PEDS exam 1

Infant Development and Health

Causes of Infant Death

  • Most common cause of death in infants: Positional asphyxiation.

Age-Related Task Abilities

  • 2 Months:

    • Grasp reflex begins to fade.

    • Infants can hold their head up when placed in a prone position.

    • Vision primarily black and white for the first 1-2 months.

    • Head circumference increases by approximately 1.5 cm per month (about half an inch).

  • 6 Months:

    • Infants can roll from a front to back position (prone to supine).

    • Capable of holding a bottle.

    • Begins to use a pincer grasp, significant development noted by 8 months.

    • Recognizes their own name.

  • 8-10 Months:

    • Develops a crude pincer grasp.

    • Can pull themselves across the floor (crawling).

    • Growth rate of approximately 2.5 pounds per month from 8-12 months.

  • 12 Months:

    • Infants can stand alone.

    • Walks while holding furniture (referred to as cruising).

    • Engages in activities like playing patty cake.

    • First visit to the dentist recommended.

    • Weaning off the bottle should begin at this stage.

    • Closure of the posterior fontanelle.

  • 1-2 Years:

    • Capable of scribbling on paper.

    • Attempts to run.

    • Can climb stairs.

    • May push shopping carts.

    • Closure of the anterior fontanelle typically occurs.

  • 2-3 Years:

    • Can draw a circle.

    • Ability to kick a ball.

    • Interest in activities such as martial arts.

    • Transition to drinking 2% milk.

    • Should be introduced to varied food groups.

    • Engages in parallel play.

    • Transition to forward-facing car seat.

    • At 2 years, children may say "no" to assert control (Erik Erikson's theory).

  • 3-4 Years:

    • Sleep duration of 9-11 hours per night.

    • Typically only requires 1 nap during the day.

    • Gains between 3-5 pounds per year.

    • Grows 1-1.5 inches per year.

Adolescent Health Considerations

  • Hormonal Fluctuation Risks: Increased risk of suicide during hormonal changes.

  • Reflective Listening: Important therapeutic technique.

  • Ortolani Movement: Clinical test used for detecting Developmental Dysplasia of the Hip (DDH), identified by a click sound when hip is dislocated.

Physical and Cognitive Milestones in Childhood

  • Breast Development: Occurs over 4-4.5 years, progressing from sexual maturity stages 2 to 5.

  • Growth Spurts: Height velocity begins to increase about 6 months before the onset of breast development.

  • Menstruation Onset: Occurs around stage 4 of breast development, approximately 1 year after peak height velocity.

  • Skills Development (Common by Age 5-6):

    • Ability to use scissors.

    • Learning to button clothes.

    • Brushing teeth.

    • Using a spoon for eating.

    • Throwing a ball overhand.

    • Learning basic letters and numbers.

  • Ages 7-10 Years:

    • Capable of repeating back instructions.

    • Recommended sleep: 8-10 hours.

    • Should develop the habit of flossing teeth.

    • Losing baby teeth begins during this age.

    • All immunizations should be completed by age 11.

    • Children underweight should remain in booster seats until 10-12 years old.

  • Adult Mental Health Statistics (By Age 18):

    • 1 out of 6 young adults experience intimate partner violence.

    • Importance of depression screenings mentioned.

Reflexes Assessed at Birth

  • Moro Reflex: Startle response seen in infants.

  • Babinski Reflex: Neurological reflex where the big toe moves upward and other toes fan out when the sole of the foot is stroked; typically observed in infants up to 2 years. In adults, this may indicate neurological injury.

  • Rooting Reflex: Reflex action where the baby turns its head and opens its mouth when the corner of its mouth or cheek is stroked, indicating readiness to feed.

Pain Assessment Scales

  • FLACC (Face, Legs, Activity, Cry, Consolability): Used for assessing pain in nonverbal patients, specifically infants and children aged 2 months to 7 years.

  • FACES: Pain assessment tool for children 3 years and older.

Tanner Stages of Sexual Maturity Development

Girls:

  • Genital Development: Occurs over 4.5 years across stages 2 to 5, with testicular development preceding penile growth.

  • Pubic Hair Development: Typically occurs over 3.5 years, usually following breast development.

  • Facial and Axillary Hair: Development begins about 2 years after the onset of pubic hair growth.

  • Voice Change: Most significant changes occur between genital stages 3 and 4.

  • Onset of Ejaculation: Generally begins at genital stage 3.

  • Growth Spurts: Occurs over 4-5 years, with the highest rate of height increase observed in the first 2-3 years, peak height velocity falls between genital and pubic stages 3 and 4.

Boys:

  • Developmental shifts: Boys begin to care more about their peers’ opinions than their parents once they reach puberty.

Counseling Techniques

  • Motivational Interviewing: A collaborative, goal-oriented, and person-centered counseling style designed to enhance personal motivation toward behavioral change.

Concept Definitions

  • Cognitive Development: Refers to the ways individuals think and process information.

  • Development: Concerns how children function and reach milestones.

  • Maturity: Refers to behavioral aspects of growth and development.

  • Failure to Thrive: A condition where infants fall significantly behind in weight, height, or rate of weight gain compared to standards for their age and sex.

  • Retractions: Clinical sign indicating possible respiratory distress, characterized by the inward pulling of skin, muscles, and soft tissues around the ribs, sternum, or neck during inhalation.

  • Milk Consumption Risks: Excessive milk intake can inhibit iron absorption due to calcium, leading to anemia.

Erikson's Stages of Psychosocial Development

  1. Trust vs Mistrust: Birth to 18 months.

  2. Autonomy vs Shame and Doubt: 18 months to 3 years.

  3. Initiative vs Guilt: 3 to 5 years.

  4. Industry vs Inferiority: 6 to 11 years.

  5. Identity vs Role Confusion: 12 to 18 years.

  6. Intimacy vs Isolation: 19 to 40 years.

  7. Generativity vs Stagnation: 40 to 65 years.

  8. Integrity vs Despair: Age 65 and above.

Piaget’s Theory of Cognitive Development

  • Sensorimotor Stage (Birth to 2 years): Infants learn about the world through their senses and motor actions, and develop object permanence.

  • Preoperational Stage (2 to 7 years): Characterized by the development of language and symbolic thinking, with struggles in taking others' perspectives and logical reasoning.

  • Concrete Operational Stage (7 to 12 years): Emergence of logical thinking, ability to understand conservation and reversibility.

  • Formal Operational Stage (12 years and older): Adolescents develop the ability to think abstractly, reason hypothetically, and employ deductive reasoning.

Maslow’s Hierarchy of Needs

  1. Physiological Needs: Basic survival essentials such as food and water.

  2. Safety Needs: Security in personal, financial, emotional, and health aspects.

  3. Love and Belonging Needs: Importance of social relationships.

  4. Esteem Needs: Needs for self-esteem, recognition, and achievement by self and others.

  5. Self-Actualization: The pursuit of personal growth, creativity, and fulfilling one’s potential.

Infant Vitals

  • Temperature: Normal range is between 36.1-37.2°C (97-99°F).

  • Pulse Rates:

    • Newborn (birth to 4 weeks) : 110-160 bpm.

    • Infant (1-12 months): 90-160 bpm.

    • Toddler (1-2 years): 80-140 bpm.

    • Preschooler (3-5 years): 70-120 bpm.

    • School aged (6-12 years): 60-110 bpm.

    • Adolescent (13-18 years): 50-100 bpm.

  • Respiratory Rates:

    • Newborn: 30-60 breaths/min.

    • Infant: 25-60 breaths/min.

    • Toddler: 25-30 breaths/min.

    • Preschooler: 20-25 breaths/min.

    • School aged: 20-25 breaths/min.

    • Adolescent: 16-20 breaths/min.

  • Oxygen Saturation: Should be equal to or above 95%.

  • Blood Pressure: Routine measurements should begin at age 3 years.

Childhood Immunizations Schedule

  • At Birth: Hepatitis B.

  • 2 Months: DTaP (diphtheria, tetanus, and pertussis), RV (rotavirus), IPV (polio), Hib, PCV (pneumococcal conjugate vaccine).

  • 6 Months: DTaP, IPV (6-18 months), PCV, Hep B (6-18 months), RV, Hib.

  • 6-12 Months: Seasonal flu vaccination annually.

  • 12-15 Months: IPV (third dose), Hib, PCV, MMR (measles, mumps and rubella), Varicella (chickenpox).

  • 12-23 Months: Hepatitis A (administered in 2 doses at least 6 months apart).

  • 15-18 Months: DTaP.

  • 4-6 Years: DTaP, MMR, Polio.

  • 11-12 Years: Tdap, HPV, Meningococcal vaccine.