peds exam 1

family-centered care recognizes WHO as the expert in the child's care/needs?

the family

empower and enable them

types of parenting styles

1. authoritarian (dictatorial)

2. authoritative (democratic)

3. permissive

4. passive

describe an authoritarian parenting style

very high control, little warmth

unquestionable rules, "because I said so"

ex: you can never watch TV on a school night

describe an authoritative parenting style

high control but also high warmth

give and take, communication is key, situation could affect rules

ex: you can watch tv for 30min on a school night if your HW is done

describe a permissive parenting style

little control, lots of warmth

parent sees self as a friend, resource, role model

describe a passive parenting style

very little control, very little warmth

parent is uninvolved, indifferent, and emotionally removed

ex: neglect

why is limit-setting important for children?

gives them a sense of security and protection from harm

limits are based on...

developmental level

discipline should be...

1. focused on the behavior, not the child (ex: johnny is NOT bad, but the action of hitting IS)

2. consistent

3. timely (when the action occurs)

what is a common form of discipline?

timeout

what components of timeout are necessary to make it an effective form of discipline?

1. must explain the process to the child

2. length of time = 1 min per year of age

3. takes place in a safe area

4. audible signal for end of time out (bell, alarm, etc)

5. time does not START until child is calm

describe atraumatic care

utilizing interventions to eliminate/minimize psychological and physical distress

DO NO HARM

how can we achieve atraumatic care?

1. foster parent and child relationship

2. promote sense of self control

3. prevent or minimize bodily injury and pain

how do we foster the parent and child relationship in the clinical setting?

prevent or minimize separation from family

close contact should be allowed for just about everything except sterile procedures

how do we promote a child's sense of control in the clinical setting?

allow the child to make CHOICES, maintain privacy, help make room feel safe

how do we prevent or minimize bodily injury and pain in the clinical setting?

distractions: cold, heat, vibration, etc.

adhesive removers

jumping through hurdles, doing the most

characteristics that put children at highest risk for illness

1. premature

2. very low/low birth weight

3. attending childcare centers

4. living in poverty, homeless

5. children of immigrant families

6. existing with chronic medical and/or psychiatric illness and/or disabilities

describe biologic (physical) growth

height, weight, bone, teeth, and organ changes

what are the domains of development?

1. physical

2. cognitive

3. language

4. emotional/psychosocial

5. moral

describe physical development

coordination and control of muscles, includes:

1. gross motor skills

2. fine motor skills

what is the theoretical foundation of cognitive development?

jean piaget's stages

describe piaget's stages of cognitive development

cognitive development occurs in predictable stages of reasoning towards mature, logical thinking

according to piaget, children are born with _________________________ that can be maximized through __________________________

biologic POTENTIAL; environmental interactions

mechanisms of cognitive development according to piaget

adaptation (assimilation and accomodation) (words)

what are the piaget stages of cognitive development?

1. sensorimotor

2. preoperational

3. concrete operational

4. formal operational

sensorimotor stage occurs from...

birth to 2 years (infancy, beginner toddler)

preoperational stage occurs from...

2-7 years (early childhood)

concrete operational stage occurs from...

7-11 years (middle childhood)

formal operational occurs from...

11-15 years (later childhood)

what is the theoretical foundation of psychosocial development?

erik erikson's stages

describe erikson's stages of psychosocial development

series of critical stages in which the child must master a core conflict/task in order to progress to the next stage

the core conflicts recur throughout life

what are erikson's stages of psychosocial development?

1. trust vs. mistrust

2. autonomy vs. shame and doubt

3. initiative vs. guilt

4. industry vs. inferiority

5. identity vs. role confusion

trust vs. mistrust stage occurs from...

birth to 1 years (infancy)

autonomy vs. shame and doubt stage occurs from...

1 to 3 years (toddler)

initiative vs. guilt stage occurs from...

3 to 6 years (preschooler)

industry vs. inferiority stage occurs from...

6 to 12 years (middle childhood)

identity vs. role confusion stage occurs from...

12 to 18 years (adolescence)

what is the theoretical foundation of moral development?

kohlberg

describe kohlberg's levels of moral development

actions evolve from being externally driven into individual and abstract

what are kohlberg's levels of moral development?

1. preconventional: based on reward and punishment

2. conventional: based on external ethics

preconventional level of moral development occurs from...

3-7 years

conventional level of moral development occurs from...

8-13 years

how to communicate with families in the clinical setting

1. encourage them to talk

2. direct focus to child (Johnny looks pale... Johnny looks tired... etc.)

3. listening and cultural awareness

4. be empathetic

5. provide anticipatory guidance

6. utilize interpreter as needed for all things medical

how to communicate with children in clinical setting

1. allow time for child to feel comfortable

2. avoid sudden or rapid advances

3. talk to parent first if child is shy

4. get on child's level

5. use simple words, speak clearly and concisely

6. speak in positives

7. offer a choice only when one exists

8. be honest

9. allow to express concerns and fears

universal language of children

play

what is the role of play in child development?

1. allows children to express feelings and fears

2. facilitates development

3. teaches socially acceptable behavior

4. provides protection from everyday stressors

describe onlooker play

a child watches other children play

describe solitary play

plays alone, but enjoys presence of others, interest centered on own activity

occurs during infancy

describe parallel play

plays alongside, not with, another

characteristic of TODDLERS

describe associative play

children engage in separate activities but exchange toys and comment on one another's behavior

describe cooperative play

play in which children genuinely interact with one another, taking turns, playing games, or devising contests

therapeutic play encourages WHAT?

the expression of feelings (teaches coping strategies)

a toddler is very upset, having a temper tantrum, what toy can you give them to help them through this situation (via therapeutic play)?

a hammer, yo-yo, a ball and a target

help them displace their frustration

a child is afraid, seeking comfort during a procedure, what toy can you give them to help them through this situation (via therapeutic play)?

a doll or stuffed animal

(i am guessing)

infancy

birth to 12 months

neonate

birth to ~1 month

early childhood

1-6 years

toddler

1-3 years

preschool age

3-6 years

middle childhood (school age)

6-11 or 12 years

later childhood

11-19 years

adolescence

12-18 years

what does it mean to say developmental SKILLS are systematic and hierarchical?

skills are developed in a specific sequence, must accomplish one skill before you can accomplish next

what does it mean to say development is predictable and individual?

development occurs in a predictable sequence: rapid changes in the first year of life, growth starts cephalo-caudal, then proximal-distal but the timing is individual

current AAP recommendations for frequency of pediatric check-ups

32 visits through age 21 years

1. newborn

2. 1 week

3. months: 1, 2, 4, 6, 9, 12, 15, 18, 24, 30, and 36

4. yearly after 36 months (3 years)

birth weight of an infant at least doubles by...

6 mo

an infant should triple their weight by...

1 year

most infant growth occurs where?

head (big neuro developments)

OFC 2cm > chest at birth, OFC = chest at 1 year

how is head growth measured? who gets their head measured?

occipital frontal circumference (OFC)

all children

when does the anterior fontanel close?

12-18 months

when does the posterior fontanel close?

6-8 weeks

infant height increases by ______ in first year

50%

infants have a ____________ heart rate and are in sinus ____________________

fast; arrhythmia

infancy VS

1. HR 90-160bpm

2. low blood pressure

3. fast RR (40-50s)

4. poor thermoregulation

why are infants are at risk for dehydration?

have more water content at baseline (78% ECF)

immature kidneys are not yet concentrating urine

describe the GI system in infancy

immature digestion with increasing stomach volume

is frequent passive regurgitation normal in infants?

yes

what form of nutrition is most easily digested by infants?

breast milk

more easily digested than formula

what is the most immature organ in infancy?

liver

infants are born with ___________________________ that decreases at about 2 months of age

passive immunity

thus, immunizations start at 2mo mark!

when is passive immunity acquired from the mother?

in the last 3 mo of pregnancy

what babies are born with diminished immunity and are thus at incr risk of infection?

premature babies

WHAT is rich in antibodies and good for the baby's immunity?

colostrum

describe dentition in infancy

teeth first erupt between 6-10 months

6-8 teeth by 12 mo

indications of teething

1. drooling

2. sucking/biting on fingers, hand, or objects

3. irritability

4. difficulty sleeping

5. mild fever

6. rub ears

7. decr appetite for solid foods

when can you start giving an infant solid food?

around 6 mo when teeth first erupt

infants should have a positive babinski reflex from ___________ until ____________

birth; 12 months

age at which infant can raise head when prone

2 mo

age at which infants has no head lag (!)

4 mo

age at which infant rolls from abdomen to back

5 mo

age at which infant rolls from back to abdomen (boss moment)

6 mo

age at which infant can sit unsupported

8 mo

age at which infant can pull to standing position and creeps on hands and knees (crawls)

9 mo

big injury risk at this point!!!!! can grab things, knock things over, fall into things, GET INJURED

age at which infant cruises or walks while holding onto something with 2 hands

11 mo

age at which infant walks with one hand-held

12 mo

when an infant is able to raise their head and shoulders when prone, what should you anticipate happening soon?

the infant will be able to ROLL soon (back to side, front to back, then back to front)

describe infancy gross motor skills development

2 mo. raises head when prone

3 mo. raises head and shoulders when prone, light head lag

4 mo. no head lag, able to sit propped up, rolls from back to side

5 mo. rolls from abdomen to back

6 mo. rolls from back to abdomen

8 mo. sits unsupported

9 mo. pulls to standing position, creeps on hands and knees

11 mo. cruises or walks while holding onto something with 2 hands

12 mo. sits from standing, walks with one hand-held

age range at which infant is able to grasp objects voluntarily, use palmar grasp, and hold bottle

4-6 mo

age range at which infant moves object from hand to hand

6-8 mo

age range at which infant grasps rattle by handle, neat pincer grasp, and tries to build 2 block tower unsuccessfully

10-12 mo