Sometimes Well Child
Baby are you Down, Down, Down, Down, Down?
Under pressure
Rash Decisions
Passing the TORCH
100
These vaccines are usually given at the 2 month well child check.
What are DTaP, Hib, HepB, IPV, PCV20 and Rotavirus?
Bonus question x2
100
This is the most common heart defect seen in Down syndrome patients.
What is an AVSD?
AVSD 45%
VSD 35%
ASD 8%
PDA 7%
100
This is the age the AAP recommends beginning blood pressure measurements at well child checks.
What is 3 years old?
100
This rash consists of red, blotchy spots that may contain small white or yellow bumps (pustules) in the center.
Erythema toxicum neonatorum
Usually on face, chest, back and limbs and spares palms and soles.
Lesions can appear and disappear within hours
Clears spontaneously within one to two weeks
100
The acronym TORCH stands for this
(Bonus question)
Toxoplasmosis
Other (Bonus)
Rubella (German Measles)
Cytomegalovirus (CMV)
Herpes Simplex Virus (HSV)
200
These two vaccines are typically given at the 12 month well child check and should not be combined
What are MMR and Varicella?
Approximately 5 more seizures per 10,000 doses when using the combined vaccine
MMRV- more likely to cause high fevers (102°F or higher) after the first dose compared to administering separate shots at the same visit.
Remains an option for the second dose (usually at ages 4-6) as the risk of febrile seizures diminishes significantly
200
This is the most common cancer seen in children with Down Syndrome.
What is Leukemia?
10 to 30 times higher risk compared to the general population.
Acute Myeloid Leukemia: 150-fold increased risk of developing AML before age 5.
Acute Lymphoblastic Leukemia: 20-fold increased risk.
200
Hypertension is diagnosed if a child has elevated auscultatory-confirmed BP readings on this number of different visits.
200
This rash starts at the hairline, behind the ears, or on the face, then spreads downwards and appears about 3 to 5 days after the first symptoms (fever, cough, red eyes).
What is Measles rash?
Often starts as flat spots that may merge as they spread
Koplik spots: small blue-white with red base spots on inner cheek 1-2 days before rash begins
Contagious 4 days before rash appears and for 4 days after it erupts
200
This TORCH infection causes chorioretinitis, hydrocephalus and intracranial calcifications
What is Congenital Toxoplasmosis?
300
Inability to walk independently at this age is considered a gross motor delay.
What is 18 months?
300
This blood test must be done for all children with Down syndrome between birth and 1 month of life and repeated annually from 1-21 years.
What is a CBC?
To r/o transient myeloproliferative disorder or polycythemia at first
then to monitor for depleted blood cell lines
300
A SBP or DBP reading below this centile is considered normal blood pressure for children 1-12 years of age (as long as it is not hypotensive).
What is the 90th centile?
300
This rash consists of small, clear/cloudy fluid-filled blisters, which are generally on an erythematous base.
What is Neonatal Herpes?
Dew drops on a rose petal
Often appear in clusters
Some lesions break/crust over
Usually appear between week 1-3 of life but also shortly after birth
300
This TORCH infection causes notched, widely spaced central incisors, blindness and deafness.
What is Syphilis (Late)?
Bonus question
400
Hepatitis B serology (HBsAg and anti-HBs) should be checked at this age for infants exposed to congenital Hepatitis B.
What is 9-12 months old?
OR
1-2 months after completing the vaccine series
Testing before 9 months may yield false positives from HBIG given at birth.
400
This blood test is done on NBS, at 6 and 12 month visits and then annually from 1-21 years for Down Syndrome patients.
What is TSH?
High risk of developing thyroid dysfunction, with a lifetime prevalence of 13%-63%
Congenital hypothyroidism is ~28 times more common in infants with Down syndrome
400
SBP and DBP measurements above or equal to this centile signify Stage 1 hypertension in 1-12 year olds
What is the 95th centile?
https://www.mdcalc.com/calc/4052/aap-pediatric-hypertension-guidelines
400
This rash did not improve after using Desitin appropriately for several days
What is a candidal diaper rash?
Satellite lesions: small papules or pustules on the periphery of the main infection
Candida thrives in warm, moist areas and may appear after antibiotic use or accompany oral thrush
Antifungal cream to area then apply zinc-oxide based barrier on top
400
This TORCH infection causes sensorineural deafness, eye abnormalities, rash and cardiac defects
What is Rubella?
Bonus question
500
This test should routinely be ordered for ALL children between 9-11 yrs and again between 17-21 yrs.
What is a lipid panel?
Children with risk factors should be screened between 2-8 yrs and 12-16 yrs.
AAP indicates that non-fasting sample are acceptable for initial screening
500
All children with Down Syndrome must have a sleep study done by this age.
What is 4 years old?
Can be done much earlier if snoring
Down Syndrome children are at an extremely high risk—roughly 30% to over 90%—of developing obstructive sleep apnea (OSA)
500
In a child with newly diagnosed hypertension with no other medical conditions, this is the age you would consider Cardiology workup instead of Nephrology workup.
What is 6 years old?
500
This rash appears suddenly, can rapidly worsen and is currently involved in an outbreak in Chicago.
What is a Meningococcal rash?
500
This TORCH infection causes cicatricial skin lesions, limb hypoplasia and neuro/ocular defects
What is Congenital Varicella?
