Recent

  • Show all results for ""

🎧 New: AI-Generated Podcasts Turn your study notes into engaging audio conversations. Learn more

Newborn Screen
151 Questions
1 Views

Newborn Screen

Created by
@leichnam

Podcast Beta

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is a core disorder with a deficiency in acyl-CoA?

  • Hypothyroidism, primary congenital
  • Cystic fibrosis
  • Pompe Disease, Probable Late Onset
  • Medium-chain acyl-CoA dehydrogenase deficiency (correct)

    • What is the purpose of the Automated Auditory Brainstem Response (AABR) test?

  • To provide an overall auditory health assessment
  • To assess the vestibulocochlear nerve's response to sound (correct)
  • To measure sound waves from the inner ear
  • To evaluate hearing loss in older children

    • Which of the following carriers has the highest detection rate mentioned in the content?

  • Hb S (sickle)-carrier (correct)
  • Galactosemia carrier
  • Cystic fibrosis carrier
  • Pompe Disease, Carrier

    • Which format should be used to describe the history of present illness during a visit?

    <p>OLDCARTS format</p> Signup and view all the answers

    For which congenital condition is carrier status indicated, according to the content provided?

    <p>Cystic fibrosis</p> Signup and view all the answers

    What is one of the key identifying data points collected during an infancy visit?

    <p>Gender</p> Signup and view all the answers

    What does the O in OPQRST stand for in the context of the history of present illness?

    <p>Onset</p> Signup and view all the answers

    How long does each hearing screening test typically take?

    <p>5 to 10 minutes</p> Signup and view all the answers

    At what age does a child typically start to coo responsively?

    <p>2 months</p> Signup and view all the answers

    Which aspect of development does the Denver Developmental Screening Test II primarily assess?

    <p>Gross and fine motor skills</p> Signup and view all the answers

    What is a key factor to inquire about during social history in a pediatric evaluation?

    <p>Presence of household pets</p> Signup and view all the answers

    Which component is NOT typically included in a comprehensive family history assessment?

    <p>Family hobbies</p> Signup and view all the answers

    When assessing the home environment, what type of information is relevant?

    <p>Type of heating/cooling system</p> Signup and view all the answers

    What is a critical aspect of parent-child interaction to observe during assessments?

    <p>Responsiveness to the child’s needs</p> Signup and view all the answers

    What should be included in a thorough immunization history inquiry?

    <p>Any missed doses or reactions</p> Signup and view all the answers

    What is important to assess regarding the setting of the child's home?

    <p>Duration of residence</p> Signup and view all the answers

    Which drug is associated with the risk of facial and ear anomalies as well as congenital heart disease?

    <p>Isotretinoin</p> Signup and view all the answers

    What is a potential consequence of maternal alcohol use during pregnancy?

    <p>Fetal alcohol syndrome</p> Signup and view all the answers

    What effect does smoking during pregnancy have on neonatal outcomes?

    <p>Reduced weight and increased SIDS risk</p> Signup and view all the answers

    Which teratogenic drug is associated with spina bifida?

    <p>Valproate</p> Signup and view all the answers

    What defines advanced maternal age in the context of pregnancy?

    <p>35 years and older</p> Signup and view all the answers

    Which medication is a known folic acid antagonist that can lead to neural tube defects?

    <p>Trimethoprim</p> Signup and view all the answers

    Accidental exposure to which substance during pregnancy can lead to fetal alcohol-like syndrome and preterm labor?

    <p>Toluene</p> Signup and view all the answers

    What is a potential effect of using tetracycline during pregnancy?

    <p>Enamel hypoplasia</p> Signup and view all the answers

    What is the significance of interval history in pediatric assessments?

    <p>It is crucial if there are delays of more than 2 months between visits.</p> Signup and view all the answers

    Which of the following symptoms falls under the respiratory review of systems for infants?

    <p>Stridor</p> Signup and view all the answers

    Which anticipatory guidance area involves ensuring children sleep safely?

    <p>Injury Prevention</p> Signup and view all the answers

    What should be the approach of a healthcare professional towards parental concerns?

    <p>Allow parents to express concerns before providing information.</p> Signup and view all the answers

    Which of the following is NOT a priority area of anticipatory guidance in the neonatal period?

    <p>Vaccination Schedule</p> Signup and view all the answers

    In the infant review of systems, which symptom would suggest a hematologic concern?

    <p>Easy bruising</p> Signup and view all the answers

    What aspect does anticipatory guidance primarily aim to facilitate?

    <p>The optimal growth and development of children.</p> Signup and view all the answers

    What should be included in a comprehensive review of systems for infants?

    <p>Developmental milestones and behavior.</p> Signup and view all the answers

    What is the most significant risk factor associated with maternal diabetes during pregnancy?

    <p>Risk of hypoglycemia in the infant</p> Signup and view all the answers

    Which maternal condition can lead to neonatal sepsis?

    <p>Infection</p> Signup and view all the answers

    What potential complication can arise from systemic lupus erythematosus in a pregnant mother?

    <p>Stillbirth</p> Signup and view all the answers

    What condition is associated with maternal hyperparathyroidism during pregnancy?

    <p>Hypocalcemia in the infant</p> Signup and view all the answers

    What is an indicator of fetal distress observed during labor?

    <p>Fetal tachycardia</p> Signup and view all the answers

    Which of the following is NOT typically evaluated in a neonatal history assessment?

    <p>Maternal diseases</p> Signup and view all the answers

    What is a result of RH or other blood group sensitization in neonates?

    <p>Neonatal jaundice</p> Signup and view all the answers

    What aspect of developmental history is critical to assess?

    <p>Achievement of milestones</p> Signup and view all the answers

    What is the primary purpose of the newborn heel stick screening?

    <p>To identify genetic and metabolic disorders</p> Signup and view all the answers

    Which condition is not typically included in the mandatory newborn screening tested in Virginia?

    <p>Respiratory syncytial virus</p> Signup and view all the answers

    What is required for performing the heel stick screening on an infant?

    <p>It must be performed after 24 hours of life</p> Signup and view all the answers

    What was a significant statistic regarding neonatal screening reported in July 2021?

    <p>8,600 infants were screened for 31 disorders</p> Signup and view all the answers

    What is the role of the Virginia Department of Health's newborn screening staff?

    <p>To follow-up on abnormal test results for infants</p> Signup and view all the answers

    What is one of the two tests used to screen for hearing in infants?

    <p>Otoacoustic Emissions (OAE)</p> Signup and view all the answers

    In which area of assessment is the OPQRST format specifically utilized?

    <p>History of Present Illness</p> Signup and view all the answers

    Which of the following core disorders is associated with enzyme deficiency?

    <p>Phenylketonuria (PKU)</p> Signup and view all the answers

    What is a significant characteristic of the AABR hearing screening test?

    <p>It evaluates the response of the vestibulocochlear nerve</p> Signup and view all the answers

    Which carrier status has the highest number mentioned in the content?

    <p>Hb S (sickle)-carrier</p> Signup and view all the answers

    Which of the following represents a secondary disorder that can be detected in the differential diagnosis of a core condition?

    <p>Galactosemia, duarte (unspecified)</p> Signup and view all the answers

    What is the primary focus of the Bright Futures tables for infancy visits?

    <p>Providing anticipatory guidance</p> Signup and view all the answers

    At what age should a child typically start tracking objects past midline?

    <p>2 months</p> Signup and view all the answers

    Which primary congenital disorder is characterized by a deficiency in hormone production?

    <p>Hypothyroidism, primary congenital</p> Signup and view all the answers

    Which of the following factors is NOT commonly assessed in a child's immunization history?

    <p>Vaccination site cleanliness</p> Signup and view all the answers

    What should be a critical focus when gathering information about family history?

    <p>Mental health disorders</p> Signup and view all the answers

    During a social history assessment, which of the following is least likely to be relevant?

    <p>Favorite family activities</p> Signup and view all the answers

    What is an appropriate action if a child is described as living in a home with smokers?

    <p>Make a note for potential health risks</p> Signup and view all the answers

    Which developmental milestone is typically observed at 2 weeks of age?

    <p>Moves head to side</p> Signup and view all the answers

    In the context of parent-child interaction, which behavior is least indicative of a healthy response to a child's needs?

    <p>Ignoring the child’s cues</p> Signup and view all the answers

    When assessing a child's household situation, which aspect is most critical?

    <p>Home environment characteristics</p> Signup and view all the answers

    What is a potential effect of maternal hyperthyroidism on pregnancy outcomes?

    <p>Preterm delivery and SGA</p> Signup and view all the answers

    Which complication is associated with maternal diabetes during pregnancy?

    <p>Large for gestational age infants and hypoglycemia</p> Signup and view all the answers

    Which of the following maternal conditions is known to cause congenital heart block in newborns?

    <p>Systemic lupus erythematosus</p> Signup and view all the answers

    What is a common neonatal complication associated with maternal infections during pregnancy?

    <p>Neonatal sepsis</p> Signup and view all the answers

    What effect does maternal hypertension have on pregnancy outcomes?

    <p>Small for gestational age infants, premature birth, and placental abruption</p> Signup and view all the answers

    What is a potential outcome of RH or other blood group sensitization in neonates?

    <p>Neonatal jaundice and fetal anemia</p> Signup and view all the answers

    What is a significant risk associated with maternal infections like HIV and Hepatitis during pregnancy?

    <p>Infection risk for the neonate</p> Signup and view all the answers

    What potential issue can arise from hyperparathyroidism in a pregnant woman?

    <p>Neonatal hypocalcemia</p> Signup and view all the answers

    Why is it necessary to obtain interval history in pediatric assessments?

    <p>To understand any serious health issues or changes in care.</p> Signup and view all the answers

    Which aspect is NOT included under the developmental review in the infant assessment?

    <p>Feeding frequency</p> Signup and view all the answers

    What is the primary goal of anticipatory guidance provided to parents?

    <p>To facilitate optimal growth and development for children.</p> Signup and view all the answers

    Which factor is MOST important to address when discussing sleep position with parents of infants?

    <p>Promoting the back-to-sleep position.</p> Signup and view all the answers

    What should healthcare providers avoid when engaging with parents about their child's health?

    <p>Using medical jargon to explain health concerns.</p> Signup and view all the answers

    Which area of anticipatory guidance is focused specifically on preventing child-related injuries?

    <p>Injury Prevention</p> Signup and view all the answers

    What is a key consideration regarding documentation in pediatric assessments?

    <p>Ensuring records are understandable to others.</p> Signup and view all the answers

    Which statement best characterizes the concept of 'Bright Futures'?

    <p>A project aimed at standardizing anticipatory guidance.</p> Signup and view all the answers

    What must occur if an infant receives a blood transfusion after the initial heel stick screening?

    <p>The heel stick must be repeated if the infant is under 6 months.</p> Signup and view all the answers

    What is the legal requirement regarding newborn screening in Virginia?

    <p>Screening is mandatory for all infants unless religious objections are stated.</p> Signup and view all the answers

    How many metabolic and hereditary disorders are screened for in Virginia's newborn program?

    <p>30 disorders.</p> Signup and view all the answers

    When should the heel stick screening ideally be performed on a newborn?

    <p>After 24 hours of life.</p> Signup and view all the answers

    What is the primary follow-up action for the Virginia Department of Health after identifying abnormal test results?

    <p>Follow up with the parents about the screening results.</p> Signup and view all the answers

    What is the recommended evaluation for maternal health regarding age when considering pregnancy risks?

    <p>Maternal age should be between 16 and 35 years.</p> Signup and view all the answers

    Which teratogenic drug is known to cause microcephaly and congenital heart disease?

    <p>Alcohol</p> Signup and view all the answers

    Which maternal factor is associated with reduced weight and increased risk of sudden infant death syndrome (SIDS)?

    <p>Smoking</p> Signup and view all the answers

    What complication can result from exposure to radioactive iodine during pregnancy?

    <p>Fetal hypothyroidism</p> Signup and view all the answers

    Which of the following medication categories is a known folic acid antagonist linked to neural tube defects?

    <p>Antiepileptic drugs</p> Signup and view all the answers

    What is one significant consequence of exposure to Tetracycline during pregnancy?

    <p>Enamel hypoplasia</p> Signup and view all the answers

    Which maternal risk factor can lead to growth retardation and developmental issues in the neonate?

    <p>Substance abuse</p> Signup and view all the answers

    What potential risk does the use of Lithium during pregnancy pose to the fetus?

    <p>Ebstein anomaly</p> Signup and view all the answers

    At what age can a child typically begin to track an object past the midline?

    <p>2 months</p> Signup and view all the answers

    Which aspect of social history is essential to understand family risk factors for pediatric patients?

    <p>Family dynamics and composition</p> Signup and view all the answers

    What is an important factor to consider while taking family history related to mental health?

    <p>All systems and first-degree relatives including mental health</p> Signup and view all the answers

    Which criterion is NOT typically assessed when evaluating the home environment of a child?

    <p>Parental education levels</p> Signup and view all the answers

    Which of the following correctly describes a developmental milestone for a 2-week-old infant?

    <p>Moves head side to side</p> Signup and view all the answers

    What is a critical element to include when documenting immunization history for a pediatric visit?

    <p>Past doses and any adverse reactions</p> Signup and view all the answers

    Which of the following is NOT relevant when assessing risk factors for a child during a social history inquiry?

    <p>Parents' marital satisfaction</p> Signup and view all the answers

    Which method of communication is indicated as essential between parents and children during assessments?

    <p>Frequent direct eye contact</p> Signup and view all the answers

    What is the primary reason for conducting an interval history in pediatric assessments?

    <p>To identify any gaps in medical history during extended periods</p> Signup and view all the answers

    Which symptom would indicate a concern in the gastrointestinal review of systems for infants?

    <p>Projectile vomiting</p> Signup and view all the answers

    In the context of anticipatory guidance, which area focuses on ensuring safe sleep for infants?

    <p>Sleep Position</p> Signup and view all the answers

    Which of the following practices should a healthcare provider NOT employ when addressing parental concerns?

    <p>Provide subjective opinions on parenting</p> Signup and view all the answers

    What is a suitable approach in responding to parental issues during an infant assessment?

    <p>Encourage expression of concerns before providing solutions</p> Signup and view all the answers

    What component is NOT typically included in the review of systems for an infant?

    <p>Cognitive development</p> Signup and view all the answers

    What is the main focus of the Bright Futures initiative in pediatric care?

    <p>To establish uniform standards for anticipatory guidance</p> Signup and view all the answers

    Which aspect of history taking can significantly contribute to forming a diagnosis in pediatric evaluations?

    <p>Comprehensive interval history and its details</p> Signup and view all the answers

    What effect can maternal diabetes have on the infant?

    <p>Large for gestational age (LGA) and risk of hypoglycemia</p> Signup and view all the answers

    Which condition is associated with maternal hyperparathyroidism?

    <p>Hypocalcemia</p> Signup and view all the answers

    What complication is specifically noted as a potential outcome of systemic lupus erythematosus during pregnancy?

    <p>Congenital heart block</p> Signup and view all the answers

    What is a significant risk associated with maternal hyperthyroidism during pregnancy?

    <p>SGA and birth defects if on Methimazole or Tapazole</p> Signup and view all the answers

    Which of the following maternal conditions can cause fetal anemia?

    <p>Blood group sensitization</p> Signup and view all the answers

    What maternal condition is associated with an increased risk of neonatal sepsis?

    <p>Infection</p> Signup and view all the answers

    What is an expected outcome for infants born to mothers with untreated hyperthyroidism?

    <p>Neonatal Grave's disease</p> Signup and view all the answers

    What potential consequence does maternal hypertension pose during pregnancy?

    <p>Risk of SGA, premature birth, and placental abruption</p> Signup and view all the answers

    Which developmental milestone is typically observed at 2 months regarding fine motor skills?

    <p>Tracks past midline</p> Signup and view all the answers

    What is included in the Denver Developmental Screening Test II?

    <p>Comprehensive assessment of developmental milestones</p> Signup and view all the answers

    Which factor is relevant to inquire about when assessing a child's social history?

    <p>Presence of household pets</p> Signup and view all the answers

    Which aspect of family history should not be overlooked during assessments?

    <p>Medical history of first-degree relatives</p> Signup and view all the answers

    What should be included in a comprehensive immunization history?

    <p>Documentation of missed doses</p> Signup and view all the answers

    Which information is considered least relevant when discussing the child's home environment?

    <p>Presence of siblings</p> Signup and view all the answers

    What is a key indicator of a child's personal-social development at 2 months?

    <p>Responds to facial expressions</p> Signup and view all the answers

    In assessing parent-child interaction, which factor is most critical?

    <p>Parental response to the child's needs</p> Signup and view all the answers

    Which disorder is a core disorder with a higher severity indicator based on the number indicated?

    <p>Hb SS-disease (sickle cell anemia)</p> Signup and view all the answers

    Which hearing screening method directly measures the response to sound produced in the inner ear?

    <p>Otoacoustic Emissions (OAE)</p> Signup and view all the answers

    What is the primary component utilized in describing the quality of pain during a patient visit?

    <p>Quality assessment</p> Signup and view all the answers

    Which carrier status indicates a potential genetic link to hemoglobin disorders?

    <p>Hb S (sickle)-carrier</p> Signup and view all the answers

    How are the Automated Auditory Brainstem Response and Otoacoustic Emissions testing methods characterized in terms of time and discomfort?

    <p>Short and non-invasive</p> Signup and view all the answers

    Which of the following genetic disorders is characterized by a medium-chain acyl-CoA enzyme deficiency?

    <p>Medium-chain acyl-CoA dehydrogenase deficiency</p> Signup and view all the answers

    In the context of carrier screening, which condition is least represented based on its carrier detection number?

    <p>Very long-chain acyl-CoA dehydrogenase deficiency carrier</p> Signup and view all the answers

    Which aspect of congenital screening is most emphasized for systematic assessment?

    <p>Health history collection</p> Signup and view all the answers

    What is a requirement for the newborn heel stick screening mandated by Virginia law?

    <p>It must be performed after 24 hours of life unless the parent objects.</p> Signup and view all the answers

    Why is interval history especially necessary during pediatric assessments?

    <p>If the child has undergone significant medical changes</p> Signup and view all the answers

    How many metabolic and hereditary disorders did DCLS screen for in July 2021?

    <p>31 disorders</p> Signup and view all the answers

    What action must be taken if a newborn receives antibiotics before the heel stick screening?

    <p>The screening must be repeated.</p> Signup and view all the answers

    Which component is NOT part of the infant review of systems?

    <p>Motor skill development</p> Signup and view all the answers

    What is the typical outcome of the newborn screening in Virginia regarding positive results?

    <p>More than 600 infants identified with one or more disorders annually.</p> Signup and view all the answers

    What approach should healthcare professionals take when addressing parental concerns?

    <p>Encourage parents to articulate their worries first</p> Signup and view all the answers

    What is the maximum age up to which tests can be repeated if necessary?

    <p>6 months</p> Signup and view all the answers

    What area does the anticipatory guidance framework NOT specifically target?

    <p>Cognitive milestone assessment</p> Signup and view all the answers

    In which component of the comprehensive history is the most emphasis placed during a pediatric visit?

    <p>Developmental milestones</p> Signup and view all the answers

    Which of the following is a key principle of effective anticipatory guidance for infants?

    <p>Ensure standardized approaches to diverse topics</p> Signup and view all the answers

    Which of these behaviors should be noted for potential flagging during the review of systems?

    <p>Attachment issues</p> Signup and view all the answers

    What is one of the anticipated outcomes of effective anticipatory guidance?

    <p>Enhanced parental ability to manage health concerns</p> Signup and view all the answers

    Which of the following maternal health factors is directly associated with an increased risk for reduced birth weight and SIDS?

    <p>Smoking during pregnancy</p> Signup and view all the answers

    What is a primary result of exposure to Isotretinoin during pregnancy?

    <p>Facial and ear anomalies</p> Signup and view all the answers

    What defines advanced maternal age in the context of pregnancy?

    <p>Over 35 years old</p> Signup and view all the answers

    Which of the following teratogenic drugs is associated with causing spina bifida?

    <p>Valproate</p> Signup and view all the answers

    Which maternal factor is linked to the development of Ebstein anomaly in neonates?

    <p>Lithium use</p> Signup and view all the answers

    Which of the following is a potential consequence of maternal alcohol consumption during pregnancy?

    <p>Fetal Alcohol Syndrome</p> Signup and view all the answers

    What impact does exposure to radioactive iodine during pregnancy have on the fetus?

    <p>Fetal hypothyroidism</p> Signup and view all the answers

    Which of the following statements about teratogenic drugs is true regarding tetracycline?

    <p>Leads to enamel hypoplasia</p> Signup and view all the answers

    Study Notes

    Core Disorders

    • Biotinidase deficiency, partial (BIO partial)
    • Congenital adrenal hyperplasia, salt-wasting (CAH (SW))
    • Cystic fibrosis (CF)
    • Hb C-disease (Hb F,C)
    • Hb SC-disease (Hb F,S,C)
    • Hb SS-disease (sickle cell anemia) (Hb F,S)
    • Hypothyroidism, primary congenital (CH)
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCAD)
    • Phenylketonuria (PKU)
    • Pompe Disease, Probable Late Onset (Probable LOPD)

    Secondary Disorders:

    • Cystic fibrosis carrier (CF carrier)
    • Galactosemia carrier (GALT carrier)
    • Galactosemia, duarte (unspecified)
    • Hb C beta-thalassemia (Hb F,C,A)
    • Hb S (sickle)-carrier (Hb F,A,S)
    • Mucopolysaccharidosis type I Carrier, (MPS-1 Carrier)
    • Pompe Disease, Carrier
    • Thyroid-binding globulin deficiency (TBG)
    • Very long-chain acyl-CoA dehydrogenase deficiency carrier (VLCAD carrier)

    Hearing Screening

    • Automated Auditory Brainstem Response (AABR)
      • Measures how the vestibulocochlear nerve responds to sound
      • Clicks or tones are played through earphones and electrodes placed on the baby's head to measure the response
    • Otoacoustic Emissions (OAE)
      • Measures sound waves produced in the inner ear
      • A probe placed just inside the ear canal measures the response when clicks or tones are played into the baby's ears

    General Information to Include in Notes

    • Date of Visit
    • Name of Patient
    • Birth date of patient
    • Gender of patient
    • Race of patient
    • Informant (who is providing the information)

    Chief Complaint

    • Reason for visit, in the caregiver's words
    • "Well visit" is acceptable.

    History of Present Illness

    • Events leading to visit in OPQRST or OLDCARTS format.
      • O – Onset of event
      • P – Provocation or Palliation
      • Q – Quality of pain or other symptom
      • R – Region or Radiation
      • S - Severity
      • T – Time (History)
    • If a well visit - Review medical records including prior office notes, well visits, screening results, etc.
    • Statement of overall health status
    • Current/chronic medical illnesses with date of onset
    • Hospitalizations with date and reason
    • Surgeries with date, location, and provider
    • Medications with dose, route, frequency, and indication
    • Members of the care team
    • Accidents, injuries, or poisonings

    Prenatal History

    • Maternal weight gain during pregnancy
    • Maternal illnesses (chronic or acute)
    • Maternal environmental exposure
    • Maternal medications taken during pregnancy
    • Maternal substance use
    • Maternal nutrition
    • Maternal social situation

    Common Teratogenic Drugs

    • Alcohol
      • Fetal alcohol Syndrome, microcephaly, congenital heart disease
    • Fluoxetine (SSRI)
      • Minor malformations, low birth weight, poor neonatal adaptation
    • Folic Acid Antagonist (trimethoprim, triamterene, phenytoin, primidone, phenobarbital, carbamazepine)
      • Neural tube, cardiovascular, renal, and oral cleft defects
    • Isotretinoin (Accutane) and Vitamin A
      • Facial and ear anomalies, congenital heart disease
    • Lithium
      • Ebstein anomaly
    • Phenytoin
      • Hypoplastic nails, IUGR, atypical facies
    • Radioactive Iodine
      • Fetal Hypothyroidism
    • Radiation
      • Microcephaly
    • Stilbestrol (DES)
      • Vaginal adenocarcinoma during adolescence
    • Streptomycin
      • Deafness
    • Testosterone-like drugs
      • Virilization of female
    • Tetracycline
      • Enamel Hypoplasia
    • Thalidomide
      • Phocomelia
    • Toluene (solvent abuse)
      • Fetal alcohol – like syndrome, preterm labor
    • Valproate
      • Spina Bifida
    • Vitamin D
      • Supravalvular aortic stenosis

    Maternal Risk Factors

    • Maternal Age

      • 35 years old – Advanced Maternal Age

      • 16 – 35 years old – Normal Maternal Age
      • < 16 years old – Young Maternal Age

    • Maternal Health

      • Smoking - Reduced weight & increased SIDS risk
      • Alcohol - Negative effects on brain development, cyanotic heart disease, arrhythmias, CHF, prematurity
      • Substance Abuse - Growth retardation, IUGR, NAS/neonatal withdrawal
      • Trauma - Blunt, Penetrating?– Evaluate Everything

    • Maternal Health Conditions

      • Hypertension
        • SGA, premature birth & placental abruption
      • Diabetes
        • LGA infant, risk of hypoglycemia
      • Hypothyroidism
        • Poor growth, jaundice
      • Hyperthyroidism
        • Preterm delivery, SGA, birth defects if on Methimazole or tapazole or could have neonatal Grave’s disease
      • Hyperparathyroidism
        • Hypocalcemia
      • Infection
        • Neonatal Sepsis
      • Systemic Lupus Erythematous
        • Congenital heart block, rash, anemia, thrombocytopenia, neutropenia, cardiomyopathy, stillbirth
      • HIV, Hepatitis B & C
        • Infection risk
      • Rheumatic Fever
        • Atrial fibrillation, CHF
      • RH or other blood group sensitization
        • Fetal anemia, hypoalbuminemia, hydrops, neonatal jaundice

    Birth History

    • Length of pregnancy in weeks
    • Maternal intrapartum events
      • Hospital visits
      • Illnesses
      • Special care
    • Neonatal intrapartum events
      • Tachycardia
      • Abnormal ultrasound exams
      • Fetal decelerations during labor

    Neonatal History

    • APGAR scores
    • Does the baby require resuscitation?
    • Events in the newborn nursery:
      • Adjustment to extrauterine life
      • Feeding
      • Other problems
    • How old was the baby when you took them home?
    • Problems during the first days of life:
      • Hypoglycemia
      • Respiratory distress
      • Infection
      • Jaundice
      • Difficulty with temperature regulation
      • Trouble with feeding, voiding, or stooling
      • Others
    • Results of Screening test (if not previously reviewed or if repeated)
    • Old records may be helpful if complications were present

    Feeding History

    • Type of feeding (breast or bottle)
    • Feeding problems (resolved or current)
    • Weight problems; failure to gain weight

    Developmental History

    • Achievement of milestones - appropriate or delayed?
    • Milestone regression?
    • Family norms

    Developmental Milestones

    • 2 weeks
      • Gross Motor
        • Moves head side to side
      • Fine Motor
        • Regards face
      • Personal - Social
        • Alerts to bell
    • 2 months
      • Gross Motor
        • Lifts shoulder while prone
      • Fine Motor
        • Tracks past midline
      • Personal - Social
        • Smiles responsively
      • Language
        • Cooing
        • Searches for sound with eyes

    Immunization History

    • Extremely important
    • Missed doses?
    • Any reactions?

    Immunization Schedules

    • Birth to 18 yrs immunization schedules including “catch-up” schedule
    • Websites for resources include:
      • https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
      • https://www.immunize.org/handouts/

    Family History

    • ALL systems and first-degree relatives
    • Do not forget mental health disorders
    • Ask about anything that may be pertinent for the current visit

    Social History

    • Family unit details
      • How many in home?
      • WHO is in the home?
      • Parents married?
      • Who cares for child?
      • Family attitudes
    • Risk factors for child

    Social History Continued

    • Type of residence (house, apartment, or mobile home)
    • Location of home (town or country)
    • Age of home
    • Water source (city or well)
    • Type of heating/cooling system
    • Basement presence and dryness
    • Pets or large animals in home
    • Smoking in home or car
    • Parental occupations

    Parent/Child Interaction

    • How does the parent respond to the child’s needs?
    • Is there eye-contact?
    • Is there communication with siblings?
    • Do the parents communicate to each other/patient with sensitivity and respect?
    • Does the parent handle and respond to the child in a developmentally appropriate way?

    Interval History

    • Necessary if long period (greater than 2 months for infants) between visits
    • Very important if child has had serious illness, new diagnosis, or surgery
    • Necessary if child has been in protective care

    Infant Review of Systems:

    • General
      • Birth weight, weight changes, feeding frequency, fevers, lack of crying, incessant crying
    • Derm
      • Rashes, discolorations
    • Hem/Onc
      • Easy bruising, bleeding
    • Eye
      • Strabismus, oscillations/nystagmus, blindness
    • Ear
      • Hearing abnormalities, ear discharge
    • Nose/Mouth
      • Loud breathing/snoring, nasal congestion/discharge
    • Cardiac
      • Cyanosis
    • Respiratory
      • Wheezing, stridor, cough
    • Gastrointestinal
      • Vomiting (projectile vs.non-projectile), jaundice, feeding issues, colic, stool frequency, color and character
    • Urinary
      • Frequency, hematuria
    • Musculoskeletal
      • Joint abnormalities
    • Developmental
      • Milestones
    • Behavior
      • Attachment issues, attention issues
    • Sleeping position, environment (use of blankets, pillows, etc.)

    Take Home Points for Recording Patient History

    • First, let parents express concerns
    • Ask open-ended questions
    • Be objective and non-judgmental
    • Express your interest in the patient AND the informant
    • Ensure records are readable (correct spelling and grammar)
    • The history may make the diagnosis

    Anticipatory Guidance

    • Bright Futures - AAP project to standardize and improve issues in anticipatory guidance for pediatricians and other health care providers.
    • 5 Main Areas in Neonatal/Infant Period
      • Injury Prevention
      • Violence Prevention
      • Sleep Position
      • Nutritional Counseling
      • Fostering Optimal Development

    Anticipatory Guidance Topics by Age:

    • Birth
      • Injury Prevention
        • Crib safety
        • Hot water heaters
      • Violence Prevention
        • Assess bonding
      • Sleep Position
        • Back to sleep
        • Crib Safety
      • Nutritional Counseling
        • Exclusive breast feeding
      • Fostering Optimal Development
        • Discuss parenting skills
        • Refer for support if needed

    Newborn Heel Stick Screening

    • A mandated screening test for genetic and metabolic disorders in all babies, performed after 24 hours of life and repeated if a baby receives antibiotics or a transfusion.
    • Virginia mandated the test in 1966.
    • The Virginia Department of Health follows up on abnormal test results for more than 20,000 babies each year.
    • Screenings can be repeated on infants up to 6 months of age.
    • The test involves taking a blood sample from the heel.
    • The blood is placed on specific circles on a paper card.

    Newborn Heel Stick Screening in Virginia

    • Virginia screens for over 30 disorders.
    • In July 2021, the Division of Consolidated Laboratory Services (DCLS) screened 8,600 babies for 31 metabolic and hereditary disorders, confirming 431 diagnoses with a critical disorder or carrier status.

    Core Disorders Screened for

    • Biotinidase deficiency, partial (BIO partial)
    • Congenital adrenal hyperplasia, salt-wasting (CAH (SW))
    • Cystic fibrosis (CF)
    • Hb C-disease (Hb F,C)
    • Hb SC-disease (Hb F,S,C)
    • Hb SS-disease (sickle cell anemia) (Hb F,S)
    • Hypothyroidism, primary congenital (CH)
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCAD)
    • Phenylketonuria (PKU)
    • Pompe Disease, Probable Late Onset (Probable LOPD)

    Secondary Disorders Screened for

    • Cystic fibrosis carrier (CF carrier)
    • Galactosemia carrier (GALT carrier)
    • Galactosemia, duarte (unspecified)
    • Hb C beta-thalassemia (Hb F,C,A)
    • Hb S (sickle)-carrier (Hb F,A,S)
    • Mucopolysaccharidosis type I Carrier, (MPS-1 Carrier)
    • Pompe Disease, Carrier
    • Thyroid-binding globulin deficiency (TBG)
    • Very long-chain acyl-CoA dehydrogenase deficiency carrier (VLCAD carrier)

    Hearing Screening

    • Two tests are used: Automated Auditory Brainstem Response (AABR) and Otoacoustic Emissions (OAE).
    • AABR measures how the vestibulocochlear nerve responds to sound.
    • OAE measures sound waves produced in the inner ear.
    • Both tests are quick (5 to 10 minutes) and painless.

    Congenital Heart Disease Screening

    • There is no specific screening test for congenital heart disease, but it is important to consider it during routine infant visits.

    General Information to Collect During an Infant Visit

    • Date of Visit
    • Identifying data:
      • Name
      • Birth date
      • Gender
      • Race
      • Informant

    Chief Complaint

    • Summarize what brings the patient in for the visit in the caregiver's own words.
    • "Well visit" is acceptable.

    History of Present Illness

    • This includes detailed information about the events leading up to the visit, using OPQRST or OLDCARTS format (Onset, Provocation, Quality, Region, Severity, Time).
    • Review previous medical records, screening results, etc.

    Maternal Risk Factors

    • A list is provided detailing the potential effects of maternal conditions such as hypertension, diabetes, hypothyroidism, hyperthyroidism, hyperparathyroidism, infections, systemic lupus erythematosus, HIV, hepatitis B & C, rheumatic fever, and RH or other blood group sensitization.

    Birth History

    • Length of pregnancy in weeks
    • Maternal intrapartum events (e.g., hospital visits, illnesses, special care)
    • Neonatal intrapartum events (e.g., tachycardia, abnormal ultrasounds, fetal decelerations)

    Neonatal History

    • APGAR scores
    • Resuscitation needs
    • Newborn nursery events (e.g., adjustment to extrauterine life, feeding, problems)
    • Age of the baby when brought home
    • Problems during the first few days of life (e.g., hypoglycemia, respiratory distress, infection, jaundice, temperature regulation difficulties, feeding/voiding/stool issues).
    • Screening test results

    Feeding History

    • Type of feeding (e.g., breast or bottle)
    • Feeding problems (e.g., resolved or current)
    • Weight problems or failure to gain weight

    Developmental History

    • Achievement of developmental milestones (e.g., appropriate or delayed)
    • Any milestone regression?

    Developmental Milestones

    A table detailing developmental milestones for a 2-week and 2-month old is provided.

    Immunization History

    • Review immunization doses given and any reactions.

    Immunization Schedules

    • Information is provided on current immunization schedules for infants up to 18 years old.
    • Links to the CDC and Immunize.org websites are provided.
    • There are apps available to assist with immunization schedules.

    Family History

    • Review family history of all systems and first-degree relatives, including mental health disorders.
    • Also, consider family history of anything pertinent to the current visit.

    Social History

    • Details about the family unit, such as the number of people at home, family structure, who cares for the child, and family attitudes.
    • Risk factors for the child, such as housing, water source, heating/cooling systems, pets, smoking, and parental employment.

    Parent/Child Interaction

    • Observations on how the parent responds to the child's needs, eye contact, communication with siblings, and overall parenting interactions.

    Interval History

    • Collect information essential for visits longer than 2 months for infants.
    • This includes information on serious illnesses, new diagnoses, surgeries, or protective care.

    Infant Review of Systems

    • A comprehensive list of systems to review for infants, including general, dermatological, hematologic, eye, ear, nose/mouth, cardiac, respiratory, gastrointestinal, urinary, musculoskeletal, developmental, behavioral issues, and sleeping position.

    Take Home Points

    • Encourage parents to express concerns first.
    • Ask open-ended questions.
    • Be objective and non-judgmental.
    • Show interest in both the patient and the informant.
    • Ensure records are legible and well written.
    • The history is crucial in determining the diagnosis.

    Anticipatory Guidance

    • It is essential to provide information and resources to parents to support healthy growth and development of their children.
    • Bright Futures, a project by the American Academy Pediatrics (AAP), provides standardized anticipatory guidance for pediatricians and other health care providers.
    • The 5 main areas in the neonatal/infant period are injury prevention, violence prevention, sleep position, nutritional counseling, and fostering optimal development.

    Anticipatory Guidance Table

    • A table provides specific anticipatory guidance topics for different age groups.
      • Birth to 9 months: crib safety, hot water heaters, bonding/attachment, back to sleep, exclusive breastfeeding, parenting skills, and appropriate referrals.

    Newborn Heel Stick Screening

    • A screening test for genetic and metabolic disorders
    • Mandated in all states, but the list of conditions screened for varies by state
    • Required for all infants by law in Virginia, unless objected to on religious grounds
    • Must be performed after 24 hours of life and repeated if the infant receives antibiotics or a transfusion
    • The Virginia Department of Health follows up on abnormal test results for more than 20,000 infants each year
    • Repeat tests can be performed on infants up to 6 months of age
    • Procedure involves filling out a form, putting on gloves, cleaning the newborn's heel, sticking with a lancet, wiping the first drop of blood with gauze, and placing a drop of blood in each of five test circles

    Virginia Screens for over 30 Disorders

    • 98,000 babies screened annually for 30+ metabolic and hereditary disorders
    • Over 600 babies are identified as having one or more disorders each year

    Newborn History

    • Gather information on the infant's overall health status, including any current or chronic medical illnesses, hospitalizations, surgeries, medications, and other members of the care team
    • Note any accidents, injuries, or poisonings

    Prenatal History

    • Gather information on the mother's pregnancy, including weight gain, illnesses, environmental exposures, medications, substance use, nutrition, and social situation

    Common Teratogenic Drugs

    • Alcohol can result in fetal alcohol syndrome, microcephaly, and congenital heart disease
    • Fluoxetine (SSRI) can lead to minor malformations, low birth weight, and poor neonatal adaptation
    • Folic acid antagonists, including trimethoprim, triamterene, phenytoin, primidone, phenobarbital, and carbamazepine, can cause neural tube, cardiovascular, renal, and oral cleft defects
    • Isotretinoin (Accutane) and Vitamin A can result in facial and ear anomalies, and congenital heart disease
    • Lithium can lead to Ebstein anomaly
    • Phenytoin can cause hypoplastic nails, IUGR, and atypical facies
    • Radioactive iodine can cause fetal hypothyroidism

    Common Teratogenic Drugs

    • Radiation can lead to microcephaly
    • Stilbestrol (DES) can cause vaginal adenocarcinoma during adolescence
    • Streptomycin can cause deafness
    • Testosterone-like drugs can cause virilisation of female infants
    • Tetracycline can cause enamel hypoplasia
    • Thalidomide can cause phocomelia
    • Toluene (solvent abuse) can lead to fetal alcohol-like syndrome, and preterm labour
    • Valproate can cause spina bifida
    • Vitamin D can cause supravalvular aortic stenosis

    Maternal Risk Factors

    • Maternal age:
      • Greater than 35 years old: Advanced Maternal Age
      • 16 to 35 years old: Normal Maternal Age
      • Less than 16 years old: Young Maternal Age

    Maternal Risk Factors

    • Maternal health:
      • Smoking: Reduced weight and increased SIDS risk
      • Alcohol: Negative effects on brain development, cyanotic heart disease, arrhythmias, CHF, prematurity
      • Substance abuse: Growth retardation, IUGR, NAS/neonatal withdrawal
      • Trauma: Blunt, penetrating? Evaluate everything

    Maternal Risk Factors

    • Condition | Effect
    • --|--- Hypertension | SGA, premature birth, and placental abruption Diabetes | LGA infant, risk of hypoglycemia Hypothyroidism | Poor growth, jaundice Hyperthyroidism | Preterm delivery, SGA, birth defects if on Methimazole or tapazole, or could have neonatal Graves' disease Hyperparathyroidism | Hypocalcemia Infection | Neonatal sepsis Systemic Lupus Erythematosus | Congenital heart block, rash, anemia, thrombocytopenia, neutropenia, cardiomyopathy, stillbirth HIV, Hepatitis B & C | Infection risk Rheumatic Fever | Atrial fibrillation, CHF RH or other blood group sensitization | Fetal anemia, hypoalbuminemia, hydrops, neonatal jaundice

    Birth History

    • Length of pregnancy in weeks
    • Maternal intrapartum events: Hospital visits, illnesses, special care
    • Neonatal intrapartum events: Tachycardia, abnormal ultrasound exams, fetal decelerations during labor

    Neonatal History

    • APGAR scores
    • Resuscitation required?
    • Events in the newborn nursery: Adjustment to extrauterine life, feeding, other problems
    • Age of baby when taken home

    Neonatal History

    • Problems during the first days of life: hypoglycemia, respiratory distress, infection, jaundice, difficulty with temperature regulation, trouble with feeding, voiding, or stooling
    • Screening test results
    • Old records may be helpful if complications were present

    Feeding History

    • Type of feeding: Breast or bottle
    • Feeding problems: Resolved or current?
    • Weight problems: Failure to gain weight?

    Developmental History

    • Achievement of milestones: Appropriate or delayed?
    • Milestone regression?
    • Family norms

    Developmental Milestones

    • Age | Gross Motor | Fine Motor - Adaptive | Personal-Social | Language
    • --|---|---|---|---| 2 weeks | Moves head side to side | Regards face | Alerts to bell | 2 months | Lifts shoulder while prone | Tracks past midline | Smiles responsively | Cooing, searches for sound with eyes
      • Denver Developmental Screening Test II

    Immunization History

    • Extremely important
    • Missed doses?
    • Any reactions?

    Immunization Schedules

    • Birth to 18 years immunization schedules, including catch-up schedules
    • https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
    • https://www.immunize.org/handouts/

    Family History

    • All systems and first-degree relatives
    • Include mental health disorders
    • Ask about anything that may be pertinent for the current visit

    Social History

    • Details of the family unit: How many in the home? Who is in the home? Parents married? Who cares for the child? Family attitudes
    • Risk factors for the child

    Social History

    • Home characteristics: House, apartment, or mobile home?
    • Location: Town or country?
    • Age of the home
    • Water source: City or well water?
    • Heating/cooling system type
    • Basement: Dry or damp?
    • Pets or livestock: Type?
    • Smoking in the home or car: Who smokes?
    • Parents and siblings' occupations

    Parent/Child Interaction

    • Parent's response to the child's needs: Eye contact, communication with siblings, communication with each other and the patient, developmental appropriateness

    Interval History

    • Necessary if long period (> 2 months for infants) between visits
    • Very important if the child has had a serious illness, new diagnosis, or surgery
    • Necessary if the child has been in protective care

    Infant Review of Systems

    • General: Birth weight, weight changes, feeding frequency, fevers, lack of crying, incessant crying
    • Derm: Rashes, discolorations
    • Hem/Onc: Easy bruising, bleeding
    • Eye: Strabismus, oscillations/nystagmus, blindness
    • Ear: Hearing abnormalities, ear discharge
    • Nose/Mouth: Loud breathing/snoring, nasal congestion/discharge
    • Cardiac: Cyanosis
    • Respiratory: Wheezing, stridor, cough
    • Gastrointestinal: Vomiting (projectile vs. non-projectile), jaundice, feeding issues, colic, stool frequency, color, and character
    • Urinary: Frequency, hematuria
    • Musculoskeletal: Joint abnormalities
    • Developmental: Milestones
    • Behavior: Attachment issues, attention issues
    • Sleeping position, environment (use of blankets, pillows, etc.)

    Take Home Points

    • Let parents express concerns first
    • Ask open-ended questions
    • Be objective and non-judgmental
    • Express interest in both the patient and the informant
    • Ensure records are legible (correct spelling and grammar)
    • The history may make the diagnosis

    Anticipatory Guidance

    • Information conveyed to parents verbally or in written materials that is meant to assist in facilitating optimal growth and development for their children

    Anticipatory Guidance

    • Bright Futures: AAP project to standardize and improve anticipatory guidance for pediatricians and other healthcare providers
    • http://brightfutures.aap.org
    • Five main areas in the neonatal/infant period:
      • Injury prevention
      • Violence prevention
      • Sleep position
      • Nutritional counseling
      • Fostering optimal development

    Anticipatory Guidance

    • Age | Injury Prevention | Violence Prevention | Sleep Position | Nutritional Counseling| Fostering Optimal Development
    • --|---|---|---|---|---| Birth | Crib safety, hot water heaters | Assess bonding and attachment | Back to sleep, crib safety | Exclusive breastfeeding | Discuss parenting skills, refer for support as needed

    Newborn Heel Stick Screening

    • Newborn heel stick screening is a mandatory test in all states for genetic and metabolic disorders.
    • The list of disorders screened for varies by state.
    • In Virginia, the screening was mandated in 1966 and must be performed on all infants unless the parent or guardian objects due to religious reasons.
    • The test must be performed after 24 hours of life and repeated if the infant receives antibiotics or a transfusion.
    • The Virginia Department of Health annually follows up on more than 20,000 infants with abnormal test results.
    • Repeat tests can be performed for infants up to 6 months of age.
    • The procedure involves cleaning the newborn's heel, sticking with a lancet, wiping the first drop of blood with gauze, and placing a drop of blood in each of the five test circles.

    Virginia Newborn Screening

    • Over 98,000 babies are screened annually for over 30 metabolic and hereditary disorders.
    • Over 600 infants are identified each year as having one or more disorders.
    • In July 2021, 8,600 babies were screened for 31 disorders and 431 were diagnosed with a critical disorder or carrier status.

    Core Disorders Screened for

    • Biotinidase deficiency, partial (BIO partial): 1
    • Congenital adrenal hyperplasia, salt-wasting (CAH (SW)): 1
    • Cystic fibrosis (CF): 1
    • Hb C-disease (Hb F,C): 1
    • Hb SC-disease (Hb F,S,C): 5
    • Hb SS-disease (sickle cell anemia) (Hb F,S): 5
    • Hypothyroidism, primary congenital (CH): 3
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCAD): 1
    • Phenylketonuria (PKU): 1
    • Pompe Disease, Probable Late Onset (Probable LOPD): 1

    Secondary Disorders

    • Cystic fibrosis carrier (CF carrier): 17
    • Galactosemia carrier (GALT carrier): 3
    • Galactosemia, duarte (unspecified): 3
    • Hb C beta-thalassemia (Hb F,C,A): 1
    • Hb S (sickle)-carrier (Hb F,A,S): 259
    • Mucopolysaccharidosis type I Carrier, (MPS-1 Carrier): 4
    • Pompe Disease, Carrier: 6
    • Thyroid-binding globulin deficiency (TBG): 2
    • Very long-chain acyl-CoA dehydrogenase deficiency carrier (VLCAD carrier) : 1

    Hearing Screening

    • Hearing screening is performed using the automated auditory brainstem response (AABR) or otoacoustic emissions (OAE) tests.
    • AABR measures the vestibulocochlear nerve response to sound.
    • OAE measures sound waves produced in the inner ear.
    • Both tests are quick and painless.

    Screening for Congenital Heart Disease

    • Screening for congenital heart disease is one of the five main areas in the AAP Bright Futures project.

    General Information for Infant Visits

    • Date of visit
    • Identifying data: name, birth date, gender, race, informant.

    Chief Complaint for Infant Visits

    • What prompted the patient's visit in the caregiver's own words.
    • Accepting "Well visit" is acceptable.

    History of Present Illness for Infant Visits

    • Events leading to the visit utilizing the OPQRST or OLDCARTS format.
    • For well visits, review the medical record for past notes, screening results, and overall health status.
    • List any current/chronic illnesses with date of onset, hospitalizations with date and reason, surgeries with date, location, provider, medications with dose, route, frequency, and indication.
    • List other members of the care team and mention any accidents, injuries, or poisonings.

    Prenatal History for Infant Visits

    • Questions pertaining to pregnancy including weight gain, illnesses, environmental exposures, medications, substance use, nutrition, and social situation.

    Teratogenic Drugs

    • Alcohol: Fetal alcohol syndrome, microcephaly, congenital heart disease.
    • Fluoxetine (SSRI): Minor malformations, low birth weight, poor neonatal adaptation.
    • Folic Acid Antagonist (trimethoprim, triamterene, phenytoin, primidone, phenobarbital, carbamazepine): Neural tube, cardiovascular, renal, and oral cleft defects.
    • Isotretinoin (Accutane) and Vitamin A: Facial and ear anomalies, congenital heart disease.
    • Lithium: Ebstein anomaly.
    • Phenytoin: Hypoplastic nails, IUGR, atypical facies.
    • Radioactive Iodine: Fetal hypothyroidism.
    • Radiation: Microcephaly.
    • Stilbestrol (DES): Vaginal adenocarcinoma during adolescence.
    • Streptomycin: Deafness.
    • Testosterone-like drugs: Virilization of female.
    • Tetracycline: Enamel hypoplasia
    • Thalidomide: Phocomelia.
    • Toluene (solvent abuse): Fetal alcohol-like syndrome, preterm labor.
    • Valproate: Spina bifida.
    • Vitamin D: Supravalvular aortic stenosis.

    Maternal Risk Factors

    • Maternal Age

      • 35 years old: Advanced maternal age.

      • 16-35 years old: Normal maternal age.
      • < 16 years old: Young maternal age.
    • Maternal Health
      • Smoking: Reduced weight and increased SIDS risk.
      • Alcohol: Negative effects on brain development, cyanotic heart disease, arrhythmias, CHF, prematurity.
      • Substance abuse: Growth retardation, IUGR, NAS/neonatal withdrawal.
      • Trauma: Blunt or penetrating?

    Developmental Milestones

    • Age | Gross Motor | Fine Motor - Adaptive | Personal-Social | Language
    • -- | --- | --- | --- | ---
    • 2 weeks | Moves head side to side | Regards face | Alerts to bell |
    • 2 months | Lifts shoulders while prone | Tracks past midline | Smiles responsively | Cooing, searches for sound with eyes

    Immunization History

    • It is critical to review the immunization history.
    • Note any missed doses or reactions.
    • The text provides helpful links to immunization schedules.

    Family History

    • Include all systems and first-degree relatives.
    • Remember to inquire about mental health disorders.
    • Ask about any pertinent information for the current visit.

    Social History

    • Details of the family unit: how many people live in the home, who lives in the home, marital status of the parents, who cares for the child, family attitudes, and risk factors for the child.
    • Home details including type of dwelling, location, age of the home, type of water, heating/cooling system, basement, pets, any smoking in the home, and occupations of the parents and siblings.

    Parent/Child Interaction

    • The way the parent responds to the child's needs: eye contact, communication with siblings, communication between parents, handling and responding to the child in a developmentally appropriate way.

    Interval History

    • Must be obtained if there is a significant period between visits (more than 2 months for infants).
    • Critical to obtain if the child has had a serious illness, new diagnosis, surgery, or has been in protective care.

    Infant Review of Systems

    • General: Birth weight, weight changes, feeding frequency, fevers, lack of crying, incessant crying.
    • Derm: Rashes, discolorations.
    • Hem/Onc: Easy bruising, bleeding.
    • Eye: Strabismus, oscillations/nystagmus, blindness.
    • Ear: Hearing abnormalities, ear discharge.
    • Nose/Mouth: Loud breathing/snoring, nasal congestion/discharge.
    • Cardiac: Cyanosis.
    • Respiratory: Wheezing, stridor, cough.
    • Gastrointestinal: Vomiting (projectile vs. non-projectile), jaundice, feeding issues, colic, stool frequency, color and character.
    • Urinary: Frequency, hematuria.
    • Musculoskeletal: Joint abnormalities.
    • Developmental: Milestones.
    • Behavior: Attachment issues, attention issues.
    • Sleeping position: Environment (use of blankets, pillows, etc.).

    Take Home Points for History Taking

    • Allow parents to express their concerns.
    • Ask open-ended questions.
    • Be objective and non-judgmental.
    • Express interest in the patient and the informant.
    • Ensure the record is legible for others to read.
    • Remember that a thorough history may lead to a diagnosis.

    Anticipatory Guidance

    • The goal is to provide information to parents/caregivers that will help promote optimal growth and development of their child.
    • Bright Futures is an AAP project focusing on anticipatory guidance for pediatricians and other healthcare providers.
    • The program focuses on the following five areas for neonates/infants: injury prevention, violence prevention, sleep position, nutritional counseling, and fostering optimal development.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Newborn Screening PDF

    Description

    This quiz covers various core and secondary genetic disorders, including conditions like Biotinidase deficiency, Cystic fibrosis, and Phenylketonuria. Additionally, it includes information about carriers of these disorders and related hearing screenings. Test your knowledge on these important health conditions and their implications.

    More Quizzes Like This

    Genetic Disorders
    10 questions

    Genetic Disorders

    FreshestAffection avatar
    FreshestAffection
    Genetic Disorders Quiz
    34 questions

    Genetic Disorders Quiz

    PlayfulHarmony avatar
    PlayfulHarmony
    Genetic Disorders: Down Syndrome and Cleidocranial Dysostosis
    15 questions

    Genetic Disorders: Down Syndrome and Cleidocranial Dysostosis

    DelectableField avatar
    DelectableField
    Genetic Disorders: Inheritance Patterns
    10 questions

    Genetic Disorders: Inheritance Patterns

    WellBredNephrite4206 avatar
    WellBredNephrite4206
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser