test 4 Flashcards
What visits should you discuss toilet training at
9 mos
12
15
18
most kids potty train between
2 1/2 - 3 1/2
Physiological readiness for potty training
18 mos
what is the order of potty training/control
1) nocturnal bowel control
2) daytime bowel control
3) daytime bladder control
4) nocturnal bladder control
average age for kids to be fully potty trained
3-4 years
guidelines to assess child physical skill readiness for potty training
has voluntary sphincter control
stays dry for 2 hrs, may wake from naps still dry
is able to sit, walk and squat
assists in dressing self
guidelines to assess child cognitive skills for toilet training readiness
recognizes urge to urinate or defecate
understands meaning of words used by family in toileting
understands what the toilet is for
understands connection between dry pants and toilet
is able to follow directions
is able to communicate needs
guidelines to assess child interpersonal skills for toilet training readiness
Demonstrate desire to please parent
expresses curiosity about use of toilet
expresses desire to be clean and dry
Guidelines to assess parental skills for toilet training readiness
expresses desire to assist child with training
recognizes childs cues for readiness
has no compelling factor that will interfere with training (new job,move, newborn, family loss
Awakening in first ⅓ of night with confused thinking and slow speech
Confusional arousals
Awakening 1-3hr after falling asleep w/ characteristic behaviors
Sleep walking/sleep terrors
Stage N3 (deep sleep) instability -Genetic predisposition
Sleep walking/sleep terrors
sleep cycle length in newborns
Sleep cycles are 60 minutes, gradually increase to 90 minutes in child/adults
How long per day do full term infants sleep
(16-18hrs) sleep per day in intervals day/night
Neonates begin sleep cycle in
REM
REM comprises ___ of total sleep time in newborns and gradually decreases to ____ by adolescence
50%
25-30%
From 6-12 months- adulthood REM changes to last
1/3 of the night
Infants capable of sleep through night without feed by
6 mos
Within 4hrs of bedtime, DEEP NREM sleep
Confused, disoriented, does NOT remember, unaware of caregiver attempts to console, returns to sleep QUICKLY
sleep terror
Later in night, LIGHT REM sleep
Scared, upset, DOES remember, receptive to comforting measures, delayed returning to sleep d/t fear
nightmare
Associated with genetics and iron deficiency
restless leg syndrome
Colic often diagnosed using Wessel’s rule of threes
Crying for more than 3 hrs/day, at least 3 days/wk, for more than 3 wks
Colic usually resolves by
3 mos
echniques for calming infants include Dr.Harvey Karp’s “5 Ss”
swaddling, side or stomach holding, soothing noises( ie. shushing, singinging, white noise), swinging, or slow rhythmic movement (rocking, walking, or riding a car), and sucking on a pacifier.
Atypical tantrums (destructive or injurious) may be indicative of a more serious underlying condition such as
sleep disturbances, ADHD, mood disorders, or family stressors.
Hot water heater temperature
No higher than 120 degrees F. Always test water before bathing or showers to prevent burns.
Riding correctly without a car seat usually occurs
8-12 yrs old & at about 4’9 in height
Children should always sit in a car seat or booster seat and ride in the backseat of the car as this is the safest place for them until the age of
13
enuresis can be a sign of
Endocrine- diabetes mellitus, diabetes insipidus, hyperthyroid, abnormal release of nighttime vasopressin,
what meds are approved for nocturnal enuresis
Desmopressin and Imipramine approved for nocturnal enuresis
when do you take Desmopressin
2 hours before bedtime
need to know about Imipramine
Higher success rate but high side effects
Lethal if overdose-fatal cardiac arrhythmia
Suicide black box warning
Anticholinergic side effects
Cardiac dysrhythmias (need baseline EKG)
Anticholinergic properties
Increased sphincter tone
Can treat comorbid anxiety/depression & ADHD
reasons for encopresis
Commonly caused by delayed physical maturation Harsh toilet training IBS Spinal cord trauma/injury Hirschsprung disease Lead poisoning Hypothyroid Hypokalemia Hypercalcemia Diabetes Intestinal smooth muscle disorder (Scleroderma) Pain medication use Chronic laxative use
Meconium stool by
48 hours old
stools per day for infant
Typically 3-4 small stools per day
breastfed stool
Breastfed- sticky, light yellow, curdy, sour
Many small stools/day for first few weeks then decrease to 1-6 stools/day
Infrequent stools not problematic in exclusively breastfed infants if thriving (may go 8-14 days without stool)
formula stool
darker, firmer, smellier
2-4 stools/day first month
