Healthy Child: Growth and Development Flashcards
1 month developmental milestones
Gross motor
- Head lag (poor head/neck control)
Fine motor
- Grasp reflex — holds hand in fist
- Babinski reflex
- Rooting reflex
- Tonic neck
Language
- Responds to touch and voices
- Sensory motor communication
Social/Cognitive
- Finds safety with caregiver and looks at face
2-3 months developmental milestones
Gross motor
- Kicks legs — 2 legs kick at 2 months
Fine motor
- Grasp reflex fades
- Hands kept loose
Language
- Response to sounds
- Able to make sounds with mouth
Social/Cognitive
- Smiles and coos when seeing a familiar face
4-5 months developmental milestones
Gross motor
- Head control by 4 months
- Rolls from front to back by 5 months
Fine motor
- Grabs objects voluntarily (rattle)
- Moro and other reflexes diminish
Language
- Mimics sounds heard
- Able to change cry tone for different needs
Social/Cognitive
- Soothed by caregiver’s voice
- Copies expressions
- cries if ignored/alone
6-9 months developmental milestones
Gross motor
- Birth weight doubles by 6 months
- Rolls from back to front (6 mos)
- Can sit unsupported (7 mos)
- Pulls self up
- Crawls/creeps
Fine motor
- Holds bottle (6 mos)
- Transfers objects from 1 hand to other
Language
- Babbling words (Mama/Dada)
- Responds to name
- Report if not babbling by 9 mos **
Social/Cognitive
- Identifies face and strangers
- Separation anxiety begins at 6 mos
10-12 months developmental milestones
Gross motor
- Stands alone
- Prone to sitting (10 mos)
Fine motor
- Pincer grasp (10 mos) — finger foods
- can remove objects from a container (11 mos)
Language
- Able to make a variety of sounds
- Mimics gestures
- Understands “yes” and “no”
Social/Cognitive
- Vocalization and speech (talking toys/books)
- Purposeful play
12 months developmental milestones
Gross motor
- Birth weight triples
- Sits down from standing
- Walks while holding hand
- Crawls upstairs
Fine motor
- Tries to build 2 block tower (unsuccessful)
- Tries to turn book pages
Language
- 3-5 words
- Nonverbal gestures (waving, nodding)
Social/Cognitive
- Shy; stranger danger
- Can follow short simple directions
- Searches for hidden objects (object permanence)
18 months developmental milestones
Gross motor
- Walks up/down stairs while holding hand
- Throws ball
- Jumps in place with both feet
Fine motor
- Turns 2 pages in a book (uncoordinated)
- Holds cup and spoon
- Builds tower of 4 blocks
- Scribbles with crayon
- NO finger dexterity (no scissors or pencils)
Language
- 10+ words
- Follows commands (“don’t touch”)
- Uses gestures to show what they want (point)
Social/Cognitive
- Angry baby — Temper and ownership (“mine”)
- Parallel play — children play next to each other (no direct interaction with others)
2 years developmental milestones
Gross motor
- Walks without help
- Run and kick ball
- Walks up and down stairs independently 1 step at a time
Fine motor
- Builds a tower of 7 blocks
- Draws vertical lines
- Able to turn1 page at a time
- Opens doors by turning knobs
Language
- Says own name
- 300+ words
- 2-3 word sentences
- Identifies pictures with names
Social/Cognitive
- Imitates adult behavior — T-toilet train — T-toddlers by age — T- two years old
- Gains independence
3 years developmental milestones
Gross motor
- Tricycle and jumps forward
- Learning balance
- Walks up stairs with alternating feet
- Stand on one foot
Fine motor
- Draws circles
- Spoon feeds self
- Undresses self
- Holds crayons with fingers instead of fists
- Scissors (yes)
- Zips up a zipper
Language
- 3-4 word sentences
- Asks “why” a lot
- Knows age
- Follows more complex instructions
Social/Cognitive
- Associative play — unorganized play without a goal or rules
- Imaginary friends and symbolic play
4 years developmental milestones
Gross motor
- Skips, hops on 1 foot
- Catches a ball 50% of the time
- Climbs and jumps
Fine motor
- Draws 4 sided shapes
- Can pour drinks and make food
Language
- Able to tell stories
- Can memorize alphabet and numbers
Social/Cognitive
- Imaginary play— dress up
- Plays with other children rather than alone
0-18 months (infant) psychosocial development (Erikson)
Attributes
- Trust vs mistrust
- Virtue: hope & optimism
Need/Focus
- Safety with mother/caregiver (feeding — trust; mistrust when ignored)
Good outcome
- Trust and faith in environment and with caregivers
Bad outcome
- Fear and suspicion with people and environmen
18 mos - 3 yrs (Toddlers & Early childhood) psychosocial development (Erikson)
Attributes
- Autonomy vs Shame & Doubt
- Virtue: will use freedoms and self-restraint
Need/Focus
- Independent from parents
Good outcome
- Independence and control over behavior and skills = autonomy
Bad outcome
- Failure to achieve autonomy leads to shame and doubt
3-6 yrs (preschool) psychosocial development (Erikson)
Attributes
- Initiative vs guilt
- Virtue: purpose, ability to start activities and goals
Need/Focus
- Powerful within family and exploring
Good outcome
- Initiative + assertive = sense of purpose
Bad outcome
- Asserting too much power = disapproval and guilt
6-12 yrs (school-age) psychosocial development (Erikson)
Attributes
- Industry vs inferiority
- Virtue: competence in intellectual, social and physical skills
Need/Focus
- Good with neighbors, classmates, and friends
Good outcome
- Feeling competent with social and academic demands
Bad outcome
- Failure in social and academia = feeling inferior
12-18 yrs (adolescence) psychosocial development (Erikson)
Attributes
- Identity vs role confusion
- Virtue: fidelity, fitting into the world as own person
Need/focus
- Socializing and fit into peer groups
Good outcome
- Sense of self and personal identity — Staying true to yourself
Bad outcome
- confused with self identity = lonely and isolated
0-2 yrs (infant & toddler) cognitive development (Piaget)
Stage
- Sensorimotor — thinks in the present moment through the senses
- Object permanence* — objects are still there even if you can’t see it
Teaching
- Teach in the present moment
Example
- Catheter insertion for an 18 month child? — Teach them what you are doing as you are doing it
3-6 yrs (preschool) cognitive development (Piaget)
Stage
- Preoperational thinking — Imaginative, symbolic thought, magical thinking*
- Do not understand cause and effect
- Understands future and past
Teaching
- Teach shortly before
- Teach: the day of, the morning of, a few hours before, etc.
Example
- Catheter insertion for a 4 year old? — Teach the child what you are going to do
7-11 yrs (skill learning) cognitive development (Piaget)
Stage
- Concrete operational — logical thought, follows rules, rigid thinking
- Only 1 way to do something
- Limited abstract thoughts
Teaching
- Teach days before
- Include skills
- Demonstration and reading
- Teach them: tomorrow we will, you will do this everyday…
Example
- Which child can the nurse teach bandage placement skills? — 7 years old and up
12-15 yrs (adolescents/adults learning) cognitive development (Piaget)
Stage
- Formal operational — developing abstract thought, cause and effect thinking (love, hate, morality)
Teaching
- Teach like an adult!
- 12+ yrs old can manage their own care
- Teach: Report these finding…, if you see this then follow up…
Example
- Which child can manage their own care? — A 13 yr old with type I DM
- Tip — Risk taking behavior = non-compliance
Nurse’s role for safety promotion and injury prevention
Nurse’s role is to educate and provide anticipatory guidance
Which age group(s) of children should be put in a REAR facing car seat?
Birth to 2-4 years
Which age group(s) of children should be put in a FRONT facing car seat?
2-5 years old
Which age group(s) of children should be put in a BOOSTER seat?
5 until the seat belt fits property (about 9-12 years old)
Car seat tips (7)
- Rear and front facing seats need to use a 5 point harness
- Straps should be below the shoulders for rear-facing
- Chest clip needs to be at nipple or armpit level — never on abdomen
- LATCH system should be used (if available), not seatbelts
- Children under 12 should ride in the back seat
- Center seat is safest from impact
- Rear facing car seat should never go in front of an airbag
Tips for drowning prevention (8)
- Fence off swimming pools
- Ensure kids wear life jackets in and around bodies of water
- Learn how to swim
- Supervise children in and around water — including tubs
- Close toilet lids; don’t leave children unattended in the bathroom
- Empty all containers with liquids (buckets)
- If a near-drowning incident occurs, always bring the child to the hospital for evaluation— fatalities can occur hours later
Tips for burn prevention (6)
- Smoke alarms — at least one per level of the home, outside bedrooms — test monthly/replace batteries every 6 months
- When cooking, use furthest burner, turn pot handles to the back of the stove, and never leave stove unattended
- Water heater temperature should be set to at or below 120 F — Test water before placing child
- Avoid heating food in microwave – superheated hot pockets can scald
- Use safety caps to block unused electrical outlets
- Fire resistant fabrics for pajama
Tips for poisoning prevention and treatment (6)
- Lock up medications, cleaning products, and chemicals
- Have poison control number available
- Advise parents NOT to use ipecac syrup to induce vomiting
- Activated charcoal (acetylcysteine) — used for acetaminophen overdose
- Chelation therapy — used for iron or lead overdose
- Gastric lavage
Choking prevention tips
- Supervise children at mealtimes
- Avoid choking hazards — round foods (hot dogs, nuts/seeds, chunks of meat/cheese/peanut butter/raw vegetables, whole grapes, hard/sticky candy, popcorn, gum)
Choking s/s
- Wheezing
- Strider
- Coughing
- Dyspnea
- Clutching neck with hands (universal sign)
- Inability to speak
- Cyanosis
Universal sign of choking?
Clutching neck with hands
Choking interventions?
- Use back blows and chest thrusts for children under 1 yr
- Use abdominal thrusts for children over 1 year old
- Do NOT perform blind finger sweep — this can lodge the object further in the airway
- If the child becomes unconscious, begin CPR
Pain scale used for (0-6 mos)
CRIES scale (0-10)
- Crying
- Requires O2
- Increased VS
- Expression
- Sleeplessness
Pain scale for 2 mos — 7yrs
FLACC Scale (0-10)
- Face
- Legs
- Activity
- Cry
- Consolability
Pain scale for 3 and up
- Wong-Baker FACES pain rating scale
Pain scale for 8 and up
Numeric (0–10)
VS order for children?
Count respirations before touching the child — then apical HR — then BP — Temperature last
How long do we listen for HR and RR for infants and toddlers?
1 minute (to screen for irregularities)
VS ranges for 0-1 yr (infant)
- HR — 110-160 bpm
- RR — 30-60 breaths/min
- BP — 70-105/35-55
- Temp — Axillary - 97.8-99.5F (36.5-99.5C) — Ear - 96.4-100.4 F (36.7-38C)
- O2 > 95%
VS ranges for 1-3yrs (toddler)
- HR — 80-110 bpm
- RR — 24-40 breaths/min
- BP — 85-105/40-65
- Temp — Axillary - 97.8-99.5F (36.5-99.5C) — Ear - 96.4-100.4 F (36.7-38C)
- O2 > 95%
VS ranges for 3-6yrs (preschool)
- HR — 70-110 bpm
- RR — 22-34 breaths/min
- BP — 90-110/45-70
- Temp — Axillary - 97.8-99.5F (36.5-99.5C) — Ear - 96.4-100.4 F (36.7-38C)
- O2 > 95%
VS ranges for 6-12 yrs (school-age)
- HR — 65-105 bpm
- RR — 18-30 breaths/min
- BP — 97-120/55-70
- Temp — Axillary - 97.8-99.5F (36.5-99.5C) — Ear - 96.4-100.4 F (36.7-38C)
- O2 > 95%
VS ranges for 12-18 yrs (adolescent)
- HR — 60-100 bpm
- RR — 12-18 breaths/min
- BP — 110-130/65-80
- Temp — Axillary - 97.8-99.5F (36.5-99.5C) — Ear - 96.4-100.4 F (36.7-38C)
- O2 > 95%
Dysmenorrhea
Painful periods/ period pain
Amenorrhea
Amenorrhea is the absence of a menstrual period in a female who has reached reproductive age
Variococele
Swelling of the spermatic cord
Epididymitis
- Inflammation of the epididymis — can lead to unilateral pain and swelling
- Affects young, sexually active clients assigned male at birth, under 35
Testicular torsion
Testicle rotated around spermatic cord
- Blocks blood flow to testicle
- Can lead to necrosis
Symptoms of testicular torsion
- Sudden severe pain in scrotum and lower abdomen on affected side
- Swelling and redness
Causes of testicular torsion
Most common to least common
- Tesicle not strongly attached to scrotum at birth
- Minor trauma around scrotum
- Vigorous physical activity OR during sleep
Treatment for testicular torsion
Immediate surgical detorsion (ideally within 6 hours of symptom onset)
Gynecomastia
Enlarged breasts in males
A four year old child should be speaking how many word sentences?
4 to 5 word sentences
Immunizations for 2 week to 1 month old infant
- Hepatitis B #1 at birth
- Hepatitis B #2 at 1-2 mos
2 month old infant vaccinations
- Diphtheria, tetanus, & acellular pertussis (DTaP) #1
- Inactivated poliovirus (IPV) # 1
- Haemophilus influenza type b (Hib) #1
- Pneumococcal conjugate (PCV13) #1
- Rotavirus (RV) #1
- Combo vaccines are available for DTap and IPV with either Hep B or Hib
4 month old infant vaccinations
- Diphtheria, tetanus, & acellular pertussis (DTaP) #2
- Inactivated poliovirus (IPV) #2
- Haemophilus influenza type b (Hib) #2
- Pneumococcal conjugate (PCV13) #2
- Rotavirus (RV) #2
- Combo vaccines are available for DTap and IPV with either Hep B or Hib
6 month old infant vaccinations
- Diphtheria, tetanus, & acellular pertussis (DTaP) #3 (can do combo)
- Inactivated poliovirus (IPV) # 3 (can be 6-18 mos)
- Haemophilus influenza type b (Hib) #3
- Pneumococcal conjugate (PCV13) #3
- Rotavirus for RotaTeq (RV5) #3
- Hepatitis B (Hep B) #3 (can be 6-18 mos)
- Influenza at 6 months and annually thereafter
9 month old infant vaccinations
- Hepatitis B (Hep B) #3 (can be 6-18 mos), omit if combo vaccine has been used previously
- influenza annually
- Provide info about upcoming MMR, Varicella, and Hepatitis A vaccines
1 year old vaccinations
- Haemophilus influenzae type b (Hib) may be given at 12 to 15 months of age. (This is dose #3 or #4)
- Measles, mumps, rubella (MMR) #1 — 12 -15 months.
- Varicella (VAR) #1 is given at 12 to 15 months.
- Pneumococcal conjugate (PCV13) #4 — 12-15 months
- Hepatitis B (Hep B) #3 (if not given earlier)( Hep B may be given any time between 6 months and 15 months)
- Diptheria, tetanus, & acellular pertussis (DTaP) #4 — 15 to 18 months. (DTaP may be given as early as 12 months if at least 6 months have elapsed since the third dose)
- Inactivated poliovirus (IPV) #3 (if not given earlier). IVP #3 may be given any time between 6 and 18 months.
- Influenza vaccine is given annually.
- Hepatitis A (Hep A) #1 can be given any time after 12 months. Hep A #2 can be given at least 6 months after the first dose, but should be given by 23 months.
2 year old vaccinations
- Administer any immunizations not given previously according to the recommended catch up schedule
- Influenza vaccine is given annually
3 year old vaccinations
- Administer any immunizations not given previously according to the recommended catch up schedule
- Influenza vaccine is given annually
4-6 year old vaccinations
- Diphtheria, tetanus, and acellular pertussis (DTaP) #5 (no #5 if #4 was given at or over 4 yrs old)
- Inactivated poliovirus (IPV) # 4 at least 6 months after last dose — this is final dose in series
- MMR #2 unless previously given
- Varicella (VAR) #2 unless previously given — if if given before 4, it is valid as long as 4 weeks after prior dose
- Influenza annually
7-10 year old vaccinations
- MMR #2
- VAR #2
- Inactivated poliovirus (IPV) #4
- Tetanus, diphtheria, & acellular pertussis (Tdap) used instead of DTaP for catch ups in this age group
- Influenza annually
- Other immunizations not up to date
11-12 year old vaccinations
- Review immunization record. Administer and catch ups
- Meningococcal conjugate vaccine #1 (then booster at 16 yrs)
- Human papillomavirus (HPV) #1, #2, #3. (First dose at 11 yrs, second dose 1-2 mos later, third dose after 16 more weeks)
- Tetanus and diphtheria toxoids ad acellular pertussis (Tdap) is given in one dose to all adolescents in this age range
- Influenza anually
Adolescent Tdap administration
- Administer a single dose at 11-12 years
Adolescent Meningococcal administration
- Administer a single dose of at 11-12 years and a booster at 16 years
Adolescent HPV administration
- 3 series dose to adolescents aged 11-12
- give 1st dose, then second 1-2 months after, then third after another 16 weeks
