The University of Arizona Health Sciences

Knowledge

Throughout his/her learning, the student should acquire and use knowledge of the mechanisms and developmental variations in normal values, disease manifestations. By the end of the clerkship, the student should, at a minimum, be able to:

I. Growth

  • Demonstrate ability to plot accurately height, weight, and head circumference measurements in a growth chart.
  • Discuss the significance of growth percentiles, with particular attention to an appreciation of why growth is a good index of health.
  • Discuss the adverse effects on growth in intrauterine factors, malnutrition, maternal deprivation and social/cultural factors.

II. Development

  • Describe the developmental changes that occur as the preterm baby matures.
  • Identify and discuss major developmental milestones and developmental assessment using the Denver II Test.
  • Discuss at least one developmental disorder.
  • Discuss the concept of cognitive and emotional maturation.

III. Health Maintenance

  • Discuss the importance of "health maintenance" or well-child visits.
  • State the recommended schedule for well-child visits for ages birth to 18 years, and list ideas for anticipatory guidance for each age.
  • List the routine schedule of childhood immunizations and which vaccines are given, their common side effects and contraindications to their administration.
  • List when lead levels, blood pressure checks, vision testing and hematocrits are recommended.

IV. Nutrition

  • Describe the importance and benefits of breast feeding.
  • Counsel and provide emotional support a breastfeeding mother.
  • Describe what constitutes a normal diet at different age groups and list the caloric requirements for growth at different ages.
  • Describe common nutritional disorders in the US including iron deficiency anemia and obesity.
  • State common food formulas for infants and their use and limitations.
  • Describe the causes of failure to thrive.

V. Fluids and Electrolytes

  • Recognize and clinically evaluate dehydration.
  • Write maintenance fluid orders for any pediatric patient with normal renal function.
  • Write fluid orders (both intravenous and oral) for uncomplicated gastroenteritis.
  • Describe basic physiologic principles and apply them in the management of acute dehydration and acute metabolic acidosis.

VI. Common Pediatric Illnesses

The following list identifies the problems that commonly prompt patients to seek medical care (i.e. presenting complaints or symptom complexes).  Each complaint, diagnosis, physical finding/ laboratory test result (problem) is accompanied by a list of the most common related diagnoses as well as a list of less common but significant other diagnoses that may need to be considered.  Although more rare conditions may occasionally need to be considered, they are not included in this core list.

Common Complaint / Dx >

Common Related Diagnoses

Significant Other Dx to Consider

Cough

pneumonia

croup

bronchiolitis

bronchitis

asthma

sinusitis

cystic fibrosis

pertussis

tuberculosis

foreign body aspiration

GE reflux

Chlamydia pneumonitis

Fever

occult bacteremia

UTI, pyelonephritis

viral exanthems

varicella

measles

fifth disease

roseola

scarlet fever

osteomyelitis

meningitis

febrile convulsions

septic arthritis

Kawasaki's disease

JRA

viral exanthem - rubella

tuberculosis

Sore throat

pharyngitis, strep

scarlet fever

pharyngitis, other

mononucleosis

rheumatic fever

cervical adenitis

pharyngeal and retropharyngeal abscesses

recurrent tonsillitis

Otitis

middle ear effusion

recurrent otitis media

otitis media

otitis externa

deafness

speech and language delay

mastoiditis

URI

conjunctivitis

allergic rhinitis

sinusitis

periorbital/orbital cellulitis

Abdominal pain

appendicits

UTI/pyelonephritis

gastroenteritis

constipation

PID

gastritis

colic

intussusception

vasculitis, e.g. HS purpura

pregnancy

encopresis

inflammatory bowel disease

ulcer

hepatitis

ovarian/testicular torsion

psychogenic abdominal pain

abdominal mass/malignancy

Wilm's tumor

neuroblastoma

lymphoma

hydronephrosis

incarcerated hernia

Vomiting

GE reflux

pyloric stenosis

gastroenteritis

2nd to infections -

strep pharyngitis

otitis

volvulus/bowel obstruction

diabetic ketoacidosis

increase intracranial pressure

hepatitis

pyelonephritis

pregnancy

Diarrhea +/- vomiting

gastroenteritis

viral

bacterial

Giardia

failure to thrive

hemolytic uremic syndrome

dehydration

Skin problems

acute urticaria

atopic dermatitis

contact dermatitis

Monilial skin infections

scabies

impetigo/cellilitis

tinea infections

anaphylaxis

drug reaction rash

Stevens Johnson syndrome

seborrheic dermatitis

Skin wounds

cellulitis

animal wounds

trauma

burns

child abuse

tetanus

rabies

Lower extremity problems

ankle injury

knee injury

congenital hip dislocation

non-accidental trauma

Osgood-Schlatter disease

Legg-Calvé-Perthes disease

slipped femoral capital epiphysis

Limp/limb pain

tendonitis

toxic synovitis

infectious -

septic arthritis

osteomyelitis

cellulitis

Nurse's maid elbow

arthritis (JRA)

sickle cell crisis

rheumatic fever

leukemia/tumors

CNS problems

headaches

migraine

tension

seizure disorders

febrile convulsions

increased intracranial pressure

 

VII. Physical Findings/Laboratory Findings

The following section deals with the more common physical findings that merit further exploration. Sometimes the effort is to determine if a normal variant or minor vs. significant disease is occurring.  The list is not exhaustive, but the primary emphasis is on diagnoses unique to pediatrics.

Common Complaint / Dx

Common Related Diagnoses

Significant Other Dx to Consider

Heart murmur

innocent murmurs

cardia septal defects

acute rheumatic fever

coarctation of the aorta

valvular stenosis

Lymphademopathy

infectious mononeucleosis

bacterial adenitis

viral infections

Kawasaki's disease

lymphoma/leukemia

HIV/AIDS

cat scratch disease

mycobacterial infections

Splenomegaly

systemic infectious disease

mononeucleosis

tumors

hemolytic anemias

sickle cell disease

Hepatomegaly

hepatitis

congestive heart failure

cirrhosis

Impaired vision

strabismus/amblyopia

myopia/hyperopia

leucocoria

retinoblastoma

cataracts

Pallor/anemia

iron deficiency anemia

lead poisoning

hemolytic anemia - hereditary acquired

malignancy

sickle cell disease

occult blood loss

Bruising/petechiae

trauma

vasculitis

hemophilia/Von Willebrand's

HS purpura

leukemia

secondary to infection

Hematuria

trauma

UTI

acute glomerulonephritis

   post streptococcal

hemolytic uremic syndrome

HS purpura

lupus

Proteinuria

orthostatic proteinuria

nephrotic syndrome

glomerulonephritis

lupus

 

VIII. Other Pediatric Problems

  • Describe the indications for prophylaxis for bacterial endocarditis.
  • Describe the presentation and principles of treatment of diabetes mellitus.
  • Describe the content of the newborn disease screen and interpret screening results for hypothyroidism.
  • Develop an organized approach to the dysmorphic child.
  • Evaluate the child with hypertension.
  • Describe disorders of altered tone and reflexes and recognize upper versus lower motor neuron disorders.
  • Evaluate the child with recurrent infections.
  • Recognize the different forms of shock and describe the principles of management.
  • Recognize and evaluate respiratory failure in children.
  • Describe normal growth patterns and recognize deviations from these patterns.

IX. Unique Issues of the Newborn

  • Assign APGAR scores.
  • Recognize and assess respiratory distress in the newborn.
  • Recognize and assess cyanosis in the newborn.
  • Recognize and assess pallor in the newborn.
  • Recognize the features of congenital infections.
  • Recognize and assess shock in the newborn.

X. Unique Issues of Adolescents

  • Assess physical growth and development.
  • Describe different stages of acne and approaches to its treatment.
  • Screen adolescents for the presence of scoliosis.
  • Give anticipatory guidance regarding adolescent pregnancy and its effects, birth control, sexually transmitted diseases, drugs, alcohol, accident prevention and firearms.

XI. Behavioral Problems

  • Interact with patients referred for behavioral/emotional problems including obtaining a non-judgmental history and beginning to develop a plan for further evaluation and treatment.
  • Describe developmental patterns of child behavior, including colic, sleep patterns, stranger anxiety, toilet mastery.
  • Describe the impact on the family when the child has an acute, chronic or potentially fatal illness.
  • Evaluate the child's social competence in the family, in school, and with peers.
  • Observe and record parent-infant and parent-child interactions

XII. Poisoning

  • Describe the extent and prevention of accidental poisoning in children less than 5 years of age.
  • Describe the importance of anticipatory guidance in prevention.
  • Obtain accurate history of poisonings while maintaining a non-judgmental approach.
  • Identify common types of poisonings at various ages.
  • Describe the general principles of management of ingested poisons.
  • State the etiology, identification and management of the child with lead poisoning.

XIII. Accidents and Injuries

  • State the extent to which accidents are responsible for more than one half of all childhood deaths.
  • Describe the role and value of anticipatory guidance in prevention of the majority of diseases.
  • State age-specific measures for accident prevention.

XIV. Pediatric Therapeutics

  • Discuss dosing of medications in children based on differences in patient size and drug absorption, distribution, metabolism and excretion.
  • Discuss why retin-A, tetracycline, the quinolones and chloramphenicol are not used in certain pediatric patients.
  • Describe practical considerations related to drug administration and compliance in pediatrics.

XV. Child Abuse

  • List risk factors in the family and child that puts a child at risk for abuse (non-accidental injury).
  • Identify specific injuries or patterns of injury that should alert the physician to the possibility of child and/or sexual abuse.
  • List the components of the work-up and immediate management of a child suspected of being abused.