Infancy 10-24 months Flashcards
Developmental theories of infants 10-24 months?
Trust v. Mistrust
- the infant needs should be met
When do teeth first erupt?
9-12 months
- bottle fed babies: look for carries and tooth decay
When can babies first raise their heads?
10 months
When is the birth weight doubled and tripled?
Doubled: 6 months
Tripled: 1 year
- weight loss is bad, physiological sign
Average weight and height of 2 year old?
weight: 12 kg or 26.5 lbs
height: 86.6cm or 34 inches
When does the anterior fontanel close?
18 months
- if not, hypothyroidism
When can toilet training begin?
22-24 months
When can a child hold urine for more than 2 hours?
By 14-18 months
How should motor development look?
Symmetrical and progressive
Gross motor to fine motor
Crawling to walking to running to jumping
Sleeping pattern of 10-24 month old?
sleeps total of 10-15 hours/day
Nutritional pattern of 10-14 month old?
less interested in food
wants to explore world
Nutritional pattern of 15-18 month old?
refuses meals to show power
small servings advised
Nutritional pattern of 19-24 month old?
Increased ability to concentrate on meals
Restrict milk to 16 oz to save room for other foods
Elimination abilities of 10-14 month old?
Muscle control of sphincter not sufficiently developed to start toilet training
Elimination abilities of 15-24 month old?
Has BM at appropriate time when placed on a potty.
Indicated wet pants
Elimination abilities of 18-24 month old?
- more regular pattern of elimination
- toilet training successful if pattern established
Activity of 9-12 month old?
- Creeps and crawls
- scoots on bottom
- walks holding onto furniture
- starts holding spoon
Activity of 12-15 month old?
- Walk on own/holding hand
- can only crawl upstairs
- can throw a ball
Activity of 15-18 month old?
- Walking, may run/climb
- scribbling on paper
- feeds themselves
Activity of 18-24 month old?
- runs, falls often
- kicks balls
What needs to happen at every infant physical exam?
VS: temp, RR, HR Height, lying down Weight: infant scale in a diper Head circumfrence - growth chart every visit
Normal HR
- 0-12 months
- 1-11 years
HR
- 0-12 months: 100-160 bpm
- 1-11 years: 70-120 bpm
Normal RR
- 6-12 months
- 1-5 years
RR
- 6-12 months: 24-30bpm
- 1-5 years: 20-30bpm
Normal temp
98.6 F
What systems need to be examined at every visit?
HEENT Heart Lungs Neuromusular- symmetrical Developmental Milestones
What history needs to be reviewed at every visit?
Eating Sleeping Bowel/bladder Developmental milestones Illnesses/ ER visits
When should rolling occur?
4-6 months
When should sitting occur?
6 months
When should walking occur?
12 months
When should toilet training occur?
Not before 24 months
When does babbling occur?
6-9 months
- if not, may have hearing problem or delay
When should their first word occur?
10-12 months
What are signs of cardiac disease in an infant?
- Poor feeding
- Growth failure
- Respiratory distress
- Lethargy, should be active
- Cyanosis, circumoral
What are the signs of respiratory distress in an infant?
- Cyanosis
- Elevated RR
- Use of accessory muscles
- Head bobbing…more common in younger children
- Nasal flaring
- Retractions
- Wheezing
- Stridor
- hearing a thud on inspiration, probably object
- Rales, rhonchi, wheezing
How and when to introduce solid foods to an infant?
- Not before 6 months
- One at a time
- No cows milk before 12 months
- eats with fingers, holds cup and spoon
what needs to be check with kids on formula?
- check hemoglobin every 3 months
- if constipated, give low iron formula
How will teething appear?
drooling
difficulty sleeping
irritable
What is atopic dermatitis?
- most common childhood skin disorder
- disseminated rash on face, arms and butt
- easily infected because kids scratch with dirty nails
- Red rash, papular lesions
- Associated with childhood asthma
Atopic dermatitis treatment:
- steroid cream, use mild potency to avoid changes in skin pigmentation
- bathe daily
- secondary infection: and anti-staph antibodies
- kids should wear gloves at night, keep nails short
- use mild soap and keep moisturized
- avoid sun and extreme temp changes
Who should not get vaccinated?
- allergies/ allergic rxn
- immunocompromised- for live vaccine
- chronic kidney disease
- if toxic (fever, diarrhea)
What is toilet training usually dependent on? Around what age?
Dependent on emotional and physical readiness
- walks well
- can stay dry for periods of time
- discomfort when soiled
Rarely before 18 months
When does AAP recommend children to be screened for developmental delays?
9 months
18 months
24 or 30 months
When should children be screen specifically for ASD?
Autism Spectrum Disorder
18 months
24 months
When is hemoglobin checked?
9-12 months
If anemic look for: lead, diet, sickle cell
When are lead levels checked?
12 months, venous testing
What is some general anticipatory guidance you can give parents for 9-15 month kids?
- Consistent schedule is important
- reward good behavior, don’t give attention to bad behavior
- They have broader emotional reactions: fear, stubborn
What is some general anticipatory guidance you can give to parents for 15-18 months kids?
time of temper tantrums and power dynamics
What is some general anticipatory guidance you can give to parents for 18-24 months kids?
- time of language acquisition
- child is still very active, will run and jump
What is some nutritional anticipatory guidance you can give to parents for 9-15 months kids?
less interest in food
What is some nutritional anticipatory guidance you can give to parents for 15-18 months kids?
eating may become a battle
What is some nutritional anticipatory guidance you can give to parents for 18-24 months kids?
- encourage an interest in different foods
- never use food as punishment/reward
What is some elimination anticipatory guidance you can give to parents for 9-15 months kids?
too early to potty train
What is some elimination anticipatory guidance you can give to parents for 15-18 months kids?
may begin practice potty training
What is some elimination anticipatory guidance you can give to parents for 18-24 months kids?
- girls generally train earlier than boys
- smaller kids train faster than larger kids
- bladder training is usually after bowel training
What is some safety anticipatory guidance you can give to parents for 9-15 months kids?
Childproof the home so kid can explore home freely
What is some safety anticipatory guidance you can give to parents for 15-18 months kids?
Maintain vigilance
What is some safety anticipatory guidance you can give to parents for 18-24 months kids?
Maintain vigilance for choking, burns, fires
What is the most preventable pediatric health problem?
High lead levels aka lead poisoning
What does high lead levels lead to?
- decreased intelligence
- impaired neurobehavioral development
- decreased growth
- seizures
What is a high lead level?
In NYC = 10+
In NY state = 5+
Why are kids at higher risk for lead poisoning?
- more hand to mouth activity
- absorption is greater in kids
What are sources of lead?
- Lead based paint
- Soil ,dust
- Drinking water
- Parental /hobbies..stained glass,furniture repair,finishing
- Toys
- Occupations..battery recycling,building demolition etc
How to reduce lead exposure?
- wash hands before eating
- wash toys/pacifiers
- have parents change before coming in house
- eat frequent meals
- increase iron and Ca in diet
When are high lead levels followed up on?
3 months after initial venous test
What lead level requires hospitalization?
70+g/dL
Otitis media
- acute infection of middle ear
- Common in 6-36 month kids
- Organisms: S.pneumo, H.influenza, Moraxella catarrhalis
- watch and wait for 72 hours
What is persistent acute OM?
persistent otitis media symptoms after 48-72 hours of antibiotics
What is chronic OM
persistent s/s for 3 months or more
- anatomical problem
What are toxic markers for otitis media?
- decreased activity
- dehydration
- decreased feeding
- fever
When should parents see an improvement with OM?
When is follow up scheduled?
- improvement within 24 hours of treatment
- f/u in 48 hours
- chronic f/u in 3-4 weeks
