[PEDIA] Normal Vital Signs, Infantile and Physiologic Reflexes, and Milestones (SJ)

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 0-28 days old?

HR: 104-162 bpm

RR: 31-60 cycles/min

BP: 60-80 / 30-53 mmHg

MAP: 40 or higher

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 1-3 months old?

HR: 104-162 bpm

RR: 31-60 cycles/min

BP: 73-105 / 36-68 mmHg

MAP: 48 or higher

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 4-11 months old?

HR: 109-159 bpm

RR: 29-53 cycles/min

BP: 82-105 / 46-68 mmHg

MAP: 58-80

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 1-3 years old?

HR: 89-139 bpm

RR: 25-39 cycles/min

BP: 82-105 / 46-68 mmHg

MAP: 53-81

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 4-6 years old?

HR: 71-128 bpm

RR: 17-31 cycles/min

BP: 91-114 / 50-74 mmHg

MAP: 63-87

What is the normal heart rate, respiratory rate, and blood pressure of a patient who is 12 years old or older?

HR: 50-104 bpm

RR: 12-25 cycles/min

BP: 105-136 / 62-87 mmHg

MAP: 76-103

What is the normal temperature when taken orally?

33.5-37.5°C

What is the normal temperature when taken via the axilla?

36.5-37.5°C

What is the normal temperature when taken rectally?

36.6-38°C

What is the normal temperature when taken temporally?

36.3-37.8°C

Give the stimulus, response, and age of suppression of the Moro reflex.

Stimulus: sudden neck extension

Response: shoulder abduction and elbow and finger extension followed by arm flexion and abduction

Age of Suppression: 4-6 months

Give the stimulus, response, and age of suppression of the Startle reflex.

Stimulus: sudden noise

Response: shoulder abduction and elbow and finger extension followed by arm flexion and abduction

Age of Suppression: 4-6 months

Give the stimulus, response, and age of suppression of the Rooting reflex.

Stimulus: stroking lips or around mouth

Response: moving mouth and head towards stimulus in search of nipple

Age of Suppression: 4 months

Give the stimulus, response, and age of suppression of the Positive supporting reflex.

Stimulus: light pressure or weightbearing on plantar surface

Response: legs extend for partial support of body weight

Age of Suppression: 3-5 months replaced by volitional weight bearing with support

Give the stimulus, response, and age of suppression of the Asymmetric tonic neck reflex.

Stimulus: head turning to side

Response: extremities extend on face side, flex on occiput side

Age of Suppression: 6-7 months

Other name: Archer’s or Fencer’s reflex

Give the stimulus, response, and age of suppression of the Symmetric tonic neck reflex.

Stimulus: (1) neck flexion; (2) neck extension

Response: (1) arms flex, legs extend; (2) arms extend, legs flex

Age of Suppression: 6-7 months

Give the stimulus, response, and age of suppression of the Palmar grasp reflex.

Stimulus: touch or pressure on palm or stretching finger flexors

Response: flexion of all fingers, hand fisting

Age of Suppression: 5-6 months

Give the stimulus, response, and age of suppression of the Plantar grasp reflex.

Stimulus: pressure on sole distal to MT heads

Response: flexion of all toes

Age of Suppression: 12-14 months when walking is achieved

Give the stimulus, response, and age of suppression of the Automatic neonatal walking reflex.

Stimulus: on vertical support plantar contact and passive tilting of body forward and side to side

Response: alternating automatic steps with support

Age of Suppression: 3-4 months

Give the stimulus, response, and age of suppression of the Placement or Placing reflex.

Stimulus: tactile contact on dorsum of foot and hand

Response: extremity flexion to place hand or foot over obstacle

Age of Suppression: before end of first year

Give the stimulus, response, and age of suppression of the Neck righting or Body derotational reflex.

Stimulus: neck rotation in supine

Response: sequential body rotation from shoulder to pelvis towards direction of face

Age of Suppression: 4 months replaced by volitional rolling

Give the stimulus, response, and age of suppression of the Tonic labyrinthine reflex.

Stimulus: (1) supine; (2) prone

Response: (1) predominant extensor tone; (2) predominant flexor tone

Age of Suppression: 4-6 months

Give the stimulus, response, and age of emergence of the Head righting reflex.

Stimulus: visual and vestibular

Response: align face or head vertically, mouth horizontally

Age of Suppression:

• Prone — 2 months

• Supine — 3-4 months

Give the stimulus, response, and age of emergence of the Head and body righting reflex.

Stimulus: tactile, vestibular, and proprioceptive

Response: align body parts in anatomic position relative to each other and gravity

Age of Suppression: 4-6 months

Give the stimulus, response, and age of emergence of the Protective extension reflex.

Stimulus: displacement of gravity outside supporting base in sitting or standing

Response: extension or abduction of lateral extremity towards displacement to prevent falling

Age of Suppression:

• Sitting anterior — 5-7 months

• Lateral — 6 months

• Posterior — 7-8 months

• Standing — 12-14 months

Give the stimulus, response, and age of emergence of the Equilibrium or tilting reactions.

Stimulus: displacement of center of gravity

Response: adjustment of tone and posture of trunk to maintain balance

Age of Suppression:

• Sitting — 6-8 months

• Standing — 12-14 months

Enumerate the gross motor developmental milestones per age.

3 months — good head control in sitting; rolls back to side

6 months — ability to sit; rolls both ways

9 months — crawls; pulls to stand and cruises

12 months — walks with hand held or independently; can squat (stand to sit)

18 months — can run; walks stairs

24 months — kicks ball; runs better

3 years — balances on one foot; rides a tricycle

4 years — hops on one foot; stands on one foot for 5 seconds

5 years — skipping; stands on one foot for 10 seconds; mature gait; walks backwards heel-toe

Enumerate the language developmental milestones per age.

3 months — cries and coos

6 months — babbles and makes vowel sounds

9 months — uses gestures; understands “no”

12 months — mama/dada specific; has at least two other words; responds to name

18 months — 4-20 words; follows simple instructions; one or more body parts

24 months — two-word sentences; body parts; intelligible most of the time (75%); 200 words

3 years — first and last name; knows age and sex; three-word sentences; can count 3 objects

4 years — four- to five-word sentences; counts to 4; knows colors

5 years — counts to 10 or more objects; six- to eight-word sentences; knows coins; knows address

Enumerate the fine motor developmental milestones per age.

3 months — grasps toy; object to mouth; hands to midline

6 months — thumb opposition emerging; reaches with one hand

9 months — can release voluntarily; pincer grasp (crude); can point

12 months — bangs 2 blocks together; grossly turns pages in a book; puts objects in a container; pincer grasp (mature)

18 months — builds tower of 2 or 4 cubes; throws ball; scribbles

24 months — builds tower of 6 or 7 cubes; turns a door knob; can draw a vertical line

3 years — builds tower of 9 or 10 cubes; holds crayon with fingers; copies circle

4 years — throws ball overhead; uses scissors; draws circle and square; can draw person of 2-4 parts

5 years — catches a ball; copies triangle; draws person with a body

Enumerate the social developmental milestones per age.

3 months — smiles at face

6 months — recognizes family members

9 months — plays patty cake and peek-a-boo

12 months — waves bye-bye

18 months — feeds self; takes off simple clothes

24 months — can put on some clothes

3 years — dresses; potty trained; separates easily

4 years — tries to be independent; imaginary play

5 years — ties shoelaces, sings, and dances