Peds Development Chart

2 months milestones

responsive smile, eye contact, voluntary grasp, head turning, posterior fontanel closes

2 months warning signs

poor eye contact, not alert to parents, rolling, asymmetry of movements, stiffens when approached

newborn weight changes

loses about 10% of birth weight in first 3-5 days of life, back to birth weight by 2 weeks

4 months milestones

laughing, cooing (ohh, ahh), grasps object, head control (not head lag), turning head to sounds, newborn reflexes resolve, lifts on chest when prone

6 months milestones

plays peek-a-boo (object permanence), babbling (ba, ma, ga), raking grasp, transferring objects across midline, banging objects, rolling back and forth, birthweight doubles, primary teeth erupt

8 months milestones

sits without support, object permanence is developed

9 months milestones

stranger anxiety, nonspecific mama or dada, pincer grasp, picks up food to eat

9 month warning signs

cannot sit without support

10 month milestone

waves bye-bye, crawling, cruising (standing and walking with support)

12 months milestones

says at least 1 word (ball, dog), standing alone, first steps/walking, birth weight triples, appears potbellied and bowlegged

15 months milestones

makes marks with crayon, stacks 2 blocks, running, squating,

15 month warning signs

no walking

18 months milestones

stacks 3-4 blocks, throws ball overhead, anterior fontanel closes

18 month warning sign

hand dominance before 18 months

2 year/24 months milestones

says 2-word sentences (more please), stranger anxiety resolves, feeds self with spoon and cup, turn pages in book, copies circles and cross, takes off clothes, kicks ball, jumps in place, daytime toilet training usually started, 50% of adult height achieved

2.5 years/ 30 months milestones

quadruple birthweight

3 year/36 months milestones

says 3-word sentences (Charlie bit me), interactive imaginative play, stacks 7-8 blocks, hand dominance, draws person with head and 1 other body part, ride tricycles, jumps forward, primary teeth (20) present, slender physique

4 year milestones

says 4-word sentences, uses scissors, brushed teeth, dresses and undresses with some help, draws person with at least 3 other body parts, skips on 1 foot, alternative feet on stairs

5 year milestones

says 5-word sentience, can count to 10, names 4 or more colors, draws person with at least 6 body parts, able to copy squares and triangles

6 year milestones

starts losing primary teeth

anticipatory guidance

genera safety at home even if it’s not what they are here for

principles of atraumatic care

minimize separation from family, promote sense of control (choices), minimize pain

pediatric assessment considerations

build trust by talking with fam without touching first, start with least invasive (not temp and looking in mouth), offer options not yes or no, look listen then feel

pediatric vital signs and measurements

full min for respirations and apical heart rate first, not worried until above 97% or bellow 3%, BMI not used until over 2 (preemies have 2 years to catch up), measure head for up to 36 months

normal peds vital signs

Temp: 36.5-37

Pulse: 80-150 infant 55-85 12 plus

resp rate: 25-55 infant 12-18 12 plus

BP: 65-100/45-65 infant 110-153/65-85 12 plus

anterior fontanelle closes

12-24 months, 18 is average, shouldn’t be early

posterior closes

2-3 months

head lag stops at 

4 months

normal lymph node size

1 cm or smaller, shouldn’t be firm (cancer)

relation of eyes to ears of infant

ears should be above top of eye line

abnormal respiratory assessment

nasal flaring and shoulder raising with head down is sign of distress, obstruction causes wheezing, fluid causes crackles, infants but not toddlers are belly breathers

cardiac assessment

visual pulsations, thrill or buzzing is not normal, innocent murmurs may be heard laying or upright

tanner stages of puberty

girls start at 8 with breast buds

boys start at 10 with enlargement of scrotum and testes

abnormal male genitourinary findings 

cryptorchidism: undescended testicles

hypospadias: urethral opening is on underside of penis

normal peds urine output

1 ml/kg/hr

peds med administration considerations

always measure in syringe not teaspoon (mg vs ml), never add to formula, give with bite to something sweet or on side of cheek not middle of tongue, vastus lateralis for IM until 2, pinna down under 3 up over 3, suction nose before nasal meds

procedural considerations

what does the kid know/want to know before, don’t lie about pain, be ready before they come to limit time waiting and growing anxiety, approach with confidence, allow to express feelings, praise and reward with seeing parent

IV considerations

check site every hour!, which hand (thumb sucker), don’t use koban which restricts edema

trust vs. mistrust

0-1 year, trust that basic needs (nourishment and affection) will be met

autonomy vs shame/doubt

1-3 years, develop a sense of independence in many tasks

initiative vs guilt

3-6 years, take initiative on some activities, may develop guilt when unsuccessful or boundaries overstepped

industry vs inferiority

7-11 years, develop self-confidence in abilities when competent or sense of inferiority when not

identity vs confusion

12-18 years, experiment with and develop identify and roles

sensorimotor

0-2 years, coordination of senses with motor responses, sensory curiosity about the world, language used for demands and cataloguing, object permanence at 4-8 months (stranger danger and miss mom because she exists even though I can’t see her

preoperational

2-7 years, symbolic thinking, use of proper syntax and grammar to express concepts, imagination and intuition are strong but complex abstract thoughts are still difficult, conservation is developed

concrete operational

7-11 years, concepts attached to concrete situation, time space and quantity are understood and can be applied but not as independent concepts

formal operational

11 and up, theoretica, hypothetical, and counterfactual thinking with abstract logic and reasoning, strategy and planning become possible, concepts learned in one context can be applied to others

three temperaments (behavioral tendencies)

easy, difficult, slow to warm up

degree of fit is how well temperaments of baby and caregivers

positional plagiocephaly

flat spot on one side of head or back of head

forehead protruding, ears not in line with each other

torticollis

twisted neck, stiff neck that is congenital or acquired from plagiocephaly and can cause future issues, physical therapy and treat underlying cause

amblyopia

anisometropia (refractive errors) or strabismus (lazy eye) that can cause irreversible vision loss or blindness, needs treatment if present after 2 months old or doesn’t go away after 2 months, patch covering strong eye

infant calorie requirements

120 kcal/kg/day

infant nutrition

vit D supplementation for all babies, iron supp for breastfeed after 4 months, nothing else for first 4 months, introduce open cup and utensils by 9 months, breastmilk or formula is only drink for first year

time for toilet training

when kid is ready. may be around 24-30 months, resistance and regression is common and ok

live vaccines

MMR, varicella, flumist, not given to severely immunocompromised and pregnant

hepatitis B

viral liver infection transmitted through blood, mucus membranes, and semen that is vaccine preventable (at birth)

rotavirus

common viral gastrointestinal infection, transmission through fecal-oral, most common symptom is diarrhea

diphtheria

bacterial infection of nose and throat that causes swelling of neck, gray mucus in back of throat, and skin sores; droplet transmission

tetanus

bacterial infection causes painful muscle (neck) contractions that affect breathing

pertussis

“whooping cough”, bacterial infection with coughing fits causing inspiratory “whoop” that can lead to vomiting, antibiotic prophylaxis

haemophilus influenzae type B (hib) and pneumococcal

bacterial infection affecting kids under 5, droplet transmission, antibiotic prophylaxis

polio

viral infection causing flu-like symptoms, paralysis, and death; fecal-oral contact route; eradicated in US

measles

highly virulent viral disease that can lead to encephalitis and deafness, negative pressure isolation, causes rash that starts on face and Koplik spots and sensitivity to light

mumps

viral infection via droplet transmission, long incubation, causes swollen parotid gland and flu-like symptoms

rubella

viral infection with rash beginning on face and flu-like symptoms, causes miscarriage and birth defection

varicella

highly virulent viral infection with pruritic rash with red base before crusting over (in various stages of healing at one time)

Hep A

viral infection causing mild to severe liver inflammation through contaminated food or water (fecal-oral)

HPV

viral infection causing warts and some cancer, transmitted through skin to skin or mucosa, vaccine is given at age 10

meningococcal

bacterial infection that causes stiff neck, fever, non-blanching red or purple or brown rash; antibiotic prophylaxis

scarlet fever

symptoms: “sandpaper-like”/ “strawberry tongue”, tonsillitis, and fever; tested with strep test

acute glomerulonephritis

most common cause of kidney disease (from group A strep infection), S: dark urine, edema, fatigue, hypertension

rheumatic fever

inflammatory disease if strep is not treated that affects heart (lifelong), blood vessels, and joints (nodules)

mononucleosis

viral illness cause by Epstein-Barr virus, S: fever, swollen and red/white tonsils, splenomegaly, malaise, and elevated WBC, no vaccine

fifth disease 

viral infection causing slapped cheek and flu symptoms, severe risk of anemia to fetus and miscarriage during trimester, no vaccine

HIV

no vaccine, leads to AIDS, flue symptoms, strict ART management not cure

what illnesses are treated with antibiotic prophylaxis?

pertussis Hib meningococcal