Week 3 Flashcards
Infant and Toddler
1
Q
Cephalocaudal growth
A
child gains control of the head and neck before trunk and limbs
2
Q
Proximodistal growth
A
child gains control of arm movements before handmovements
3
Q
Diferentiation
A
increasing sutural and functional complexity
- arm movements become hand movements become finger movements
4
Q
Physical growth - birth weight at 6 months
A
weight doubles by 6 montsh
5
Q
Physical growth - birth weight at 1 year
A
triples by 1 y ear
6
Q
Length of baby - by one year
A
increased by 50%
7
Q
Head circumference - growth in one year
A
increased by 50% (where brain is!!)
8
Q
Newborn to 1 month - physical grouth (3)
A
- gain 200g/week
- lose some weight in initial few days as mom’s breast milk hasn’t come in, this is gained back
- head circumference increases 1.5cm/month
9
Q
Newborn to 1 month - sensory
A
- stares at faces and black and white geometric shapes
- follows objects in line of vision
10
Q
Newborn to 1 month - motor skills - fine (2)
A
- holds hand in fist
- draws arms and legs to body when crying
11
Q
Newborn to 1 month - motor skills - gross (4)
A
- primitive reflexes (rooting, suck, moro, grasp, stepping)
- may lift head for a second or two when prone (tummy time)
- comforted with touch
- alert to high pitch noises
12
Q
Rooting reflex
A
starts when corner of baby’s mouth is stroked or touched
baby will turn head and open mouth to find breast or bottle
lasts till 3-4 months
helps baby get ready to suck
13
Q
suck reflex
A
32 week of pregnancy starts- 36 weeks fully developed
14
Q
suck reflex and premies
A
this reflex may not be fully developed = ng tubes
15
Q
grasp reflex
A
stroke palm and fist closes
lasts till 5-6 months old
16
Q
Stepping
A
Walk or “dance” reflex
moves feet when held in upright position = tap feet
lasts till 9-12 months
17
Q
2-4 months - physical growth (3)
A
- 200g/week
- 1.5 cm/month in length
- 1/5 cm/head circumference
18
Q
2-4 months - sensory (2)
A
- follows objects 180
- turns head to voices and sounds
19
Q
2-4 months - motor skills - fine (3)
A
- hold toys when placed in hand
- looks and plays (eat/sucks) with fingers
- bring hands to midline
20
Q
2-4 months - motor skills - gross (5)
A
- moro reflex fades
- can turn from side to back and return (danger)
- decrease in hand lag when pulled to sit
- sits with head midline with some bobbing
- in tummy time holds head up and supports weight with forearms
21
Q
Moro reflex
A
- aka startle reflex. T
- when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out his or her arms and legs, cries, then pulls the arms and legs back in
22
Q
4-6 months - physical growth (6)
A
- 200g/week
- 1.5 cm/month in length
- 1.5 cm/month in head circumference
- DOUBLE YOUR BIRTH WEIGHT
- teething starts
- ingests 100mL/kg/day
23
Q
4-6 months - sensory (3)
A
- examines complex visual imagines
- watches course of a falling object
- responds readily to sound
24
Q
4-6 months - fine motor skills (5)
A
- grasps at will (ex mom’s hair)
- drops when offered another object
- hold feet and sucks on those as well
- holds bottle
- grasps with hole hand (palmar reflex)
25
Palmar reflex
when baby grasps with the whole hand (not just fingers)
26
4-6 months - gross motor skills (4)
- no bobbing head when sitting
- no head lag
- turns from abdomen to back by 4 months and back to abdomen at 6 months
- when held standing supports own weight
27
6-8 months - physical growth (3)
- 140g/week
- 1cm/month in length
- slowing down in comparison to first 6 months
28
6-8 months - sensory (2)
- recognizes own name and responds by looking and smiling
- enjoys small and complex objects at play (rattles)
29
6-8 months - fine motor skills (3)
- bangs objects held in hands
- transfers objects from one hand to the other
- beginning pincer grip (palmer faces)
30
6-8 months - gross motor skills (3)
- most inborn reflexes extinguished
- steadily sits up with no support by 8 months
- likes to bounce in standing position
31
Inborn reflexes that keep to adulthood
- cough
- blinking
- gag reflex
- sneeze
- yawn
32
8-10 months - physical growth (2)
- 140g/week
- 1cm/month in length
33
8-10 months - sensory (3)
- understands words such as "no", "cracker" "milk"
- may say one word in addition to mama and dada
- recognizes sounds with difficulty
34
8-10 months - Motor skills - fine (2)
- picks up small objects (DANGER = choking)
- use of pincer grasp well
35
8-10 months - motor skills - gross (3)
- crawls or pulls whole body along floor by arms
- pulls self to standing and sitting by 10 months
- recovers balance when sitting
36
10-12 months - physical growth (2)
- 140 g/week
- 1cm/months in length
37
10-12 months - sensory
plays peek-a-boo and patty cake
38
10-12 months - fine motor skills (2)
- may hold crayon or pencil and make marks on paper
- places objects into containers through holes
39
10-12 months - gross motor skills (3)
- stands alone
- walks holding onto furniture
- sits down from standing
40
Birth to 3 months - psychosocial development - 3 dimensions
- stages of play
- communication
- personality
41
Birth to 3 months - stages of play (3
- visual (mobiles, black and white, mirrors),
- auditory
- physical (rocks and cuddles)
42
Birth to 3 months - communication (3)
- coos
- babbles
- cries
43
Birth to 3 months - personality (2)
- two way-interaction (comfort by sounds, cuddling, eye contact)
- respond best to high-pitched voice (baby talk)
44
3-6 months - stages of play (3)
- noisemakers
- stuffed animals
- contrasting colours
45
3-6 months - communication (4)
- verbalizes during play and familiar faces
- cries less
- squeals
- babbles
46
3-6 months - personality (4)
- no one baby is the same
- some can sleep for 8 hours undisturbed, some 2-3
- some cry a lot some are chill
- all about inborn genetics but can change
47
6-9 months - stages of play (3)
- teething toys
- wants to be a socialite with adults and children
- soft toys so they can munch on them
48
6-9 months - communication
- increase vowel and constant sounds
- likes syllables together
- uses speech-like cadence to babbling
49
9-12 months - stages of play (4)
- enjoys blocks and nesting cups
- surprise toys
- peekaboo
- push and pull toys
50
9-12 months - communication (4)
- understands no
- says dada/mama
- learns one or two other words
- receptive speech surpasses expressive speech
51
12-24 months - physical growth (3)
- 225g/month
- 9-12 cm/year
- anterior fontanel closes
52
12-24 months - sensory
- visual acuity 20/50 (reading a menu in a dark restaurants)
53
12-24 months - motor skills - fine (4)
- builds a tower of four blocks
- scribble on paper
- undress self
- throws a ball
54
12-24 months - motor skills - gross (3)
- runs
- growing ability to walk and finally walks with ease (cant use IV in feet)
- starts stairs with ease a few months later
- likes to push and pull toys
55
2-3 years - physical growth
- 1.5-2.3 kg/year
- grows 5-6.5cm/year
56
2-3 years - motor skills - fine
- draws circle and rudimentary forms
- learns to pour
- learning to dress self
57
2-3 years - motor skills - gross
- jumps
- kicks ball
- throws ball overhand
58
1-3 years - stages of play (5)
- love presence of other children though may play independently (parallel play)
- imitative behaviour (Ex a play kitchen)
- refine fine motor skills (wooden puzzles, cloth books)
- gross motor activities (trike, soft bat)
- cognitive skills through music, art, stories
59
1-3 years - communication (4)
- won't shut up
- exponential growth of vocab
- releases stress by pounding
- interpersonal skills start to develop
60
1-3 years - personality (3)
- continue general behaviour from infancy (natural growth)
- may appear more negatively in toddlerhood (NO)
- parents have to adapt and change their behaviour to learn to communicate
61
3-6 years - physical growth (2)
- 1.5-2.5 kg/year
- grows 4-6cm/year
62
3-6 years - sensory ability (2)
- visual acuity continues to improve (well lit restaurant)
- can focus on and learn letters and numbers
63
3-6 years - motor skills - fine (8)
- scissors
- draw shapes
- draw stick figure
- arts and crafts
- tie shoes
- buttons
- brushes teeth
- uses spoons fork knife
64
3-6 years - gross motor skills (3)
- throws ball overhand
- climbs well
- rides tricycle or balance bikes
65
3-6 years - stages of play (3)
- associative play (doing same thing but not really together)
- dramatic play (dolls, house, hospital, puppets)
- cognitive growth (books, TV, music, stories
66
3-6 years - communication (3)
- all parts of speech developed now just honing skills
- talk to, explain, give options
- allow them to ask questions
67
3-6 years - personality (2)
- need of a nurturing environment based on personality
- the loud, active, needs a gentle place to express themselves and not suppress it
68
Prenatal history - supplements
- folic acid
- iron
- multi vitamins
69
Folic acid deficiency
- MOTHER = anemia, peripheral neuropathy
- FETUS = congenital abnormality
70
Iron (2)
- supports development of placenta and fetus
- helps body make blood supply to supply O2 to fetus
71
Multi vitamin (2)
- Calcium and Vitamin D = help promote development of baby's teeth and bones
- vitamins A, E, B, zinc and iodine
72
Infancy - health promotion (5)
- prophylactic eye care to prevent neonatal gonococcal ophthalmia (ophthalmic antibiotic agent erythromycin
- Intramuscular administration of vitamin K1 to prevent vitamin K deficient bleeding
- Hepatitis B vaccination
- umbilical cord care to prevent infection
- monitor for hyperbilirubinemia and hypoglycaemia
73
SIDS - what
- sudden infant death syndrome
- sudden death of an infant <1 year that remains unexplained after complete post-mortem exam (investigate death scene and case history)
74
Proposed theories for SIDS (6)
- brainstem abnormality in neurological regulation of cardiorespiratory control
- genetic predisposition
- "triple threat" of 1) underlying infant vulnerability, 2) critical incidence, 3), environmental stressor
- maternal smoking
- bed sharing
- sleep position
75
SIDS - risk level
- cause unknonw, some infants are at increased risk
- incidence has decreased since "Back to Sleep" campaigns in 1999
76
SIDS - canadian stats
- declined in canada
- second leading cause of death of healthy infants
- higher rate amongst vulnerable populations
77
SIDS - safe sleep (5)
- provide smoke-free enviro, before and after baby is born
- breastfeeding
- place baby on their back to sleep
- provide baby a firm surface with no pillows, comforters, quilts, bumper pads
- place baby to sleep in a crib cradle or bassinet next to your bed
78
Non-intentional injuries - purple crying program
aka shaken baby syndrome
P - peak of crying (2 months)
U - unexpected
R - resists soothing (sometimes this happens)
P - pain-like face (sometimes this happens)
L - long lasting (crying can be up to 5 months)
E - evening (more in evening than earlier)
79
Colic - what (5)
- paroxysmal abdominal pain or cramping manifested by loud crying and drawing up legs to abdomen
- many theories of etiology
- if no diagnosable cause, care is supportive
- medications may be recommended
- thorough, detailed history of usual daily events is essential
80
Signs of teething (8)
- drooling,
- increased finger-sucking,
- biting on hard objects
- irritability
- difficulty sleeping
- refusal to eat
- mild temperature increase (NOT fever)
- ear rubbing
81
Treatment of teething
- cold teething rings
- topical anaesthetics
- analgesics (acetaminophen, ibuprofen)
82
Diaper dermatitis (5)
- most common cause of contact dermatitis
- reaction to diaper deposits and friction
- increases pH of skin opening door to irritants and microbes
- Ammonia in urine isn't nice on its own
- also can be a fungal infection as a side effect of taking antibiotics
83
Presentation of diaper dermatitis
- raw, moist, weeping macules and papules of the skin in direct contact with the diaper
- usually perineum, genitals, buttocks are affected, skin folds are spared
- severe cases; infant develops a rash that is fiery red, raised, confluent. Pustules with tenderness can also be present
84
treatment of diaper dermatitis
- zinc oxide cream....don't wipe off completely after each use, dab each
- mineral oil on cloth
- expose to air
85
Injury prevention in infancy - falls (4)
- do not leave infant unsecured in infant seat, even as newborn
- do not place baby on high surfaces such as tables, hood of car, beds, unless holding child
- keep doors to stairways closed/gates (crawling)
- standing walkers are not recommended
86
Injury prevention in infancy - burns (4)
- check temp of bath water and foods/beverages
- do not hold infant while drinking hot beverages
- cover electrical outlets
- supervise infants so that play with electrical cords cannot occur
87
Injury prevention in infancy - motor vehicle crashes (3)
- use only approved restraint systems
- seat must be used for every trip even if very short
- seat must be properly buckled to cars lap belt system
88
Injury prevention in infancy - drowning (3)
- never leave infant alone in bath of even 2.5cm/1in of water
- supervise when in water even when life preserver is worn
- flotation devices (arm inflatables) are not certified life preservers
89
Injury prevention in infancy - poisoning
- keep meds out of reach of children
- teach proper dosage and admin of meds to parents
- clean products and other harmful substances should be out of reach
- have poison control centre number programmed into cell phone
90
Injury prevention in infancy - choking (2)
- avoid foods that commonly cause choking
- keep small toys and all items with small parts away from infants, esp toys with not under 3 lables
91
Injury prevention in infancy - suffocation (4)
- position infant on back for sleep
- do not place pillows, stuffed toys, or other objects near head
- do not use plastic in crib
- avoid latex balloons
92
Injury prevention in infancy - strangulation (3)
- be sure cribs have slats spaced 6cm or less apart
- mattress must fit tightly against crib rails
- curtains, blind cords, etc
93
Failure to thrive - what (3)
- based on growth parameters
- wight for length is most accurate indicator
- AKA growth faltering or pediatric undernutrition
94
Failure to thrive - growth parameters (3)
- drop more than 2 percentiles from baseline
- persistently below the 3rd to 5th percentile
- are <80% of median weight for height
95
Causes of failure to thrive (4)
- inadequate caloric intake
- inadequate absorption
- increased metabolism
- defective utilization
96
Causes of failure to thrive - caloric intake
- incorrect formula prep, neglect, food fads, excessive juice consumption, poverty
97
Causes of failure to thrive - inadequate absorption
- CF, celiac disease, vitamin or mineral defficiencies
98
Causes of failure to thrive - increased metabolism
- hyperthyroidism, congenital heart defects, immunodeficiency
99
Causes of failure to thrive - defective utilization
- trisomy 21 or 18, congenital infection, metabolic storage diseases
100
Failure to thrive - health promotion (4)
- providing positive feeding environment
- teaching successful feeding strategies
- supporting child and family
- early recognition, diagnosis, intervention is critical
101
Toddler health promotion - toddler appetite slump (4)
- lower growth rate = lower needs
- advise parents to offer small amounts of high nutrition foods
- advise parents to avoid "food fights" and give toddlers independence in feeding as much as possible
- advise parents to look at week's intake and not just the day's intake
102
Toddler health promotion - iron deficient anemia (2)
- advise parents to avoid excessive milk and juice
- bottle mouth syndrome or early childhood cavities (taking milk to bed)
103
0-3 - oral health promotion
- if at risk for tooth decay, brush teeth by adult with fluoridated toothpaste
- if not at risk, brush with water only
104
0-3 - oral health promotion - risks (6)
- non fluoridated water
- visible defect (white chalky area on teeth)
- regularly consumes sugar between meals
- special needs that make cooperation with toothbrushing a challenge
- brushing <1x/day
- premature, with BW <1500g
- parent has tooth decay
- visible plaque
105
Toilet training - physical readiness (5)
- voluntary control of sphincters (18-24 months)
- ability to stay dry for 2 hours
- regular bowel movements
- gross motor skills of sitting walking squatting
- fine motor skills to be able to remove clothes
106
Toilet training - mental readiness (3)
- recognizes need to defecate or void
- verbal or nonverbal communication skills to indicate when wet or needs to void or defecate
- cognitive skills to imitate behaviour and to follow directions
107
Toilet training - psychological readiness (3)
- wants to please parents
- able to sit 5-8 minutes without fussing
- curious about adults - wants wet or soiled diapers changed
108
Toilet training - parental readiness
- recognizes child's level of readiness
- low stress time, willing to give the time
109
Injury prevention in Toddlerhood - falls (2)
- supervise toddler closely
- provide safe climbing toys
- begin to teach acceptable places for climbing
110
Injury prevention in Toddlerhood - poisoning (3)
- keep meds and poisonous materials locked away
- use child-resistant containers and cupboards closed
- post poison control centre number by every phone
111
Injury prevention in Toddlerhood - burns (3)
- keep pot handles turned inward on stove
- do not burn fires without close supervision
- use a fire screen
112
Injury prevention in Toddlerhood - motor vehicle crashes (3)
- insist on care safety seat use for all trips
- use approved safety seat only
- keep child in rear-facing seat until 2 years of age or until achieving the highest weight/height recommendation
113
Injury prevention in Toddlerhood - drowning (5)
- supervise any child near water
- swimming classes do not protect a toddler from drowning
- use child-resistant pool and spa covers
- use approved child life jackets near water and on boats
- empty buckets when not in use
114
Pre-schooler age health promotion - aggression (4)
- influenced by bio, sociocultural, familial factors
- frustration
- modeling
- reinforcement
115
Pre-schooler age health promotion - fears (2)
- greatest number and variety of real and imagined fears present (dark, being alone, animals)
- exact cause unknown
116
Pre-schooler age health promotion - sleep
- trouble going to sleep, bedtime fears, wake during night, nightmares
- may prolong bedtime through elaborate rituals
- different interventions
117
Injury prevention in preschool years - motor vehicle crashes (3)
- verify that child is belted properly in car before starting it
- car seats and booster seats should be placed in back seat
- child restraint systems must be used until child is 57 inches tall (8-12 years) and can `safely use regular car safety belts
118
Injury prevention in preschool years - motor vehicle and pedestrian accidents (3)
- teach child to never go into the road
- safe, preferably enclosed, play yard
- child should be supervised at all times
119
Injury prevention in preschool years - drowning
- teach child to never go into water without an adult
- provide supervision whenever child is near water
120
Injury prevention in preschool years - burns (5)
- instruct child in dangers of matches, lighters
- teach child to stop, drop, adn roll if clothes are on fire
- practice escapes form home
- visit to fire station can reinforce learning
- teach child to call 911
121
Injury prevention in preschool years - needlesticks in hospital (2)
- keep needles out of reach
- remove them from unit immediately after use
122
Injury prevention in preschool years - electrical injury (4)
- avoid use of electrical cords if possible
- keep equipment out of major traffic areas
- cover any electrical outlets not being used for equipment
- monitor child closely
123
Children are NOT small adults (8)
- body surface area large for weight = infants are susceptible to hypothermia
- shorten and narrow trachea = more susceptible to foreign body obstruction
- until late school age cardiac output is rate dependent not stroke volume dependent making HR more rapid
- until 12-18 months of age kidneys do not concentrate urine effectively --> not optimal control over electrolytes
- higher metabolic rates (higher O2 needs, higher caloric needs)
- up to 4-5 diaphragm is primary breathing muscle (CO2 not effectively expired when child is distressed)
- up till 10 years there is faster RR (fewer, smaller alveoli, less lung volume)
- until puberty bones are soft and more easily bent (increase incidence of fractures)
124
Ossification
- bone formation
- not fully complete at birth
- 1) fibrous membrane still exists between cranial bones (fontanelles grow 2-16)
- secondary ossification
- long bones grow at epiphyses, cartilage cell are replaced by osteoblasts
125
children vs gravity
- long bones are porous and less structurally sound
- bones can bend, buckle, break
- spine of fetus has convex curves (learn to hold head - cervical concave, learn to stand - lumbar concave
126
Muscles/tendons/ligaments
- almost completely formed at bir
127
Muscles/tendons/ligaments
- almost completely formed at birth
- muscles lengthen and get increase in diameters as you age
- max diameter is reached at 10 yrs (girl) 14 years (boy)
- until puberty, ligaments and tendons are stronger than bones
128
Age appropriate pain scales
- NIPS
- FLACC
129
NIPS (3)
- neonatal infant pain scale
- greater than 3 indicates pain
- pain meds is not the only answer
130
FLACC (4)
- Face/Legs/Activity/Cry/Consolability
- ages 1-7
- can be used for older non-verbal patients
- body language scale
131
NIPS - how you evaluate (5)
rate 0-2
- facial expression - relaxed vs - cry - quiet vs whimper vs vigorous
- breathing - usual vs change
- arms - relaxed vs flexed/extended
- legs - relaxed vs flexed/extended
132
FLACC - how you evaluate (5)
rate 0-2
- Face - non vs occasional grimace vs constant clenched
- Legs - normal vs restless vs kicking
- activity - quiet vs squirming vs arched rigid jerking
- cry - none vs moans/whimpers vs crying screams sobs
- consolability - content vs measured by touch hug vs difficult to console or comfort
133
Flacc pain scale - awake (3)
- observe for 2-5 mins
- observe legs and body uncovered
- reposition patient or observe activity, assess body for tenseness and tone
134
Flacc pain scale - asleep (4)
- observe for 5 mins or longer
- observe body and legs uncovered
- if possible reposition the patient
- touch body and assess for tenseness and tone
135
FLACC - behavioural score - 0-10
0 = relaxed, comfortable
1-3 = mild discomfort
4-6 = moderate
7-10 = severe
136
Medication calculation (2)
- weight base medication
- drug metabolism is slower in infants
137
why is drug metabolism slower in infants (2)
- maturation of pathways
- total percentage of water in the body is much higher compared to older children and adults
138
Daily fluid calculation
- higher metabolic rate higher oxygen needs higher caloric needs
- until 12-18 months kidneys do not concentrate urine effectively and do not exert optimal control over electrolyte secretion adn absorption
139
Fluid components - pediatrics
- dextrose in maintenance fluids (higher O2 caloric needs)
- D10 in neonates
- D5NS up to adult sized teens
- prophylactic potassium (20KCl) in NPO patients under 12-18 months (prevent hypokalemia)`
140
Daily fluid calculation rule -
4/2/1
:
4mL/kg/hr for first 10kg
2mL/kg/hr for next 10 kg
1mL/kg/hr for each kg after 20
141
Daily fluid calculation - fluid restricted
ex 75% maintenance
calculate 100%, multiply it by 0.75
142
daily fluid calculation - fluid over-hydration
ex 150% maintenance
calculate 100% MIVF x 1.5
143
Vitals; HR, RR, BP, MAP (0-28 days)
HR = 104-162
RR = 21-60
BP = 60-80/30-53
MAP = 40 or higher
144
Vitals; HR, RR, BP, MAP (1-3 months)
HR = 104-162
RR = 31-60
BP = 73-105/36-68
MAP = 48 or higher
145
Vitals; HR, RR, BP, MAP (4-11 months)
HR = 109-159
RR = 29-53
BP = 82-105/46-68
MAP = 58-80
146
Vitals; HR, RR, BP, MAP (1-3 years)
HR = 89-139
RR = 25-39
BP = 85-109/37-67
MAP = 53-81
147
Vitals; HR, RR, BP, MAP (4-6 years)
HR = 71-128
RR = 17-31
BP = 91-114/50-74
MAP = 63-879
148
Purpose of the PEW system (3)
- identify pediatric patients who are at risk of deterioration
- mitigate risk (through clinical and procedural response)
- escalate to a higher level of care if mitigation is unsuccessful
149
4 steps of PEW
1) PEWS score
2) situational awareness bundle
3) escalation aid
4) SBAR (communication framework)
150
1 - PEWS score
- range between 0 and 13
- higher PEWS score is higher risk of clinical deterioration
- 6 flow sheets depending on age (0-3mo, 4-11mo, 1-3 years, 4-6 years, 7-11 years, 12+ year
151
How to calculate PEWS`
- vital signs
- behaviour (0-3, playing, sleeping, irritable, lethargic/confused)
- respiratory (normal, 10 above, 20 above, 5 below, more or less O2)
- cardiovascular
- take highest score
152
situational awareness - factors that contribute to risk of pediatric clinical deterioration
- caregiver concern
- unusual therapy
- watcher patient (pt that has already crashed, funny feeling, high risk post op etc)/
- PEWS score above 2
- communication breakdown
153
Escalation aid
- if 2, review with other HCP
- if 4, alert charge nurse, etc.
- if 5-13, MRP (most responsive physician) to review
- esp for healthy children
