Podcast
Questions and Answers
Which of the following is NOT considered an early life stressor or adverse childhood event (ACE)?
Which of the following is NOT considered an early life stressor or adverse childhood event (ACE)?
What is a potential benefit of high-quality early childhood programs like Head Start?
What is a potential benefit of high-quality early childhood programs like Head Start?
Which of the following is NOT a component of well-child checks (WCCs)?
Which of the following is NOT a component of well-child checks (WCCs)?
At what ages are standardized developmental screening tools recommended to be administered at a minimum during well-child checks (WCCs)?
At what ages are standardized developmental screening tools recommended to be administered at a minimum during well-child checks (WCCs)?
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Which of the following is NOT a typical example of a gross motor milestone in infancy?
Which of the following is NOT a typical example of a gross motor milestone in infancy?
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According to the content, what are the four domains of childhood development?
According to the content, what are the four domains of childhood development?
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When should a baby start eating solid foods?
When should a baby start eating solid foods?
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What is a common developmental milestone at 8 months of age?
What is a common developmental milestone at 8 months of age?
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What is the primary goal of well-child checks?
What is the primary goal of well-child checks?
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Which of the following is NOT a principle of child development?
Which of the following is NOT a principle of child development?
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Which of the following is NOT a developmental domain assessed by the ASQ-3?
Which of the following is NOT a developmental domain assessed by the ASQ-3?
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What is the typical number of wet diapers per day for an infant?
What is the typical number of wet diapers per day for an infant?
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Which of the following is NOT a determinant of growth?
Which of the following is NOT a determinant of growth?
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Which of these is a parameter of growth?
Which of these is a parameter of growth?
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Which of the following growth charts is used for children aged 0-2 years?
Which of the following growth charts is used for children aged 0-2 years?
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Which of the following is a typical example of a variant in growth?
Which of the following is a typical example of a variant in growth?
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Why is it important to understand normal growth patterns?
Why is it important to understand normal growth patterns?
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How do Social Determinants of Health (SDoH) affect growth and development?
How do Social Determinants of Health (SDoH) affect growth and development?
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Which of the following is typically NOT included in a pediatric history for school-aged children, unless applicable?
Which of the following is typically NOT included in a pediatric history for school-aged children, unless applicable?
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What is the recommended daily sleep duration for toddlers?
What is the recommended daily sleep duration for toddlers?
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Study Notes
Pediatrics and Adolescent Medicine
- Module 3 covers History & Physical (H&P) and well-child checks.
- This subject matter is taught by Angela Deubel, PA-C, at the University of New Mexico.
Introduction to Development & Growth: Pediatric Health Maintenance
- Development and growth are tracked from birth.
- Screening is done to identify problems.
- Resources include: The American Academy of Pediatrics Bright Futures, the Center for Disease Control, NM Department of Health, and CDC.
Development
- Development is a broad term encompassing four domains:
- Physical/motor skills
- Cognitive skills
- Language skills
- Behavioral, social-emotional, and mental health domains.
- Well-child checks aim to identify developmental delays or risks.
4 Principles of Child Development
- Development is predictable.
- Pathways are measurable (milestones).
- There is a developmental trajectory.
- Developmental norms vary widely (age, sex, individual rate).
- H&P examinations vary based on the developmental level and understanding of norms. Factors affecting development include physical, social, environmental, and disease.
To Recognize Abnormal Growth
- To understand abnormal growth, one must understand normal growth.
- Determinants of growth include maternal nutrition, intrauterine environment, genetics, environment/diet, and chronic illness.
- Patterns of growth are predictable, pulsatile, and seasonal.
- Parameters of growth include weight, length/height, weight-for-length/BMI, head circumference, and Tanner Stages.
How do Social Determinants of Health (SDoH) affect growth and development?
- Adverse childhood experiences (ACEs) like maltreatment, poverty, family instability, unsafe neighborhoods, lead exposure, and racism influence growth and development negatively.
- 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/educational programs are crucial.
- Programs like Head Start can improve:
- Health outcomes
- Learning and social skills
- School readiness
- School meals
- Home visitations
- Supportive social services
- Parent classes
Well-child Checks (WCC)
- WCCs prevent illness (immunizations, safety, nutrition).
- WCCs track growth and development (milestones, social behaviors, learning).
- WCC addresses parental concerns (sleeping, eating, development, social skills).
- WCCs use a team approach to support infants, children, and adolescents.
Standardized Developmental Screening Tools
- Standardized developmental screening tools are used as a minimum at 9, 18, and 24/30-month well-child visits.
- Screening occurs anytime concerns are raised.
- Examples of gross motor milestones in infancy:
- 1 month: chin up when prone
- 2 months: visual tracking of object
- 4 months: reaching for objects
- 6 months: sitting unassisted
- 8 months: pincer grasp
- 9 months: crawling
- 11 months: can stand and cruise
- Development screening tools like ASQ-3.
Pediatric History: Infants and Toddlers (0-3yrs)
- Information collected covers birth history, medical history, family history, social history, developmental milestones, feeding, sleeping, stooling/urination, and vaccinations.
Examples of Infant and Toddler Norms
- Feeding: 2-month-old infants: 4-5 oz formula every 3-4 hours; 4-6 months: up to 8 oz every 3-4 hours.
- Sleeping: 0-6 months: 15-16 hrs/day; 6 months and beyond: 10-11 hrs/day.
- Stooling/Urination: Infants may defecate once, many times, or even skip a day. Infants have 4-6 wet diapers per day or more.
History: School-Aged Children (4-11yrs)
- This history includes: birth history (if applicable), medical history, family history, social history, developmental milestones, feeding, sleeping, vaccinations, and school performance.
Pediatric Vital Signs
- A table of normal vital signs by age is provided (newborn to 13+ years), including heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure.
Examples of Pediatric Growth Charts
- WHO for 0-2 years
- CDC for 2-20 years
- CDC for children with Down Syndrome
- Life Expectancy for cerebral palsy
Normal Variants in Growth
- Common growth variants, including constitutional delay of growth and adolescence, familial short stature, congenital GH deficiency, Turner syndrome, and primary nutritional deficiency.
Growth Chart Practice
- Plotting examples using WHO charts for ages <2 and CDC charts for ages >=2.
- Calculating percentiles for weight, length/height, weight-for-length/BMI and determining if the results are normal.
Well-Child Checks: Components
- Context (age & development of child, environment)
- Priorities of the Visit (address family’s needs first)
- Health Supervision: History, surveillance of development, ROS, observe interaction with others, Screening, Vaccinations
- Anticipatory guidance: injury prevention, violence prevention, sleep positioning, nutritional needs, and general development.
Timing of WCC: Infants, Toddlers & Children
- The recommended frequency for well-child visits (newborn/nursery; 1 week; 1, 2, 4, 6, 9 months; 12, 15, 18 months; 2, 2.5 yrs; and annually from 3 to 10 years.)
Infants
- Discussion about the unique and challenging aspects of examining infants and well-child visits in infants.
Childhood Vaccines: Practice
- Checking the 2025 immunization schedule for the specific ages of 1 day old, 6 months old, 15 months old, 5 years old, and 10 years old.
Toddlers & School-aged Children
- Discussion about the unique and challenging aspects of examining toddlers/school-aged children. What is a well-child visit like?
A Note on Lead Screening
- All children enrolled in NM Medicaid are to be screened for lead at 12 and 24 months.
- AAP recommends universal lead screening for all children.
- Acceptable levels are <5 mcg/dL
- If 5+ mcg/dL, further screening, retesting and followup care needed.
Group Work: 6-month-old WCC
- A case study of a 6-month-old girl presenting for a well-child visit.
- Questions to be answered about growth, immunizations, developmental milestones, introduction of solids, anticipatory guidance, and universal screening. Note that the patient is breastfeeding exclusively.
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Description
This quiz covers Module 3 of Pediatrics and Adolescent Medicine, focusing on History & Physical (H&P) assessments and well-child checks. Learn about developmental milestones, screening for issues, and the principles of child development. Based on instruction from Angela Deubel, PA-C, at the University of New Mexico.
