Sudden Infant Death Syndrome - SIDS Pediatrics
The Hospitalized Child Video Lecture
Saturday, January 31, 2009
Power Point Downloads
Download the power point lecture notes to see pictures thet'll re-enforce information.
Growth and Development
Pediatric Physical Assessment
Advanced Orthopedic Physical Assessment
Immunizations / communicable diseases:
Child Abuse
Pediatric Cardiac Lecture
Growth and Development
Pediatric Physical Assessment
Advanced Orthopedic Physical Assessment
Immunizations / communicable diseases:
Child Abuse
Pediatric Cardiac Lecture
Erikson's Eight Stages of Development
1. Learning Basic Trust Versus Basic Mistrust (Hope)Chronologically, this is the period of infancy through the first one or two years of life. The child, well - handled, nurtured, and loved, develops trust and security and a basic optimism. Badly handled, he becomes insecure and mistrustful.
2. Learning Autonomy Versus Shame (Will)The second psychosocial crisis, Erikson believes, occurs during early childhood, probably between about 18 months or 2 years and 3½ to 4 years of age. The "well - parented" child emerges from this stage sure of himself, elated with his new found control, and proud rather than ashamed. Autonomy is not, however, entirely synonymous with assured self - possession, initiative, and independence but, at least for children in the early part of this psychosocial crisis, includes stormy self - will, tantrums, stubbornness, and negativism. For example, one sees may 2 year olds resolutely folding their arms to prevent their mothers from holding their hands as they cross the street. Also, the sound of "NO" rings through the house or the grocery store.
3. Learning Initiative Versus Guilt (Purpose)Erikson believes that this third psychosocial crisis occurs during what he calls the "play age," or the later preschool years (from about 3½ to, in the United States culture, entry into formal school). During it, the healthily developing child learns: (1) to imagine, to broaden his skills through active play of all sorts, including fantasy (2) to cooperate with others (3) to lead as well as to follow. Immobilized by guilt, he is: (1) fearful (2) hangs on the fringes of groups (3) continues to depend unduly on adults and (4) is restricted both in the development of play skills and in imagination.
4. Industry Versus Inferiority (Competence)Erikson believes that the fourth psychosocial crisis is handled, for better or worse, during what he calls the "school age," presumably up to and possibly including some of junior high school. Here the child learns to master the more formal skills of life: (1) relating with peers according to rules (2) progressing from free play to play that may be elaborately structured by rules and may demand formal teamwork, such as baseball and (3) mastering social studies, reading, arithmetic. Homework is a necessity, and the need for self-discipline increases yearly. The child who, because of his successive and successful resolutions of earlier psychosocial crisis, is trusting, autonomous, and full of initiative will learn easily enough to be industrious. However, the mistrusting child will doubt the future. The shame - and guilt-filled child will experience defeat and inferiority.
5. Learning Identity Versus Identity Diffusion (Fidelity)During the fifth psychosocial crisis (adolescence, from about 13 or 14 to about 20) the child, now an adolescent, learns how to answer satisfactorily and happily the question of "Who am I?" But even the best - adjusted of adolescents experiences some role identity diffusion: most boys and probably most girls experiment with minor delinquency; rebellion flourishes; self - doubts flood the youngster, and so on.
Erikson believes that during successful early adolescence, mature time perspective is developed; the young person acquires self-certainty as opposed to self-consciousness and self-doubt. He comes to experiment with different - usually constructive - roles rather than adopting a "negative identity" (such as delinquency). He actually anticipates achievement, and achieves, rather than being "paralyzed" by feelings of inferiority or by an inadequate time perspective. In later adolescence, clear sexual identity - manhood or womanhood - is established. The adolescent seeks leadership (someone to inspire him), and gradually develops a set of ideals (socially congruent and desirable, in the case of the successful adolescent). Erikson believes that, in our culture, adolescence affords a "psychosocial moratorium," particularly for middle - and upper-class American children. They do not yet have to "play for keeps," but can experiment, trying various roles, and thus hopefully find the one most suitable for them.
6. Learning Intimacy Versus Isolation (Love)The successful young adult, for the first time, can experience true intimacy - the sort of intimacy that makes possible good marriage or a genuine and enduring friendship.
7. Learning Generativity Versus Self-Absorption (Care)In adulthood, the psychosocial crisis demands generativity, both in the sense of marriage and parenthood, and in the sense of working productively and creatively.
8. Integrity Versus Despair (Wisdom)If the other seven psychosocial crisis have been successfully resolved, the mature adult develops the peak of adjustment; integrity. He trusts, he is independent and dares the new. He works hard, has found a well - defined role in life, and has developed a self-concept with which he is happy. He can be intimate without strain, guilt, regret, or lack of realism; and he is proud of what he creates - his children, his work, or his hobbies. If one or more of the earlier psychosocial crises have not been resolved, he may view himself and his life with disgust and despair.
These eight stages of man, or the psychosocial crises, are plausible and insightful descriptions of how personality develops but at present they are descriptions only. We possess at best rudimentary and tentative knowledge of just what sort of environment will result, for example, in traits of trust versus distrust, or clear personal identity versus diffusion. Helping the child through the various stages and the positive learning that should accompany them is a complex and difficult task, as any worried parent or teacher knows. Search for the best ways of accomplishing this task accounts for much of the research in the field of child development.
Socialization, then is a learning - teaching process that, when successful, results in the human organism's moving from its infant state of helpless but total egocentricity to its ideal adult state of sensible conformity coupled with independent creativity
2. Learning Autonomy Versus Shame (Will)The second psychosocial crisis, Erikson believes, occurs during early childhood, probably between about 18 months or 2 years and 3½ to 4 years of age. The "well - parented" child emerges from this stage sure of himself, elated with his new found control, and proud rather than ashamed. Autonomy is not, however, entirely synonymous with assured self - possession, initiative, and independence but, at least for children in the early part of this psychosocial crisis, includes stormy self - will, tantrums, stubbornness, and negativism. For example, one sees may 2 year olds resolutely folding their arms to prevent their mothers from holding their hands as they cross the street. Also, the sound of "NO" rings through the house or the grocery store.
3. Learning Initiative Versus Guilt (Purpose)Erikson believes that this third psychosocial crisis occurs during what he calls the "play age," or the later preschool years (from about 3½ to, in the United States culture, entry into formal school). During it, the healthily developing child learns: (1) to imagine, to broaden his skills through active play of all sorts, including fantasy (2) to cooperate with others (3) to lead as well as to follow. Immobilized by guilt, he is: (1) fearful (2) hangs on the fringes of groups (3) continues to depend unduly on adults and (4) is restricted both in the development of play skills and in imagination.
4. Industry Versus Inferiority (Competence)Erikson believes that the fourth psychosocial crisis is handled, for better or worse, during what he calls the "school age," presumably up to and possibly including some of junior high school. Here the child learns to master the more formal skills of life: (1) relating with peers according to rules (2) progressing from free play to play that may be elaborately structured by rules and may demand formal teamwork, such as baseball and (3) mastering social studies, reading, arithmetic. Homework is a necessity, and the need for self-discipline increases yearly. The child who, because of his successive and successful resolutions of earlier psychosocial crisis, is trusting, autonomous, and full of initiative will learn easily enough to be industrious. However, the mistrusting child will doubt the future. The shame - and guilt-filled child will experience defeat and inferiority.
5. Learning Identity Versus Identity Diffusion (Fidelity)During the fifth psychosocial crisis (adolescence, from about 13 or 14 to about 20) the child, now an adolescent, learns how to answer satisfactorily and happily the question of "Who am I?" But even the best - adjusted of adolescents experiences some role identity diffusion: most boys and probably most girls experiment with minor delinquency; rebellion flourishes; self - doubts flood the youngster, and so on.
Erikson believes that during successful early adolescence, mature time perspective is developed; the young person acquires self-certainty as opposed to self-consciousness and self-doubt. He comes to experiment with different - usually constructive - roles rather than adopting a "negative identity" (such as delinquency). He actually anticipates achievement, and achieves, rather than being "paralyzed" by feelings of inferiority or by an inadequate time perspective. In later adolescence, clear sexual identity - manhood or womanhood - is established. The adolescent seeks leadership (someone to inspire him), and gradually develops a set of ideals (socially congruent and desirable, in the case of the successful adolescent). Erikson believes that, in our culture, adolescence affords a "psychosocial moratorium," particularly for middle - and upper-class American children. They do not yet have to "play for keeps," but can experiment, trying various roles, and thus hopefully find the one most suitable for them.
6. Learning Intimacy Versus Isolation (Love)The successful young adult, for the first time, can experience true intimacy - the sort of intimacy that makes possible good marriage or a genuine and enduring friendship.
7. Learning Generativity Versus Self-Absorption (Care)In adulthood, the psychosocial crisis demands generativity, both in the sense of marriage and parenthood, and in the sense of working productively and creatively.
8. Integrity Versus Despair (Wisdom)If the other seven psychosocial crisis have been successfully resolved, the mature adult develops the peak of adjustment; integrity. He trusts, he is independent and dares the new. He works hard, has found a well - defined role in life, and has developed a self-concept with which he is happy. He can be intimate without strain, guilt, regret, or lack of realism; and he is proud of what he creates - his children, his work, or his hobbies. If one or more of the earlier psychosocial crises have not been resolved, he may view himself and his life with disgust and despair.
These eight stages of man, or the psychosocial crises, are plausible and insightful descriptions of how personality develops but at present they are descriptions only. We possess at best rudimentary and tentative knowledge of just what sort of environment will result, for example, in traits of trust versus distrust, or clear personal identity versus diffusion. Helping the child through the various stages and the positive learning that should accompany them is a complex and difficult task, as any worried parent or teacher knows. Search for the best ways of accomplishing this task accounts for much of the research in the field of child development.
Socialization, then is a learning - teaching process that, when successful, results in the human organism's moving from its infant state of helpless but total egocentricity to its ideal adult state of sensible conformity coupled with independent creativity
Friday, January 30, 2009
Newborn - Reflexes
What reflexes should be present in a newborn?
Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in newborn babies:
Root reflex - This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his/her head and open his/her mouth to follow and "root" in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding.
Suck reflex - Rooting helps the baby become ready to suck. When the roof of the baby's mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Babies also have a hand-to-mouth reflex that goes with rooting and sucking and may suck on fingers or hands.
Moro reflex - The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his/her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him/her and begin this reflex. This reflex lasts about five to six months.
Tonic neck reflex - When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the "fencing" position. The tonic neck reflex lasts about six to seven months.
Grasp reflex - Stroking the palm of a baby's hand causes the baby to close his/her fingers in a grasp. The grasp reflex lasts only a couple of months and is stronger in premature babies.
Babinski reflex - When the sole of the foot is firmly stroked, the big toe bends back toward the top of the foot and the other toes fan out. This is a normal reflex up to about 2 years of age.
Step reflex - This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his/her feet touching a solid surface.
Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in newborn babies:
Root reflex - This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his/her head and open his/her mouth to follow and "root" in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding.
Suck reflex - Rooting helps the baby become ready to suck. When the roof of the baby's mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Babies also have a hand-to-mouth reflex that goes with rooting and sucking and may suck on fingers or hands.
Moro reflex - The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his/her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him/her and begin this reflex. This reflex lasts about five to six months.
Tonic neck reflex - When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the "fencing" position. The tonic neck reflex lasts about six to seven months.
Grasp reflex - Stroking the palm of a baby's hand causes the baby to close his/her fingers in a grasp. The grasp reflex lasts only a couple of months and is stronger in premature babies.
Babinski reflex - When the sole of the foot is firmly stroked, the big toe bends back toward the top of the foot and the other toes fan out. This is a normal reflex up to about 2 years of age.
Step reflex - This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his/her feet touching a solid surface.
Immunizations in Childhood and Adolescent
What Immunization Is
Immunization is the process by which a subject is rendered immune or resistant to a specific disease
Natural exposure – contact with the agent
Artificial exposure – parts of the infectious agent or inactivated version is given for the purpose of becoming immune to the disease agent it causes.
Childhood Immunization
Childhood immunization schedule American Academy of Pediatrics
http://www.cispimmunize.org/
Download children age 0 - 6
Download children age 7 - 18
Hepatitis B (HepB) Vaccine
All infants should receive the first dose soon after birth or before hospital discharge.
Second dose should be given at least 4 weeks after the first
Third dose 16 weeks after the first dose and at least 8 weeks after the second dose
Infants born of HBsAg-postive mothers should receive first immunization within 12 hours of birth as well as HBIG.
Diphtheria, Tetanus, Acellular Pertussis
DTaP
Given at 2, 4 and 6 months
4th dose between 15 and 18 months
Last DTaP at the 4-6 year pre-K check up
1st Tdap at age 11-12 years or at least 5 years from last DTap
Every 10 years after that
Polio
Injection form at 2 months, 4 months after 6 months and at kindergarten check-up
Oral not given due to shedding in stool.
Haemophilus Influenza Type b
Hib
Given at ages 2 and 4 months
Last dose at 12 months
Any child entering child care or pre-kindergarten under age 5 years would be required to have Hib.
Not a standard immunization for children born outside the USA
Measles, Mumps, Rubella
MMR
Two doses:
1st 12 months or older
2nd dose kindergarten visit
If no record of second dose it should be given at 11 to 12 year old visit
May develop a rash a week to ten days after immunization
Not immunized against wild strain – exposure would bring milder case
Varicella
Chicken pox – recommended at 12 months and second dose at 4-6 years or kindergarden visit
Susceptible children over 13 years would receive two doses at least 4 weeks apart
Pneumococcal Vaccine
PCV - Prevnar
Recommended for all children 2 to 23 months and certain populations up to 59 months
Asthma
Sickle cell anemia
Cystic fibrosis
2, 4, 6 and 4th dose after 12 months of age
Human Papillomavirus
HPV is the most common sexually transmitted virus
40 types of HPV
Spread through sexual contact
Can cause cervical cancer
Can also cause genital warts
Human Papillomavirus
HPV series
Recommended for all girls 11-12 years
Can be given as young as 9 years
Get HPV before first sexual contact
1st dose
2nd dose 2 months after 1st dose
3rd dose 6 months after dose one
HPV Contraindications:
Allergy to yeast or reaction to first immunization
HPV will not help if already infected
Meningococcal
Meningococcal disease is a serious illness
Leading cause of bacterial meningitis in 2 – 28 year old in USA
Meningococcal polysaccharide Vaccine
MPSV4
Prevents 4 types of meningococcal diseases – 2 out of 3 of the most common strains seen in the US
Recommendations
MCV4 recommended for all children at their routine preadolescent visit (11 – 12 years)
College freshmen living in dorms
U.S. military recruits
Traveling to Africa
Persons exposed to meningitis outbreak
Influenza (Flu) Vaccine
"Flu shot": Inactivated vaccine containing the virus
Approved for infants older than 6 months
Nasal spray flu vaccine: live, weakened flu viruses
Approved for children over 5 years to 49 years.
When to get Flu Vaccination?
October or November yearly
Contraindications to Flu Vaccine
Children with severe allergy to chicken eggs.
Severe reaction to influenza vaccination in the past.
Less than 6 months of age.
Children who have developed Guillain-Barre syndrome after previous immunization.
Do not give if child has moderate to severe illness with fever until a later date.
Premature Infants
AAP currently recommends that all premature infants receive full dose immunizations at the same chronologic age as term infants even if hospitalized
Contraindications include: significant febrile seizure, active seizure disorders, encephalopathy (DTaP)
Infants with BPD or RAD should receive influenza immunizations
Infants with congenital heart and premature infants immunization against RSV.
Hepatitis B may be deferred until discharge unless mother is Hep B positive
OPV should not be given in NICU
Do NOT dilute dosages
Usually given when they reach at least 2 kg or 4.4 pounds
To Immunize or Not to Immunize (common myths not to immunize: invalid)
Children on antibiotics
Children with minor illness – otitis, cough, diarrhea, sore throat, low grade fever
Children with mild allergies
Breast feeding infants
Children with pregnant household contacts
True Contraindications
True allergic response
Rash or hives after previous vaccination
Allergy to eggs or egg products should not be given influenza vaccination
Allergic to streptomycin should not be given IPV or influenza vaccination
Reactions to Immunizations
Fever greater than 103, shock or collapse, or inconsolable crying for greater than 3 hours. (DTaP)
Low grade fever, fussiness, and soreness at injection site are not reasons to prevent further vaccinations
Mild rash or fever may occur 10 days to 2 weeks after MMR or Varicella
Interventions
Tylenol every 4 hours for fussiness or low grade fever
Warm bath
NO ASPIRIN
NO Motrin for infants under 6 months of age
AAP recommends Tylenol for all ages due to confusion in dosing.
Adolescents
Hepatitis A (recommended only)
Pneumococcal if they have any chronic disease: heart, sickle cell disease, cystic fibrosis, diabetes, or organ transplant or receiving chemotherapy
Hepatitis B
MMR: second booster
D Tap
Varicella if no reliable history or negative titers
Meningococcemia for all college freshman and all military
Influenza yearly
Hepatitis A
Recommended for children and adolescents living in selected states or regions and for certain high risk groups
This would include California, Texas, and Arizona
2 doses 6 months apart
Live Vaccines
MMR and Varicella
Pregnancy
HIV +
Immunodeficiency
Chemotherapy: not given until 6 months after treatment is completed.
L.A. Unified Recommendations
Complete health and immunization record
All new students must have written results of a PPD test for tuberculosis within 12 months
If Manoux test is positive a chest x-ray is required
Treatment is recommended unless the child has some immune suppressed condition.
PPD Waiver
I hear by request exemption of the child from the tuberculosis assessment requirement for school / childcare entry because this is contrary to my beliefs. I understand that should there be cause to believe that my child is infected with active TB or should there be a tuberculosis outbreak, my child may be temporarily excluded from school.
Pre-school and Child Care
Pre-kindergarteners must be immunized against Haemophilus influenza type B or Hib.
This is not a standard immunization for children born outside the United States
Hib would not be required for a child over 5 years of age.
Kindergarten
Second MMR: Measles, Mumps, Rubella
Hepatitis B
Hepatitis A in high risk areas
D Tap: tetanus, diphtheria, pertussis
Communicable Diseases
Chicken pox (varicella)
Measles (Rubeola)
Pertussis (Whooping Cough)
Rubella (German Measles)
Scarlet Fever
Mumps
Varicella
Agent: varicella zoster virus
Incubation: 10 – 14 days
Transmission: respiratory
Period of communicability: 2 days before eruption of vesicles until lesions crusted.
Prodromal phase: slight fever, malaise, pruritic rash; macular to papular to vesicular.
Varicella
Communicability: children who have "chicken-pox" are infectious for two days before the vesicles erupt until all vesicles are crusted over.
Management of Varicella
Isolation
Skin care: tepid bath, calamine lotion, clip finger nails.
Keep from scratching
Antihistamines for itching - Benadryl
No ASA – acetaminophen only.
Varicella vaccine now available.
Measles or Rubeola
Agent: Virus
Transmission: respiratory, blood and urine
Incubation period: 10 to 20 days
Period of Communicability: 4 days before and 5 days after rash appears.
Prodromal stage: fever, cough, conjunctivitis, Koplik spots.
Rubella or German Measles
Agent: Rubella virus
Source: nasopharyngeal secretions; secretions in blood, stool, and urine.
Transmission: direct contact.
Incubation period: 14 to 21 days
Period of communicability: 7 days before to 5 days after appearance of rash.
Rubella
Rash first appears on face and rapidly spreads downward
Isolate from pregnant women
TORCH – affects fetus
Mumps
Disease caused by a virus that spreads through saliva and infects many parts of the body especially the parotid salivary gland.
Incidence has decreased to about 1,000 per year.
Two potential complications: encephalitis and orchitis (inflammation of testicle)
Pertussis (Whooping Cough)
Agent: Bordetella Pertussis
Source: Respiratory
Transmission: droplet spread or contact with contaminated article.
Incubation period: 10 days
Period of communicability: before onset of paroxysms to 4 weeks after onset.
Interventions
Erythromycin for the child and all contacts
Very dangerous for the neonate – most often the contact is an adult with a chronic cough
May led to hospital admission – ventilator assist
Scarlet Fever
Caused by group A Streptococcus
Rash is usually seen in children under age 18 years.
Rash appears on chest and abdomen – feels rough like a piece of sandpaper
Redder in the arm pits and groin area.
Rash lasts 2-5 days
After rash disappears fingers and toes begin to peel
Face is flushed with a pale area around the lips.
Scarlet Fever
Management of Scarlet Fever
Respiratory precautions for 24 hours.
Oral antibiotic for 10 days.
Treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray.
Encourage fluids.
See health care provider if fever persists.
Fifth Disease
Fifth disease is a mild childhood illness caused by the human parvovirus B19 that causes flu-like symptoms and a rash. It is called fifth disease because it was fifth on a list of common childhood illnesses that are accompanied by a rash, including measles, rubella (or German measles), scarlet fever (or scarlatina), and scarlatinella, a variant of scarlet fever.
Fifth Disease
Primarily seen in school-age children between ages 5 and 14 years.
Causes a reddish rash on the child’s face that looks as if the child has been slapped.
Fifth Disease Symptoms
Starts as a vague illness.
Fever, nasal congestion, sore throat, fatigue, muscle aches and headache.
7-10 days later the facial rash appears (slapped cheeks rash).
Light pink rash on arms and spreads to the trunk in a lacelike pattern.
Immunization is the process by which a subject is rendered immune or resistant to a specific disease
Natural exposure – contact with the agent
Artificial exposure – parts of the infectious agent or inactivated version is given for the purpose of becoming immune to the disease agent it causes.
Childhood Immunization
Childhood immunization schedule American Academy of Pediatrics
http://www.cispimmunize.org/
Download children age 0 - 6
Download children age 7 - 18
Hepatitis B (HepB) Vaccine
All infants should receive the first dose soon after birth or before hospital discharge.
Second dose should be given at least 4 weeks after the first
Third dose 16 weeks after the first dose and at least 8 weeks after the second dose
Infants born of HBsAg-postive mothers should receive first immunization within 12 hours of birth as well as HBIG.
Diphtheria, Tetanus, Acellular Pertussis
DTaP
Given at 2, 4 and 6 months
4th dose between 15 and 18 months
Last DTaP at the 4-6 year pre-K check up
1st Tdap at age 11-12 years or at least 5 years from last DTap
Every 10 years after that
Polio
Injection form at 2 months, 4 months after 6 months and at kindergarten check-up
Oral not given due to shedding in stool.
Haemophilus Influenza Type b
Hib
Given at ages 2 and 4 months
Last dose at 12 months
Any child entering child care or pre-kindergarten under age 5 years would be required to have Hib.
Not a standard immunization for children born outside the USA
Measles, Mumps, Rubella
MMR
Two doses:
1st 12 months or older
2nd dose kindergarten visit
If no record of second dose it should be given at 11 to 12 year old visit
May develop a rash a week to ten days after immunization
Not immunized against wild strain – exposure would bring milder case
Varicella
Chicken pox – recommended at 12 months and second dose at 4-6 years or kindergarden visit
Susceptible children over 13 years would receive two doses at least 4 weeks apart
Pneumococcal Vaccine
PCV - Prevnar
Recommended for all children 2 to 23 months and certain populations up to 59 months
Asthma
Sickle cell anemia
Cystic fibrosis
2, 4, 6 and 4th dose after 12 months of age
Human Papillomavirus
HPV is the most common sexually transmitted virus
40 types of HPV
Spread through sexual contact
Can cause cervical cancer
Can also cause genital warts
Human Papillomavirus
HPV series
Recommended for all girls 11-12 years
Can be given as young as 9 years
Get HPV before first sexual contact
1st dose
2nd dose 2 months after 1st dose
3rd dose 6 months after dose one
HPV Contraindications:
Allergy to yeast or reaction to first immunization
HPV will not help if already infected
Meningococcal
Meningococcal disease is a serious illness
Leading cause of bacterial meningitis in 2 – 28 year old in USA
Meningococcal polysaccharide Vaccine
MPSV4
Prevents 4 types of meningococcal diseases – 2 out of 3 of the most common strains seen in the US
Recommendations
MCV4 recommended for all children at their routine preadolescent visit (11 – 12 years)
College freshmen living in dorms
U.S. military recruits
Traveling to Africa
Persons exposed to meningitis outbreak
Influenza (Flu) Vaccine
"Flu shot": Inactivated vaccine containing the virus
Approved for infants older than 6 months
Nasal spray flu vaccine: live, weakened flu viruses
Approved for children over 5 years to 49 years.
When to get Flu Vaccination?
October or November yearly
Contraindications to Flu Vaccine
Children with severe allergy to chicken eggs.
Severe reaction to influenza vaccination in the past.
Less than 6 months of age.
Children who have developed Guillain-Barre syndrome after previous immunization.
Do not give if child has moderate to severe illness with fever until a later date.
Premature Infants
AAP currently recommends that all premature infants receive full dose immunizations at the same chronologic age as term infants even if hospitalized
Contraindications include: significant febrile seizure, active seizure disorders, encephalopathy (DTaP)
Infants with BPD or RAD should receive influenza immunizations
Infants with congenital heart and premature infants immunization against RSV.
Hepatitis B may be deferred until discharge unless mother is Hep B positive
OPV should not be given in NICU
Do NOT dilute dosages
Usually given when they reach at least 2 kg or 4.4 pounds
To Immunize or Not to Immunize (common myths not to immunize: invalid)
Children on antibiotics
Children with minor illness – otitis, cough, diarrhea, sore throat, low grade fever
Children with mild allergies
Breast feeding infants
Children with pregnant household contacts
True Contraindications
True allergic response
Rash or hives after previous vaccination
Allergy to eggs or egg products should not be given influenza vaccination
Allergic to streptomycin should not be given IPV or influenza vaccination
Reactions to Immunizations
Fever greater than 103, shock or collapse, or inconsolable crying for greater than 3 hours. (DTaP)
Low grade fever, fussiness, and soreness at injection site are not reasons to prevent further vaccinations
Mild rash or fever may occur 10 days to 2 weeks after MMR or Varicella
Interventions
Tylenol every 4 hours for fussiness or low grade fever
Warm bath
NO ASPIRIN
NO Motrin for infants under 6 months of age
AAP recommends Tylenol for all ages due to confusion in dosing.
Adolescents
Hepatitis A (recommended only)
Pneumococcal if they have any chronic disease: heart, sickle cell disease, cystic fibrosis, diabetes, or organ transplant or receiving chemotherapy
Hepatitis B
MMR: second booster
D Tap
Varicella if no reliable history or negative titers
Meningococcemia for all college freshman and all military
Influenza yearly
Hepatitis A
Recommended for children and adolescents living in selected states or regions and for certain high risk groups
This would include California, Texas, and Arizona
2 doses 6 months apart
Live Vaccines
MMR and Varicella
Pregnancy
HIV +
Immunodeficiency
Chemotherapy: not given until 6 months after treatment is completed.
L.A. Unified Recommendations
Complete health and immunization record
All new students must have written results of a PPD test for tuberculosis within 12 months
If Manoux test is positive a chest x-ray is required
Treatment is recommended unless the child has some immune suppressed condition.
PPD Waiver
I hear by request exemption of the child from the tuberculosis assessment requirement for school / childcare entry because this is contrary to my beliefs. I understand that should there be cause to believe that my child is infected with active TB or should there be a tuberculosis outbreak, my child may be temporarily excluded from school.
Pre-school and Child Care
Pre-kindergarteners must be immunized against Haemophilus influenza type B or Hib.
This is not a standard immunization for children born outside the United States
Hib would not be required for a child over 5 years of age.
Kindergarten
Second MMR: Measles, Mumps, Rubella
Hepatitis B
Hepatitis A in high risk areas
D Tap: tetanus, diphtheria, pertussis
Communicable Diseases
Chicken pox (varicella)
Measles (Rubeola)
Pertussis (Whooping Cough)
Rubella (German Measles)
Scarlet Fever
Mumps
Varicella
Agent: varicella zoster virus
Incubation: 10 – 14 days
Transmission: respiratory
Period of communicability: 2 days before eruption of vesicles until lesions crusted.
Prodromal phase: slight fever, malaise, pruritic rash; macular to papular to vesicular.
Varicella
Communicability: children who have "chicken-pox" are infectious for two days before the vesicles erupt until all vesicles are crusted over.
Management of Varicella
Isolation
Skin care: tepid bath, calamine lotion, clip finger nails.
Keep from scratching
Antihistamines for itching - Benadryl
No ASA – acetaminophen only.
Varicella vaccine now available.
Measles or Rubeola
Agent: Virus
Transmission: respiratory, blood and urine
Incubation period: 10 to 20 days
Period of Communicability: 4 days before and 5 days after rash appears.
Prodromal stage: fever, cough, conjunctivitis, Koplik spots.
Rubella or German Measles
Agent: Rubella virus
Source: nasopharyngeal secretions; secretions in blood, stool, and urine.
Transmission: direct contact.
Incubation period: 14 to 21 days
Period of communicability: 7 days before to 5 days after appearance of rash.
Rubella
Rash first appears on face and rapidly spreads downward
Isolate from pregnant women
TORCH – affects fetus
Mumps
Disease caused by a virus that spreads through saliva and infects many parts of the body especially the parotid salivary gland.
Incidence has decreased to about 1,000 per year.
Two potential complications: encephalitis and orchitis (inflammation of testicle)
Pertussis (Whooping Cough)
Agent: Bordetella Pertussis
Source: Respiratory
Transmission: droplet spread or contact with contaminated article.
Incubation period: 10 days
Period of communicability: before onset of paroxysms to 4 weeks after onset.
Interventions
Erythromycin for the child and all contacts
Very dangerous for the neonate – most often the contact is an adult with a chronic cough
May led to hospital admission – ventilator assist
Scarlet Fever
Caused by group A Streptococcus
Rash is usually seen in children under age 18 years.
Rash appears on chest and abdomen – feels rough like a piece of sandpaper
Redder in the arm pits and groin area.
Rash lasts 2-5 days
After rash disappears fingers and toes begin to peel
Face is flushed with a pale area around the lips.
Scarlet Fever
Management of Scarlet Fever
Respiratory precautions for 24 hours.
Oral antibiotic for 10 days.
Treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray.
Encourage fluids.
See health care provider if fever persists.
Fifth Disease
Fifth disease is a mild childhood illness caused by the human parvovirus B19 that causes flu-like symptoms and a rash. It is called fifth disease because it was fifth on a list of common childhood illnesses that are accompanied by a rash, including measles, rubella (or German measles), scarlet fever (or scarlatina), and scarlatinella, a variant of scarlet fever.
Fifth Disease
Primarily seen in school-age children between ages 5 and 14 years.
Causes a reddish rash on the child’s face that looks as if the child has been slapped.
Fifth Disease Symptoms
Starts as a vague illness.
Fever, nasal congestion, sore throat, fatigue, muscle aches and headache.
7-10 days later the facial rash appears (slapped cheeks rash).
Light pink rash on arms and spreads to the trunk in a lacelike pattern.
Neonate video assessment
Health and Physical assessment in nursing for the Infant: Videos
Head to Toe Examination: Infant 1
Head to Toe Examination: Infant 2
Head to Toe Examination: Infant 3
Head to Toe Examination: Infant 4
Head to Toe Examination: Infant 5
Head to Toe Examination: Infant 6
Head to Toe Examination: Infant 7
Head to Toe Examination: Infant 8
Head to Toe Examination: Infant 9
Head to Toe Examination: Infant 10
Head to Toe Examination: Infant 11
Head to Toe Examination: Infant 12
Head to Toe Examination: Infant 13
Head to Toe Examination: Infant 14
Head to Toe Examination: Infant 15
Head to Toe Examination: Infant 16
Head to Toe Examination: Infant 17
Head to Toe Examination: Infant 18
Pediatric Video assessment
Health and Physical assessment in nursing for the children: Videos
Medical History
Medical Measurements
Functional Integrity
Head and throat Exam
Abdominal Exam
Thorax and Lungs
Cardiac Exam
Circulation
Muscle strenght and tone
Pediatric sensations,gait and meningeal signs
Pediatric Physical Assessment
Lecture notes
Health Assessment
Collecting Data
By observation
Interviewing the parent
Interviewing the child
Physical examination
Bio-graphic Demographic Information
Name, age, health care provider
Parents name age /siblings age
Ethnicity / cultural practices
Religion / religious practices
Parent occupation
Child occupation: If an adolescent
Past Medical History
Allergies
Childhood illness
Trauma / hospitalizations
Birth history
Did baby go home with mom / special care nursery
Genetics: anything in the family
Current Health Status
Immunizations
Any underlying illness / genetic condition
What concerns do you have today?
Review of systems
Ask questions about each system
Measuring data: growth chart, head circumference, BMI
Nutrition: breast fed, formula, eating habits
Growth and development: How does parent think child is doing?
Physical Assessment
General appearance & behavior
Facial expression
Posture / movement
Hygiene
Behavior
Development: grossly fits guidelines for age
Vital Signs
Temperature: rectal only when absolutely necessary
Pulse: apical on all children under 1 year
Respirations: infant uses abdominal muscles
Blood pressure: admission base line
Height and weight and head circumference for 2 years and younger
Physical Assessment
Skin, hair nails
Head, neck, lymph nodes: fontanelles
Eyes, nose, throat…look at palate and teeth
Chest: auscultate for breath sounds and adventitious sounds
Breasts: tanner scale
Heart: PMI, murmurs
Neurological
Glasgow coma scale
Observe their natural state: Play games with them, especially children under 5 year
CNS grossly intact: II – XII
Newborn reflexes
Rooting: disappears at 3-4 months
Sucking: disappears at 10 to 12 months
Palmar grasp: disappears at 3 to 4 months
Plantar grasp: disappears at 8 to 10 months
Tonic neck: disappears by 4 to 6 months
Moro (startle): disappears by 3 months
Babinski: disappears by 2 years
Stepping reflex: disappears by 2 months
Infant Exam
Examine on parent lap
Leave diaper on
Comfort measures such as pacifier or bottle.
Talk softly
Start with heart and lung sounds
Ear and throat exam last
Toddler Exam
Examine on parent lap if uncooperative
Use play therapy
Distract with stories
Let toddler play with equipment / BP
Call by name
Praise frequently
Quickly do exam
Preschool Exam
Allow parent to be within eye contact
Explain what you are doing
Let them feel the equipment
School-age Child
Allow the older child the choice of whether to have a parent present
Teaching about nutrition and safety
Ask if the child has any concerns or questions
How are they doing in school?
Do they have a group of friends they hang out with?
What do they like to do in their free time?
School-age Exam
Allow choice of having parent present
Privacy and modesty.
Explain procedures and equipment.
Interact with child during exam.
Be matter of fact about examining genital area.
Adolescent
Ask about parent in the room
Should have some private interview time: time to ask the difficult questions
HEADSS: home life, education, alcohol, drugs, sexual activity / suicide
Privacy issues: HIPPA
Vital Signs
Choose your words carefully when explaining vital sign measurements to a young child. Avoid saying, for example, "I’m going to take your pulse now." The child may think that are going to actually remove something from his or her body. A better phrase would be "I’m going to count how fast your heart beats."
Temperature
Use of tympanic membrane is controversial.
Oral temperature for children over 5 to 6 years.
Rectal temperatures are contraindicated if the child has had anal surgery, diarrhea, or rectal irritation.
Check with hospital policy.
Pulse
Apical pulse for infants and toddlers under 2 years
Count for 1 full minute
Will be increased with: crying, anxiety, fever, and pain
Pulse rates
Neonate: 70 – 190
1-year: 80 – 160
2-year: 80-130
4-year: 80 – 120
6-year: 75-115
10-year: 70-110
14-year: 65 – 105 / males 60 – 100
18-year: 55-95 / males 50 - 90
Apical Pulse
Heart Sounds
Auscultate Heart Sounds at aortic, pulmonic, erbs, tricuspid and mitral points.
Respiratory
Count for one full minute
May want to do before you wake the infant up
Rate will be elevated with crying / fever
Pre-term: 40 – 60
Newborn: 30 – 40
Toddler: 25
School-age: 20
Adolescent: 16
Panic levels: <> 60
Clinical Tip
To accurately assess respirations in an infant or small child wait until the baby is sleeping or resting quietly.
You might need to do this before you do more invasive exam.
Count the number of breaths for an entire minute.
Blood Pressure
The width of the rubber bladder should cover two thirds of the circumference of the arm, and the length should encircle 100% of the arm without overlap.
Crying can cause inaccurate blood pressure reading.
Consider norms for age.
Blood Pressure Cuff
Height
Needs to be recorded on a growth chart
Gain about an inch per month
Deviation of height on either extreme may be indication for further investigation: endocrine problems
Height Measurement
Height Measurement
Weight
Needs to be recorded on a growth chart
Newborn may lose up to 10% of birth weight in 3-4 days.
Gains about ½ to1 oz per day after that
Too much or too little weight gain needs to be further investigated.
Nutritional counseling
Weight norms
Double birth weigh by 5-6 months
Triple birth weight by 1 year
Nutrition
How much formula?
How often being breast fed?
Solid foods: 4 to 6 months of age
What are they eating?
Over 1 year: How much milk vs solid foods. They can have whole milk.
Nutrition
School age: typical diet
Favorite foods
I always ask the child if I were to ask their mom what do they need to eat more of what would she say?
Nutrition
Most common nutritional problems:
Iron deficiency anemia
Obesity
Anorexia
Head Circumference
Head Needs to be measured until age 2 years
Plot on growth curve
Check fontales:
Anterior: closes by 12 to 18 months
Posterior: closes by 2-5 months
Shape: flat headed babies due to back-to-back sleep position
Mouth
Palate
Condition of teeth
Number of teeth
No teeth eruption by 12 months think endocrine disorder
Appliances
Brushing / visit to dentist
Eyes
Check for red-reflex: lack of this may mean retinoblastoma
Can the infant see: by parent report
Strabismus:
Alignment of eye important due to correlation with brain development
May need to corrected surgically
5-year-old and up can have vision screening
Refer to ophthalmologist if there are concerns
Common eye infections:
Conjunctivitis:
A red-flag in the newborn may be STD from travel down the birth canal
Pre-school: number one reason they are sent home: wash with warm water / topical eye gtts
Inflammation of eye: history of juvenile arthritis
Ear Exam
Otitis Media
Most common reason children come to the pediatrician or emergency room
Fever or tugging at ear
Often increases at night when they are sleeping
History of cold or congestion
Otitis
ROM: right otitis media
LOM: left otitis media
BOM: bilateral otitis media
OME: Otitis media with effusion
(effusion means fluid collection)
Pleural effusion, effusion of knee
Why a problem?
Infection can lead to rupture of ear drum
Chronic effusion can lead to hearing loss
OM is often a contributing factor in more serious infections: mastoiditis, cellulitis, meningitis, bacteremia
Chronic ear effusion in the early years may lead to decreased hearing and speech problems
Management
Oral antibiotics: re-check in 10 days
Tylenol for comfort
Persistent effusion:
PET: pressure equalizing tubes
Outpatient procedure
Need to keep water out of ears
Hearing evaluation
Speech evaluation
Head, chest, and abdominal circumference.
Chest exam
A high percentage of admissions to hospital are respiratory: croup, bronchitis, pneumonia, and asthma
In the infant it is hard to separate upper air-way noises from lower air-way noises.
How does the child look? Color, effort used to breathe
Possible Sites of Retractions
Chest assessment
Retractions
Subcostal
Intercostal
Sub-sternal
Supra-clavicular
Red flags: grunting / nasal flaring
Wheeze or Stridor
Wheezes occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure.
Wheezes is lower airway
Asthma = expiratory wheezes
A stridor is upper airway
Inflammation of upper airway or FB
Abdominal Girth
Abdominal Assessment
Clinical Tip
Inspection and auscultation are performed before palpation and percussion because touching the abdomen may change the characteristics of the bowel sounds.
Bowel Sounds
Normally occur every 10 to 30 seconds.
Listen in each quadrant long enough to hear at least one bowel sound.
Absence of bowel sounds may indicate peritonitis or a paralytic ileus.
Hyperactive bowel sounds may indicate gastroenteritis or a bowel obstruction.
Health Assessment
Collecting Data
By observation
Interviewing the parent
Interviewing the child
Physical examination
Bio-graphic Demographic Information
Name, age, health care provider
Parents name age /siblings age
Ethnicity / cultural practices
Religion / religious practices
Parent occupation
Child occupation: If an adolescent
Past Medical History
Allergies
Childhood illness
Trauma / hospitalizations
Birth history
Did baby go home with mom / special care nursery
Genetics: anything in the family
Current Health Status
Immunizations
Any underlying illness / genetic condition
What concerns do you have today?
Review of systems
Ask questions about each system
Measuring data: growth chart, head circumference, BMI
Nutrition: breast fed, formula, eating habits
Growth and development: How does parent think child is doing?
Physical Assessment
General appearance & behavior
Facial expression
Posture / movement
Hygiene
Behavior
Development: grossly fits guidelines for age
Vital Signs
Temperature: rectal only when absolutely necessary
Pulse: apical on all children under 1 year
Respirations: infant uses abdominal muscles
Blood pressure: admission base line
Height and weight and head circumference for 2 years and younger
Physical Assessment
Skin, hair nails
Head, neck, lymph nodes: fontanelles
Eyes, nose, throat…look at palate and teeth
Chest: auscultate for breath sounds and adventitious sounds
Breasts: tanner scale
Heart: PMI, murmurs
Neurological
Glasgow coma scale
Observe their natural state: Play games with them, especially children under 5 year
CNS grossly intact: II – XII
Newborn reflexes
Rooting: disappears at 3-4 months
Sucking: disappears at 10 to 12 months
Palmar grasp: disappears at 3 to 4 months
Plantar grasp: disappears at 8 to 10 months
Tonic neck: disappears by 4 to 6 months
Moro (startle): disappears by 3 months
Babinski: disappears by 2 years
Stepping reflex: disappears by 2 months
Infant Exam
Examine on parent lap
Leave diaper on
Comfort measures such as pacifier or bottle.
Talk softly
Start with heart and lung sounds
Ear and throat exam last
Toddler Exam
Examine on parent lap if uncooperative
Use play therapy
Distract with stories
Let toddler play with equipment / BP
Call by name
Praise frequently
Quickly do exam
Preschool Exam
Allow parent to be within eye contact
Explain what you are doing
Let them feel the equipment
School-age Child
Allow the older child the choice of whether to have a parent present
Teaching about nutrition and safety
Ask if the child has any concerns or questions
How are they doing in school?
Do they have a group of friends they hang out with?
What do they like to do in their free time?
School-age Exam
Allow choice of having parent present
Privacy and modesty.
Explain procedures and equipment.
Interact with child during exam.
Be matter of fact about examining genital area.
Adolescent
Ask about parent in the room
Should have some private interview time: time to ask the difficult questions
HEADSS: home life, education, alcohol, drugs, sexual activity / suicide
Privacy issues: HIPPA
Vital Signs
Choose your words carefully when explaining vital sign measurements to a young child. Avoid saying, for example, "I’m going to take your pulse now." The child may think that are going to actually remove something from his or her body. A better phrase would be "I’m going to count how fast your heart beats."
Temperature
Use of tympanic membrane is controversial.
Oral temperature for children over 5 to 6 years.
Rectal temperatures are contraindicated if the child has had anal surgery, diarrhea, or rectal irritation.
Check with hospital policy.
Pulse
Apical pulse for infants and toddlers under 2 years
Count for 1 full minute
Will be increased with: crying, anxiety, fever, and pain
Pulse rates
Neonate: 70 – 190
1-year: 80 – 160
2-year: 80-130
4-year: 80 – 120
6-year: 75-115
10-year: 70-110
14-year: 65 – 105 / males 60 – 100
18-year: 55-95 / males 50 - 90
Apical Pulse
Heart Sounds
Auscultate Heart Sounds at aortic, pulmonic, erbs, tricuspid and mitral points.
Respiratory
Count for one full minute
May want to do before you wake the infant up
Rate will be elevated with crying / fever
Pre-term: 40 – 60
Newborn: 30 – 40
Toddler: 25
School-age: 20
Adolescent: 16
Panic levels: <> 60
Clinical Tip
To accurately assess respirations in an infant or small child wait until the baby is sleeping or resting quietly.
You might need to do this before you do more invasive exam.
Count the number of breaths for an entire minute.
Blood Pressure
The width of the rubber bladder should cover two thirds of the circumference of the arm, and the length should encircle 100% of the arm without overlap.
Crying can cause inaccurate blood pressure reading.
Consider norms for age.
Blood Pressure Cuff
Height
Needs to be recorded on a growth chart
Gain about an inch per month
Deviation of height on either extreme may be indication for further investigation: endocrine problems
Height Measurement
Height Measurement
Weight
Needs to be recorded on a growth chart
Newborn may lose up to 10% of birth weight in 3-4 days.
Gains about ½ to1 oz per day after that
Too much or too little weight gain needs to be further investigated.
Nutritional counseling
Weight norms
Double birth weigh by 5-6 months
Triple birth weight by 1 year
Nutrition
How much formula?
How often being breast fed?
Solid foods: 4 to 6 months of age
What are they eating?
Over 1 year: How much milk vs solid foods. They can have whole milk.
Nutrition
School age: typical diet
Favorite foods
I always ask the child if I were to ask their mom what do they need to eat more of what would she say?
Nutrition
Most common nutritional problems:
Iron deficiency anemia
Obesity
Anorexia
Head Circumference
Head Needs to be measured until age 2 years
Plot on growth curve
Check fontales:
Anterior: closes by 12 to 18 months
Posterior: closes by 2-5 months
Shape: flat headed babies due to back-to-back sleep position
Mouth
Palate
Condition of teeth
Number of teeth
No teeth eruption by 12 months think endocrine disorder
Appliances
Brushing / visit to dentist
Eyes
Check for red-reflex: lack of this may mean retinoblastoma
Can the infant see: by parent report
Strabismus:
Alignment of eye important due to correlation with brain development
May need to corrected surgically
5-year-old and up can have vision screening
Refer to ophthalmologist if there are concerns
Common eye infections:
Conjunctivitis:
A red-flag in the newborn may be STD from travel down the birth canal
Pre-school: number one reason they are sent home: wash with warm water / topical eye gtts
Inflammation of eye: history of juvenile arthritis
Ear Exam
Otitis Media
Most common reason children come to the pediatrician or emergency room
Fever or tugging at ear
Often increases at night when they are sleeping
History of cold or congestion
Otitis
ROM: right otitis media
LOM: left otitis media
BOM: bilateral otitis media
OME: Otitis media with effusion
(effusion means fluid collection)
Pleural effusion, effusion of knee
Why a problem?
Infection can lead to rupture of ear drum
Chronic effusion can lead to hearing loss
OM is often a contributing factor in more serious infections: mastoiditis, cellulitis, meningitis, bacteremia
Chronic ear effusion in the early years may lead to decreased hearing and speech problems
Management
Oral antibiotics: re-check in 10 days
Tylenol for comfort
Persistent effusion:
PET: pressure equalizing tubes
Outpatient procedure
Need to keep water out of ears
Hearing evaluation
Speech evaluation
Head, chest, and abdominal circumference.
Chest exam
A high percentage of admissions to hospital are respiratory: croup, bronchitis, pneumonia, and asthma
In the infant it is hard to separate upper air-way noises from lower air-way noises.
How does the child look? Color, effort used to breathe
Possible Sites of Retractions
Chest assessment
Retractions
Subcostal
Intercostal
Sub-sternal
Supra-clavicular
Red flags: grunting / nasal flaring
Wheeze or Stridor
Wheezes occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure.
Wheezes is lower airway
Asthma = expiratory wheezes
A stridor is upper airway
Inflammation of upper airway or FB
Abdominal Girth
Abdominal Assessment
Clinical Tip
Inspection and auscultation are performed before palpation and percussion because touching the abdomen may change the characteristics of the bowel sounds.
Bowel Sounds
Normally occur every 10 to 30 seconds.
Listen in each quadrant long enough to hear at least one bowel sound.
Absence of bowel sounds may indicate peritonitis or a paralytic ileus.
Hyperactive bowel sounds may indicate gastroenteritis or a bowel obstruction.
Child growth and development
Video Lecture on Child growth and development
Lecture notes for Child growth and development
Growth and Development occurs in the following order
- Infancy
- Early Childhood
- Middle Childhood
- Adolescent
Stages of Growth and Development
lInfancy
•Neonate : Birth to 1 month
•Infancy : 1 month to 1 year
lEarly Childhood
•Toddler:1-3 years
•Preschool:3-6 years
lMiddle Childhood
•School age : 6 to 12 years
lLate Childhood
•Adolescent : 13 years to approximately 18 years
Principles of Growth and Development
Growth is an orderly process, occurring in systematic fashion.
Rates and patterns of growth are specific to certain parts of the body.
Wide individual differences exist in growth rates.
Growth and development are influences by are influences by a multiple factors.
Development proceeds from the simple to the complex and from the general to the specific.
Development occurs in a cephalocaudal and a proximodistal progression.
There are critical periods for growth and development.
Rates in development vary.
Development continues throughout the individual's life span.
Growth Patterns
The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.
Why developmental assessment?
Early detection of deviation in child’s pattern of development
Simple and time efficient mechanism to ensure adequate surveillance of developmental progress
Domains assessed: cognitive, motor, language, social / behavioral and adaptive
Gross Motor Skills
The acquisition of gross motor skill precedes the development of fine motor skills.
Both processes occur in a cephalocaudal fashion
Head control preceding arm and hand control
Followed by leg and foot control.
Gross Motor Development
Newborn: barely able to lift head
6 months: easily lifts head, chest and upper abdomen and can bear weight on arms
Head Control
Sitting up
2months old: needs assistance
6 months old: can sit alone in the tripod position
8 months old: can sit without support and engage in play
Ambulation
9 month old: crawl
1 year: stand independently from a crawl position
13 month old: walk and toddle quickly
15 month old: can run
Fine Motor - Infant
Newborn has very little control. Objects will be involuntarily grasped and dropped without notice.
6 month old: palmar grasp – uses entire hand to pick up an object
9 month old: pincer grasp – can grasp small objects using thumb and forefinger
Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: "mama/dada specific
18-20 months: 20 to 30 words – 50% understood by strangers
22-24 months: two word sentences, >50 words, 75% understood by strangers
30-36 months: almost all speech understood by strangers
Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate words properly
Always ask about history of otitis media – ear infection, placement of PET – tubes in ear
Early referral to MD to assess for possible fluid in ears (effusion)
Repeat hearing screening test
Speech therapist as needed
Red Flags in infant development
Unable to sit alone by age 9 months
Unable to transfer objects from hand to hand by age 1 year
Abnormal pincer grip or grasp by age 15 months
Unable to walk alone by 18 months
Failure to speak recognizable words by 2 years.
Fine Motor - toddler
1 year old: transfer objects from hand to hand
2 year old: can hold a crayon and color vertical strokes
Turn the page of a book
Build a tower of six blocks
Fine Motor – Older Toddler
3 year old: copy a circle and a cross – build using small blocks
4 year old: use scissors, color within the borders
5 year old: write some letters and draw a person with body parts
Toddlers
Issues in parenting - toddlers
Stranger anxiety ( crying when baby sees someone she doesnt know and they are trying to carry her) – should dissipate by age 2 ½ to 3 years
Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3
Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely
Thumb sucking
Toilet Training
Pre-School
Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself
Pre-school tasks
Red flags: preschool
Inability to perform self-care tasks, hand washing simple dressing, daytime toileting
Lack of socialization
Unable to play with other children
Able to follow directions during exam
Performance evaluation of pre-school teacher for kindergarten readiness
School-Age
School Years: fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building: models – legos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers
School performance
Ask about favorite subject
How they are doing in school
Do they like school
By parent report: any learning difficulties, attention problems, homework
Parental expectations
Red flags: school age
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting, animal abuse
School Age: gross motor
8 to 10 years: team sports
Age ten: match sport to the physical and emotional development
School Age: cognitive
Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.
13 to 18 Year Old
Adolescent
As teenagers gain independence they begin to challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents
Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide
Adolescent Teaching
Relationships
Sexuality – STD’s / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons
Subscribe to:
Posts (Atom)
