Boards: Pediatrics

Visual Milestone: Fixates briefly on mom face

1 month

Anemia Screening in Infants:

1 year (Healthy infant stores enough iron for 6 months)

Babinksi Reflex Disappears

1-2 years However, a strong babinski at 6 months would be considered abnormal.

Average age of menarche is 12. It is normal to have irregular cycles for: ______

1-2 years after menarche

Treatment options for AOM failure or repeat infection with history of antibiotic in past 3 months: (2)

1. Augmentin 2. Cefdinir

Measles presentation:

1. Prodrome of fever, cough, coryza, and conjunctivitis. 2. Koplik Spots on buccal mucosa. 3. Maculopapular rash starts on the face and spreads downward. Spares palms and soles.

Signs of orbital cellulitis:

Abrupt onset of unilateral eye pain EOM causing pain and limited Proptosis to affected eye Exopthalamus Fever & Chills Medical emergency - ED

Screening Test for Scoliosis

Adams forward bend test

Tanner Stage V (Boys)

Adult Pattern

Tanner Stage V (Girls)

Adult Pattern

Adults have _____ teeth and children have _______ First eruptions are lower central incisors at age: Lose first teeth (central incisors) at age:

Adults: 32 Children: 20 6-10 months 6 years of age

Oedipal Stage:

Age 3-6; child wants to marry their parent of the opposite sex.

Can draw a stick person with 3 body parts. Rides a bicycle with training wheels:

Age 4

Can draw a stick person with 6 body parts. Copies a square.

Age 5

Ties shoes and can copy a triangle.

Age 6

Visual acuity should be 20/20 by age _______. If <20/30 refer to ophthalmologist.

Age 6

When can a child normally learn how to ride a bicycle?

Age 6-7

First line treatment for AOM and pediatric sinusitis

Amoxicillin

Physiologic Anemia of the Infant

Around 8-10 weeks, the infants hemoglobin drops. Normal variation.

Dietary in Infancy:

Avoid cow's milk until age 12 Solids at 4-6 months (1-2 times per day mixed with BM or formula). Avoid rice cereal because of arsenic. Introduce new foods 1 at a time to avoid allergies.

Treatment option for AOM with PCN allergy:

Azithromycin or Clarithromycin

Normal weight loss in neonate:

BF: 10% Formula: 5% (Returns to birth weight at 2 weeks)

Crytorchidism referral:

Between 6-12 months. Requires surgical intervention by age 1.

Pseudogynecomastia

Bilateral enlarged breast is due to fatty tissue. Both breasts feel soft to touch and are NOT tender. Common in obese males.

Kernicterus

Bilirubin encephalopathy: Form of brain damage resulting from bilirubin entering the brain. Signs: Lethargy, poor feeding, vomiting, irregular respiration

Piaget Stages of Cognitive Development: Sensorimotor

Birth - 2 years Object Permanence

Cephalohematoma

Bleed that does NOT cross suture lines. This is concerning and is abnormal. Requires cranial XRAY.

Dacrostenosis

Blocked lacrimal duct. Eyes are watery, eyelashes matted and when lacrimal gland is touched, tears produced. Txn: Lacrimal duct massage

20-40 degrees for scoliosis: POC:

Bracing

Tanner Stage III (Girls)

Breast and nipple growth. One mound, no separation.

Tanner Stage II (Girls)

Breast bud and areola starts to develop

Caput succedaneum: _______ Cephalohematoma:______

CS: Crosses the midline (self resolves) Cephalohematoma: Does NOT cross the midline (worrisome)

Red Reflex tests for:

Cataracts and Retinoblastoma (Normal: Symmetric red/orange glow)

Chlamydia Ophthalmia

Chlamydia eye infection that presents 4-10 days after birth. - Signs: Red, watery eyes that becomes purulent - Txn: Requires SYSTEMIC Erythromycin (gtts at birth are not effective for chlamydia)

<20 degree Scoliosis: POC:

Closely monitor

Asymmetry of gluteal or thigh folds may indicate:

Congenital Hip Dysplasia

Risks for neonate of chlamydia + mother during labor: (2)

Conjunctivitis and PNA**

2 Month Milestones:

Coos and lifts head when prone

4 year old milestones:

Copies a cross, draws person with 3 body parts, hops/stands on 1 foot

Bornholm Syndrome

Coxsackie viral infection causing myalgias and thoracic cavity pain.

Scaly greasy flaky skin on the scalp of newborns/infants.

Cradle Cap (Seborrheic Dermatitis) Txn in infants: Topical olive oil

Colic: (Rule of 3's)

Crying for no apparent reason. <3 months of age >3 hours a day (same time each day) > 3 days per week Generally resolves around 3-4 months

Pel-Ebstein Sign

Cyclic fevers (on and off) for 1-2 weeks. Seen with Hodgkin's Lymphoma.

Newborn Screening: IRT

Cystic Fibrosis

DTaP is given: ____- Tdap is gven:____ Td: _____

DTaP: <7 (5 dose series) Tdap: May be given once per lifetime. Offered at 11-12 to replace one dose of Td. Td: Given every 10 years

Never place an anorexic patient on what type of birth control?

Depo Provera (increases the risk for osteoporosis)

Rome IV criteria used for:

Functional Constipation. 1 of the following present each week for at least a month. Holding stool, hard BM, large size stools, fecal mass in rectum, 2 or less stools per week, fecal incontinence episodes

Dermal Melanocytosis

"Mongolian Spots" - Blue/black spots - Common in Asians, Hispanics, and AA - Fade by 2-3 years of age

Erythema Toxicum

"Newborn rash" - Small pustules with erythema base. Present on the 2nd to 3rd day of life and resolve in 1-2 weeks.

Nevus Simplex:

"Salmon Patch" or "Stork bite" Flat, pink patch often on eyelid/neck (color changes with crying) Typically fades by 18 months

Faun Tail Nevus

"Tuft of hair" over the lumbosacral region (Refer as this is a sign of NTD) Order US and then MRI

Leukocoria

"White pupil" - retinoblastoma

Rotavirus

3 dose series: 2, 4, 6 months

Hepatitis B Vaccine

3 dose series: Birth 1-2 months 6 months

Visual Milestone: Fixates on toy and can follow as it moves.

3 months

Rheumatic Fever

Immune reaction following strep pyogenes infection. Often related to untreated Strep. Use the JONES Criteria for diagnosis.

Tanner Stage 1 (Boys)

Prepubertal

2 year old milestones:

Walks, runs, speech mostly understood by family, can copy a straight line, 2-3 word sentences - Temper tantrums, says "no" often

Turner Syndrome Presentation: Absence/partial absence of 1 X chromosome (X)

Webbed Neck, Short stature, ovarian failure, 4th digit shortened, ear malformations

amblyopia

"Lazy eye:"

6-12 months gain: ____ ounces per week ______ inches per month

3-4 ounces per week 1/2 inch per month

3 year old milestones:

3-5-word sentences, can copy a circle, rides a tricycle. Language is mostly understood by strangers. Stacks more than 6 cubes, can throw a ball overhead, plays with other children but not great at sharing Exhibits the Oedipal Phase (wants to marry parent of opposite sex)

IPV

4 dose series 2, 4, 6 months and 4 years

HiB

4 dose series 2, 4, 6, 12 months (Also a 3 dose series - 2, 4, 6)

PCV13 (Prevnar 13)

4 dose series 2, 4, 6, 12-15 months

Laughing milestone

4 months

HPV vaccine has been approved up to age:

45

DTAP

5 dose series: 2, 4, 6, 15-18 months and 4 years

Bulimia prevalence: ____ Anorexia Prevalence: _____

5% in college females (10x greater than males) 1.5% in teenage girls

Infants rolls in BOTH direction at age: _____

6 months

Visual Milestone: Makes good eye contact and turns head to noises/voices.

6 months

Neonates lose up to 10% of their birth weight but regain it in 2 weeks. Double their birth weight at: ______ Triple their birth weight at: ________

6 months 12 months

Teething begins:

6-8 months (Mgmt: analgesics and ice rings)

0-6 months gain: ____ ounces per week ______ inches per month

6-8 ounces per week 1" per month

DTaP should not be given:

7+ years of age (Use Tdap and Td)

Piaget Stages of Cognitive Development: Concrete Operational

7-11 Math, Numbers

Booster Seat until:

8-12 years or 4' 9"

Infant plays peek a boo and patty cake at age: _______

9 months

Newborn Reflex: Step Reflex

Foot placed on surface, infant will pull up foot and place other down. "Stepping" - Disappears at 6 weeks

Meningococcal (MCV4) is given:

Freshmen in college who live in dormitories

Risk factors for newborn hearing loss:

Hyperbilirubinemia TORCH infections (Varicella, CMV, Toxo) Low APGAR

Head Circumference Msmt: Up to 3 years: HC increases ______ cm by 12 months

Increases 12 cm in 12 months (Fastest growth in first 3 months)

Failure to Thrive:

Infant becomes malnourished. <5th percentile on the growth chart (WHO for <2 and CDC for 2+)

Secondary Amenorrhea

No menses in 6 months (or 3 cycles) after previous menarche. Consider PCOS, anorexia, stress MOST commonly caused by pregnancy

Delayed puberty in boys

No testicular enlargement by 14

Pathologic Jaundice

Occurs within the first 24 hours of life. Elevated total bilirubin levels.

Galeazzi sign

One femur appears shorter when supine. Sign of congenital hip dysplasia.

Precocious Puberty in Girls

Onset of puberty before age 8

Puberty

Onset of secondary sex characteristics and sexual maturity. -Testes begin to produce test testosterone - Ovaries produce estrogen/ progesterone

6 Month Milestones:

Palmar grasp, passes objects from one hand to another, sits without support, rolls both directions

Congenital Hypothyroidism

Part of the newborn screening. Signs: Umbilical hernia, open posterior fontanelle, physiologic jaundice that lasts longer than usual, poor feeding

Jaundice that occurs within the first 24 hours of life.

Pathologic Jaundice. Always needs to rule out sepsis or TORCH.

Jaundice that should be promptly evaluated: (2)

Pathologic in the first 24 hours Pathologic in a healthy full term infant after 2 weeks

Tanner Stage IV (Boys)

Penis becomes WIDER, continues getting longer. Scrotum becomes larger, darker, more ruggae.

Tanner Stage III (Boys)

Penis grows LONGER, scrotum continues to grow.

9 Month Milestones:

Pincer grasp, waves "bye bye", party cake claps, plays peek a boo, crawls, pulls self up on furniture

Epstein pearls

Small white epithelial cysts on infants gums/palate

4 Month Milestones

Social smile, babbles, hands to mouth, rolls from back to tummy, holds head unsupported

Scarlet Fever presentation:

Sore throat, tonsillar exudate, strawberry tongue "Sandpaper rash"

Vitamin D Supplementation in BF infants:

Starts the first few days of life. 400 Units daily.

Light Reflex tests for:

Strabismus (Normal: Symmetrical and bright light reflex)

Most common organism for AOM:

Strep Pneumoniae

Newborn Reflex: Babinksi Reflex:

Stroke bottom of foot (heel to toes) - Upward extension of great toe and fanning of additional toes is normal in newborns/infants.

Newborn Reflex: Rooting Reflex

Stroking the corner of the mouth will cause the baby to turn toward stimulus. - Disappears at 3-4 months

BreastFEEDING jaundice:

Suboptimal BM intake causes failure to produce stool Txn: Increase frequency/duration of feedings.

Newborn Reflex: Moro Reflex

Sudden loud noise - infant extends/abducts extremities and then slowly adducts back to place. - Disappears at 3-4 months

>40 degrees for scoliosis: POC:

Surgery consult

If testicles have not descended by 1 year (cryptorchidism):

Surgical correction at 1 year. Increases risk for testicular cancer.

Newborn female genitalia appearance:

Swollen with white/bloody discharge (maternal hormones) - normal finding

Reye's Syndrome

Syndrome which may cause a spectrum of symptoms that range from lethary, encephalopathy, seizures, coma and death. May be caused by: Postviral (Varicella or Influenza) or ASA exposure.

Still's Murmur: (Vibratory/musical)

Systolic murmur that is most commonly heard when supine. Will resolve by adolescence.

Klinefelter Syndrome presentation (XXY):

Tall stature, small scrotum/penis, absence of facial hair, osteoporosis Txn: Testosterone

Tanner Stage II (Boys)

Testes/scrotum enlarges, scrotum darkens, more ruggae

Case Study: Adolescent male complains of scrotal heaviness with a hard, painless lump. History of cryptorchidism as an infant.

Testicular Cancer

Case Study: Adolescent male with abrupt onset of severe unilateral testicular pain, redness, swelling. Severe nausea and vomiting.

Testicular Torsion (Negative cremasteric reflex on ipsilateral side).

Dx for Gonococcal Ophthalmia:

Thayer Martin Chocolate Agar

Seborrheic Dermatitis (Cradle Cap)

Thick scaling (waxy) on the scalp - Txn: Mineral oil, olive oil, baby shampoo Apply and gently massage

Epispadia

Urethral meatus in on the top of the penis (dorsal). Refer to urology.

Hypospadia

Urethral meatus on the underside of the penis (ventral). Refer to urology.

12 Month Milestones

Uses sippy cup, 1-2 words, stands independently

Caput succedaneum

"Cone shaped head" Edema CROSSES the suture line and is due to prolonged labor/vaginal pressure. Self resolves on its own.

Burner Syndrome

"Stinger" Burning/numbness sensation felt during contact sports (generally from contact to neck/shoulder area - Brachial Plexus area) Brachial Plexus: Nerves from spinal cord to the shoulder and arm. Generally no treatment indicated.

Txn for Gonococcal Ophthalmia:

- Prevention: Erythromycin ointment at birth - Txn: Requires hospitalization for IV antibiotics

Meningococcal Vaccine given:

11-12 years of age 16-18 give booster

Piaget Stages of Cognitive Development: Formal Operational

12 + to Adulthood Abstract thinking, logic, morals

Visual Milestone: Prolonged visual eye contact and recognizes self in mirror.

12 months

Anterior Fontanel closes:

12-18 months

Primary cause of mortality in adolescents and young adults: Second highest cause of mortality:

1st: MVA 2nd: Suicide

Newborns have myopia. Their eyes may wander/cross for the first _________ months of life. Newborns do not shed tears.

2

Transition from whole milk around what age?

2

Length measurements (linear supine) until age: _____

2 (At age 2 switch to standing height and add BMI)

Posterior Fontanel closes

2 months

Social smile

2 months

Age where the child can jump:

2 years

Rear-facing carseat until:

2 years or reaching maximum height AND maximum weight

Piaget Stages of Cognitive Development: Preoperational

2-7 years Egocentric/ Pretend Play

Breastmilk and Formula: _______ calories per ounce

20

Age Correction for premature infants continues for:

24-30 months

Treatment for UTI in children:

2nd or 3rd generation Cephalosporin (Ex: Cefixime) Amox has poor coverage with urinary bacteria and there is a high resistance with E. Coli.

JONES Criteria

Diagnostic indicator for Rheumatic Fever: (Must have 2) - Joints (swollen/red) - Heart (murmurs/carditis) - Nodules (subcutaneous nodules) - Erythema Marginatum (painless rash) - Sydenham Chorea (flinching movement)

Autism Spectrum Disorder

Disorder of communication and social skills. Signs: Sensitivity to noise/light/touch, poor eye contact, prefers to be alone, repetitive motions/movements (arm flapping), slow developing language/communication - More common in males

3 first line treatment options for Lyme:

Doxycycline Amoxicillin Cefuroxime (2nd generation)

5 year old milestones:

Draws a body with 6 body parts

#1 cause of death in children ages 1-3: _____ Most common type of childhood cancer: ____ Most common type of brain tumor in children: ___

Drowning ALL Medulloblastoma

15 Month Milestones

Eats with a spoon, 4-6 words

ALP levels in children/adolescents:

Elevated (Due to growing bones/osteoblast activity)

Orbital Cellulitis can be a serious complication of rhinosinusitis. Especially linked to the ______ cavities.

Ethimoid Sinuses

Treatment for Absence Seizures

Ethosuximide

Gynocomastia

Excessive breast tissue in males. Round, rubbery, tender under the breast tissue. May be unilateral or bilateral.

Atlantoaxial Instability

Excessive mobility of the C1 and C2 spine, commonly seen with Down's Syndrome. If a child with DS desires to engage in sports, they must have a cervical xray performed beforehand. If this is present, they are prohibited.

Breastfeeding jaundice

Exclusively breastfed neonate. Jaundice appears AFTER the first 24 hours, peaks on days 3. Caused by insufficient intake of breastmilk.

Hirschsprung disease symptoms

Failure to pass meconium within the first 24 hours Abdominal distention Biliary emesis Failure to gain weight Abdominal distention Chronic progressive constipation "Congenital Megacolon"

Pseudogynecomastia

Fatty tissue deposited under the areola; often seen with obese males.

Hand Foot Mouth Disease

Fevers and URI followed by blisters/lesions to hands, feet and rectum. Oral lesions + are painful and cause poor feedings and fussiness. Txn: Self limiting and resolves on its own in 5-7 days

Newborn Reflex: Palmar Grasp:

Finger placed in palm, infant closes hand. - Disappears at 3-4 months

Hydrocele

Fluid in the scrotum. Transillumination + (bright glow) Commonly found in newborns but may need surgical correction at a later time.

Breastmilk Jaundice

Generally occurs a 1-2 weeks. Indirect bilirubin levels elevated. Txn: Temporarily stop BF and then resume in 48 hours.

Galactosemia

Genetic disorder where the child cannot metabolize galactose. These neonates cannot be breastfed.

Febrile seizures have been known to be:

Genetically influenced Occur more commonly when temperatures fluctuate quickly. They typically occur as 1 single seizure. Children who are known to have febrile seizures may be given a benzodiazepine during febrile illnesses.

Newborn Reflex: Anal Wink

Gently stroke anal region - contraction of perianal muscle + - If absence, consider spinal cord lesion

Erythromycin eye ointment is applied at birth to prevent what infection?

Gonococcal Ophthalmia

Gonococcal Ophthalmia:

Gonorrhea eye infection that presents 2-5 days after birth. Signs: Redness, conjunctivitis, discharge, swollen eyelids - Can lead to BLINDNESS

Vaccine Adverse Event Reporting System (VAERS)

Government program to report clinically adverse events of immunizations.

Prohibited from playing sports:

HCM Marfan's Mononucleosis Atlantoaxial Instability MVP

Kawasaki disease (inflammation of the blood vessels) signs:

HIGH fevers (5+ days), lymphadenopathy, bright red rash, strawberry tongue, cracked lips - After rash subsides the skin desquamates - Txn: High dose ASA and IVIG - Follow-Up: Cardiologist for years as effects may present later on in life

Indirect Hernia

Hernia that protrudes into the scrotum

Roseola Infantum

Herpes Virus 6. Causes 3-5 days of HIGH fevers. Following fever, flat maculopapular rash appears on the trunk. Commonly seen in 6 months- 3 years.

Kawasaki Disease treatment:

High dose ASA and IVIG FU with cardiology long term as effects may present later in life

Lead Screening:

High-risk children should be screened at age 1 to 2 years.

Neuroblastoma: ______ Wilm's Tumor: _______

Highly malignant tumor in childhood. Commonly presents as metastatic abdominal mass. Dx: US and Urine Catecholamine ----- Congenital kidney neoplasm (more common in AA girls)

Lymph node pain following alcohol consumption is seen with:

Hodgkin's Lymphoma

Impetigo

Honey colored crusted lesions most commonly caused by staph aureus. Txn: Mupirocin topical

Preseptal Cellulitis:

Infection of the anterior portion of the eyelid. Causing redness, pain, and swelling. Does NOT involve the orbit and therefore should not affect EOM or vision.

Osgood Schlatter Disease

Inflammation of the tibial tuberosity causing "knee pain" swelling and tenderness. Related to overuse. - Commonly seen in adolescent athletes. - Txn: RICE and quadricep strengthening stretches

Phenylketonuria (PKU)

Inherited disorder where the individual cannot metabolize phenylalanine. If left untreated can cause seizures and brain damage. Txn: Phenylalamine Free Diet (no protein - meat, seafood, nuts, dairy, eggs)

Congenital Hypothyroidism symptoms:

Initially asymptomatic (has mother's hormones) followed by: Feeding problems, inactivity, prolonged jaundice, umbilical hernia

Esotropia

Inward turning of the eye(s) "Cross eyed"

BreastMILK jaundice:

Jaundice that begins 4-5 days after birth. Txn: Temporarily stop BF while infant clears out bilirubin and then restart.

JONES and PEACE for Rheumatic Fever (2 of the Jones or 1 Jones and 2 Peace)

Joints (arthritis) O (heart - carditis) Nodules Erythema Marginatum (painless rash) Sydenham Chorea (movement disorder) Previous hx RF ECG with PR prolongation Arthralgias CRP and ESR elevated Elevated temp

Osteochondritis Dessicans (OCD) most common locations:

Knee*, Ankle, Elbow OCD: Small piece of bone/cartilage breaks off due to poor blood supply (often related to trauma). Self resolving in many children/adolescents, however may require casting or surgery.

Signs of Anorexia:

Lanugo, bradycardia, hypotension, dizziness, peripheral edema, low BMI (<18.5), osteoporosis, amenorrhea

Port Wine Stain (Nevus Flammeus)

Large flat macular patch (unilateral) Grows with child and does not regress.

MMR and Varicella:

Live Vaccines - Both are 2 dose series 1 year and 4-6 years

Fragile X Syndrome symptoms (X Chromosome mutation)

Macrocephaly, long face, large protuberant ears, learning disability

Down Syndrome features:

Macroglossia/open mouth Slanting eyes (palpebral fissures) Small hands with Simian Crease Short stature Round face with flat features Intellectual Disabilities Congenital Heart Defects

Cafe Au Lait Spots

Macular light brown spots (If >6 refer to neurologist to rule out NF)

Risks for SIDS:

Male Smoking Low Birth Weight Poverty

Emancipated minors include: (Have full autonomy/ do not require consent)

Married Active Duty Court Approved

Signs of epiglottitis:

Medical Emergency* - Send to ED Tripod sitting, drooling*, muffled voice (hot potato), dyspnea, anxiety, hyperextended neck to facilitate breathing - Most commonly caused by HiB virus (reduced throughout years due to vaccine)

Fetal Alcohol Syndrome features:

Microcephaly Thin upper lip with smooth philtrum Flat nasal bridge Neurocognitive/behavioral issues

Strabismus

Misaligned of the eye (deviation)

Child Abuse facts: REQUIRED to report suspected or confirmed abuse

Most commonly the parent as the offender. Signs: Inconsistent stories with injuries, torso locations (hide well), avulsion fractures, bruises in various degrees of healing, offender never leaving victim side - Individuals who are disabled or cognitively impaired are at higher risk for abuse

Antidote for Acetaminophen poisoning/overdose

N-Actylcysteine

Phenylalamine Diet

NO eggs, meats, seafood, dairy, nuts (protein)

Primary dysmenorrhea (painful menstruation) treatment:

NSAIDs or Naproxen (inhibit the prostaglandins) Menafanic Acid

Coarctation of the Aorta:

Narrowing of a portion of the aorta. Causes decreases blood blow which may present as lethargy, fussiness, irritable, pale, dyspneic Signs: No femoral pulses, SBP >arms (not normal)

Tanner Stage IV (Girls)

Nipple/areola elevated from breast. Secondary mound.

Delayed Puberty in Girls

No breast development by 12 No menarche by 15

Primary Amenorrhea

No menarche by age 15 with normal growth and development. Most likely chromosomal.

Tanner Stage I (Girls)

Prepubertal

Vitamin K at birth:

Prevents bleeding

Direct Hernia

Protrusion through the abdominal wall

Precocious puberty in boys

Puberty before the age of 9

Hemangioma

Raised vascular lesion that is bright red in color. Grows rapidly in the 1st year and then will involute the next 1-5 years

Physiologic gynecomastia

Related to hormonal fluctuations. Often breasts are tender and asymmetrical.

If a child did NOT complete their Hep A or Hep B series, what is the course of action:

Restart from where you left off. Do NOT restart the series.

Prophylaxis treatment for close contacts with Epiglottitis

Rifampin

Medication used in Autism Spectrum Disorder

Risperidone (antipsychotic) Refer to psychologist

Providers do NOT need consent for the following interventions with children/adolescents:

STDs, Pregnancy, Birth Control

Ortolani Maneuver

Screening for Dysplasia of the Hip Abduct the hips and place in frog position. If "click" present or you can feel the trochanter displaced, it is positive and requires referral to ortho.

Barlow Maneuver

Screening for Dysplasia of the Hip: Legs put together with upwards pressure applied. Positive if you hear a "clunk" - refer to ortho

Sturge-Weber syndrome

Skin and meningeal angiomatous lesions. Port-wine nevus with trigeminal nerve involvement. Dx: Opthalmology eval and MRI

Newborn Milestones:

Sleeps 16 hours per day and feeds every 2-3 hours

Milia

Small white (1mm) raised papules commonly seen on the nose of newborns due to retention of sebaceous material.

18 Month Milestones

Walks up steps, 10-20 words, knows 4 body parts

Newborn Reflex: Tonic Neck Reflex (Fencing):

When head is turned, the ipsilateral side will extend arm and leg. Opposite side will flex.

Carotemia

Yellow/orange skin coloring. Sclera remains white. Caused by diet high in Vitamin A (carrots and other yellow vegetables) Infants may present with an orange nose. Vitamin A levels will be normal or slightly elevated, no treatment is required.