Exam 1 2/2 - Outline

Growth & Development: Toddlers (1–3 years)

Biological Development

1. Proportional Growth

2. Sensory Developmenot

• Vision:

  • 20/40 vision is acceptable

  • Continues to improve; depth perception developing

  • Strabismus (crossed eyes) may be noticeable and should be evaluated

• Hearing, Smell, Taste, Touch:

  • All senses are well developed

  • Toddlers explore environment and food with senses

  • Taste preferences begin; they may prefer familiar flavors

3. Maturation of Systems

• Neurological:

  • Brain growth slows, but still developing

  • Myelination of spinal cord mostly complete by 2 years

• Respiratory:

  • Upper respiratory infections common

  • Short Eustachian tubes = more ear infections

• Gastrointestinal:

  • Voluntary control of elimination begins (potty training readiness around 18–24 months)

• Immune System:

  • Continues to mature; fewer infections over time

• Skin:

  • Better thermoregulation than infants

• Endocrine:

  • Hormone regulation maturing, but still developing

4. Gross Motor Development

5. Fine Motor Development

Toddler Development (1–3 years)

Psychosocial Development — Erik Erikson

Stage: Autonomy vs. Shame and Doubt

Tip to Remember:

Support, not shame = self-confidence

Control everything for them = self-doubt

Cognitive Development — Jean Piaget

Transition: Sensorimotor → Preoperational Stage

1. Sensorimotor (Final Substages)

Age Range: 12–24 months

2. Preoperational Stage (Begins ~2 years)

Substage: Preconceptual Phase (2–4 years)

How it all connects:

• Psychosocial (Erikson): “I want to do it myself” = autonomy

• Cognitive (Piaget): “I think the world is all about me” = egocentrism

Social Development of Toddlers (1–3 Years)

1. Attachment & Language

Attachment

Example: Toddler wants to do things alone — “Me do it!” — but still seeks comfort from parent.

Language Development

Key Concepts:

• Comprehension always precedes speech.

• Uses gestures + words to communicate.

• May label body parts, emotions, toys.

• Language develops rapidly, especially with encouragement and conversation.

2. Personal-Social Behavior

Other Traits:

• Strong-willed, easily frustrated

• Affectionate: hugs/kisses parents, pictures, screens (e.g., FaceTime)

• Growing independence in hygiene, dressing, and feeding

3. Play

Type of Play:

• Parallel Play (hallmark of toddlerhood):
  

  • Plays next to but not directly with other children.

  • No cooperation or shared goals.

  • Example: Two toddlers playing with blocks side-by-side but not talking to each other.

Functions of Play:

• Cognitive, social, emotional, and physical development

• Practice of real-life activities (e.g., feeding a doll, talking on toy phone)

Common Toys:

Toy Safety Tips:

• Age-appropriate

• No small parts that can cause choking

• Sturdy and well-maintained

4. Body Image & Sexual Development

Sexual Development

• Begins early (curiosity-driven)

• May touch genitals — often due to normal sensations like needing to pee or itching

• Not sexual in the adult sense — it’s about exploring and awareness

Body Image

• Toddlers begin identifying body parts

• Important to teach accurate names in a calm, age-appropriate way

• Learn that bodies have differences (e.g., boys vs. girls)

• Caregivers should respond to questions honestly but simply

Teaching Tip: Avoid shaming — teach in a positive, factual way. “That’s your penis. Everyone has body parts, and we take care of them.”

Coping with the Toddler (1–3 Years)

1. Toilet Training

Readiness Signs for Toilet Training

2. Temper Tantrums

How to Handle:

• Ignore behavior — no reaction

• Ensure safety — prevent self-harm

• Remain calm — do not reward tantrums with attention

3. Sibling Rivalry

Tips:

• Involve toddler in caring for the baby

• Maintain the toddler’s routine

• Offer one-on-one time

4. Negativism

How to Manage:

• Offer two choices (e.g., “Do you want the red shirt or the blue shirt?”)

• Minimize questions that allow for a “no” answer

• Keep routines predictable

• Stay calm and reassuring

• Give limited control options

5. Stress in Toddlers

6. Regression

7. Fears in Toddlers

Health Promotion of the Toddler (1–3 Years)

1. Nutrition

2. Sleep and Activity

3. Dental Health

• Avoid juice-filled sippy cups and bottle propping at night

• Offer water at bedtime

• Limit juice intake throughout the day

• Fluoride rinses NOT recommended for children under 6 years |

4. Injury Prevention

Toddlers are curious, mobile, and unaware of danger — constant supervision is key!

• Lock away medications and cleaning supplies

• Use child-proof locks and high storage

• Never refer to medicine as “candy”

Preschooler Development (3–5 Years)

Focus:

Proportional Growth, Gross Motor, and Fine Motor Skills

1. Proportional Growth

Weight Gain

Height Gain

• Also increases about 2.5–3.5 inches/year

• Growth is steady but slower than in toddlerhood

• Body proportions become more adult-like (longer limbs, less belly protrusion)

2. Gross Motor Development

• Walks, runs, climbs, jumps confidently

• Rides a tricycle

• Tiptoes, balances on one foot for a few seconds |
  | 4 years |

• Skips and hops well on one foot

• Catches a ball reliably |
  | 5 years |

• Skips on alternate feet

• Jumps rope

• Begins learning to skate and swim |

Note: These skills help prepare them for group sports and physical games by age 4–5.

3. Fine Motor Development

• Copies a circle

• Imitates vertical and horizontal lines

• Holds crayon/pencil with fingers

• Scribbles part of name |
  | 4 years |

• Traces simple shapes

• Builds tower of 9–10 blocks

• Constructs bridges (basic spatial reasoning)

• Laces shoes (but may not tie yet)

• Uses scissors

• Drops small items into narrow containers (refined hand-eye coordination) |
  | 5 years |

• Uses writing/drawing tools well

• Draws more detailed shapes and figures (e.g., basic person, house)

• Writes some letters or name clearly

4. Combination of Gross + Fine Motor

• Preschoolers (4–5 years) show increased coordination:
  

  • Can start participating in sports or team games

  • Engage in group creative tasks (e.g., art projects, building together)

  • Develop both physical confidence and social cooperation

Preschool Development (3–5 Years)

Focus:

Psychosocial & Cognitive Development

1. Psychosocial Development – Erik Erikson

Stage: Initiative vs. Guilt (Ages 3–6)

• They try to help, lead games, ask many questions

• Encouraged when adults support curiosity and do not shame mistakes |
  | Guilt | - Develops if efforts are constantly criticized or restricted

• The child may feel embarrassed or wrong for trying new things

• Leads to hesitancy, fear of failure |

Superego Development (Conscience)

• Around this age, children develop a sense of right and wrong

• Influenced by parental approval/disapproval

• Beginning of moral awareness

Examples:

• A child “cooks” a fake meal and serves it proudly = Initiative

• A child is scolded for spilling during pretend play and stops playing = Guilt

• Child tells on a peer for “being bad” = Superego forming

2. Cognitive Development – Jean Piaget

Stage: Preoperational (2–7 years)

Preschoolers are in the preconceptual phase (ages 2–4) and moving toward intuitive thought phase (ages 4–7)

Key Features:

Additional Features of Pre-operational Thinking:

• Egocentrism: Sees things only from their own perspective.

• Animism: Believes inanimate objects have feelings (“The chair is sad”).

• Transductive reasoning: Connects unrelated events in illogical ways.

• Centration: Focuses on one aspect of a situation at a time (e.g., only the height of a glass, not the width).

Key Teaching Tip for Nurses/Parents:

Use simple explanations, visual aids, and reassurance to help preschoolers understand health or procedures, since their thinking is still based on perception and imagination, not logic.

Social Development of the Preschooler (Ages 3–5)

1. Attachment

Preschoolers are becoming more emotionally secure and independent.

2. Language Development

Language is the primary tool for learning, interaction, and emotional expression.

Key Behavior: Talks constantly, asks endless questions, and narrates play.

3. Personal-Social Behavior

Preschoolers are growing in independence, self-awareness, and social cooperation.

Theme: Social, cooperative, likes to please adults, but still wants control over small decisions.

4. Play

Play is critical to learning and development in preschoolers. It reflects their growing imagination, social skills, and motor abilities.

Play Characteristics:

1. Promotes Motor Skills: Running, jumping, climbing, etc.

2. Imaginative & Dramatic: Pretend play, dress-up, role play (e.g., doctor, superhero).

3. Imitative: Mimics real-life roles (e.g., parent, teacher).

4. Imaginary Friends: Normal and healthy; helps with emotional expression and social practice.

5. Toys: Dress-up dolls, farm sets, kitchen tools, puppets.

6. Media Use: Limit screen time; ensure parental supervision of content.

7. Sharing: Begins to understand the concept of sharing, but may still resist it.

5. Body Image & Sexual Development

Preschoolers develop a growing awareness of their own bodies and differences among people.

Body Image

Sexual Development

Parental Role: Stay calm, use correct terms, and give simple explanations. Avoid shame or punishment.

Coping with the Preschooler (3–5 Years)

1. School Experience

Preschool is a key step in developing social, emotional, and academic readiness.

Key Aspects:

5 R’s of Early Brain & Child Development (AAP Recommended):

Goal: Support a child’s confidence and curiosity as they enter structured learning environments.

2. Sex Education

3. Aggression

Aggression can be normal or problematic, depending on context and frequency.

• Modeling (imitating aggressive adults/peers)

• Reinforcement (aggression is rewarded or ignored) |
  | Management | - Address root cause (e.g., frustration, modeling)

• Seek parenting support or professional help if persistent/aggressive behaviors escalate |

4. Speech Problems

Speech development is rapid in preschool years, but some problems are common.

5. Stress and Fears

Preschoolers experience emotional stress, often tied to growing independence and social exposure.

Signs of Stress (by Age):

• Possessiveness (belongings)

• Jealousy

• Separation anxiety

• Mealtime/Naptime battles

• Destructive behavior |
  | 4 years | - Insecurity

• Desire for companionship

• Exploration of sex/gender roles

• Activity overload

• Fearfulness

• Craving attention |
  | 5 years | - Desire for approval

• School-related worries

• Tendency to procrastinate

• Possessiveness over items

• Engaging in name-calling

• Increased worrying |

Management Strategies:

Health Promotion of the Preschooler (3–5 Years)

1. Nutrition

Tip: Keep offering a variety of foods even if rejected at first—exposure leads to acceptance.

2. Sleep and Activity

• Nightmares: Frightening dreams that wake the child (child is alert, may remember).

  • Example: A child wakes up crying after dreaming about monsters.

• Night Terrors: Occur in deep sleep, child may scream, thrash, appear awake but is not fully conscious (won’t remember the event).

  • Example: A child sits up screaming and sweating but doesn’t respond when called. |

| Sleep Rituals | Establish a consistent bedtime routine: bath, story, cuddle time. Helps ease transitions and reduce sleep anxiety. |

3. Dental Health

4. Injury and Safety Prevention

Preschoolers are active, imaginative, and often unaware of real dangers.

Key Risk Areas and Examples:

Growth and Development: School-Age Child (6–12 Years)

1. Biological Development

Proportional Growth

• May begin orthodontic evaluation if needed |
  | Sleep | Needs about 10–12 hours per night |
  | Gender Differences | Girls grow faster than boys during this stage (typically begin puberty earlier) |

2. Maturation of Body Systems

Gastrointestinal (GI) System

• Improved glucose regulation

• Caloric needs remain high, but appetite may decrease slightly compared to earlier years

Renal System

• Bladder capacity increases

• Improved control over urination and elimination

Cardiovascular System

• Heart growth slows but continues steadily

• Vital signs stabilize to near-adult ranges:
  

  • Heart rate and respiratory rate decrease

  • Blood pressure increases slightly

Immune System

• Gains greater competence and memory response

• Fewer infections compared to toddler/preschool age

Musculoskeletal System

• Bones grow longer and stronger

• Mineralization of bones increases (calcium important)

• Growth spurts may lead to awkward movements or “growing pains”

Sexual Maturity

• Period of transition (no fixed age)

• Appearance of some secondary sex characteristics (e.g., breast budding in girls, testicular enlargement in boys)

• Highly variable — age of onset differs significantly by child |

Note: There is no universal age to assume full sexual maturity characteristics — development is highly individual.

Psychosocial & Cognitive Development: School-Age Child (6–12 Years)

1. Psychosocial Development – Erik Erikson

Stage: Industry vs. Inferiority

• The child begins to feel a sense of accomplishment through schoolwork, sports, art, and friendships.

• Wants to learn, produce, and succeed.

• Enjoys completing tasks and receiving praise or recognition.

• Gains confidence when encouraged to set and reach goals.

Example: Child feels proud after learning to ride a bike or finishing a science project.

| Inferiority |

• Develops when the child fails to achieve success or is overly criticized, especially by adults or peers.

• May feel incompetent, doubt abilities, or withdraw from challenges.

Example: A child who constantly hears “you’re not good at this” may stop trying altogether.

Goal for Caregivers: Encourage effort and celebrate small achievements, not just outcomes.

2. Cognitive Development – Jean Piaget

Stage: Concrete Operational (Ages ~7–11)

Example: Understands that if you pour the same amount of water into a tall glass, it still has the same volume. |

| Understanding Relationships | Recognizes cause and effect, sequencing, and classification.

Can categorize objects, understand time and space, and grasp simple math operations. |

| Perspective-Taking | Starts to understand others’ feelings and viewpoints (decreased egocentrism).

Important for developing empathy and building friendships. |

Educational Tip: School-age children are ready for hands-on learning, experiments, and tasks with clear steps and explanations.

Social Development: School-Age Child (6–12 Years)

1. Developing a Self-Concept

Example: A child who hears “You’re good at drawing” may develop confidence in their creative skills.

2. Body Image

Nurse Tip: Promote body positivity and focus on health rather than appearance.

3. Sexual Development

Nurse’s Role in Sexual Education:

Sex Education Guidelines:

• Respect natural curiosity at this age

• School-age years are an ideal time to start formal sex education

• Emphasize lifespan education — not a one-time “talk”

• Teach correct terms, boundaries, consent, and self-respect

4. Play

School-age children’s play is more structured, skill-based, and social.

Summary: School-age play promotes physical development, cognitive growth, social skills, and emotional regulation.

Health Promotion: School-Age Child (6–12 Years)

1. Nutrition

• Appetite more stable and predictable |
  | Fast Food | High risk of excess calories, fat, and sodium. Encourage home-cooked meals and portion awareness. |

Tip: Teach the importance of nutrient-rich foods to support bone growth and immunity (e.g., calcium, iron, protein).

2. Sleep and Rest

Key Sleep Behaviors:

• Sleep needs are individualized and may vary

• Ages 8–11 may resist bedtime (want independence, busy schedules)

• By 12 years, children become less resistant to bedtime as routines are established

Tip: Maintain consistent routines and reduce screen time before bed.

3. Injury Prevention

School-age children are more active, curious, and take greater risks, often without fully understanding consequences.

Why Injuries Occur:

Common Risks & Prevention Tips:

Nurse/Parent Role: Teach safety skills, use protective equipment, and model safe behavior.

Adolescent Development (Ages 11–20)

Biological Development

1. Stages of Adolescence

2. Neuroendocrine Regulation of Puberty

3. Puberty: Sexual Maturation

Onset:

• Girls: 9–13.5 years

• Boys: 9.5–14 years

• Highly individualized — influenced by genetics, nutrition, health, and environment.

First Signs of Puberty:

4. Tanner Stages of Sexual Maturity (SMR)

Tanner Stages describe the progression of puberty in both boys and girls. There are 5 stages for breasts, genitals, and pubic hair.

Girls – Tanner Stages: Breast Development (Thelarche)

Girls – Pubic Hair

Boys – Tanner Stages: Genital Development

Boys – Pubic Hair

(Same as girls in terms of stages)

5. Adolescent Growth

6. Body System Maturation

Respiratory System

• Increased lung size and vital capacity

• Boys may experience voice deepening due to laryngeal changes

Cardiovascular System

• Heart size and strength increase

• Blood pressure increases (SBP)

• Resting heart rate decreases

Neurological System

• Ongoing brain development, especially frontal lobe (judgment, decision-making)

• Emotional control still developing — contributes to risk-taking

7. Motor Skills

Adolescent Development (11–20 Years)

Psychosocial & Cognitive Development

1. Psychosocial Development – Erik Erikson

Stage: Identity vs. Role Confusion

Phases of Identity Formation

• Puberty begins

• Changes in self-concept due to body image and comparison with peers

• Mood swings, fantasy life, daydreaming common

• Needs clear limits and consistent structure

Example: Feels insecure about body changes and needs reassurance.

| Middle Adolescence (15–17) |

• Begins separating from parents emotionally

• Defines personal values, beliefs, strengths, and weaknesses

• Identifies more with peer group than family

Example: Starts exploring different social groups or activities to “find their tribe.”

| Late Adolescence (18–20) |

• Gains greater independence

• Chooses career/vocation

• Develops own morality separate from parents

• Achieves a clear identity and may form mature relationships

Example: Applies to college, identifies life goals, forms serious romantic partnerships.

2. Cognitive Development – Jean Piaget

Stage: Formal Operational Thought (Begins ~11 years)

Example: A teen may understand global issues, form opinions on social justice, but still make impulsive personal decisions.

Adolescent Development (11–20 Years)

Social Development & Health Promotion

1. Social Development: Play & Recreation

2. Technology as a Social Environment

Risks of Technology Use:

• Cyberbullying: Harassment through social media or messaging

• Online predators

• Distraction while driving (texting, using apps)

• Mental health impacts: Anxiety, self-esteem issues from social comparison

Nurse Tip: Teach digital safety, responsible posting, and healthy screen limits.

3. Health Concerns in Adolescence

Adolescence is a critical period for developing long-term health habits and addressing emerging risks.

4. Health Promotion: Nutrition & Injury Prevention

Nutrition

Injury Prevention

Adolescents are natural risk-takers due to incomplete brain development (frontal lobe). Common injuries can be intentional or unintentional.

Nurse/Parent Role: Encourage open communication, model healthy behaviors, and provide nonjudgmental guidance.

Health Promotion & Common Pediatric/Adolescent Health Conditions

1. Skin Conditions

Scabies

• Cause: Female mite burrows into skin, lays eggs & feces.

• Symptoms:

  • Intense pruritus, especially at night

  • Inflamed lesions, excoriations

  • Symptoms appear 30–60 days post-exposure

Treatment:

• Topical:

  • Permethrin 5% cream (apply neck-down, repeat in 1 week)

  • Lindane (less preferred due to neurotoxicity)

• Oral:

  • Ivermectin (if >15 kg)

Nursing Considerations (List)

• Treat all close contacts

• Wash bedding/clothing in hot water

• Bag unwashable items for 72+ hours

• Keep nails short (prevent reinfection)

• Apply meds as prescribed, avoid face/eyes unless directed

• Educate on itching continuing after treatment (from inflammation, not live mites)

Pediculosis Capitis (Head Lice)

• Common in school-age children

• Lice live 48 hours off scalp; females live 30 days

• Nits (eggs) laid at base of hair shaft

• Hatch in 7–10 days

Treatment:

• Pediculicides (permethrin 1%)

• Manual nit removal

• Treat environment (wash items, vacuum)

• Recheck hair in 7–10 days

2. Elimination Disorders

Enuresis (Bedwetting)

• Definition: Urinating in bed twice/week for ≥3 months after age 5

• Types:

  • Primary: never had nighttime dryness

  • Secondary: returns after being dry

  • Nocturnal: night

  • Diurnal: day

Causes:

• Organic: UTI, structural defects, diabetes, sickle cell, small bladder

• Psychological: stress, trauma

Evaluation:

• Physical exam

• Bladder diary

• Psych eval if stress suspected

Management:

• Conditioning therapy (enuresis alarms)

• Bladder training

• Medications:

  • Tricyclic antidepressants (Imipramine)

  • DDAVP (desmopressin)

  • Antispasmodics

• Just wait it out method (maturity resolves it)

Encopresis (Fecal Soiling)

• Definition: Soiling 1x/month for 3+ months in child ≥4 years

• More common in boys

• Often follows stress, constipation, impaction

Symptoms:

• Abdominal pain, nausea, decreased appetite

• Palpable fecal mass

• Soiling with strong odor, social withdrawal

Management:

• Rule out organic causes

• Psychotherapy

• Dietary changes (high fiber)

• Fecal evacuation: laxatives, enemas

• Stool softeners

• Bowel training

3. Acne Vulgaris

• Affects >50% of adolescents

• Causes:

  • Genetic

  • Hormonal (puberty-related)

  • Diet, hygiene, stress

• Psych Impact: self-esteem issues

Patho:

• Involves hair follicles + sebaceous glands

• Formation of comedones (blackheads/whiteheads)

Treatment:

• General skin care

• Topical retinoids, benzoyl peroxide, antibiotics

• Oral antibiotics, isotretinoin for severe cases

Nursing Considerations:

• Educate about long-term therapy

• Avoid harsh scrubbing

• Encourage psych support

4. Reproductive Health

Male Concerns

Female Concerns

5. Sleep Problems in Toddlers/Preschoolers

Communicable Diseases in Children

1. Varicella (Chickenpox)

Causative Agent: Varicella-Zoster Virus (Herpesvirus)

Transmission: Contact & droplet precautions

Incubation Period: 2–3 weeks (usually 14–16 days)

Period of Communicability:

• 1 day before lesions erupt until all lesions are crusted over

Symptoms:

• Macule → papule → vesicle → crust

• Itchy rash, fever, malaise, loss of appetite

Nursing Considerations:

• Isolate infected child

• Provide skin care – keep skin clean/dry

• Change linens daily

• Keep child cool – avoid overheating

• Apply pressure instead of scratching (to avoid secondary infection)

• Keep nails trimmed and consider mittens if child scratches

2. Fifth Disease (Erythema Infectiosum)

Causative Agent: Human Parvovirus B19

Transmission: Respiratory secretions, blood

Incubation Period: ~4–14 days

Rash Stages:

1. “Slapped cheek” facial redness (fades in 1–4 days)

2. Maculopapular rash on arms/legs (proximal → distal) for 1+ week

3. Rash reappears with heat, trauma, irritation

Treatment:

• Supportive care: antipyretics, analgesics

• No isolation necessary once rash appears

Special Precautions:

• Pregnant women exposed during 1st trimester have a low risk of fetal complications (e.g., hydrops fetalis) — advise medical follow-up

3. Exanthem Subitum (Roseola Infantum)

Causative Agent: Human Herpesvirus Type 6 (HHV-6)

Common Age: 6 months–3 years

Presentation

• Sudden high fever (can trigger febrile seizures)

• Fever drops abruptly → rash appears

  • Rash begins on trunk, spreads to face and extremities

  • Non-pruritic, pink macules or maculopapules

Treatment:

• Supportive care only

  • Antipyretics for fever

  • Encourage fluids and rest

4. Scarlet Fever

Causative Agent: Group A beta-hemolytic Streptococcus (GABHS)

Incubation Period: 2–4 days (range 1–7 days)

Period of Communicability:

• During incubation and until 24–48 hours after starting antibiotics

Symptoms:

• High fever, headache, vomiting, abdominal pain, malaise

• “Strawberry tongue” (white coating sloughs off to red, swollen papillae)

• Enlarged tonsils, may be covered with exudate

• Bright red pharynx

Rash (Exanthema):

• Appears within 12 hours of prodrome

• Feels like sandpaper, starts in groin, axilla, neck, then spreads

• Desquamation (peeling) of hands/feet occurs during recovery

Treatment:

• Antibiotics (usually penicillin or amoxicillin)

• Bedrest, fluids, analgesics during febrile phase

• Follow-up for throat culture or repeat evaluation

Complications:

Prevention: Early treatment of strep throat reduces complication risk

Non-Vaccine Communicable Diseases & Related Health Condition

1. Conjunctivitis (“Pink Eye”)

Nursing Care:

• Infection control: hand hygiene, no school for 24 hrs after antibiotic starts

• Wipe secretions inner canthus → outward, away from unaffected eye

• Follow medication regimen exactly

2. Aphthous Stomatitis (Canker Sores)

• Benign, but painful oral ulcers

• Onset often triggered by trauma or stress

• Duration: 4–12 days

3. Herpetic Gingivostomatitis (HSV-1)

• Duration: 5–14 days |
  | Recurrent | Cold sores on lips

• Triggered by stress, trauma, or sunlight |

4. Stomatitis – General Management

• Pain management: topical anesthetics, antihistamines

• Encourage soft foods, use of straws

• Monitor for dehydration

• Prevent autoinoculation (spreading to eyes or genitals)

5. Intestinal Parasites

Giardiasis

• Most common intestinal parasite

• Spread via fecal-oral route (daycare, water, animals)

• Symptoms: Diarrhea, cramps, vomiting, anorexia, FTT, loose stools alternating with constipation

Diagnosis:

• Stool samples (x3)

• EIA, ELISA, DFA

Treatment:

• Flagyl (metronidazole)

• Furoxone (furazolidone)

• Albenza (albendazole)

Pinworms (Enterobiasis)

6. Ingestions & Poisoning

High-Risk Household Items

Treatment Principles:

1. Treat the child, not the poison

2. Stop exposure

3. Identify substance

4. Prevent absorption

Interventions:

• Mucomyst (acetaminophen)

• Naloxone (opioids)

• Digibind (digoxin)

• Flumazenil (benzodiazepines)

Education:

• Call Poison Control (before home treatments)

• Prevention: cabinet locks, childproofing, proper labeling

7. Lead Poisoning

Pathophysiology:

• Lead is stored in bones, teeth, brain, liver, and erythrocytes

• Affects:
  

  • Hematologic system (anemia)

  • Renal system

  • CNS (neurotoxicity, behavioral problems, ↓ IQ)

Screening & Diagnosis:

• Capillary BLL for screening only

• Venous blood draw for confirmation

• Universal screening at 1–2 years old

• BLL ≥10 mcg/dL: clinical concern

• BLL ≥20: requires environmental investigation

• BLL ≥45: needs chelation therapy

Chelation Therapy:

• Dosing: 10 mg/kg TID for 5 days → BID for 14 days |
  | EDTA (Calcium disodium EDTA) | IV/IM; used with BAL if BLL >70 |
  | BAL (Dimercaprol) | Deep IM, not for use with peanut allergy or G6PD deficiency |
  | Rebound effect | Stored lead can re-enter bloodstream after chelation |

Nursing Education:

• Anticipatory guidance, follow-up, environmental control

• Education about hidden sources of lead (paint, toys, soil)