Pediatrics and Adolescent Medicine Quiz

Pediatrics and Adolescent Medicine

• This module covers well-child checks (H&P) in pediatrics.
• Well-child checks aim to identify developmental delays or risks early.

Introduction to Development & Growth: Pediatric Health Maintenance

• Growth and development milestones are tracked from birth.
• Screening ensures no developmental issues are missed.
• Resources for pediatric health maintenance include the American Academy of Pediatrics Bright Futures, the Center for Disease Control, the NM Department of Health, and the CDC.

Development is a broad term

• Childhood development encompasses physical/motor, cognitive, language, behavioral, social-emotional, and mental health domains.
• Well-child checks aim to detect developmental delays early.

4 principles of child development

• Development is predictable.
• Pathways are measurable, including milestones and developmental trajectories.
• The range of norms for growth and development is wide, affected by age, sex, and individual rates.
• H&P is variable and influenced by developmental level and understanding of norms.

To recognize abnormal growth

• Understanding normal growth is crucial for detection of abnormalities.
• Determinants of growth include maternal nutrition, intrauterine environment, genetics, environmental factors, and chronic illnesses.
• Different parameters for growth assessment include weight, length/height, weight-for-length, BMI, head circumference, and Tanner Stages.
• Growth patterns are predictable, pulsatile, and seasonal.

How do Social Determinants of Health (SDOH) affect growth and development?

• Early childhood stressors and adverse childhood events (ACEs), such as maltreatment, poverty, family instability, unsafe neighborhoods, lead exposure, and racism, are negatively associated with growth and development.
• Negative effects include inadequate coping skills, difficulty regulating emotions, reduced social functioning, cognitive delays, poor academic achievement, chronic diseases, and tobacco/alcohol/drug use.

Overcoming Adversity: Early childhood programs

• High-quality developmental and educational programs, like Head Start, are crucial for improving outcomes.
• These programs often encompass improved health outcomes, enhanced learning and social skills, improved school readiness, school meals, home visitations, supportive social services, and classes for parents.

Well-child checks (WCC)

• WCCs focus on illness prevention through immunizations and safety discussions, tracking growth and development, addressing parental concerns, and building strong, trustworthy relationships.
• Developmental screening tools are necessary at various check-ups.

Standardized developmental screening tools

• Standardized developmental screening tools are necessary for 9-month, 18-month, and 24- or 30-month well-child checks; and whenever concerns arise.
• Sample examples of milestones include chin-up, tracking objects, reaching, sitting, pincer grasp, crawling, and standing /cruising at specific age ranges.

Examples of developmental screening tools

• Examples include the Ages and Stages Questionnaire (ASQ-3), a questionnaire covering communication, gross motor skills, fine motor skills, problem-solving, and personal-social development.

Pediatric History: Infants & Toddlers (0-3 years)

• A well-child check includes birth history, medical history, family history, social history, developmental milestones, feeding, sleeping, stooling and urination, and vaccination records.

Examples of Infant and Toddler Norms

• Feeding patterns, including formula/breast milk frequency and introduction to solid foods, are noted.
• Sleep patterns vary, along with stooling and urination frequency and consistency.
• Diaper frequency and wet diaper output varies between children.

History: School-Aged Children (4-11 years)

• For school-aged children, the history includes birth history (if applicable), medical history, family history, social history, developmental milestones, feeding, sleeping, vaccination records, and school performance.

Pediatric Vital Signs

• A table of normal vital signs for different ages (newborn to adolescent) is provided.
• Vital signs include heart rate, respiratory rate, systolic and diastolic blood pressure.

Examples of Pediatric Growth Charts

• Different growth charts are used depending on the child's age and potential condition.
• Charts from the CDC, WHO, and other organizations are used to track developmental growth.

Normal Variants in Growth: Constitutional Delay and Familial Short Stature

• Illustrations of various growth patterns are included, such as constitutional delay of growth and adolescence, familial short stature, congenital GH deficiency, Turner Syndrome, and primary nutritional deficiency.

Growth Chart Practice

• Instructions on plotting the growth of children within the CDC and WHO standards to assess growth standards are provided.
• Practice problems are provided.

Well-Child Checks: Components

• Well-child checks involve context (age, development, environment), priorities of the visit, health supervision (history, surveillance of development, ROS, observations, interaction), and immunizations.
• Anticipatory guidance includes injury prevention, violence prevention, sleep positioning, nutrition, and general development.

Timing of WCC: Infants, Toddlers & Children

• Specific timeframes for well-child checks for infants, toddlers, and children are outlined (e.g., newborn, 1 week, 1 month, 2 months, 4 months, 6 months, 9 months, different intervals, and yearly intervals, adolescents as well).

Infants

• The unique challenges and considerations in examining infants are discussed.

Childhood vaccines

• Practices on the different vaccination schedules for various age groups (1 day old, 6 months, 15 months, 5 years, 10 years) are discussed.

Toddlers & School-aged Children

• Discussion of examining toddlers/school-aged children.

A note on lead screening

• Lead screening is required for all children on NM Medicaid at 12 and 24 months of age.
• AAP recommends universal screening at these ages.

Group Work: 6 mo old WCC

• A 6-month-old girl presents for a well-child check with concerns about introducing solids.
• Specific information about nutrition, sleep, elimination, length, weight, head circumference is provided to guide the well-child check assessment.

Additional information on growth charts

• WHO growth charts for 0-2 years, CDC growth charts for 2+ years and charts for special conditions, such as Down Syndrome and Cerebral Palsy are referenced.
• The technical differences used between the WHO and CDC growth charts are discussed, emphasizing the WHO is the reference for growth for breastfed infants that are breastfed for 4 months or longer up to 1-year-old.