PEDS EXAM 1
Family Units
Traditional: Mom, dad, kid(s)
Nontraditional:
1. Single parent
2. Adoptive
3. Blended: single, divorced or widowed parents, combined families
4. Multigenerational: including grandparents living in same household
5. Same-sex
6. Grandparent led
7. Communal: many family units living together
Normal Growth & Development
INFANT
Infancy period: Child’s birth – 12 months
(first 28 days = neonatal period b/c baby’s characteristics/behaviors are impacted by the
transition from fetal environment to extrauterine environment)
Biological Development:
Rapid growth in the first 6 months and then slows down
Weight:
● Doubles by 6 months
● Triples by 12 months
Height
Head circumference indicator of brain growth
Fontanels
1. Posterior “tanga” – closes in 1-3 months
2. Anterior – closes in 12-18 months
Vital Signs
97.7 – 99.0 F
Most accurate Rectal
Most used Axillary
Hard time maintaining their temperature
HR: 80 – 150 bpm
Apical method taken for 1 full minute
RR: 25 – 55 rpm
Also taken for a full minute
BP: a. Normal range is 65 to 100/45 to 65 mm Hg.
b. Rarely taken until children reach 3 years of age.
c. If taken, an electronic method should be used.
Temp:
PEDS EXAM 1
Dentition
Drooling starts at 4 months
Deciduous teeth within the first 6-9 months
By 12 months = 6-8 teeth
First: lower central incisors.
Next: upper central incisors.
Last: upper and lower lateral incisors
Cleansed daily with a washcloth or soft child’s toothbrush
NO toothpaste
Cavities = Occurs when putting baby to sleep with a bottle filled with formula, breast milk/juice
Senses
See
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20/100
Only see black & white until 7 months
I enjoy the human face
I like things in black & white
Pseudostrabismus, what appears to be crossed or wandering eyes,
commonly is seen in babies until 6 months of age when binocular vision is
established
Hear
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NJ State Requirement for Testing & Documentation
ALL babies should have a hearing test done at birth
4 months – babies turn head to sound
10 months – babies respond to name
Prevent speech delay = if a hearing deficit exists, intervention should begin
as early as possible and no later than 6 months of age
Smell
● Intact & I can tell the difference between my mommy’s breast milk than
others
Taste
● Touch is soothing to me
● I enjoy infant massages
Touch
● I prefer tasting sweeter things
PEDS EXAM 1
Motor Development
1 Month
2 Months
3 Months
4 Months
5 Months
6 – 7 Months
8 – 9 Months
12 Months
15 months
● Infant when laid prone will be able to lift head (head lag) and turn a little bit but
still lacks control
● Talk to parents about:
o Denver screening tool: putting their child on the abdomen to develop core
muscles “tummy time”
● Can hold up head a bit more and when in prone can lift the shoulders & chest a
little bit
● At this stage, explore with parents if the baby is doing well with tummy time
● Big developmental stage that babies have tummy time
● Less head lag
● starts to roll over from belly to back, engaging core muscles
(Due to the c spine the baby may be able to roll from back to belly just b/c of the shape
of the spine and not purposeful, therefore parents should be advised not to leave babies
on a high surface where this may happen & they can harm themselves.)
● If there is still a delay in tummy time, there needs to be an intervention with the
parents due to the developmental delay and this should be addressed.
● There is an issue because the baby should be able to lift their shoulders & chest
● Rolling from supine to prone, more core muscles are needed to go from back to
belly than from belly to back
● rocking back & forth
● crawl or getting up on their knees
● tripod sitting
● birth weight has doubled
● Sitting by myself unsupported
● Pull myself to a standing position
● Beginning to walk
● Birth weight triples
If not walking by this age there is a gross motor delay
PEDS EXAM 1
1 – 2 MONTHS
3 MONTHS
4 – 5 MONTHS
6 – 7 MONTHS
8 – 9 MONTHS
10 – 12
MONTHS
GROSS
REFLEXES
Grasp (thumb grabbing)
Tonic neck
Sucking
Rooting (stroking baby’s cheek)
Moro/Startle
(+) Babinski up to 9 months
Head lag
Lifts head when prone
Head lag diminishing
Moves hand to mouth
Reflexes mostly gone
Plays with feet
Puts weight on feet when held
Rolls from tummy roll to back
Tripod sitting w/ body leaning forward
Head lag has disappeared
Turn from back to tummy
Sits well
Crawls & pulls self to standing
Stands with help
FINE
Grasp reflex
Drops things
Follows objects with eyes to midline
Clenched fist
(-) Babinski
Stands alone
Walks with holding one hand
Begins to walk alone @12
10 months:
self feed with fistfuls of food in mouth
11 months:
offer object to another person
12 months:
Can eat finger food neatly
Begins using spoon
Poke things with my index finger
Grasp reflex diminishing/absent
Holds objects when placed in hands
Hold hands in front of my face
Reach and grasps voluntarily
Transfers objects from one hand to the other
Uses PALMAR grasp
Uses PINCER grasp (uses thumb)
Able to work with smaller objects
Purposefully drops objects
Psychosocial Development:
Piaget is how they learn (cognitive)
Erik Erickson
Trust vs. Mistrust
Parents educated to not let baby cry for long periods of time,
okay to hold and console baby will not spoil them
PEDS EXAM 1
Piaget
Sensorimotor
Babies learn through their SENSES
● I am learning thru my environment and thru my senses.
● Very orally, this is how I learn.. does not matter if it is a choking hazard to me
6 – 7 MONTHS: Object permanence develops
● When the child realizes an object is there even when they cannot see it
o Peek a Boo
● Stranger anxiety develops
10 - 12 MONTHS:
● Will activetly hunt for a hidden toy
Nutrition
Breastfeeding (contains antibiotics & WBC to fight infectio) or bottle feeding till age 1
● Feeding guidelines:
o 1 month of age: 4 oz. every 3 to 4 hr.
o 6 months, they drink approximately 8 oz. at each feeding.
● Solid foods added to diet at 6 MONTHS
● New foods should be introduced slowly, add days apart in case of allergic reactions
● Require Vitamin D (since keeping out of sun) and fluoride supplements (starting at 6
months)
● Infants should have a min of 6 - 8 wet diapers & 4 stools per DAY
Safety
Sleep on back
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Tummy time! Important to avoid plagiocephaly
Car seats should be placed rear facing in the back seat (2 full years)
First 6 months keep out of sunlight especially between 10am-4pm
Use UVA/UVB sunscreen, cover skin, sunglasses
Choking hazards
PEDS EXAM 1
TODDLER
Toddlerhood period: 1 – 3 years
Little humans short legs & pendulous bellies, wide gait with arms out
Biggest time for tantrums: “terrible 2’s” (parents can forewarn, set limits to help)
Very curious
Biological Development:
Less growth & less food
Weight – 4x birth weight by 3rd year
Height – By age 2, half of adult height
BMI – 2 years and older
Head circumference – anterior fontanel closes 12 – 18 months
Vital Signs
Temp: 98.6 F
HR: 70 – 110 bpm
Radial pulse can be used
2 years and older
RR: 20 – 30 rpm
BP: STARTS HERE AT
AGE 3
Dentition
Full set of teeth by 2.5 years
Brushed daily with soft child’s toothbrush
NO toothpaste until child can spit on command
15 MONTHS
Senses
● Hearing, smell, touch and taste
developed!
● Vision 20/50
Motor Development:
GROSS
Walk independently
Crawl upstairs
18 MONTHS
Climb stairs with help
Jump in place
2 YEARS
Climb stairs one foot at time while holding
railing
Walk backwards
Run and kick a ball
FINE
Drink from cup using both
hands
Scribble
Put block in cup
Throw a ball
Build tower of 2 blocks
Take off their clothes
Use spoon but mess up
Feed themselves
Build tower of 6 blocks
PEDS EXAM 1
Erik Erickson
Autonomy
vs.
Shame & Doubt
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Develop egocentrism and independence
They feel they can do it themselves
Can develop shame when punished for accidents
Parents must help with independence through actions that reduce stress
Allow transition objects
Establish rituals – sleeping, bathing, eating
Provide simple choices
Avoid tasks they can’t master
Piaget
Preoperational
Experience the world directly
Animism – animate objects
● Start to notice differences, for example boys vs. girls, colors and shapes
● Parents showed incorporate learning into daily conversations/activities
Nutrition
Physiological anorexia Slower growth & decreased appetite
Food jags – picky eaters
● Parents should be advised that this is normal and should focus on nutritious food when
they do want to eat
Can switch to cow’s milk by 1 YEAR but must be whole milk b/c need fats for optimal brain growth
Sleep
Require 14 hours of sleep
Include nap time during the day (can forewarn child to reduce tantrums)
Toilet training:
Must be physically and emotionally ready
Obtain potty chair
Punishment can lead to shame and fear
Play
Parallel play - Toddlers play independently but side by side
Safety
● Constant supervision needed
● Choking hazards, burns, drowning, car seats
PEDS EXAM 1
PRESCHOOLER
Preschool period: 3 – 5 years
Magical thinkers – believe their thoughts (good or bad) have powers
Biological Development:
“Losing baby fat”
Weight
Height
BMI – 2 years and older
Vital Signs
Temp: 98.6 F
HR: 65 – 110 bpm
RR: 20 – 25 rpm
BP: STARTS HERE AT AGE 3
Dentition
Start to lose teeth by 4 – 5 years ; beginning of preschool period eruption of deciduous
(primary) teeth is complete
Child should be allowed to practice teeth brushing
Senses
● Hearing, smell, touch and taste developed
● Vision 20/30 by age 5
3 YEARS
4 YEARS
5 YEARS
GROSS
Ride a tricycle
Jump or Tip toe
Hop on 1 foot
Balance on 1 foot
Walk heel to toe
Skip/Jump rope
Initiative vs. Guilt
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Motor Development:
FINE
Use fork
Copy a circle/cross
Use dull knife
Draw a person w/ at least 6 anatomical parts in correct spots
Erik Erickson
Believe they can do it!
Likes to help
Magical thinking
Good things happen because of good thoughts
Bad things happen because of bad thoughts
When punished think they are bad not what they did
Like to please
PEDS EXAM 1
Piaget
Can view problem from their viewpoint only
Magical thinking – imaginary friends
Preoperational
Animism – animate objects
● Fears unrelated to reality
● Fear of body mutilation
Sleep
Nightmares and terrors common
Nutrition
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The requirement for calories per unit of body weight continues to decrease slightly to 90
kcal/kg.
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The estimated daily caloric requirement for preschoolers is 1,000 to 1,800 calories
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Fluid requirements may also decrease slightly to approximately 100 ml/kg/day,
but requirements are affected by climatic conditions.
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Protein requirements increase during childhood, and the recommended intake
for preschoolers is 13 to 19 g/day (0.45 to 0.67 oz/day)
Milk and dairy products are excellent sources of calcium. Low-fat and nonfat milk
may be substituted for higher fat choices, so the quantity of milk may remain the same
while limiting fat intake overall.
Excessive consumption of fruit juices and other sugar-sweetened beverages has been
associated with dental caries n adverse Cardiometabolic affect
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12 hours of sleep n take day time infrequent day time naps
Play
Associative play – play together with others
Safety
● Booster seats
● Risk for personal and sexual abuse
PEDS EXAM 1
● Stranger danger – establish a safety word
● Health screenings
SCHOOL-AGE
School-age period: 6 – 12 years
Biological Development:
Slow & Steady growth
Weight
Height – Growth spurts at 12 years for female (2 years later for males)
BMI
Vital Signs
Temp: 98.6 F
HR: 65 – 100 bpm
RR: 18 – 22 rpm
BP:
Dentition
Lose all teeth by age 6
Dental hygiene very crucial
Senses
● Hearing, smell, touch and taste developed
● Vision 20/20
Motor Development:
Increase in muscle coordination and strength
Gross ex. Dance class, sports, roller boarding, skiing
Fine ex. Keyboarding typing, cursive writing, knitting, musical instruments,
model building
Sexual Development:
Females – before age 12
Menarche (first menstruations)
Males – 2 years after ~14
Tanner Scale – Ped’s assessment for sexual development from pre-puberty to
adolescence
Industry vs.
Inferiority
Psychosocial Development:
Erik Erickson
● Likes to have a purpose and succeed, socialize
● Feel inferior when unable to achieve something
● Like positive reinforcement and meeting expectations
PEDS EXAM 1
● Identifies with same sex
● Models after others
Concrete operational
Piaget
Literal thinkers – lacks ability to think abstractly
● Visual learners
● Reversibility and Conservation are learned
Nutrition
● Monitor intake and exercise
Play
All forms of play – solitary, associative, cooperative
Safety
Leading cause of death – unsupervised injuries
● School phobias and bullying
● Peer pressure
● Lying, cheating and stealing (done it to meet expectations – not to be mean)
PEDS EXAM 1
ADOLESCENT
A period: 13 – 20 years
Biological Development:
Dramatic growth
Weight
Height – Growth spurts at 12 years for female (2 years later for males) due to hormones
Tanner scale sexual development scale
FEMALES
STAGE 1
STAGE 2
Breast budding
STAGE 3 – 5
Ovulation
Menarche
MALES
Pre-pubertal
Testicular enlargement
Breast enlargement may occur
Voice changes
Facial hair
Ejaculation (wet dreams)
BMI
Vital Signs
Temp: 98.6 F
HR: 60 – 100 bpm
RR: 15 – 20 rpm
BP: 90/60 – 120/80
Dentition
Third molars appear (wisdom teeth)
Senses:
All senses developed!
Motor Development:
All gross and fine motor skills developed
Identity vs.
Role confusion
Erik Erickson
● Develop a true sense of themselves
● Independent thinking
3. phases:
1. Early adolescence: Conformity (follow the crowd, focus on body
changes, frequent mood swings)
2. Middle adolescence: Challenge (break rules, take risks)
3. Late adolescence: Individuality (Finding themselves, become
PEDS EXAM 1
independent adults, setting goals)
Piaget
Formal operations
Abstract thinking and logical reasoning
3 phases:
1. Early – Egocentric
2. Middle – Invincible
3. Late – Goal oriented
Nutrition
● Increase vitamin D and Calcium to promote healthy bone growth
● Weight fluctuation due to different diets
Safety
● Sexual health
● Breast self-exams, testicular self-exams
● Tattoos and piercing