Lecture 2 Health promotion in infancy and early childhood

Question 1

Growth during infancy

Answer 1

1. Weight: Increases by 1.5 lb. per month; doubles by 6 months of age.
2. Length: Increases by 1 inch per month.
3. Head circumference: Increases by 0.5 inch per month.
4. By the end of the first year: Weight has approx. tripled; height has increased by approx. 45%; head circumference has increased by approx. 33%.
5. Example: 3 kg newborn - will weigh 6 kg at 6 months (double) and 9 kg at 1 year (triple).

Question 2

Foramen ovale

Answer 2

Fetal shunt in which blood passes across the ventricular septum from the right atrium to the left atrium.
First shunt to close (functionally), due to cord clamping and increased systemic vascular resistance. Closes structurally during the first months or years.

Question 3

Ductus arteriosus

Answer 3

Fetal shunt that connects the pulmonary artery to the aorta - bypasses the lungs.
Closes in response to increased oxygen and decreased circulating prostaglandins.

Question 4

Ductus venosus

Answer 4

Fetal shunt that allows blood to bypass the liver to the inferior vena cava.
Turns into a ligament (ligamentum venosum) after obliteration.

Question 5

Teeth begin to erupt around the age of _

Answer 5

6 months.

Question 6

Solid food and cow’s milk - ages

Answer 6

Solid food can be introduced beginning at 6 months; cow’s milk should be introduced no earlier than 1 year.

Question 7

Introduction of new foods

Answer 7

Introduce one solid food at a time, and new food at 4-7 day intervals to better identify allergies.

Question 8

Language during infancy

Answer 8

1. 3-9 months: Single syllables, nonspecific babbling (may say “mama” but this does not represent “mother” yet).
2. End of first year: 1-5 words, symbolic representation (“mama” represents “mother”).

Question 9

Motor skills - 2-3 months

Answer 9

Gross - bear some weight (improved strength).
Fine - smiles responsively at 2 months, recognizes faces at 3 months.
Risks - can roll off flat surfaces.

Question 10

Motor skills - 5-6 months

Answer 10

Gross - pulls to sit, loss of head lag, rolls from abdomen to back (5 months), back to abdomen (6 months).
Fine - reaches, some grasping.
Risks - can aspirate small objects.

Question 11

Motor skills - 6-9 months

Answer 11

Gross - sits erect without support, pulls to stand, stands while holding on.
Fine - palmar grasp.
Risks - can fall out of crib/mattress.

Question 12

Motor skills - 9-12 months

Answer 12

Gross - moves from prone to sitting position, “cruising” - travels while hanging on to furniture.
Fine - pincer grasp.
Risks - higher injury potential once mobile - set limits.

Question 13

Vision/hearing - at birth

Answer 13

20/100-20/400 vision; responds to bell.

Question 14

Vision/hearing - 1 year

Answer 14

20/40-20/60 vision; active listening.

Question 15

Solitary play

Answer 15

Infants - play alone and involve one sense at a time - sensorimotor stage.

Question 16

Teething vs. viral/bacterial illness

Answer 16

With teething there should be no temperature over 101 (39), vomiting or diarrhea.

Question 17

Leading cause of death/injury - birth to 6 months

Answer 17

Congenital abnormalities and prematurity.

Question 18

Leading cause of death/injury - 6 months to 1 year

Answer 18

Accidents (overall leading cause of death from birth to 14 years; motor vehicle accidents leading cause of death from 1 year and up; 2/3 of all injuries occur in the home).

Question 19

Vehicle safety

Answer 19

Until 2 years of age, the child should be in the back seat with the car seat facing backward. After outgrowing the car seat the child should use a booster seat they are until 4’9” tall and between ages of 8 and 12. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Question 20

IM injection site

Answer 20

Vastus lateralis (infants); deltoid (older children). No firm age for when to switch from VL to deltoid (book says 12-18 months), but the development of the child’s muscles should be considered.

Question 21

Transductive logic

Answer 21

1. Toddlers - cause-effect thinking or “playing the blame game” - two events occurring closely in time receive cause-effect attributes.
2. Example - Child is taught that a woman with a large abdomen is carrying a baby, thinks that a man with a beer belly is also carrying a baby.

Question 22

Global organization

Answer 22

1. Toddlers - the belief that if something changes in one part of a whole, so does everything else.
2. Example - A child refuses to sleep in their room because the location of the bed is changed.

Question 23

Toilet training

Answer 23

At 18-24 months, the toddler develops sphincter control, awareness of the need to use the bathroom, and improved leg muscle movement; can then be taught to use the toilet.

Question 24

Parallel play

Answer 24

Toddlers - children play side-by-side and may imitate each other, but are not directly interactive with one another.

Question 25

Treatment for acetaminophen overdose

Answer 25

Acetylcysteine (Mucomyst) - *within 12 hours* to prevent liver damage.

Question 26

Telegraphic speech

Answer 26

Children between the ages of 3 and 4 years (preschool) form sentences of approximately three or four words and include only the words most essential to convey meaning; such speech is often termed "telegraphic" because of its brevity.

Question 27

Associative play

Answer 27

*Preschoolers* - children engage in group play with similar or identical activities, but do not really follow rules.

Question 28

Cooperative play

Answer 28

*Preschoolers* - similar to associative play but with improved organization and communication, role performance.

Question 29

Iron deficiency anemia

Answer 29

1. Common disease in early childhood - may be caused by drinking too much cow's milk which reduces the appetite for solid food (the child's source of vitamins and iron). 2. Symptoms: Porcelain-like complexion, poor muscle development, frequent URIs. 3. Interventions: Iron-fortified formula/cereal, vitamin C (promotes iron absorption).

Question 30

Failure to thrive (FTT)

Answer 30

1. Inadequate growth resulting from an inability to obtain or use calories. 2. A weight (and sometimes height) that falls below the *5th percentile* for the child's age. 3. Organic FTT: Physiologic/congenital problem (e.g., heart defect) that results in inadequate growth. 4. Inorganic FTT: Environmental, behavioral (e.g., parents lack education on feeding practices), financial, etc. concerns that prevent adequate intake of food.

Question 31

Lead poisoning (plumbism)

Answer 31

1. An increase in blood lead levels often caused by lead-based paints and pipes; may be exacerbated by poor intake of *calcium and iron*. 2. Primarily causes neurologic symptoms but may cause no symptoms at all - blood lead level for diagnosis. 3. Treatment: Chelation therapy. Interventions: Educate parents on lead sources (old houses, toys), increase child's intake of *calcium and iron*.

Question 32

Otitis media (OM)

Answer 32

1. The presence of fluid in the middle ear along with acute signs of illness and symptoms of middle ear inflammation. Often follows a URI. 2. Symptoms: High fever, pain/pressure and resulting irritability, rolling head or pulling ear, loss of appetite. 3. Treatment: Antibiotics (only if bacterial), analgesics, myringotomy (a surgical incision of the eardrum) - performed by an ENT to relieve pain and facilitate drainage.

Question 33

Varicella (chickenpox)

Answer 33

1. Symptoms: Slight fever, malaise and anorexia for first 24 hours; lesions begin on neck or trunk and spread to face, scalp and extremities, producing severe itching. 2. Treatment is focused on relieving symptoms.

Question 34

Signs and symptoms of acetaminophen poisoning

Answer 34

1. Early: Nausea and vomiting, loss of appetite, elevated liver enzymes. 2. Late: Jaundice, clay-colored stools, dark urine.

Question 35

During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner?

Answer 35

Turn his or her head to side when sound is at ear level.

Question 36

Landau reflex

Answer 36

When the infant is suspended in a horizontal prone position, the head is raised and the legs and spine are extended; appears at 6 to 8 months and persists until 12 to 24 months.