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EXAMINING A BABY
GENERAL PRINCIPLES
Stop, Look, and Listen
Sit down
Make it a game
Save the worse for last
Dont ask and dont lie
Engage parents
No shots, I
promise!
Can I look in
your ears?
HEENT
Head:
Anterior fontanelle
Assess upright
while calm
Closes ~ 9-18 mo
Eyes
Infants head fall
Ears
Oropharynx
HEENT
CARDIAC/RESPIRATORY
Quiet
Murmurs
Pulses
Respiratory rate
How long should you count?
Periodic breathing
How can you get a good respiratory assessment?
Younger patients
Older patients
ABDOMINAL EXAM
Distraction
Let a parent do it
Umbilical hernia
Should be easily reducible
Can be normal up to 5 years of age
Spleen size
More likely to feel spleen tip in newborns
1-2 cm below costal margin
10
NEURO - TODDLER
Coordination grab for object in
multiple directions
Assess tone/head lag/suck
Gait walk to mom or dad
Walk to parent
11
SKIN
12
MUSCULOSKELETAL
Assess in the most comfortable position
Abducted and externally rotated hip
concern for septic hip
Arm hanging straight down at side and not
using Nursemaids elbow
13
Age
Age
Age
Infant
Newborn
to 3 months
Term neonates (0 to 28 days)
Toddler
Awake Rate
Rate
85 to
Sleeping Rate
3 months to 2 years
100 to 190
75 to 160
2 to 10 years
60 to 140
60 to 90
Preschooler
Infants
(1 to 12 months)
School-age child
Children 1 to 10 years (5th BP
>
10 years
percentile)
Adolescent
Children >10 years
22 tomm
34 Hg
<70
60 to
18 to 30
<70 mm Hg + (age in years x 2)
100
50 to 90
mm
Hg16
12 to
<90 mm Hg
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15
16
If unimmunized:
If they look good, look for sources of
fever on exam
If they dont look good, treat them like
a little baby
Consider infections such as measles
and pertussis that immunizations
cover for
17
Mild Pain
Tylenol 15mg/kg q4 (PO/IV/PR)
Ibuprofen 10mg/kg q6
Moderate Pain
Oxycodone
Toradol (IV/IM)
Severe Pain
Fentanyl IV or IN
Morphine 0.1mg/kg
18
Common cold
Croup
Bronchiolitis
Asthma
Pneumonia
19
CROUP
Fever
Inspiratory Stridor
20
21
BRONCHIOLITIS
#1 cause of hospitalization
for US infants < 12 months
Inflammation and
obstruction of the lower
respiratory tracts
Characterized by cough,
respiratory distress,
increased secretions, wet
wheezes
22
23
BRONCHIOLITIS
THINGS WITHOUT GREAT EVIDENCE
24
Requiring supplemental O2
Social concerns
25
ASTHMA
Reversal of
symptoms by a
bronchodilator
26
27
ASTHMA
THE EVIDENCE
28
PNEUMONIA
Viruses
S. pneumoniae
Group A Strep
MRSA
H. flu
Mycoplasma
Chlamydia trachomatis
Chlamydia pneumoniae
29
30
PNEUMONIA: TREATMENT
31
32
QUESTIONS?
33