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What it expected axillary temp for an infant age birth to 1 year?
97.7 to 98.9 F
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What is expected oral temp for a child age 1 to 12 years?
98.1 to 99.9 F
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What is expected oral temp of child 12 years and older?
97.8 to 98.0 F
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What is normal pulse range from birth to 1 week?
100-160/min with brief fluctuations depending whether crying or sleeping
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What is normal pulse range from 1 week to 3 months?
100-220/min
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What is normal pulse range from 3 months to 2 years?
80-150/min
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What is normal pulse range from 2 to 12 years?
70-110/min
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What is normal pulse range for 12 years and older?
50-90/min
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What is normal respirations for a newborn?
30-60/min with short periods of apnea (less than 15 seconds)
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What are normal respirations for newborn to 1 year?
30/min
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What are normal respirations for 1 to 2 years?
25-30/min
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What are normal respirations for children 2 to 6 years old?
21-24/min
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What are normal respirations for children 6 to 12 years old?
19-21/min
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What are normal respirations for children 12-18 years old?
16-18/min
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What is normal blood range for an infant?
- Systolic 60-80 mm Hg
- Diastolic 40-50 mm Hg
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Blood pressure readings for ages 1 to 16 years should be compared to what standard measurement table?
The National High Blood Pressure Program Tables
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Erect head posture is expected after what age?
4 months
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What measurements identify growth rate for a child?
- weight
- height
- BMI (Body mass index)
- head circumference
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Where can you find growth charts for comparison?
CDC- Center for Disease Control and Prevention
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Lymph nodes, if palpable, should be:
small, nontender, and mobile
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Posterior fontanel closes between what ages?
2 and 3 months of age
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Anterior fontanel closes between what ages?
12-18 months
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Visual acuity in infants can be checked by:
Holding an object in front of the eyes and checking to see if the infant is able to fix on the object and follow it.
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Which charts are used to check visual acuity of older children?
Snellen chart or symbol chart
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Visual acuity is hard to determine until what age?
3 years
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What test is used to assess color vision?
The Ishihara test
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Peripheral vision fields for:
upward
downward
nasally
temporally
- upward 50 degrees
- downward 70 degrees
- nasally 60 degrees
- temporally 90 degrees
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A test to demonstrate equal movement of eyes is:
Cover/Uncover test
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Evaluation of any sign of strabismus should done at what age?
4-6 years of age
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To evaluate the presence of nystagmus, you would have the child perform:
Six cardinal fields of gaze
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Palpebral means:
of or pertaining to the eyelids
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Definition of red reflex (present in infants)
A circular red light reflected from the retina of the eye.
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Definition of macula
A minute yellowish area near the center of the retina. Can effect central vision.
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In infants, to visualize the tympanic membrane, you should:
pull the pinna down and back
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To visualize the tympanic member in children 3 or older you should:
pull the pinna up and back
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Normal color of tympanic member?
pearly gray
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Which to landmarks should be visible when viewing the internal ear?
- Umbo (tip of the malleolus)
- Manubrium (long process or handle)
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Definition of medical home
Primary healthcare provider who has a long-term and comprehensive relationship with the family.
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What are 4 special issues in health supervision?
- Cultural influences
- Community influences
- Chronic illness in child
- Child adopted internationally
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Comprehensive health supervision includes frequent psychosocial assessments including the following:
- Health insurance coverage
- transportation to health care
- financial stressors
- family coping
- school's response to chronic illness
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Comprehensive screening for infectious disease is a must in internationally adoped children
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Common diseases in internationally adopted children are:
intestinal parasites--aprox 25%
Giardia lamblia--aprox 19%
latent tuberculosis--19%
hepatits B
HIV
Syphilis
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Components of health supervision
- Developmental surveillance and screening
- Injury and Disease Prevention
- Health promotion
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Defintion of Developmental surveillance
Ongoing collection of skilled observations made over time during health care visits.
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Developmental screenings
Brief assessment procedures that identify children who warrant more intensive assessment and testing
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Factors placing an infant or toddler at risk for developmental problems include:
- Birthweight less than 1,500 g--(3.31 lbs.)
- Gestational age less than 33 weeks
- Central nervous system abnormality
- Hypoxic ischemic encephalopathy
- Maternal prenatal alcohol or drug abuse
- Hypertonia
- Hyperbilirubinemia requiring exchange transfusion
- Kernicterus
- Congenital malformations
- Symmetric intrauterine growth deficiency
- perinatal or congenital infection
- suspected sensory impairment
- chronic (more than 3 months) otitis media with effusion
- inborn error of metabolism
- HIV infection
- lead level above 19 mg/dl
- parental concern about developmental issues
- parent with less than high school education
- single parent
- sibling with development problems
- parent with developmental disability or mental illness
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Hypoxic ischemic encephalopath
Damage to cells in the central nervous system (the brain and spinal cord) from inadequate oxygen. Hypoxic-ischemic encephalopathy allegedly may cause in death in the newborn period or result in what is later recognized as developmental delay, mental retardation, or cerebral palsy. This is an area of considerable medical and medicolegal debate.
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Definition of
encephalopathy
a term that means brain disease, damage, or malfunction. Encephalopathy can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma, or death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations (for example, poor coordination of limb movements).
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Hypertonia
condition marked by an abnormal increase in muscle tension and a reduced ability of a muscle to stretch. It is caused by injury to motor pathways in the central nervous system, which carry information from the central nervous system to the muscles and control posture, muscle tone, and reflexes. When the injury occurs in children under the age of 2, the term cerebral palsy is often used
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Hypotonia
state of low muscle tone[1] (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength
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Hyperbilirubinemia
the bilirubin level in the blood is higher than normal
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Kernicterus
damage to the brain centers of infants caused by increased levels of unconjugated bilirubin
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Warning signs of any age
No response to environmental stimilus
Persistently up on toes (longer than 30 seconds) in supported standing position
- No Response could mean sensory deficit
- Up on toes could mean Cerebral Palsy
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Possible developmental concern if a child rolls over before 3 months
Hypertonia
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Possible developmental concern if a child has persistent fisting after 2-3 months
Neurologic dysfunction
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Warning sign of persistent head lag in a child after 4 months could indicate?
Hypotonia
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Warning sign of a child 5 months or older not reaching for toys could indicate?
Motor, Visual, or cognitive deficit
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Warning sign of a child 6 months or older with the lack of tripod sitting could indicate?
Hypotonia
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A child 6 months or older that is not smiling could indicate...
Visual deficit, attachment issue
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Warning sign of primitive reflex persistence in a child of 6 months or older could indicate?
Neurologic dysfunction
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A child 6 months or older that is not babbling could indicate the developmental concern of
Hearing deficit
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No reciprocal vocalizations or facial expressions in a child 9 months or older is a warning sign for
Autism spectrum disorders
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No spoon or crayon use by a child age 12 months or older is warning sign for?
Fine motor delay
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A child who is not walking by 15-18 months is considered to be experiencing what?
Gross motor delay
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No imitative play by a child 18 months or older is a warning sign for ?
Autism spectrum disorders
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If a child shows hand dominance present prior to 18 months, this would indicate a possible...?
hemiplegia in opposite upper extremity
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A child 18 months or older without having spoken a first word may have a possible ...?
hearing deficit, expressive language deficit
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Echolalia (repetitive speech) or inability to follow simple commands in a child 24 months or older is a warning sign for ...
Social delay or autism spectrum disorders
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Any child who loses a developmental milestone such as a child who was able to sit without support and now can not needs a full evaluation. Indicates a significant neurologic problem.
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High sensitivity means:
a high false-positive rate
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low specificity
a low false negative rate
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Risk assessment determines ...
liklehood of developing a condition
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universal screening
entire population is screened regardless of individual risk
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selective screening
done when a risk assessment indicates the client has one or more risk factors for the disorder
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Amino acid metabolism disorders
- phenylketonuria
- maple syrup urine disease
- homocystinuria
- citrullinemia
- argininosuccinic acidemia
- tyrosinemia type I
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Metabolic Screening consists of
- Amino acid metabolism disorders
- Organic acid metabolism disorders
- Fatty acid oxidation disorders
- Hemoglobinopathies
- Others
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Organic acid metabolism disorders consist of
- isovaleric acidemia
- glutaric acidemia type I
- hydroxymethylglutaric aciduria
- multiple carboxylase deficiency
- methylmalonic acidemia due to mutase deficiency
- methylmalonic acidemia cblA and cblB forms
- 3-methylcrotonyl-CoA carboxylase deficiency
- propionic acidemia
- beta-ketothiolase defiency
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Fatty acid oxidation disorders:
- medium-chain acyl-CoA dehydrogenase deficiency
- very-long-chain acyl-CoAdehydrogenase deficiency
- long-chain 3-OH acyl-CoA dehydrogenase deficiency
- trifunctional protein deficiency
- carnitine uptake defect
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Hemoglobinopathies:
- sickle cell anemia
- HbS/beta-thalassemia
- HbS/C disease
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Others:
- congenital hypothyroidism
- biotinidase deficiency
- congenital adrenal hyperplasia
- classical galactosemia
- cystic fibrosis
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Screening tools:
- Denver II
- Denver PRQ
- Child Development Inventory (CDI)
- Ages and Stages Questionnaire (ASQ)
- Parents' Evaluation of Developmental Status (PEDS)
- Batelle Developmental Inventory Screening Tool
- Bayley Scales of Infant Development II
- Early Language Milestone Scale
- Denver Articulation Screening
- Goodenough-Harris Drawing Test
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Denver II
Birth - 6 years---Assesses personal - social, fine motor-adaptive, language, and gross motor skills
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Denver PRQ Screening tool
Parental report
Birth-6 years--Assesses personal - social, fine motor-adaptive, language, and gross motor skills
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Child development Inventory (CDI)
Parental report
Birth -6 years---Simple questions about infant, toddler, or preschooler behaviors.Measures social, self-help, gross motor, fine motor, expressive language, language comprehension, letter, numbers, and general development as appropriate
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Ages and Stages Questionarre
Parental report
Birth -6 years---Assesses communication, gross motor, fine motor, personal-social, and problem solving skills
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Parent's evaluation of developmental status screening tool
Parental report
Birth -8 years ---Screens for a wide range of developmental, behavioral, and family issues
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Batelle developmental inventory screening test
Direct elicitation (special training)
12-96 months---Assesses fine and gross motor, adaptive, personal -social, receptive and expressive language, and cognitive skills
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Bayley Scales of Infant Development II
- 1-42 months
- Direct elicitaion
- Requires special Training
- Thorough
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Early Language Milestone Scale
- Birth - 3 years
- Requires standarized kit
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Denver Articulation Screening
- 2.5 -7 years
- 5 minutes to administer
- Does not evaluate language ability
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Goodenough-Harris Drawing Test
- 5-17 years
- Child draws a person,which is analyzed for body parts, clothing, proportion, and perspective
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Child needs a metabolic screening after 48 hours old even if one was done with the first 48 hours.
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Need to identify hearing loss by 3 months of age
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Vision Screening for Neonates
- hold object 10-12 inches from the face
- after fixation, infant should follow to midline
- by 2 months of age- should be able to follow object to 180 degrees
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Photoscreening can help identify problems such as ocular malalignment, refractive error, lens and retinal problems
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Use black and white patterns to perform vision screening on infants less than 6 months of age.
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Steps to follow when using a vision screening chart
- place the chart at the child's eye level
- place a mark on the floor 20 feet from the chart
- align the child's heels on the mark
- have the child read each line with one eye covered and then with the other eye covered
- have the child read each line with both eyes
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Hearing Screening Methods
- Auditory brain stem response (ABR)
- Evoked otoacoustic emissions (EOAE)
- visual reinforcement audiometry (VRA)
- Tympanometry
- Conditioned play audiometry (CPA)
- Pure-tone (conventional) audiometry
- Whisper test
- Weber Test
- Rinne Test
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Auditory brain stem response (ABR)
- Newborn-6 months
- Measures electroencephalographic waves
- Results could be affected by ear debris
- Infant must be quiet
- sedation may be needed
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evoked otoacoustic emissions (EOAE)
- newborn-6 monthsor developmentally delayed children at the infant's level of functioning
- machine produces clicks that stimualtes cilia in the cochlea and measures the response
- infant must be quiet
- results may be inaccurate in first 24 hours of life
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Infants should have how many teeth by 1 year of age?
6-8
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How many teeth should children and adolescents have?
20 deciduous and 32 permanent
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Chest shape of infants should be?
circular with anteroposterior diameter equaling the transverse or lateral diameter
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chest shape of children and adolescents should be ?
transverse diameter to anteroposterior diameter changes to 2:1.
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Breath sounds in children and adolescent are vesicular heard over lung fields
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Heart sounds for children
- Clear and crisp
- s1 louder at the apex of heart
- s2 louder near the base of heart
- sinus arrhythmias associated with respirations are common
- physiologic splitting of s2 and s3 heart sounds are expected findings in children
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Infant pulses
Brachial, temporal and femoral should be palpable full and localized
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Bowel sounds should be heard how often?
5-30 seconds
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Descending colon-cylindric mass that is possibly palpable in the lower left quadrant due to presence of stool
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Infant spines should be?
without dimples or tuft of hair and midline with an overall C-Shaped lateral curve
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Sucking and rooting reflexes
- Birth -4 months-
- elicited by stroking cheek or edge of mouth
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Palmar grasp
- birth to 6 months
- elicited by placing object in palm
- infant should grasp
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Plantar grasp
- birth to 8 months
- elicited by touching the sole of foot
- toes curl downward
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Moro reflex (startle)
- birth to 4 months
- elicited by striking a flat surface an infant is lying on or by allowing the head and trunk in a semi sitting position to fall backward to an angle of at least 30 degrees
- infants arms and legs symmetrically extend and then abduct while her fingers spread to form a c shape
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tonic neck reflex (fencer postion)
- birth to 3 to 4 months
- elicited by turning head to one side
- infant extends the arm and leg on that side and flexes arm and leg on opposite side
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babinski reflex
- birth to 1 year
- elicited by stroking the outer edge of the sole of foot up toward the toes
- toes fan upward and out
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Stepping reflex
- Birth to 4 weeks
- elicited by holding an infant upright with his feet touching a flat surface.
- infant makes stepping movements
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Cranial nerves
- 1 olfactory
- II optic
- III oculomotor
- IV trochlear
- V trigeminal
- VI abducens
- VII facial
- VIII acoustic
- IX glossopharyngeal
- X Vagus
- XI Spinal Accessory
- XII Hypoglossal
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Cranial Nerve- I olfactory
expected findings in infants and children/adolescents
- infants- difficult to test
- c/a- identifies smells through each nostril individually
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Cranial nerve- II optic
expected findings in infants and children/adolscents
- infant- looks at facce and tracks with eyes
- c/a- has intact visual acuity, peripheral vision, and color vision
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Cranial Nerve- III oculomotor
expected findings of infants and children/adolscents
- Infants- Blinks in response to light and Has pupils that are reactive to light
- C/A- Has no nystagmus and PERRLA is intact
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Cranial nerve - IV Trochlear
Expected fingings in infants and children and adolscents
- Infant- looks at face and tracks with eyes
- C/A- has the ability to look down and in with eyes
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Cranial Nerve - V Trigeminal
Expected findings in infants and children/adolscents
- Infant - Has rooting and sucking reflexes
- C/A - Is able to clench teeth together and detects touch on face with eyes closed
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Cranial Nerve - VI Abducens
Expected findings in infants and children/adolescents
- Infant - looks at thave and tracks with eyes
- C/A - Is able to see laterally
- with eyes
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Cranial Nerve - VII Facial
Expected finding in infants and children/adolescents
- Infants- Has symmetric facial movements
- C/A - has the ability to differentiate between salty and sweet on tongue and has symmetric facial movements
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Cranial Nerve- VIII Acoustic
Expected findings in infants and children/adolescents
- Infants - tracks a sound and blinks in response to a loud noise
- C/A - Doeks not experience vertigo and has intact hearing
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Cranial nerve- IX Glossopharyngeal
Expected findings in infants and children/adolescents
- Infants - has an intact gag reflex
- C/A - has an intact gag reflex and is able to taste sour sensations on back of tongue
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Cranial Nerve- X Vagus
Expected findings in infants and children/adolescents
- Infant - has no difficulties swallowing
- C/A - Speech clear, no difficulties swallowing
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Cranial Nerve - XI Spinal Accessory
Expected fingings in infants and children/adolescents
- infants - moves shoulder symmetrically
- C/A - has equal strength of shoulder shrug against examiner's hands
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Cranial nerve - XII Hypoglossal
Expected findings in infants and children/adolescents
- infants - has no difficulties swallowing and opens mouth when nares are occluded
- C/A - Has a tongue that is midline and is able to move tongue in all directions with equal strength against tongue blade resistance
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Deep tendon reflexes in pediatric patients
- Partial flexion of lower arm at biceps tendon
- Partial extension of lower arm at triceps tendon
- Partial extension of lower leg at patellar tendon
- Plantar fexion of foot at Achilles tendon
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Cerebellar function assessment for children and adolscents
- Finger to nose test - Rapid coordinated movements
- Heel to shin test- able to run the heel of one foot down the shin of the other leg while standing
- Romberg test- Able to stand with slight swaying while eyes closed
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