Doctor's Orders
The age at which healthy children should have their first cholesterol screening.
9 to 11 years old
Or, between 2 and 10 years of age if have family history of high cholesterol, early CAD, or CAD risk factors (obesity, DM, HTN).
Can be a non-fasting test.
Test again between 17 and 21 years
The Moro (startle) reflex should disappear by this age.
6 months
Stepping: 2 months
Rooting: 4 months
Palmar grasp: 5-6 months
Tonic neck (fencing) reflex: 5-7 months
Plantar grasp: 9-12 months
The name of this skin finding.
Congenital dermal melanocytosis
Tend to lighten overtime, but may not completely disappear
Age at which infants should be able to roll from tummy to back.
4-6 months
The earliest age at which an otherwise healthy infant should receive an annual flu shot.
6 months
The age at which all children should have their first HIV test.
15 to 18 years
If sexually active, screen annually for HIV, gonorrhea, and chlamydia (would add syphilis to this list).
In a pediatric patient with scoliosis, this is the Angle of Trunk Rotation at which you should get radiographs and refer to an orthopedist.
Scoliometer reading > 7 degrees (if BMI < 85th percentile), or 5 degrees if BMI >/- 85 percentile.
Obtain scoliosis radiographs (standing, full-length PA and lateral views of the spine) to determine the Cobb angle. A Cobb angle of 10 degrees or less does NOT meet the definition of scoliosis. You should counsel patients that such a small curve is common and no further treatment or work-up is needed other than ongoing annual evaluations. If the curvature worsens or the patient develops symptoms (pain), repeat imaging.
The name of this skin finding.
Salmon patch / Angel's kiss / Stork bite (back of neck)
Caused by capillary malformations at birth
Tends to lighten overtime (months to years)
The age at which infants should be able to sit upright, without support.
~9 months
The first doses of MMR and varicella vaccines are given to children in this age range.
12-15 months
The ages at which both term and pre-term infants should get screened for iron deficiency.
Term infants: 9-12 months, preterm infants: 5-6 months
Other indications for iron deficiency screening include annual testing in adolescents with moderate to heavy menses, chronic weight loss, nutritional deficit, or participate in athletic activity.
This is 1 sign that a toddler may be ready for toilet training.
- Able to remain dry for several hours.
- Show interest in sitting on a potty chair and express visible signs of preparing to urinate or defecate.
- want to be changed after having a dirty diaper or pull-up.
- Can place things where they belong and can understand and carry out simple verbal commands.
Often ~ 18-24 months
The name of this skin finding.
BONUS 200 pts: Name the multi-organ condition that can cause this
Port wine stain
Treatment: pulse dye laser therapy (laser's light is absorbed by hemoglobin in the blood vessels, heating and collapsing them without harming surrounding skin. Can dramatically lighten stains, with some patients seeing near-complete clearance, though recurrence is possible)
If on the face, concerned about Sturge-Weber Syndrome (may also see developmental delay, learning difficulties, ADHD, seizures, other neuro findings, macrocephaly, ocular findings/vision loss).
Your patient is here for their 2 year visit. The parent asks whether their child can now use a forward facing car seat. This is what you tell them.
Whenever the child outgrows the height/weight limits for their rear-facing seat. It is generally safer to keep them rear facing for longer.
Most infants will outgrow their infant car seat around 9-12 months. Parents can buy a "convertible" car seat that can stay rear-facing until age 2, and then faced forward. Consider mentioning this at the 6-9 month visits.
A healthy 16 year old who previously completed all their routine childhood vaccines, and plans to go to college, will typically be due for these 2 vaccines at their annual visit.
MenACWY (Menveo or MedQuadfi) and MenB (Bexsero or Trumenba)*
*MenB is given to at-risk adolescents aged 16-23 (ideally between 16 to 18) going to college, military, etc. It is typically a 2 dose series, but can be given as a 3 dose series for rapid immunity if needed (e.g., going to college in 6 months)
The age at which children should start having routine vision screenings.
4 to 5 years
- Can be done at 3 years if cooperative.
- E charts are better than pictures.
- Visual acuity of < 20 / 30 should be evaluated by an ophthalmologist.
In-toeing is a common finding in young children, and often benign and/or self-limited. These are red flags that this could be a pathological finding (name at least 2 physical exam or medical history findings).
1. Asymmetry or unilateral (cerebral palsy, club foot or skew foot)
2. Delayed developmental milestones (cerebral palsy)
3. Breech positioning at >/= 34 wks gestation, family history of DDH, apparent leg length discrepancy (developmental hip dysplasia)
4. Pain or limp
Common causes of in-toeing include:
- Metatarsus adductus (most common cause in infants < 1 years, usually resolves by age 1)
- Internal tibial torsion (usually resolves by 5 years; use of special shoes/orthotics/braces is not recommended
- Increased femoral anteversion (usually resolves by 11 years)
The name of this skin finding.
BONUS 200 PTS: Name of a multi-organ condition that can cause this.
Ash leaf spot
Tuberous sclerosis: rare genetic disorder causing benign tumors and lesions in the brain, heart, kidneys, lungs, skin, and other organs, leading to symptoms like seizures, intellectual disabilities, developmental delays, and various skin issues
A parents asks you if they should give their child a baby walker. This is what you advise them.
"Contrary to what the name suggests, these devices do not help children learn to walk. They actually eliminate the desire to walk. To make matters worse, they present a serious tipping hazard when the child bumps into an obstacle, like a small toy or a throw rug. Children in walkers are also more likely to fall down stairs and get into dangerous places otherwise beyond their reach."
A healthy 11 to 12 year old who previously completed all their routine childhood vaccines will typically be due for these 3 vaccines at their annual visit (apart from COVID/flu if applicable).
TdAP, Meningococcal (MenACWY), HPV
These are the 3 indications for TB screening in pediatric populations.
(1) exposure to TB or a family member with positive tuberculin test
(2) born in or recently traveled to high risk country (outside of US, Canada, New Zealand, Western or North European countries)
(3) parents or close contacts who are new immigrants from a high risk country, or have been recently incarcerated.
IGRA is preferred esp. if have had BCG vaccine.
A mother tells you that she is concerned about her 4 month old infant "turning blue" when he cries or feeds. He has an episode in the office, and you note bluish discoloration around his lips, hands, and feet while crying. The discoloration gets better when you place the infant in a knee-to-chest position. You think this is the diagnosis.
Tetralogy of Fallot
The knee-chest position increases systemic vascular resistance (SVR), which promotes movement of blood from the right ventricular (RV) into the pulmonary circulation rather than the aorta.
This should be differentiated from a breath-holding spell, where the infant's face may become blue or white whenever angry and may even pass out.
The name of this skin finding.
BONUS 200 PTS: Name of a multi-organ condition that can cause this (or 300 PTS if you can name 2)
Cafe au lait macules
flat, light to dark brown skin patches resembling coffee with milk, caused by excess melanin, often present from birth or early childhood, and are usually harmless; however, having multiple spots (especially more than six) or large, irregularly bordered ones (like "coast of Maine") can signal genetic conditions like Neurofibromatosis Type 1 (NF1) or McCune-Albright syndrome
This is how parents/caregivers can encourage their baby to crawl.
Placing interesting objects just beyond their reach, or even creating obstacle courses with pillows etc. (but avoiding stairs - make sure to block off with a baby gate!). This is ALWAYS supervised. Most infants will start crawling around 8-10 months, but can range from 6-12 months.
The first 2-3 doses of these five vaccines are given to infants at their 2, 4, and 6 month visits.
RV, DTaP, Hib, PVC (15 or 20), IPV
RV: 2, 4, 6*
Hib: 2, 4, 6*, 12-15
PCV: 2, 4, 6, 12-15
IPV: 2, 4, 6 - 18, 4-6 yrs
DTaP: 2, 4, 6, 15-18, 4-6 yrs