Infancy 2-10 months Flashcards
Erickson’s developmental theory for Infants 2-10 months
Trust v. Mistrust
- fulfill basic needs: nourishment, warmth and physical contact
When should infant be able to lift head?
2-4 months
When should head lag disappear in an infant?
20 weeks
When should an infant roll from abdomen to back?
4-6 months
When should an infant begin to reach for objects?
4-6 months
When should an infant roll from back to abdomen?
6-8 months
When should an infant be able to sit unsupported?
6-8 months
When should an infant creep on hands and knees?
8-10 months
When should an infant pull self to stand and take steps?
8-10 months
What fine motor skills does a 2-4 month old have?
hands open
plays with hands and feet
What fine motor skills does a 4-6 month old have?
palmar grasp
manipulated smalls objects
What fine motor skills does a 6-8 month old have?
holds bottles
bangs objects
What fine motor skills does a 8-10 month old have?
crude pincher grasp
What vision/sensory skills does a 2-4 month old have?
follows objects
turns head to side when sound is made
What vision/sensory skills does a 4-6 month old have?
begins hand-eye coordination
smiles at mirror image
What vision/sensory skills does a 6-8 month old have?
recognizes parents
focus on small objects
What vision/sensory skills does a 8-10 month old have?
localized sound by turning head in appropriate direction
What socialization/vocalization does a 2-4 month old have?
coos
babbles
starts to laugh
What socialization/vocalization does a 4-6 month old have?
laughs aloud
babbles one-syllable sounds
What socialization/vocalization does a 6-8 month old have?
imitates sounds
plays peek-a-boo
two-syllable words
What socialization/vocalization does a 8-10 month old have?
says “dada” and “mamma”
comprehends “no”
What is the sleep pattern of a 2-4 month old?
sleeps about 15 hrs/day, nocturnal
What is the sleep pattern of a 4-10 month old?
varies by infant
How much/often does a 2-4 month old eat?
4 oz feeding, 6x per day
When can kids start solids?
6 months and older
- one at a time every 3-4 days
What age can kids feed self with small morsels and uses spoon?
8-10 months
What history should be reviewed at every visit?
- Sleeping
- Eating
- Activity
- Developmental Milestones
- Last visit…immunization
- ER visits
What is considered a fever in a 3-36 month old?
Fever ≥ 102.2°F (39°C)
When is diarrhea acute v. chronic?
Acute: transient, self limited
Chronic: more than 2 weeks
May be viral or bacterial
What history needs to be taken when infant presents with diarrhea?
- Length of illness
- Stools..frequency, looseness, presence of gross blood
- Oral intake..assoc.vomitting?
- Associated symptoms..fever,rash
- Urine output
- Contacts with other infectious illness
How to assess the hydration status of an infant?
- Moist mucosa
- Presence of saliva and tears
- Skin Turgor
- Weight
- Number of diapers
- Alertness
- Temperature
- HEENT, ABD.
What does blood in diarrhea indicate?
Bacterial infection
What is a common cause of acute diarrhea (without blood) in infants?
- Viral enteritis.. Norwalk, Adenovirus
- Entertoxin: E-coli
- Parasitic: Giardia
- Extraintestional infection: OM,UTI
- Antibiotic Induced: esp. ampicillin
What is the most common cause of chronic diarrhea in infants?
- secondary to chronic constipation
- formula intolerance
Mild v. Moderate signs of dehydration in an infant?
- Mild: dry mouth, absence of tears
- Moderate: sunken eyes, poor turgor, sunken fontanels
Severe signs of dehydration in an infant?
- lethargic
- parched mouth and tongue
- minimal/no urine output
- increased HR, weak pulse, deep breathing, cool extremities
- prolonged/minimal cap refill
- deeply sunken eyes
- sunken fontanel
What is the treatment for diarrhea in an infant?
- Hydration with Pedialyte (1 mL per kg of body weight)
- Tx. underlying cause, like OM
- Continue breastfeeding or formula
- Give RV vaccine
When should an infant be hospitalize for diarrhea?
- Unable to keep fluids in
- Bloody diarrhea
- Lethargy
- Concern about parenting
- > 10% dehydration: sunken fontanels, poor turgor
What is diaper dermatitis?
Cause: Candida albicans
Satellite Lesions: beefy red, shiny, sharply demarcated borders, papules or pustules
Found: skin folds and mouth
How is diaper dermatitis diagnosed?
- detailed history
- physical exam
- take a sample and look under microscope
How to educate parents on diaper dermatitis?
- change diapers frequently and clean diaper with tepid water
- keep child without diapers
- keep baby clean and dry as possible
- careful hand washing technique
- maybe topical antifungal
What is the follow up for diaper dermatitis?
Parents:
- check mouth frequently
- call back in 3 days if not improved
What is SIDS?
- sudden death infant under 1 year
- remains unexplained
What increases the risks of SIDS?
- Low SES
- males
- Family hx: smoking, drug abuse
- Low birth weight
- Black, Alaskan, American Indians
- Siblings of SIDS
- Premature infants w/ recurrent apneic episodes
How to prevent SIDS?
- back to sleep
- nothing in crib: low, flat, firm surface
- avoid overheating
- no bed sharing/ co sleeping
- no alcohol/drug use in house
Bronchiolitis
- inflammation of bronchioles
- Cause: viral (Adenovirus, Influenza, Mycoplasma pneumonia, Rhinovirus)
- Common in kids less than 24 months
- Spread via humans in peak winter through early spring
What are risk factors for bronchiolitis?
- low birth weight
- prematurity
- CHD, Resp. Dx
How does bronchiolitis present?
- peak at 6 months
- 2-3 days rhinnorhea and cough
- low grade temp
- usually playful and active
When should an infant with bronchiolitis be hospitalize?
- less than 6 months
- tachypnea
- poor intake or signs of dehydration
- lethargic
- CHD, Resp dx., neuromuscular dx., premature
- Resp. distress: RR >70, O2 stat.
How to treat bronchiolitis?
- hydration
- steam
- bronchodilator/nebulizer
- f/u in 24 hours
What is intussusception?
Invagination of one part of the intestine into another-distal ileum into cecum
What are the signs of intussusception?
-
What is pyloric stenosis?
- hypertrophy of pyloric muscle-obstruction of gastric outflow
- usually 2-10 weeks
- mostly males
What are the signs of pyloric stenosis?
- projectile non-bilious vomiting
- firm mobile-olive shaped mass in epigastrium
How is pyloric stenosis treated?
Pyloromyotomy
