Age groups and milestones Flashcards
Caloric requirements: birth to 6 months–
120 kcal/kg/day
Caloric requirements: 7 mo to 1 year–
100 kcal/kg/day
Caloric requirements: 2 yo to 10 yo:
70 to 100 kcal/kg/day
Caloric requirements: Adolescents (greater than 10)
45 kcal/kg/day
Breastfeeding during painful procedures provides _______
analgesia
The longer the mother breastfeeds, the ____ chance of the child to be overweight independent of education and socioeconomic status.
Less
How is adequate nutrition confirmed in infants?
Weight gain
Within the first three months of life, there should be weight gain of __ g/day
30 grams/day equivalant to 1 oz/day
After the first three months, the NEXT three months should have weight gain of __ to __ g/day
15 to 20 grams/day
For infants that are exclusively breast fed, when should you start Vitamin D supplementation? What is the dose?
Should start at 2 months and continue throughout adolescence. The does is 400 IU/day
For exclusively breastfed infants, when should iron supplementation be started? What is the dose? Where does the iron typically come from?
Iron is started after 6 months of age. The dose is 1 mg/kg/day. The iron typically comes from fortified cereals.
What is the accepted amount of initial weight loss following birth?
10%
The first initial weight loss is typically regained within __ to __ days?
7 to 14 days
The infants weight should double by ___ months
Five
The infants weight should triple by ___ months
12
The infants weight should quadruple by ___ years of age
2
How much weight should three-year-olds through school-aged children gain?
4 to 6 pounds a year
School aged children should gain how many pounds annually?
5-7 lbs./year
Primary teeth eruption begins at ___ months and lasts until ___ months:
6 months
24 months
Permanent tooth eruption begins at __ years and ends at __ years
6 years
13 years
Tooth eruption mnemonic: Come Little Children Munch Meat — is used for primary teething. What is the order at which you would expect to see tooth eruption?
Central Incisor Lateral Incisor Cuspid First Molar Second Molar
What is the order in which the permanent teeth erupt?
Central Incisor (6 to 8 years) Lateral Incisor (7-9 years) Cuspid (9-12 years) First Bicuspid (10-12 years) Second Bicuspid (10-12 years) First Molar (6 to 7 year) Second Molar (11-13 years)
What nursing theorists concentrated on sensorimotor stages and what the brain knows?
Jean Piaget
Sensorimotor stage: ____ to __ years
Birth to 2 years
In the sensorimotor stage, infants rely on their _______ _______.
Primitive reflexes
Preoperational/Preconceptual Stage: Ages __ years to __ years. This phase focuses on ________.
2 years to 4 years old
Fantasy
Piaget: Intuitive/Preoperational thinking: ___ years to __ years. This is the beginning of __________.
4 - 7 years
Causation
Concrete thinking (Piaget) is ages ___ to ___. Provide an example of concrete thinking.
7 to 11 years
Memorization
Formal operational thought (Piaget) is ages __ to __ years. Children in this stage are capable of _____ conclusions.
11 - 15 years
Logical
Erikson’s stages: infancy
birth to 1 year
Trust vs. Mistrust
Erikson’s stages: Toddler
1 - 3 years
Autonomy vs. Shame/doubt
Erikson’s stages: Preschool
3 to 6 years
Initiative vs. Guilt
Erikson’s stages: School age
6 to 12 years
Industry vs. Inferiority
Erikson’s stages: Adolescence
12 to 18 years
Identity vs. Role confusion
Freud: Principle of pleasure:
Id
Freud: Principle of reality/self-interest
Ego
Freud: Principle of morality/conscience
Superego
According to Freud, what stage are infants in?
Oral stage
Birth to 6 months, Freud says infants are what?
Orally passive
7 to 18 months, Freud says infants are?
Orally aggressive (teething, oral satisfaction)
Freud: What stage are toddlers in? (1.5 - 3 years)
Anal
Freud: Preschoolers (3 - 6 years old) are in this stage:
Phallic stage (love opposite sex, Oedipal complex)
Freud: School age children (6 to 12 years) are in this stage:
Latency stage
Freud: Adolescence (12 to 18 years) are in this stage:
Genital Stage
What is the adjustment of developmental expectations for premature infants through the age of 2 years?
Corrected gestational age (CGA)
Head circumference is measured until what age?
2 years old
When do you begin measuring body mass index (BMI)?
2 years old
What is the equation for body mass index?
weight (kg) / height (m) squared
Generalized assessment tool used from birth to 6 years of age that measures: gross motor development, fine motor development, language, and personal/social development.
Denver II
When does the infant have good head control?
2-3 months
When does the infant roll back to front?
5 to 6 months
When does the infant sit alone?
7 months
When does the infant pull to stand?
9 to 10 months
When does the infant stand alone?
11 to 12 months
When does the infant walk?
12 to 14 months
When does the infant walk up and down stairs?
22 to 24 months
When does does the infant jump?
24 to 48 months
When can the infant grasp and shake a rattle?
2 to 3 months
When can the infant reach for objects?
3 to 4 months
When can the infant complete hand-to-hand transfer?
5 to 6 months
When can the infant perform a raking grasp?
6 to 7 months
When can the infant perform a finger grasp?
7 to 9 months
When do you see the pincer grasp?
8 to 10 months
When can the infant mark on paper?
10 to 12 months
When can the infant stack 3 blocks?
17 to 18 months
When can the infant stack 6 to 7 blocks?
22 to 24 months
When can the infant smile and coo?
2 to 3 months
When can the infant laugh?
4 to 5 months
When can the infant babble?
5 to 6 months
When does the infant say “mama-dada”
8 to 9 months
When can the infant wave bye-bye?
8 to 9 months
When does the infant understand “No”
9 to 10 months
When does the infant point to body parts?
15 to 18 months
When can the infant form 2-word sentences?
18 to 22 months
When does the infant have a 30 to 50 word vocabularly?
22 - 24 months
Children should remain in a backward facing carseat until what age?
12 months
All children under the age of __ years or __ pounds must be in a car seat.
4 years
40 pounds
What is the dose for IM vaccines typically?
0.5 mL
Vaccine intervals need to be at least __ weeks apart?
6 weeks
HBV: when is the first dose? Second dose? Third dose?
First dose after birth before discharge
Second dose: 2 months
Third dose: 6 months
If an infant is born to a hepatitis B positive mother, what should happen in addition to receiving the HBV?
Hepatitis B immunoglobulin within 12 hours of birth
If the mother’s hepatitis status is unknown then what happens?
Patient receive hepatitis B within 12 hours of birth, if mom tests positive, HBIG should be given no later than 1 week of age
Rotavirus is a series of __ vaccines given from __ weeks to __ weeks.
3
6 to 36 weeks
You do not give Rotavirus after 8 months due to the increased risk of what?
Intussusception
DTaP is a series of ___ vaccines
3 vaccines
DTaP is not indicated for children greater than __ years old.
7
Tdap is a series of _ vaccine(s) given at age __ with recommended boosters every __ years.
1 vaccine given at age 11 with booster given every 10 years
Hib is a series of __ vaccines given at what ages?
3 vaccine series given at 2, 4, and 6 months
When should you receive a Hib booster?
12 months
Hib is not recommended for children greater than __ years old?
5 years
Pneumococcal vaccine is a series of __ vaccines, given at what ages? When do you get the booster?
3 vaccine series given at 2, 4, and 6 months with 1 booster at 12 months
If a child has special disease processes, such as splenic dysfunction or HIV, they should receive an additional pneumococcal vaccine at ___ months
24 months
IPV is a series of __, given at:
4
2, 4, 6 months and 6 years
When do you begin the annual flu shot for infants?
6 months
What is the dose for influenza vaccine for children aged 6 to 35 months?
0.25 ml
When do children get the full 0.5 mL vaccine?
3 years
Children younger than __ years receive __ doses 1 month apart
9 years receive 2 doses
MMR vaccine: Series of __ given when? What is the EARLIEST age of administering MMR?
2 vaccine series
given @ 12 months and 12 years
6 months, but will still need dose @ 12 months
Varicella is a series of __ given when?
2, 2 doses between 12 months and 12 years
What vaccine is typically avoided when giving MMR?
Varicella
HAV- _ dose series given between __ months and __ months with a minimum interval of __ months.
2 dose series given between 12 months and 24 months with a minimum 6 month interval
Meningococcal vaccine: series of __ given at age __ with a booster at the age of __.
2 vaccine series given at age 11 or 12 with a booster given at age 16.
When is the earliest you can receive the HPV vaccine?
9 years but recommended at 11 or 12 years
If you receive the HPV vaccine before the age of __ it is a 2 dose series, otherwise it is a 3 dose series.
15 years
What are reportable events that should be reported to the vaccine adverse events reporting system (VAERS)?
Anaphylaxis
Encephalitis
Death
What percent of genetic defects are identified before the age of 6 months?
80%
When obtaining a pedigree history (genogram), how many generations should be included?
Three
This genetic disorder occurs in 1:660 births and has an association with increased maternal/paternal age with retardation ranging from mild to severe.
Trisomy 21
These findings indicate what genetic disorder: Eyes set wider apart than usual, protruding tongue, single palmar crease, hypotonia, and Brushfield spots?
Trisomy 21
Klinefelter’s syndrome is seen only is ____ and is caused by an extra ___ chromosome.
males
X
Klinefelter’s syndrome occurs in every 1: _____ births
1:1000
Klinefelter’s syndrome is the most common cause of ___________ and _________ in men.
Hypogonadism
Infertility
These phenotypical manifestations exhibit what genetic disorder? Tall stature, gynecomastia, learning disability, personality impairment
Klinefelter’s syndrome
_____ Syndrome is the most common sex-chromosome anomaly seen in females.
Turner’s Syndrome
Turners syndrome occurs in ever 1:_____ births
1:2,000
These findings indicate what genetic disorder?
Webbed neck, “shield” shaped chest with widely spaced nipples, hypertension, and bicuspid aortic valve/coarctation of the aorta?
Turner’s Syndrome
Inherited connective tissue disorder affecting skeletal, cardiac, and ophthalmic body systems which occurs in 1:20,000 births.
Marfan Syndrome
These phenotypical presentations indicate what genetic disorder? Arm span exceeds height, hyperextension of joints, kyphoscoliosis, aortic aneurysms, ectopia lentis and iridonesis
Marfan Syndrome
This genetic disorder is found in Ashkenazic Jewish population and occurs in 1:2,500 births
Tay-Sachs Disease
What is the biggest red flag to warrant testing for Tay-Sachs disease?
Decreased muscle tone. Will learn to crawl then stops with arms/legs laid out
Tay-Sachs disease is a ______ disease leading to death
progressive
These are typical manifestations of what genetic disorder? Decreased muscle tone, cherry red macula, blindness, deafness, seizures, dementia, death
Tay-Sachs disease
Congenital defect of the parathyroid glands, thymus, and the conotruncal region of the heart?
DiGeorge (Velocardiofacial) Syndrome
In DiGeorge syndrome, there is an increase susceptibility to _______ due to thymus aplasia.
Infection
DiGeorge syndrome has significant neonatal morbidity and mortality associated with ____ defects.
Cardiac
DiGeorge syndrome reveals [hypo/hyper] parathyroidism with [hypo/hyper] calcemia
hypoparathyroidism
hypocalcemia
Low birth weight is defined as:
Less than 2,500 g
Very low birth weight is defined as :
less than 1,500 g
Extremely low birth weight (ELBW) is defined as:
less than 1,000 g
Appropriate for gestational age (AGA): between __ and __ percentile.
10-90%ile
Large for gestational age (LGA):
greater than 90%ile
Small for gestational age:
less than 10%ile
when are APGARs calculated?
1 and 5 minutes
Prematurity is defined as being born before __ weeks
37
Congenital growth disorder shown by hemihypertrophy, large organs, and other symptoms
Bewith-Wiedemann Syndrome
Fatal condition defined as an abnormal accumulation of fluid in two or more fetal compartments
Hydrops fetalis
Normal newborn heart rate:
120 to 170 BPM
Normal newborn respiration rate:
30-80 breaths per minute
Pinpoint white papules on face, prominent on cheeks, nose, chin, and forehead that spontaneously disappear within 3-4 weeks of life
Milia
Obstructed sweat (eccrine gland) ducts; sometimes referred to as “prickly heat”
Miliaria
Most common newborn rash; usually appears between days 2 to 5 after birth; characterized by blotchy red spots on the skin with overlaying white or yellow papules or pusutues; resolves by the 14th day
Erythema toxicum
Typically a subtle shade discoloration located on either flank; may not be present at birth but likely to increase in size with age; suspect neurofibromatosis if there are many large spots or if more than 6 spots in a child older than 5
Cafe au lait spots
Benign, flat, congenital birthmark with wavy borders and irregular shape; common color is blue; may last up to 3 to 5 years after birth, almost always dissappear by puberty
Mongolian spots
Vascular birthmark (malformation) consisting of superficial and deep dilated capillaries in the skin; produce a reddish to purplish discoloration of the skin; permantent
Port-wine stain
Raised, soft red lumps on the skin, more common in premature babies, usually shrinks/fades after 6 months
Strawberry mark (hemangiomas)
When does rooting disappear
3 to 4 months
When does sucking disapear
3 to 4 months
When does Moro disappear
3 to 4 months
When does palmar grasp disappear
3 to 6 months
When does plantar grasp disappear
4 months
When does placing/stepping disappear
1 to 2 months
When does tonic neck disappear
3 months
When does babinski disappear
12 months or when walking
This type of head swelling crosses the midline and usually resolves in 2-3 days
Caput succadaneum
This does head swelling does not cross the midline, usually requires closer monitoring
Cephalohematoma
To be categorized as microcephaly or macrocephaly, your head must be smaller or larger than __ standard deviations
two
More than one hair whorl could indicate what
poor brain growth
This is the largest fontanel
Anterior
When does the anterior fontanel close?
18 months
when does the posterior fontanel close?
2 to 3 months
Salt and pepper speckling (Brushfield spots of the iris) are associated with:
Down Syndrome
What should you consider if you note a radio-femoral pulse delay?
Coarctation of the aorta
What is it called when you cannot retract the foreskin?
Phimosis
How do you check for developmental dysplasia of the hip?
Ortolani’s click and Barlow’s maneuver
This occurs 1:10,000 to 25,000 newborns, causing developmental delays, seizures, retardation
PKU
This occurs in newborns causing liver dysfunction, coagulapothies and occurs every 1:60,000 to 80,000 births
Galactosemia
Irreversible condition characterized by brain damage and developmental problems resulting from prenatal alcohol exposure
Fetal alcohol syndrome
How is FAS diagnosed?
Physical examination
What manifestations does this indicate: birth defects of the heart, bone, kidney, joints, ears/eyes. Abnormal facial features: small eye openings, thin upper lip, smooth philtrum, upturned nose, small head size, poor weight gain, intellectual disability
Fetal Alcohol Syndrome
The newborn period is from __ to __ months; while infancy is __ to __ months.
1 to 2 months
1 to 12 months
According to the Bright Futures guidelines, what is the schedule for well-child checks?
2 weeks, 2 mo, 4 mo, 6 mo, 9 mo, 12 mo
At what well child check would you not expect to provide any vaccines if the child is on time with vaccinations?
9 mo visit
At what visits would you check a child’s hematocrit?
6 mo, 9 mo, and 12 mo
What is a vitamin deficiency that causes fissures at the corners of the lips?
cheilosis
Pigeon chest
Pectus carinatum
Sunken chest; and the most common congenital deformity of the anterior wall of the chest.
Pectus excavatum
T or F: Gynecomastia and galactorrhea is a normal finding in males up to 3 months old?
True
In a toddler, where should the liver edge be palpable?
1 to 2 cm below the right costal margin
At what age should the testes be fully distended into the scrotum?
3 months
What is Galeazzi sign and when is it seen?
Unequal knee height seen in developmental hip dysplasia
What is the most alarming type of enlarged lymph nodes?
Supraclavicular
At what point is there considered to be hearing loss in an infant?
At a loss of 20 to 30 decibels
When does “Stranger Danger” develop?
6 months
When does an infant develop separation anxiety?
8 months
What is an affective bond that develops over the first year and will differentiate into other emotions later?
Attachment
When should the infant’s first dental appointment be scheduled?
By 1 year old
From age two months to 1 year, how much should you expect the infant to sleep?
8-12 hours/night
What is the recommended screen time for children younger than 18 months?
The AAP does not recommend screen time for this age group.
Any baby younger than ___ weeks that develops a fever should have a full septic work-up done.
4 weeks (30 days)
Within the first two months of life, __% of fevers are viral.
40%
When assessing the degree of illness in an infant, it is important to remember that responses are ________.
Behavioral
The toddler age group is ages:
1 to 3 years
The preschool age group is ages:
4 to 5 years
IF a family has a history of dyslipidemia or CV disease, at what age should you check the child’s cholesterol?
2 years
Beginning in the toddler age group (age 12 mo), what is the schedule for WCC?
12 mo, 15, mo, 18 mo, 24 mo, 30 mo, and 36 mo
At what age will the child begin having a WCC annually?
Age 3
Height and weight should be documented at every well child check until age __, then annually.
Age 2
Where should you be able to palpate the liver in a toddler/preschool aged child?
1-2 cm below the right costal margin
“Bowed legged” (normal variant in toddlerhood)
Genu varum
“Knock-knees” (normal variant in preschooler)
Genu valgum
What age does tibial torsion typically resolve?
Age 4
This is in-toeing, which is normal until adolescent stage
Femoral anteversion
What age should the toddler be able to run with wide gait, up and down steps, and kick a ball without falling?
Age 2
When should a child be able to ride a tricycle?
Age 3
When should the child be able to ride a bicycle without training wheels and go up and down stairs with alternating feet?
Age 4
When can the child jump rope and skip?
Age 5
What age can the child turn a doorknob?
Age 2
At what age can the child copy a circle?
Age 3
What age can a child: tie their shoes and copy a squate?
Age 5
The tendency of children to cognize their environment only in terms of their own point of view:
Egocentrism (Piaget)
What should the visual acuity be by age 5?
20/30
What age should the hearing test be changed to the pure tone audiometry?
Over 3 years
What type of play do toddlers involve in?
Onlooker and parallel play
Preschoolers partake in what type of play?
Associative, cooperative, dramatic, and physical play
What is the gold standard for the diagnosis of developmental delays in infants/toddlers to 42 months of age with separate mental, motor, and behavioral rating scales?
Bayley Scales of Infant and Toddler Development
When should the spoon be introduced to the child for use?
15-17 months
How many hours/night should the toddler sleep?
10 to 12 hours with daily naps
What age do nightmares begin?
Age 3
Night terrors typically occur between __ to __ years; most outgrow as they get older
2 to 6 years
When does physiologic and psychological readiness for toilet training begin?
1.5 - 2.5 years
What is the AAP recommendation for screen time for children aged 2-5 years?
No more than 1 hour per day
At what age would there be a concern for a patient not being toilet trained during the day time hours?
At age 4
Stuttering can be normal and last as long as __ months. If last longer than this, you should refer.
6 months
What is characterized by altered response to environmental stimuli and impaired social interactions?
Autism Spectrum Disorder (ASD)
School-aged children is considered what age?
6 years to 12 years
What is the average growth of weight and height in this age group?
Weight: 5 to 7 lbs/year
Height: 2 - 3 inches/year
BMI greater than __ percentile is considered obesity
95th
When should the screening for scoliosis begin?
Age 9
What stage has the development of self esteem?
School-aged group
In the school age group, how many hours would they be expected to sleep per night?
8-10 hours/night
This age group should begin having conversations about sex, STI’s, menarche, hormonal/body changes
School-aged group (ages 6-12)
What is the AAP recommendation for screen time for the school-age group?
PCP/patient/family should develop a Family Media Use Plan
What is the most common form of child abuse?
Neglect
__% of abusers in child abuse are the parents
80%
Adolescent age group:
12 - 20 years
When should pelvic exams begin (if sexually active)?
Age 21
HEADSS format assessment stands for what?
Home environment, Employment/education, Activities, Drugs, Social, and Sexuality
PACES format for interviewing adolescents:
Parents/peers, Accident, alcohol & drugs, Cigarettes, Emotional issues, School/sexuality
SAFETEENS format for interviewing adolescents:
Sexuality, Accidents/abuse, Firearms/homicide, Emotions, Toxins, Environment, Exercise, Nutrition, Shots
Menarche between breast development in stages __ to __; but predominately in stage __.
3 to 4; 4
At what age is puberty considered precocious for girls? boys?
Girls before age 8
Boys before age 9
How often should you have dental cleanings?
Every 6 months
What are the peak ages for anorexia and bulimia?
14 to 18 years
