Child Health Growth & Development Crecimiento y desarrollo de la salud infantil.

Sits with out help. 6 - 9 months.

6-9 months

pincer grasp

8-10 months

grasping reflex

A neonatal reflex that occurs when something touches the infant's palms. The infant responds by grasping tightly.

The student nurse is reviewing the medical record of a 4-year-old diagnosed with *failure to thrive (FTT)*.

(La enfermera estudiantil está revisando el registro médico de un niño de 4 años diagnosticado con retraso en el desarrollo (FTT).)

Fetal alcohol syndrome (FAS) is a leading cause of intellectual disability and developmental delay in the United States. Diagnosis includes history of prenatal exposure to any amount of alcohol, growth deficiency, neurological symptoms (eg, microcephaly), or specific facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures). Asking about alcohol use during pregnancy can identify newborns and infants who are at risk for FAS. Family support, early intervention, and prevention for subsequent pregnancies are important for families with an infant with this diagnosis.

(Option 1) Advanced maternal age has been associated with a higher incidence of trisomy 21 (Down syndrome). Characteristic features include a single palmar crease and a short neck with excess skin (nuchal fold).

Certain behaviors are common in the adolescent period, ages 11 (early adolescence) to 20 (late adolescence). Teenagers engage in risk-taking behaviors and want to be just like their peers. Adolescents with chronic disease may have difficulty managing their illness due to a false sense of security and the belief that nothing bad can happen to them.

(Option 1) Although the client may not be managing the disease well currently, there is nothing to indicate that the child is suicidal. (Option 3) It is unrealistic to expect the parents of an adolescent with DM to monitor the child's diet. Teenagers have developed their own code of behavior and need independence. (Option 4) An adolescent is fully able to understand disease management, including risks of noncompliance, but may choose to ignore the issue out of a desire to be like peers.

Things that most children can do by a certain age are considered developmental milestones. These include the following areas of development: social/emotional, language/communication, cognitive, and physical. Each child develops in a unique pattern, and ages are considered as general guidelines for assessing development. Normally, a toddler develops the ability to use a spoon by 18 months. Therefore, a 3-year-old should be able to eat with a spoon.

(Option 1) Catching a ball 50% of the time is a developmental expectation for a 4-year-old. (Option 2) A 4-year-old can copy or draw a square with a pencil or crayon. Copying shapes other than a circle is a developmental expectation for a 5-year-old. (Option 4) Hopping on one foot is a developmental expectation for a 4-year-old.

Clients with influenza are maintained on droplet precautions, and anyone entering the room must wear a facemask. Medical play during the preschool period (age 3-6 years) facilitates psychosocial integrity. Crayons are age-appropriate toys. Drawing noses on facemasks will help the child feel more comfortable with procedures and provides a developmentally appropriate diversion.

(Option 1) Puzzles would be more appropriate for the school-age child (6-12 years). (Option 2) Stacking blocks would be more appropriate for the toddler (age 1-3 years). (Option 4) Maintaining contact with peers would be more appropriate for the adolescent (age 12-19 years).

(Option 1) Formula should never be sweetened. Honey (especially raw or wild) should not be offered to children age <12 months because their immature gut systems are susceptible to Clostridium botulinum (botulism) infection.

(Option 2) Common allergenic foods (eg, eggs, fish, peanut products) may be introduced along with other foods starting at age 4-6 months.

Separation anxiety is common during infancy and toddlerhood. Allowing the child to be with the primary caregiver when appropriate will decrease the stress caused by separation.

(Option 2) It is not recommended that caregivers restrain a child for a procedure. Medical personnel are most appropriate for this duty. The caregiver can be a source of comfort after the procedure is complete.

(Option 1) This is an appropriate action; swimming pools should be surrounded by fences with childproof locks to prevent accidental drowning. Wading pools and all water containers should be emptied after each use.

(Option 2) This is an appropriate action; childproof gates should be installed on stairs and at the entrances to rooms that could pose danger to a child.

(Option 2) School-age children may imagine how life would be different if they were with their biological parents. Self-esteem issues begin to develop around this time with the possible sense of loss of the biological family. School-age children may be sensitive to physical differences between themselves and their adoptive family.

(Option 3) Children age 3 and under are unable to understand differences between adoptive and biological parents. The age at which to begin discussions about being adopted is debatable, but use of positive language is always encouraged. The terms "given up" or "put up" for adoption or someone's "real" parents are inappropriate and should be avoided.

(Option 1) Strict scheduling by the nurse reduces the adolescent's perception of control and independence, which may increase stress. Adolescents should be allowed to determine their daily schedule when possible.

(Option 3) Loss of privacy (eg, forced parental presence) can increase anxiety in the adolescent client. Adolescents should be asked if they want parents present for procedures and what level of parental involvement they prefer.

The vast majority of children diagnosed with ASD lack the acquisition of communication skills during the first 2 years of life. A healthy 2-year-old should have a vocabulary of about 300 words and should be able to string 2 or more words together in a meaningful phrase. Assessing this child's language abilities would be the priority.

(Option 4) Although not the priority assessment, it would be important to ask the parent about the child's play activities. Children with ASD often have a restricted interest in and preoccupation with a single toy, exhibit repetitive behaviors when playing with the toy, and insist on the same play routine.

(Option 3) A 10-month-old is not at an appropriate age to make this decision. The assessment should be completed in a quiet environment with the caregiver present to promote calmness. Health history should be obtained in a private area to avoid violations of the Health Insurance Portability and Accountability Act.

(Option 4) It is appropriate for the caregiver to remain with the child during the physical assessment as a source of comfort.

(Option 2) Children typically begin to use well-formed syllables such as "mama" and "dada" by approximately age 7 months. A referral for a hearing test should be made if there is an absence of well-formed syllables by age 11 months or intelligible speech is not present by 24 months.

(Option 4) Lack of attentiveness and appropriate response when given a direction is characteristic of a toddler who has a hearing impairment.

(Option 1) Gastrointestinal bleeding is a concern for clients with iron poisoning but has no link to lead toxicity.

(Option 4) Lead poisoning is most threatening to the kidneys and neurological system; liver injury typically does not occur. Severe liver damage is closely associated with acetaminophen overdose or Reye syndrome.

(Option 2) Cigarette smoking is linked to perinatal loss, sudden infant death syndrome, low birth weight, and prematurity. Specific facial characteristics or syndromes are not typically caused by tobacco exposure in utero.

(Option 4) Valproate (Depakote), a medication used to control seizures, is an FDA pregnancy category D drug that can cause neural tube defects such as spina bifida, but not the distinct facial features of FAS.

At birth fontanelles

(Options 1 and 2) At birth, the infant has non-ossified membranes called *fontanelles*; these "soft spots" lie between the bones of the cranium. The 2 most noticeable are the anterior and posterior fontanelles, which are soft and non-fused. Fontanelles should be flat, but slight pulsations noted in the anterior fontanelle are normal as is temporary bulging when the infant cries, coughs, or is lying down. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months.

A distraught parent informs the nurse of bleeding in a 1-day-old girl. What is an appropriate response by the nurse after assessing a small amount of bloody mucus in the newborn's diaper?

(Un padre angustiado le informa a la enfermera de la hemorragia en una niña de 1 día. ¿Cuál es la respuesta apropiada de la enfermera después de evaluar una pequeña cantidad de moco con sangre en el pañal del recién nacido?)

(Prevent heat loss) *Conduction*

(contactos con objetos frios, manos frias, estetoscopia, en la pesa)

excess caloric expenditure

(excesos de gasto calorico)

startlet reflex

(igual que el moro, pero lo desencadena un ruido, un aplausao, un grito y llora)

shy, timid, or *withdrawn*, often avoiding social interaction

(retraido)

squad baby

(sentarse, agacharse, cuclillas)

(Prevent heat loss) *Radiation*

(tenerlos lejos de lugar frio,)

A distraught parent informs the nurse of bleeding in a 1-day-old girl. What is an appropriate response by the nurse after assessing a small amount of bloody mucus in the newborn's diaper?

1. "Laboratory work will need to be completed to determine your newborn's hormone levels." 2. "The health care provider will prescribe a dose of medication to stop the bleeding." 3. "We will continue to monitor the amount, color, and consistency of the drainage." 4. "What visitors have been present since the baby was born?"

(Prevent heat loss) *eva*poration

1. DRywell/wrap - (el babeo lo moja se humedece) - (los dyper si se orina mucho, s emoja se enfria)

FETAL ALCOHOL SYNDROME

1. anormal palm crease. 2.Jiftering. 3. Hypoglicemia. 4. Risk seizure. 5. Irritability 6. Easy startle.(asustarse) 7. Mental retardation

Hearing impairment in children

1. family history, 2. an infection, 3. use of certain medications, 4. or a congenital disorder.

Toddlers with hearing deficits:

1. shy, timid, 2. or withdrawn, 3. avoiding social interaction

MENTAL RETARDATION SCRENING

1. PKU. 2. FENILCETONURIA. 3. GALACTOSEMIA. 4. HIPOTIROIDISMO

failure to thrive (FTT). Socioeconomic risk factors include:

1. Poverty - most common. 2. Social or emotional isolation - parents may lack the support system needed to assist them with the problems of child rearing. 3. Cognitive disability or mental health disorder. 4. Lack of nutritional education - parents may not have knowledge of proper feeding techniques or appropriate calorie intake based on age and size of the child.

FETAL ALCOHOL SYNDROME NURSE INTERVENTION

1. SEIZURE PRECAUTION. 2. MONITOR HYPOGLICEMIA. 3. QUIET ENVIROMENT. 4. RESUCITATION EQUIPMENT AT BED SIDE.

crib slat (listón de la cuna)

2 3/8 inches

Sits with support. 4 - 5 months.

4-6 months

Tonic neck reflex (fencer position)

BIRTH TO 3 or 4 MONTHS. Turn newborn head turned to the right: Right arm/leg EXTEND Left arm/leg flex. Turn newborn head to the left: Left arm/leg EXTEND Right arm/leg flex.

autism spectrum disorder (ASD).

ASD is a complex neurodevelopmental disorder characterized by the onset of abnormal functioning before age 3. The 2 core symptoms of ASD are abnormalities in social interactions and communication (verbal and nonverbal), and patterns of behavior, interests, or activities that can be restricted and repetitive. Social skills, especially communication, are delayed more significantly than other developmental functioning and are the focus during client assessment.

MENTAL RETARDATION IN COMMUNITY?

AVOID ALCOHOL IN PREGNANCY

Key interventions include:

Adhering to the infant's home routine (eg, meal and sleep times) as closely as possible (Option 1). Providing a favorite toy or pacifier (Option 2). Encouraging caregivers to remain whenever possible during hospitalization. Providing a quiet sleep environment with reduced stimulation to promote restful sleep (Option 4). Offering a familiar object (eg, caregiver's shirt, blanket, voice recording) during stressful situations (Option 5).

The purposes of the first visit include:

Assessing risk for dental disease. Providing dental care and treatment of dental caries. Providing anticipatory guidance about dental hygiene, fluoride, diet and dietary habits, and non-nutritive sucking. Establishing care with a licensed dentist and scheduling future visits.

(Prevent heat loss) *Convection*

Away open door, Away from draft.

Risk factors for FTT include:

Disordered feeding techniques. Prolonged breast or bottle feeding. Unstructured meal times. Negative or difficult interactions at meal time. Poor parental feeding skills. Negative attitudes toward food - fear of obesity or an overweight child.

Lead poisoning still occurs in the United States, although not as often as in previous decades. A common source of exposure is lead-based paints found in houses built before 1978, when such paint was banned. Blood lead level (BLL) screenings are recommended at ages 1 and 2, and up to age 6 if not previously tested.

Because lead poisoning particularly affects the neurological system, elevated BLLs (≥5 mcg/dL [0.24 µmol/L]) are dangerous in young children due to immature development of the brain and nervous system. A mild to moderate increase in BLL can manifest with hyperactivity and impulsiveness; prolonged low-level exposure can cause developmental delays, reading difficulties, and visual-motor issues. Extremely elevated BLLs can lead to permanent cognitive impairment, seizures, blindness, or even death.

Hiccups

Chlorpromezine

types of play. preschool period (age 3-6 years)

Crayons . Drawing noses on facemasks

Pediatric clients are at increased risk for impaired psychosocial integrity during stressful experiences (eg, hospitalization, surgical procedures, medical treatment) and require developmentally appropriate care based on their age to assist with managing stress. Unaddressed or ineffectively managed developmental needs may lead to or worsen the client's anxiety, disobedient behavior, and/or social withdrawal.

Developmentally appropriate nursing care for an adolescent client includes: Encouraging interaction with peers (eg, hospital visits, internet communication), which supports the developmental need for social connection and support and reduces stress and anxiety (Option 2). Involving the client in care planning to address the developmental needs for control and independence (Option 4). Assisting the client to discuss emotions or fears related to treatment (eg, changes in body image, disability, possibility of death) to improve coping, support the developmental need for understanding, and decrease anxiety (Option 5).

*infant cries* "all the time," (llanto del niño bebe patrones indicaciones)

During the first 3-4 months of life, it is not unusual for an infant to cry 1-3 hours a day in response to being hungry, thirsty, tired, in pain, bored, or lonely.

(Option 1) This applies to a child age 3-5. (Option 2) By age 10-12, a child will be aware that death affects everyone. (Option 3) An adolescent has the cognitive ability to think about the spiritual and religious aspects of death.

Educational objective: A child age 3-5 believes death is reversible. A child age 6-9 understands that death is permanent but has difficulty in perceiving one's own death. By age 10-12, a child will be aware that death affects everyone.

Preschool children (age 3-6) are magical thinkers. Night fears are common during this period, and distinguishing between reality and fantasy is difficult. It is appropriate for parents to acknowledge their child's fears. A preschooler would be comforted and fears would be allayed if the parents looked under the bed and reassured the child that no tigers were there (Option 3).

Educational objective: Magical thinking is common during the preschool period. It is not unusual for a child to have an imaginary friend, and parents should be taught that this is a normal part of development. Magical thinking satisfies children's questions about the world they live in.

Mammary gland enlargement, non-purulent vaginal discharge (leukorrhea), and mild uterine withdrawal bleeding (pseudomenstruation) are benign transient findings commonly seen in newborns; these are physiologic responses to transplacental maternal estrogen exposure. Reassurance should be provided. Monitoring the amount, color, and consistency is the appropriate action (Option 3).

Educational objective: Mammary gland enlargement, non-purulent vaginal discharge (leukorrhea), and mild uterine withdrawal bleeding (pseudomenstruation) are benign transient findings commonly seen in newborns; they are physiologic responses to transplacental maternal estrogen exposure. Reassurance should be provided.

(Option 3) This is an appropriate action; as children grow taller and can stand, they may be able to crawl over the crib rails and fall.

Educational objective: Mobile baby walkers are associated with injuries such as falls and drowning as they can easily tip over. Children can also reach higher places while in a baby walker, enabling them to pull hot objects and dangerous substances off counters and tables

(Option 4) Adolescents have abstract thinking abilities that enable introspection about their adoption. They typically do not like differing from their peers. Open and honest communication is important at this age.

Educational objective: Preschool-age children (3-6 years) are in Piaget's preoperational stage of cognitive development. They become increasingly verbal but are unable to understand cause and effect, often ascribing inappropriate causes to phenomena; therefore, the adopted child may feel responsible for being adopted.

(Option 2) Most children have all of their primary teeth by age 2 or 3. Dental care is needed at a much earlier age.

Educational objective: Regular visits to the dentist, starting within 6 months of first tooth eruption or by the first birthday, are recommended by pediatric professional organizations. Early assessment, dental care, anticipatory guidance, and education about periodontal disease prevention facilitate good oral health for children.

(Option 3) Infants should be transitioned to whole milk, not low-fat milk, at age 12 months. Due to rapid growth, a child's brain requires the nutrition from the fat found in whole milk

Educational objective: The pincer grasp should be present by age 10 months. Offering small finger foods allows the infant to develop fine motor skills. The child will also enjoy the ability to self-feed and explore a variety of nutritious foods.

*Parallel play* is characteristic of the toddler years but is not limited to this age group. Parallel activities occur when children play independently near one another with no group organization or common goals (Option 4). Although they may share toys, each child remains primarily focused on their own activity rather than directly interacting with the others.

Educational objective: Toddlers typically exhibit parallel play, during which they participate in various activities alongside one another but remain primarily independent. Parallel play is without group organization or common goals.

Children age 3-6 (preschool) are in Piaget's preoperational stage of cognitive development. At age 5, children are not able to fully understand cause and effect and will therefore ascribe inappropriate causes to phenomena (eg, scraped knee was caused by earlier misbehavior).

Five-year-olds are developmentally capable of understanding adoption on a basic level; however, it may be difficult for them to understand the concept of having another family. The child might notice that friends are not adopted. Preschool-age children may also believe they are responsible for being adopted and may develop separation issues and fear abandonment.

DEVELOPMENTAL MILESTONE OF TODDLERS

HITO DEL DESARROLLO DE LOS NIÑOS

Moro reflex

Infant reflex where a baby will startle in response to a loud sound or sudden movement.

the Health Insurance Portability and Accountability Act.

La Ley de Portabilidad y Responsabilidad de Seguros de Salud.

toddlerhood

niño pequeño

The nurse is admitting an infant who has severe growth deficiency and facial characteristics of indistinct *philtrum*, a thin upper lip, and short palpebral fissures. Which question should the nurse ask to assess the cause of these clinical findings?

La enfermera está admitiendo a un bebé que tiene una deficiencia grave de crecimiento y características faciales de *filo* indistinto, un labio superior delgado y fisuras palpebrales cortas. ¿Qué pregunta debe hacer la enfermera para evaluar la causa de estos hallazgos clínicos?

Children´s believes about death. Age 3 -5.

Magical thinking, fantasy. They think that the death is reversible.

types of play. adolescent (age 12-19 years).

Maintaining contact with *peers*

Children´s believes about death. Birth to age 2.

No understanding death.

Toddlers (age 1-3) display an egocentric approach as they strive for autonomy. They attempt to control their experiences through intense emotional displays, such as temper tantrums or forceful negative responses (eg, "no!"). Hospitalization results in loss of a toddler's usual routines and rituals, often resulting in regressive behavior. The toddler may also be frequently separated from the parents, leading to separation anxiety.

Nursing care activities should be similar to home routines, such as providing preferred snacks and anticipating nap time. The toddler should be given options rather than asked yes/no questions to limit the potential negative responses. It is also important to encourage participation and presence of the parents whenever possible.

Coating criterion (CRiterio de entubar)

O2 < 50% / CO2 > 50%

Appropriate nonpharmacological pain management interventions for infants include:

Offering concentrated sucrose, if prescribed, which is associated with reduced indicators of pain in infants (eg, presence and duration of crying, grimacing) (Option 1). Assisting the parent to hold the infant skin-to-skin ("kangaroo care"), which provides sensory stimulation that calms the infant and reduces indicators of pain (Option 3). Offering nonnutritive sucking interventions (eg, pacifiers), which help to calm the infant during painful procedures (Option 4). Swaddling the infant, which provides a sense of comfort and security and reduces crying and heart rate (Option 5).

*failure to thrive*

no prosperar

baby toys test

Paper toilet test. (los juguetes tienen que ser mayor que el hueco del toilet)

types of play. school-age child (6-12 years).

Puzzles

Accidents associated with child walkers include:

Rolling down stairs (the most common cause of injury). Burns - children can reach high in a walker, enabling them to grab hot pot handles, reach heaters and fireplaces, or grab a hot cup of liquid off a counter or table. Drowning - a child can fall into a bathtub or pool while in a mobile walker. Poisoning - the child can reach higher objects.

Even if a parent is close by and watching a child in a walker, an accident may not be preventable. Children can move quickly and the parent or caregiver may not be able to respond quickly enough.

Safer alternatives to mobile baby walkers include stationary walkers (no wheels) and play areas. If parents or caregivers insist on using a baby walker, they should be advised to choose one that meets the American Society for Testing and Materials safety standards. Walkers with braking mechanisms stop if at least one wheel drops off the riding surface.

types of play. toddler (age 1-3 years).

Stacking blocks

Risk factors for FTT include:

Substance abuse. Domestic violence and/or parental history of child abuse. Poverty, food insecurity. Parents who have a negative perception of the child.

Toddlers with hearing deficits:

They may seem extremely inattentive when given directions and appear "dreamy." Speech is usually monotone, difficult to understand, and loud. Increased use of gestures and facial expressions is also common.

Children´s believes about death. Adolescent.

Understand on a adult level. think about spiritual & religiuous death

Children´s believes about death. ages 6 - 9.

Understand. and concerd about the medical or physical aspects.

Children´s believes about death. ages 10 - 12.

Understand. and woory about you own death.

*infant cries* The nurse needs to determine:

What "all the time" means. When the "all the time" crying started. What makes the crying worse and what makes it better. The quality of the crying (tone, pitch, loudness) Length and quality of periods of silence.

Risk factors for FTT include:

Young parent age. Unplanned or unwanted pregnancy. Lower levels of parental education. Single-parent home. Social isolation. Chronic life stresses/anxiety in the home.

*Cold Stress*

any environmental condition causing loss of body heat

*infant cries* nurse interventions

assess the infant's pattern

aide

ayudante

Toilet training readiness

control of the anal and urethral sphincters occurring at age 18-24 months. Bowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years.

2 core symptoms of autism

disorder are abnormalities in social interactions and communication (verbal and nonverbal), and patterns of behavior, interests, or activities that can be restricted and repetitive. Social skills, especially communication, are delayed more significantly than other developmental functioning.

milestones

hitos

Physiologic risk factors for failure to thrive (FTT)

include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate.

(Option 3) The presence of parents or the primary caregiver during hospitalization reduces separation anxiety and decreases the infant's stress response. Therefore, caregivers should remain whenever possible throughout all the client's care (eg, procedures, medication administration, scans).

los cuidadores deben permanecer siempre que sea posible durante toda la atención del cliente (por ejemplo, procedimientos, administración de medicamentos, exploraciones).

feels responsible for being placed for adoption

se siente responsable de ser colocado en adopción.

Burn

set. water heater less than 120 farenheit

forefingers

the two fingers next to the thumbs; index fingers

philtrum

the vertical groove between the base of the nose and the border of the upper lip.