Pediatric Milestones, Vaccines, and anticipatory guidance Flashcards
1
Q
0-1 Month
A
- Moro and grasp reflex
- Responds to noise
- Minimal social
2
Q
2 months
A
- 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
Q
3 months
A
- Lifting head and chest
2. Moro reflex disappears
4
Q
4 months
A
- 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
5
Q
6 months
A
- 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”
6
Q
9 months
A
- 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”
7
Q
12 months
A
- 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”
8
Q
15 months
A
- Walks
- Uses cup
- several words
- temper tantrums
9
Q
18 months
A
- Walks up stairs*
- Drinks from a cup and eats with a spoon*
- Several single words*
- Points to 1 body part
- Temper tantrums
10
Q
24 months
A
- 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”
11
Q
3 y/o
A
- 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”
12
Q
4 y/o
A
- 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”
13
Q
5 y/o
A
- 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
14
Q
6 y/o
A
- Ties shoes
- Skips with alternating feet
- knows R and L hands
“at 6, skins shoes, person w/ parts”
15
Q
When do the following reflexes disappear:
- Moro
- Walking/stepping
- Rooting/suck
- Tonic neck
- Palmer grasp
- Planter grasp
- Upward Babinski
A
- 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
16
Q
Common pediatric anticipatory guidance
A
- 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
17
Q
Car seat Recommendations
A
- 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
18
Q
What Vx in contraindicated w/ an allergy to:
- Baker’s yeast
- Eggs
- Gelatin
- Thimerosal
- Neomycin and Streptomycin
A
- 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
19
Q
What Vx in contraindicated w/ an allergy to:
- Baker’s yeast
- Eggs
- Gelatin
- Thimerosal
- Neomycin and Streptomycin
A
- 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
20
Q
Killed (inactivated) vaccines
A
- Influenza
- Polio SalK (K=killed)
- HepA
- Rabies
* may need booster
21
Q
What is the only live vaccine that can be given to HIV patients
A
MMR
*given if CD4>200/ul
22
Q
Subunit conjugate vaccines (presents only essential antigens needed to induce an immune system response instead of giving entire organism)
A
- S. pneumococcal
- H. influenza
- N. meningitidis
- PCV13
“SHiN-P”
*Made of capsular polysaccharides so often used for many encapsulated organisms
23
Q
Subunit conjugate vaccines (presents only essential antigens needed to induce an immune system response instead of giving entire organism)
A
- S. pneumococcal
- H. influenza
- N. meningitidis
- PCV13
“SHiN-P”
*Made of capsular polysaccharides so often used for many encapsulated organisms
24
Q
Subunit recombinant vaccines (a type of subunit vaccine in which recombinant DNA technology is used to manufacture antigen molecules and placed into Baker’s yeast)
A
- HepB
2. HPV
25
Toxoid vaccines (chemically modified inactivated toxins from toxin-producing organism to allow the body to recognize the harmless toxin)
1. Tetanus
2. Diptheria
3. Pertussis
26
Evaluating a parent w/ a crying baby
1. how much does baby cry
2. what do you do to calm (what works what doesn't)
3. what do you do when you feel overwhelmed
4. what support do you have
27
Calming a crying baby education/tips
1. Crying is normal and peaks at 2 months of age
2. crying can last hours
3. typically occurs at night
4. can cause frustration
5. check for basic necessities: diaper, hungry, temp, burp
6. its ok to put baby down and walk away
7. MAKE a plan and share it!
Try 5 S's: Shush, swing, swaddle, side/stomach position, suck
28
5 S's of calming a crying baby
1. Shush
2. Swing
3. Swaddle
4. Side/stomach position
5. Suck
29
What vaccines do you get at birth
HepB#1
| Vit K
30
What vaccines do you get at the 2 months WCC
* 5 shots and 1 oral vx
1. DTaP #1
2. HiB #1
3. HepB #2
4. PCV13 #1
5. IPV #1
6. Rota #1 (oral dose)
31
What vaccines do you get at the 4 months WCC
* 4 shots and 1 oral vx (same as 2 month but no HepB)
1. DTaP #2
2. HiB #2
3. PCV13 #2
4. IPV #2
5. Rota #2 (oral dose)
32
What vaccines do you get at the 6 month WCC
* 5-6 shots and 1 oral vx (same as 2 month but possible flu)
1. DTaP #3
2. HiB #3
3. HepB #3
4. PCV13 #3
5. IPV #3
6. +/-TIV #1 (need #2 at least 4 weeks later)
7. Rota #3 (oral dose)
33
What vaccines do you get at the 9 month WCC
None :)
34
What vaccines do you get at the 12 month WCC
* 6 shots
1. HiB #4
2. PCV13 #4
3. MMR #1
4. Varivax #1
5. TIV #2
6. HepA #1
35
What vaccines do you get at the 15 month WCC
None :)
36
What vaccines do you get at the 18 month WCC
1. DTap #4
| 2. HepA #2
37
What vaccines do you get at the 24 month WCC
none
38
When you get Kindergarten shots and what vaccines do you get
4-6y/o
1. DTap #5 booster
2. IPV #4
3. MMR #2
4. Varivax #2
39
What teenage vaccines do you get
11-13: Tdap booster, HPV #1, MCV #1
16-18: MCV #2
40
What scheduled vaccines do adults need
>56: Menomune for those at increased risk
>60: Zostavax for shingles
>65 Pneumovax (q5yrs)
41
What ages do you give DTaP and Tdap?
DTaP (4 doses w/ booster): 2mon, 4, mon, 6mon, 15-18mon, booster at 4-6y/o
Tdap: 11-12y/o, booster q10yr
42
What ages do you give Hib?
2 mon, 4, mon, 6 mon, 12-15mon
43
What ages do you give HepA vx?
12-23 month and 6-18 months after booster
| 12 month WCC and 18 month WCC
44
What ages do you give HepB vx?
Birth, 2 month, 6 month
45
What interval do give HPV vx?
1. start 11-12 (up to 26 for females and 21 for males)
2. #2- 2 months after #1
3. #3- 6 months after
46
When do you give TIV (inactive flu vaccine)?
healthy kids 6 months- 18yrs
*need 2 doses if under the age of 9 and it is there first time getting the vaccine
47
What ages do you give MCV (meningococal) vx?
11-12 y/o and booster at 16
48
What ages do you give PCV13 vx?
2 mon, 4 mon, 6 mon, 12-15mon
49
What ages do you give IPV vx?
2 mon, 4 mon, 6 mon, booster at 4-6y/o
50
What ages do you give MMR vx?
12 mon, 4-6y/o booster
51
What ages do you give rotavirus vx?
oral solution
2 mon, 4 mon, 6 mon
* minimum age 6 weeks
* Max age for 1st dose 14 weeks and 6 days
* MAX AGE for any dose is 8 months
52
What ages do you give Varivax vx?
12 mon, 4-6
53
Describe Tanner staging of pubic hair for males
2- Straight pubic hair at base of penis (age 11-12)
3- Coarse dark and curly pubic hair (age 13)
4- Hair is almost completely full (age 14-15)
5- Pubic hair achieves adult appearance (age 16-17)
54
Describe Tanner staging of pubic hair for females
2- minimal straight pubic hair, long and downy (age 11)
3- increased pubic hair, dark and coarse, lateral extension (age 12)
4- adult-like, extends across pubis (age 13)
5- adult appearance, extends to medial thighs (age 14-15)
55
Describe Tanner staging of breast for females
2- breast buds palpable, areola enlarge (age 11)
3-elevation of areola contour, areola enalrgement (age 12)
4- secondary mound of areola and papilla (age 13)
5- Adult breast contour (age 14-15)
56
When does the first tooth typically erupt in an infant
6-8 months
57
How many baby and adult teeth do you have?
20 baby teeth
| 32 adult teeth
58
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When does the following fontelles close?
Anterior:
Posterior:
Sphenoidal:
Mastoid:
```
Anterior: 18-24 months
Posterior: 2-3 months
Sphenoidal: 6 months
Mastoid: 6-18 months
