Pediatric Medicine Overview

AAP vs CDC Pediatric Age

• AAP Bright Futures categorizes ages as infant (0-2), child (2-12), and adolescent (12-21), with further subdivisions for adolescence (early 11-14, middle 15-17, late 18-21).
• CDC categorizes ages as infant (0-1/0-28 days neonatal), toddler (1-3), preschooler (3-5), child (6-11), and adolescent (12-17).

Pediatric Histories Compared to Adult Medicine

• Pediatric histories differ from adult histories due to parent-as-historian differences between parental and child perspectives.
• These differences encompass prenatal, birth, maternal/family, social, and immunization histories.

Pediatric Physical Exam (PE)

• Pediatric PE varies based on age and specific conditions, distinguishing between general and focused assessments.
• Specific milestones for newborns, infants, toddlers, and children are evaluated for developmental progression.

Physiological Differences

• Body surface area (BSA) is proportionally larger in infants and children compared to adults.
• Skin is thinner and more permeable in children.
• Blood-brain barrier (BBB) is less developed in young children, so they present different sensitivities to medication.
• Children, particularly infants, are obligate nose breathers.
• Airways are shorter and narrower, lung capacity is lower, and metabolism/absorption rates are higher than those of adults.
• Imature immune systems, along with a greater rate of tissue growth necessitate higher water and calorie intake in children compared to adults.

Developmental Considerations

• Immature organ systems in young children affect medication metabolism and absorption, requiring careful clinical consideration.
• Growth and developmental skills vary with age, impacting learning and resilience.
• Children have a longer life expectancy than adults.

Prevention and Safety

• Child safety and well-being require co-dependent adult assistance, particularly for unique environmental exposures (e.g., placental transfer, breastfeeding, outdoor activities).

Disease and Injury

• Children have unique illnesses and injuries.
• Age at diagnosis may affect disease severity.
• Some conditions are more common in childhood.
• Bone fractures in children require different clinical considerations than adults because of their different physiology.
• Some illnesses are more common in specific parts of human development.
• Some conditions are common to certain age groups.

Neonatal Evaluation (M2)

• APGAR scoring assesses newborn health status one and five minutes post-birth.
• The five areas assessed are appearance, pulse, grimace, activity, and respiration, with each component scored on a 0-2 scale.
• The need for respiratory intervention might be a value of 4 or less.

Newborn Vital Signs

• Heart rate (HR)
• Respiratory rate (RR)
• Blood pressure (BP)
• Temperature (Temp)
• Infants typically double their birth weight by four months and triple their birth weight by one year.
• Full-term newborns (average) birth weight is between 7 pounds and 13 pounds, with some drop during the first few days.
• Normal average lengths are approximately 20 inches at birth, and approximately 10 inches during the first year.

Newborn Complete Examination

• Vital signs and general appearance are assessed in newborns.
• Head, neck, chest, eyes, ears, nose, throat, mouth, cardiovascular (auscultate heart and lungs and palpate femoral pulses), stomach (palpate, auscultate, and inspect abdomen), and musculoskeletal are examined.
• Musculoskeletal system includes inspecting genitalia and anus, back, limbs and eval of Reflexes.
• Abnormal head shapes, typical common problems, and normal features are included as potential concerns.

Neonatal Screening Panel

• The screening panel covers five main categories: endocrine, hemoglobin, bilirubin, amino acids, organic acids, fatty acid oxidation, and others (e.g., congenital heart disease and hearing loss).
• Genetic and NICU screenings (for newborns) are relevant.
• Guidelines for critical congenital heart disease, and other testing intervals are vital.

Common Newborn Problems

• Jaundice, hypoglycemia, murmurs (heart sounds), respiratory distress, birth trauma, prematurity, multiple births, and infections are common issues in newborns.

Pediatric Developmental Checks (WCC)

• Purposes of WCC are prevention of illness, tracking development, and raising parental concerns.
• The well-child check is a team effort, considering context, visit priorities, anticipatory guidance, and an injury or violence prevention approach.
• Nutritional needs, general development, and injury and violence prevention guidelines are part of the check-up. Timing for WCCs includes first week (newborn), 1st week/3-5 days, one to four months, 6-9 months, 12-15, 18, 2, 2.5, and yearly visits.

Adolescent Growth and Development (M4)

• Puberty timing differs between boys and girls, including puberty start (age 10-12 in boys; 8-11 in girls) and end (age 16-18 in boys; 14-16 in girls).
• Specific developmental milestones, such as testicular enlargement, pubic hair, body hair, and voice changes, differentiate genders.
• Key physiological changes, such as appearance of breast and facial hair in each sex.

Adolescent Health Issues

• Adolescents experience significant emotional, cognitive, and psychosocial changes, affecting behavior.
• Preventative care during adolescence (enrolled in primary care) covers immunizations, contraception, and testing for sexually transmitted infections (STIs).
• ROS (review of systems) and social history assessments (including issues with sex, drug/alcohol use, and tobacco use) and common health problems will be relevant. This often correlates with poverty.

Leading Causes of Death in Adolescents (Ages 15-29)

• Accidents are the leading cause of death.
• Suicide is a significant concern.
• Firearms are a common factor in accidents and suicide related to this age group.
• Other causes include chronic illnesses.

Confidentiality in Pediatric Settings

• Confidentiality varies, depending on a child's maturity, intelligence, and independence and medical conditions (e.g., chronic illness).
• Legal parameters concerning HIPAA (Health Insurance Portability and Accountability Act) govern the release of information from a child's health records to parents.
• Exceptions exist for imminent harm. Parental consent is typically required, except in limited circumstances of mature minors, when a child's health situation does not require parental input.

Child Abuse Recognition (M5)

• Common signs of child abuse, e.g., bruising, concerning locations and patterns.
• Methods of recognizing injuries consistent with inflicted trauma, especially those in non-ambulatory infants, such as broken frenula or bruises in areas of the body not accessible to the child, are included.
• The TEN-4 rule suggests assessing the torso, ears, neck, and frenulum for potential patterns of abuse.
• Certain bruising patterns and sentinel injuries, e.g. intra-oral and subconjunctival hemorrhage, strongly suggest abuse.
• There are resources for reporting of abuse.

Other topics

• Transition to adult care and pre-participation sports physicals are other important topics for adolescents.