Growth & development

Question 1

4 months of age

Answer 1

Average weight is 14 – 16 lbs, length is 24
inches
* Baby can grasp and reach, puts things in
mouth
* Good head control, holds head up when in
tummy time
* Begins to rollover both ways
* Laughs out loud, squeals

Question 2

6 months of age

Answer 2

Babbles, imitates sounds
* Sits without support or forward on
hands
* Rolls from back to abdomen
* Holds bottle
* Smiles at self in mirror
* Briefly searches for lost object

Question 3

9 – 12 months of age

Answer 3

9 Months
* Responds to name
* Stranger anxiety
* Pulls to Stand, cruises
* Waves ‘bye bye’
* 12 months
* Stands alone, can walk with support, crawls well
* Knows name, 2 – 3 words
* Places objects in container
* Primitive reflexes disappear (moro, rooting, Babinski)
* May have security blanket

Question 4

Infant Red Flags of Development

Answer 4

0-1 Month: Poor suck/swallow; sweating/fatigue with feeds; poor,weight gain
* 3 Months: No attempt to raise head, increased/decreased tone, no hand-mouth activity, does not turn to voice, no tracking
* 6 Months: Does not sit without support, no eye contact, no babble
* 9 Months: No self-feeding, no reciprocal vocalization
* 12 Months: Has not tripled birth weight, not pulling to stand, no vocalization, no transferring of objects between hands, does not point/gesture, walks on heels

Question 5

Toddler: 15 months to 2 years of age

Answer 5

Anterior fontanel closes
* Responds to whisper test
* Shows affection, begins to follow
simple directions
* Physiologic control of sphincters is
developing
* Scribbles; builds 4 blocks
* Runs, jumps, begins to climb stairs
* Drinks from a cup, begins to use
spoon
* Knows 2 -3 body parts
* Vocabulary of ~ 10 words, puts words
together by age 2
* Temper tantrums begin!

Question 6

Toddler: Red Flags

Answer 6

Does not imitate sounds
* Does not engage in eye contact
* Does not move about and
explore
* Previously learned language or
skills disappearing
* Does not notice trucks, animals,
trains
* Does not make wants known in
ways other than crying

Question 7

Preschool Age: 3 – 4 years

Answer 7

3 Years
Jumps in place, rides tricycle, kicks ball, builds tower of 8 – 10 blocks
Vocabulary 200+ words
Knows own gender and learning others’
Increasing ability to share
Names a friend
Follows 2 – 3 step directions
Pedals tricycle, alternates steps on stairs
* 4 Years
Hops/jumps on one foot
Copies circle, builds tower with 10 blocks
Concrete and egocentric
Make believe, Tells a story
Cooperates with other children
Catches a ball, puts a puzzle together

Question 8

Preschool: Age 5

Answer 8

Speaks very clearly
* Has friends, knows their names
* Counts to 10 or higher
* Can draw a person with 6 or
more parts, can write name
and/or recognize letters
* Copies geometric shapes
* Plays simple board games
* Beginning to understand rules
* Knows gender
* Swings, climbs and hops

Question 9

Preschool: Age 5 Red flags

Answer 9

Unable to calm self
* Hair/eyelash pulling
* Stool holding
* No pretend play
* Unintelligible speech
* Unable to count to 10
* Easily distracted, does not
respond to people
* Cannot complete simple selfcare activities, like brushing
teeth

Question 10

School Age Child: 6 - 9 Years

Answer 10

Increased motor strength, rides a
bike, sports team
* Increased ability to share, has many
friends; learning right from wrong,
learns to follow rules and household
chores
* Understands concepts of space,
cause/effect
* Reading and writing, like school

Question 11

School Age Child: 10-12 years old

Answer 11

Writing and fine motor skills improve
Tells and writes stories that makes sense
Selective in friendships; may have ‘best friend’
Know how people feel based on what they see and hear
Beginning adolescence

Question 12

Adolescent/Teen

Answer 12

Show more concern about themselves; clothing, grooming.
Developing identify, social skills
Emotions, sadness, lack of self-confidence, peer pressure
Less affection for parents, anger
Complex thought, can have meaningful conversations
Competitive sports, high academic goals
Interest in relationships: exploration

Question 13

School Age and Teen Red Flags

Answer 13

Problems with peer group; inability to
make or retain friends
* Cruelty to animals, self mutilation
* Not using language to express feelings
* Peer pressure to use alcohol, smoking,
illicit drugs
* Acute or progressive decline in school
performance
* Lack of interest in usual activities
* Severe behaviors

Question 14

Communication with Acutely Ill Children

Answer 14

Promotes transfer of information as well as establishes rapport
* Careful attention to word selection, body language, facial
expression, tone of voice
* Involve children in discussions about illness; provide
information the child can understand and process
* Not providing any information to child about their illness allows them to make up stories about their illness that may be far worse than reality
* Children beginning at age 6-7 should be included in decision
making

Question 15

Developmental Concepts in Illness and Death
3-5 Years

Answer 15

3-5 Years: Concepts, Lack of concept of ‘forever’, See death as temporary, Time is more ‘compacted’, Interpret words
literally/concrete Need less details

Question 16

Developmental Concepts in Illness and Death
Middle Childhood 6-12 years

Answer 16

Developing logic and reasoning skills; awareness of illness and
death. Understanding death as permanent. Interest in physical process of death. Rules and rituals are important. Can participate in decision, making/assent

Question 17

A one-month-old who was opioid-exposed, but did not require
treatment, develops nasal congestion and is having difficulty
feeding. What is the best explanation?
a. Infants are obligatory nose breathers and with congestion, it
is difficult to breathe and feed
a. Infants are obligatory nose breathers and with congestion, it is difficult to breathe and feed.
b. Nasal congestion is most likely related to opioid withdrawal.
c. The infant is most likely to have a cold and may miss some
feedings while ill.
d. Nasal congestion can be a normal finding and should not
impact feeding

Answer 17

a. Infants are obligatory nose breathers and with congestion, it is difficult to breathe and feed.

Question 18

The parents of a 6-month-old infant who is being admitted for dehydration are very concerned that a hemangioma on his arm has gotten significantly larger since birth. What is the best
response?
a. Hemangiomas can continue to grow as the child grows until adulthood
b. Hemangiomas can be small at birth, will grow larger until about 6 months and then start to resolve
c. Dehydration can exacerbate the appearance of any skin rash, making it more pronounced.
d. Parents should refer this question to the primary care provide

Answer 18

b. Hemangiomas can be small at birth, will grow larger until about 6 months and then start to resolve

Question 19

Parents ask about language expectations for their 7-monthold infant. The best response includes:
a. Giggles, smiles and can point to what he wants
b. Babbles, imitates sounds, can say 4 -5 words
c. Giggles, vocalizes different sounds, looks for items when
out of view
d. Babbles, looks for items when out of view, can say 4 – 5
words

Answer 19

c. Giggles, vocalizes different sounds, looks for items when
out of view

Question 20

A 15-month-old has learned to point with her right index finger
to indicate some needs and can say 3 – 4 words, understood by
parents. In starting an intravenous line, it is best to:
a. Avoid using right hand or forearm
b. Explain the procedure to the child
c. Ask parents to explain steps of the process to child
d. Ask child to point to area that she would like used for IV

Answer 20

a. Avoid using right hand or forearm

Question 21

A 6-month-old infant should be able to:
a. Reach for a toy, crawl and sit unsupported
b. Transfer objects from hand to hand, roll over from belly to back and sit unsupported
c. Transfer objects from hand to hand, roll over both ways and sit with support
d. Reach for a toy, sit with support and crawl

Answer 21

b. Transfer objects from hand to hand, roll over from belly to back and sit unsupported

Question 22

A 10 month old is being admitted to the PICU with reactive
airway disease. The best way to administer continuous albuterol
for this child is to:
a. Use mask and apply tape to keep straps attached to face
b. Consider giving Q1 hour nebs vs continuous
c. Use blow by technique, with tubing close to face
d. Ask parents to hold child and assist in holding face mask in
place

Answer 22

d. Ask parents to hold child and assist in holding face mask in
place

Question 23

A one-year-old requires a fingerstick lab test. Which of the
following is the best toy to offer after the procedure?
a. Shape sorter
b. Transformer car
c. Jack in the Box
d. Markers and a coloring book

Answer 23

c. Jack in the Box

All the others have too small of parts for a 1 yr old

Question 24

A 20-month-old is being admitted to the general pediatric unit
for croup. Questions to determine if his developmental level is
normal include:
a. Can he run, jump, climb stairs and point to 3 body parts?
b. Does he know 20 words, and 4 – 5 body parts?
c. Can he run, jump, climb stairs and follow 2-step instructions?
d. Can he hop on one foot and does he know all body parts?

Answer 24

c. Can he run, jump, climb stairs and follow 2-step instructions?

Question 25

A 3-week-old infant presents to the ED with a fever of 102, without other symptoms. The infant is breastfeeding well and gaining weight. What information is MOST important in completing the history? a. Sick contacts b. Maternal history of smoking during pregnancy c. Maternal history of positive group B strep culture d. 36 weeks gestational age

Answer 25

c. Maternal history of positive group B strep culture

Question 26

An 8-year-old has just been diagnosed with leukemia. Parents do not want him to know the diagnosis until he is in the hospital for treatment. What is the best approach? a. Agree with parents, and wait until he is beginning to start treatment b. Discuss the importance of allowing child to know his illness now and be involved in any decision making. c. Prepare child by playing a game with him to demonstrate what will happen in the hospital, without disclosing the diagnosis d. There is no reason for him to know the diagnosis as long as he is aware of treatment as it occurs.

Answer 26

b. Discuss the importance of allowing child to know his illness now and be involved in any decision making. He has reached the age of assent

Question 27

A 3-month-old suffered a prolonged seizure lasting 30 minutes and required intubation with treatment. He is extubated on PICU day 2, and on day 3 is noted to have flaccid extremities and cannot maintain his head in an upright position when held. Appropriate intervention includes first: a. ordering an emergent brain MRI b. discussing his previous baseline activities with family c. monitoring, as this activity is normal for age d. obtaining physical therapy consult

Answer 27

b. discussing his previous baseline activities with family to discover if the exam is a departure from this child's normal exam or if this is a new exam finding.

Question 28

A 7-month-old infant is admitted to the PICU with RSV bronchiolitis and is treated with a high-flow nasal cannula. The nurses note that the infant does not try to roll at all. This infant had missed the 4-month and 6-month immunizations. Which of the following questions is most important to ask parents? a. Is the infant always calm and quiet? b. Does the infant roll over and try to sit up? c. Has the infant begun to crawl? d. Does the infant sleep on back or abdomen?

Answer 28

b. Does the infant roll over and try to sit up? Undiagnosed development delays could be present

Question 29

Which parameters are MOST important to measure over the first 12 months of life? a. Weight, length, hemoglobin b. Weight, head circumference and developmental milestones c. Fontanel presence and developmental milestones d. Length, head circumference, hemoglobin and iron level

Answer 29

b. Weight, head circumference and developmental milestones Can intervene to catch growth failures, hydrocephalus, and not achieving milestones

Question 30

A bottle-fed 4-month-old infant is admitted for failure to thrive. When obtaining a review of systems, parents report emesis after every feeding and loose stools which sometimes look like they contain blood. What should be considered at this point? a. Immediate GI consult b. Obtain CBC, CMP and stool culture c. Change formula to one that is hypoallergenic and elemental d. Change formula to a soy based formulation

Answer 30

c. Change formula to one that is hypoallergenic and elemental Symptoms of milk protein allergy

Question 31

A 5-year-old with asthma will be starting kindergarten. In reminding him how to use his inhaler, developmentally appropriate information includes: a. his triggers that can cause an asthma exacerbation b. that he recognizes that spacer is round in shape and can count 3 puffs c. that he can set up his own albuterol neb and insert the medication d. That he can draw an accurate picture of the MDI and spacer

Answer 31

b. that he recognizes that spacer is round in shape and can count 3 puffs

Question 32

A 13-year-old diagnosed with IDDM learns insulin dosing and carbohydrate counting. He adds a nutrition app to his cell phone and wants to use it with each meal. He does not want the school nurse to be involved in checking his blood sugar levels, but wants to obtain them himself. Based on his developmental level, which is most appropriate? a. Allow self-care until he experiences a problem and then involve the school nurse. b. Encourage the teen to have a discussion with the school nurse with his plans and her support c. Tell the teen that it is better if the nurse assists with checking his blood sugars until his illness has stabilized. d. Assist him in a plan for his care that he can check off daily along with writing down his BG and meals

Answer 32

b. Encourage the teen to have a discussion with the school nurse with his plans and her support.