Peds exam #1

What is a normal reaction to a vaccination?

Low grade fever (less than 101) injection site tenderness, fussiness

What is a live vaccination?

Takes the organism weakens it without making you super ill so your body can adapt and make antibodies against it if you were to get sick

When Vaccines Should Not Be Given:

• Live Vaccines to Immunocompromised Children
• Prior Allergic Reaction (anaphylaxis, generalized rash)
• Seizures
• Fever Greater than 101

Who can we not give live vaccines to?

Immunocompromised people

Who is included in immunocompromised people?

• IVIG administration
• Steroids for greater than two weeks
• Pregnant women
• Neutropenia
• Chemotherapy

What is the teaching for MCV (Meningococcal) ?

Do not give if history of Guillian-Barre

What is the teaching with MMR?

Delay in Pregnancy or attempting within 1 month
Test 1st if severe Allergy to gelatin, eggs, neomycin

What is anticipatory guidance?

Proactive approach
Focuses on needs of child at each stage
Education provided by RN and HCP
Promotes safety

Examples of anticipatory guidance:

• Swim safety

• Gate on steps

• Choking prevention cutting food into bite sized pieces

• Baby locks

What does growth help show?

If a child is healthy relative to their weight length and height

Also tells us for chronic illness how they are doing

What does head circumference show?

If skull is growing / brain

Can show disorders / problems early

What are the main pediatric measurements?

• Head circumference

• Height vs. length

• Weight

What do growth charts show us?

The different curves relevant to a child

** Different curves are okay just follow the curve

When does a curve become a problem?

-2 / +2 levels

What are physical factors that affect growth and development?

Nutrition, milk, food, diet, sleep, activity, stable safe home, water, electricity

What are social factors that affect growth and development?

Comfort, friendships, active parents, neglect, abuse, helicopter parents, siblings

What are health factors that affect growth and development?

genetics, premature babies, chronic conditions

When is newborn screening mandated?

At birth

When is iron deficiency anemia screened for?

9-12 months

When is lead screening?

9-12 months (LS)

When is developmental screening?

12 months

When is vision screening?

3-5 years

When is hearing screening?

4 years

When is autism screening?

18 and 24 months

When is scoliosis screening?

10 - 16 years

When is STI / HIV screening?

15 years

When is Mental Health • Depression and Anxiety (PHQ-9) screening?

12 years

When should birth weight double by ?

6 months

When should birth weight triple by ?

1 year

When does the posterior fontanel close ?

2 months

How many teeth are expected by 12 months?

6 - 8

When should the babinski reflex disappear by?

18 months

When will baby lift head?

2 - 3 months

When will baby rolls abdomen to back?

4 months

When will baby rolls back to abdomen?

5 months

When will baby sit up unsupported?

7 months

When should baby begin crawling ?

6-9 months

When should baby start cruising (holding onto something stand)?

11 months

When should baby begin to walk?

12 months

What are baby gross motor milestones?

lift head
rolls abdomen to back
rolls back to abdomen
sits unsupported
begins crawling
cruising
may attempt 1st steps

What are baby fine motor skills?

involuntary grasp of object in hand
carries object in mouth
voluntary grasp of object in hand
holds bottle and transfers objects month
pincer grasp
Holds crayon, stack two blocks

When should baby involuntary grasp of object in hand?

1 month

When should baby carry object in mouth?

4 months

When should baby voluntary grasp of object in hand?

5 months

When should baby holds bottle and transfers objects?

6 months

When should baby pincer grasp?

11 months

When should baby Holds crayon, stack two blocks?

12 months

Speech milestones:

• 2 months: social smile response
• 3 months: coos, babbles
• 6-9 months: stranger anxiety begins
• 6 months: imitates sounds
• 8-9 months: says “Dada” and “Mama” with meaning
• 11 months: may say 1 word with meaning (“hi”, ‘bye” or “no”)
• 12 months: 3-5 new words

Why is breastfeeding recommended for first 6 months of life?

➢Provides quality nutrition
➢Reduces likelihood of overweight
➢Decreasing incidence of SIDS

Infant nutrition:

• Limited to no water
• 2-3oz q3-4 hours during 1st month of life
• 6-8 wet diapers/day
• Stool color/frequency/consistency
• Frequency of feedings/change in food habits

Infant sleep:

• Nocturnal (night time) sleep patterns begins by 3 to 4 months
• By 4 months: 14-15 hours of sleep per day, 9-11 hours of sleep at night
• By 12 months: Sleep throughout the night, 1-2 daytime naps

Safe sleep practices:

Place infant on their back to sleep, Use a firm mattress that fits snuggly, Crib slats should
be no farther than 6 cm apart, Remove crib mobiles by 4-5 months, No pillows, wedges, toys or extra blankets No co-sleeping

Infant safety burns:

• Water temp less than or equal to 120 degrees F
• Check bath water temp
• Use smoke and carbon monoxide detectors
• Sunscreen for infants at 6 months of age

Infant safety choking:

• Check for loose buttons
• Cut up grapes/hotdogs (No coin sized food)

Infant safety environment:

• Cabinet locks
• Drowning safety
• Gun Safety

Fine and gross motor skills: Preschooler:

• Hand strength improves
• Cut, draw shapes, button clothes
• Coordination improves with more complex movement
• Run, throw, jump
• Skipping and hopping on one foot

Preschooler language development:

• Vocabulary expands to over 2,100 words by age 5
• Sentence structure evolves
• Language becomes the primary communication method

Speech concerns preschool:

• Not asking questions
• 4 year old who hard to understand outside of family
• Stuttering past age 5

Preschool behaviors:

Aggression
•Hitting, Biting, Kicking (Peaks at age 2-4)
•Frustrates easily
Fears
•Dark, monsters, animals
Body Image and Sexuality
•Normal curiosity
•Use correct anatomical terms

What is parallel play?

Preschooler age 2-3, play near each other but not together

What is associative play?

Age 3-4 developmental stage where children interact, share toys, and converse during playtime, but still pursue individual goals without a shared plan or common objective

What is cooperative play?

age 4-6 play together

Preschool age dental health:

• Full set of deciduous (primary) teeth
• Supervised brushing and flossing
• Early dental trauma should be assessed by dentist

Adolescent: when do rapid growth spurts occurs?

Age 11-14

Able to express self

Who gets taller first?

Girls

Abstract thought

Adolescents growth and development complex fine and gross motor:

Secondary Sex Characteristics
When thinks like an adult?
Menstruation

Compares self to others?
Tanner Staging

Adolescent nutrition concepts:

1. Increased caloric needs
2. Iron
3. Hydration
4. Eating Disorders/Body Image

Adolescent sleep:

• Circadian rhythm shifts

• Screen time

• Sleep deprivation risks

What are Piaget’s four stages?

Sensorimotor

Pre operational

Concrete operational

Formal operational

When does Sensorimotor stage occur ?

Age 0-2 explore through senses, starts with basic reflexes then movements get more complex and purposeful, object permanence (7-8months)

When does Pre operational stage occur?

Age 2-7, language and symbols big imagination and pretend play, animism and egocentric thinking

When does Concrete operational stage occur?

Age 7-11, kids learn to apply logical rules to objects, literal thinkers, understanding the concept of conservation, categorize by shape or type

When does formal operational stage occur?

Age 12 - adult, learn to apply logical rules to abstract concepts, can analyze environment and problem solve, hypothetical thinking, understands consequences of own actions

How many Erikson’s stages are there?

6

Trust vs. Mistrust, Autonomy vs. Shame and Doubt, Initiative vs, Guilt, Industry vs. Inferiority, Indentity vs. Role Confusion, Intimacy vs Isolation

What is the Trust vs. Mistrust stage?

Age 0-18 months, needs met? trust caregivers? crying when diaper is wet hungry

goal is to develop trust and bond with caregivers

What is the Autonomy vs. Shame and Doubt stage?

Age 18 months - 3 years: I can do it myself, confidence beginning, separation from parents, tantrums, no!, development positive reinforcement with boundaries, potty training

goal is to develop confidence in their own abilities

What is the Initiative vs, Guilt stage?

Age 3-5, school, more interested in socializing with peers, endless questions

Goal is to gain confidence to complete task and purpose in their actions

What is the Industry vs. Inferiority stage?

Age 5-12 sense of self, doing things right, acceptance from peers, Desired Outcome: Competence, self-esteem, and feelings of pride and accomplishmen

What is Indentity vs. Role Confusion stage?

• Age: 12 to 18 years (Adolescent).

• Central Conflict: "Who am I? How do I fit into society?".

• Key Cues & Behaviors: Forming a distinct personal identity separate from parents, navigating intense emotions, and searching for personal values.

• Desired Outcome: A strong, clear sense of self and a clear picture of their future

What is Intimacy vs Isolation stage?

• Age: 18 to 40 years (Young Adult).

• Central Conflict: Forming deep, meaningful connections.

• Key Cues & Behaviors: Searching for a life partner or close community to share life with.

• Desired Outcome: Safe relationships filled with commitment and love