Infant To Child Assessment

Infant to Child Assessment

INFANT TO CHILD EXAM

  NEWBORN 3-6 MONTHS 6-12MONTHS > 3 YEARS OLD
EYE EVALUATION
& VISION SCREENING
Red Reflex

(Red Reflex must be present; if absent, may be congenital cataracts)

-Newborns are nearsighted (myopia) w/ vision of 30/400

-Infants can focus at distance of 8-10 inches
Red Reflex
Fix & Follow

-Infants > 3 months-assess ability to fixate on objects & social response to parents face

-2-4 months of age, eye alignment should occur

-Infant will hold hands close to face to observe them; at 6 months able to make eye contact
Red Reflex
Corneal Light Reflex
Cover/Uncover Test
Fix & Follow

-Corneal Light Reflex & Cover/Uncover Test are used to assess strabismus
Red Reflex
Corneal Light Reflex
Cover/Uncover Test
Visual Acuity
Ophthalmology
-Preschool children: Tumbling E or Allen Cards

-Vision at 3 years 20/50
-Vision at 4 years 20/40
-Vision at 5 years 20/30
-Vision at 6 years 20/20
EAR EVALUATIONStartle (Moro Reflex)Able to stop & listen to new sounds; stops crying when hearing parents voice

-Peak incidence for OM is 6 months-36 months of age; commonly seen following URI

-Approx. 80% of OM cases resolve spontaneously
Responds to name

-12-18 months-follows directions without cues

-18-24 months-50% of speech intelligible to strangers
MOUTH EVALUATIONFirst teeth will come in about 6 - 10 months (primary dentition)

-Oral health risk assessment starts at 6 months

-Fluoride supplementation at 6 months

2 1/2 years of age: has complete set of primary teeth (20 teeth)
HEART EVALUATIONNormal HR 120-160 with marked sinus arrhythmia

-The purpose of assessing B/P in all 4 extremities is to assess for coarctation

-Suspect coarctation of the aorta if pulses are unequal & weak &/or high B/P in upper extremity with low B/P in lower extremity

-Murmurs are common: 10% are significant
HR 80-120 at 3 years of age

-HR 70-110 at 6 years of age

-B/P screening should begin in children at 3 years of age; dyslipidemia risk assessment at 2,4,6,8,10 years of age (assess by their diet)

-FLP usually done at 18-21 years of age
GI EVALUATIONBilirubin is a normal component of RBC's

-> 5mg/dL is termed hyperbilirubinemia

-If full-term newborn, bilirubin peaks on 3rd or 4th day

-In premature neonates, bilirubin peaks on 5th to 7th day

-Hyperbilireubin is treated by phototherapy

-Neonates loose up to 7% of body weight but should regain it by 2 weeks of age

-Meconium; infants should pass within 24 hours of birth (if not-may be intestinal obstruction)

Birth weight doubles at 6 months and triples at 12 monthsAvoid cows milk for 1st year of life; cows milk is most common cause of iron deficiency anemia in babies < 12 months

-can start solid foods 4-6 months; start with iron fortified rice cereal

-Introduce 1 food at a time for 4-5 days

-Anemia screening is done at 9-12 months
MUSCULOSKELETAL
EVALUATION
Assess for hip dysplasia: Barlow's & Ortolani's maneuvers

-Galeazzi Test- unequal knee height

-Assess for club foot: Talipes equinovarus is the most common (urgent referral)

-Assess for club foot: metatarsus adductus

 

Diagnostic Tests

Federally mandated testing

  • TSH
  • PKU
  • Universal screening for hearing loss is done in nursery

 

Other Common Diagnostic Tests

Testing varies from state to state

  • Sickle Cell Disease (can detect 4 types of hemoglobin: hemoglobin F, S, A, and C)
  • H & H (done in late infancy 9-12 months)
  • Lead Screening (high-risk children at age 1-2 years)

 

CDC Recommended Childhood Immunizations

Recommended Childhood Immunizations

AGE BIRTH 1 MONTH 2 MONTHS 4 MONTHS 6 MONTHS 12 MONTHS 15 MONTHS 18 MONTHS
VACCINE
HEPATITIS B HEP B #1 HEB B #2 HEP B #3
DIPHTHERIA, TETANUS, PERTUSSIS
(DTaP)
DTaP DTaP DTaP DTaP
HEMOPHILUS INFLUENZA TYPE B Hib Hib Hib Hib
INACTIVATED
POLIOVIRUS
(IPV)
IPV IPV IPV
*can administer 6-18 months)
MEASLES, MUMPS,
RUBELLA
(MMR)
MMR #1
VARICELLA VARICELLA
PNEUMOCOCCAL
(PCV)
PCV PCV PCV PCV

*CDC Recommended Childhood Immunizations with Catch-Up Schedule

*Must Have CDC Immunization App for Health Care Providers

*More Information on Prenatal & newborn visit

 

References

McCance, K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2010). Pathophysiology: The biologic basis for disease in adults and children (6th ed.).

Dunphy, L.M., Winland-Brown, J. E. (2011).  Primary Care:  The Art and Science of

Advanced Practice Nursing.  Philadelphia, PA.  F.A. Davis. 

Uphold, C.R., & Graham, M.V. (2013). Clinical guidelines in family practice. (5th ed.)    Gainesville, Fl.: Barmarrae Books, Inc.

Boynton, R., Dunn, E.S., & Stephens, G.R. (2009). 6th edition.  Manual of Ambulatory

Pediatrics.  Philadelphia:  Lippincott.

Youngkin, E.Q., & Davis, M.S. (2012). Women’s health: A primary care clinical guide

(4th. ed ). Norwalk, CT: Appleton and Lange.