Infant 2-10 Months

Question 1

Erickson’s Psychosocial Development

=

Answer 1

Trust vs. Mistrust

• fullfillment of basic needs such as nourishment, warmth, and physical contact

Question 2

Piaget’s Theory of Cognitive Development

Argues that we have to conquer 4 stages of cognitive development

S______

______ Operational

______ Operational

______ Operational

Answer 2

Argues that we have to conquer 4 stages of cognitive development

Sensorimotor

Pre

Concrete

Formal

Question 3

Growth and Development

• Physical Characteristics
  
  • ​W____
  • H_____
  • Head ______
  • G____ chart plots WHO/CDC
• Use the ____ growth charts to monitor growth for infants and children ages 0-2 y of age in the US
• Use the ____ growth charts to monitor growth for children age 2 and older

Answer 3

• Weight
• Height
• Circumference
• Growth
  
  • WHO 0-2y
  • CDC >2y

Question 4

Newborn to 2 months

Gross Motor Skills

• Head =
  
  • When does the head lag disappear?
• Neck =
• Hands =

Answer 4

• Can lift and turn head when lying on back
  
  • Complete head lag when newborn, slight at 12 wks, should disappear at 20wks
• Unable to support head when sitting
• Fisted, arms flexed

Question 5

3-4 months

• Eyes =
• Hands and feet =
• When lying face down =
• Neck =
• Primitive reflexes =
• Rolling =

Answer 5

• Track objects (better muscle control), increased vision to tell objects apart from backgrounds
• Begin to control but not fine tuned, no grasp just swiping at objets
• Cobra (raises up upper torso, shoulders, head)
• can Sit with support, keep head up
• Dissappeared
• Stomach to back at 4 months

STOMACH to BACK 4m, BACK to STOMACH 5-6

Question 6

5-6 months

• Sitting =
• Hands =
• Rolling =
• When lying on tummy =

Answer 6

• Sit alone WITHOUT support (only moments at first then up to 30sec)
• Grasps blocks or cubes with ulnar palmar grasp (doesn’t use thumb)
• Back to Stomach
• Push up with arms to raise shoulderes and head to look around and reach objects

Question 7

6-9 Months

• What gross motor activity begins?
• Sitting =
• Standing =

Answer 7

• Crawling
• Sit without support for long periods of time
• Pulls into standing position while holding furniture, can sit down from standing

Question 8

9-12 Months

• Standing =
• Walking =

Answer 8

• Begins to balance while standing alone
• Takes steps holding hand, may take few steps alone

Question 9

Fine Motor

1. 2-4m
2. 4-6m
3. 6-8m
4. 8-10m

Answer 9

1. hands open, plays with hands and feet
2. palmar grasp, manipulates small objects
3. holds bottle, bangs objects
4. pincer grasp

Question 10

Positioning 1-12 months

Pictures

Answer 10

Question 11

Sensory Development

Vision/Sensory

1. 2-4m =
2. 4-6m =
3. 6-8m =
4. 8-10 =

Answer 11

1. follows objects, turns head to side when sound is made
2. begins eye hand coordination, smiles at mirror
3. recognized parents, focuses on small objects
4. localizes sound by turning head in appropriate direction

Question 12

Sensory Development

• Hearing begins when? Prefers the ____ voice
• Touch, taste, and smell mature at _____, what taste is preferred?
• Vision of newborn infant can see within a range of?
• When do they get color vision? By 2 months can track objects up to ____ degrees, and prefers looking at?
• Inner ear (v_____) senses, the infant responds to (2)

Answer 12

• before birth, mature at birth, human
• birth, sweet
• 8-12 inches
• 4-6m, 180 degrees, faces
• vestibular, rocking and changes in position

Question 13

Socialization/Vocalization

1. 2-4m =
2. 4-6m =
3. 6-8m =
4. 8-10m =

Answer 13

1. coos, babbles, starts to laugh
2. laughs aloud, babbles one syllable sounds
3. imitates sounds, plays peek a boo, two syllable words
4. says “dada” and “mamma” ,comprehends “no”

Question 14

Sleep Pattern

1. 2-4m =
2. 3-4m =
3. 4-10m =

Answer 14

1. 15 hrs/day nocturnal
2. Circadian rhythm normalization
3. varies by infant

Question 15

Feeding

• What is best? What is used alternatively?
  
  • 2-4m = how much per feeding? how many feedings per day?
  • 6-8m =
  • When to introduce SOLID food? - recommended by AAP
• Developmental readiness includes
  
  1. Ability to ___ with or no support
  2. Has good ____ control
  3. Able to open ____ and ____ forward when food is offered

Answer 15

• Breastfeeding, Formula
  
  • 4oz, 6/day
  • Chews and bites
  • 6 months
• Readiness
  
  1. sit
  2. head
  3. mouth, lean forward

Question 16

Solid Foods

• Progression of solid food =
  
  • Add one new food every?
• Portion sizes
  
  • Cereal =
  • Vegetables/Fruits =
• 8-10m = picks up small morsels and feeds self, able to use _____ with much spilling, r____ motion
• Introduce _____ around ___ months

Answer 16

• Iron fortified cereal -> pureed fruits and veggies -> meats
  
  • 3-4 days
• Portions
  
  • 2-4 tbs bidaily
  • 2 tbs bidaily
• spoon, raking
• proteins at 8m

Question 17

History Overview for Every Visit

• S______
• E______
• A______
• D______ M______
• Last visit…..I______
• _ _ visits

Answer 17

• Sleeping
• Eating
• Activity
• Developmental Milestones
• Immunization
• ER

Question 18

Anticipatory Guidance

• Nutrition and F______
• Fever > ______ degrees F __-__ months of age
  
  • ​AAP recommends only using _____ thermometers in children
  • Where to take most accurate temp?
• S____ pattern
• T____ eruption
• Imm______
• S____ tips
• Soc______
• When months are the follow up visits? (4)
• Common problems

Answer 18

• feeding
• 102.2, 3-36m
  
  • digital
  • rectal
• Sleep
• Teeth 5/6m to 1 yr, theres a range, we don’t rly worry about it
• Immunization
• Safety
• Socialization
• 2, 4, 6, 9

Question 19

Diarrhea

Acute =

Chronic =

Causes (2)

Answer 19

transient, self limited

> 2 weeks

Viral or bacterial

Question 20

Diarrhea History

• L_____ of illness
• Stool fr_____, l___ness, presence of any?
• Oral _____.. assoc vomiting?
• A_____ symptoms..fever, rash
• U____ output
• Contacts with other _____ illness

Answer 20

• Length
• frequency, looseness, gross blood?
• intake
• associated
• urine
• infectious

Question 21

Diarrhea PE: Hydration Status

What do you look at?

• Moist _____
• Presence of s____ and t___
• Skin ____
• W___
• # of _____
• A____ness
• T_____
• 2 body systems?

Answer 21

• mucosa
• saliva, tears
• turgor
• weight
• diapers
• alertness
• temp
• HEENT, ABD

Question 22

Acute Diarrhea

​Causes

• Viral enteritis (2)
• Enterotoxin (1)
• Prasitic (1)
• Extraintestinal infection (2)
• ____ induced? esp ampicillin
• BLOOD IN STOOL -> MUST _____

Answer 22

• Norwalk, Adenovirus
• E.coli
• Giardia
• OM, UTI
• Abx
• TEST

Question 23

Chronic Diarrhea

• _____ COMMON
  
  • ​Chronic constipation…with _____ diarrhea
  • Formula ______
  • ______ with >2 wks

Answer 23

• MOST
  
  • overflow
  • intolerance
  • collaborate

Question 24

Diarrhea Dehydration

• ​Mild, Moderate, Severe
  
  • ​6-9% ___ mouth, absence of ____
  • >10% sunken (2), poor _____

Answer 24

• dry, no tears
• eyes, fontanels, poor turgur

Question 25

Symptoms of Severe Dehydration ## Footnote * Severe dehydration is a? How do children appear? * ____ mucosal membranes/tongue * ______ or no urine output * _____ heart rate, ____ pulses, ____ breathing, and ___ extremities * ____ capillary refill * Deeply _____ eyes (and/or fontanel in a baby)

Answer 25

* medical emergency, lethargic maybe even unconscious * dry * minimal * Increased, weak, deep, cold/mottled * slow * sunken

Question 26

Treatment of Diarrhea ## Footnote (3) * ORS: __ ml/kg of body weight how often? * Treat associated \_\_\_\_\_\_ * Continue what?

Answer 26

Hydration, Pedialyte, Ricealyte (ORS) * 1 ml/kg every 5 min over 3-4 hrs * infection * breastfeeding or formula

Question 27

Hospitalizable Diarrhea ## Footnote * Unable to keep ____ in * ____ diarrhea * L\_\_\_\_\_ * Poor \_\_\_\_, few wet \_\_\_\_\_ * Concern about p\_\_\_\_\_\_ * \>10% \_\_\_\_\_, sunken \_\_\_\_, poor \_\_\_\_\_

Answer 27

* fluids * Bloody * Lethargic * output, few diapers * parenting * dehydration, fontanels, turgor

Question 28

Follow Up Diarrhea ## Footnote * _____ in 12 and 24 hours * I\_\_\_\_ * # of \_\_\_\_\_ * F\_\_\_ * Act\_\_\_\_ * F/U in ____ at 24-48 hrs

Answer 28

* Phone * Intake * Diapers * Fever * Activity * Office

Question 29

Diaper Dermatitis ## Footnote * Etiology: (1) is often the causitive agent * Objective Data * ​B\_\_\_\_, r\_\_\_, shiny, sharply demarcated borders, s\_\_\_\_ lesions: er\_\_\_\_\_ papules or pustules * _______ found in skin folds and _____ (thrush), inspect entire body * Assessment * ​Diagnosis through?

Answer 29

* **Candida Albicans****​** * Objective Data * Beefy, red, satellite, erythematous * Candidiasis, mouth * H and P

Question 30

Diaper Dermatitis Education and Follow Up ## Footnote * Education * ​Check entire body for \_\_\_\_\_ * _____ diapers frequently and cleanse diaper area with ____ water at each diaper change, keep child ____ diapers as often as possible, do not use _____ pants * Keep baby clean and d\_\_\_\_, especially warm ____ areas * Careful hand\_\_\_\_\_ technique * Topical _____ may be indicated, what drug? * Follow up * Check _____ frequently, call immediately if you see? * Call back in 3 day if?

Answer 30

* rash * Change, tepid, without, plastic * dry, esp warm moist areas * handwashing * antifungal - Nystatin * mouth -\> white spots * no improvement

Question 31

What is this a picture of?

Answer 31

Irritant Diaper Dermatitis

Question 32

Oral Thrush (Candida) ## Footnote Normal vs. Buccal Mucosa Involvement

Answer 32

Question 33

SIDS/SUIDS Sudden Infant Death Syndrome ## Footnote SIDS = SUIDS =

Answer 33

* sudden death of infant \< 1 yr that remains unexplained after complete case investigation * sudden unexpected infant deaths that occur suddenly and unexpectedly in previous healthy infants and have no obvious cause of death prior to investigation (unexplained).

Question 34

SIDS/SUIDS Risk Factors ## Footnote * Infants sleeping on their \_\_\_\_\_ * ____ infant sleep surfaces and _____ bedding, t\_\_\_ or other objects in sleep environment * Maternal ____ during pregnancy * Over\_\_\_\_\_ * \_\_\_maturity or low birth \_\_\_\_ * ____ a bed with others * Sleeping place other than ____ (adult bed, couch, chair) * Faulty _____ of cribs or beds * Ob\_\_\_, fa\_\_\_\_, or d\_\_\_ or alc\_\_\_ use by persons supervising or sleeping with child * Quality of _____ at time of death * Family's a\_\_\_\_\_ to provide safe sleep or play environment for child

Answer 34

* stomach * soft, loose, toys * smoking * heating * premature, low birth weight * Sharing * crib * design * Obese, fatigue, drugs/alcohol * supervision * ability

Question 35

Interventions for SIDS/SUIDS ## Footnote * What position? * Crib safety and bedding? * Room temp? * Avoid bed \_\_\_\_/ \_\_\_-sleeping * Avoid \_\_\_\_/\_\_\_\_\_ use: esp cigarette smoking in hour or car and during breastfeeding

Answer 35

* "Back to sleep" (supine position) * Slats 2 3/8 inces apart, firm mattress, no plastic, crib alternatives include flat/low/firm surface, drawer, moses basket * Avoid overheating: room temp 68-72F * sharing, cosleeping * drug/alcohol

Question 36

Education ## Footnote 1. Education in child\_\_\_\_ classes and hospitals of expectant and new parents on safe infant sl\_\_\_\_ environments 2. In hospital assessments by nurses with parents to assess a baby's sleep environment when it goes \_\_\_\_\_ 3. C\_\_\_ distribution programs for families 4. Parent education campaigns on \_\_\_\_-sharing NOT ___ sharing 5. _____ cessation education and support for pregnant and parenting women and other caregivers 6. Make sure that infant leaves hospital and has a ____ care provider established 7. Encouraging \_\_\_\_\_feeding 8. P\_\_\_\_\_ offered at each sleep 9. Avoid products that claim to reduce the risk of \_\_\_\_ 10. Parents educated not to let baby get too \_\_\_ 11. The "\_\_\_\_ to Sleep" campaign; baby sleeps on back everytime * Specific messaged targeted to families and childcare providers who traditionally practice stomach sleep positions and/or bed sharing 12. _____ requirements for _____ providers on safe sleep environments and infant sleep positions

Answer 36

1. childbirth classes, sleep 2. home 3. Crib 4. room sharing NOT bed sharing 5. Smoking 6. primary 7. breast 8. Pacifier 9. SIDS 10. hot 11. Back to Sleep 12. Licensing requirements for daycare

Question 37

Bronchiolitis = * Children \< ____ months * Peak in ____ and early ____ seasons * _____ are the only source of infection * Route of transmission? * What virus can cause it? * Also viruses such as A\_\_\_\_, In\_\_\_\_, Mycloplasma \_\_\_\_\_, Rh\_\_\_\_\_

Answer 37

Inflammation of the bronchioles...VIRAL * \<24 * Winter, Early Spring * Humans * Direct/Close Contact * RSV (Respiratory Syncytial Virus) * Adenovirus, Influenza, M. Pneumonia, Rhinovirus

Question 38

Risk Factors for Bronchiolitis (3)

Answer 38

Low Birth Weight Prematurity CHD (coronary heart disease), Respiratory diseases

Question 39

Bronchiolitis Presentation ## Footnote * Peaks at? * Symptoms and duration? * Fever? * How does the child feel, present?

Answer 39

* 6 months * 2-3 days rhinorrhea, cough * Low grade temp * usually active, playful

Question 40

Hospitalizable Bronchiolitis ## Footnote * At what age? * RR of? * Poor ____ or signs of \_\_\_\_\_\_ * L\_\_\_\_\_ * Diagnosises such as? (3) * Care at home may not be \_\_\_\_\_ * Signs of Respiratory Distress (4)

Answer 40

* \<6 months * Tachypnea 30-60 * intake, dehydration * Lethargy * CHD, Respiratory, Neuromuscular dx, Prematurity * adequate * Distress -\> RR\>60, Nasal flaring, O2 \<95%, Intercostal Retractions

Question 41

Bronchiolitis Treatment (4) F/U when?

Answer 41

Hydration Steam Do not typically use bronchodilators/nebulizers - not effective, may give one time trial if severe Observe 24 hrs in office

Question 42

Intussusception ## Footnote = * \< __ yo with abdominal pain * Recent ____ infection * L\_\_\_\_\_ - does not play, pain resolves, plays again * Positive stool tests for? * Tx =

Answer 42

Invagination of one part of intestine into another-distal ileum into cecum * \<2 y w abdominal pain * Viral * Lethargy * + FOBT, Currant Jelly Stool w blood + mucous * Surgery

Question 43

Pyloric Stenosis = * May present from infants at what age range? * Mostly in what gender? * Classic Symptom = * What will you feel? * Treatment =

Answer 43

Hypertrophy of pyloric muscle-obstruction of gastric outflow * \>2 wks - 10wks * Male * **Projectile non-bilious vomiting** * **Firm mobile-OLIVE shaped mass in epigastrium** * Pyloromyotomy