exam 2 Flashcards by Michelle Madaras

in infants weight increases - lbs

up to __ lbs in 1st year of life

■ Proportional changes: weight, height, head, nervous system, chest
● Weight increases 6-8lbs, up to 20lbs in the 1st year of life

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■ Posterior fontanelle closes by

■ Posterior fontanelle closes by 2 months of life

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Eye alignment in infants:
some children get _____, but usually resolves close to __ ___

Red reflex should be

■ Eye alignment

● Some children get cross eyed at times, but usually resolve close to 4 months (Strabismus)

■ Red reflex should be symmetrical

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The abdominal muscles do not fully develop until

Make sure to assess for any ____ or ____

The abdominal muscles do not fully develop until 3 years of life

Make sure to assess for any hernias or masses

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For boys make sure to assess ___
both should be ___ by ___ ___
Note any _____

■ For boys:
● Both testicles are descended by 6 months
● Note any hydrocele

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For girls make sure to asses for ____ ___

■ For girls:
● Assess for labial adhesions

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When assessing the musculoskeletal system make sure to assess
1)
2) - do this by
3)

■ Musculoskeletal

● Leg fold symmetry

● Hip abduction (if born breech get hip ultrasound at 6 months)
○ To make sure there are no hip clicks.
○ Barlow maneuver and Ortolani maneuver will assess for hip click

● Foot shape and flexibility (look for club footing)

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Make sure to assess skin for
1) - most common
2)
3)
________ are normal and can look like a bruise

■ Skin: rashes

● Common – infantile eczema

● Lesions

● Bruising or burns

○ Mongolian spots are normal

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Growth and development in infants should be ____

1
2
3
4
5

Growth and development in infants should be proportional

weight
height
head
nervous system
chest

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During newborn visit make sure to ask about
1)
2)
such as
3)
4)
5) complications such as ____ or ____
6) ____ admission
7) any ____
8) what _____ they received

1) Birth history
Vaginal/C-section (reason)
Weeks gestation
Stay in hospital (# days)

2) Complications during pregnancy
PIH, Pre-E, Eclampsia, HELLP
GDM
Maternal/infant blood work

3)Complications during delivery
Operational birth
Infection

4) Birth weight and Discharge Weight

5) Jaundice or Infection

6) NICU Admission

7) any Medications

8) Immunizations

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Concerning signs when checking weight
1)

Assess for _____ feedings

1) Lost more than 6% of birth weight

2) Not back to birth weight by 2 weeks

Assess for poor feedings

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Make sure to check ____ in elevated in hospital or at newborn visit.

bilirubin

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Make sure to assess for infection of
1)

umbilical cord

circumcision

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Feeding difficulties

Regurgitation and spitting up occur because

How to help prevent spitting up in regards to feeding

Can be normal but may seem alarming to some parents

Make sure _____ is ____ ___. If not thats when we ____

■ Feeding difficulties
● Regurgitation and spitting-up
○ Acid reflux is prevalent d/t sphincters are not mature

○ Encourage parents to break up feeding after ~15mL. burp the child and then return to feeding

○ Spitting up can be large amount and it is normal for it to come out of the nose

Make sure weight is going up. If not thats when we give meds for acid reflux

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Colic def-

usually disappears at age

___ ____ crying is normal

colic - crying over 3 hours multiple days a week

disappears at age 3-6 months

night time crying is normal

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What increases the risk of SIDs
(5)

Preemies
Siblings of SIDS victims
Smoking during pregnancy & in the home
Multiple births
Low Apgar scores

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What is the Moro Reflex

when does it disappear by

sudden loud noise will cause symmetric abduction and extension of the arms followed by adduction and flexions of the arms over the body

disappears by 3-4 months (although some references state disappears between 4-6 months)

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Describe the placing/stepping reflex

when does it disappear by

hold baby upright and allow the dorsal surface of one foot to touch the edge of the table – baby will flex the hip and knee –(make stepping motion)

Disappears around 2 months old

Describe the Babinski reflex

When does it disappear

Stroke on the sole of the foot, foot turns in and toes flare up

Disappears around 6-24 months

Describe the tonic neck reflex

Appears at _ to _
disappears at age

turning head to one side with jaw over shoulder causes the arm and leg on side where head is turned to extend. The arm and leg opposite with flex.

Appears birth to 2 months, disappears 4-6 months

Describe the rooting reflex

Disappears by age

stroking the corner of the mouth causes baby to turn toward the stimulation and suck

Disappears by 3-4 months.

Describe the grasp reflex

disappears by age

Pressing a finger or object to baby’s palm, baby makes a fist and tries to grab object

Disappears 3-6 months old

Grasping reflex disappears at age

Crude pincer starts at

Neat pincer starts by

Reflex at 3-6 months

Crude pincer grasp 7-8 months (grabbing object with all fingers)

Neat pincer by 11-12 months (able to pick up cheerio with index finger and thumb)

What gross motor development will the infant start to develop ? (4)

Head control

Rolling over

Sitting

Locomotion

what is head lag? What does head control look like?

Head lag is when the infant is helped to sit up the head falls back (unable to support their own head) Head control - when you pull a baby up to seated position they are able to tuck their chin down and support their own head

When does locomotion usually start?

locomotion = movement starts at 6 months of life can be crawling or butt scooting

infant nutrition breast vs bottle introduce solid foods at age when selecting foods start with Wean from bottle at age wait until ___ to give child cows milk

breast is better but let parent choose most important thing is to get the baby to eat introduce solid foods at age 6 months to prevent GI disorders when selecting foods start with non-sweet vegetables first then do fruits later. Do 1 food/week. Give peanut butter and eggs at about 9 months old Wean from bottle at age 18 months wait until 1 year to give child cows milk

What kind of car seat should an infant be in 2 key points

should be in rear facing car seat until 2 years of age. Should have a 5 point harness

6-9 month old visit - feeding/nutrition ask if they are How Amount any ___ ___ if so how much any ____/____ any ____ ____

Breast / bottle fed or both How often in 24 hour period Amount each feeding Solids yet? How much? Amount of juice/water Parental concerns?

6-9 month old visit - sleeping 1) 2) 3)

Number of nighttime awakenings 6 months should be able to sleep through night if waking up at night don't give bottle since they are getting solid foods during the day. Hours sleeping during the day should sleep through night and have 2-3 naps during the day Where the infant sleeps sleep in their own bed. Sleep on back on hard mattress with no blankets, stuffed animals, or pillows until 1 year to decrease risk of SIDS.

6-9 month old visit - family assessment any: Ask the primary care provider if they have sufficient ____ and ___ ____ does the child ____ _____

Any changes in family situation Ask Primary care provider if they have Sufficient rest and Support system does the child attend Daycare? (there is an increased risk of getting sick when child attends daycare)

6-9 month old visit - ROS 1) 2) 3) (especially on that wakes them up at night or is ____) 4) 5) frequency and consistency of 6) # 7) use of 8) 9) up to date on

Temperament (will start to see a little bit of temper tantrums) Nasal symptoms - @ 6 months that start to be able to breath out of their mouth more Cough Vomiting or spitting up - acid reflux usually resolves @ about 6 months with development of spinster Frequency & consistency of stools (should occur with almost every feeding. can be a variety of colors depending on diet) Number of wet diapers - 6/day is normal Use of extremities – equal? Make sure the aren't favoring one side Rashes immunizations - up to date

6-9 month old visit make sure to start discipline and parenting

make sure to start baby proofing house. Cover outlets, put poison away, no small pieces left out discipline and parenting - use distraction and positive reinforcement. Save no for very harmful things infants do

6-9 month old visit dental health teething starts around no teething doesn't usually cause can cause infant to _____ but should be evaluated for ____

dental health - starts teething at about 6 months. Remind no fluoride toothpaste can cause tooth staining in ingested. No orajel can cause throat to become numb and suppress gag reflex teething doesn't usually cause high grade fevers can cause infant to pull at ear due to increased pressure in ear but should be evaluated for ear infection

first flu vaccine administered at how

@ 6 months or older must get 2 shots 1 month apart the first time they get flu vaccine up till age 8 then 1x/year

first flu vaccine administered at how

@ 6 months or older must get 2 shots 1 month apart the first time they get flu vaccine up till age 8 then 1x/year

6-9 month old anticipatory guidance for parent 1) set 2) no 3) give them 4) make sure to have ____ and ___ 5) don't leave child

1) set Hot water thermostat less than 120◦ 2) no Small parts / toys 3) Poison prevention - give parents number to poison control 4) make sure to have Safety locks and Stair gates 5) don't leave child unattended by ANY standing water

6-9 month old common parental concerns 1) ____ and ____ ____ 2) discipline - ___ don't work 3) pacifiers - get rid of by age

1) _separation anxiety and stranger fears 2) discipline - timeouts don't work 3) pacifiers - get rid of by age 2

babbling starts at

6 months

at 6-9 months play usually consists of

at 6-9 months play usually consists of putting things in mouth

Make sure to ___ to child nightly

read

how to help do an exam on this age group

do it on moms lap show the instruments you are going to use and make it playful pull down and out on ear lobe

6-9 month old socially appropriate games make sure to establish a

6-9 month old socially appropriate games - pat-a-cake, peek-a-boo make sure to establish a bedtime