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Drugs taken during pregnancy – steroids (can cause cleft Others: Breech, Shoulder, Footling, Double-footling, Back
palate), Dilantin (cleft lip and palate), valproic acid (spina Duration of labor – Primigravid: 10-12 hours, Multigravid: 4-
bifida), Thalidomide (Phocomelia – having short limbs; 6 hours.
Amelia – absence of limbs) Oligo/Polyhydramnios
Exposure to X-ray, injurious smoking, and alcoholism – NEONATAL HISTORY (>24 hours to 28 days)
smoking (IUGR, SGA, post-mature, misscarriage), Length of stay in NICU – at least 48 hours. If 3-5 day stay,
alcoholism (fetal alcohol syndrome – microcephaly, can think of CS delivery. If 1 month stay, think of congenital
precipitate abortion) problems, or problems during pregnancy/labor
Infection – in first 2 months sepsis – give antibiotics until
Term of pregnancy – culture is negative
Preterm: <37 weeks Jaundice – Physiologic: after 24 hours until 5-7 days. If
Full-Term: 37-42 weeks within first 24 hours, think of HUS most common cause of
Post-term: >42 weeks hemolytic disease of the newborn treatment is
phototherapy, using bililite. Bililite is also used for
NATAL/BIRTH HISTORY hyperbilirubinemia, regardless of age group. If the jaundice
- covers the FIRST 24 HOURS OF LIFE appears in the later weeks of life neonatal hepatitis,
- after 24 hours neonatal history extrahepatic biliary atresia, breastfeeding jaundice, sepsis
Bleeding problems – earliest clue bleeding or hematoma
Spontaneous Breathing – how long? Was resuscitation from the site of injection of vitamin K. Acquired prothrombin
done? complex deficiency failure to receive vitamin K at birth, and
Reasons for delayed/non-spontaneous breathing: are common for patients who are purely breastfed
Asphyxiated baby, Airway obstruction, Meconium aspiration, complications: hematoma and intracranial bleed.
CNS problem, Mother was given excess anesthesia Respiratory problem – Pneumonia – most common
- if delayed breathing hypoxemia hypoxia NEC problem. Hyaline membrane disease – lasts 28 days of life,
most common in premature babies. Common cold: 8-10x a
APGAR score year among the young, 3-5x a year among adults, 2-4 days
- to know if there is a need to resuscitate in duration.
- the most important is HEART RATE/PULSE
- Interpretation: NUTRITIONAL/FEEDING RECORDS
<3 – needs resuscitation Type of feeding
4-6 – asphyxiated, observe Natural Breast feeding
>7 – good Artificial feeding – any other forms of feeding aside from
breast feeding, including from a dropper, a bottle, through
Birthweight spoon, OGT, etc.
- Average birthweight of Filipinos: 3500 g Mixed feeding – combination of the two
Cord Coil and Meconium Staining
- Baby is under distress and suffered asphyxia If the patient is bottle-fed - ask what type of milk is being
Cord coil: Umbilical cord coiled around the neck or abdomen used, how is it being prepared. If breast feeding, ask the
asphyxia brain damage mental retardation mother how she prepares her breast before feeding (cleaning
Meconium staining of amniotic fluid fetal distress, the area of the areola with ordinary bath soap and warm
especially if thickly stained (mild only if lightly stained) water)
DON’TS putting moisturizers in the breast – the patient will
Appearance of the Umbilical Cord and Placenta be able to swallow it; also, don’t ALWAYS use soap and
- first, describe the SHAPE of the umbilical cord - water to clean the breast soap has drying effect: at the first
cylindrical/rope-like. Gros appearance: gray/grayish-white, cleaning, use soap and water. In the next breast feeding, just
soft and glistening. Cut section: 2 arteries, 1 vein arteries use water. NEVER use alcohol drying effect, and can
have thicker wall, narrow lumen, not collapsed . veins have a cause cracking of the nipple
thinner wall, larger lumen, collapsed. FORGET THE COLOR.
- 1 artery, 1 vein single umbilical artery syndrome Bottle-feeding: example, the patient is 1-month old. What is
associated with congenital malformation, affecting the the frequency of feeding of a 1-month old? Ideally, the baby
kidneys tell the parents to check for the urine output of the needs to feed 12 times, so you need more than 12 bottles of
patient, and do routine urinalysis, before sending the patient milk. How long will you submerge the bottles in boiling water?
home. 15-20 minutes. Never boil rubber nipples/pacifiers – just soak
it in warm water. If you boil it, it becomes jelly.
Manner of delivery – is it induced? facilitated delivery
(use of drugs). NSD normal spontaneous delivery. CS – Introduction of solids – PREFERRABLY 6 months, but you
Cesarean Section. can start as early as 4 months. (Answer 6 months if asked in
Presentation – Most common: Cephalic/Facial/Chin/Brow the exam!). Disadvantage of patients given solid foods earlier
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than 6 months if they become adults, they become picky type of house do they live in (maybe they live in a one-room
eaters, obesity, early manifestations of hypersensitivity house)
reaction. Tell the mother to watch out for these if she plans
to start early solid food feeding. FAMILY HISTORY – exactly the same as the adult, except
the history of the caregiver, or anybody directly involved in
Adequacy of food/milk intake – Short term assessment: taking care of the patient grandparents, aunts, yayas.
The baby sleeps after feeding, gets quiet after feeding, plays,
and smiles. Long term assessment: Weight-gain SYSTEMS REVIEW – just like in adult history
Expected Weight Gain
600g for the first 6 months (20g expected wt gain x 30days) REGIONAL EXAMINATION
2kg per year for the first 5 years of life Inspection, Palpation, Percussion, Auscultation – follow
8kg – expected minimum weight of a 1 year old child this sequence as long as the patient is very cooperative. If
Formula: not, then there can be variation of this sequence.
Age in mo x 600/mo + BW (3000g) – 1st 6 months – 20 g/day Example: 2 year old patient as he entered the OPD started
Age in mo x 500/mo + BW (3000g) – next 6 months – 15g/day to cry. He was kicking and struggling. How will you do your
Age in years x 2 + 8 if older than 1 year old PE? You can still proceed with the PE. You don’t need the
patient to be quiet for inspection. Proceed to palpation – the
PAST MEDICAL HISTORY (same as adult history) head, neck, extremities, axilla, inguinal area, except the
Details of prior illness or hospitalization abdomen, which is affected by crying (increased
Surgery intraabdominal pressure may give false positive results). You
Allergy can also proceed with percussion you don’t need the
Accidents – appropriate to the age group. patient to be quiet to elicit dullness, resonance, etc. You can
Certain accidents are age-appropriate. Example: 1 year old isolate the sound from crying and the sound you want to hear
who fell from the stairs, and a 10 month old swallowing a from the PE. Auscultation will be difficult. But, with repeated
foreign body. auscultation to patients, both noisy and quiet ones, you will
Adolescents – ask about sexual habits, contraceptives, be able to differentiate the sounds from the cry from the
teenage pregnancies and venereal diseases. Act and speak breath and heart sounds. If the patient is struggling and
with authority, especially when talking about these things. (If crying, the best PE you can do is the examination of the
not, the adolescent will think twice about telling you these ORAL CAVITY – it’s already open, you don’t need to use a
things, because it’s as if you know nothing of what they’re tongue depressor. You can also start PE of the EAR and
talking about. Others will try to test you). Don’t put malice. other ORIFICES of the body, except the anus – the patient
will cry anyway once you start your exam, so just do it.
IMMUNIZATION
Know the vaccines that should have been given, and what Do NOT stop the patient from crying (the more he will cry),
vaccines should still be received by the patient because eventually, he will get TIRED. You can then
examine the abdomen.
DEVELOPMENTAL MILESTONES
Most awaited milestone: SMILING. If your patient is adolescent, HEADS FFIRST
Emphasize on the more important milestones: Home life – space privacy, neighborhood
Social Smile – 2 months Education – school transfer, grades after school activities
Vocalization – 2-4 months Abuse – physical, sexual, verbal, emotional
Standing – 10 months Drugs – includes tobacco and alcohol, age of initiation,
Walking – 15 months frequency, done alone or in a group
Toilet training – 18 months, completed at 3 years Safety – sports and motor vehicle safety measures,
Supine to prone – 7 months hazardous activities, sexuality/sexuality identity, reproductive
health issues
SOCIAL AND PERSONAL HISTORY
Check on the personality characteristics, personal habits, Family – family genogram, structure, history of
sleep pattern, feeding pattern, toileting, games and play, addiction/alcohol/drug abuse, parenting concerns
living conditions, sources of financial and psychological Friends – peer group, gang, cult
support, school history. In the younger and toddler age Image – body perceptions, appearance, fashion trends
group, focus on the feeding history – what does the patient Recreation – sports, recreational activities, how often, social
like to eat? networking
Example: The mother is complaining that the patient does not Spirituality and connectedness – faith beliefs, importance
want to eat vegetables ask if the people in the household and influence of faith community support
are eating vegetables too. What type of vegetables are being Threats and Violence – self harm or harm to others, running
prepared? How do you cook the vegetables? away, cruelty to animals, fights, arrests, stealing
Example: The mother is complaining that the sleeping time
of the patient is at 1 am ask where do they live, and what
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