9/26 Pediatric Growth, Development, and Health Nursing Review

Flashcards covering pediatric physical growth, vision, hearing, fine/gross motor development, psychosocial/cognitive milestones, anticipatory guidance, minor consent, screening tools, contraception, and STIs.

Infant Physical Growth Rate

Most rapid in the 1st year of life.

Posterior Fontanel Fusion Age

$$6\text{--}8\text{ weeks}$$

Infant Weight Doubling Age

$6\text{ months}$ (average birth weight doubles).

Infant Length Increase (First 6 Months)

Increases by $1\text{ inch/month}$ in the 1st 6 months.

Infant Weight Tripling Age

$12\text{ months}$ (average birth weight triples).

Infant Length Increase (6–12 Months)

Increases by $0.5\text{ inches/month}$ from 6 to 12 months.

Infant Head and Brain Growth at 12 Months

Head size increases by $33\%$ and weight of brain increases $2.5\times$.

Anterior Fontanel Closure Age

$$12\text{--}18\text{ months}$$

Infant Visual Acuity at Birth

Blink reflexes (doll eyes) present; fixates on objects $8\text{--}10\text{ inches}$ away.

Infant Visual Acuity at 1 Month

Can follow in range of $90^\circ$ (not past midline); watches parent as they speak; tear glands function.

Infant Visual Capabilities at 1.5–3 Months

Peripheral vision $180^\circ$; doll's eyes reflex begins to disappear; binocular vision begins to develop at $6\text{ weeks}$ and starts to focus on smaller objects.

Binocular Vision Onset

Begins to develop at $6\text{ weeks}$ in infants.

Infant Visual Capability at 3 Months

Focuses on a visual object and reaches toward it; can follow past midline.

Infant Visual Capability at 3–5 Months

Recognizes a feeding bottle; looks at hand while sitting or lying on back.

Infant Visual Capability at 5–7 Months

Adjusts posture to see an object; retrieves a dropped toy; hand-eye coordination starts to develop.

Infant Hearing Response at Birth–1 Month

Startled reflex (responds to loud noises).

Infant Hearing Response at 2–3 Months

Turns head to side for sound at ear level.

Infant Hearing Response at 3–4 Months

Locates sound by turning head side and looking in direction.

Infant Hearing Response at 4–6 Months

Locates sound by turning head to look.

Infant Hearing Response at 6–8 Months

Turns head in a curving arc and responds to name.

Infant Hearing Response at 9–13 Months

Learns to control and adjust responses to sounds.

Palmar Grasp Reflex Timeline

Occurs as a reflex in the 1st $2\text{--}3\text{ months}$ and becomes voluntary.

Fine Motor Skill at 3–4 Months

Will hold objects placed in hands.

Fine Motor Skill at 5 Months

Grasp is now voluntary.

Fine Motor Skill at 6 Months

Can grasp feet.

Fine Motor Skill at 7 Months

Can transfer objects from one hand to another.

Pincer Grasp Onset and Full Development

Starts to use pincer grasp at $8\text{--}9\text{ months}$; typically developed by $11\text{ months}$.

Fine Motor Skill at 10 Months

Can intentionally throw or let go of an object.

Fine Motor Skill at 11–12 Months

Can manipulate objects.

Head Control Pulled to Sit (1 Month)

Complete head lag.

Head Control Pulled to Sit (2 Months)

Partial head lag.

Head Control Pulled to Sit (4 Months)

Almost no head lag.

Head Control Prone (1 Month)

Momentarily lifts head.

Head Control Prone (4 Months)

Lifts head & chest $90^\circ$ & bears weight on forearms.

Head Control Prone (6 Months)

Lifts head, chest, upper abdomen & can bear weight on hands.

Sitting Development at 1 Month

Back rounded, no ability to sit upright.

Sitting Development at 2 Months

Can try to pull up with some head control.

Sitting Development at 4 Months

Only lumbar is rounded; able to sit erect with good head control.

Sitting Development at 7 Months

Can sit alone, leaning on hands for support.

Sitting Development at 8 Months

Sits without support.

Locomotion Milestone at 7 Months

Bears full weight on feet.

Locomotion Milestone at 9 Months

Stands holding onto furniture; crawls with abdomen on floor & pulls self forward, creeps on hands & knees.

Locomotion Milestone at 10 Months

Takes deliberate steps while standing.

Breast Milk Characteristics (0–4 Months)

Easily digestible micronutrients, low fat content, contains immune globulins.

Breastfeeding Contraindication

Contraindicated for mothers who are HIV+.

Vitamin D Supplementation in Breastfed Infants

Exclusive breastfed infants should receive $400\,\text{IU}$ Vitamin D daily (QD).

Solid Food Introduction (4–6 Months)

Introduced for taste & experience of chewing; introduced every $5\text{--}7\text{ days}$.

Honey Restriction in Infants

No honey for $< 1\text{ year}$ due to the risk of infant botulism.

Extrusion Reflex Timeline

Present at $4\text{--}6\text{ months}$; reflex is gone by $6\text{--}12\text{ months}$.

Fluid Requirements for First 4–6 Months

Infants do not require additional fluids for the first $4\text{--}6\text{ months}$.

Fluoridated Water Recommendation (< 6 Months)

Fluoridated water is not recommended for infants $< 6\text{ months}$.

Primary Nutrition Source (6–12 Months)

Breastmilk or iron-fortified formula.

Whole Cow's Milk Recommendation

Whole milk is not recommended for infants $< 12\text{ months}$.

Toddler Weight Gain Rate

Weight gain slows to $4\text{--}6\,\text{lbs/year}$.

Birth Weight Quadrupling Age

Birth weight should be $4\times$ by $2.5\text{ years}$.

Toddler Height Growth Rate

Height increases by approximately $3\text{ inches/year}$.

Toddler Growth Pattern

Growth is steplike rather than linear.

Acceptable Vision Acuity (Up to Age 3)

$$20/40\text{--}50$$

Amblyopia

Leading cause of vision loss among children where eyes & brain are not working together (1 eye normal, 1 blurry).

Permanent Vision Loss Risk Age in Amblyopia

By $7\text{ years old}$, amblyopia vision loss may be permanent.

Amblyopia Treatment Methods

Consistent glasses/contacts, forcing child to use weak eye via patch or blurring drops.

Toilet Training Sphincter Control Onset

$$18\text{--}24\text{ months}$$

Toilet Training Readiness Indicators

Sphincter control at $18\text{--}24\text{ months}$, staying dry for $2\text{ hours}$, fine motor skills to remove clothing, willingness to please parents, curiosity about habits, impatience with wet/soiled diapers.

Toddler Growth & Development Characteristic

Intense period of exploration where clear guiding (limit setting) from adults assists toddler.

Preschool Growth & Development Characteristic

Refining tasks mastered in toddlerhood.

Gross Motor Skills at 12–13 Months

Walks alone.

Gross Motor Skills at 18 Months

Runs but falls easily.

Gross Motor Skills at 2 Years Old

Walks up & down stairs.

Gross Motor Skills at Age 3

Walking, running, climbing, jumping.

Gross Motor Skills at Age 4

Skips & hops on $1\text{ foot}$, catches ball.

Gross Motor Skills at Age 5

Skips on alternate feet, jump rope, learns to skate & swim.

Fine Motor Skill at 18 Months

Throws ball.

Fine Motor Drawing Skill at Age 3

Draws a circle.

Fine Motor Drawing Skill at Age 4

Draws a person with $3+$ body parts.

Fine Motor Writing Skill at Age 5

Can write some letters in name.

Toddler Play Type

Parallel play, imitation, locomotive skills, tactile play.

Preschool Play Type

Associative play, imitation, imaginary playmates, mutual play with parents.

Tantrum Characteristics

Kicking, screaming, breath holding; increases when child is ill, hungry, frustrated, tired; usually lasts $5\text{ minutes}$ or less.

Effective Management of Tantrums

Consistency, stay calm, ensure safety, ensure naps & meals, positive reinforcement.

Negativism Management in Toddlers

Offer $2$ appropriate choices, reduce opportunity for child to say no, stay in routine, remain calm and reassuring.

Preschool Sleep Requirement

Average $12\text{ hours/night}$.

Toddler Injury Prevention Priorities

Creating safe exploration environment; car seat safety ($5\text{-point}$ harness, booster seats in rear seat); prevention of drowning, burns, poisoning, falls, aspiration, suffocation, bodily harm.

Preschooler Injury Prevention Focus Shift

Shifts from protection to education (poisoning, pedestrian MVC, seat belts, bicycle helmets).

School-Age Period Boundaries

Begins with shedding of 1st deciduous teeth and ends at puberty with acquisition of final permanent teeth.

School-Age Physical Growth Rates

Height increases by $2\text{ inches/year}$; weight increases by $2\text{--}3\text{ kg/year}$.

School-Age Lung Development

Lungs fully develop by age $8\text{--}10$.

School-Age Heart Size

Heart is smaller in relation to the rest of the body.

Prepubescence

$2\text{-year}$ period preceding puberty, occurring between ages $9\text{--}12$ (girls ~$2\text{ years}$ earlier than boys).

Average Age of Puberty Onset

$12\text{ years}$ in girls and $14\text{ years}$ in boys.

Delayed Puberty Criteria in Females

If breast development hasn't occurred by $13\text{ years}$, or if menarche has not occurred by $2.5\text{ years}$ after onset of breast development.

Nursing Role in Sex Education

Treat sex as a normal part of growth & development; middle childhood is ideal time for formal sex ed.

School-Aged Peer Group Focus

Psychosocial relationships center around same-sex peers; formation of groups or clubs.

Internalizing Stress Symptoms in Children

Withdrawal, delaying tactics, daydreaming.

Externalizing Stress Symptoms in Children

Aggression, delinquency.

Physical/Behavioral Stress Presentations in Children

Stomach pain or headache, sleep problems, bed-wetting, changes in eating habits, aggressive or stubborn behavior, reluctance to participate, regression to earlier behaviors (thumb-sucking).

Sleep Requirement for 5-Year-Old

$$11.5\text{ hours}$$

Sleep Requirement for 11-Year-Old

$$9\text{ hours}$$

Most Common School-Age Injury

Motor vehicle crash (MVC), pedestrian or passenger.

Adolescent Biological Growth Spurt

Final $20\text{--}25\%$ linear growth, up to $50\%$ of ideal body weight, change in BMR.

Adolescent Cardiovascular Changes

Heart, blood volume, and systolic blood pressure (SBP) increase in size & strength; heart rate (HR) decreases.