Pediatric Milestones, Vaccines, and anticipatory guidance Flashcards
0-1 Month
- Moro and grasp reflex
- Responds to noise
- Minimal social
2 months
- Holds head up when on tummy*
- Begins to follow things with eyes and recognize people at distances
- Cooing*
- Turns head to sound
- Social smile at people*
3 months
- Lifting head and chest
2. Moro reflex disappears
4 months
- Starts to babble
- Reaches for toy w/ 1 hand and grasps object*
- Holds head unsupported
- Rolls from prone to supine*
- Brings hands to mouth*
- Copies facial expressions (smiling or frown)
**colic resolves in most baby by this age
6 months
- Sits upright w/o support*
- Babbles/strings vowels together (ah, eh, oh) and starts to say consonants (m, b)*
- Stranger anxiety*
- Begins to pass things from one hand to the other
- Rolls over in both directions*
“6 strangers switch sitting at 6 months”
9 months
- Understands “no”
- Uses finger to point at things
- Pincer grasp*
- Crawls*/ explores
- Pull-to-Stand/Stands holding*
- nonspecific mama-dada*
- responds to name
“Can crawl and therefore explore, and it takes 9 months to be a mama”
12 months
- Stands and walks holding onto furniture*
- “Mama-dada” specific and “uh-oh”*
- Hands you book when wants to hear story*
- Follows simple directions (pick up toy)
“Knows 1 word by 1”
15 months
- Walks
- Uses cup
- several words
- temper tantrums
18 months
- Walks up stairs*
- Drinks from a cup and eats with a spoon*
- Several single words*
- Points to 1 body part
- Temper tantrums
24 months
- Runs*
- 2-word sentences/several hundred word vocabulary
- Follows 2 step commands
- Shows defiant behavior*
- Builds tower of 4 or more block*
- Kicks and throw a ball*
- Makes or copies a straight line*
- Parallel play*
“puts 2 words together at 2, and 1/2 of speech is understood by stranger”
3 y/o
- Dresses and undresses self*
- Says first name, age, sex*
- Group play*
- Carries on conversation w/ 2-3 sentences*
- Plays make-believe
- Repeats 3 numbers
- Rides tricycle*
- Screws/unscrews jar lids or turns door handle*
“tricycle, 3 cubes, 3 numbers, 3 kids make a group”
4 y/o
- plays mom and dad
- knows basic rules of grammar like “he” and “she”/ uses past tense
- Can say first and last name*
- Draws person with 2-4 body parts*
- Copies a cross and draws a square*
- Hops and stands on one foot for up to 2 seconds*
- Catches bounced ball*
“head shoulder, knees and toes- 4 body parts, 4/4 language understood, draw 4 sides of a square”
5 y/o
- Wants to please*
- Uses future tenses “grandma will be here”
- Draw person w/ 6 body parts
- copies triangle and other shapes
- stands on 1 foot for 10 sec or longer
6 y/o
- Ties shoes
- Skips with alternating feet
- knows R and L hands
“at 6, skins shoes, person w/ parts”
When do the following reflexes disappear:
- Moro
- Walking/stepping
- Rooting/suck
- Tonic neck
- Palmer grasp
- Planter grasp
- Upward Babinski
- Moro (Aka parachute): 2 months
- Walking/stepping: 2 month
- Rooting/suck: 4 months
- Tonic neck: 5-7 months
- Palmer grasp: 5-6 months
- Planter grasp: 9-12 months
- Upward Babinksi: normal until 2y/o
Common pediatric anticipatory guidance
- Car seat rules
- Sunscreen at least SPF 15 in kids >6months q 2hrs or after swimming
- Smoke detectors every room
- CO detectors near bedrooms- check batteries regularly
- Lock up meds, cleaning suppy
- Lock up guns and ammunition separately
- <2hrs TV/electronics
Car seat Recommendations
- All kids <8 must be in a child restraint system and in rear of vehicle
- Rear facing: up to age 2 or 20 lbs
- Forward-facing w/ 5 point harness: 1 OR
over 20lbs and until at LEAST 40lbs - Booster sear or car seat: 4-8y/o AND 4’9” tall (height may come after)
- Back seat of car until 13y/o or 100lbs
What Vx in contraindicated w/ an allergy to:
- Baker’s yeast
- Eggs
- Gelatin
- Thimerosal
- Neomycin and Streptomycin
- Baker’s yeast: HepB (think B-B)
- Eggs: influenza
- Gelatin: vaicella, influenza
- Thimerosal: preservative in multi-dose vaccines
- Neomycin and Streptomycin: MMR and inactivated polio
What Vx in contraindicated w/ an allergy to:
- Baker’s yeast
- Eggs
- Gelatin
- Thimerosal
- Neomycin and Streptomycin
- Baker’s yeast: HepB (think B-B)
- Eggs: influenza
- Gelatin: vaicella, influenza
- Thimerosal: preservative in multi-dose vaccines
- Neomycin and Streptomycin: MMR and inactivated polio
**local reactions are NOT CI
Killed (inactivated) vaccines
- Influenza
- Polio SalK (K=killed)
- HepA
- Rabies
* may need booster
What is the only live vaccine that can be given to HIV patients
MMR
*given if CD4>200/ul
Subunit conjugate vaccines (presents only essential antigens needed to induce an immune system response instead of giving entire organism)
- S. pneumococcal
- H. influenza
- N. meningitidis
- PCV13
“SHiN-P”
*Made of capsular polysaccharides so often used for many encapsulated organisms
Subunit conjugate vaccines (presents only essential antigens needed to induce an immune system response instead of giving entire organism)
- S. pneumococcal
- H. influenza
- N. meningitidis
- PCV13
“SHiN-P”
*Made of capsular polysaccharides so often used for many encapsulated organisms