peds: growth and development Flashcards
what ages do you use growth charts for?
birth to 24 months
what three groups use different growth charts (compared to normal use)?
1) . ages 2-20 yrs
2) . down’s syndrome
3) . premature infants
what three things do growth charts plot?
weight, length, head circumference
when do concerns come up with growth charts?
concerns arise when there is a fall off in one or more measurements over 2-3 visits
what are some things to think of if head circumstance is too large?
spinal fluid build up or hydrocephalus
what are five developmental domains?
gross motor fine motor language cognitive social, emotional, behavioral
what are 7 components of gross motor?
movements with large muscles, head control, pushing up with arms when prone, sitting, crawling, standing, walking
what are 6 components of fine motor?
movement using small muscles, palmar grasp, pincer grasp, transferring hand to hand, picking objects up, place objects/stacking
what are 4 components of language/communication?
receptive communication
expressive communication
speech
non verbal communication
what are 3 components of cognitive domain?
memory, reasoning, problem solving
what are 3 components of social, emotional, behavioral domain?
1) . attachment to family, caregivers
2) . self-regulation
3) . interaction with others
what is anticipatory guidance?
Advice and recommendations given by health care provider to help parents understand the expected growth and development of their children.
what are 5 components of anticipatory guidance?
1) . family adjustment, cultural issues
2) . nutrition- age related and adequacy
3) . developmental milestones- constant progression
4) . health maintenance- vaccines, oral health, screenings
5) . safety- travel, home, visiting, risk behaviors
newborns prefer what position? sleeps for about how many hours? feeds every __-__ hrs
preferred flexed position, sleeps 20 hrs on average, feeds every 2-4 hrs
anticipatory guidance for newborns (7)
1) . feeding expectations
2) . elimination- voiding, stooling
3) . crying, settling, soothing
4) . skin care, newborn rash
5) . bathing, cord care, circumcision care
6) . sleep position
7) . parent rest, traveling, siblings
one month milestones (7)
1) . turns head when in supine position
2) . hands fisted, near face
3) . strong, well coordinated suck
4) . follows face, gazes at black/white objects
5) . startles to sound, voice (mom)
6) . recognizes mom’s voice
7) . throaty noises
anticipatory guidance one month visit
1) . Parental adjustment, stress, rest/sleep
2) . Baby sleep, sleep position
3) . Feeding, feeding schedule
4) . Crying, consoling, pacifier use
5) . Time on tummy- build up different muscles
6) . Expected milestones next month
7) . Signs of illness, when to call or have checked
8) . Safety, car seat use, smoke exposure
9) . Assess cultural issues, parental knowledge
2 signs of serious illness in one month old
loss of interest in feeding or development of a fever
one month red flags (3)
1) . no response to loud noises
2) . low muscle tone, poor feeding
3) . caregiver indifference
when is most congenital hearing loss discovered?
most congenital hearing loss picked up in the nursery (screening)
two month milestones (8)
1) . Chest up in prone position
2) . Head bobs when held sitting
3) . Hands open at times, brings to mouth
4) . Opens mouth at sight of breast, bottle
5) . Recognizes mom’s face, follows movements
6) . Reciprocal smile
7) . Alerts to voice, sounds, contrasting objects
8) . Early vocalizations, coos,
Anticipatory Guidance Two Month Visit (8)
1) . Parental adjustment, stress, rest, siblings
2) . Sleep schedule, position, safe bed
3) . Feeding, show, discuss growth, weight gain
4) . Tummy time, social interaction
5) . Baby temperament, fussy times, soothing
6) . Milestones next two months
7) . Safety, car seat, smoke, water heater temp
8) . Parent return to work, childcare, age expected illnesses
developmental red flags at 2 months (3)
1) . Does not alert to sound
2) . Inability to raise head when prone- weakness or poor muscle tone
3) . Not focusing, fixating on faces- visual impairment or decreased neurological development
four month milestones (7)
1) . Sits with chest support
2) .No head lag when pulled to sit
3) . Rolls tummy to back
4) . Hands open, reaches, plays with rattle
5) . Mouths objects, smiles at pleasurable sights, sounds
6) . Stops crying to parents voice, laughs, babbles, increasing vocalization
7) . Turns to voices, calms with soothing voice
Anticipatory Guidance Four Month Visit (7)
1) . Parent/sibling adjustment, stress, rest
2) . Feeding, nursing, formula, solids
3) . Sleep position, put down drowsy
4) . Tummy time, sit up time, talking, singing, play
5) . Assess temperament, how parents managing
6) . Safety, car seats, changing table, small objects
7) . Child care, travel, age expected illnesses
developmental red flags for four months (4)
1) . no cooing, gurgling sound
2) . not bringing hands to midline
3) . lack of smiling
4) . overall low muscle tone
six month development (6)
1) . Sits propping with hands, rolls back to front
2) . Reaches with one hand, transfers hand to hand, brings object to mouth, shakes toy
3) . Regards object dropped in front, rakes, attempts to grasp
4) . Responds to name, forming attachment to caregivers
5) . Expanded types of vocalizations, facial expressions
6) . Stranger “wariness”, strong caregiver attachment
anticipatory guidance for 6 months (7)
1) . Parent/sibling adjustment, stress, changes
2) . Feeding routines, solid food intro plan, sippy
3) . Sleep position, location, routines, changes
4) . Tummy, sit up time, talking, reading, play
5) . Anticipating mobility, walkers, stairs, safe toys
6) . Safe environment, travel, choking hazards
7) . Child care, expected illnesses
developmental red flags for 6 months (4)
1) . not turning to voices
2) . does not transfer hand to hand
3) . no smiling, laughing, limited facial expressions
4) . overall low muscle tone, particularly trunk
nine month old development (5)
1) . Gets to sitting and sits well, starting to crawl, may start to pull up to stand
2) . Transfers hand to hand, pincer grasp, finger feeds, bangs two objects together, observes held objects
3) . Looks towards familiar object when named, attends to music, follows a point, gestures
4) . Ma ma, da da nonspecifically, imitates sounds
5) . Responds consistently to name
how many illnesses does the average kid get during the first year of life?
5-8
Anticipatory Guidance Nine Months (6)
1) . Parent/family stress, changes
2) . Feeding, food offering, textures, cup
3) . Consistent routines, positive feedback, distraction for undesirable behaviors
4) . Reading, play, exploration, avoid screens
5) . Safe environment, travel, child care
6) . Expect separation anxiety
developmental red flags nine months (4)
1) . Lack of complex babbling with consonants
2) . Not sitting or rolling
3) . Limited social interaction
4) . Loss of previously noted milestones/skill
12 month old development (7)
1) . Cruising, taking steps
2) . Holds crayon, scribbles after demo, throws things
3) . Finger feeds, drinks from cup held by adult
4) . Looks for object hidden, shares objects
5) . Responds to “no”, points to indicate wants object, gives object to adult
6) . First words, comprehends multiple words
7) . Early emotionality, waves, gestures
Anticipatory Guidance Twelve Months (6)
1) . Family stress, changes, involvement
2) . Bedtime routine, naps
3) . Appropriate foods, encourage self feeding, expect “grazing”
4) . Expand activities, play, reading, interactive toys, no screens
5) . Safety, home environment, toys, supervision, car seats, child care
6) . Screenings – lead and hemoglobin
when do you stop worrying about babies sleeping on their backs?
when they can turn over on their stomachs by themselves (plus support head)
12 month red flags (4)
1) . not responding to name, understand “no”
2) . not standing, weight bearing
3) . emotional indifference, not looking when caregiver points
4) . loss of previously demonstrated skill
15 month development (6)
1) . Stands without pulling up, walks well, stoops, climbs
2) . Scribbles on own, stacks cubes, turns pages
3) . Solitary play for short periods
4) . Gets object when asked to, points to object to indicate interest, points to one body part
5) . Three to five words
6) . Demonstrates empathy and bit of drama
anticipatory guidance for 15 months (6)
1) . Family changes, child care
2) . Deal with stranger anxiety and drama calmly
3) . Consistent bedtime, nap routines, no bottle
4) Praise, positive discipline, allow choices
5) . Review appropriate foods, transition to whole milk, brushing teeth
6) . Home safety, safe storage, travel
15 months red flag (4)
not using mama or dada, no pincer grasp, absence of pointing to show interest, loss of previous milestones
18 month development (6)
1) . Runs well, throws ball, stacks four blocks
2) . Matches objects
3) . Pretend play
4) . Emotional demonstrations, shame, possessiveness, dramatic reactions
5) . Points to several body parts and objects
6) . Uses 10 – 20 words, understands more
anticipatory guidance for 18 months (8)
1) . Family changes, childcare, safety
2) . Dealing with emerging independence, anxiety
3) . Praise for good behavior, consistency
4) . Reading, play on child’s level
5) . Appetite variability
6) . Can see sleep fluctuations
7) . Supervised exploration, becoming more curious
8) . Autism screening
18 month red flags (3)
1) . not using at least 5-6 words
2) . not walking independently
3) . not pointing to show interest, gesturing
anticipatory guidance 24 months (8)
1) . Nutrition, sleep, safety
2) . Use adult speech, speak slowly
3) . Praise for appropriate behavior
4) . Understand child’s temperament, evolving personality
5) . Approach to potty training
6) . Limit screen time, encourage physical activity
7) . Read, interactive play, play around/with other children
8) Screenings – lead, autism
24 month red flags (4)
1) . Lack of words, two words sentences
2) . Not following simple commands
3) . Not walking well, running, climbing
4) . Lack of imitation, poor eye, face contact
2.5 years old development (7)
1) . Walks stairs with rail, jumps in place
2) . Brushes teeth
3) . Puts things away with direction
4) . Aware of more details, pictures, objects
5) . Imitates adult behavior, sweeping, talking on phone
6) . Understands action words, playing, washing
7) . Can name objects by use, broom, spoon
Anticipatory Guidance 2.5 Years (6)
1) . Nutrition, sleep, safety, consistency
2) . Reading, often child has favorite story
3) . Simple commands, patience
4) . Encourage self expression, play with other children
5) . Observe/understand how your child reacts to other people and situations
6) . Limit screens, encourage exploration
3 year old development
Goes up stairs, peddles trike, catches Copies circle, begins to use scissors Independent eating, gets shoes on Knows age, gender, starts to share Imaginative play, fearful of imagined things Knows body parts, function Up to 200 words, several word sentences Asks to be read to,
3 year old development (8)
1) . Goes up stairs, peddles trike, catches
2) . Copies circle, begins to use scissors
3) . Independent eating, gets shoes on
4) . Knows age, gender, starts to share
5) . Imaginative play, fearful of imagined things
6) . Knows body parts, function
7) . Up to 200 words, several word sentences
8) . Asks to be read to,
Anticipatory Guidance 3 yrs (6)
1) . Nutrition, sleep, safety, family changes
2) . Preschool
3) . Read, sing, encourage child to talk about friends, experiences
4) . More interactive toys, explore, fantasy
5) . Encourage exploration, spend time outside
6) . Limit screen time
red flags 3 yr olds (3)
1) . not talking using several sentences
2) . frequent falls, difficulty with steps/stairs
3) . not pretend playing
4 year old development (7)
1) . Balances on one foot, hops couple of times
2) . Copies square, writes first couple of letters of name, point to 4 – 6 colors
3) . Uses toilet, brushes teeth alone
4) . Knows simple analogies, hot/cold, up/down
5) . Has friend(s), plays in groups
6) . Follows several step instructions
7) Tells stories, uses words that describe feelings
4 year old Anticipatory Guidance (7)
1) / Nutrition, sleep, safety, supervision
2) . Easily encouraged or hurt, more emerging emotional feelings
3) Play interests, activities, limit screen time
4) Reading regularly, library time
5) . Understanding body, body parts function
6) . Discussed preschool and readiness
7) . Attempt hearing, vision screening
4 year old red flags (4)
1) . poor speech articulation
2) . does not answer simple questions
3) . cannot jump in place
4) . ignores other children
5-6 year old development (9)
1) . Skips, walks backward, hope one foot well
2) . Copies triangle, uses scissors, writes 1st name
3) . Dresses and bathes independently, puts on shoes
4) . Counts to ten, identifies letters out of order, knows colors, reads up to 25 words, simple + and -
5) . Has friends, apologizes for mistakes
6) . Know R and L, understand adjectives, rhymes
7) . Defines simple words, know tele # parent
8) . Can retell simple story
9) Days of week, plays board games
5-6 year old Anticipatory Guidance (6)
1) . Nutrition, sleep, dental
2) . Safety – vehicles, riding toys, home, water, private areas
3) . School – preschool, starting K garden
4) . Temperament, discipline, limits, consistency
5) . Parents model appropriate behavior
6) . Hearing and vision screening
5-6 year old red flags (4)
1) . Not recognizing shapes, letters, colors
2) . Resists dressing, using toilet
3) . Not drawing simple pictures, square, cross
4) . Unusually fearful, shy, moody, not distinguishing real vs make believe
7-8 year old development (5)
1) . Functioning well in school
2) . Relationships with friends, peers
3) . Emerging characteristics of personality
4. Interests – sports, other physical activities, creative
5) . Can begin to see somatic complaints, headaches, tummy aches, anxiety
7-8 year old Anticipatory Guidance (5)
1) . Nutrition, sleep, safety
2) . School interest, performance, any issues
3) . Encourage trying new activities, sports, dance, music, outdoor
4) . Discuss rules/expectations, consequences, approach to discipline
5) . Emotional management, resolving conflicts, dealing with anxiety
7-8 year old red flags (3)
1) . emotional swings, anxiety, withdrawal
2) . declining school performance
3) . significant family stress, illness, divorce, loss of parent
9-10 year old development (5)
1) . Performing within expected at school
2) . Appropriate relationships with peers, friends, family
3) . Increasing responsibility day to day decisions, home expectations
4) . Understands consequences, being consistent
5) . Outside school interests, activities
9-10 year old Anticipatory Guidance (6)
1) . Nutrition, sleep, safety puberty
2) . School - What is child good at, what is challenging?
3) . Quiet time, space for homework
4) . Promote independence, responsibility
5) . Normal emotions, management of anger
6) . Non school activities, what suits child’s interest and temperament
11-14 year old development (6)
1) . School – transition to middle high school
2) . Adult personality emerging
3) . More interest about growth, health related topics
4) . Increasing independent decision making
5) . Risk taking behaviors
6) . Pubertal changes usually present but to variable degrees
11-14 year old Anticipatory Guidance (7)
1) . Nutrition, sleep, safety, puberty
2) . School – often see performance meander during middle school
3) . Rules, expectations, consequences
4) . Taking responsibility
5) . Dealing with stress, anxiety
6) . Risk taking behaviors
7) . Communicating with parents
15-18 year old development (7)
1). School – high school, afterwards
2). Increasingly desire independence
3). Driving
4). Dating, social friends
Working
5). Thinking about the future
6). Anxiety/depression can become significant
7). Risk taking behaviors, sexual activity
15-18 year old Anticipatory Guidance (6)
1) . Nutrition, sleep, puberty
2) . Risk taking behaviors, driving, drugs/alcohol, sex, importance of making good decisions
3) . School interest, performance, post high school
4) . Maintaining healthy relationships
5) . Relationship with parents, communication
6) . Stress normal, healthy ways to deal with, reduce
growth and developmental assessment at ___ well visits
all
what are the three developmental screening tools?
1) . ages and stages questionnaires (ASQ-3)
2) . PEDS- parents evaluation of developmental status
3) . MCHAT-R: modified checklist for autism in toddlers
components of ASQ: what does it cover? ages up to? literacy level?
Covers behavior, language, motor, problem solving; Ages up to six years
Literacy level 6th grade
components of PEDS: what does it cover? ages up to? literacy level?
covers behavior, language, motor, problem solving and social-emotional
up to age 8, 5th grade literacy
MCHAT: what does it assess for? what two ages is it used at?
assesses for autism ad autism spectrum; ages 18 months and 24 months
