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Infant & Childhood Development Infant & Childhood Angel Solomon, MS PA‐C Infant & Childhood Development y Gross Motor y 3 month –head control y 4 month –roll over y 6 month –sit independently y 9 month –crawl y 12 month –walk y 18 month –climbs stairs, run y 24 month –kick ball UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Infant & Childhood Development y Language y 2 month – coos y 6 month –babbles y 12 month – mama, dada y 18 month –4‐20 words y 24 month – combining words, 50% comprehensible UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Infant & Childhood Development y Language cont… y 3 year –75% comprehensible y 4 year – 100% comprehensible y Age 7 or 8 –speech, language, articulations close to adult Infant & Childhood Development y Social/Fine motor y 3 month –laugh y 6 month – reaches, feeds self y 9 month –indicates wants, pincer grasp y 12 month –imitates, follow 1 step commands UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Infant & Childhood Development y Social/Fine motor cont… y 18 month –scribbles, feeds self w/spoon, potty training, stacks 3‐4 blocks y 24 month –follow 2 step commands, wash/dry hands y 3 yr – dresses with supervision UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Newborn & Infant Growth y Newborns may lose up to 10% of their birth weight in the first week of life y Most regain birth weight in about 10 days y First 6 months: gain about 1oz/day y At 6 months: weigh 2x birth weight y At 12 months: weigh 3x birth weight, height 1.5x birth length UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Childhood Growth y After 2 years of age: 2‐3 kg and 5‐7cm/year y Average 30 month child weighs 30 pounds and is 30 inches tall y Average 4 year‐old weighs 40 pounds and is 40 inches tall y Weight LOSS in a child is always suspicious UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Abnormal Growth y Failure to Thrive y Short Stature UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) FTT y Definition: Weight that decreases to below the 3rd/5th percentile or weight loss that crosses 2 major percentiles y Causes: y Nonorganic: Environmental/Social is #1 (poverty, poor feeding technique, neglect/abuse, parental mental health) y Organic – Affects every system, 1st 3 months MC due to infection, Metabolic Disease, Congenital Heart Disease, GERD, Milk Protein intolerance, Cystic UMDNJ PANCE/PANRE Review Course Fibrosis (becoming Rutgers July 1, 2013) FTT‐continued y Initial Eval: y History – Identifies cause of in majority of cases (feeding patterns, vomiting, bowel habits, social/emotional/financial stability, development) y Physical –focus on signs of organic disease, evidence of abuse/neglect, dysmorphic features, skin lesions, heart murmur, abdominal masses, neuro exam y Labs –Cbc, Bun, Cre, Electrolytes, UA C&S y Treatment –R/O organic cause, Hi calorie diet, Education, Frequent monitoring, If severe require hospitalization, social services UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) GROWTH DISTURBANCES y Distinguish between normal and abnormal conditions y Tools for Evaluation: y 1. Growth Curves –critical factor in evaluation y 2. Target Height –helpful to evaluate growth potential y Boys ‐ [(Mothers Ht in cm + 13) + Father’s Ht in cm] / 2 y Girls –[Mothers Ht in cm + (Father’s Ht in cm –13)] / 2 y 3. Bone Age –measure of skeletal maturation UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) SHORT STATURE y 1. Familial Short Stature y 2. Constitutional Growth Delay y 3. Chronic Conditions UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) SHORT STATURE y Normal Variants y Familial Short Stature –Normal birth size, deceleration on growth curve first 2 years of life, Normal bone age and puberty, target height is short y Constitutional Growth Delay –Normal birth size, growth pattern similar to familial short stature, Delayed bone age and puberty, “Late bloomers” Target height normal UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) SHORT STATURE y Chronic conditions y Endocrine –GH Deficiency, Hypothyroidism, Cushing syndrome/disease y Nutritional y Systemic Disease –GI, Renal, Cardiac, Pulmonary, Immunology y Genetic Syndromes –Turner, Prader‐Willi, Down UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) HEENT y URI y Amblyopia y Acute Otitis Media y ENT Foreign Bodies y Chronic Otitis Media y Otitis Externa y Croup UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) VIRAL URI y Common in any age group; especially infants and toddlers y Lasts 7‐10 days y MCC: Rhinovirus y Symptoms: y Runny nose, nasal congestion, coryza, sneezing, mild conjunctivitis, sore throat, hoarseness, cough. Fever often presents for first 2‐3days y Tx: Cough and cold medications. No antibiotics!!! UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) OTITIS MEDIA y Acute Otitis Media y Suppurative infection of the middle ear cavity y Most prevalent in children between 6 and 24 mo y Bacterial y Streptococcus Pneumoniae (most common) y Haemophilus influenza y Moraxella Catarrhalis y Viral y Respiratory Syncytial Virus y Rhinovirus y Influenza virus UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Otitis Media y Risk Factors y Day Care Attendance y Formula Fed Infants (feeding position) y Second hand cigarette smoke y Presentation & Diagnosis y Often follows an upper respiratory tract infection(URI) by 1‐7 days y Usually presents with fever, poor feeding, pain and/or irritability, vomiting, ear pulling y TM : bulging, red, landmarks not visualized, immobile (Pneumatic Otoscopy with evaluation of movement of TM) y Antibiotics DOC: Amoxicillin 80‐90 mg/kg/d (erythromycin if allergic) y If tx failure after 48 hours: amoxicillin/clavulanate, cefuroxime, cefdinir, ceftriaxone UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Chronic Otitis Media y Definition – recurring or persistent infection or inflammation for several months y Risk Factors ‐ multiple ear infections, allergies, trauma, swelling of the adenoids y Sx – hearing loss, otorrhea, pressure, ear ache y PE: infxn, air‐fluid levels. discharge, perforation y Tx: Abx, Surgery (Myringotomy/Repair/Adenoids) y Complications: Mastoiditis, Deafness UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) OTITIS EXTERNA y Inflammation of the skin in the outer ear canal y Commonly caused by water trapped in the canal from swimming in lakes or pools y Pathogens: y Staphylococcus aureus y Pseudomonas aeruginosa y Symptoms: y Pain, purulent discharge, pain elicited with traction on pinna or tragus y Treatment: y Topical Antibiotic/Corticosteroid drops y (Acetic Acid/Polymyxin B/Neomycin/Quinolone) UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Viral Croup Viral Croup – Laryngotracheobronchitis Most common cause of stridor in children y Peak ages : 6 months to 3 years. Fall/Winter • Sx: Barking cough, URI symptoms, hoarseness, fever, inspiratory stridor y Pathogen: parainfluenza virus common y Diagnosis: H & P, season helpful (Fall/Winter) <50% “steeple sign on ant neck X‐ray y Treatment: Hydration, Humidity! Steroids if severe UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) AMBLYOPIA y Definition: decreases or loss of vision in one or both eyes in the absence of ocular or CNS pathology y Initiated by any condition that results in abnormal/unequal visual input between the “critical period” of birth to 8‐9 years of age y Dx: Visual Acuity, RF ie.. Strabismus, congenital cataracts, FHx y Tx: Patching, essential within the critical period; otherwise loss may be permanent UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) UMDNJ PANCE/PANRE Review Course Courtesy of Dean John Bonsall, MD, FACS (becoming Rutgers July 1, 2013) ENT FOREIGN BODIES y Commonly seen: Buttons, beads, marbles, nuts, toy parts, Bugs too y Ear: Ear pain, drainage, hearing loss y Nose: Unilateral purulent rhinitis, persistent sinusitis, blocked nasal passage on exam y Removal: Do not blindly probe! If visible, forceps, curette, Foley (inflated past foreign body), etc Restraint is essential to prevent further injury UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Which of the following is the most common presenting symptom of epiglottitis in a child? 1. Early morning sputum production 2. Muffled phonation 3. Barking cough 4. Rhinorrhea UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) Which of the following is the most common presenting symptom of epiglottitis in a child? 1. Early morning sputum production 2. Muffled phonation 3. Barking cough 4. Rhinorrhea UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) When treating clinical croup, you could reasonably include all of the following except: 1. IV steroids 2. Intubation 3. Racemic epinephrine 4. Oxygen and cool mist 5. IV Ceftriaxone UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) When treating clinical croup, you could reasonably include all of the following except: 1. IV steroids 2. Intubation 3. Racemic epinephrine 4. Oxygen and cool mist 5. IV Ceftriaxone UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) A 15 month old male presents with a 2 day history of upper respiratory infection type symptoms followed by a barky cough and low grade fever. Which of the following is the most appropriate management of this patient? 1. Albuterol 2. Racemic L‐ epinephrine 3. Intubation for ventilatory support 4. IV Antibiotics 5. Dexamethasone IV, IM or PO UMDNJ PANCE/PANRE Review Course (becoming Rutgers July 1, 2013) A 15 month old male presents with a 2 day history of upper respiratory infection type symptoms followed by a barky cough and low grade fever. Which of the following is the most appropriate management of this patient? 1. Albuterol 2. Racemic L‐ epinephrine 3.
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