Newborn Care
True or False: It's always standard of care to check newborn hearing at birth
What is:
True: A newborn hearing screen is standard of care prior to leaving the hospital
True or False: Asymmetric leg creases will always be present in developmental hip dysplasia?
What is:
False
Not present if bilateral hip dysplasia
How long does toilet training typically take?
On average 6 months
When do we screen for lead and anemia?
What is:
-12 months for both lead level and hematocrit (required by state insurance)
- also screen if symptomatic or high risk for lead exposure
- Different recommendations from UPSTF vs AAP (insufficient evidence vs at risk)
What is the leading cause of death in children?
What is: Injuries
Exclusively breastfed infants should be given what supplement(s)?
What is: Vitamin D and iron
How long do we perform a routine hip exam in kids (ie until what age or what milestone)?
What is:
Until the kid is walking independently
What age do you counsel patients to start toilet training?
What is:
Typically starts around 18-24 months of age (dependent on cultural norms)
(AAP recommends that the process of toilet training begin only when the child is developmentally ready or shows signs of readiness)
Parents typically use the internet for resources which is not always consistent with AAP recommendations and should be advised by providers.
When do you check a Fundal Reflex?
What is:
Birth to 5 years old at every WCC
True or False: The Fundal (red) Reflex in a newborn presents the same across different ethnic groups?
What is:
False
There is variation in the normal red reflex across different ethnic groups
Lighter pigmented skin: orange to red
Moderately pigmented skin: yellow to orange
Darker skin: darker color, may be blue appearing
What are protective factors against SIDS (sudden infant death syndrome)?
What is:
- Breastfeeding
- pacifier use
- Room sharing without bed sharing
What are three risk factors for developmental hip dysplasia?
What is:
Breech***
Family History
Lower extremity swaddling that binds the hips in adduction
(These kids get a hip US at 6 weeks regardless of exam findings, pelvic X-ray if >4 months old)
At what age does a child have voluntary control of sphincter muscle (to control urination and defecation?)
What is:
Voluntary coordination of sphincter control is accomplished by 12 to 15 months of age. Myelinization of pyramidal tracts to the sphincters is complete by 12 to 18 months of age.
When is the Washington State Newborn Screen done?
What is:
- between 18 and 48 hours of birth (before 18 hours can have false positives)
- between 7 and 14 days
(this is state law)
Why is the newborn screen done twice?
What is:
- To catch things that can be missed on the initial screening (i.e., congenital hypothyroidism and CAH) due to delayed biochemical marker elevation.
- A second screening increases sensitivity and reduces the risk of missed cases (up to 20-30%)
What factors during the first year of life are associated with increased risk of childhood obesity?
What is:
- Stopping breastfeeding before 6 months of age
- Introducing solid foods before 6 months of age
What timeline is most important for examining for developmental hip dysplasia?
What is:
- during the 2nd week and 4th week of age
- After 3 months, Ortolani and Barlow maneuvers are not as reliable (high specificity 98-99% in infants <3 months, sensitivity varies based on skill of examiner 87-97%)
True or False: When a child refuses to potty train, something is developmentally wrong
What is:
False
Up to 20% of kids may refuse at some point
●Attempting training at too early an age
●Excessive parent/caregiver-child conflict
●Irrational fears or anxieties about toileting
●Difficult temperament, such as negative persistence or poor adaptability
●Hard, painful stools from chronic constipation
When do we use a postpartum Edinburgh scale as part of a well child exam?
What is:
At 1-, 2-, 4- and 6-month visits
What is:
NO
Insurance covers: Newborn (first week of life), 1 month, 2 months, 4,6,9, 12,15,18,24,30,3 years +
If you need an extra appointment in the first month (weight concerns, new parents), bill it as a weight check
True or False: Vision is screened with hearing at birth prior to discharge from the hospital
False
A one-time vision screening is done between three and five years of age to detect amblyopia
Insufficient evidence to screen before age 3
Annual visual acuity beginning at age 4
What is the most reliable sign of developmental hip dysplasia in a kid > 3 months?
What is:
Limitation of hip abduction
(One study showed sensitivity of 78 percent and specificity of 93 percent in the detection of radiographically confirmed DDH, another study showed sensitivity of 69 percent and a specificity of 54 percent)
True or False: Nocturnal Enuresis is a sign of a serious pathological problem in a child
False
Present in up to 15% of 5-year-olds
Spontaneously resolves ~15% per year
At what age is the ASQ (Ages and Stages Questionnaire) done and covered by insurance?
What is:
- 9, 18 and 30 months
USPSTF found insufficient evidence to recommend formal developmental screening or autism-specific screening if the parents/caregivers or physician have no concerns. Screen with CDC guidelines and if positive use ASQ.
Can you order a newborn state screen after 14 days if the second state screen was missed?
What is:
Yes, but the values must be interpreted based on age-specific ranges