posterior fontanel closes - ✔✔ 6-8 weeks
pincer grasp developed - ✔✔ 10 months
grasp an object with full hands - ✔✔ 2-3
... [Show More] months
sit alone - ✔✔ 7-8 months
head lag disappears - ✔✔ 4-6 monhts
rolling over - ✔✔ 5-6 months
doubles birth weight - ✔✔ 6 months
builds a tower of 2 blocks, sometimes fails - ✔✔ 12 months
anterior fontanel closes - ✔✔ 12-18 months
can pull to stand - ✔✔ 9-11 months
comprehends "no" - ✔✔ 9-10 months
says 3-5 words with meaning - ✔✔ 12 months
introduction to solid food - ✔✔ 4-6 months
able to crawl - ✔✔ 6-7 months
forms words combinations - ✔✔ 18 months
can tie own shoes - ✔✔ 5 years
can stand on one foot for a few seconds - ✔✔ 3 years
birth weight quadrupled - ✔✔ 30 months
picky eater due to decreased growth - ✔✔ 18 months
transition to whole milk - ✔✔ 1 year
Normal vision - newborn - ✔✔ 20/400
normal vision-6 months of age - ✔✔ 20/100
children that require further evaluation with pediatric ophthalmologist - ✔✔ 5 years or > with visual acuity 20/30 or worse
3 years of age with visual acuity 20/50 or worse
infants who fail gross visual acuity testing
all age groups who demonstrate more than one-line difference between the eyes
cause of abnormal red reflex - ✔✔ leukocoria - a white pupillary reflex can indicate:
*cataracts
*retinal detachment
*retinoblastoma: an eye cancer that begins in the back of the eye (retina), most commonly in children.
Conjunctivitis IN NEWBORNS - ✔✔ ALL NEONATES WITH CONJUNCTIVITIS REQUIRE EVALUATION BY A PEDIATRIC OPHTHALMOLOGIST
in ALL cases of neonatal conjunctivitis, conjunctival swabs and scrapings must be obtained for culture , with tx based on test results
Allergic conjunctivitis - ✔✔ * Itching is the hallmark of this condition, often accompanied by tearing, burning, nasal congestion, and mucoid discharge
* Rhinitis or allergic pharyngitis, mild lid edema, fine papillary hypertrophy (cobblestone appearance of conjunctiva)
* Remove the offending allergen when possible; Instill artificial tears during acute phase Oral antihistamines( Zyrtec, Allegra); Antihistamine eye drops; Mast-cell stabilizers
Chlamydial conjunctivitis - ✔✔ ■ Usually presents in young sexually active persons between the ages of 18-30.
■ Transmission occurs from autoinoculation from infected genital secretions
■ Patient may have photophobia and enlarged, tender preauricular nodes
■ Adolescents- Systemic antibiotics (e.g. azithromycin or doxycycline) - oral ABX
■ Once diagnosis is established, a genital work-up of patient and sexual partner is indicated Investigation for other sexually transmitted diseases
■ newborns: Systemic erythromycin, Investigate for other sexually transmitted diseases
* subacute or chronic in nature - may have symptoms for months
Hyperacute bacterial conjunctivitis - ✔✔ ●A severe, rapidly progressing sight-threatening ocular infection most often affecting sexually active young adults and newborn infants
● In adolescents/adults organism is transmitted from genitals to hands and then to eyes
● In newborns, transmission is via vaginal delivery from an infected woman (3-5 days of age)
■ Characterized by abrupt onset of copious yellow-green purulent discharge that is bilateral, with lid edema, erythema, and chemosis
■ Preauricular adenopathy often present
■ Immediate referral to an ophthalmologist for aggressive management to prevent serious complications
● Systemic antibiotics; topical antibiotics
Bacterial conjunctivitis - ✔✔ ■ Acute onset of ocular irritation and tearing
■ Develops in one eye initially and then spreads to the other eye within 48 hours
■ Within 1-2 days, mucopurulent or purulent discharge develops
■ Eyelids often edematous with collection of debris at base of lashes and matting of eyelashes upon awakening
■ Diffuse hyperemia of bulbar and tarsal conjunctiva
■ Lymphadenopathy is minimal
■ Broad spectrum antibiotic
● Azithromycin 1% soln; Fluoroquinolones (moxifloxacin, gatifloxacin) are highly effective, some resistance is occurring; Polytrim
● Dose should be delivered in a single drop. If two drops required, instructions to wait 5 minutes between drops should be given (eyelid capacity to hold fluid is typically exceeded by one drop)
Viral conjunctivitis - ✔✔ ■ Leading cause of conjunctivitis in children; highly contagious
■ Usual mode of transmission are contaminated fingers and pool water
■ Characterized by conjunctival hyperemia, edema, and watery discharge; acute onset
■ Usually starts unilateral with bilateral involvement within 24-48 hours
■ Vision unaffected; photophobia uncommon
■ Preauricular node involvement is common
■ Usually self-limiting
■ Some evidence that topical antibiotic shortens course and prevents bacterial superinfection:
-short course (5 days)
-topical erythromycin 5mg/g opth ointment
or Polytrim (polymyxinB-trimethoprim soln)
■ Diluted Chamomile tea and other herbal remedies used in some cultures (ask about home remedies)
■ If using topical antibiotics, Children >2 years treat with broad spectrum topical eye drops such as Polytrim [Show Less]