- a newborn neck should be examined for size, anomalies and webbing in conjunction with this

Turner's syndrome

- a JVP that is visible when a child is sitting upright is always this

Abnormal

- this substance can be found in newborns often enlarged breasts because of the influence of maternal estrogen

white liquid (witch's milk)

- an infants respiratory pattern is this

- the abdomen protrudes on inspiration and retracts on expiration

Diaphragmatic

- these occur due to increased negative intrathoracic pressure from the forced expansion of the chest cage during labored breathing

Retractions

- normal infant chest produces this note on percussion

Hyperresonant

- breath sounds are usually louder and harsher in this age group

Infants and small children

- normal breath sounds in the lung periphery

- offers little help in diagnosis of consolidation

Bronchovesicular or Bronchial

- characteristically harsh inspiratory noise created by obstruction of the larynx or extrathoracic trachea

- most common acute cause is viral laryngotracheobronchitis (croup)

- most common chronic cause is laryngomalacia

Stridor

- from the ages of 4-7 the apical impulse moves from this side of the MCL

Left to Right

- opposed to adult S2 split sound volume, is the pulmonary or aortic closure sound louder in children?

Pulmonary

- an S2 split may be heard normally at this location in many infants and children

Apex

- many pathologic murmurs not heard until a few days after birth because of physiologic changes with this structure

Ductus Arteriosis

- very common in children age 3 to 7

- grade II to III, brief, early to mid systolic, @ LSB

- vibratory murmur that decreases with standing or sitting

Still's murmur

- heard over the upper sternum, clavicle and vessels of the neck in young children

- varies with child's head position, loudest in upright position

Venous Hum

- in adolescents this grade I-II, short-mid systolic, blowing murmur is heard at the 2nd/3rd interspaces @ LSB

Pulmonary Ejection Murmur

- may be asymptomatic at birth, but present with shock and severe acidosis at one week of life when the infant's ductus arteriosis closes

Coarctation of the aorta

- hepatomegaly, diaphoresis, poor feeding, and respiratory distress

Signs of heart failure

- involves atonic abdominal musculature

Prune belly syndrome

- this finding in children less than 2 years of age are more common in black children

- usually resolve by age 5

Umbilical hernia

- with scoliosis at 20 degrees of deviation, this is recommended

- with scoliosis at 40 degrees of deviation, this is recommended

Bracing then Surgery

- more common in first born girls w/ a traumatic birth

- examined with Barlow's (adduct hips w/ lesser trochanter pressure) or Ortalani's tests (return dislocated hip via abduction)

- may cause skin folds of thigh/butt to be asymmetrical

- ultrasound used for evaluation <4 months

- 6 mon (Pavlik harness), 6-18 (Spica cast), >18 (surgery)

Congenital Hip Dislocation

- bow legs is common in 1-3 yr old children

- increased distance between knees

- x-rays show symmetric bowing

- resolves with growth

Genu varum

- growth disturbance of the medial tibial epiphysis

- may be confused with genu varum (but is asymmetrical or abnormally severe)

- proximal tiba develops an angular deformity

- detected on x-ray w/ abnormal fragmentation of the medial epiphysis of the tibia

- treated w/ surgery or bracing

-

Blount's disease

- knock knees are common in 3-5 yr olds

- increased distance between the feet when knees are touching

- self-correcting

Genu valgum

- most common cause of in-toeing

- nonpathologic seen in children under age 5

- rotational deformity caused by in utero molding

- hips/knees normal, legs/feet rotate inward

- frequent tripping seen

- usually corrects by age 2

Tibial torsion

- testes that descend in the inguinal canals when placed in warm, comfortable environments (bathtub)

- distinguish from undescended testes

Retractile testes

- not retractable at birth

- 90% retractable by 3

- circumcision for phimosis not usually done until 7 or 10

Foreskin

- one potential cause of SIDS in male infants

- more often present with females

- serum electrolytes should be checked with this

Ambiguous genitalia

- do not circumcise babies with this defect because the foreskin will be used for repair at approximately 1 yr

Hypospadias

- thin white transparent hymenal membrane that blocks the vaginal outlet

- vaginal bleeding will present as a dark red bulge

- cause for delayed onset of menses

Imperforate hymen

- common in prepubertal girls

- caused by fusion of labia minora from inflammation of the thin vaginal mucosa that adheres in midline

- most lyse spontaneously

Labia minora adhesions

- positioning, alertness, spontaneous movements, symmetry, eye position and movement, cry and primitive reflexes

- deep tendon reflexes (biceps and patellar)

Pediatric Neuro Exam

- head lag, reach and grasp objects, transferring objects from hand to hand/sitting alone, walking

4/5/7/14 months

- Mama, Dada -> specific words -> 2/3 word sentences

9/15/24 months

- upgoing toe in response to noxious stimulation of the S1 dermatome

- present until 3 or 4

Babinski reflex

- elicited by startling the child

- responds w/ extension of arms, flexion, clenching of hands and flexion of knees/hips

- infant will then cry

- lost about 4-5 months

Moro reflex

- when infant's head turns to one side, ipsilateral arm extends, contralateral arm flexes

- disappears in 4-6 months

Tonic neck reflex

- handedness is developed around this age

15 months

- high risk of mortality and morbidity

- Brudzinski's (flexing child's neck illicits flexion of hips/knees, stiffness of neck or pain) and Kernig's (inability to extend leg because of pain when 1 hip flexed) signs used to diagnose

- both however unreliable in children under 3

Meningitis