Health promotion of infant and toddler Flashcards by Ngozi Omeke

research shows involving ______in care is something they expect and desire and helps with outcomes

family

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Give Equal ______ to the different parenting styles regardless of your personal opinions and beliefs

respect

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parenting style:
– do what I say you’re going to do, has rules and they’re going to be followed

authoritarian

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parenting style:

– have no control, pretty much let the kid decide, let the child regulate whatever they want to do,

permissive

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Parenting style:

–is a combo of authoritarian/permissive, have boundaries and standards that they want the kid to follow, is not about control with the kid but is on being able to focus on action to get the kid to comply with what is going on

authoritative

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kids are like a _____ –too much pressure or too little pressure is not good

spring

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What are the three parenting styles?

authoritarian
permissive
authoritative

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–explaining why it is right or wrong, works when they can see the world from outside, doesn’t happen until 4th or 5 th grade

Reasoning

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–can be in extremes and can take connotation of shame and criticism, is more so if youre saying youre a bad boy for breaking that toy, be mindful of how you word things

Scolding

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– rewards, research shows it works really well.

Behavioral Modification

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– MUST BE CONSISTENT, can work but you have to be consistent

Ignoring

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t/f: all discipline has its place

true

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Time-out
general rule for time-outs are??

one minute per year of age

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– it teaches that violence is acceptable, if the parent is upset they can end up harming the child, kids also develop a tolerance to the spanking (if theyre not here I don’t have to worry about it)

Corporal/physical punishment

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–works sometimes by taking away certain things

Loss or removal of privileges

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Schools
Peer groups
Local community
Race and ethnicity
Social class – wealth vs. poverty

Mass media influences – advertisements, association to obesity
two hours total/day beginning at two years of age
Religious and traditional influences

sociocultural influences

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___ is the primary source of strength and support for the child

Family

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Family centered care
Stressors
Fear of bodily injury and pain
Separation from parents and loved ones
Fear of the unknown
Loss of control and autonomy

Stressors of Hospitalization

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What are the phases of separation anxiety?

protest phase
Despair phase
detachment phase

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stards at 6 months and lasts until 30 months
Cry and scream, cling to parent

protest phase

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–get a little depressed, less activity than expected, get them something familiar
Crying stops, evidence of depression, regression

despair phase

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very extreme long term, happens when parents run out of FMLA, look like theyre going back to normal, can happen with long extended stay, they recover from it and learn new skills, overcome different stressors in life, no long term issues usually
Denial, resignation; not contentment

detachment phase

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Promote freedom of movement
Maintain child’s routine, if possible
Self-care (age-appropriate)
Wearing street clothes
Making food choices
Schoolwork
Friends and visitors

normalizing environment for children

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______ _____ _________can help with procedures – sometimes have animal therapy, collab with them, right before the procedure is the best time

child life specialist

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What level are these toys appropriate for?

toddler

What level are these crayons appropriate for?

older child

focus on maintaining health with preventions

community health concepts

Are PSA type stuff

primordial

immunizations are an example of what level of prevention?

primary

screening for exposure is?

secondary prevention

include optimizing programs such as rehab

tertiary

Active immunity can be gained from?

natural immunity from contracting the disease artificial immunity from receiving a vaccination

Passive immunity can come from?

Natural immunity conveyed from mom to neonate Artificial immunity from immunoglobulin administration

______ is the act of introducing antigen

vaccination

______ is something that gets developed as far as the immune system (sometimes over time)

immunity

Diphtheria Tetanus Pertussis Poliomyelitis Measles Mumps Rubella Haemophilus influenzae Type b Hepatitis A Hepatitis B Influenza Pneumonia Varicella (chickenpox) Rotavirus Human papillomaviruses Meningitis Zoster (shingles)

vaccine preventable diseases

Be familiar with the schedule – updated annually Be aware of contraindications and precautions Provide information and anticipatory guidance Be prepared for adverse reactions Ensure parental consent prior to administration Provide safe administration Ensure documentation is complete

role in immunizations

you dont have to memorize about when certain vaccines are given, but you do need to understand that different vaccines are given at _______

different ages

its ok to give a vaccine when a child has a low grade fever, but not a severe one if they have a severe fever, the vaccine will be _______ ________

less effective

If the patient is immunocompromised or has had a recent blood transfusion, which type of vaccines should you not give?

life attenuated vaccines

if the patient has had a recent blood transfusion, how long should you want before giving their vaccine?

3-5 months

If an individual is pregnant, which type of vaccines cannot be given?

live vaccines

severe febrile illness and immunoglobulin administration are?

contraindications for vaccine administration

military, marriage, pregnancy, STDs, mental health

conditions for medical emancipation

Appropriate needle length ______ for infants < 28 days old; 1 inch for infants 1 month and older

5/8 inch

Appropriate anatomical site – IM – 22-25 gauge <12 months old – ______ >12 months old – may use deltoid muscle if enough muscle mass exists

vastus lateralus

Appropriate anatomical site – _____ – 5/8-inch, 23-25 gauge <12 months old – outer thigh >12 months old – upper-outer triceps

Subcut

If multiple vaccines – space an_______ apart

inch

best position to administer vaccines for child or infant

Inject rapidly without aspiration Inject vaccines that cause most pain last Distraction – blowing bubbles Encourage a comforting hold Breastfeeding or sweet-tasting solution for <2-year-olds Tactile stimulation Use a colorful bandage Cool compresses to site Parent may give acetaminophen or ibuprofen afterwards

minimizing discomfort measures for vaccine administraiton

_______ vaccines hurt the most, wait until the end to give them

pneumonia and MMR

pressing an inch above the injection site is an example of?

tactile stimulation

give IM before ______

SUBQ

Tenderness, redness, swelling

Local reactions – most frequent, least severe

Low-grade fever, malaise, muscle pain, headache, syncope, loss of appetite

Systemic reactions – less frequent than local reactions

Epinephrine and airway management equipment should be available for this allergic reaction to vaccines

anaphylaxis

sycope happens more with men getting the ______vaccine –response doesn’t always happen immediately

HPV

Provide VIS (Vaccine Information Statement) – federal law requires it Document date, site, route, manufacturer, and lot number Discuss s&s of a reaction with parents Provide materials – After the shots… Review education

Vaccine Information, Guidance, and Documentation

_______ children are most susceptible to the complications of communicable disease

Immunocompromised

Barrier protection from blood and body fluids Respiratory hygiene/cough etiquette Safe injection practices Hand hygiene

standard precautions

Reduce risk by direct or indirect contact

contact precautions

must clean hands wear gloves gown dedicated or disposable equipment

contact precautions

Reduce risk by airborne droplet nuclei (<5 mm) suspended in air Negative pressure isolation rooms

airborne precautions

clean hands put on fit tested n 95 keep door closed to room

airborne precautions

Reduce risk by droplets (>5 mm) do not remain suspended in air These droplets travel 3 feet or less through the air

droplet precautions

clean hands make sure eyes, nose, and mouth are fully covered before room entry remove face protection before room exit

droplet precautions

What transmission precautions are used with varicella zoster?

airborn, contact, of course standard

When is varicella zoster (chicken pox) transmissible?

day before rash appears until rash scabs over Probably 1 day before eruption of lesions (prodromal period) to 6 days after first crop of vesicles when crusts have formed

Is there a vaccine for the varicella virus?

yes, live attenuated vaccine

Prodromal stage—slight fever, malaise Pruritic rash begins a macule → vesicle then erupts Rash is typically centripetal → extremities, face

clinical manifestations of Varicella

Keep child cool as it may lessen number of lesions Symptomatic relief – diphenhydramine or antihistamines Varicella immune globulin minimizes severity in exposed child Acyclovir IV given to immune compromised children oatmeal baths may help keep fingernails short keep in cool clothing –cotton linens, topical antiitch stuff

treatment for varicella virus

What are the transmission precautions for Measles (Rubeola)?

Airborn precautions until day 5 of the rash

how is Measles (Rubeola) transmitted?

Usually by direct contact with droplets of infected person; primarily in the winter

Possible complications Otitis media, pneumonia, laryngitis, encephalitis

possible complications from Measles (Rubeola)

Clinical manifestations Prodromal state: fever, ________ → 3 Cs: ________, cough, __________ “Koplick Spots” on ________ _____________ rash on day 3-4 of illness

clinical manifestations of Measles (Rubeola) Clinical manifestations Prodromal state: fever, malaise → 3 Cs: coryza, cough, conjunctivitis “Koplick Spots” on mucosa Maculopapular rash on day 3-4 of illness

Treatment Bed rest, antipyretics, and support Vitamin A supplements

treatment for Measles (Rubeola)

Coryza is hallmark of _______

Measles (Rubeola)

what Measles (Rubeola) may look like

what is the transmission for mumps?

Direct contact with or droplet spread from an infected person Droplet and Contact Precautions

What precautions are needed for mumps?

droplet and standard and contact

when is mumps communicable?

Period of communicability – immediately before and after swelling

Clinical manifestations Prodromal state: fever, headache, malaise, anorexia for 24 hours → earache that increases with chewing Swollen and tender in one or both parotid glands

clinical manifestations of mumps

Treatment IV fluids if vomiting or unable to eat and drink Soft foods if able to eat Analgesics Hot or cold compresses, whichever feels better

treatment for mumps

______ after puberty will have swelling of the testees or ovaries

mumps

oophoritis =______

ovary inflammation

orchitis = ______ –elevate scrotum –roll up a towel and place it underneath

testes inflammation

you can actually pass it to the baby in utero: miscarriage, still birth, or cataracts. Vaccinated or not.

Rubella (German Measles)

Vaccinate after pregnancy,

Rubella (German Measles)

What are the transmission precautions for Rubella (German Measles)?

droplet and standard

they need to abstain or wear condom if mom is not vaccinated bc the vaccine is live attenuated

Rubella (German Measles)

mumps

Rubella (German Measles)

Clinical manifestations Low-grade fever, headache, malaise, sore throat, profuse nasal drainage, diarrhea, rash (from face towards legs)

Rubella (German Measles)

Treatment Supportive care

Rubella (German Measles)

B-19 virus more common in kids than adults saliva, sputum, blood starts out like a cold, and can have cold for a few days theyre most contagious before the rash even appears

Erythema infectiosum

What precautions are necessary for Erythema infectiosum ?

droplet standard

this can affect pregnancy so keep them away, (small percentage can result in fetal demise which can cause miscarriage)

erythema infectiosum

is there a vaccine available for erythema infectiosum?

no vaccine is available

Clinical manifestations Fever, runny nose, headache Rash appears in three stages 1. “Slapped Cheek” appearance 2. Maculopapular red spots on extremities from proximal to distal 3. Rash subsides but reappears when skin is irritated Polyarthropathy Syndrome

erythema infectiosum or fifth disease

what is the treatment for Erythema infectiosum or fifth disease?

supportive care

fifth disease

erythema infectiosum or fifth disease

hallmark is slap cheek appearance rash moves from prosimal to distal areas

fifth disease

pain and swelling in joints: polyarthropathy syndrome –treated. arthritis pain can last up to 9 years, should resolve but there have been lingering pain from the syndrome as a result of the disease though

fifth disease erythema infectiosum

if you have a kid in your ER with rashes and stuff: use ___ precautions and use your ____

all, N95

___ ounces of weight gain every week

5-7

______ birth weight by six months ______ birth weight by one year

Double, Triple

Height increases one ______ for six months Growth in “spurts” rather than gradually

inch/month

Depth perception begins by 7-9 months Parachute reflex appears at 7 months

Sensory changes

Grasps object,

2-3 months

Palmar grasp has a bidextrous approach,

5 months

Transfers object between hands, ___ Pincer grasp, _____ Finger-feds self, ______ Removes objects from container,______ Builds tower of two blocks (but fail), _____

7 months 9 months 10 months 11 months 12 months

Grasps object, 2-3 months Palmar grasp has a bidextrous approach, 5 months Transfers object between hands, 7 months Pincer grasp, 9 months Finger-feds self, 10 months Removes objects from container, 11 months Builds tower of two blocks (but fail), 12 months

Fine Motor Development

Head lags, 1-3 months Rolls over, 4-5 months Sits leaning forward on hands, 6-7 months Crawls and pulls up, 8-9 months Stands alone and walks with hand held, 10-12 months

gross motor development

development of sitting

Cephalocaudal direction of development Crawling, 6-7 months Creeping, 9 months Walk with assist, 11 months Walk alone, 12 months

locomotion

Crying is first verbal communication, 1-3 months Vocalizations, 4-5 months Begins to imitate sounds, 6-7 months Meaning of “NO”, 8-9 months Two to three words with meaning by one year of age, 10-12 months

language development

Crying is first verbal communication,

1-3 months

Vocalizations, 4-5 months Begins to imitate sounds, ______

6-7 months

Meaning of “NO”, ______ Two to three words with meaning by one year of age, 10-12 months

8-9 months

Bright, shiny object such as mobile Talk/sing to them Play music box Rattle, chimes Rock infant or use swing Move legs in swimming motion Splash in bath Bounce on lap

Play and the Infant – Birth to 6 Months

Play peek-a-boo Rock or bounce Let them feel textures Repeat simple words Pat-a-cake Call them by name Name parts of body and other frequently seen objects Clap hands Let them play in running water with supervision Simple nursery rhymes Roll ball

Play and the Infant – 6 Months to 1 Year

Need for setting safe limits to prevent injury Behavior is exploratory, not oppositional Remove unsafe objects and unsafe areas Age-appropriate discipline “Time-out”

Limit Setting and Discipline for infants

Aspiration of foreign objects Suffocation Motor vehicle injuries Falls Poisoning Burns Drowning

injury prevention for infants

Aspiration and suffocation Drownings SIDS prevention “back to sleep” Heating bottles Risk of falls Safety while traveling Do not place car seats in front seat with airbags

Injury Prevention – Birth to 3 Months

Keep small objects out of reach Do not feed hard or round cylindrical foods Avoid candy, nuts, food with pits or seeds Do not feed lying down Inspect toys for removable parts Watch storage of chemicals Keep latex balloons out of reach Remove toys hanging above crib when child can push up Keep plants out of reach Secure furniture Child-proof home

Injury Prevention – 4 to 7 Months

Keep small objects away and off of floor Only small pieces of food No beanbags Fence pools and install a gate alarm No pools of water Close bathroom doors Always keep one hand on child when child is in tub Avoid walkers Fence stairways Secure furniture Guards around heating appliances Baby-proofing

Injury Prevention – 8 to 12 Months

Attachment – distinct preference around 6 months Separation anxiety – normal around ______ Stranger anxiety – begins between ______ Nurses can talk softly, meet at eye level, and maintain a safe distance Play as major socializing agent

4-8 months , 6-8 months

VFrom nipple to solids 4-6 months of age Weaning from breast/bottle may begin Extrusion reflex disappears reflex where the tongue pushes food or stuff out, disappearance of it indicates they are ready for solids Swallowing is more coordinated Head control Able to sit while supported in chair

Nutrition – Assessing Readiness for Solids

Eggs, milk, peanuts, tree nuts, fish, shellfish, wheat, and soy Manifestations GI – abdominal pain, vomiting, cramping, diarrhea Respiratory – ”barky” cough, wheezing, rhinitis, dyspnea Cutaneous – urticaria, rash, atopic dermatitis Systemic – anaphylactic, growth failure

food sensitivity

many allergies are ______ milk intolerance is developed as we become adults

grown out of

______ appear approx. 6-10 months

Central incisors

During the first two years of life _________________ = # of teeth

age of child in months minus 6

drooling, ↑finger sucking, or biting on hard objects, irritability, difficulty sleeping, mild temperature elevation, ear rubbing, and decreased appetite for solids no aspirin and no whiskey

teething s/s

Weight less than 5th percentile though height WNL

failure to thrive

Inadequate caloric intake Inadequate absorption – i.e., CF/Celiac disease Increased metabolism – hyperthyroidism Defective utilization – Genetic/metabolic child abuse and neglet

Failure to Thrive (FTT)

Focus is on reversing the cause Long-term effects Shorter statures Lower weights Lower scores on psychomotor development Lower IQ scores Eating and behavioral issues help them catch up on calories and growth never assume that information is known, don’t be condescending

FTT

Sudden death of infant <1 year remaining unexplained after an autopsy

SIDS

Risk factors Maternal smoking Co-sleeping Prone sleeping Soft bedding Low birth weight Low Apgar scores Recent viral illness Siblings of two or more SIDS victims Male sex Infants of Native American or African American ethnicity

Risk factors for SIDS

Avoid smoking during pregnancy and near the infant Breastfeeding Supine sleeping position “Back to Sleep” Avoid soft, moldable mattresses, blankets, and pillows Avoid bed sharing Avoid overheating during sleep Vary infant head position to prevent plagiocephaly Educate parents on “tummy time” during awake hours fontanels are open so they can pass through the birth canal tummy time- 10-15 minutes three to five times a day, will help them get stronger

Reducing the Risk of SIDS

Weight gain about 5 lbs./year

toddlers

Birth weight should be _____by 2-3 years of age

quadrupled

Height increases to about _____ for toddlers

3 in./year

Intense period of exploration Temper tantrums, obstinacy occur frequently Clear guidance such as limit setting necessary

toddlers

Steady growth in height and weight Walks without help but loses balance easily Throws ball but falls Throws objects Scribbles Uses cup with lid Tolerates some separation from parent Imitates parents Kisses parents Expresses emotions Knows 4-6 words

milestones for 15 months

Small appetite due to reduced growth Anterior fontanel closed Runs clumsily and often falls Jumps in place Can turn pages in a book (two or three at a time) Manages spoon without rotation Imitates Unzips clothing Temper tantrums “Mine!” – Begins to understand ownership Security item (ex- blanket) Says 10 or more words but may be hard to understand Points to body parts

major milestones 18 months

Height at 2 years, double that number = roughly their adult height May be able to control bowel and bladder during the day Runs with wide stance Picks up objects without falling Turns pages one at a time Imitates vertical and circular strokes when drawing Turns doorknob 300-word vocabulary, 2–3-word phrases Can say own name, talks constantly

major milestones 24 months

Birth weight quadrupled Has all primary teeth (20) Jumps with both feet Takes tiptoe steps Good hand-finger coordination Holds crayon with fingers vs fist Names colors Notes gender differences Separates more easily from parent

major milestones 30 months

May be able to control bowel and bladder at night Rides tricycle May try to dance, but fall Complete four-to-five-word sentences Talks incessantly Asks questions… Why? Starts to sing songs Feeds self Can help set table May have fears (dark, monsters) Focus is on Parallel Play Eager to please parents

major milestones 3 years

Erikson’s - Autonomy vs. Shame and doubt Negativism Ritualization Separation anxiety Piaget’s sensorimotor and preoperational phase Awareness of causal relationships between two events Learn spatial relationships “there is something behind that cabinet door”

psychosicail/cognitive development for toddlers

make decisions and do things by themselves (when they cant achieve it its where the shame and doubt comes in) negativism: moody and strong emotions, don’t want to be stubborn or disrespectful routines (talk to the parents and ask about routines so that they can have routines) they are very egocentric its expected for them to be egocentric

toddlers

Voluntary sphincter control Able to stay dry for 2 hours Fine motor skills to remove clothing Willingness to please parents Curiosity about adult’s or sibling’s toilet habits Impatient with wet or soiled diapers Bowel training usually comes before bladder training Practice sessions of 5-8 minutes can be frustrating for kids and parents 18 to 24 months old is the period where this can be alright, mylenation does not occur in the spinal cord that controls the anal sphincter until around this age bowel will come before bladder

assessing readiness for toilet training

Motor vehicle injuries – car seat safety 5-point harness Booster seats in rear seat of the car Drowning Burns Poisoning Falls Aspiration and suffocation Bodily damage

injury prevention for todlers

Phenomenon of “physiologic anorexia” Ritualism is common Improved ability to chew and swallow Don’t reduce fat intake in child younger than 2 Avoid sweets and nutrient-poor, high-calorie foods Tips Offer 3 full meals, 2 snacks Portions = ¼ size of adult or 1 Tbsp./year of age Serve near room temperature Cut into bite-size pieces Finger foods vs. utensil use kids self regulate and they should carry it and practice it, shouldn’t force them to eat but the parent should decide what theyre eating encourage utensile use

promoting nutrition in toddlers

Model eating behaviors Lifelong eating patterns established in childhood Don’t allow to eat whatever they want, but don’t coerce either May require 20 exposures to new food before accepting it Positive attitude May prefer only one type of food for a few days May scream or throw food Praise for trying new food Include familiar foods with new foods

promoting health habits in toddlers