Aquifer Pediatric: Case 2 - Infant Well Child 2, 6, 9 Mo Questions & Answers

Aquifer Pediatric: Case 2 - Infant Well Child 2, 6, 9 Mo Questions & Answers Of the following, which best reflects the caloric requirement of most healthy term babies in the first 1 to 2 months of life? Choose the single best answer. A. 50 kcal/kg/day B. 100 kcal/kg/day C. 150 kcal/kg/day D. 200 kcal/kg/day Answer Comment The correct answer is B. TEACHING POINT Caloric Requirements of 1- to 2-Month-Olds Term infants Infants born at 37 weeks gestational age require 100 to 120 kcal/kg/day. Average daily weight gain for term infants is 20 to 30 grams. Preterm infants Infants born at 37 weeks gestational age require 115 to 130 kcal/kg/day. Very preterm infants Infants born at 32 weeks gestational age require up to 150 kcal/kg/day. Which of the following positions is most appropriate for Asia at this age (2 mo)? Choose the single best answer. The best option is indicated below. Your selections are indicated by the shaded boxes. A. Front seat, facing the rear B. Front seat, facing the front C. Back seat, facing the rear D. Back seat, facing the front The correct answer is C. TEACHING POINT Car Seat Safety Children under age 13 years old should not sit in the front seat. Until age 2 years, children should face rearward. The National Safety Transportation Board and the AAP stress that the back seat is the safest place in a vehicle for children. The middle of the back is the most protected part of the automobile. Car seats for children are required by law in all 50 states. Proper use is essential for optimum performance. The most effective car seat restraint is a five-point harness, consisting of two shoulder straps, a lap belt and a crotch strap. Which of the following vaccines will you give Asia today at her 2-month visit? Select all that apply. Resources Link to the CDC's webpage for current immunization schedules for children and adolescents. CDC Vaccine Schedules app Information on how to talk with parents about immunizations. A. DTaP (diphtheria/tetanus/acellular pertussis) B. MMR (measles/mumps/rubella) C. HepB (hepatitis B) D. Hib (Haemophilus influenzae) E. IPV (inactivated polio vaccine) F. PCV13 (pneumococcal conjugate vaccine - 13 serotypes) G. RotaV (pentavalent rotavirus vaccine) H. HepA (hepatitis A vaccine) The correct answers are A, C, D, E, F, G. The appropriate immunizations for Asia today are her first doses of: DTaP (A) Hib (D) IPV (E) PCV13 (F) and RotaV (G) She should also receive her second HepB (C); her first was given in the nursery before discharge. (If a child has not received a HepB in the nursery, HepB #1 should be administered at the first office visit.) The MMR (B) and HepA (H) vaccines are not given until 12 months of age. By what ages should an infant double and triple his or her birth weight? Choose the single best answer. A. Double by 3 months, triple by 6 months B. Double by 4 months, triple by 6 months C. Double by 5 months, triple by 12 months D. Double by 9 months, triple by 15 months C; Double by 5 months, then triple by 12 months (1 yr) They will double birth length by 4 yrs Developmental Observations About Asia Pulls to a seated position without a head lag. Able to sit well without additional support. Grabs block with her nearest hand and transfers it to the other hand and places it in her mouth. Uses raking grasp to try to pick up a small toy on the table. Frequently babbles, but not saying any specific words. Question Has Asia performed the expected developmental milestones for a 6-month-old infant? The best option is indicated below. Your selections are indicated by the shaded boxes. A. Yes B. No A; Yes 6-Month Developmental Milestones Gross motor -Rolls over -Sits unsupported -No head lag when pulled to sit from supine Fine motor -Reaches for objects -Looks for dropped items Language -Turns toward voice -Babbles (i.e., use of repetitive consonants: ba-ba-ba or da-da-da) (When the child says da-da-da, the family reinforces the sounds by praising the infant; then the infant makes the connection of the sound to the father.) Social/Adaptive -Feeds self -Demonstrates stranger recognition, the prelude to stranger anxiety Besides home safety, what are additional topics you could discuss with Asia's mom regarding anticipatory guidance at this age (6 mo)? Car seat placement 2. Avoid using a walker 3. Dietary changes 4. Expected developmental changes 5. Sleep patterns Of the following, which are developmental milestones that you expect to see in a developmentally appropriate 9-month-old infant? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Waves bye-bye B. Has a well developed pincer grasp C. Sits without support D. Walks well E. Says 2 words plus "mama" and "dada" A and C 12 month developmental milestones 12 Month Developmental Milestones By the time a child is 12 months old, developmental milestones include: Gross motor: Stands alone (many can walk well). Fine motor: Has a well developed, "neat" pincer grasp. Language: Says "mama" and "dada" (specific) and one or two other words. Social/adaptive: Hands parent a book to read, points when wants something, imitates activities and plays ball with examiner. Which of the following are on your differential diagnosis (RUQ mass at 9 months)? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Appendiceal abscess