Peds exam 1

___ of an infant refers to: Increase in physical size

Growth

Infant growth —> doubles birth weight by ____ of age and triples birth weight by ____ of age)

6 months , 12 months

___ of an infant refers to:  sequential process by which infants and children gain various skills and functions

Development

___of an infant refers to: increase in functionality of various body systems of developmental skills

Maturation

Screening tools for newborns and infants:  
___: a quick screen to determine whether a child is achieving developmental milestones in the areas of gross motor, fine motor, language, and personal social skills. It can be used with children from birth to 6 years of age. 

 Denver II Developmental Screening Test

Screening tools for newborns and infants:

___: identifies infants and young children whose social and emotional development requires further evaluation to determine if referral for intervention services is necessary.

Ages and Stages

Screening tools for newborns and infants:  

____: From birth to 5 years, your child should reach milestones in how he plays, learns, speaks, acts and moves. (it’s like a CDC website w/ resources)

Learn the Signs. Act Early

How to assess the growth and development of a premature infant

Subtract the number of weeks that the infant was premature from the infant’s chronological age

Dance/Step 

• With one foot on a flat surface the infant puts the other foot down as if to "step"

• Appears: ____

• Disappears: ____

• 

• Appears: birth

• Disappears: 4-8 weeks

Sucking

• Reflexive sucking when nipple or finger is placed in infant’s mouth 

• Appears: ___

• Disappears: ___

• 

• Appears: birth

• Disappears: 2-5 months

Rooting/root reflex

• When the infant’s cheek is stroked, the infant turns to that side, searching with mouth 

• Appears: ___

• Disappears: ___

• 

• Appears: birth

• Disappears: 2-5 months

Moro

• With sudden extension of the head the arms abduct and move upward and the hands form a “C” 

• Appears: ___

• Disappears: ___

• 

• Appears: birth 

• Disappears: 4 months

Tonic neck/Asymmetric tonic neck reflex 

• While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed (also called the ___ position)

• Appears: ___

• Disappears: ___

• 

• also called the fencing position

• Appears: birth

• Disappears: 4 months

Palmar grasp

• Infant reflexively grasps when palm is touched

• Appears: ___

• Disappears: ___

• 

• Appears: birth

• Disappears: 4-6 months

Plantar reflex

• Infant reflexively grasps with bottom of foot when pressure is applied to plantar surface

• Appears: ___

• Disappears: ___

• 

• Appears: birth

• Disappears: 9 months

Babinski

• Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension

• Appears: ___

• Disappears: ___

• 

• Appears: birth

• Disappears: 12 months

Posterior fontanel closes by ____

8 weeks

Social smile occurs by ___

2 months

Head turns to locate sounds by ___

3 months

Steady head control is achieved by ___

4 months

Able to roll from tummy to back and from back to tummy by ___

5-6 months

Plays “peek-a-boo” after ___

6 months

Able to transfer objects from hand to hand by ___

7 months

Able to sit unsupported at ___

8 months

Able to crawl at ___

10 months

Waves “bye-bye” at ___

10 months

Fine pincer grasp appears at ___

10-12 months

Able to walk with assistance at ___

10-12 months

Says a few words in addition to “mama” and/or “dada” at ___

12 months

Can sit down from standing position without help at ___

12 months

Development of gross motor skills in infancy:

Lifts and turns head to side in prone position

Head lag when pulled to sit

Rounded back in sitting

1 MONTH

Development of gross motor skills in infancy

Raises head and chest, holds position

improving head control

2 MONTHS

Development of gross motor skills in infancy

Raises head to 45 degrees in prone

Slight head lag in pull to sit

3 MONTHS

Development of gross motor skills in infancy

Lifts head and looks around

Rolls from prone to supine

Head leads body when pulled to sit

4 MONTHS

Development of gross motor skills in infancy

Rolls from supine to prone and back again

Sits with back upright when supported

5 MONTHS

Development of gross motor skills in infancy

Tripod sits

6 MONTHS

Development of gross motor skills in infancy

Sits alone with some use of hands for support

7 MONTHS

Development of gross motor skills in infancy

Sits unsupported

8 MONTHS

Development of gross motor skills in infancy

Crawls, abdomen off floor

9 MONTHS

Development of gross motor skills in infancy

Pulls to stand

Cruises

10 MONTHS

Development of gross motor skills in infancy

Sits from standing position

Walks independently

12 MONTHS

Anterior fontanel closed between ___

12 and 18 months

Throws ball overhand by ___

18 months

Kicks ball by ___

24 months 

Can walk up and down the stairs by ___ (2 feet on each step) 

24 months

Walks with wide stance at ___

24 months

Feeds self with spoon and cup at ___

2 years

Daytime toilet training can begin by age __

2 years

Two-to three- word sentences are spoken by ___

2 years

Own first and last name can be stated by ___

2 ½ to 3 years

All primary teeth (20) are present by ___

3 years

Three-to four- word sentences are spoken by ___

3 years

Names what has been drawn by ___

3 years

Copies a circle (drawing) with facial figures by ___

3 years

Rides Tricycle by ___

3 years

Stands on one foot for a few seconds by ___

3 years

Uses sentences of four or five words by ___

4 years

Draws 3-part stick figures by ___

4 years

Can walk up and down the stairs using alternate footing by ___

4 years

Can skip and hop on one foot by ___

4 years

Uses sentences of 6-8 words by ___

5 years

Can tie shoelaces by ___

5 years

Throws and catches ball well by ___

5 years

Skates with good balance by ___

5 years

Leading cause of death in toddlers/preschooler is ___

Leading cause of death in toddlers/preschooler is unintentional injury. 

MUST focus on safety education. 

Car seats and booster seats must be used in the backseat of the car at all times. Swimming lessons and Pool fences for drowning prevention

Curious about the world around them and like to explore. Accidental poisoning is a safety issue. Use of ipecac syrup is NO LONGER recommended (rapid-acting emetic) → Teach parents that it is NOT recommended to induce vomiting in any way because it may cause more damage. CALL Poison control center.

Develops concepts of numbers by ___

6 years

Knows right and left hands by  ___

6 years

Likes table games and simple card games by  ___

6 years

Uses table knife for cutting meat by ____

7 years

Mechanical in reading by ___

7 years

Can count backwards from 20 by ___

8 years

Likes the reward system by ___

8 years

Puberty:

Girls sequence of maturational changes/puberty: can begin anytime between ___ old in this order: breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation 2 years after first signs (breast changes)

Boys sequence of maturational changes/puberty: can begin anytime between ___ old in this order: enlargement of testicles, growth of pubic hair/axillary hair/hair on upper lip/hair on face, rapid increase in height, changes in larynx causing voice changes, nocturnal emissions ( also known as wet dreams or nocturnal orgasms)

Puberty:

Girls sequence of maturational changes/puberty: can begin anytime between 8-13 years old in this order: breast changes, rapid increase in height and weight, growth of pubic hair, appearance of axillary hair, menstruation 2 years after first signs (breast changes)

Boys sequence of maturational changes/puberty: can begin anytime between 9 ½ and 14 years old in this order: enlargement of testicles, growth of pubic hair/axillary hair/hair on upper lip/hair on face, rapid increase in height, changes in larynx causing voice changes, nocturnal emissions ( also known as wet dreams or nocturnal orgasms)

Leading cause of death in school age / adolescents is ___

Leading cause of death is unintentional injury. 

MVA (motor vehicle accidents) refuse to ride with an impaired person or one who is driving recklessly, ALWAYS wear a seatbelt, passenger seat for 12 years of age or older, discourage distractions while driving-cell phones, texting, eating or smoking; if drinking alcohol or any drugs call someone to pick you up, never drive under the influence

Learn how to swim and basic water safety rules

Ask about depression (sadness, withdrawn) and thoughts of suicide or hurting self/others

When does birth weight double?

5-6 months

When does birth weight triple?

12 months 

When does birth length double?

4 years

When does a child use scissors?

4 years

When does a child tie his/her own shoes?

5 years

___: remember pain after 6 months

Infants

___: fear intrusive procedures

Toddlers

___: fear of body mutilation

Preschoolers

___: fear of loss of control over their bodies

School-age

___: concerned about change in body image

Adolescent

Erikson Stage 1: ____

• from ___ to ____ 

• Goal is to promote consistency 

Trust vs mistrust 

Infancy to 1 year 

Erikson stage 2: ___ 

• From ___ to ___

• Goal is to promote freedom and encouragement to master new tasks

Autonomy vs shame and doubt 

Toddlerhood (1-3 years)

Erikson stage 3: ___

• from ___ to ___

• Conscience develops to maintain initiative without impinging on others. Child initiates play activities.

Initiative vs guilt

Preschooler (3-6 years)

Erikson stage 4: ___

• from ___ to ___

• Focus on achievement and learning rules. Gains sense of self-worth

Industry vs inferiority

School age (6-12 years)

Erikson stage 5: ___

• from ___ to ___

• Sense of self concept. Identification of roles and integration of own values into society. Focus on peers. 

Identity vs role confusion

12-18 years 

Separation anxiety

• 3 phases

• ___ (cry, scream, inconsolable)

• ___ (crying stops, depression/withdrawn)

• ___

• Most intense in toddler age groups

• Important way to minimize/manage → encourage parental presence/ minimize separation as much as possible

Protest phase

Despair phase

Detachment/denial

2 main stressor seen across age groups ___ & ____

Separation anxiety and loss of control

Diagnostic test for autism

MCHAT

Minors who may give consent include: ___

Emancipated minor - has established independence from his/her parents through marriage, pregnancy, or service in the armed forces, or by a court order.

By ___ of age, children recognize death as permanent

By ages ___, children understanding of death is the same as an adult (inevitable, universal and irreversible)

6 years of age

ages 9-10

Children as young as ___ are able to report location and degree of pain

3 years

___

Evaluates facial expression, cry, breathing patterns, arm movements, leg movements, and state of arousal.

Used to evaluate pain in preterm and full term neonates up to ___ after birth

Neonatal Infant Pain Scale (NIPS) 

up to 6 weeks after birth

• 

FLACC stands for: ___

• Used with children between ____ or until child can self-report

Face, Legs, Activity, Cry, Consolability (FLACC)

2 months and 7 years

Wong Baker FACES Pain Rating Scale 

• Age group: ___

• 

For toddler, preschooler, school age, adolescent 

Numeric pain scale

• age group: ___

Numeric pain scale

• 9 years - adult 

___ dose is usually ___ mg/Kg/dose every 6-8 hours PRN

Ibuprofen dose is usually 5-10 mg/Kg/dose every 6-8 hours PRN