Nemours Collegeville- Peds Rotation

What are key developmental milestones at 1 month?

Lifts head prone, Moro reflex, turns head side to side. tracks to midline, smiles reflexively, fontanelles open and soft, +red reflex, +femoral pulse

What education is given at 1 month?

Diet, behavior (sneezing, hiccups, straining), safe handling, falling

Guidance: spoiling, sibling rivalry, diaper rash, pacifier

Sleep: location, sleeping position

What are key developmental milestones at 2 months?

Head to 45°, follows past midline, vocalizes/coos, alerts to sound, smiles responsively, kicks, fontanelles open and soft, +red reflex, sleeps 15–16 hrs/day, closure of posterior fontanel

What vaccines are given at 2 months?

DTaP, IPV, Hib, Hep B, Prevnar, Rota

What education is given at 2 months?

Diet, Behavior: crying, thumb sucking, do not leave unattended

What are milestones at 6 months?

primitive reflexes disappear except Babinski, head leads when pulled, rolls front to back, voluntary grasp, rakes objects, chewing, mouthing, tripod sit, bears weight on legs, anticipates food

What vaccines are given at 6 months?

DTaP, IPV, Hib, Hep B, PCV, Rota

What anticipatory guidance is given at 6 months?

Stranger anxiety starts

What are developmental milestones at 9 months?

Sits without support, begins creeping/crawling, feeds self-cracker, looks for dropped toy, transfers objects from one hand to another, pulls to stand, waves bye, fontanelles open, # of teeth

What screenings or vaccines are given at 9 months?

Lead screening?, Hep B?, Hgb

What anticipatory guidance is given at 9 months?

Diet: junior foods, finger foods, start cup, may start whole milk

Accident: no nuts, popcorn, hard candy, fall from stairs, hot water <120, # for poison control

Guidance: expect decrease in appetite, no spanking

What are milestones at 12 months?

pulls to stand, neat pincer grasp, stands holding on, claps or pat-a-cake, hold cup to drink, walks ± help, mama/dada nonspecific fontanelles opnen, #teeth, Babinski disappears when walking

What vaccines are given at 12 months?

Varivax, MMR, Hep A, PPD?

What guidance is provided at 12 months?

Diet: mash able food, whole milk, start cup,

Behavior: more mobile, minor discipline

Guidance: allow to feed self, looks in mirror, plays with book, falls easily when learning to walk

What are milestones at 15 months?

stands alone, plays pat-a-cake, stacks 2 blocks, takes lid off containers, follows simple commands, says mama/dada, additional words, fontanelles open, # of teeth

What vaccines are given at 15 months?

DTaP, Hib, PCV

What education is given at 15 months?

Diet: table food, whole milk (16-32 oz/day), vitamins

Behavior: feeds self, hugs, scribbles, simple games

Accident: hot water <120, cover outlets, burn prevention, teach hot and cold

Guidance: anticipate temper tamptrums, irritative behavior, wean bottle, don’t start toilet training, read and talk to child

What are developmental milestones at 18 months?

Walks well, climbs, drinks from cup well, stacks 3 cubes, says dad/mom specific, indicates wants by pointing and pulling rather than crying, follows 1-2 step commands, additional words?

What vaccines or labs are given at 18 months?

Hep A

What education is provided at 18 months?

Diet: 3 meals/day with snacks, limit juices

Behavior: likes water play

Accident: fall after climbing, runs into street, cover outlets, water temp <120

Guidance: accept negativism, likes to play with ball, to be chased, and to be read to, toilet train when ready

What are developmental milestones at 2 years?

2–3 word phrases, runs well, walks up and down stairs, handles spoon well, stacks 6 blocks, plays hide & seek

What labs or vaccines are given at 2 years?

Catch up if behind, Hep A

What education is given at 2 years?

Diet: 3 meals/day with snacks

Behavior: runs well but falls, loves romping, rough and tumble play

Accident: street dangers, cards, knives, fall

Guidance: accept negativism (use stop), start toilet training, parallel peer play

Dental care

What are developmental milestones at 3 years?

goes up stairs alternating feet, knows age and sex, makes tower of 9 cubes, balances on one foot, helps in dressing and washes hands, pedals tricycle, creative thinking, mostly intelligible speech to stranger, uses I, check vision

What education is given at 3 years?

Diet: 3 meals/day with snacks, iron-rich foods, multi-vit

Behavior: peer relationships start

Prevention: knives, guns, caution with strangers, fluoride supplements to 0.5mg

Guidance: make dental appt, play groups, brief speech dysfluency can be expected

What are key milestones at 4 years?

Hops on 1 foot, throws ball, plays with others, counts 4 objects, recognizes few colors, draws circle, speech intelligible, questioning, check vision/hearing

What immunizations are given at 4 years?

DTaP, IPV, MMR, Varivax

What education is provided at 4 years?

Diet: 3 meals/snacks, offer healthy foods, multi-vit

Behavior: irritates adults, magical thinking

Prevention: safety belts, window guards, water safety

Brush teeth, regular dentist visits avoid secondary smoke

Guidance: monitor TV programs, learning to dress/undress

What are developmental milestones at 5 years?

skips, dresses/undresses, copies square, knows age/colors, counts to 10, speech clear, start kindergarten

What vaccines are given at 5 years?

MMR

What education is given at 5 years?

Diet: 3 meals/snacks, variety of healthy foods

Prevention: bicycle safety/helmets, seat belts, brush teeth daily, learn to swim, regular dental visits

Guidance: encourage peer interaction, enjoys games, proper discipline

What milestones are seen at 6 years?

Exercise, sports, enuresis, school grade/performance, peer/family relationships

What education is given at 6 years?

Diet/exercise: limit salt+fat, give fruit + snacks not chips, regular physical activity

Prevention: seat belts, helmets, swim lessons, smoke detectors

Dental: regular brush and dental visits

Other: sunscreen, passive smoke, fluoride supplements, changes expected with onset of puberty

What immunizations/labs are given at 11 years?

Tdap, Meningococcal, HPV, Lipid panel