stages: female development
A
- Tanner 1: nipple elevation only (10 years and younger)
- Tanner 2: breast budding and enlargement of the areola (age 10 to 11.5)
- Tanner 3: elevation of breast contour (age 11.5 to 13)
- Tanner 4: areola and nipple form a secondary mound above the breast (age 13 to 15)
- Tanner 5: mature stage (age 15+)
13
Q
Menarche
A
- usually begins 2 years after thelarche (breast budding) at Tanner stage 3 to 4.
14
Q
Precocious puberty
A
Development of secondary sexual characteristics before
– 8 years in girls
– 9 years in boys
Premature menarche: Before age 10
15
Q
Delayed Puberty/Menarche
A
No signs of development by age
– 13 in girls
– 14 in boys
- Athletes
- Chronic Disease
- Pituitary Tumors
- Hormonal Abnormalities (FSH and LH)
- Chromosomal Abnormailty
– Turner Syndrome (XO)
– Klinefelter’s Syndrome (XXY)
16
Q
Ortolani’s test
A
- indicates hip IS dislocated
- Palpable (click) of femoral head gliding in and out of acetabulum
- Reduction of a dislocated femoral head
17
Q
Barlow’s test
A
- indicates hip can be passively dislocated
- Hip is flexed, thigh adducted while pushing posteriorly causing femoral head to dislocate posteriorly
- Dislocation is palpable as femoral head slips out of acetabulum
CPD F2014
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