1 / 42

WELL CHILD CARE

Objectives 1. Interpret growth data for children 2. Counsel parents on the proper diet for children 3. Perform appropriate physical exam for age of the child and understand abnormal and normal findings 4. Working knowledge of developmental milestones 5. Know appropriate laboratory screening tests and how to interpret them 6. Know which immunizations are needed for each age and the common side effects 7. Be able to give anticipatory guidance 8. Perform an age appropriate exam.

ave
Download Presentation

WELL CHILD CARE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. WELL CHILD CARE Becky Risinger, MD, FAAP

    2. Objectives 1. Interpret growth data for children 2. Counsel parents on the proper diet for children 3. Perform appropriate physical exam for age of the child and understand abnormal and normal findings 4. Working knowledge of developmental milestones 5. Know appropriate laboratory screening tests and how to interpret them 6. Know which immunizations are needed for each age and the common side effects 7. Be able to give anticipatory guidance 8. Perform an age appropriate exam

    3. OVERVIEW 1. GROWTH 2. NUTRITION 3. DEVELOPMENT 4. PHYSICAL EXAMINATION 5. SENSORY SCREENING 6. LABORATORY 7. IMMUNIZATIONS 8. HEALTH EDUCATION

    4. GETTING STARTED Greet the parent and the child Interim History Recent History Hospitalizations Any Problems-Open Ended What is their agenda for this visit?

    5. Growth Parameter Norms Weight *Weight loss in first few days 5-10% *Returns to birth weight by 7-10 days *Double birth weight by 4-5 months *Triple birth weight by 2 years *Average annual weight gain 5 lbs/year from 2 years old through puberty

    6. Growth Parameter Norms Height 20 inches at birth 30 inches at 1 year 36 inches at 3 years 40 inches at 4 years Average annual growth rate 2-3 inches per year from 1 year old through puberty

    7. Growth Parameter Norms Head Circumference *35 centimeters at birth *Increases 2 centimeters/month first 3 months *Increases 1 centimeter/month from 4 through 12 months *After 1 year old increases only 10 centimeters for life

    8. Growth Parameter Problems Height Below the 5th percentile 1) Growing along his/her own curve-follow 2) Plateau Hypothyroidism Chronic Disease (congenital heart disease, renal disease, etc.)

    9. Growth Parameters-Problems Weight Above the 95th percentile If other parameters are on the same percentile-not a problem If the height is less than the 75th percentile, then take a detailed diet history and counsel on proper diet for age or refer to a nutritionist for counseling

    10. Growth Parameter-Problems What weight is a problem? A weight less than 80% of the median weight for height is failure to thrive. Weight loss in an infant is always cause for alarm and requires a work-up. Recent illness Inadequate intake-infants require 110 kcal/kg/day Unless the cause is obvious (like milk intolerance), the baby should have a work-up.

    11. Growth Parameters-Problems Head Circumference >95th Percentile Deserves a work-up (unless height and weight are the same percentile) Work-up includes: *Head ultrasound to rule-out hydrocephalus *Rapid growth of head since last visit should be a work-up ASAP *Can measure the family’s head size, familial macrocephaly

    12. Growth Parameters-Problems <5th Percentile Rule out microcephaly Causes: Familial microcephaly(benign) Infectious disease (TORCH) (Check eyes and hearing if they have this) Craniosynostosis-requires surgical correction

    13. Growth Parameters-Problems Failure to Thrive When a child is not growing, it is reflected first in the weight then the height finally if severe, in the head size

    14. Nutrition Newborn Breast Milk Nurse every 2-3 hours, 15 minutes per side 5-8 wet diapers/ day No vitamins for babies

    15. Nutrition Newborn Formula 3-4 ounces every 3-4 hours Total volumes: 1 week 18-24 ounces 1 month 22-26 ounces 2-3 months 28-32 ounces

    16. Nutrition Two-Three Months Breast Feeding 5-6 feedings per day About 6 wet diapers per day Vitamins Tri-vi-flor 0.25mg with Iron 1 ml po q day

    17. Nutrition Two-Three Months Formula 28-32 ounces per day Spitting up: Not a problem unless baby has a poor weight gain or aspiration. 1)After eating, keep at an angle for 30 minutes 2)Thicken feedings with cereal 3)Change formula Cow’s milk protein Soy bean protein Casein hydrolysate

    18. Nutrition Four-Five Months Breast Milk or Formula Cereal/Apple Juice Vegetables Fruit

    19. Nutrition Six to Eleven Months Breast Milk or Formula Cereal/Fruit/Vegetable/Meats 6-8 months 4 feedings/day 9 months 3 feedings per day Table food can be started as early as 6 months Beware of Choking

    20. Nutrition Over One Year Old Food Group # Servings Fruits 2 or more Vegetable 3 or more Grains 6 or more Milk*, Cheese, Yogurt 2 or more Meat, Fish, Poultry 3 or more Beans, Eggs, Nuts Fats, Oils & Sweets In moderation Younger children may eat smaller serving sizes *Children <2 years old should drink whole milk

    21. Development Age Performance 1 month While prone, lifts head off table 2 months Smiles responsively; vocalizes 3 months Laughs 4 months Head erect and steady when held in sitting position; squeals; grasps 5 months Smiles spontaneously; rolls over. 6 months No head lag if pulled to sitting position 9months Sits alone for 5 seconds after support is released; transfers block from hand to hand; feeds self finger foods. 10 months Pulls to standing position; pincer grasp; says “ma-ma” or “da-da”; plays peek-a-boo, anxiety toward strangers

    22. Development Continued Age Performance 12 months Cruises, stands alone for 2-3 seconds; bangs 2 blocks together; imitates vocalizations. 18 months Walks well; points for wants; drinks from cup without assistance; mimics household chores 21 months Says 3 words (in addition to “ma-ma” and “da-da”); removes article of clothing besides hat. 2 years Scribbles spontaneously; points correctly to one body part; does simple household tasks. 3 years Pedals tricycle; sentences of 3 words and uses plurals; washes and drives hands. 4 years Copies circles and cross; dresses with supervision 5 years Dresses without supervision; can tolerate separation from parent for 5 minutes without anxiety. 6 years Copies a square, draws a man with 6 parts 7 years Copies a triangle; draws man with 12 details, reads several one-syllable printed words; rides bicycle (without training wheels) 8 years Ties shoes; copies diamond; draws man with 16 details; knows days of the week

    23. Development-Speech Age Stages of Development Examples 2-4 months Cooing Noises, mostly vowel sounds 4-12 months Babbling Mama,gaga,baba 12-18 months Single Words Daddy, ByeBye, no, Juice 18-24 months Two word phrases Baby up, Read book, go byebye 24-36 months Simple sentences Sasha go to park now, Mommy make dinner

    24. Development-Speech (cont.) When should you worry? *Doesn’t make eye contact/disinterested in social interaction *Has other areas of developmental delay *Not smiling socially by 2 1/2-3 months of age *No cooing by 4-5 months *No babbling by 7-9 months *No attempts to gain parents attention withsounds by 12 months *Doesn’t say “Mama,” “Dada,” “Papa” by 12-14 months *Doesn’t say first word by 14-16 months (excluding Mama, Papa, Dada) Doesn’t say 2-word sentences by 24-28 months *Doesn’t link together nouns and verbs by 28-30 months

    25. Laboratory What is required *Second neonatal screen *Hemoglobin or Hematocrit *Lead Screening

    26. Laboratory Cont. Neonatal Screen Congenital Adrenal Hyperplasia Phenyketonuria Galactosemia Sickle Cell Anemia Hypothyroidism

    27. Laboratory Cont. Lead Screening 1. Do lead survey- if any “yes” responses, do a lead screen at 6 months if all “no” responses, do a lead screen at 12 months 2. Results of the lab test less than 10 micrograms/dL, no follow up needed 10-14 microgm/dL -rescreen every 3-4 months until either: *2 subsequent consecutive measurements are less than 10 microgm/dL, OR *3 subsequent consecutive screens are less than 15 microgm/dL -screen every year 15-19 microgm/dL refer to a physician >19 microgm/dL Medical Emergency, refer that day for a work-up

    28. Laboratory Cont. Hemoglobin Anemic when the Hemoglobin is less than: 10.5 at 6 months 11.0 at one year 12.0 at two years

    29. Laboratory Cont. Treatment 1. 6 MG elemental Iron/kilogram/day divided TID 2. Recheck hemoglobin in one month after treatment is started.

    30. Infant-Toddler Exam Begins as you visit with the parent and start to observe the child. Position of the child-may do better in the parent’s lap * Head-palpate sutures and fontanels, examine hair and scalp * Ears-external ear and canal otoscope/check hearing * Nose-look in Can listen with stethoscope to see if air is moving well in each side * Eyes-red reflex, extra-ocular movements, pupil (reaction to light and shape) light reflex, cover test * Mouth-look at the oral mucosa and palate, check teeth * Neck-nodes, thyroid, range of motion, clavicles

    31. Vision Screening Birth Check Red Reflex Children 0-2 years Red reflex, Pupils react equally to light, Cover test for children over 6 months Children 3-4 years Child should be able to read more than half of the 20/40line or four out of six H;O;T;V; symbols Cover Test Children 5 years and up Should be able to read majority of 20/30 line or four out of six H;O;T;V symbols Cover Test

    32. Tuberculosis Screening Since your child’s last skin test: -Has anyone in your family had tuberculosis? _Do you know of any situation where your child was around an adult who has been diagnosed or suspected as having TB? -Was your child born in or has our child visited a foreign country where there is a lot of TB? -TB can cause fever of long duration, unexplained weight loss, weakness, chest pain, a bad cough, hoarseness or coughing up blood. -To your knowledge, has your child had contact with anyone who is/has been an intravenous (IV) drug user? -HIV-infected? -In Jail/prison? -Recently moved to the US from a foreign country?

    33. Infant-Toddler Exam (cont.) * Chest-movements (retractions), breath sounds * Heart-look for precordium movement, feel for any thrills or heaves, listen for rate, rhythm, murmurs, systolic and diastolic sounds, extra sounds, check pulses, note color * Abdomen-listen for bowel sounds, palpate liver and spleen, any masses (may need to flex the legs to get a good exam) * Genitalia- Male-meatus and testes down Female-separate labia * Rectum-look for separating buttocks * Back & Extremities-observe sacral area, straightness of the back, observe legs, knees, ankles, observe feet, leg length equality, folds, hips, range of motion of joints upper and lower.

    34. Infant-Toddler Exam (cont) * Neurological Mental Status Response to stimuli Developmental level Cranial Nerve (observe facial movements) Open mouth, smile, show teeth, close eyes, wrinkle brow, gag Motor Muscle mass and tone Strength, coordination-handling toys, spontaneous play, sitting, walking, crawling Reflexes Infantile Moro, suck, tonic neck Deep tendon clonus Babinski

    35. Newborn Exam Head-observe for molding, cephalohematoma, caput, palpate sutures, fontanels Eyes-red reflexes (for cataracts) Mouth-palate intact Chest- palpate breasts, check clavicles Abdomen-examine cord, may be able to palpate kidneys Genitalia-Male, check for hypospadias and undescended testes Back-sacral dimple Extremities-Check for dislocated hips Skin-jaundice

    36. Newborn Exam (Cont’d) Neurological-Muscle strength and tone Grasp Rooting Sucking Moro Head Control Stepping and Placing Deep Tendon Reflexes Babinski Tonic Neck Reflex Observe for Cranial Nerve Changes

    37. Newborn Exam (Cont’d) Reflex Disappears Moro 1-3 Months Rooting 3-4 Months Palmer Grasp 4 Months Tonic Neck Reflex 5-6 Months Plantar Grasp 8-15 Months Suck Response 12 Months Babinski 1-2 years Most of the special reflexes observed in the newborn age group are called “Primitive” and will disappear as the infant’s central nervous system myelinates. The retention of the Special reflexes beyond the expected age of disappearance indicates pathology, including cerebral palsy or other central nervous system defects.

    38. Heart Exam Requires a Quiet Patient *Inspection General appearance Physical abnormalities Color of skin and mucous membranes Cyanosis Pallor Jaundice Clubbing Respiration

    39. Heart Exam (cont’d) Palpation Peripheral pulses Chest Precordium PMI Thrill/Heave Listen Rate Rhythm S1-S2 Systolic/Diastolic Four limb blood pressure Bottom line: is it normal?

    40. Immunizations Birth Hepatitis B#1 2 months DPT, IPV, Prevnar, HIB 4 months DPT, IPV, Prevnar, HIB 6 months DPT, Prevnar, HIB, Hep B#2 9 months HepB#3, IPV 12 months MMR, HIB, Varicella, Prevnar 15-18 months DPT 2 years Hepatitis A 2 1/2 years Hepatitis A 4 years MMR, DPT, IPV 12-13 years DT 18 years Meningococcal vaccine

    41. Health Education Birth-12 Months Nutrition Safety Formula/Breast Bath Safety Introducing Foods Smoke Detectors Feeding Technique Car Seats Childproofing Health Promotion Poisoning Information Immunization Information Walkers/Jumpers Choking Toxin/Lead Exposures Teething/Bottle Caries Exposure to Smoking Family Medical Resource Use Siblings Treatment of Minor Family Planning Acute Illnesses Family Concerns

    42. Health Education 1-4 Years Nutrition Safety Basic Foods Firearm Safety Good Snacks Smoke Detectors Appetite Control Car Seats Choking Water Safety Poisoning Information Health Promotion Childproofing Immunization Information Dental Education Family Toilet Education Set Limits/Discipline T.V. Habits Reward Good Behavior Exposure to Smoking Sibling Relations Medical Resource Use Read/Play Together

    43. Health Education 5-12 Years Nutrition Safety Basic Foods Seat Belts/Auto Safety Good Snacks Bicycles/ATV Appetite Control Skating/Athletics Water Safety Health Promotion Smoke Detectors T.V. Habits Firearm Safety Medical Resource Use Tobacco Family Alcohol/Drugs Security Regular Exercise Discipline Patterns Tooth and Gum Care Handling Responsibility Pubertal Changes/Sex Communication Handling Losses

More Related