Infants & Toddlers
Why do we not give honey during the first year of life?
Because of the risk for botulism
Explain the difference between marasmus and kwashiorkor
Marasmus is deficiency of nutrients leading to a thin, loose skin appearance
Kwashiorkor: deficiency of just protein, appears as ascites, prominent abdomen
What does poorly defined body boundaries mean for the preschool child?
afraid of intrusive procedures, believe that if skin breaks, insides will leak out
What stage of Piaget's development is the school age child in?
They are in the concrete operational stage: they no longer think of things as abstract and are able to use logic from tangible, real experiences, and organize into groups
**they have mastered the concept of conservation: when I pour the same amount of water into two different sized glasses, it is still the same amount
What is the clinical manifestation of impetigo?
Honey colored crusts!!
-begins as a reddish macule, becomes vesicular, sharply marginated outlines, ruptures easily, moist erosion, pruritus common
What is the term for the following reflex described below?
Clap when mom says lets play patty cake
this is a secondary circular reflex, when 4-8 month olds respond to people and objects
The other reflexes are primary circular 1-4 mo old where they replace reflexes with voluntary behavior and secondary schema at 8-12 mo in which they are able to use intellectual reasoning
What is SIDS and what are the risk factors and preventative factors we can teach families?
SIDS is sudden infant death syndrome it is the sudden death of an infant while sleeping, can be determined postmortem during autopsy
Risk factors: male, history of viral illness, prone positioning in bed, blankets, stuffies, LOW APGAR SCORE, maternal smoking, substance abuse, co-sleeping
Prevention: infants need to sleep alone, on their backs, in a crib with a firm mattress and tightly fitted draw sheet, breastfeeding and pacifier usage can also prevent as well
What is the difference between nightmares and sleep terrors?
Nightmares the child can wake up and recall events. During sleep terrors the child will not remember in the morning and will remain asleep, but is traumatizing in appearance because they seem awake and are screaming.
What are latchkey children and what are they at risk for?
Our textbook defines latchkey children as ones lacking parental supervision and are responsible for their own care following the school day
They are at risk for delinquency and injury
If the parent removes a tick off of their child, what should they be on the lookout for within the next 30 days?
Development of a bullseye (erythema migrans) rash and symptoms of infection: fever, cold symptoms etc
(indication of lyme disease)
What are the differences between types of play for infants and toddlers?
Toddlers- parallel play (next to, but not with others)
What might the infant have if they are exhibiting paroxysmal abdominal pain and drawing their legs up while crying?
What are the possible causes and treatments for this condition?
What might you tell the parents about the duration of this condition.
This infant has Colic.
Causes can be excessive air when feeding, feeding too fast, emotional
Treatments: soothe, rock baby, give pacifier, change positioning.
You would tell the parents it usually resolves on it's own within 3 months of age
What are common concerns children of this age need to cope with?
-readiness for school, infection control, sexual education, fears: animism, being in the dark, left alone, big dogs, ghosts, doctors, stress, aggression, speech problems
Tx: desensitization therapy for fears, finding out what the child knows and answering based on knowledge for sexual education, parents can anticipate factors that cause high stress in their child, DASE testing for speech problems
What does tanner staging measure in males and females?
Females: breast changes and pubic hair distribution
What causes atopic dermatitis (eczema) and how do we treat it?
family history of allergies, asthma rhinitis
Tx: aquaphor, cetaphil, eucerin, oral antihistamines, baths, moisture locking lotions, cold compresses, keep nails short and don't scratch
Bonus: why do we keep nails short and not scratch? to prevent secondary infections like impetigo from forming when bacteria from our fingers is introduced to skin lesions
What are some indications that a child is ready to be potty trained?
they can stay dry for 2+ hours during the day, willingness to please parents, curious about siblings going to the bathroom, don't want to sit in a wet diaper for too long
things to note: daytime dryness often achieved before nighttime, bowel training is achieved before bladder training
What is the difference between otitis media and otitis externa?
Otitis media is a middle ear infection that is caused by the infant's short eustachian tubes in the ears, it can be prevented by not putting the child to bed with a bottle, no pacifier, breastfeeding, treated with antibiotics
Otitis externa is swimmers ear which is in the ear canal, the best treatment is to keep the ear canal dry during swimming, saline irrigation, with steroid/abx drops, ear plugs, swim caps
What is the order of emergency treatment for a child that ingests a dangerous household chemical?
Call poison control center first, assess the child, do gastric decontamination: levage, induce vomiting, charcoal, prevent reoccurence
What are the screening recommendations for sexually transmitted infections?
Women under the age of 25 who are sexually active should be screened for Gonorrhea and Chlamydia, all pregnant women should be screened for syphillis, HPV screening recommended for all women above age 21
What is the criteria for referral to the burn center?
-Partial thickness: 10% of total body surface areas
-burns on face, hands, feet, buttocks, genitalia
-third degree burns, electrical burns, chemical burns
-inhalation injury
-burns with preexisting conditions, if the hospital doesn't have ability to care for children, with concomitant trauma
What phase is the child in that has immature thinking, bound to the present, symbolic thought, believes their teddy bear is alive, exhibit egocentrism, and utilizes transductive reasoning?
They are in the preconceptual phase of the preoperational stage. They are about 2-4 years old.
What are the indications, risk factors , and lifestyle modifications for autism spectrum disorder?
Indications: impaired social attention, atypical object use
RF: male, paternal and maternal age over 40 years, metabolic abnormalities
Lifestyle modifications: decreased stimulation, consistent routine, keep interruptions to a minimum
What are the signs of foreign body obstruction and what are we most worried about?
Signs are wheezing, cyanosis, stridor, unilateral nose drainage, paroxysmal cough
We are worried about a partial obstruction turning into a complete obstruction, in which the child cannot take in any air through the airway within a matter of minutes
Explain the difference between the three eating disorders anorexia, bulimia, and binge eating.
Anorexia- intense fear of weight gain, absence of menstruation, perfectionist, under eat and over exercise
Bulimia- 3x more common than anorexia, close to normal weight, can be slightly overweight, induced vomiting and use of laxatives after eating, compulsive uncontrollable urges to overeat, damage to GI tract and dental erosion, purging
Binge eating- compulsive overeating, done in secret, weekly for months, feels out of control and depressed, no purging
Math question yay!
You have a 20 kg child that comes in with 30% TBSA burns. What is your initial fluid rate per the Parkland formula?
a) 2400 ml/hr
b) 100 ml/hr
c) 150 ml/hr
d) 210 ml/hr
a. 2, 400 ml/hr is the initial fluids rate
However, for the first 8 hours it would be 150mL per hour
2400 divided by 2 equals 1200, 1200 divided by 8 equals 150mL