Health Promotion & Growth/Development Flashcards
Peds test #1
Wellness visits schedule
newborn, 1, 2, 4, 6 (q3 months starts): 9, 12, 15, 18months. (Q6 starts) 2 years, 2.5 years, 3 years (then yearly on out)
Infant Wellness visit
newborn, 1, 2, 4, 6, 9 and 12 months.
Infant Psychosocial & cognitive development theories
Erikson: trust vs mistrust- infant perceiving their mets being met by caregiver or not.
Piaget: sensorimotor stage- manipulate objects, cause/effect. Object permanence (by 8 months)- just bc it isn’t seen, doesn’t mean it doesn’t exist (hiding objects out of site- they will go look for them)
motor milestones: infancy
1 month: hold chin up from chest , relaxes fingers at rest
2 mo: holds head up when on stomach, moves arms and legs
4mo: head steady w/o support, hands to mouth, holds toys, pushes up on elbows,
6 mo: rolls from stomach to back, tripod position
9 mo: transfer objects from hand to hand, use full hand to rake food into mouth, sits without support
12 mo: pulls to stand, walks holding onto furniture, can drink from lidless cup (adult holding), use thumb and forefinger to grasp at food
infant cognitive milestones
2 mo: watch caregiver as they move, brief focus on toy
4mo: open mouth when sees bottle or breast if hungry, shows interest in hands
6mo: objects in mouth, reach for toys, close mouth when full
9 mo: looks for objects out of sight (permanence)
12mo: puts objects on container, looks for hidden objects
infant social/emotional milestones
1mo: looks at caregiver, calms down when picked up or spoken to
2mo: social smile (responds to smiles), seems happy to see caregiver
4mo: chuckles, copies some facial expressions, makes sounds to get attention
6mo: looks at self in mirror, knows familiar faces, laughs
9mo: likes “peek-a-boo”, many facial expressions, reacts when caregiver leaves, looks when name is called, stranger danger (8 mo)
12mo: can play simple games
Common infant ailments seen by PCP
-brief resolved unexplained events: cyanosis, pallor, irregular, slowed or absent breathing, hyper or hypotonia, altered level of responsiveness. Diaper rash, candidiasis (thrush of mouth, seborrhea (cradle cap- rash, scales on scalp = painless and not itchy), acne neonatorum (resolves within a few months), roseola- benign febrile exanthum- herpes, rash on trunk and neck, rose colored papule and macule, fever
Newborn Vaccines
-first yr of life they will receive: DTaP, Hib (H. flu), HEP B, Pneumococcal (PCV13), IPV (polio), Rotavirus (RV), flu
Newborn nutrition and progression
-breastfeeding Q2-3H or 8-12 times/day
-formula: newborn takes 2 oz Q2-3H, 4mo: 26-36 oz/day, 12mo: 30oz/day
-progress to solid foods around 6mo if ready: tongue extrusion reflex, increased milk intake or frequency, ability to sit in high chair with good head control. Start with iron-fortified cereals and other purees.
-no cows milk for 1 year, no honey or sugary foods, limit juices to 4oz/day
Newborn safety
increased mobility = increased risk for danger: wiggle off flat surfaces, falls, cords, cabinets, electrical outlets etc.
-suffocation- bed free of loose items, crib away from pull cords on curtains, no plastic bags
-electrocution- cover outlets, away from cords
-choking- keep small objects away, clean floor, cut food into small pieces (high risk foods: popcorn, carrots, hard candy, grapes, marshmallows, hot dogs)
-burns- dont carry hot liquids while holding infant, dont leave hot beverages on coffee tables
-poisoning, drowning, car seat rear facing
-SIDS (RF: low birthweight, maternal smoking, exposure to secondhand smoke, sleep on soft surfaces, loose bedding, co-sleeping)
Toddler (12-36 mo) psychosocial, cognitive and moral development
Erikson (psychosocial): autonomy vs. shame & doubt - learn to do some things on their own, parents must establish firm rules to prevent harm
piaget (cognitive): sensorimotor (up to 2 yrs) and peroperational (begins at 2 yrs)- manipulates object to learn and begins to imitate others
Kohlberg (moral): pre conventional- learning obedience to avoid punishment, not focused on right and wrong
Toddler activity:
-learning to walk- bowed legs and flat feet
-improved hand/eye
-feed themselves, stack blocks, manipulate smaller objects
Toddler cognitive development milestones
15mo: use objects for intended use, stack two small objects
18mo: copies adult chores (sweeping with broom), plays with toys purposefully
24-30mo: holds something in one hand while doing something with the other, uses knobs and switches on toys, plays with more than one toy at a time- uses toys to pretend. simple prob-solving skills, two-step instruction following, knows at least one color
36mo: avoids touching hot objects when warned, copies a circle
toddler mvmt/physical development
15mo: takes a few steps on own, feeds self with fingers
18mo: walks independently, push/pull toys when walking, scribbles, drinks from cup w/o lid, attempts to use spoon, climbs on couch/chair independently
24-30mo: runs, kicks ball, walks up and down stairs, uses spoon, turns doorknobs, takes some clothes off by themselves, jumps with both feet, turns pages
36mo: use fork, string items together like beads, puts some clothes on by themselves, walks up and down stairs with one foot on each step
toddler social/emotional development
15mo: hug caregiver, points to things they want, claps, copies other children
18mo: points to show something interesting, extends hands to be washed, looks at book pages, may move away from caregiver but makes sure they’re close- separation anxiety
24-30 mo: notice when others are upset, looks to caregiver to determine how to act in new situations, plays with other children, simple routines. fears, security object
36mo: share and play with other kids, separates easily from caregiver
Toddler Vaccines
MMR, Varicella, HEP A
Toddler safety
burns, falls, poisoning, choking, drowning, firearm safety, rear-facing carseat until 2yrs old
Nutrition
-picky eating- food jags (fixating on food and then refusing it)
-cows milk okay
-avoid processed foods, fast food, sugar
toddler developmental concerns
-potty training- signs of readiness include diaper remains dry for 2H at a time, words for urine and stool, bringing a clean diaper to the caregiver to be changed.
-temper tantrums
-regression of acquired developmental skills due to stress, change in routine or illness: new sibling, new day care or home, hospitalization
-limit media
Toddler health problems
- atopic dermatitis- eczema
- common cold
- acute otitis media- ear infection
Preschooler (3-6yrs) psychosocial, cognitive, moral development
Erikson (psychosocial): initiative vs guilt: plans and initiates activities, wants to please caregiver, asserts self, makes up games. feels guilt if excluded from activities above their level
Piaget (cognitive): pre- operational: egocentrism (can’t perceive others having a different point of view) and transductive reasoning that connects to unrelated events via cause and effect. Magical thinking. knows right from wrong
Kohlberg (Moral): pre-conventional: understand right from wrong- learn how to deal with angry feelings (unwanted behavior may occur- hitting or biting)
Preschooler Cognitive milestones
3yo: draws circle when shown how, takes hand away from hot stove
4yo: knows first and last names, can memorize address, can count to 10 or higher, knows at least 4 colors, begins to understand time (before/after)
5yo: draws person with 3 or more body parts, tells what comes next in a story, names several colors, uses fork and spoon
preschooler mvmt/physical development
3yo: use fork, put loose clothing on independently, strings large items together
4yo: unbuttons some buttons, catches bounced ball, grasps pencil with thumb and finger, feeds self
5yo: buttons some buttons, hops on one foot
preschooler social/emotional milestones
3yo: calms down within 10min of caregiver leaving. notice other children and will join
4yo: likes to do new things, creative/imaginitive play (with other children too), able to cooperate, talks about interests, comforts other children, likes to help
5yo: follows simple directions, wants to please friends, discovers gender differences, distinguish between real and make-believe, likely to follow rules, simple chores
preschooler health promotion
communication and social development, sleep, oral health, safety, nutrition, school readiness (language development, social situations etc)
4yo well child visit Vaccines
all boosters of previous vaccines: DTap, IPV, MMR, varicella
preschooler developmental concerns
-lying
-gender related concerns
-media- educational materials to supplement, preview content
common health concerns for preschoolers
-5th disease: erythema infectious, parvovirus- resp transmission or blood. bright red cheeks- rash on trunk and upper extremities- lacy appearance
-hand foot-mouth disease- fecal/oral route- poor handwashing
-conjunctivitis- pink eye- bacterial is extremely contagious, viral is self-limiting
School-aged children (6-12yo) physical development
-secondary sex characteristics between age 9-14)
-integumentary system: acne and pubic hair development
school-aged child Psychosocial/cognitive and moral development theories
Erikson (psychosocial): industry vs. inferiority: learning to do more things on their own, confidence in ability to achieve goals (good to be challenged), develops competence, likes to understand how things work
Piaget (cognitive) concrete operational: Thinks with logic and concrete manner, put items in sequential order, learns about objects by manipulation, understands concepts of reversibility, conservation and time.
Kohlberg (moral): conventional: follows rules, takes societal law into perspective, can see things from different perspectives
School-aged social and emotional development
-friendships- usually identify a best friend. deal with peer pressure but doest give in if they have good social skills and self-esteem. may be targeted by bullying. Peer groups usually with same gender.
-school- encourages separation from caregiver
-body image- self-esteem, peer acceptance
-gender-identity
school-aged health promotion
-learning: school, reading. eval for learning disabilities if struggling
-communication about social development
-physical activity: 60min daily
-mental health
school-aged child safety
sports (equipment, hydration etc)
-never swim alone, swim lessons, life jackets in big bodies of water
-biking
-car- booster seat if <4 ft 9, <12yo sit in backseat
-pedestrian- look both ways, hold hands
-firearm
-fire- escape plan, supervise matches
school-aged vaccines
flu, DTap, HPV, meningococcal
school-aged developmental concerns
-school refusal
-bullying
-obesity
-cheating, lying, stealing
-media- safety online, cyberbullying
common school-age health problems
-flu
-tinea corporis (ringworm), tinea pedis (athletes foot), tinea capitis (scalp fungal infection)
-pharyngitis- sore throat, strep
-tonsillitis
adolescent (early-10-13yo to late-18-21yo) physical development
early: testicular enlargement, penile growth. breast buds, pubic/axillary hair, growth spurt, menarche.
middle: growth spurt, nocturnal emissions, body/facial hair. Peak female growth velocity
late: increased lean muscle mass (both)
PUBERTY
adolescent psychosocial/cognitive/moral development milestones
Erikson (psychosocial): identity vs role confusion: self-conscious of changing body (early), concerns with attractiveness (middle), more stable body image in late stage, forming identity and beliefs. require support from peers and family, may participate in risky behavior.
Piaget (cognitive): formal operational- develops abstract thought, feels invulnerable in middle stage, better impulse control by late stage, can see others perspectives
Kohlberg (moral): post conventional- understands that morally right and legally right are not always the same, establishes own set of morals which may be different from those of the family
adolescent social/emotional development
-caregivers- maintain relationships with adolescent despite their distancing- dont talk down to them. be open and honest in conversation
-peers: middle adolescence begins more interaction with other sex.
-dating
-gender identity
-boyd image
adolescent safety
-sports safety
-home environment, internet safety, car/driving safey
-mental health
-preg risk reduction, reduce STI risk
-substance use
-personal hygiene
adolescent vaccine
complete the HPV series and potentially second dose of meningococcal
adolescent developmental concerns
-substance use disorder
-violence (verbal, sexual, physical abuse. bullying)
-eating disorders
-depression, suicide
-media safety
common adolescent health problems
-infectious mononucleosis- virus caused by epstein-barr virus- oral secretions
-acne vulgaris
-dysmenorrhea- painful uterine cramps
