Until what age do kids stay backseat rear-facing buckle
2 y.o
Reach the height/weight limit, whichever comes first, of current car seat before graduating to the next:
Rear facing: infant seat, convertible seat
Forward facing: convertible seat, combination seat
High back booster
No back booster
When can kids stop using booster seat?
4’9” tall, about 80 pounds, about 8 y.o
8 SIDS risk factors
Low birth weight Low APGAR score Recent viral illness Male gender Maternal smoking Co-sleeping Prone-sleeping Soft bedding
Umbilical cord care
Umbilical cord will gradually dry, become black and then fall off, usually within the first 10 days.
Clamp/tie may fall off in the first 2 days.
Try to keep cord clean and dry.
If the area around the umbilical cord looks red or is sticky, contact PCP.
Some clear, sticky brown oozing around belly button -normal healing
Newborn bathing
2-3x/week for 5-10 min
Avoid soap = drying; use gentle non-soap cleanser, fragrance-free oil
2 inches water for < 6 mo
Face while clothed, genital areas last with water
If uncircumcised, clean outside only; do not retract forcefully - often 2-3 yo or puberty (smegma is normal - dead skin cells)
Egg white discharge normal in daughters
Non accidental head trauma (shaken baby syndrome)
Often result of frustration with crying baby
Teach coping mechanisms
Place the child in a safe place and take a break
“Period of Purple Crying” video
PURPLE crying
Period of PURPLE Crying begins at about 2 weeks of age
Continues until about 3-5 months of age, peak at 2 mo
Unexpected: come and go without incident
Resists soothing
Pain-like face
Long lasting (5 hours or more)
Evening
< 3 mo signs of tiredness
Jerky movements Staring into distance Arching back Eye rubbing Yawning Fussing Whining Clenching fists Frowning Sucking on fingers Ignoring distractions Losing interest
0-6 mo infant nutrition
Breastmilk or formula only (both = 20kcal/oz)
Most babies need feeds every 2-4 hours, and they have around 8-12 feeds every 24 hours.
Sometimes feeds might last up to an hour, especially if breastfeeding.
Take Vitamin D supplement for baby/mom; mom take 150 mcg iodine supplement
Exception: infant cereal may be added as early as 4 mo with pediatrician recommendation
Goal: double birth weight by gaining 2 lbs/mo or 1 oz/30 g per day
6-12 mo infant nutrition
Breastmilk or formula is still primary source of nutrients until 12 mo
Most older babies feed every 3-4 hours (can use feeding cup at 6 mo)
Goal: triple birth weight by gaining about 1 lb/mo or 0.5 oz per day
Introducing solids
Recommended to wait at least 6 mo
- More mature GI system
- Less sensitive to allergens
- Developmentally ready
- Head control
- Pincer grasp
- Eye hand coordination
Add 1 food at a time. Waiting 4-7 days between for ID of allergens.
No added salt, sugar, or honey
No cows milk until 12 mo
Full fat milk from 1-2 years for brain myelination
By 12 mo, baby will limit breast/formula to 500-600ml
Dental care
No bottles in bed
No juice before bed
No juice in bottle, only cup
Rice size fluoridated toothpaste 6 mo, pea size once they can spit
1-2 mo old concerns
- Crying more than usual
- Not feeding well
- Very tired or sleeps a lot more than expected (> 16 hrs)
- Not moving arms or legs
- Not responding to bright light or seeing things – for ex, isn’t following your face with her eyes
- Not making sounds like gurgling
- Not hearing things – for ex, not startling to loud sounds or turning her head towards sounds
- Not sleeping well
- Post partum depression
- Not smiling
2-3 mo old concerns
- Crying more than usual
- Can’t focus his eyes on something but instead crosses his eyes most of the time (it’s normal for baby’s eyes to cross occasionally in these months)
- Not looking you in the eyes, even for a short time
- Doesn’t pay attention to faces
- Not making sounds or responding to loud noises
- Hands in fist most time
- Very floppy or very stiff
Education points
Car seats Gun safety Pool safety Trampoline Poison control (800 222 1222) Smoking cessation
1-3 yo (4) targeted points
The Terrible Twos: positive parenting/boundary setting
Toilet training: assessing for readiness, positive reinforcement
Injury: burns, poisoning, drowning, falls
- Lock poisons and meds away
- Stair gates
- Never leave unsupervised in bathtub; 2 in to drown
Nutrition: picky eaters
Full fat milk until 2 yrs → brain development
Iron-deficiency anemia is common
Toilet training education points at 1-3 yo
Control of sphincters occurs around 18-24 mo
Assessing readiness:
- Waking from naps dry
- Verbalizing need to go
- Dry for < 2 hours during day
- Nighttime dryness may not happen until 4-5 yrs
Planning:
- Caregivers able to invest time
- Appropriate toilet
- Feet on floor or stool
- Limit time on toilet to 5-8 min
- Stay with child
- Teach hand hygiene
Nutrition for toddlers
- Full fat milk until 2 yrs
- Avoid food battles
- May restrict food to 4-5 main foods
- Avoid using food as reward
- Offer iron-rich foods (iron-fortified cereal, red meats, leafy greens, fish, dried fruit, beans)
3-5 yo education points
Forward facing 5 point harness car seats
Gun safety, pool safety, trampoline, poison control (800 222 1222), smoking cessation
Preparation for School
- Traffic Safety
- Prevention of sexual abuse
- Right to say “no!”
- Encourage communication
- Seek out trusted caregivers and safe environments
Red flags
- Inappropriate sexual knowledge
- Regressions
School-aged kids education points
- Enuresis
- ADHD
- Stress/Anxiety
- Bullying
Overstimulation:
-Help your child put into words the feelings that their expressing through behavior.
(For ex, ‘I can see that you’re upset’, ‘I can see that you’re feeling overwhelmed’)
-Suggest that your child goes to a quiet place if they’re tired or cranky from overdoing it.
(For ex, she could read or listen to quiet music in her bedroom)
- Talk with your child about which activities they find most interesting or valuable. They might need to think about letting some activities go if they find they have too much to cope with.
- Look into mindfulness strategies for your child. You might be able to find some that you and your child could practice together.
- Your child needs enough time during the week to do homework, spend time with family, socialize with friends and just be by themselves.
Adolescents education points
STI’s
Contraception
Healthy lifestyle
Mental Health
- Eating disorders
- Stress
- Self-harm
- Social media
Obesity prevention
- Limit sugary drinks: dental caries
- No more than 2 hours of screen time/day
- No TV’s or screens in sleeping areas
- Eat breakfast daily
- Limit eating out: heart disease, T2DM
- Eat together at the table
- Limit portion sizes
