what are the unique issues in pediatrics healthcare that are different from adults - correct
answer history and physical changes over time.
dual patient (parent and child are both at the visit and both have input).
early experiences shape brain development and influence lifelong health. weight or age based
medication dosing.
age specific illness and presentation.
vaccine schedules.
anatomic and physiologic differences between children and adults - correct answer immature
blood/ blood brain barrier.
higher respiratory rate.
larger body surface area.
thinner skin.
rapidly dividing cells.
higher metabolic rate.
immature immune system.
key components of pediatric history taking - correct answer *dental history, nutrition, sleep, GI
elimination*.
birth history, developmental history, allergies, immunization history, exercise, school history,
social history, family history.
pediatric physical assessment pearls for infants and toddlers - correct answer sit down during
the exam (level height with child).
examine infants and young children in caregiver's lap.
build rapport and establish trust by examining adult first.
let the child play and touch the exam equipment.
do parts of the exam with them.
start with hear and lung exam while child is quiet.
pediatric physical assessment pearls for pre-school and school age children - correct answer ask
the child the history questions.
assess development by asking them to draw.
,tricks for oropharynx (show me your tongue or breathe like a dog).
tricks for respiratory (blow out candles or blow something off your hand)
pediatric physical assessment pearls for adolescents - correct answer confidentiality is key.
always allow one on one time with provider.
use language the child uses and ask questions more than one way.
foster independence is appropriate (prepare transition to adult care).
may take time to establish trust.
always get consent throughout your exam for patient comfort.
how to assess the pulse in pediatrics - correct answer assess for quality of rate, rhythm,
volume.
0-2 years old use apical pulse.
2+ years old use radial pulse.
count for a full minute.
compare upper and lower extremities.
palpate femoral pulses (absent or weak is diagnostic of coarctation of aorta).
pulse is increased during fevers, crying, pain, activity (so might need to take again when calm).
normal heart rates per age group - correct answer premie - 120-170.
0-3 months - 110-160.
3-6 months - 100-150.
6-12 months - 90-130.
1-3 years - 80-125.
3-6 years - 70-115.
6-12+ years - 60-100.
how to assess respiratory rate in pediatrics - correct answer assess rate and pattern.
take when child is quiet.
count for a full minute.
normal breathing for infants is obligate nose breathers, use diaphragm for breathing, and
periodic breathing (pauses during breathing).
,normal respiratory ranges per age group - correct answer premie - 40-70.
0-3 months - 30-60.
3-6 months - 30-45.
6-12 months - 25-40.
1-3 years - 20-30.
3-6 years - 20-25.
6-12 years - 14-22.
>12 years - 12-18.
respiratory distress in pediatrics - correct answer increased respiratory rate. retractions or use
of accessory muscles. nasal flaring. head bobbing. grunting. stridor. audible wheeze. change in
skin color.
oxygen saturation in pediatrics - correct answer use pulse oximetry. <95% is concerning
blood pressure assessment in pediatrics - correct answer begin measuring in all children age 3.
(can assess if <3yo if they have chronic, renal, cardiac disease).
use correct size cuff.
crying or anxious children can have higher BP.
normal pressure depends on age and weight.
HTN is >95th percentile at 3 different visits.
stages of hypertension in pediatrics - correct answer normal: <90th percentile.
elevated: >90th percentile to <95th percentile. or 120/80 to <95th percentile.
stage 1 HTN: >95th percentile to <95th percentile + 12mmHg. or 130/80 to 139/89.
stage 2 HTN: >95th percentile + 12mmHg. or >140/90.
normal blood pressure levels per age group - correct answer premie - 55-75/35-45
0-3 months - 65-85/45-55.
3-6 months - 70-90/50-65.
6-12 months - 80-100/55-65.
1-3 years - 90-105/55-70.
3-6 years - 95-110/60-75.
, 6-12 years - 100-120/60-75.
>12 years - 100-120/70-80.
Assessing for orthostatic hypotension - correct answer take BP and HR after 5min of supine
rest.
repeat after 3min of standing.
systolic BP drop >20 or diastolic >10 then should be concerned.
wong-baker faces pain rating scale - correct answer 0 = no hurt.
2 = hurts little bit.
4 = hurts little more.
6 = hurts even more.
8 = hurts whole lot.
10 = hurts worst.
behavioral indicators of pain in pediatrics - correct answer vocalizations (crying, whimpering,
whining).
facial expression (grimacing, tightly closed eyelids, grinding/ clenching jaw).
breath holding.
changes in sleep.
rubbing or touching painful site, guarding, avoiding use.
cannot bear weight.
assessing last menstrual period in pediatrics - correct answer assess at every visit starting 10yrs
old.
history should include age of menarche, last menstrual period, frequency, duration, cramping.
Normals:
median age menarche is 12yrs old.
average cycle interval is 32 days in first gynecological year.
menstrual cycle interval is 21-45 days.
flow length is 7days or less.
three to six pads or tampons per day.
answer history and physical changes over time.
dual patient (parent and child are both at the visit and both have input).
early experiences shape brain development and influence lifelong health. weight or age based
medication dosing.
age specific illness and presentation.
vaccine schedules.
anatomic and physiologic differences between children and adults - correct answer immature
blood/ blood brain barrier.
higher respiratory rate.
larger body surface area.
thinner skin.
rapidly dividing cells.
higher metabolic rate.
immature immune system.
key components of pediatric history taking - correct answer *dental history, nutrition, sleep, GI
elimination*.
birth history, developmental history, allergies, immunization history, exercise, school history,
social history, family history.
pediatric physical assessment pearls for infants and toddlers - correct answer sit down during
the exam (level height with child).
examine infants and young children in caregiver's lap.
build rapport and establish trust by examining adult first.
let the child play and touch the exam equipment.
do parts of the exam with them.
start with hear and lung exam while child is quiet.
pediatric physical assessment pearls for pre-school and school age children - correct answer ask
the child the history questions.
assess development by asking them to draw.
,tricks for oropharynx (show me your tongue or breathe like a dog).
tricks for respiratory (blow out candles or blow something off your hand)
pediatric physical assessment pearls for adolescents - correct answer confidentiality is key.
always allow one on one time with provider.
use language the child uses and ask questions more than one way.
foster independence is appropriate (prepare transition to adult care).
may take time to establish trust.
always get consent throughout your exam for patient comfort.
how to assess the pulse in pediatrics - correct answer assess for quality of rate, rhythm,
volume.
0-2 years old use apical pulse.
2+ years old use radial pulse.
count for a full minute.
compare upper and lower extremities.
palpate femoral pulses (absent or weak is diagnostic of coarctation of aorta).
pulse is increased during fevers, crying, pain, activity (so might need to take again when calm).
normal heart rates per age group - correct answer premie - 120-170.
0-3 months - 110-160.
3-6 months - 100-150.
6-12 months - 90-130.
1-3 years - 80-125.
3-6 years - 70-115.
6-12+ years - 60-100.
how to assess respiratory rate in pediatrics - correct answer assess rate and pattern.
take when child is quiet.
count for a full minute.
normal breathing for infants is obligate nose breathers, use diaphragm for breathing, and
periodic breathing (pauses during breathing).
,normal respiratory ranges per age group - correct answer premie - 40-70.
0-3 months - 30-60.
3-6 months - 30-45.
6-12 months - 25-40.
1-3 years - 20-30.
3-6 years - 20-25.
6-12 years - 14-22.
>12 years - 12-18.
respiratory distress in pediatrics - correct answer increased respiratory rate. retractions or use
of accessory muscles. nasal flaring. head bobbing. grunting. stridor. audible wheeze. change in
skin color.
oxygen saturation in pediatrics - correct answer use pulse oximetry. <95% is concerning
blood pressure assessment in pediatrics - correct answer begin measuring in all children age 3.
(can assess if <3yo if they have chronic, renal, cardiac disease).
use correct size cuff.
crying or anxious children can have higher BP.
normal pressure depends on age and weight.
HTN is >95th percentile at 3 different visits.
stages of hypertension in pediatrics - correct answer normal: <90th percentile.
elevated: >90th percentile to <95th percentile. or 120/80 to <95th percentile.
stage 1 HTN: >95th percentile to <95th percentile + 12mmHg. or 130/80 to 139/89.
stage 2 HTN: >95th percentile + 12mmHg. or >140/90.
normal blood pressure levels per age group - correct answer premie - 55-75/35-45
0-3 months - 65-85/45-55.
3-6 months - 70-90/50-65.
6-12 months - 80-100/55-65.
1-3 years - 90-105/55-70.
3-6 years - 95-110/60-75.
, 6-12 years - 100-120/60-75.
>12 years - 100-120/70-80.
Assessing for orthostatic hypotension - correct answer take BP and HR after 5min of supine
rest.
repeat after 3min of standing.
systolic BP drop >20 or diastolic >10 then should be concerned.
wong-baker faces pain rating scale - correct answer 0 = no hurt.
2 = hurts little bit.
4 = hurts little more.
6 = hurts even more.
8 = hurts whole lot.
10 = hurts worst.
behavioral indicators of pain in pediatrics - correct answer vocalizations (crying, whimpering,
whining).
facial expression (grimacing, tightly closed eyelids, grinding/ clenching jaw).
breath holding.
changes in sleep.
rubbing or touching painful site, guarding, avoiding use.
cannot bear weight.
assessing last menstrual period in pediatrics - correct answer assess at every visit starting 10yrs
old.
history should include age of menarche, last menstrual period, frequency, duration, cramping.
Normals:
median age menarche is 12yrs old.
average cycle interval is 32 days in first gynecological year.
menstrual cycle interval is 21-45 days.
flow length is 7days or less.
three to six pads or tampons per day.
