Growth/Development + Anatomy/Physiology - Pediatrics

Infancy

First year of life

neonatal/newborn

First month of life

• Spend most of their time sleeping (up to 16 hrs/day), eating

• Can’t tell the difference between caregivers and strangers

• Sucking reflex

• Can focus on faces

0-2 mo

• More active - smile, make eye contact, follow objects with their eyes

• Recognize caregivers

• Use hands to examine objects, roll over

• Active extremity movement

2-6 mo

• Babble, say their 1st word

• Sit w/out support, crawling, learn to walk

• Teething, put things in their mouth

• Cry when separated from their parents - separation anxiety

6-12 mo

• Warm the stethoscope

• Use a pacifier

• Let the parent hold the infant

• Do the more painful or uncomfortable procedures last

• Explain each procedure

How should you assess infants?

Toddler

1-3 yo

• Walk, open doors/drawers - explore

• Imitate the behaviors of older children/parents

• Speak 4-6 words

12-18 mo

• Vocabulary 10-15 words

• 2 yo - pronounce 100 words

• Point to a common object - toddlers can name it

• Understand cause and effect

• Balance, gait improving, running, climbing

• Cling to their parents, special objects (blanket, stuffed animal).

18-24 mo

Preschool

• Rapid increase in language

• Walk, run well, begin throwing/catching/kicking

• Learning which behaviors are appropriate

3-6 yo

School-age

• Can think in concrete terms, respond to direct questions, help take care of themselves

• School - concerns about popularity, peer pressure

• Understand that death is final

6-12 yo

True

Only in toddlers and preschool age should you begin assessing the feet first and move to the head

True or false: when assessing children between the ages of 6-12, begin your assessment at the head and move toward the feet.

Adolescents

• Think abstractly, participate in decision making

• Personal morals - values/beliefs

• Shift from relying on family to relying on friends for emotional support, social development, acceptance from their peers

• Puberty 

12-18 yo

• Smaller lungs, heart’s higher in the chest

• Glottic opening (vocal cords) - higher, more anterior

• Long, floppy, U-shaped epiglottis

• Larger/rounder occiput

• Larger tongue, more anterior

• Less developed rings of cartilage in the trachea - collapses if the neck is hyperextended

How is the pediatric airway different from an adult’s?

False - nose breathers

True or false: infants are mouth breathers, requiring more suctioning to maintain a clear airway

• Higher O2 demand, smaller O2 reserve (smaller lungs = smaller reserve)

• Underdeveloped intercostal muscles (muscle fatigue onset is faster)

• Belly breathers - rely on their diaphragm

Why do infants have a greater risk of hypoxia?

Infant (1mo-1yo): 30-60

Toddler (1-3 yo): 24-40

Preschool (4-5): 22-34

School age (6-12): 18-30

Adolescent (13-18): 12-16

RR for infant - adolescent

They have thinner chest walls

Why are breath sounds easier to hear in children?

• Newborn - 3 mo: 85-205

• 3 mo - 2 yo: 10 -190

• 2 - 10 yo: 60-140

• >10 yo: 60-100

HR newborn to >10 yo

pallor, weak distal pulse, delayed cap refill (>2 sec), cool hands/feet

Signs of vasoconstriction

• Occipital region is larger, increasing the momentum of the head during a fall

• Subarachnoid space - smaller, less cushioning for the brain

• Brain tissue, cerebral vasculature - fragile, susceptible to bleeding from shearing forces

• Needs a higher amount of cerebral blood flow, O2, glucose - secondary damage from hypotension/hypoxia

Why is the brain at an increased risk for injury in children?

False - less common in children, C-spine injury most likely to the ligaments

True or false: spinal cord injuries are more common in pediatric pts than adults

Internal organs are closer together (Liver, spleen, kidneys - more frequently injured)

Why are children at greater risk for multiple organ injury?

Liver and spleen (larger and anterior)

What 2 organs are more susceptible to bleeding and injury from blunt or penetrating trauma?

Fontanelles

Soft areas where the baby’s skull has not fused together. Fused by 18 mo (anterior), 6 mo (posterior).

False - normal

True or false: bulging is an ominous sign when an infant is crying, coughing, or lying on their back/stomach

increased intracranial pressure

Bulging fontanelles when the infant isn’t crying indicates ….

dehydration

Sunken fontanelles indicate

True

True or false: growth plates are weaker than ligaments and tendons