Pediatric Growth and Development: Vaccines and Feeding

size, function, safety, screening

Well Child Visits: Components

-Growth and development screening

• Growth = increase in ____

• Development = increase in _________ physically and intellectually

-Physical exam

-Nutrition

-Behavior

-________

-Anticipatory guidance

-Counseling, education

-Other __________ tests 

-Immunizations

predictable, wide, social, 3-5, 2, 9, annually

Well Child Visits

-Main Principles of Development

• Proceeds along a _________ pathway

• “Normal” development has a _____ range

• Physical, ______, and environmental factors can affect development and health

• Child’s developmental level affects how you perform H&P

-AAP Well Child Visit Recommendations → newborn, __-__ days, 1/_/4/6/_/12/15/18 months, 2 year, 2.5 year, 3 year, then _________

Hep B

What is the only vaccine given at birth?

2 months

What age should a child receive their Hep B, rotavirus, DTap, HIB, IPV, PCV13 or 20?

Oh 2 Be DR HIP

4 months

What age should a child receive their rotavirus, DTaP, HIB, IPV, PCV13 or 20?

Do it 4 DR. HIP

Influenza

What vaccine can start at 6 months? Need 2 doses the first time and then 1 dose annually

12 months

When can the infant get the MMR, varicella, and HepA vaccine?

1 Very MAD HIPster

RSV, 8

___ monoclonal antibody for all infants < _ months entering RSV season

4-6 years

When should the infant get their second dose of MMR and varicella? 

Very DIM Between 4-6 PM

11-12 years

How old should the patient be when they receive their first Tdap and meningococcal vaccines?

16

When should the patient get their second dose of meningococcal vaccine?

11-12, 9

The HPV vaccine should be given the patient at age ___-___ years, but it can be started as early as _ years old 

-9-14 year old children can get a 2 dose series 6-12 months apart

-15 and older need 3 dose series at 0, 1-2 mo, 6 mo apart

weight, 2, age, BMI, WHO, premature

Growth Charts

-Measurements → height, _________, and head circumference (usually stop at _ years old)

-Growth Chart → measure weight for ___, height for age, head circumference for age, weight for height, and ___

• ____ chart for birth to two years old, CDC for 2+

• Separate charts for boys and girls

-Special growth charts for ____________ infants

weight, height, increasing, height, tumor, sutures

Abnormal Growth Patterns

-Inadequate caloric intake → _______ percentile falls first, followed by ______ then HC

-Hypothyroidism → ____________ weight but falling _______ percentile

-Large HC → familial megalocephaly, hydrocephalus, brain ______

-Small HC → premature closure of __________

-Pay attention to sudden, extreme, or persistent declines in growth

lose, 2, 6, triple, 20-30, 15-20

Rules of Thumb for Growth: Weight

-Newborns can _____ 5-10% of birthweight

• Should be back up to birthweight within _ weeks 

-Double birthweight by _ months 

-_______ birthweight by 1 year 

-Gain approximately ___-___g/day for the first 3-4 months and ___-___ g/day for the rest of the first year 

20, 30, double, 35

Rules of Thumb for Growth: Height and Head Circumference

-Height

• __ inch is the average length at birth

• __ inch is the average length at 1 year

• _________ birth length by 4 years

-Head Circumference

• __ cm average at birth

• Increases by 1cm/month for first 6-12 months

nutrition, D, protein, sugar, 3-4, antibodies, infections, allergic, loss, bleeding, PPD

Normal Infant Nutrition: Benefits of Breastfeeding

-Provides optimal ___________ → only lacks vitamin _

• Colostrum → thick, yellowish fluid; high in ________, low in ______, contains other beneficial compounds

• Milk comes in around __-__ days after birth

-Loaded with mom’s __________ → protects or helps child fight off __________

-Decrease other health issues like ______ diseases, DM, leukemia, and SIDS

-Benefits mom → helps with weight ____, reduces uterine __________ after delivery by speeding up uterine involution, and reduces development of ___, HTN, DM

hand, opening, tongue, crying

Hunger Cues

-Putting ______ in mouth

-Rooting

-_________ mouth and sticking ________ out 

-Fussiness/_________

2, 2, 4, 8, demand, 10, 1, 8

Feeding: Formula vs Breastfed Infant

-Formula Fed

• Newborn - _ months → 2 oz every _ hrs

• 2-4 months → _ oz every 3-4 hours

• 4-6 months → 4-6 oz every 3-4 hours

• 6-12 months → _ oz every 4-5 hours

-Breastfed Infant

• Fed on ________

• Feeds every 1.5-2 hours at first

• Feeds 8-12x/day

• __ minutes on each breast

-Rule of thumb → amount of formula they drink increases on average by _ oz/month before leveling off at _oz

voiding, gain, 6-8, 4, varies

Feeding: Adequacy of Milk Intake

-Assessed by ________ and stooling patterns and weight _____

• __-__ wet diapers/day 

• Breastfed infant → loose, yellow, seedy stools _x/day 

• Formula fed infant → stooling _______

4-6, 2-3, allergies, 4

Feeding: Introduction of Solids

-Around __-__ months

-Baby cereal (rice, oatmeal, barley)

-One food every __-__ days

• Do this to not support nutrition but to help get the baby used to solids

-Identify food _________/intolerances

-About _oz of solids at each meal (2-3x/day)

1, 4, 8, 6, 1, whole, fat, 24

Feeding: Juice, Honey, Cow’s Milk

-Juice

• Should wait until _ year old

• 100% juice, no sugar added

• No more than _oz/day until 3 years old

• Older children can have no more than _ oz/day

• Can introduce sippy cup with water at _ months

-Honey

• After _ year old due to risk of infant botulism

-Cow’s Milk

• After 1 year

• 2% or _____ milk until 2 y/o then ___ free or 1%

• No more than __ oz/day