exam 1- PEDS Flashcards
Jean Piaget (theorist)
swiss theorist on how children learn
framework for understanding how thinking during childhood progresses and differs from adult thinking
Piaget Infancy
Sensorimotor Period
Birth to 2yo
reflexive behavior used to adapt to environment
egocentric view of the world
development of object permanence [awareness object exists even when they disappear from sight]
at the end, infant shows more evidence of reasoning
Piaget Toddlerhood and Preschool Age
Preoperational Thoughts
2 to 7 yo
thinking remains egocentric
becomes magical [events due to wishing]
dominated by perception
language becomes useful
animism [all objects have life and meaning]
Piaget School Age
Concrete Operations
7 to 11yo
thinking becomes more systematic and logical
concrete objects and activities needed
concept of time becomes clear
far past and far future remain obscure
child cannot deal with abstractions or with socialized thinking
Piaget Adolescence and Adulthood
Formal operations
11yo to adulthood
concrete to abstract and symbolic
self-centered to other-centered
can develop hypothesis
improved organizational ability, task completion, behavioral attention, self control
understand logical consequences of behavior
significance of piaget’s theory
for nurses when developing teaching plans of care for children
believed that learning should be geared to the child’s level of understanding and should be an active participant in the learning process
Sigmund Freud (theorist)
theories to explain psychosexual development
early childhood experiences provide unconscious motivation for actions later in life
certain body parts assume psychological significance as foci of sexual energy
Freufd Infancy
oral stage
mouth is a sensory organ
1st half: infant takes in and explores during oral passive substage
2nd half: infant strikes out with teeth during oral aggressive substage
Freud Toddlerhood
Anal Stage
major focus of sexual interest is anus
control of body functions is major feature
toilet training a major developmental task
a time of holding on and letting go
Freud Preschool
Phallic or Oedipal/Electra Stage
genitals become focus of sexual curiosity
superego (conscience) develops
feelings of guilt emerge
possessiveness of child for opposite-sex parent, marked by aggressiveness toward the same sex parent
identifies with or become more like same-sex parent
superego develops [inner voice that reprimands and evoke guilt]
Freud School Age
Latency Stage
sexual feelings firmly repressed by the superego (less prominent in daily life)
period of relative calm
same-sex peer groups
younger: refuse to play with children of the opposite sex
older: desire companionship of opposite-sex friends
freud adolescence to adulthood
Puberty or Genital Stage
stimulated by increasing hormone levels
sexual energy wells up in force resulting in personal and family turmoil
interest in sex flourishes as search for identity
develop more adult view of sexuality
decisions often made based on emotional state
erik erikson (theorist)
viewed development as a lifelong series of conflicts affected by social and cultural factors
each conflict must be resolved for child and adult to progress emotionally
unsuccessful resolution leaves individual emotionally disabled
inspired by Freud
Erikson Infancy
Trust v Mistrust
infant’s physical and emotional needs met in timely manner = trustworthy
signs of unmet needs: restlessness, fretfulness, whining, crying, clinging, physical tenseness, vomiting, diarrhea, sleep disturbances
Erikson Toddlerhood
Autonomy v Shame and Doubt
development of sense of control over the self and body functions
exerts self
characterized by will
elimination accomplished
Erikson Preschool Age
Initiative v Guilt
development of a can-do attitude about the self
behavior becomes goal-directed
competitive and imaginative
initiation into gender role
characterized by purpose
Erikson School Age
Industry v Inferiority
mastering of useful skills and tools of the culture
learning how to play and work with peers
characterized by competence
Erikson Adolescence
Identity v Role Confusion
begins to develop a sense of “I”
peers become of paramount importance
child gains independence from parents
characterized by faith in self
Erikson Adulthood
Intimacy v Isolation
Development of ability to lose the self in genuine mutuality with another
characterized by love
Erikson Adulthood
Generativity v Stagnation
production of ideas and materials through work
creation of children
characterized by care
Erikson Adulthood
Ego Integrity v Despair
realization that there is order and purpose to life
characterized by wisdom
Significance of Erikson’s Theory
regression is a reactivation of behavior more appropriate to an earlier stage of development
provides a theoretic basis for much of the emotional care that is given to children
Lawrence Kohlberg (theorist)
moral development as a complicated process involving the acceptance of values and rules of society in a way that shapes behavior
closely parallels Piaget’s
Kohlberg Infancy
Premorality or Preconventional Morality
Stage 0 (0-2 yo)
Naivete and Egocentrism
no moral sensitivity
decisions made on basis of what pleases child
infants like or love what helps them (vice versa)
no awareness of the effect of their actions on others
Kohlberg Toddlerhood
Premorality or Preconventional Morality
Stage 1 (2-3 yo)
Punishment-Obedience Orientation
right or wrong determined by physical consequences
Kohlberg Preschool
Premorality or Proconventional Morality
Stage 2 (4-7 yo)
Instrumental Hedonism and Conerete Reciprocity
confirms to riles out of self-interest
behavior is guided by an “eye for an eye” orientation
Kohlberg School Age
Morality of Conventional Role Conformity
Stage 3 (7-10 yo)
Good boy or good girl orientation
morality based on avoiding disapproval or disturbing the conscience
child is more socially sensitive
Kohlberg School Age
Morality of Conventional Role Conformity
Stage 4 (10-12 yo)
Law and Order Orientation
right takes on a religious or metaphysical quality
child wants to show respect for authority and maintain social order
obeys rules for their own sake
Kohlberg Adolescence
Morality of Self-Accepted Moral Principles
Stage
Social Contract Orientation
right is determined by what is best for majority
exceptions to rules can be made if a person’s welfare is violated
the end no longer justifies the means
laws are for mutual good and mutual cooperation
Kohlberg Adulthood
Morality of Self-Accepted Moral Principles
Stage 6
Personal Principle Orientation
achieved only by morally mature individual
few people reach this level
do what they think is right regardless
actions guided by internal standards
integrity most important
may be willing to die for their beliefs
Kohlberg Adulthood
Morality of Self-Accepted Moral Principles
Stage 7
Universal Principle Orientation
achieved by rare few (Mother Teresa, Gandhi, Socrates)
transcend teaching of organized religion
perceive oneself as a part of cosmic order
understand reason for existence
live for their beliefs
Hepatitis A Vaccine
beginning at 12-23 months
2 doses should be given 6 months apart
if by 2yo and not vaccinated, can do so in subsequent visits
Hepatitis B Vaccine
1st dose: at birth
2nd dose: 1-2 months
3rd dose: 6-18 months
Four doses may be given if vaccine given in combination with other vaccines given to infants
readmission is OKAY!
Haemophilus Influenzae type B (HiB)
can cause meningitis in infants and young children
(cdc not book ) :
1st dose at 2 months > 2nd dose at 4 months > 3rd dose at 6 months
Booster dose: 12-15 months
readmission is OKAY!
Pneumococcal Conjugate Vaccine (PCV)
PCV-13
1st dose: 2 months
2nd dose: 4 months
3rd dose: 6 months
4th dose: 12 to 15 months
Meningococcal Conjugate Vaccine
(serogroup A, C, W, Y)
1st dose: 11 - 12 yo
Booster dose: 16 yo
Meningococcal Serogroup B Vaccine
Between 16-18 yo
given in 2 doses
shared decision
Rotavirus Vaccine
leading cause of GI disease in infants and young children
1st: 2 months
2nd: 4 months
3rd dose: 6 months (if 3 dose series)
DO NOT GIVE to children OLDER THAN 8 MONTHS
Human Papilloma Virus Vaccine (HPV)
decrease risk for lateral genital and oropharyngeal cancers
GOAL: administer before sexually active
1st dose: 11-12 yo
2nd dose: 9-14 yo
3rd dose: > 15 yo
Tetanus-Diptheria Acellular Pertussis (TDaP) Vaccine
used to prevent pertussis (whooping cough)
If DTap > 7 yo, low grade fever and mild diarrhea common
1st dose: 11-12 yo
Influenza Vaccine
beginning at: 6 months
if not given previously at younger than 9 yo > need to receive 2 doses initially with each 1 month apart
Measles, Mumps, Rubella (MMR)
1st: 12 months
2nd: 4-6 yo
LIVE! Do not give to pregnancy
Readmission is okay!
Varicella (VAR)
1st: 12 months
2nd: 4-6 yo
LIVE! Do not give to pregnancy
DTaP for < 7 yo
1st dose: 2 months
2nd dose: 4 months
3rd dose: 6 months
4th dose: 15-18 months
5th dose: 4-6 yo
Subcutaneous Injection- Peds Consideration
sites:
infant to 11 months: thighs
12 months and up: upper outer triceps
Intramuscular injection- Peds Consideration
newborn: 0-1 month
vastus lateralis
infants: 1-12 months
vastus lateralis
toddlers: 1-2 yo (18 mos < , deltoid preferred!)
vastus lateralis * preferred
if deltoid, use less inches
children: 3-10 yo and 11-18 yo
deltoid preferred
if vastus lateralis, use more inches
Immunization Considerations
fever and rash occur 1-2 weeks after administration of a live vaccine
age-appropriate acetaminophen q6h for 24 hrs is okay for any discomfort
cold compress for first 24h to painful or red injection sites followed by hot or cold compress as needed
Peds PE: Lymph Nodes
NORMAL: small, non-tender and moveable lymph nodes
Under the size 1-1.5cm without any other concerning
Peds PE: Head and Neck
4 months: normal head lag
> 6 months: significant head lag concerning for cerebral injury
Anterior Fontanelle: closes at 12-24 months of age (average 18 months)
Posterior Fontanelle: closed by 3 months in term infants
PEDS PE: Eyes and Ears
Red Reflex: absence may indicate cataract or reitnoblastoma (appears white instead of red)
Fixate on one visual field with both eyes: 3-4 months
Amblyopia blindness from disuse: by 3-6 yo
Visual Acuity test begins at around age 3
Ages < 3yo : straighten the ear canal by pulling the pinna down and back
Low-set is when the auricle does not cross or touch the line from the eye to the occiput
PEDS PE: Nose and Mouth
Allergic salute: transverse line on nose indicating allergies
Petechiae (white dots) on the mouth are abnormal
Tonsils often larger in younger children > large enough to cause partial airway during sleep (snoring)
Eruption usually starts around 6 months > most deciduous teeth present by 30 months
PEDS PE: Thorax and Lungs
Listen to breath sounds with child sitting upright
PEDS PE: Heart
PMI in 4th IC space in midclavicular line in children < 7 yo
PMI moves to 5th IC space in older children
Auscultate: lying down, sitting up and left lateral recumbent
Split S2 in children of all ages that widens during inspiration is
NORMAL and heard in pulmonic area
Breast development (thelarche) typically around 9-10 yo
PEDS PE: Abdomen
Umbilical hernia common in younger children and will close on its own for the first few years of life
Deep palpation may not be indicated or be contraindicated and reserved for advanced providers
May palpate an enlarged liver or spleen
Important to palpate femoral pulses in baby/young child
PEDS PE: Musculoskeletal
Focus on spine and extremities
Genu varum/bow leg: seen in toddlers but abnormal if unilateral or asymmetric
Genu valgum/knock knee: normal in children up to 7 yo
Gait is broad based in toddlers > lowers the center of gravity as they age and school aged (gradually resolved)
Neurologic System: 2 weeks to 2 months
Raise head and hold positions
Neurologic system: 2 months
Moves all extremities; kicks when prone
Neurologic system: 3 to 6 months
Draws up knees and raises abdomen off table; rocks and rolls over
Neurologic system: 7 months
Sit alone and uses hands for support (tripod)
Neurologic system: 9 months
Lurches forward and pulls legs to chest in “inchworm” fashion, may move backward in same fashion; creeps and rolls
Neurologic system: 6 to 9 months
Crawls in one-sided manner (moves arm and leg on the same side of the body then the other side )
Crawls in regular fashion, alternating arm and opposite leg:
Neurologic system: 11 months
begins to pull up
Neurologic system: 12 months
cruises [attempts to walk with support or holding onto something stable]
Neurologic system: once comfortable standing and holding on
Momentarily lets go and maintains balance fora few seconds
Neurologic system: once standing balance accomplished
takes first steps (broad stance, arms flexed)
Neurologic system: 12 months
sits from a standing posture
Neurologic system: 15 months
walk alone
Neurologic soft signs
AKA BAD
poor motor coordination, sensory perceptual difficulties, and involuntary movements…
Hard signs refer to impairments in basic motor, sensory, and reflex behaviors. In contrast, “soft” neurological signs (SNS) are described as nonlocalizing neurological abnormalities that cannot be related to impairment of a specific brain region or are not believed to be part of a well-defined neurological syndrome
PEDS PE- Neurologic
Clonus Reflex
continued, rapid flexion and extension of the foot and hand; elicited by suddenly and briskly dorsiflexing the foot or hand and applying sustained and moderate pressure
PEDS PE- Neurologic Abdominal Reflex
response ipsilateral contraction of abdominal muscle with movement of the umbilicus toward the side being stroked
PEDS PE- Neurologic Cremasteric Reflex
ipsilateral testicle elevates
PEDS PE- Neurologic Babinski Reflex
response in infant is dorsiflexion, fanning of toes and hyperextension of the great toe; once walking, the response should be plantar flexion of the toes
Newborn
birth to 1 month
infant
1 month to 1 year
toddlerhood
1 year to 3 years
preschool age
3 years to 6 years
school age
6 to 11 years, or 12+
Average infant weight
doubles
triples
quadruples
7.5 lbs
by 6 months
by 12 months
by 2-3 yrs
head circumference measured
for brain growth
0-3 years
primary dentation:
6 to 8 months
most children have 20 teeth:
by 2.5 years
full set of teeth
6 years
vowels by
by 2 months old
consonants by
5 months
vocabulary of 300 words by
2 years
sense of grammar by
4 years
Gastric Acidity
gastric secretions of infants LESS ACIDIC
\milk/formula = alkalinity > decreases absorption of medications that require a more acidic environment
Gastric emptying
unpredictable in infants ; slower than in older children > prolong medication absorption
Gastrointestinal motility
infants up to 8 months have prolonged motility > the more medication is absorbed
Pancreatic enzymes
variable in first 3 months
IV Peds Considerations
immediately available for absorption into the child’s bloodstream since peripheral circulation is more responsive to environmental changes
Infant body weight is _____ % muscle
25%
Blood flow peds considerations
can be unpredictable in young children which can increase or decrease absorption of med
Gluteus maximus in infants
should be avoided due to potential for damaging sciatic nerve
topical absorption in indants
much greater due to larger BSA to weight ratio
body fluid content in infants
Body fluid content 75% of body weight in infants [need higher dose per kg of water-soluble med]
body fluid content in > 2 yo
Body fluid content 60% of body weight in > 2 yo [need higher dose per kg of water-soluble med]
Plasma proteins
Preterm and Newborn have lower levels of plasma proteins > more unbound drug circulate
blood-brain barrier
Blood-brain barrier fully matures at 2 yo > previous immaturity causes barrier to be less selective allowing distribution of medications into CNS and/or lead to paradoxical effects
Metabolism in newborn and premature
Newborn and Premature infants may not properly metabolize all the medication in a given dose due to immature metabolic enzyme systems in liver
Metabolism in older infants, toddlers, preschoolers
Older infants, toddlers, and preschoolers metabolize certain drugs more rapidly
Renal system pediatrics consideration
Newborn renal system is immature with a GFR and less efficient renal tubular function
Adult levels of renal function reached at 1 to 2 yo
Urine concentration
Infants and young children unable to concentrate urine > medication can circulate linger and reach toxic levels in the blood
Too much milk digested by baby
Too much milk can cause iron deficiency or anemia due to dilution leading to suppressed bone marrow
Breastfeeding
Exclusively breastfeed infants for 4 months [preferable 12 months]
Solid foods
avoid until 4 to 6 months
milk for 1-8 years old
Children 1-8 years old should drink 2 cups of milk per day [fat free 1-2 yo; low-fat milk > 2 yo]
milk for > 9 yo
Children > 9 yo should drink 3 cups of fat-free or low-fat milk per day
juice intake pediatric considerations
limit 4-6 oz per day
total daily intake _____% of calories for 2-3 yo
30-35%
total daily intake ____% of calories for 4-18 yo
25-35%
prealbumin levels
Can send pre albumin in determining nutritional status [ rising = patient receive quality nutrition]
how long can an ovum be fertilized
5-7 days after ovulation
how long can a sperm survive ? remain in fetal tract?
24 hrs; 80 hrs
Day 10
implantation completed
Day 21-22
heart starts beating
Week 8
all major organs in place
Week 12
blood forms in liver and shifts to spleen
fetal gender determined
Week 13-16
head smaller in portion
quickening fetal movements
Week 17-20
fluttering fetal movements
vernix caseosa [biofilm covering fetus from exposure to amniotic fluid]
lanugo present
eyebrows and hair appear
brown fat seen in back of neck, sternum and around kidney
Weeks 21-24
skin transluscent and red
lungs produce surfactant
weeks 25-28
skin less red
eyes open
blood shifts spleen to bone marrow
week 30
female fetus has all the ova she will ever need
weeks 29-32
skin pigmented to race
toenails and fingernails
more subcutaneous fat which increases chance of survival
weeks 33-38
gaining weight
maturing pulmonary system
testes in scrotum
breasts both enlarged
Which is a child more likely to lose, ICF or ECF?
ECF
Children have higher percent water in ECF
What is a true fever in an infant
100.8
Define manifestations of dehydration in relation to body weight-
mild?
moderate?
severe?
mild: less than 5% of body weight
moderate: 5-10% of body weight
severe: greater than 10% of body weight
What does a decreased bicarbonate indicate?
an ominous sign to dehydration
as evidenced by high BUN and ketones in urine
BBBicarbonate is known as a BBBase which helps prevent the body from being too acidic»_space; leads to metabolic acidosis
What happens to:
potassium
glucose
and urine specific gravity
in dehydration?
decreased
decreased
elevated: *** anything higher than 1.020 suggests dehydration
What is a sign and symptom of dehydration?
** tachypnea, tachycardia, SOB
sunken soft spot
sunken eyes with dark circles
sunken fontanelle spots
Dehydration in skin
skin tents
causes of diarrhea
intestinal: shigella, botulism
fungal overgrowth: immunosuppressed!
if been taking abx for > 2 weeks, administer antifungal
intestinal obstruction: torsion of bowels, strictures
What to avoid when diarrhea is present
juice, gatorade and antidiarrheal since we need to determine cause of diarrhea
implements measures to reduce vomiting
stay 30 mins upright after feeding
most frequent admitting diagnosis in children’s hospital
asthma
leading cause of acute and chronic illness in children
asthma
what predisposes children to asthma
children’s smaller, narrower airways and decrease elastic lung recoil make them more susceptible to airway obstruction
child’s flexible rib cage and underdeveloped chest muscles and diaphragm lead to exhaustion when respiratory effort increases
what happens with asthma as a child grows older
it is not outgrown, the severity decreases due to the increased airway diameter, improving diaphragm support and clearance of mucus
what is a silent chest
a child in severe respiratory distress who is not showing wheezing due to a decrease in air movement
an ominous sign during an asthma episode
**increase in wheezing can be good in that it signals improvement
Pulmonary function test using a peak flow meter
perform three times in one sitting and record the highest reading
low readings indicate worsening obstruction
peak expiratory flow rate (PEFR)
for children with chronic asthma
spirometry
for children older than 5 years
how often can you give a short acting beta 2 adrenergic agonist to a child?
via a nebulizer or a metered dose inhaler (MDI) as eoften as every 20 mins for 1 hour
ipratropiun bromide can be combined with albuterol in some children with severe excacerbations (older than 12 yo)
why is humidified oxygen used?
to keep the o2 sat at or greater than 95%
status asthmaticus
severe asthma exacerbation that is unresponsive to vigorous treatment measures
medical emnergency that can cause respiratory failure and death
What is perioral cyanosis
blue discoloration of the fingernails indicate that the child needs emergency treatment immediately for asthma
exercise-induced asthma
can pretreat with SABA before exercise
when is emergency asthma management prompted
when a peak flow rate that decreases or does not change even after an inhaled beta 2 adrenergic agonist or that is less than 60% of the child’s predicted baseline level or personal best
what are oral corticosteroids in relation to asthma
potent anti-inflammatory medications that are usually prescribed in short-burst courses of 5-7 days
mild persistent asthma
symptoms more often than twice per week but less than once a day
PEFR > 80% predicted
intermittent asthma
symptoms less than or equal to twice per week or only with exercise
infrequent use of bronchodilator (< 2 days a week)
asymptomatic with normal peak expiratory flow rate (PEFR)
moderate persistent asthma
daily symptoms with daily bronchodilator use
PEFR 60-80% of predicted
severe persisent asthma
severely limited physical activity
PEFR less than or equal to 60% of predicted for worsening asthma signs and symptoms
where is foreign body aspiration commonly seen
6 months to 5 years
most foreign bodies become lodged in the bronchi.. which side likely
the right main bronchus is a more common site than the left main bronchus due to anatomic development (as it is straighter and shorter)
signs and symptoms of laryngeal and tracheal obstruction
choking, dysphagia, hoarseness, croupy cough, striddor, and possibly dyspnea with cyanosis
full obstruction will require
the heimlich maneuver (if not been performed already) before the child arrives to the hospital > meaneuver forces the diaphragm upward, which generates increased intrathoracic pressure and results in increased intratracheal pressure that expels foreign body
what happens in ARDs
breakdown in alveolar-capillary barrier and fluid accumulation in the interstitium and alveoli
acute ards
capillary congestion and pulmonary edema
chronic ards
fibrosis of the lungs develop in children who do not recover from the acute stage
first priority with a child who inhaled smoke
put a NRB mask on child to 100% oxygen
clinical manifestations of smoke inhalation
singed nasal hair, cough, hoarseness, hemoptysis, soot in sputum, cyanosis, wheezing
what is periodic breathing
three or more respiratory pauses of longer than 3 seconds with less than 20 seconds of respiration between pauses
infant apnea types:
central
obstructive
mixed
central: absence of respiratory effort and air movement
obstructive: apparent respiratory efforts without air movement or sound
mixed: absence of respiratory effort and nasal air movement followed by resumption of respiratory effort without air mvoement
Bronchopulmonary Dysplasia
aka chronic lung disease of infancy
chronic obstructive pulmonary disease that occurs as a result of acute lung injury in some infants who have received supplemental o2 and mechanical ventilation
how to prevent bronchopulmonary dysplasia
administration of corticosteroids to mother before birth
postnasal surfactant
administration of vitamin A
use of nasal continuous positive airway pressure (cpap) when the infant is intubated as well as after extubation
what is the significance of theophylline or caffeine
can enhance lung compliance and improve respiratory status by relaxing smooth muscles
caffeine given for apnea
what is a good pulmonary function test
> 60
what is the inflammatory disorder of the nasal mucosa
allergic rhinitis
symptoms of allergic rhinitis
rhinorrhea, itching and paroxysmal sneezing
nasal drainage
itching
allergic salute > indent in nose due to constantly pushing up
allergic shiners > dark circles under eye
what lung sounds do you hear if the infection is in the upper airway
stridor
what lung sounds do you hear if the infection is in the lower airway
wheezing, coarse, rhonchi
when are viral infections highest
during toddler and preschool years
what do petechiae (white dots) indicate
strep
what does tonsilities indicate
strep throat
what is croup syndrom
hoarseness, barking or brassy cough
stridor, respiratory distress
age range of croup
6 months to 3 years old at highest peak
epiglottitis
acute, life threatening edema
inflammation of epiglottis and epiglottic folds
what are clinical manifestations of people with epiglottitis
tripod positioning > drooling
what is the treatment with epiglottitis
intubation first!
throat and blood cultures > antipyretics > IV abx (of ibuprofen is toradol)
what is laryngotracheobronchitis (LTB)
croup
what is bacterial tracheitis
of the upper trachea
typically in older children (5-7 yo)
lower airway problems for those
< 3 yo
> 3 yo ??
reactive airway disease
asthma
what are PPE related to RSV
respiratory– gown, mask, eye protection, gloves
emergency management is warranted in asthma if
trouble with walking or talking
listlessness or weak cry
worsening wheeze, no improvement after bronchodilator, difficulty breathing, discontinuation of play, gray or blue lips or fingernails
what is cyrstic fibrosis
autosomal recessive
chromosome 7
CFTR protein (checked on sweat test)
r/t increased viscosity of mucous gland secretions
when are universal newborn screening (and following) for cystic fibrosis
0 days
72 hrs
28 days or once discharged
management of cystic fibrosis: GI
pancreatic enzyme since they have a pancreatic insufficiency, making them unable to digest food properly
what are intrinsic factors related to SIDS
genetic predisposition
male gender
permaturity
what are extrinsic factors related to SIDS
prone sleeping
bed sharing
use of bed clothes or mattresses
infant sleeping on upholstered furniture or adult mattress
prenatal or postnasal exposure to cigarette smoke or alcohol
how long should an infant be kept in the parents’ room
minimum 6 months to ideally 1 year of age
pacifier for SIDS
wait a few weeks for breastfeeding to be established before introducing a pacifier
