1
Q
Growth
A
Increase in size, not necessarily development
2
Q
Development
A
Maturation of structures AND includes growth
3
Q
Anticipatory guidance
A
Helping families understand what is coming next
4
Q
Cephalocaudally
A
From head to toe
5
Q
Example of cephalocaudally growth
A
Head control, then sitting, then walking
6
Q
Proximodistally
A
From the trunk to the tips of the extremities
7
Q
Examples of proximodistally
A
Moving arms & legs before picking up things with fingers
8
Q
Examples of general to specific development
A
Crawling, then walking, then skipping
9
Q
Chronologic age
A
Years or months since birth date
10
Q
Mental age
A
Level of cognitive function
11
Q
Correlation between mental age & chronological age
A
Typically mental age = chronological age, but not when there involves intellectual disabilities
12
Q
Bone age
A
Determined by x-ray of tarsals and carpals
13
Q
What kind of issues would one actually utilize bone age in?
A
Endocrine issues
14
Q
Adjusted/Corrected age
A
Chronologic age minus # of weeks born prematurely
15
Q
Prematurity
A
<35 weeks post gestational age
16
Q
How long can one utilize the adjusted/corrected age?
A
First 2 years of life
17
Q
At what age does one use the length growth chart?
A
0-36 months
18
Q
At what age does one use the height growth chart?
A
2-18 years
19
Q
Weight at 6 months
A
Double of birth weight
20
Q
Weight at 1 year
A
Triple of birth weight
21
Q
Overweight BMI
A
25-29.9
22
Q
Average birth length
A
20 inches
23
Q
Rate of growth in the first year
A
10 inches
24
Q
Rate of growth in the second year
A
5 inches
25
Rate of growth each year from the 3rd year until puberty
2.5 inches
26
How to remember the rate of growth in length/height per year?
Take the average birth length and keep dividing it in half
27
When does the birth length roughly double?
4 years of age
28
When is a BMI a red flag?
BMI >/= 85%
29
When is the length or height a red flag?
30
How to know if a patient is falling off the growth curve?
Falling from an established growth percentage to a lower percentage plot
31
Red flag follow-ups
Recheck, notify HCP, patient-family education
32
2 month social/emotional milestone
Instinctual smile
33
3 month social/emotional milestone
Social smile
34
4 month social/emotional milestone
Laughs
35
4-6 month social/emotional milestone
Exhibits stranger anxiety
36
7-9 month social/emotional milestone
Enjoys peek-a-boo; likes to look in mirror
37
10-12 month social/emotional milestone
Claps hands; waves bye bye
38
3 month language/cognition milestone
Begins to babble; turn to rattling noise; notices own hands
39
6 month language/cognition milestone
Continuous babbling; babbles in response to sounds as a conversation
40
7-9 month language/cognition milestone
Understands cause & effect
41
10-12 month language/cognition milestone
Points to objects when named; says "mama" "dada"; says 5 words but understands many more
42
When can tummy time start, and how long should one promote tummy time for?
1-2 weeks after birth & encourage for 15-20 minutes each day
43
2 month physical/motor milestone
Lifts head; follows to midline; posterior fontanel closes
44
3 month physical/motor milestone
Eyes can track objects 180 degrees; raises head & neck when lying on stomach; notices own hands
45
4 month physical/motor milestone
Rakes objects; grasps rattle; begins to roll over (from stomach to back)
46
5-6 month physical/motor milestone
Rolls over bidirectionally; transfers objects between hands; reaches; pushes up on hands/knees and rocks back & forth; sits with support
47
8 month physical/motor milestone
Sits without support
48
9 month physical/motor milestone
Develops pincer grasp; feeds self bottle/cheerios; crawls; stands holding on
49
10-12 month physical/motor milestone
Claps hands; waves bye-bye; pulls self up to a stand; cruises; walks with support; may take first steps
50
12-16 month physical/motor milestones
Starts walking
51
Which reflexes are present at birth and disappear by 4 months?
Rooting, moro, tonic neck, babinski
52
Rooting reflex
Stroke the cheek, infant turns towards the side that you stroke
53
Moro reflex
Drop the baby and they sprawl legs & arms -- hands splay; startle reflex
54
Tonic neck
Head to side, one arm up, one arm out; fencing
55
Babinski reflex
Present until the child starts walking well (~18 months)
56
Which reflex is not present at birth but emerges at 6 months of age?
Parachute reflex
57
Parachute reflex
The infant should catch themselves when you pretend to drop them (prone position)
58
Toddler social/emotional milestones
Egocentric; temper tantrums; says "mine"; points to body parts; recognizes self in mirror
59
How does "stranger anxiety" changes in the toddler phase?
Reduction/resolution of it so long as parent is present but develops again when separated from the parent
60
Transitional objects
Provides security & represents parents briefly upon separation
61
Toddler
1-2 years of age
62
Infant
0-12 months
63
Language/cognition at 12 months
Says 5 words; understands many more words; shows curiosity; says own name
64
Language/cognition at 18 months
Says 50 words; understands many more words; shows curiosity; says own name
65
Language/cognition at 24 months
Says 400 words; uses 2-3 word phrases; shows curiosity; says own name
66
Trick for remembering how many words a toddler says
"My age, to my age plus one"
67
Physical motor skills at 12-18 months
Anterior fontanel closes
68
When does the posterior fontanel close?
2 months
69
When does the anterior fontanel close?
12-18 months
70
Physical motor skills at 12-16 months
Walks
71
Physical motor skills at 21 months
Climbs stairs
72
Physical motor skills at 24 months
Runs & jumps
73
Toilet training at 18-24 months
Shows interest in toilet training but cannot learn yet, related to bladder not at adult functioning level yet
74
Toilet training at 24 months
Bladder reaches adult functioning (concentration & sphincter control)
75
Toilet training at 2-3 years old
Daytime dryness; PCP won't be concerned until 3 years of age
76
Toilet training at 3-5 years old
Nighttime dryness
77
Preschool child
3-5 years old
78
Social/emotional milestones in preschoolers
Egocentricity decreases; awareness of others increase; begins social functioning; starts developing a conscience; people-pleaser; fears related to body integrity
79
Language/cognition milestones in a preschooler
Recognizes some letters; counts but does not know what the numbers mean; knows own & others gender; modest of own body
80
How many words does a preschooler know?
11,000 words
81
Tip for remembering talking in preschoolers
Their age + one = the number of word phrases they use
82
Physical/motor skills in a 3 year old
Rides a tricycle; dresses self; uses scissors; builds a tower of more than 6 blocks
83
Physical/motor skills in a 4 year old
Throws ball overhead; hops and stands on one foot for up to 5 seconds
84
Physical/motor skills in a 5 year old
Dresses self well; runs, jumps, skips, hops, somersaults -- THINK AGILE
85
School age children
6-12 years old
86
Social/emotional developments of school age children
School is a focal point; teacher is a major non-parental influence; develops first true friends; group activities; learns to cooperate and compromise; morality develops
87
Who is the greatest influence in school age children?
Parents
88
Phase 1 in morality development (6-9 years of age)
Sense of right/wrong
89
Phase 2 in morality development (10-12 years of age)
Senses of "shades of gray"
90
Language/cognition development in school-age children
Sense of time/space; cause & effect; consequences of actions; reads & spells: enjoys games with strategy
91
Physical/motor development in school-age children
Limber & prone to bone fractures; avoiding overweight & obesity
92
1st sign & age of female puberty
Breast development at ~10 years old OR "first double digit"
93
2nd sign & age of female puberty
Pubic hair at ~11 years old
94
3rd sign & age of female puberty
Height spurt at ~12 years old
95
4th/last sign & age of female puberty
Menarche at ~13 years old
96
How long do females continue to grow until?
~16 years of age
97
Precocious puberty in females
<7 in caucasians and <6 in african americans
98
1st sign & age of male puberty
Testicular enlargement at ~11 years old
99
2nd sign & age of male puberty
Pubic hair at ~12 years old
100
3rd sign & age of male puberty
Height spurt at ~14 years old
101
How long do males continue to grow until?
~21 years of age
102
Precocious puberty in males
<9 years old
103
Adolescents
13-18 years of age
104
Social/emotional developments in adolescents
Intense interest in peer group & perception of others; peer contact & involvement increasingly important
105
Sexuality developments in adolescents
Sexual behavior/experimentation may be homosexual & heterosexual -- NOT related to sexual orientation
106
Treatment of STIs and birth control
Most states, teens can be treated without parental knowledge/consent...remember... TREATMENT TRUMPS PARENTAL NOTIFICATION
107
Language/cognition developments in adolescents
Self-image concept changes with changing body; egocentric; uses past experiences in decision making
108
Physical/motor developments in adolescents
Rapid increase in height/weight; pubertal milestones
109
Infant's focus in psychosocial development
Trust (e.g., consistency, ability to predict responses)
110
Example of trust in infants
Hungry baby --> gets fed
111
Toddler's focus in psychosocial development
Autonomy (e.g., mastering new tasks)
112
Example of autonomy in toddlers
Small tasks (e.g., putting balls in bins)
113
Preschooler's focus in psychosocial development
Initiative (e.g., dressing self)
114
Example of initiative in preschoolers
Okay to be out of view for a few minutes to do a task
115
School age's focus in psychosocial development
Achievement (e.g., school & friendship)
116
Adolescent's focus in psychosocial development
Identity development (e.g., beliefs, values, sexual orientation)
117
Infant's cognitive development
Learns through interactions with the environment
118
Example of infant's cognitive development
High-pitched voices, faces, black/white images
119
Toddler's cognitive development
Egocentric (e.g., does not understand other's POV)
120
Preschooler's cognitive development
Thinking is non-logical, non-linear (e.g., santa claus)
121
School age's cognitive development
Thinking is logical, linear, concrete
122
Adolescent's cognitive development
Thinking is adaptable, flexible, abstract
123
Communication considerations in infants
Parental presence, routines, consistency
124
Communication considerations in toddlers
Avoid separation from parents, flexibility, autonomy, gross motor activity
125
Communication considerations in preschoolers
Promote initiative, give choices, short explanations, demonstrate to reduce anxiety
126
Communication considerations in school age children
Involve, explain, assess understanding, promote peers & school
127
Communication considerations in adolescents
Promote privacy and modesty, promote peer contact, open-ended questions, remain objective
128
How should one discipline?
Discipline should be based on development
129
Disciplining infants
No discipline; focus on meeting needs
130
Disciplining toddlers
Focus on distraction and redirection, positive reinforcement, consistency
131
Disciplining preschoolers
"People-pleasers"; ignore bad behavior and reward good behavior
132
Disciplining school age children
Give independence and encourage personal responsibility; discuss consequences of actions
133
Disciplining adolescents
Promote and reinforce good choices; save battles for important things
134
Social determinants of health
Neighborhoods, economic stability, education, social & community context, health, and healthcare
135
Cultural competence
The process of understanding and respecting the cultural values and practices of clients
136
Cultural congruence
The practice of applying evidence-based nursing that is in agreement with the preferred cultural values, beliefs, and practices of the healthcare consumer
137
Asian healing practices
Coining & cupping
138
Jehovah's witnesses
Opposed to receiving blood products
139
Sex
A biologic term based on body parts, chromosomes, and hormones
140
Gender/gender identity
A person's fundamental sense of being a man, woman, or indeterminant (nonbinary)
141
Gender dysphoria
The distress and unease experienced if gender identity and sex are not congruent
142
Gender identity
Who you are
143
Sexual orientation
Who you love/whom one is attracted to sexually
144
Cisgender
Gender identity matches sex assigned at birth
145
Transgender
Gender identity does not match sex assigned at birth
146
Transgender man (transmasculine)
Female to male
147
Transgender woman (transfeminine)
Male to female
148
Transition
Process of physical & social change
149
Sex reassignment (gender affirmation)
Medical treatment for those who want to adapt their bodies to the desired sex
150
Sex reassignment surgery (gender affirmation surgery)
Only the surgical part of this treatment
151
Transgender diagnostic criteria
Post pubertal; present for at least 2 years; not a symptom of another mental disorder/genetic/intersex/chromosomal abnormality; persistent, consistent, insistent
152
Nursing care for transgender patients
Ask, don't assume; be a support & resource; be aware
153
Vitamin D
400 IU started within a few days after birth in both breast-fed and bottle-fed infants; D/C after a year of age
154
Iron
Starting at age 4 until solid foods are introduced; ONLY for breast-fed infants
155
Why does iron need to be introduced at 4 months of age?
Infants have 6 months of endogenous iron from mom
156
Breast milk
Preferred; exclusively for the first 4 months
157
Formula
20 oz (at newborn) to 30 oz (4-6 months)
158
When to transition to a sippy cup?
By 12 months
159
Whole milk
1-2 years
160
Lower fat content milk
>2 years
161
When to introduce pureed solid foods?
4 months
162
What reflex needs to be gone before introducing pureed solid foods?
Extrusion reflex
163
How to introduce pureed solid foods?
One at a time to look for allergies
164
Which food should only be given in moderate amounts due to high amounts of arsenic?
Rice
165
What other grains to give, other than rice?
Oats, barley, and mixed grains
166
When to transition baby to table food?
4-12 months
167
Which foods have the highest risk for choking?
Popcorn, hot dogs, whole grapes
168
Developmental issues with toddlers
Slow growth, picky eaters
169
How to help with developmental issues with toddlers?
Focus on socialization, time-limit, avoiding battles
170
Developmental issues with preschoolers
Slow growth, food jags are common
171
How to help with developmental issues with preschoolers?
Focus on avoiding battles
172
Developmental issues with school age & adolescents
Develop habits, make choices, engage in social media & electronics
173
How to help with developmental issues with school age & adolescents?
Focus on promoting a healthy lifestyle
174
When does teething first occur?
3-4 months
175
When does the first tooth appear?
6 months
176
Deciduous teeth
Baby teeth
177
How many deciduous teeth are in place by 3 years of age?
20
178
When should children start visiting the dentist?
1 year of age
179
When do children start losing teeth?
6 years
180
What is the teeth losing process?
Loses & replaces 4 teeth per year until 12 years of age
181
Trick with remembering when the first tooth appears and when the first tooth is lost
"6&6" -- 6 months of age and 6 years of age
182
Safe sleep
Back to sleep, firm surface, tight-fitting sheets, bare crib...AND AVOID exposure to smoke, alcohol, illicit drugs
183
Common areas of drowning
Bathtubs, toilets, buckets of water, swimming pools, swimming alone, shallow water, fast moving water
184
Burn prevention
Water heater to 120 degrees F AND no baths in sinks for older infants
185
What to do if a child ingests poison?
Call poison control and do not induce vomiting
186
What does HEEADSSS stand for?
Home, Education, Employment, Activities, Drugs, Sexuality, Suicide, Safety
187
H in HEEADSSS assessment screening tool
Home
188
EE in HEEADSSS assessment screening tool
Education & employment
189
A in HEEADSSS assessment screening tool
Activities
190
D in HEEADSSS assessment screening tool
Drugs
191
SSS in HEEADSSS assessment screening tool
Sexuality, suicide, and safety
192
#1 rule in gun safety
Avoid having a gun in the home
193
#2 rule in gun safety
If a gun is in home, lock the gun and ammunition separately
194
What to teach children if they find a gun?
Stop. Don't touch. Run away. Tell an adult.
195
How long should a child sit in the backseat until?
<13 years of age
196
#1 cause of death in adolescents
Motor vehicle accidents
197
#2 cause of death in adolescents
Homocide
198
#3 cause of death in adolescents
Suicide
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