Exam #3- Pediatrics

Key dietary recommendations specific to children and adolescents

- Exclusively breastfeeding infants for a minimum of 4 months and preferably 6 month; avoid introducing solid foods until 4-6 months of age - Consume whole-grain products often; at least half the grains should be whole grains - Children 1-8 years should consume 2 cups per day of milk; use fat-free or low-fat milk or equivalent milk products for children older than 2 years - Children 9 years of age and older should consume 3 cups per day of fat-free or low-fat milk or equivalent milk products - Limit juice, but provide several services of fruits and vegetables each day. Use 100% fruit juice and not juice drinks, which contain added sugar - Total daily fat intake should not exceed 30%-35% of calories for children 2-3 years of age and 25%-35% of calories for children and adolescents 4-18 years of age. Polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oil, should tbe the primary source of fats - Elementary school age children can be taught to read food labels

2-week-old to 1-month-old Infant: Focused Assessment

- How have you been feeling? Have you made your postpartum checkup appointment? - How have you and your partner been adjusting to the baby? Do you have other children? How are they adjusting? - Have you discussed child-rearing philosophies? - Does anyone in your household smoke? - Does anyone in your household use substances? - Have you recently been exposed to or had any sexually transmitted disease? - Have you experienced any periods of sadness or feeling "down"? - Do you have any concerns about the costs of the baby's care? - Do you feel that you and the baby are safe?

Readiness for introduction of solids

- Infant can sit - Birth weight has doubled and infant weighs at least 13 lbs. - Infant can reach for an object and maintain balance. - Infant indicates a desire for food by opening mouth and leaning forward. - Extrusion reflex has disappeared (4-5 months). - Infant moves food to back of mouth and swallows during spoon feedings.

Continuing Assessment Questions

- Nutrition- How much is your child eating, how often, what kinds of foods? -Elimination- How many wet diapers, stools? Consistency of stools? - Safety- Use of car restraints? Gun violence? Smoking in the home? - Hearing/Vision- Any concerns? -Can you tell me about the times you would feel it necessary to call your doctor? - How is the family adjusting to the baby? - Are you getting enough time alone and together? - Has there been any change in the household or family's lifestyle? - Are there any financial concerns? - Are there any other questions or concerns?

Barriers to Immunization

-Complexity of the health care system, which may lead to a delay in vaccinating children when parents become confused or frustrated with the health care system; special barriers include the following --Appointment-only clinics --Excessively long waiting periods --Inconvenient scheduling --Inaccessible clinic sites --The need for formal referral from primary health care provider --Language and cultural barriers -Expense of immunization services -Parental misconceptions about disease severity, vaccine efficiency and safety, complications, and contraindications -Inaccurate record keeping by parents and health care workers -Reluctance of the health care worker to give more than two vaccines during the same visit -Lack of public awareness of the need for immunizations

Nursing Responsibility in Administering vaccines

-Know the recommended immunization schedule and the recommended alternative schedule for those with lapsed immunizations or unknown immunization history -Acquire up-to-date information because recommendations are revised frequently - Assess the family's beliefs and values to assist in the education of the family as to the rationale for immunizations, the risk and side effects, and the risks of nonimmunization - Take a careful history to determine possible contraindications or precautions and report any pertinent information to the practitioner. Educate the family as to the rationale for any contraindicaitons - Some vaccines are combination vaccines (e.g.- Pediarix- diphtheria, tetanus, pertussis, hepatitis B, and Polio). Other vaccines should not be mixed. Check manufacturer's recommendation - Administer vaccines accorded to the manufacturer's recommended sites - Use hand hygiene before vaccine administration and between children - Review with the parents common side effects and the signs of potentially severe reactions that warrant contacting the practitioner - Instruct the parents that they administer age-appropriate doses of acetaminophen every 6 hours for 24 hours if the child has discomfort related to vaccine administration - For painful or red injection sites, advise the parents to apply cold compresses for the first 24 hours; then use warm or cold compresses as long as needed - Give multiple administrations in different sites and record those sites in the medical record -Document parental consent in the medical record. Documentation should also include the type of vaccine, date of administration, manufacturer and lot number, expiration date, administration site, any data pertinent to risks and side effects and the signature and title of the person administering the immunization

What nurses can do to prevent childhood injuries

-Model safety practices in the home, workplace, and community - Educate parents and children through anticipatory safety guidance to help reduce needless injuries - Support legislative efforts that advocate prevention measures - Collaborate with other health care providers to promote safety and injury prevention

2-week-old to 1-month-old Infant: Developmental Milestones

-Personal/social: Look at parent's face; fixates, tracks, follows to midline; smiles responsively; prefers brightly colored objects. - Fine motor: newborn reflexes present. Language/Cognitive: prefers human female voice; responds to sounds; begins to vocalize. Gross motor: equal movements; lifts head; lifts head and chin (by 1 month)

Crib safety

-the distance betwhanceen slats must be no more than 2 3/8 inches wide to prevent entrapment of the infant's head or body. Mesh-sided cribs should have mesh openings smaller than 1/4 inch (6 mm). -The interior of the crib must snugly accommodate a standard-size mattress so that the gap is minimal, less than the width of two adult fingers. Excessive space could allow the infant to become wedged, potentially suffocating. -Decorative enhancements on the crib are not recommended because they can break apart and be aspirated by the infant. Design cutouts can trap an infant's arm or neck, causing death or serious injury. - Corner posts or finials that rise above the end panels can snag garments and inadvertently strangle infants - The drop side must be impossible for an infant to release. Activating the drop side must take either a strong force (at least 10 lb) or a distinct action at each locking device. Never leave the drop side down when an infant is in the crib. - Wood surfaces should be free of splinters, cracks, and lead-based paint

Language development and developmental milestones in infancy

1-3 months: Reflexive smile at first, and then smile becomes more voluntary; sets up a reciprocal smiling cycle with parent. Cooing 3-4 months: Crying becomes more differentiated. Babbling is common. 4-6 months: Plays with sound, repeating sounds to self. Can identify mother's voice. May squeal in excitement. 6-8 months: Single-consonant babbling occurs. Increasing interest in sound 8-9 months: Stringing of vowels and consonants together begins. First few words begin to have meaning (mama, dada, bye-bye, baby). Begins to understand and obey simple commands such as "Wave bye-bye." 9-12 months: Vocabulary of two or three words. Gestures are used to communicate. Speech development may slow temporarily when walking begins.

The 4- and 5-year-old Child: Sleep

10-12 hour, no nap May experience night terrors or nightmares

The 2-year-Old Child: Sleep

12-14 hr/day Usually a long afternoon nap Limit television viewing to no more than 1 hr daily

The 15- to 18- month- Old Child: Immunizations

15 mo: Haemophilus influenzae type b (Hib) #4; measles-mumps-rubella (MMR) #1 (if not given at 1 year); varicella (if not given at 1 year); pneumococcal (if not given at 1 year); hepatitis B #3 (if not given earlier) 18 mo: diphtheria-tetanus-acellular pertussis (DTaP) #4; inactivated poliovirus (IPV) #3 (if not given earlier); hepatitis B #3 (if not given earlier) Influenza vaccine given annually Hepatits A #2 (6 mo after first dose)

2-week-old to 1-month-old Infant: Elimination

6 wet diapers Stools related to feeding method

A mother is concerned about giving her infant the scheduled immunizations. What information should the nurse provide to inform the mother about the risks and benefits of immunizations? (Select all that apply.) A. "If your child is feverish or sick, we will not give any immunizations at that time." B. "Since live measles vaccine is produced by using chicken eggs, there is a slight chance of hypersensitivity in children with egg allergies." C. "We use the arm muscle for the majority of vaccines in babies." D. "Before a second dose of any vaccine is given, we check if there were any side effects after the previous dose of that vaccine." E. "Immunizations are the primary and safest means of managing preventable infectious diseases." F. "Fever and local irritation are rare after administration of the DTaP vaccine."

A. "If your child is feverish or sick, we will not give any immunizations at that time." B. "Since live measles vaccine is produced by using chicken eggs, there is a slight chance of hypersensitivity in children with egg allergies." D. "Before a second dose of any vaccine is given, we check if there were any side effects after the previous dose of that vaccine." E. "Immunizations are the primary and safest means of managing preventable infectious diseases." Rationale: A. Children do not receive immunizations when they are feverish or sick. B. Live measles vaccine is produced by chick embryo cell culture, so there is a slight chance of hypersensitivity in children with egg allergies. C. The thigh muscle is used for vaccines in infants. D. Before a second dose of any vaccine is given, the nurse checks if there were any side effects after the previous dose of that vaccine. E. Immunizations are the primary and safest means of managing preventable infectious diseases. F. Fever and local irritation are common after administration of the DTaP vaccine.

A mother tells the nurse that she will visit her 2-year-old child tomorrow around noon. During the child's bath in the morning, the child asks for his Mommy. What is the best response by the nurse? A. "Mommy will be here after lunch." B. "Mommy always comes back to see you." C. "Mommy had to go home for a while, but she will be here today." D. "Your Mommy told me yesterday that she would be here today about noon."

A. "Mommy will be here after lunch." Rationale: A. Because toddlers have a limited concept of time, the nurse should translate the mother's statement about being back around noon by linking the arrival time to a familiar activity that takes place at that time such as lunch. B. "Mommy always comes back to see you" doesn't give the child any information about when his mother will visit. C. "Mommy had to go home for a while, but she will be here today." Doesn't give the child any information about when his mother will visit. D. Noon is a meaningless concept for a toddler.

An 11-month-old is beginning to finger feed himself. What foods would be appropriate for the parents to prepare in bite sizes for him to eat? (Select all that apply.) A. Cooked carrots B. Canned peaches C. Grapes D. Popcorn E. Cheese F. Pretzel sticks

A. Cooked carrots B. Canned peaches C. Grapes Rationale: A. Soft foods such as cooked carrots would be appropriate for this infant who has several teeth. B. Soft foods such as canned peaches would be appropriate for an 11-month-old. C. Grapes, when cut up in bite-sized pieces, are all right for this infant. D. Popcorn can choke an infant, even with adult supervision, and should not be given. E. Cheese is a soft food and can be eaten by this infant. F. Pretzel sticks can choke an infant because of their hardness and skinny shape.

Which best describes the 4-year-old's concept of death? A. Death is temporary. B. Death is permanent. C. Death is personified in various forms. D. Death is inevitable at some age.

A. Death is temporary. Rationale: A. Death is seen as a temporary departure. B. Death is thought of as not permanent; life and death can change places with each other. C. Personification is typical of school-age children. D. Children 9 to 10 years of age have this understanding of death.

The development of a 2-year-old child is characterized by which activity? A. Engaging in parallel play B. Dressing oneself with supervision C. Having a vocabulary of at least 500 words D. Attained one-third of one's height as an adult

A. Engaging in parallel play Rationale: A. Two-year-olds typically play alongside each other. B. A toddler still needs help with clothing at 2 years of age. C. A vocabulary of 300 words is expected at this age. D. A child typically has grown to one-half of adult height.

A 4-year-old child is having an increase in angry outbursts in preschool. The child is very aggressive toward the other children and the teachers. This behavior has been a problem for approximately 8-10 weeks. The child's parents ask the school nurse for advice. What is initial intervention by the school nurse? A. Find out if there is anything different happening at home. B. Explain that this is normal in preschoolers. C. Encourage the parents to try more consistent and firm discipline. D. Talk to the preschool teacher to obtain validation for behavior that the parent reports.

A. Find out if there is anything different happening at home. Rationale: A. Angry outbursts in preschool are not expected behavior. More assessment is needed, but the pediatrician may need referred to a competent professional to deal with the aggression. B. Angry outbursts in preschool are not normal behavior. C. More consistent and firm discipline may be recommended by the professional. D. The validation would be helpful for the referral, but talking with the parents is the priority action. Validation of the parent's report may unintentionally convey the idea that you do not value his input or his attempt to help his child.

The mother of a 3-month-old breastfed infant asks about giving her baby water because it is summer and very warm. What is the most appropriate recommendation by the nurse? A. Fluids in addition to breast milk are not needed. B. Water should be given if the infant seems to nurse longer than usual. C. Water once or twice a day will make up for losses resulting from environmental temperature. D. Clear juices would be better than water to promote adequate fluid intake.

A. Fluids in addition to breast milk are not needed. Rationale: A. The infant will nurse according to needs. Additional fluids are not necessary for the breastfed baby. B. Supplemental water should not be given, because it may cause water intoxication as well as decrease the amount the infant breastfeeds. C. Supplemental water should not be given, because it may cause water intoxication as well as decrease the amount the infant breastfeeds. D. Clear juices do not provide sufficient caloric or nutrient intake and may interfere with breastfeeding.

Primary prevention of communicable disease results from which method of infection control? A. Immunizations B. Early diagnosis C. Strict isolation D. Good hand hygiene

A. Immunizations Rationale: A. Communicable diseases are prevented through immunization, which is primary prevention. B. Early diagnosis can prevent spread by initiating treatment and isolation if necessary. C. Strict isolation prevents spread of disease. D. Good hand hygiene prevents spread of disease.

Since the preschooler's thought process is egocentric and they enjoy learning about their environment, what is the most effective approach for communication with children this age? A. Play B. Speech C. Drawing D. Actions

A. Play Rationale: A. Play is the child's way to learn to understand and adjust to situations. B. Language is too abstract to be the most effective communication tool for preschool children. C. Drawing is not developed at this age. D. Actions are not effective for communication. Interpreting actions requires a level of abstraction not yet achieved by a preschooler.

According to Piaget, at what stage of development do children typically solve problems through trial and error? A. Sensorimotor B. Preoperational C. Formal operational D. Concrete operational

A. Sensorimotor Rationale: A. During the sensorimotor stage, infants and young toddlers develop a sense of cause and effect. B. Relational problem solving is characteristic of the preoperational stage. C. In the formal operational stage, adolescents can test hypotheses. D. Children in concrete operations solve problems in a tangible, systematic fashion.

A 6-month-old's mother is asking the nurse during an office visit for immunizations about what is normal for her infant daughter to be doing. What information given by the nurse is correct? (Select all that apply.) A. She should be sitting alone leaning forward on her hands. B. She should be able to roll from her back to her abdomen. C. She should have been rolling from her abdomen to her back for at least a month. D. She should be developing the pincer grasp. E. She grasps objects using all of her fingers in a raking motion. F. She should be pulling herself up in her crib.

A. She should be sitting alone leaning forward on her hands. B. She should be able to roll from her back to her abdomen. C. She should have been rolling from her abdomen to her back for at least a month. E. She grasps objects using all of her fingers in a raking motion. Rationale: A. Sitting alone leaning forward on her hands is tripod sitting and is age-appropriate. B. Rolling from her back to her abdomen is age-appropriate. C. She should have been rolling from her abdomen to her back for at least a month. D. Development of the pincer grasp occurs at 9 months of age. E. Grasping objects using all of her fingers in a raking motion is age-appropriate. F. She should be pulling herself up in her crib around 9 months of age.

The nurse is conducting a water-safety program for parents of young children at the pediatrician's office. What water safety information should be included? (Select all that apply.) A. Supervise the toddler in the tub regardless of how much water is in the bathtub. B. Secure the pool drain with a protective cover. C. Children can drown in as little as 4 inches of water. D. A tub of water used to bathe the dog can be a water hazard. E. Toilets cause little hazard because of the location of the water. F. Constant supervision of the child is the best safety mechanism for water safety.

A. Supervise the toddler in the tub regardless of how much water is in the bathtub. B. Secure the pool drain with a protective cover. D. A tub of water used to bathe the dog can be a water hazard. F. Constant supervision of the child is the best safety mechanism for water safety. Rationale: A. Supervision of the toddler in the tub is necessary regardless of how much water is in the bathtub. B. Securing the pool drain with a protective cover helps protect the child from entrapment. C. Children can drown in as little as 1 inch of water. D. A tub of water used to bathe the dog can be a water hazard. E. Toilets can cause a major water little hazard and the lids should be kept down. F. Constant supervision of the child is the best safety mechanism for water safety.

Why are infants particularly vulnerable to acceleration-deceleration head injuries? A. The musculoskeletal support of head is insufficient. B. The anterior fontanel is not yet closed. C. Nerve tissue is not well developed. D. The scalp has extensive vascularity.

A. The musculoskeletal support of head is insufficient. Rationale: A. The relatively large head size coupled with insufficient musculoskeletal support increases the risk to infants. B. Anterior fontanel closure, nerve tissue development, and vascularity of the scalp do not have an effect on this type of injury. C. Anterior fontanel closure, nerve tissue development, and vascularity of the scalp do not have an effect on this type of injury. D. Anterior fontanel closure, nerve tissue development, and vascularity of the scalp do not have an effect on this type of injury.

According to Erikson, with which development task is infancy concerned with acquiring? A. Trust B. Industry C. Initiative D. Separation

A. Trust Rationale: A. The task of infancy is the development of trust. B. Industry versus inferiority is the developmental task of school-age children. C. Initiative versus guilt is the developmental task of preschoolers. D. Separation occurs during the sensorimotor stage as described by Piaget.

The 2-year-Old Child: Immunizations

Administer any immunizations not given previously according to the recommended schedule Influenza vaccine annually

The 3-year-old Child: Immunizations

Administer any immunizations not given previously according to the recommended schedule Influenza vaccine annually

Patterns of growth and development

Although heredity determines each individual's growth rate, the normal pace of growth for all children falls into four distinct patterns: 1. A rapid pace from birth to 2 year 2. A slower pace from 2 years to puberty 3. A rapid pace from puberty to approximately 15 years 4. A sharp decline from 16 years to approximately 24 years, when full adult size is reached

6- to 8-year old Child: Focused Assessment; Parent

Are there any concerns related to the child's nutrition, body image, physical activity, oral health, sleep, elimination, school, family interactions, self-esteem, and ability to practice safety precautions? Is there a gun in the home? If so, is it locked away and the ammunition stored locked in a separate place? Do you have a swimming pool? If so, is it fenced on all four sides and not directly accessible from the house? Do you have a fire escape plan that you practice regularly? Do you have any family history of heart problems or stroke; has anyone in your family had a heart attack or stroke at a young age (younger than 55 years for men or 65 for women)? Is your child regularly exposed to second hand smoke?

4-month-old Infant: Health Screening

Assess for strabismus Hearing risk assessment No additional screening required

6- to 8-year old Child: Physical Measurements

Average weight gain is 2.5kg (5 1/2 lb) per year Average increase in height is approximately 5.5 cm (2 inches) per year Continue to plot height and weight Plot BMI and percentile Not any breast budding or signs of other secondary sex characteristics

The parents of a 4-year-old girl are worried because she has an imaginary playmate. What response by the nurse is most appropriate? A. "Keep watching and if the behavior continues, an evaluation may be needed." B. "Imaginary playmates are normal and useful at this age." C. "Imaginary playmates are abnormal after age 2." D. "I wonder if there is some parent-child conflict happening that you're unaware of."

B. "Imaginary playmates are normal and useful at this age." Rationale: A. Because an imaginary playmate is part of normal development, an evaluation is not necessary. B. Imaginary playmates are a part of normal development at this age. C. The peak incidence of imaginary playmates occurs at 2 to 3 years of age. These playmates usually are not present once school starts. D. There is not data correlating an imaginary playmate and conflicts between the child and parent. Imaginary playmates are normal at this age.

Which statement is most characteristic of the motor skills of a 24-month-old child? A. A toddler walks alone but falls easily. B. A toddler's activities begin to produce purposeful results. C. A toddler is able to grasp small objects but cannot release them at will. D. A toddler's motor skills are fully developed but occur in isolation from the environment.

B. A toddler's activities begin to produce purposeful results. Rationale: A. A toddler is able to walk up and down stairs at this age. B. Gross and fine motor mastery occur with other activities. C. Grasping small objects but unable to release them at will is a characteristic of infancy. D. Interaction with the environment is essential at this age.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever the infant is left with the grandparents. The nurse's response is based on which observation? A. The infant is most likely spoiled. B. An infant screaming when left with grandparents is a normal reaction for this age. C. An infant screaming when left with grandparents is an abnormal reaction for this age. D. The grandparents are not responsive to the infant.

B. An infant screaming when left with grandparents is a normal reaction for this age. Rationale: A. This is incorrect. The behavior is developmentally appropriate. B. The infant is feeling stranger anxiety, which is expected for this age. C. This is incorrect. The behavior is developmentally appropriate. D. No data have been shown to support this.

What statement is characteristic of preschool children? A. They have a well-defined body image. B. Fear of intrusive procedures is a major concern. C. They are fearful of being separation from their parents. D. They have some knowledge about their internal anatomy.

B. Fear of intrusive procedures is a major concern Rationale: A. Preschoolers have poorly defined body images. B. Preschoolers fear that their insides will come out with intrusive procedures. C. Separation anxiety is characteristic of toddlers. D. Preschoolers have little or no knowledge of their internal anatomy.

Which should the nurse recommend to help a toddler cope with the birth of a new sibling? A. Discourage the toddler from helping with care of new sibling. B. Give the toddler a doll with which he or she can imitate parenting. C. Explain to the toddler that a new playmate will soon come home. D. Prepare the toddler for upcoming changes about 1 to 2 weeks before birth of sibling.

B. Give the toddler a doll with which he or she can imitate parenting. Rationale: A. The toddler should be encouraged to participate in accordance with his or her abilities. B. The toddler can participate in the activity of caring for a new family member, but can have a doll of his or her own to care for. C. Telling the toddler a new playmate will soon come home will establish unrealistic expectations. D. Preparation should begin as soon as changes in the mother's physical appearance and the home setting occur.

During a well-child visit, the father of a 4-year-old boy tells the nurse that he is not sure whether his son is ready for kindergarten. The child's birthday is close to the cutoff date and child has not attended preschool. Which is the nurse's best recommendation? A. Have the child begin kindergarten. B. Have the child get a developmental screening. C. Observe a kindergarten class to see if his son would fit in. D. Postpone kindergarten and have the child go to preschool.

B. Have the child get a developmental screening. Rationale: A. Starting kindergarten does not address the father's concern about readiness. B. A developmental screening will provide the necessary information to help the family determine readiness. C. Observation of a kindergarten class will provide information about kindergarten but not whether the child is ready. D. If the child is ready for kindergarten, preschool may lead to boredom.

Which behavior is most characteristic of the concrete operations stage of cognitive development? A. Inability to put oneself in another's place B. Increasingly logical and coherent thought processes C. Progression from reflex activity to imitative behavior D. Ability to think in abstract terms and draw logical conclusions

B. Increasingly logical and coherent thought processes Rationale: A. Inability to put oneself in another's place is characteristic of the preoperational stage (ages 2 to 7 years). B. Increasingly logical and coherent thought processes are characteristic of concrete operations. Children in this stage are able to classify objects. C. Progression from reflex activity to imitative behavior is characteristic of the preoperational stage (ages 2 to 7 years). D. Adolescents, in the formal operations stage, have the ability to think in abstract terms and draw logical conclusions.

A mother tells the nurse that her daughter's favorite toy is a large, empty box in which a stove was packaged. She plays "house" in it with her toddler brother. What information should the nurse tell the mother about this type of play? A. This is unsafe play that should be discouraged. B. It is an example of creative play that should be encouraged. C. It suggests that there are limited family resources. D. It is suggestive of limited adult supervision.

B. It is an example of creative play that should be encouraged. Rationale: A. As long as the play is supervised, it should be encouraged. B. Creative play should be encouraged. After children create something new, they can then transfer their new knowledge to other situations. C. No indication of limited resources is evident. D. No indication of limited adult supervision is evident.

When preparing parents to teach their children about human sexuality, what should the nurse emphasize? A. A parent's words may have a greater influence on the child's understanding than the parent's actions. B. Parents should determine exactly what the child wants to know before answering a question about sex. C. Parents should avoid using correct anatomic terms because they are confusing to the preschooler. D. Parents should allow children to satisfy their sexual curiosity by playing "doctor."

B. Parents should determine exactly what the child wants to know before answering a question about sex. Rationale: A. Subtle actions such as facial expression may have a greater influence because language is not fully developed. B. It is important that the parent answer the question that the child is curious about and not redirect the child's focus by relaying higher level information than was requested. C. Using correct terminology lays the foundation for later discussion. D. Parents should encourage the asking of questions to resolve curiosity without undue investigation on the child's part.

Which intervention lowers the risk of sudden infant death syndrome (SIDS)? A. Smoking away from the infant. B. Putting the infant to sleep in the supine position. C. Making sure the infant is kept very warm while sleeping. D. Having the infant sleep with parents instead of alone in a crib.

B. Putting the infant to sleep in the supine position. Rationale: A. Maternal smoking increases the risk of SIDS. B. The "Back to Sleep" campaign is given credit for reducing the rate of SIDS in the United States. C. Overheating increases the risk of SIDS. D. Co-sleeping increases the risk of SIDS because of accidental rollover deaths.

A 3-year-old male has cerebral palsy and is currently hospitalized for orthopedic surgery. His mother says he has difficulty swallowing and cannot hold a utensil to feed himself. What is the most appropriate nursing action related to feeding this child? A. Bottle- or tube-feed him a specialized formula until he gains sufficient weight. B. Stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. C. Place him in a well supported, semi-reclining position to make use of gravity flow. D. Place him in a sitting position with his neck hyperextended to make allow gravity to help the liquids flow down his esophagus.

B. Stabilize his jaw with one hand (either from a front or side position) to facilitate swallowing. Rationale: A. He is too old for bottlefeeding, and tube-feeding must be ordered by the health care provider. The neuromuscular compromise of the jaw interferes with the child's ability to eat. B. Because the jaw is compromised, more normal control can be achieved if the feeder provides stability. Manual jaw control assists with head control, correction of neck and trunk hyperextension, and jaw stabilization. C. The child should be sitting up for meals. D. For swallowing, the neck should not be hyperextended because of possible aspiration.

A mother of a 28-month-old active boy talks with the nurse about safety in the home. She is most concerned about him burning himself because he is so curious. What information should the nurse share with the mother? (Select all that apply.) A. Use the front burners of the stove. B. Supervise the toddler when cookies are baking in the oven. C. Keep the toddler positioned nearby so he can hear the hiss of the steam iron to teach him that it is hot. D. Check that electrical outlets are still secured with safety plugs. E. Keep matches and lighters in a secured area. F. Turn pot handles away from the front of the stove.

B. Supervise the toddler when cookies are baking in the oven. D. Check that electrical outlets are still secured with safety plugs. E. Keep matches and lighters in a secured area. F. Turn pot handles away from the front of the stove. Rationale: A. Use the rear burners of the stove for safety. B. Supervising the toddler when cookies are baking in the oven is essential because of the child's curiosity and desire to get to the cookies. C. Keeping the toddler positioned nearby so he can hear the hiss of the steam iron to teach him that it is hot is a dangerous idea. D. Covering electrical outlets with safety plugs should have been done when the child was beginning to crawl, but toddlers can still try to stick objects into the electrical outlets and suffer electrical burns. E. Keeping matches and lighters in a locked and elevated area is best. Just because the items are out of reach does not make it safe. Toddlers are curious and often will climb. F. Turning pot handles away from the front of the stove is correct.

Which is descriptive of the nutritional requirements of preschool children? A. The average daily intake of preschoolers should be about 3,000 calories. B. The quality of the food consumed is more important than the quantity. C.Nutritional requirements for preschoolers are very different from requirements for toddlers. D. Requirement for calories per unit of body weight increases slightly during the preschool period

B. The quality of the food consumed is more important than the quantity. Rationale: A. The average intake for preschoolers is about 1,800 calories each day. B. It is essential that the child eat a balanced diet with essential nutrients. C. Requirements are similar for toddlers and preschoolers because their rate of growth has slowed from that of infancy. D. Caloric requirement decreases slightly during the preschool period.

For a toddler with sleep problems, what should the nurse suggest? A. Restricting stimulating activities during the day B. Using a transitional object C. Varying the bedtime ritual D. Explaining away fears

B. Using a transitional object Rationale: A. A toddler requires stimulating physical activity during the daytime, although such activity just before bed prolongs the transition from wakefulness to sleepiness. B. A transitional object, such as a stuffed animal or blanket, may help the child ease anxiety and facilitate sleep. C. A consistent ritual will facilitate sleep and are very important at this age. D. Verbal explanations that rationalize fears away are not internalized by a child at this age.

2-week-old to 1-month-old Infant: Hygiene

Bathe in warm water using mild soap and baby shampoo. Keep diaper area clean and dry.

2-Month-Old Infant: Hygiene

Bathe several times per week Watch for diaper rash and seborrheic dermatitis

2-week-old to 1-month-old Infant: Safety

Be sure crib is sage: slats <2 3/8 inces apart, firm mattress that fits the crib. Eliminate all environmental smoke Rear-facing approved infant car seat. Fire prevention: smoke detector, fire extinguishers. Water temperature <120 degrees F. Cardiopulmonary resuscitation and first aid classes; emergency phone numbers. Violence: Discuss shaking, guns in the home

6-month-old Infant: Nutrition

Begin introducing solid foods one at a time by spoon; use iron fortified cereals Hold or place in infant seat for feeding Begin to offer a cup Vitamin D supplementation 400 IU/day for breastfed infants and infants whose formula intake is less than 1 L (33 oz) per day May discontinue iron supplementation for breastfeeding infants who are taking sufficient iron rich solid foods

12-month-old Infant: Play

Beginning parallel play Push-pull toys Various-size balls Picture books Dolls and stuffed animals "Busy" Box Sandbox- be sure to cover when not in use

Cooperative play

Begins in late preschool years. Organized and has group goals, at least one leader, and children are definitely in or out of the group

Identity vs Role Confusion (12-24yr)

Begins to develop a sense of "I" this process is lifelong; child gains independence from parents; characterized by faith in self

The 15- to 18- month- Old Child: Hygiene

Begins to participate in self-care (washes face and hands with assistance)

Animism

Believes that inert objects are alive and have wills of their own ex. Toddler trips over a toy and scolds the toy for hurting her. She believes that the toy hurt her on purpose

Magical Thought

Believes that magical though is the cause of events and that wishing something will make it so Ex. Toddlers often feel extremely powerful and believe that their thoughts cause events to happen

6-month-old Infant: Physical measurements

Birth weight doubles Continue to measure and plot length, weight, and head circumference

The 2-year-Old Child: Elimination

Bowel movements decrease in number and become more regular Child remains dry for several hours Begin to think about a positive approach to toilet training

The 4- and 5-year-old Child: Elimination

Bowel movements once or twice daily Urinary output 1000 mL/day Nighttime control achieved

2-week-old to 1-month-old Infant: Nutrition

Breast milk on demand at least every 2-3 hours. Iron-fortified formula 2-3 oz every 3-4 hours if not breastfeeding. Vitamin D supplement 400 IU/day for breastfed infants and for formula-fed babies consuming few than 1 liter (33oz) per day. Place on right side after feeding

2-Month-Old Infant: Nutrition

Breastfeed on demand with increasing intervals. Formula, 4-6 oz six times per day Vitamin D supplementation 400 IU/day for breastfeeding infants and for formula fed infants if taking less then 1 L (33 oz) of formula a day

A parent has a 2-year-old in the clinic for a well-child checkup. Which statement by the parent would indicate to the nurse that the parent needs more instruction regarding accident prevention? A. "We locked all the medicines in the bathroom cabinet." B. "We turned the thermostat down on our hot water heater." C. "We stopped using the car seat now that my child is older." D. "We placed gates at the top and bottom of the basement steps."

C. "We stopped using the car seat now that my child is older." Rationale: A. Locking medicines in a cabinet, turning down the thermostat on the hot water heater, and placing gates at the top and bottom of steps are appropriate actions. B. Locking medicines in a cabinet, turning down the thermostat on the hot water heater, and placing gates at the top and bottom of steps are appropriate actions. C. A car seat should be used until the child weighs 40 pounds, at approximately 4 years of age. After that point, a booster seat that complies with federal safety guidelines should be used. Seat belts must be used with the booster seat. D. Locking medicines in a cabinet, turning down the thermostat on the hot water heater, and placing gates at the top and bottom of steps are appropriate actions.

An infant is expected to be able to say "mama" and "dada" with meaning by what age? A. 4 months B. 6 months C. 10 months D. 14 months

C. 10 months Rationale: A. At 4 months, consonants are added to infant vocalizations. B. At 6 months, babbling resembles one-syllable sounds. C. At 10 months, infants say sounds with meaning. D. 14 months is late for the development of sounds with meaning.

Although a 9-year-old male has several physical disabilities, he concentrates on what he can, rather than cannot, do and is as independent as possible. What is the most accurate interpretation of this behavior? A. The child is in denial of his situation. B. Family counseling is needed immediately. C. Adaptive coping skills are being used by the child. D. The child is using a maladaptive coping style.

C. Adaptive coping skills are being used by the child. Rationale: A. The child is describing an adaptive coping style. B. Family counseling is not needed at this time because the child is coping. C. When a child concentrates on what he can do rather than what he cannot do and is as independent as possible, the child is using an adaptive coping style. The child learns to accept physical limitations but finds achievements in a variety of compensatory motor and intellectual pursuits. D. When a child concentrates on what he can do rather than what he cannot do and is as independent as possible, the child is using an adaptive coping style.

The nurse is teaching the parent of a 2-year-old child how to care for the child's teeth. Which should be included? A. Flossing is delayed until the child is around 4 years old. B. The child is old enough to brush teeth effectively using a small toothbrush. C. Brush the teeth with plain water if the child does not like toothpaste. D. The toothbrush should be small and have hard, rounded, nylon bristles.

C. Brush the teeth with plain water if the child does not like toothpaste. Rationale: A. Flossing should be done after brushing. B. Two-year-olds cannot effectively brush their own teeth; parental assistance is necessary. C. Some children do not like the flavor of toothpaste or the foaming that result. Plain water should be used in this case. D. Soft, multi-tufted, bristled toothbrushes are recommended.

A 2-year-old has recently started having temper tantrums during which the toddler holds her breath and sometimes faints. What should the nurse tell the parents about appropriate intervention for these tantrums? A. The nurse should refer the toddler for respiratory evaluation. B. The toddler needs referred for psychological evaluation. C. Explain to the parents that although these episodes are frightening to them, they are not harmful. D. Explain to the parents that their child is getting too much attention and is spoiled.

C. Explain to the parents that although these episodes are frightening to them, they are not harmful. Rationale: A. Temper tantrums followed by holding one's breath and fainting is not a respiratory issue. B. Temper tantrums are part of this developmental stage. If they persist past a certain age or increase greatly, then the pediatrician may ask for an evaluation. C. In a healthy child, the rising carbon dioxide levels stimulate breathing to reduce carbon dioxide. When she faints and is no longer able exert control in this manner, her breathing will automatically resume. D. No data have been shown to support that the child is spoiled.

Which is the most appropriate recommendation for relief of teething pain? A. Rub the infant's gums with aspirin to relieve inflammation. B. Apply diluted hydrogen peroxide to gums to relieve irritation. C. Give the child a frozen teething ring to relieve inflammation. D. Have the child chew on a warm teething ring to encourage tooth eruption.

C. Give the child a frozen teething ring to relieve inflammation. Rationale: A. The infant's gums should not be rubbed with aspirin to relieve inflammation. It can be dangerous if the infant aspirates aspirin. In addition, aspirin is not appropriate for infants. B. Hydrogen peroxide should not be used because it is ineffective and can cause tissue damage. C. Cold reduces inflammation and should be used for relief of teething irritation. D. Cold, not warmth, reduces inflammation.

Which statement about bottle-mouth caries is correct? A. The syndrome can be prevented by rinsing the child's mouth daily. B. The syndrome is distinguished by protruding upper front teeth, resulting from sucking on a hard nipple. C. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. D. Giving the child juice in the bottle instead of milk at bedtime prevents this syndrome.

C. Giving a bottle of milk or juice at naptime or bedtime predisposes the child to this syndrome. Rationale: A. Rinsing the mouth once a day alone does not prevent bottle-mouth caries. B. This may result from pacifier use or thumb-sucking and has nothing to do with caries. C. Sweet liquids pooling in mouth during sleep cause dental caries. D. The sugar, whether in juice or milk, contributes to bottle-mouth caries when given at a time the solution will remain on the teeth.

The nurse notices that a toddler is more cooperative when taking medicine from a small cup rather than from a large cup. This is an example of which characteristic of preoperational thought? A. Egocentrism B. Irreversibility C. Inability to conserve D. Transductive reasoning

C. Inability to conserve Rationale: A. The inability to see situations from other perspectives does not facilitate medication administration. B. The inability to reverse actions physically initiated does not facilitate medication administration. C. The smaller cup makes it look like less medicine. D. Focusing on particulars does not explain the cooperation with the smaller medication cup.

The nurse is giving anticipatory guidance to the parent of a 5-year-old. Which is the most appropriate to include? A. Prepare the parent for increased aggression. B. Encourage the parent to offer the child choices. C. Inform parent to expect a more tranquil period at this age. D. Advise the parent that this is the age when stuttering may develop.

C. Inform parent to expect a more tranquil period at this age. Rationale: A. Preparing parents for increased aggression is characteristic of anticipatory guidance for children 4 years old. B. Encouraging parents to offer the child choices is characteristic of anticipatory guidance for children 3 years of age. C. The end of preschool/beginning of school age is a more tranquil period. D. Stuttering usually begins developing earlier around 3 years of age

Which characteristic best describes the fine motor skills of a 5-month-old infant? A. Has a neat pincer grasp B. Has a strong grasp reflex C. Is able to grasp object voluntarily D. Can build a tower of two cubes

C. Is able to grasp object voluntarily Rationale: A. This is characteristic of an 11-month-old infant. B. This is characteristic of a 1-month-old infant. C. This characteristic is appropriate for a 5-month-old infant. D. This is characteristic of a 15-month-old infant.

Which statement explains why it can be difficult to assess a child's dietary intake? A. Biochemical analysis for assessing nutrition is very expensive. B. Families usually do not understand much about nutrition. C. Recall of food consumption is frequently unreliable. D. No systematic assessment tool has been developed.

C. Recall of food consumption is frequently unreliable. Rationale: A. Nutrients for different foods are known; it is the quantity and type of food consumed that is difficult to ascertain. B. The family does not need nutritional knowledge to describe what the child has eaten. C. It is difficult for parents to recall exactly what their child has eaten. Concurrent food diaries are somewhat more reliable. D. Systematic tools are available, and recall is unreliable.

A 2-year-old child who is ventilator dependent will be discharged soon. The family expresses concern that the child might change the ventilator settings by exploring the control knobs and buttons. What teaching should the nurse provide? A. Teach the child not to touch the controls. B. Explain that the child cannot be left alone because of the risk of changing settings. C. Recommend ways to cover the controls to reduce the risk of the child changing settings. D. Reassure the family that developmentally the child is unable to change settings.

C. Recommend ways to cover the controls to reduce the risk of the child changing settings. Rationale: A. The toddler is too young to understand this concept. B. The child will need to be supervised while awake, and alarms must be on when the child is asleep, but lockouts or covers are still necessary. C. If the equipment does not have lockout capabilities, then clear plastic covers and tape should be applied. D. Toddlers can manipulate dials.

The parents of a 5-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hours during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What should the nurse suggest to help them deal with this problem? A. Put her in the parents' bed to cuddle. B. Let her cry herself back to sleep. C. Start putting her to bed while still awake. D. Leave her a bottle of formula when put into her crib at night.

C. Start putting her to bed while still awake. Rationale: A. Never put the infant in the adults' bed. The parents may roll over on the infant and suffocate her. Besides, having the infant in bed with them would be no guarantee of her staying asleep. B. The infant needs to be checked on if she awakens crying to make sure she is all right. This doesn't help with the problem, however. C. Parents need to develop bedtime rituals that involve putting the child in bed while still awake. If she is never allowed to acclimate to bedtime by being put in bed while awake, then when she wakes she is distressed to find herself there alone. This can create sleeping issues. D. Providing formula at night will contribute to bottle-mouth caries.

Which statement best explains the growth and development of children? A. Development proceeds at a predictable rate. B.Rates of growth are consistent among children. C. The sequence of developmental milestones is predictable. D. At times of rapid growth, there is also acceleration of development.

C. The sequence of developmental milestones is predictable. Rationale: A. There are periods of both accelerated and decelerated growth and development. B. Each child develops at his or her own rate. C. There is a fixed, precise order to child development. D. Physical growth and development proceed at differing rates.

A 4-year-old girl lies down and goes to sleep without any parental intervention, but she sometimes wakes her parents at night by screaming, thrashing, sweating, and appears frightened. The child is not aware of her parents' presence when they check on her. What information can the nurse provide to the parents about this occurrence? A. Their child is having a nightmare. B. Their child is experiencing mild sleep apnea. C. These behaviors are characteristic of a night terror. D. Their daughter is having nocturnal seizure activity

C. These behaviors are characteristic of a night terror. Rationale: A. A nightmare is a frightening dream followed by full awakening. B. Sleep apnea is a cessation of breathing during sleep. C. During night terrors the child is only partially aroused; therefore she does not remember her parents' presence. D. Screaming, thrashing, sweating, and appearing frightened does not resemble seizure activity.

The parents of 9-year-old twins tell the nurse, "The twins have filled up their bedroom with collections of rocks, shells, stamps, and cars." What information should the nurse give the parents? A. This collecting behavior is indicative of giftedness B. Collecting is characteristic of "twin" behavior. C. This is characteristic of the cognitive development at this age. D. This is characteristic of psychosocial development at this age.

C. This is characteristic of the cognitive development at this age. Rationale: A. Classification skills are characteristic of the age group, not giftedness. B. Classification skills are characteristic of the age group, not their twin status. C. Classification skills are developed during the school-age years. This age group enjoys sorting objects according to shared characteristics. D. Psychosocial development at this age is focused on accomplishment.

The 15- to 18- month- Old Child: Nutrition

Calorie, protein, and fluid requirements decrease slightly; offer a variety of foods every 2 to 3 hr. Give 2 or 3 cups of whole milk daily for calcium Vitamin D supplementation 400 IU/day if consuming less than 1 L (33 oz) per day of milk and vitamin D-fortified foods Make mealtimes pleasant; use appropriate-size utensils; colorful dinnerware Child may have fussy eating habits (physiologic anorexia) Resist giving food as a comfort measure Do not allow child to walk or play with food in the mouth

6- to 8-year old Child: Focused assessment, the child

Can you tell me how often and what foods you like to eat? How often do you eat at fast-food restaurants? How do you feel about how much you weight? Do you think you need to gain or lose any weight? What types of physical activities do you like to do? How often and for how long do you do them? Do you have any quiet hobbies that interest you? How many hours each day do you watch television, movies, or us the computer (including playing video games)? What is your favorite television program? Do you have a television in your room? How often do you brush your teeth, floss, and see the dentist? What time do you go to bed at night? What time do you get up in the morning? Do you have any trouble falling asleep, or do you wake up in the middle of the night? How often do you have a bowel movement? Are there any problems with urination? (Use the child's familiar terminology if known) Do you wet the bed? If so, how often? What grade in school are you? Are you doing well in school or having any problems? Do you feel safe at school? Do you participate in any before- or after-school programs? What kinds of activities do you enjoy doing with your friends? How do you get along with other members of your family? Is there a special family member you could talk to if you are having a problem? If so, who? Do you do any or all of the following: use a seatbelt every time you get in a car; wear a helmet every time you ride a bicycle; wear a helmet and protective pads every time you skate or use a scooter; use sun screen; swim with a buddy and only when an adult is present; always look both ways before crossing the street; use the right equipment when you play sports; know to avoid strangers and how to call for help if needed? Has anyone every physically hurt you or touched you in a way that made you uncomfortable

Irreversibility

Cannot see a process in reverse order. Cannot follow a line of reasoning back to its beginning. Cannot hold onto two or more sequential thought simultaneously. Ex. If the child takes a toy apart, the child cannot remember the sequence for putting it back together Ex. If the child is taken on a walk, the child cannot retrace steps and find the way home

Physical Readiness for toilet training

Child can remove own clothing Child is willing to let go of a toy when asked Child is able to sit, squat, and walk well Child has been walking for 1 yr.

Psychological Readiness to toilet train

Child notices if diaper is wet Child may indicate that diaper needs to be changed by pulling on diaper, squatting, or repeating a word or phrase Child communicates need to go to the bathroom or can get there by self Child wants to please parent by staying dry

Solitary Play (Independent play)

Child plays alone with toys that are very different from those chosen by other children in the area. Begins in infancy and is common in toddlers because of their limited social, cognitive, and physical skills

Toys and Specific types of Play for the School-Age Child

Collections, drawing, construction, dolls, pets, guessing games, complicated puzzles, board games, riddles, physical games, competitive play, reading, bicycle riding, hobbies, sewing, listening to the radio, watching television and videos, cooking

The 4- and 5-year-old Child: Nutrition

Continue as for 3 yo Provide nutritious snacks (child too often in a hurry to eat at mealtime) Begin to emphasize table manners Vitamin D Supplementation 400 IU/day if consuming less than 1 L (33 oz) of milk and vitamin D-fortified foods

12-month-old Infant: Hygiene

Continue as previously

6-month-old Infant: Hygiene

Continue daily routine of cleanliness Clean toys frequently

2-week-old to 1-month-old Infant: Dental

Continue prenatal vitamins and calcium if breastfeeding

2-Month-Old Infant: Dental

Continue prenatal vitamins and calcium if breastfeeding Do not prop baby's bottle

9-month-old Infant: Nutrition

Continue to breastfeed on established schedule Formula, 16-32 oz/day Vitamin D supplementation 400 IU/day if breastfed or taking less than 1 L (33 oz) per day of formula Continue Iron-fortified cereal Begin to introduce a variety of soft, mashed or chopped table food Encourage cup, rather than bottle Avoid giving large pieces of food and foods known to be associated with choking

The 15- to 18- month- Old Child: Dental

Continue to brush with a soft toothbrush twice daily; parent should floss the child's teeth Maintain diet low in sugar Do not put the child to sleep with a bottle Dental risk assessment (18 mo); refer to dentist if not done earlier

The 3-year-old Child: Dental

Continue to have the child brush with toothpaste Parent should floss the child's teeth Child should see the dentist every 6 mo

9-month-old Infant: Phyical Measurements

Continue to measure and plot length, weight, and head circimference

12-month-old Infant: Physical Measurements

Continue to measure and plot length, weight, and head circumference Weight is usually tripled birth weight Length is 50% more than birth Length

The 15- to 18- month- Old Child: Physical Measurements

Continue to measure and plot length, weight, and head circumference Anterior fontanel closed by 18 months

The 3-year-old Child: Physical measurements

Continue to plot height, weight, and BMI Growth rate is similar to that of a two year old

Toys and Specific Types of Play: Toddler

Continued exploring of the body parts of self and others; mechanical toys; objects of different textures such as clay, sand, finger paints, and bubbles; push-pull toys; large ball; sand and water play; blocks; painting ; coloring with large crayons; nesting toys; large puzzles; trucks; dolls. Therapeutic play can begin at this age

The parent of a 12-month-old male infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself because he makes too much of a mess." What is the most appropriate response by the nurse? A. "It's important not to give in to this kind of temper tantrum at this age." B. "Maybe you need to try a different type of spoon, one designed for young children." C. "It's important to let make a mess and know it will go away as he gets older." D. "He's at the stage where he is old enough to beginning learning how to feed himself."

D. "He's at the stage where he is old enough to beginning learning how to feed himself." Rationale: A. The child is developmentally ready for self-feeding. The parent should not force use of the spoon but should substitute finger foods. B. The child is developmentally ready for self-feeding. The parent should not force use of the spoon but should substitute finger foods. C. This statement focuses on the parent's concerns about the mess created by self-feeding, not the need to learn self-feeding. D. At 12 months the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for providing meals which the child can feed himself without much frustration while keeping mess to a minimum.

By what age would the nurse expect that most children would be using sentences of six to eight words? A. 18 months B. 24 months C. 3 years D. 5 years

D. 5 years Rationale: A. At 18 months of age, a child has a vocabulary of only 10 words. B. A child at 24 months uses 2- to 3-word phrases. C. A child at 3 years of age uses 3- to 4-word sentences. D. Children can make sentences of 6 to 8 words at 5 years of age. Most will use all parts of speech and construct sentences of the length an adult would use.

An 8-year-old girl with moderate cerebral palsy (CP) has recently begun participation in a regular classroom for part of the day. Her mother asked the school nurse about having her join the after-school Girl Scout troop. The nurse's response should be based on what developmental knowledge? A. Most activities such as Girl Scouts cannot be adapted for children with CP. B. Participating in after-school activities is usually extremely tiring for children with CP. C. Trying to participate in activities such as Girl Scouts leads to lowered self-esteem in children with CP. D. After-school activities often provide children with CP with opportunities for socialization and recreation.

D. After-school activities often provide children with CP with opportunities for socialization and recreation. Rationale: A. Most activities can be adapted for children with CP. B. The child, family, and activity director should assess the degree of activity to ensure it meets with the child's capabilities. C. A supportive environment will add to the child's self-esteem. D. Recreational outlets and after-school activities should be considered for the child who is unable to participate in athletic programs.

Myelination of the spinal cord is almost complete by 2 years of age. As a result of this, what can gradually be achieved by the toddler? A. Visual acuity of 20/20. B. Throwing a ball without falling. C. Slowing of gastrointestinal transit time. D. Control of anal and urethral sphincters

D. Control of anal and urethral sphincters Rationale: A. Visual acuity at this age is 20/40. B. Throwing a ball occurs at approximately 15 months. C. Increased capacity is responsible for decreased number of bowel movements each day. D. The voluntary control of elimination occurs between 18 and 24 months.

The nurse is discussing toddler development with a parent. Which intervention will best foster the achievement of autonomy in the toddler? A. Helping the toddler complete tasks. B. Helping the toddler learn the difference between right and wrong. C. Providing opportunities for the toddler to play with other children. D. Encouraging the toddler to do things for self when capable of doing them.

D. Encouraging the toddler to do things for self when capable of doing them. Rationale: A. To successfully achieve autonomy, the toddler needs to have a sense of accomplishment. This does not occur if parents complete tasks for the toddler. B. Learning the difference between right and wrong is a concept that is too advanced for toddlers and will not contribute to autonomy. C. Children at this age engage in parallel play. This will not foster autonomy. D. Toddlers have an increased ability to control their bodies, themselves, and the environment. Autonomy develops when children complete tasks of which they are capable.

Which is characteristic of the psychosocial development of school-age children? A. Peer approval is not yet a motivating power. B. A developing sense of initiative is very important. C. Motivation comes from extrinsic rather than intrinsic sources. D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment.

D. Feelings of inferiority or lack of worth can be derived from children themselves or from the environment. Rationale: A. Peer group formation is one of the major characteristics of this age group. B. A developing sense of initiative is characteristic of preschoolers. C. School-age children gain satisfaction from successful independent behaviors. D. The school-age child is eager to develop skills and participate in activities. Not all children are able to do all tasks well, and the child must be prepared to accept some feeling of inferiority.

According to Erikson, what is the primary psychosocial task of the preschool period? A.Identity B. Intimacy C. Industry D. Initiative

D. Initiative Rationale: A. Identity is the stage associated with adolescence. B. Intimacy is an adult stage. C. Industry is the stage seen in the school-age child. D. Preschoolers focus on developing initiative. The stage is known as initiative versus guilt.

Which best describes colic? A. It is usually the result of poor or inadequate mothering. B. The infant experiences periods of abdominal pain that result in weight loss. C. Infants older than 6 months of age experience periods of abdominal pain and crying. D. It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying.

D. It is paroxysmal abdominal pain or cramping manifested by episodes of loud crying. Rationale: A. There is no identified relationship between colic and inadequate mothering. B. Colic is associated with irritability and crying. C. Most commonly colic occurs in infants under 3 months of age. D. Paroxysmal abdominal pain or cramping manifested by episodes of loud crying defines colic.

A 4-year-old girl is afraid of dogs. The nurse should recommend which approach to help the parents assist their daughter to cope with this fear? A. Keep the child away from dogs. B. Buy the child a stuffed dog toy. C. Force the child to touch a dog briefly. D. Let the child watch other children play with a dog.

D. Let the child watch other children play with a dog. Rationale: A. Keeping the child away from dogs avoids the object of fear rather than approaching it and finding solutions. B. Substituting a stuffed animal for the real thing avoids the object of fear rather than approaching it and finding solutions. C. Forcing the child to interact with the dog may increase the level of fear. D. The parents should actively seek ways to deal with fear. By observing other children at play with dogs, the child can learn to adapt.

The parents of a child with fragile X syndrome want to have another baby. They tell the nurse that they worry another child might be similarly affected. What is the most appropriate nursing action? A. Assess for family history of the syndrome. B. Recommend that they not have another child. C. Reassure the family that the syndrome is not inherited. D. Recommend genetic counseling, because the syndrome is inherited.

D. Recommend genetic counseling, because the syndrome is inherited. Rationale: A. The nurse should not offer a recommendation, although a referral for genetic counseling is indicated. B. The syndrome is inherited on the X chromosome. C. The nurse should not reassure the family that the syndrome is not inherited—it is. D. Since Fragile X syndrome can be detected prenatally, the family should be referred for genetic counseling.

What action can best prevent poisoning in toddlers? A. Consistently using safety caps B. Keeping ipecac syrup in the home C. Storing poisonous substances out of reach D. Storing all poisonous substances in a locked cabinet

D. Storing all poisonous substances in a locked cabinet Rationale: A. Not all poisonous substances have safety caps. B. Ipecac does not prevent poisoning and is no longer recommended as an intervention for ingestion of poisonous substances. C. Toddlers can climb therefore little is out of their reach. D. Storing poisonous substances out of reach in a locked cabinet is an appropriate action.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. The nurse's response should be based on what developmental information? A. A pacifier should be substituted for the thumb. B. Thumb-sucking should be discouraged by age 12 months. C. Thumb-sucking should be discouraged when the teeth begin to erupt. D. There is no need to restrain nonnutritive sucking during infancy

D. There is no need to restrain nonnutritive sucking during infancy. Rationale: A. Evidence is inconclusive regarding whether a pacifier or thumb is better for satisfying sucking needs. B. Thumb-sucking and use of a pacifier should be stopped after 4 years of age. C. Thumb-sucking and use of a pacifier should be stopped after 4 years of age. D. Nonnutritive sucking reaches its peak at about 18-20 months of age.

Which statement characterizes toddlers' eating behavior? A. Their table manners are predictable. B. They have increased appetites. C. They have few food preferences. D. They become fussy eaters.

D. They become fussy eaters. Rationale: A. Use of finger foods contributes to unpredictable table manners. B. They have a decrease in appetite because they are not growing as rapidly. C. They have strong taste preferences. D. Toddlers have physiologic anorexia that contributes to fussy eating.

A 4-month-old male is brought to the clinic by his parents for a well-baby checkup. Which recommendation about injury prevention should the nurse include at this time? A. Keep doors of appliances closed at all times. B. Never use baby powder on the infant because it can be aspirated into his lungs. C. Do not permit the infant to chew paint from window ledges because he might absorb lead. D. When your baby learns to roll over you must supervise him whenever he is on a surface from which he might fall.

D. When your baby learns to roll over you must supervise him whenever he is on a surface from which he might fall. Rationale: A. The recommendation to keep doors of appliances closed at all times should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. B. The guidance to never use baby power as it can be aspirated should have been given at a first-month appointment. C. The information to prohibit the infant from chewing paint from window ledges should be included at the 9-month visit when he is beginning to crawl and pull to a standing position. D. Rolling over from abdomen to back occur between 4 and 7 months. It is appropriate anticipatory guidance to teach parents to supervise the infant whenever he is on a surface from which he may fall.

The 4- and 5-year-old Child: Dental

Dental examinations every 6 mo Continue brushing and flossing Child might begin to lose deciduous teeth

Initiative vs Guilt (3-5yr)

Development of a can-do attitude about self; behavior becomes goal-directed, competitive and imaginative; initiation into gender role; characterized by purpose

Trust vs Mistrust (0-1yr)

Development of a sense that the self is good and the world is good when consistent, predictable, reliable care is received, characterized by hope.

Autonomy vs Shame and Doubt (1-3yr)

Development of sense of control over the self and body functions; exerts self; characterized by will

Intimacy vs Isolation (25-45yr)

Development of the ability to lose the self in genuine mutuality with another; Characterized by love

6- to 8-year old Child: Developmental Milestones-Personal/Social

Develops positive self-esteem through skills acquisition and task completion; peer group becoming the primary socializing force; outgoing and boisterous, "know-it-all" but becomes for reflective and quiet by age 8 years; loves new ideas and places; has a good sense of humor, may tell crude jokes; may be argumentative and use tension-releasing behaviors such as nail biting, hair twisting, wriggling; likes to make things but often does not finish projects; loves family members but worries about them; has a strong sense of fairness and justice-- uses rules to define cooperative relationships with others (sees rules as being imposed on others)

The 4- and 5-year-old Child: Immunizations

Diphtheria-tetanus-acelluar pertussis (DTaP) #5; inactivated poliovirus (IPV) #4; measles-mumps-rubella (MMR) #2; varicella #2 Influenza vaccine annually

2-Month-Old Infant: Immunizations

Diphtheria-tetanus-acellular pertussis (DTaP) #1; inactive poliovirus (IPV) #1 (may substitute DTaP, hepatitis B and polio combination vaccine); Haemophilus influezae type b (Hib) #1; pneumococcal #1; rotavirus #1. Discuss potential effects

4-month-old Infant: Immunizations

Diphtheria-tetanus-acellular pertussis (DTaP) #2, inactivated poliovirus (IPV) #2 (may substitute DTaP, Hepatitis B, and combination polio vaccine); Haemophilus influenzae type b (Hib) #2, pneumococcal #2; rotavirus #2. Review side effects and ask about previous reactions.

6-month-old Infant: Immunizations

Diphtheria-tetanus-acellular pertussis (DTaP) #3 (may substitute DTaP, hepatitis B, and polio combination vaccines); Haemophilus influenzae type b (Hib) #3; pneumococcal #3; rotavirus #3; inactivated poliovirus (IPV) #3 and Hepatitis B #3 may be given between now and 18 mo if not in combination vaccine. Influenza vaccine annually; two doses initially, separated by at least 4 wk Ask about previous reactions Review side effects

General Activities: Preschooler

Dramatic play is prominent The child likes to run, jump, hop, and, in general, improve motor skills The child likes to build and create things (e.g., sand castles and mud pies). Play is simple and imaginative Simple collections begin

12-month-old Infant: Dental

Eight Teeth Continue Fluoride, if recommended, and brushing

6- to 8-year old Child: Play

Encourage developing collections, playing complicated board and card games, crafts, electronic and science-related games Advise limited television watching to no more than 2 hours a day Recommend increasing planned physical activity to at least 1 hour a day of moderate to vigorous exercise

6-month-old Infant: Play

Expose to different sounds and sights Begin social games (pat-a-cake, peek-a-boo) Provide bath toys, rattles, mirror, large ball, soft stuffed animals Encourage to sit unsupported Encourage to rock on hands and knees

6- to 8-year old Child: Sleep

Facilitate an individually appropriate sleep pattern; school-age children usually go to bed by 9pm and are up by 7pm If the child is not tired, advise the parent to allow quiet reading time in bed

6- to 8-year old Child: Nutrition

Follow dietary guideline-- recommended servings; teach the child how to keep track of servings and to give input to meal preparation Advise to avoid fast foods and to eat nutritious breakfast Watch calcium and iron intake Vitamin D supplementation 400 IU/day if consuming less than 1 L (33 oz) per day of milk and vitamin D-fortified foods

9-month-old Infant: Dental

Four teeth Brush erupted teeth with soft toothbrush and water Assess risk for dental caries

Nutitious Snakes

Fresh fruits, celery sticks with cheese spread, yogurt, bagels, carrot sticks, graham crackers, pretzels, puddlings

The 2-year-Old Child: Physical Measurements

Gains approximately 2.25 kg (5 lb) per year Length or height is approximately half eventual adult height Grows approximately 7.5 cm (3 inches) per year Compute and plot BMI

The 2-year-Old Child: Hygiene

Girls are prone to vaginal irritation; advise to wipe from front to back; adding 1/4 cup vinegar to bath water can relieve irritation Boys' foreskin begins to retract; retract gently to clean; never force

How to promote self-esteem in school-age children

Give your children household responsibilities according to their developmental level and capabilities. Set reasonable rules, and expect the child to follow them. Allow your child to solve problems and make responsible choices Give praise for what is praiseworthy. Do not be afraid to encourage your child to do better. Refrain from being critical, but gently point out areas that could be improved. Allow your children to make mistakes and encourage them to take responsibility for the consequences of their mistakes. Emphasize your child's strengths and help improve weaknesses. Do not do your children's homework for them because this will make them think you do not trust them to do a good job; provide assistance and suggestions when asked and praise their best efforts Model appropriate behavior toward others Provide consistent and demonstrative love

The 4- and 5-year-old Child: Focused assessment

Have you been able to encourage your child to be independent? Does your child's increasing independence create any anxiety or conflict for you? Is your child in preschool or daycare? How many hours or days? How does your child get along with other children the same age? How well does your child communicate with others? Do you have any concerns about your child's speech? Has your child's play become more imaginative? Does your child describe any fears? Can your child independently manage feeding, cleanliness, toileting, and dressing? Have you started giving your child small responsibilities or chores to do around the house? What activities do you enjoy doing together?

Cephalocaudal Pattern (Head to toe growth)

Head initially grows fastest (fetus), then trunk (infant), then legs (child). Infant can raise the head before sitting and can sit before standing

2-Month-Old Infant: Health Screening

Hearing screen if not done at birth; hearing risk assessment. Check eyes for strabismus. Assess ability to follow past midline

The 2-year-Old Child: Health Screening

Hemoglobin and lead screen Standardized developmental screening (now or at 30 mo) Autism-specific screening Fasting lipid screen for child with cardiovascular disease risk factors Tuberculosis (TB) screening if at risk

The 4- and 5-year-old Child: HEalth Screening

Hemoglobin and lead screening Vision Audiometry Blood pressure Fasting lipid screen if at risk Tuberculosis (TB) screening if at risk

12-month-old Infant: Health Screening

Hemoglobin/hematocrit if not done earlier Lead screen if not done earlier Hearing Risk assessment Tuberculosis (TB) Screening if at risk

9-month-old Infant: Immunizations

Hepatitis B #3 (can give between 6 and 18 months); omit if combination vaccine has been used previously Influenza vaccine annually Provide information about upcoming measles-mumps-rubella (MMR) and varicella vaccines

The 2-year-Old Child: Focused Assessment

How are you managing any discipline problems your child may be having? Do you have any concerns about any daycare arrangements you have? Does your child use a bottle or a cup? What do you do when your child has a temper tantrum? Do you feel confident about setting behavioral limits? How does your child communicate with others? What, if anything, have you done to begin toilet training your child? What activities do you enjoy doing together?

The 3-year-old Child: Focused Assessment

How are you managing any discipline problems your child may be having? Have you been able to encourage your child to be independent? Does your child's developing independence create anxiety or conflict for you? Is your child in preschool or daycare? How many hours or days? How does your child get along with other children the same age? How well does your child communicate with others? Do you have any concerns about your child's speech? How well is your child doing with toilet training? What activities do you enjoy doing together?

2-Month-Old Infant: Focused Assessment

How has your family adjusted to the baby? Are you able to plan time to give some individual attention to each of your other children? Are you getting enough opportunities to continue relationships and activities away from the baby? Will you describe your baby's behavior and general mood? Has your baby had any reaction to any immunizations? If so, what happened?

6- to 8-year old Child: Immunizations

If not given earlier, administer measles, mumps, and rubella (MMR)#2; varicela #2; diphtheria-tetanus-acellular pertussis (DTaP) #5 (if younger than 7 years; use Tdap if older then 7 years); and inactivated poliovirus (IPV) #4 Annual influenza vaccine Administer other immunizations if not up to date

2-Month-Old Infant: Play

Imitate vocalizations and smile Sing Change infant's environment Encourage rolling over

6- to 8-year old Child: Developmental Milestones- Gross Motor

Improved muscle mass and coordination allow for participation in a variety of sports and games

Proximodistal Pattern (From the center outward)

In the respiratory system, the trachea develops first in the embryo, followed by branching and growth outward of the bronchi, bronchioles, and alveoli in the fetus and infant. Motor control of the arms comes before control of the hands and hand control comes before finger control

6-month-old Infant: Health Screening

Initial lead screening risk assessment Hearing risk Assessment

9-month-old Infant: Health Screening

Lead risk assessment (routine lead screen at 9 or 12 mo, usually in conjunction with hemoglobin and hematocrit) Hemoglobin or hematocrit (screen at 9 or 12 mo) Formalized developmental screening Hearing risk assessment

Increasing nutritional intake

Limit to two nutritious snacks per day, and give only at toddler's request Limit to 4-6 oz of juice per day Introduce to fingers foods at age 8-10 mo, and continue to make these types of food available Limit to 16-24 oz of milk per day Keep mealtimes pleasant Do not force feed Do not feed children who can feed themselves

4-month-old Infant: Nutrition

Maintain breast feeding schedule Formula, 5-6 oz five or six times per day Bottle supplement if breastfeeding mother has returned to work Vitamin D supplementation 400 IU/day for breastfeeding infants and for formula-fed babies consuming few than 1 L (33 oz) per day

Industry vs Inferiority (6-11yr)

Mastering of useful skills and tools of the culture; learning how to play and work with peers. Characterized by competence

The 2-year-Old Child: Nutrition

May begin low-fat milk Daily diet: 2 or 3 cups of milk, two servings of protein, three small servings of vegetables, two servings of fruit, and six servings of bread Modify diet for children with elevated cholesterol (no more than 200 mg cholesterol/day, no more than 30% calories from fat and 7% from saturated fat); egg substitute, low-fat cheeses and meets, added fiber Decrease added fat and high-calorie, high-fat desserts; increase fruits, vegetables, and carbohydrates Vitamin D supplementation 400 IU/day if consuming less than 1 L (33 oz) per day of milk and vitamin D-fortified foods

12-month-old Infant: Nutrition

May begin whole milk (2-3 cups daily) Offer a variety of table foods from different food groups Vitamin D supplementation 400 IU/day if breastfed or taking less than 1 L (33 oz) per day of vitamin D fortified milk Begins to use table utensils Usually eats three meals and snacks Avoid giving foods high in salt and sugar Discuss highchair Safety

12-month-old Infant: Immunizations

Measles-mumps-rubella (MMR) #1; varcella vaccine #1 (may use combination MMRV vaccine); pneumococcal and Hib boosters (if not scheduled to be given at 15 mo); hepatitis B #3 (if not given previously) Influenza vaccine annually Hepatitis A #1

The 3-year-old Child: Self-Esteem and Competence

Model Appropriate Social Behavior Encourage your child to learn to make choices Help your child to express emotions appropriately Spend individual time with your child daily, and encourage your child to talk about the day's events Provide consistent and loving limits to help your child learn self-discipline

The 2-year-Old Child: Self-Esteem and Competence

Modeling appropriate social behavior Encouraging the child to learn to make choices helping the child to appropriately express emotions Spending individual time with the child daily Providing consistent and loving limits to help the child self-discipline Beginning toilet training only when the child is ready (dry for 2 hr, able to pull pants down, can use appropriate toileting words, can indicate the need to use the toilet)

The 4- and 5-year-old Child: Self-Esteem and Competence

Modeling appropriate social behavior; begin to include participation in religious services Encourage the child to learn to make choices Helping the child to express emotions appropriately Spending individual time with the child daily and encouraging the child to talk about day's events Providing consistent and loving limits to help the child learn self-discipline Encouraging curiosity, and providing formal learning experiences Establishing opportunities for the child to do small household chores Assessing the child's readiness for kindergarten entrance, and beginning to prepare the child for the school experience

9-month-old Infant: Hygiene

More vigilant cleanliness of diaper area as bladder volume increase Wash infant's hands and face frequently Keep toys clean

Stages of Growth and Development

Newborn- Birth-1 month Infancy- 1 month to 1 year Toddlerhood- 1 to 3 years Preschool age- 3 to 6 years School age- 6 to 11 or 12 years

9-month-old Infant: Sleep

Night waking diminishes if managed appropriately

6- to 8-year old Child: Health Screening

Objective hearing and vision screening Speech assessment for fluency Hemoglobin or hematocrit Urine for sugar and protein Blood pressure Fasting lipid screen if at risk Tuberculosis (TB) screening if at risk

The 3-year-old Child: Health Screening

Objective vision screening using appropriate chart Objective hearing screening with age-appropriate audiometric equipment Blood pressure measurement Hemoglobin, hematocrit, and lead screening Tuberculosis (TB) screening if at risk Fasting lipid screen if at risk

The 2-year-Old Child: Play

Parallel play; play begins to become imitative and imaginative Choose toys that are safe and durable: balls, picture books, puzzles with large pieces, sandbox toys, trucks, riding toys, household toys (e.g. broom, mop, carpet sweeper) Limit television viewing time

The 4- and 5-year-old Child: Play

Peak of imaginative play: Misbehavior projected onto inanimate objects or imaginary friend; participate in imaginary play; encourages curiosity and creativity Teach songs and nursery rhymes Read to the child frequently Teach basic skills of sports and games Provide playground equipment, household and garden tools, dress-up clothes, building and construction toys, art supplies, more sophisticated books and puzzles Limit television viewing time.

The 4- and 5-year-old Child: DEvelopmental Milestones

Personal/Social: Develops a sense of initiative; learns new skills and games; begins problem solving; develops a positive self-concept; develops a conscience; begins to learn right from wrong and good from bad (based on reward and punishment); learns to understand rules; identifies with parent of same gender, often closely imitating characteristics; aware of gender differences; independence in self-care; sociable and outgoing (might be aggressive or bossy); has an attention span of approximately 20 minutes Fine Motor: Proficient holding a crayon or pencils, draws purposefully; copies circle, cross, square, diamond, and triangle; draws a person with several body parts; drawing resemble familiar objects or people; may begin to write name or numbers; can tie shoelaces Language/Cognitive: vocabulary of 1500 words; begins to understand concepts of size and time (related to familiar events such as meals and bedtime); understands two opposites (e.g., same/different, hot/cold, big/little); can follow several directions consecutively; uses four-words sentences with prepositions (e.g., on, under, behind); defines five words, counts to five, names four colors; begins to see others' viewpoints; uses magical thinking; very imaginative; can complete an 8- to 10- piece puzzle Gross motor: hops on one foot or alternate feet; walks heel to toe (front and back); balances on each foot for longer time; begins to ride bicycle with training wheels; throws and catches a ball; walks downstairs using alternate feet

9-month-old Infant: Critical Milestones

Personal/Social: Feeds self finger foods; tries to get toys; looks at hands Fine motor: transfers; rakes a raisin or Cheerio; picks up and holds a small object in each hand Language/cognitive: Imitates sounds; says single syllables; begins to put syllables together Gross motor: no head lag; sits without support; stands holding onto furniture

4-month-old Infant: Developmental Milestones

Personal/Social: Loves moving faces; knows parents' voices Fine motor: grasps a rattle; follows past midline; brings hands to middle of the body. Language/ Cognitive: Laughs and squeals out loud; vocalizes; makes "ooh" sounds. Gross motor: Lifts head and chest 45-90 degrees when prone; head steady when sitting

The 15- to 18- month- Old Child: Developmental Milestones

Personal/Social: May exhibit negativism, ritualism, and increasing tolerance of separation from parents; undresses; begins temper tantrums when frustrated; may have a transition object; begins to understand gender differences Fine motor: turns book pages; begins to imitate vertical and circular strokes; vision 20/50 by 18 mo; drinks from a cup by holding it with two hands Language/Cognitive: increasing receptive language; begins to understand and say "no"; may begin to put two words together; can point to familiar objects; begins to use memory; understands spatial and temporal relations and increased object permanence; has a basic moral understanding (reward and punishment); understands simple directions; by 18 months has vocabulary of approximately 30 words ; holographic speech (uses single words with gestures to express whole ideas) Gross Motor: Walks with increasing confidence and begins to run; climbs stairs first by creeping, then walking with hand held; jumps in place; begins to throw a ball overhand without falling

2-Month-Old Infant: Critical Milestones

Personal/Social: Smiles responsively; looks at faces Fine Motor: follows to midline Language/cognitive: vocalizes making cooing or short vowel sounds; responds to a bell Gross motor: lifts head; equal movements

The 4- and 5-year-old Child: Critical Milestones

Personal/Social: puts on a t-shirt; washes and dries hands; names a friend Fine motor: imitates a vertical line; wiggles thumbs; builds a tower of eight cubes Language/cognitive: knows two adjectives (e.g., tired, hungry, cold); identifies one color; knows the use of two objects (e.g., cup, chair, pencil) Gross motor: Balances on each foot for 1 sec.; jumps forward; throws a ball overhead

2-Month-Old Infant: Developmental Milestones

Personal/Social: smiles spontaneously; enjoys interacting with others. Fine motor: Follows past midline; reflexes disappear Language/cognitive: Vocalizes "ooh" and "ah" sounds; attends to voices. Gross motor: Beginning head control when upright; lifts head 45 degrees onto forarms

The 3-year-old Child: Critical Milestones

Personal/social: Brushes teeth with help, puts on clothing, feeds a doll Fine motor: builds a tower of at least four to six cubes Language/cognition: points to and names four familiar pictures (cat, horse, bird, dog, man); speech understandable 50% of the time Gross motor: Throws a ball overhand; jumps; kicks a ball forward

The 3-year-old Child: Developmental Milestones

Personal/social: Puts on articles of clothing; brushes teeth with help; washes and dries hands using soap and water; notices gender differences and identifies with children of own gender; exhibits sexual curiosity, may begin to masturbate; knows own name and names one or more friends; increasing independence, may start preschool; ritualistic; understands taking turns and sharing but may not be ready to do so; begins to show fears (dark, shadows, animals) Fine motor: Vision approaches 20/20; builds a tower of at least eight blocks; begins purposeful drawing, can imitate a circle and a cross and draw a person with three parts; feeds self well. Language/Cognition: increasing vocabulary with intelligible speech, although dysfluency is common (thinks faster than can talk); names four familiar objects and begins to describe qualities or actions of objects; knows meaning of common adjectives (sleepy, hungry, hot); begins color identification; uses symbolic language; still egocentric; increased concept of time, space, causality; constantly asks "how" and "why" questions; can count to three; can tell full name, age, and gender. Gross Motor: jumps with both feet up and down and over a short distance; throws a ball overhand; catches large ball with both hands; balances on each foot for at least 2 seconds; begins to ride a tricycle

6-month-old Infant: Critical Milestones

Personal/social: Reaches for toy out of reach; looks at hands; smiles spontaneously. Fine motor: looks at raisin placed on contrasting surface; reaches out; follows completely side to side Language/cognitive: turns to rattle sound made of vision on each side; squeals; laughs Gross motor: rolls over both directions; no head lag; lifts head and chest completely

12-month-old Infant: Developmental milestones

Personal/social: Rolls or throws a ball with another person; explores; drinks from cup; indicates wants without crying Fine motor: Activity looks for hidden objects; puts blocks in containers; uses simple toys appropriately Language/cognitive: Names the appropriate parent; begins to say one to three single words; understands simple requests. Gross Motor: Stands alone for increasing lengths of time; stoops and recovers; walks holding onto a hand; may begin to walk alone and climb stairs (on knees)

9-month-old Infant: Developmental Milestones

Personal/social: Stranger wariness; waves bye-bye; plays social games; begins to indicate wants Fine motor: Beginning pincer grasp; actively searches for out-of-sight objects; bangs toys together Language/Cognitive: uses consonant and several vowel sounds; beginning to attach meaning to words; understands some symbolic language (blow a kiss); knows own name; says mama and dada specifically Gross motor: gets to a sitting position; pulls up to stand; creeps and crawls; walks holding on to furniture; may briefly stand alone

The 15- to 18- month- Old Child: Critical Milestones

Personal/social: begins to imitate; helps in the house; feeds self with increasing skins (still rotates the spoon, if used) and holds a cup Fine motor: Builds a tower with increasing number of blocks; scribbles; able to put a block in a cup Language/Cognitive: says 3 to 10 single words; can point to several body parts Gross Motor: walks well forward and backward; stoops and recovers

The 2-year-Old Child: Developmental Milestones

Personal/social: imitates household activities and begins to do helpful tasks; uses table utensils without much spilling; drinks from a lidless cup; removes a difficult article of clothing; begins developing sexual identity; is stubborn and negativistic: wants own way in everything; brushes teeth with help; is learning to walk; understands "soon" Fine motor: Puts blocks into a cup after demonstration; builds tower of four to six blocks; able to imitate a horizontal and circular stroke with a crayon; turns a doorknob; turns book pages one at a time, can unzip and unbutton Language/cognition: Has an approximately 300-word vocabulary, two-word sentences; points to six body parts and pictures of several familiar objects (e.g. bird, man, dog, plane); understands cause and effect, object permanence, sense of time; follows two-step directions, uses egocentric language (I, Me, mine) Gross motor: Stoops and recovers well; walks forward and backward; climbs stairs holding the railing; runs, jumps, kicks a ball

12-month-old Infant: Critical milestones

Personal/social: plays pat-a-cake; feds self; works to get a toy Fine motor: developed pincer grasp; bangs objects together; picks up two cubes Language/cognitive: Jabbers; combines syllables; mama/dada is nonspecific Gross motor: Stands briefly without support; gets to sitting position; pulls to stand

The 2-year-Old Child: Critical Milestones

Personal/social: removes one article of clothing; feeds a doll; uses a spoon or fork Fine motor: holds a pencil and spontaneously scribbles; dumps a raisin out of a bottle on command after demonstration; builds a two-block tower Language/cognitive: points to two pictures; says three to six words Gross motor: runs; walks up steps; kicks a ball forward

Summary of growth and development: The Infant 10-12 months

Physical- 12 month: birth weight triples; birth length increases by 50%. Head and chest circumference equal. Babinski reflex disappears. Motor- Gross- Can stand alone. Can walk with one hand held but crawls to get places quickly. Fine- Releases hold on cup. 10 month: finger-feeds self. 12 month: feeds self with spoon. Holds crayons to mark on Paper. 12 Months: Pincer grasp is complete. Psychosocial- Has mood changes. Quiets self. Is quieted by music. Tenderly cuddles toy. Sensory/Cognitive- Vision 20/40. Searches for hidden toy. Explores boxes, inserts objects in container. Symbol recognition is developing (enjoys books) Language/Communication- Can say two or more words. Says "Mama" or "Dada" specifically. Waves bye-bye. Begins to differentiate between words. Enjoys jabbering. Vocalization decreases when walking. Knows own name

Summary of growth and development: The Infant 4-5 months

Physical- Can breathe when nose is obstructed. Growth rate declines. Drooling begins in preparation for teething. Moro, tonic neck and rooting reflexes have disappeared. Motor- Gross- Plays with feet; puts foot in mouth. Bears weight when held in a standing position. Turns from abdomen to back. Fine- Begins reaching and grasping with palm. Hits at objects, misses. Psychosocial- Mouth is a sensory organ used to explore environment. Attachment is continuing process throughout infancy. Has increased interest in parent, shows trust, know parents. Shoes emotions of fear and anger Sensory/Cognitive- 4 months: brings hands together at midline. Vision 20/80. Begins to play with objects. Recognizes familiar faces. Turns head to locate sounds. Shows anticipation and excitement. Memory span is 5-7 min. Plays with favorite toys. Language/Communication- Crying becomes differentiated. Babbling is common. 4 months: begins consonant sounds: H, N, G, K, P, B. 5 months: makes vowel sounds: ee, ah, ooh.

Summary of growth and development: The Infant 8-9 months

Physical- Continues to gain weight, length. Patterns of bladder and bowel elimination begin to become more regular. Motor- Gross- Sits steadily unsupported. Can crawl and pull up. Fine- Pincer grasp develops. Reaches for toys. Rakes for objects and releases objects. Psychosocial- Stranger anxiety is at its height. Separation anxiety is increasing. Follows parents around the house Sensory/Cognitive- Beginning development of depth perception. Object permanence continues to develop. Uses hands to learn concepts of in and out. Language/Communication- Stringing together of vowels and consonants begins. First few words begin to have meaning (Mama, Dada, bye-bye, baby). Begins to understand and obey simple commands, such as, "Wave bye-bye." Responds to "No!" Shouts for attention

Summary of growth and development: The Infant 6-7 months

Physical- Weight gain slows to 1 pound (0.45kg) per month. Length gain of 1/2 inch (1.27cm) per month. Birth weight doubles; tooth eruption begins; chewing and biting occur. Maternal iron stores are depleted. Motor- Gross- Sits, leaning forward on hands; when supine, lifts head off table. Turns from back to abdomen. Fine- Transfers objects from one hand to the other. Picks up object well with the whole hand. Psychosocial- Smiles at self in mirror. Plays peek-a-boo. Begins to show stranger anxiety. Sensory/Cognitive- Can fixate on small objects. Adjust posture to see. Responds to name. Exhibits beginning sense of object permanence. REcognizes parents in other clothes, places. Is alert for 1 1/2-2 hours. Language/Communication- Produces vowel sounds and chained syllables. Begins to imitate sounds. Belly laughs. Babbles (one syllable) with pleasure. Calls for help. "Talks" to toys and image in mirror

Summary of growth and development: The Infant 1-2 months

Physical- fast growth; weight gain of 1 1/2 (0.68kg) per month and height gain of 1 in (2.54cm) per month during first 6 months. Upper limbs and head grow faster. Primitive reflexes present; strong suck and gag reflex. Obligated nose breather. Posterior fontanel closes by 2-3 months Motor- Gross- May lift head when held against shoulder, Head lag. Fine- Palmar grasp. 1 month: immediately drops objects placed in hand. Fist usually clenched (grasp reflex). 2 months: holds objects momentarily. Hands often open (grasp reflex fading) Psychosocial- Erickson's stage of trust vs. mistrust. Infant learns that world is good and "I am good." This stage is the foundation for other stages. Child is entirely dependent on parents and other caregivers. Needs should be met in a timely fashion. Touch is important Senory/Cognitive- Piaget's sensorimotor phase. 1 month: notes bright objects if in line of vision. Vision 20/100. Reflexes dominate behavior. 2 month: begins to follow objects Language/ Communication- Strong cry. Throaty sounds. Responds to human faces. 6-8 weeks: begins to smile in response to stimuli

Summary of growth and development: The Infant 3 months

Physical- primitive reflexes fading Motor- Gross- Can get hand to mouth. Can lift head off bed when in prone position. Head lag still present but decreasing. Fine- Holds objects placed in hands. Grasp reflex absent. Psychosocial- Smiles in response to others. Uses sucking to soothe self. Sensory/cognitive- Follows and object with eyes. Plays with fingers. Language/Communication- babbles, coos. Enjoys making sounds. Responds to voices, watches speakers

6-month-old Infant: Sleep

Place on back to sleep (infant may roll over to prone position) in a separate crib. Keep loose or soft bedding and toys out of the crib; offer pacifier for nap and bedtime. Can move to separate room Total sleep: 12-16 hours each day Sleeps all night; two or three naps Maintain sleep routine

2-week-old to 1-month-old Infant: Sleep

Place on back to sleep in parent's room in a separate crib/cradle/bassinet. Keep loose or soft bedding and toys out of the crib, offer pacifier for nap and bedtime if not breastfeeding or after breastfeeding is established. 16 or more hours by 1 month begin to establish nighttime routine

2-Month-Old Infant: Sleep

Place on back to sleep in parent's room in a separate crib/cradle/bassinet. Keep loose or soft bedding and toys out of the crib, offer pacifier for nap and bedtime. Continue nighttime routine. Play with baby when awake

4-month-old Infant: Sleep

Place on back to sleep in parent's room in a separate crib/cradle/bassinet. Keep loose or soft bedding and toys out of the crib; offer pacifier for nap and bedtime Total sleep 15-16 hr Encourage self-consoling techniques

General Activities for the School-Age Child

Play becomes organized with more direction Early school-age child continues dramatic play with increased creativity but loses some spontaneity Child is aware of rules when playing games Child begins to compete in sports

Generativity vs Stagnation (46-64yr)

Production of ideas and materials through work; creation of children; characterized by care

6- to 8-year old Child: Anticipatory Guidance

Provide health teaching to the child as well as to the parent

The 4- and 5-year-old Child: Anticipatory Guidance

Provide information and health teaching to the child as well as the parent.

The 15- to 18- month- Old Child: Play

Provide push-pull toys with short strings Noise-making toys Dolls and stuffed animals (watch for small parts) Musical toys Art supplies; large crayons, finger paints, clay Large blocks and balls

6- to 8-year old Child: Dental

Provide regular dental care every 6 mo Continue regular brushing with fluoride toothpaste and flossing (may need assistance with this) May need dental sealants as permanent molars erupt

Ego Integrity vs Despair (65+yr)

Realization that there is order and purpose to life; Characterized by wisdom

6- to 8-year old Child: Elimination

Regular bowel movements according to the child's pattern; treat constipation by increasing water intake and intake of fresh fruits and vegetables Occasional bed-wetting is within the norm; refer for more serious problems

12-month-old Infant: Elimination

Remains dry for longer periods Bowel movement decrease in number and become more regular

9-month-old Infant: Safety

Review Child-proofing, violence, exposure to cigarette smoke Discuss lowering crib mattress, household and plant poisons, burn prevention, sunscreen use, avoiding sources of lead

The 4- and 5-year-old Child: Safety

Review bicycle safety, playground safety, fire safety, poisoning (outside plants), pedestrian safety, automobile safety, sun protection May change to an approved booster seat if child has outgrown the forward-facing car safety seat Discuss gun safety, stranger awareness, good touch versus bad touch

4-month-old Infant: Safety

Review car safety and violence, exposure to cigarette smoke. Discuss choking hazards and management of choking ; avoidance of walkers; playpen and swing safety; begin child-proofing

The 15- to 18- month- Old Child: Safety

Review car safety, violence, falls, water safety, toy and toy box safety, bicycle passenger helmet, poisons Discuss choking, toy safety, firearm access, burn prevention, sun protection

The 3-year-old Child: Safety

Review choking on food, street safety, water safety, sun protection, outside poisons, playground safety Discuss bicycle and tricycle safety, fire safety, car seats (child should be in an approved forward-facing car safety seat until age 4 years or until larger than the manufacturer's recommended size and weight for the particular model)

6-month-old Infant: Safety

Review choking, walkers, violence, exposure to cigarette smoke Discuss child-proofing, drowning prevention, poison prevention

6- to 8-year old Child: Saety

Review gun safety; bicycle, skating, and scooter safety; playground safety; fire safety; automobile and pedestrian safety; water safety; sun protection; good touch vs bad touch, stranger awareness Discuss exposure to contact allergens (poison ivy, oak, sumac), tick checks, sports safety, use of reflective clothing if out at night

2-Month-Old Infant: Safety

Review house and environmental safety and conditions for call the doctor, posting of emergency numbers near the telephone, car safety, violence, avoidance of exposure to cigarette smoke. Discuss preventing falls; burns from hot liquids

12-month-old Infant: Safety

Review poisons, burns, violence, exposure to cigarette smoke Maintain the infant in a rear facing car safety seat Discuss falls, water safety, toy and toy box safety, bike passenger helmet

The 2-year-Old Child: Safety

Review toy safety, firearm safety, burn prevention, and other previously discussed subjects May change to an approved forward-facing child safety seat Discuss choking on food, street safety, water safety, outside poisons, playground safety, sun protection

Toys and Specific Types of Play: Preschooler

Riding toys, building materials such as sand and blocks, dolls, drawing materials, crayons, cars, puzzles, books, appropriate television and videos, nonsense rhymes, singing games, pretend play as something or somebody, dress-up, finger paints, clay, cutting, pasting, simple board and card games

The 3-year-old Child: Play

Similar to that of a 2 yo Likes imitative toys, large building blocks, musical toys, and riding toys such as large trucks Limit television viewing time

The 3-year-old Child: Sleep

Similar to that of a 2 yo May relinquish the nap Consider changing to a full bed if climbing out of the crib May begin to experience night terrors

The 3-year-old Child: Hygiene

Similar to that of a 2 yo Remind child about good handwashing, especially after toileting and before meals

The 3-year-old Child: Nutrition

Similar to that of a 2-yo Vitamin D supplementation 400 IU/day if consuming less that 1 L (33 oz) per day of milk and vitamin D-fortified foods

2-Month-Old Infant: Elimination

Six wet diapers Stools related to feeding method; may decrease in number

The 2-year-Old Child: Dental

Sixteen teeth; may use pea-size amount of fluoridated toothpaste, encourage not to swallow Parent should floss the child's teeth Schedule first dental visits if not done earlier

The 15- to 18- month- Old Child: Sleep

Sleep cycles decrease and the child has longer awake periods Still naps one or two times per day May resist going to bed; likes a bedtime routine

12-month-old Infant: Sleep

Sleeps through the night and has one or two naps

9-month-old Infant: Play

Social Games Provide cloth, cardboard, or plastic books Cuddle, rock, hug Ball rolling Pots and pans with wooden spoons Plastic stacking or nesting containers hide-and-seek games with toys

The 15- to 18- month- Old Child: Elimination

Sphincters become physiologically under voluntary control, but child is usually not ready for toilet training; advice parents to wait but discuss signs of readiness

The 15- to 18- month- Old Child: Health Screening

Standardized developmental screening Autism-specific screening Hearing risk assessment

6-month-old Infant: Elimination

Stools darken and become more formed as solids are increased

4-month-old Infant: Play

Talk with the baby frequently and from different locations Respond verbally and smile as infant does; cuddle Sing; expose to different environmental sounds Supervised water play Provide bright rattles, tactile toys, mirror

Centration

Tends to focus on only one aspect of an experience, ignoring other possible alternatives. Focuses on the dominant characteristic of an object, excluding other characteristics. Ex. May have difficulty putting together a puzzle, concentrating on only one detail of a piece (e.g., shape) and ignoring other qualities (e.g., color detail) Ex. Cannot follow more than one direction at a time

Common misconceptions about administration and safety of vaccines

The following conditions or circumstances are not contraindications to the administration of vaccines: -Mild acute illness with low-grade fever or mild diarrhea in an otherwise healthy child -A reaction to a previous dose of diphtheria-tetanus-acellular pertussis (DTaP) vaccine with only soreness, redness, or swelling in the immediate vicinity of the injection site

General Activities: Toddler

The toddler fills and empties containers, begins dramatic play, has increased use of motor skills, enjoys feeling different textures, explores the home environment, imitates orders, and likes to be read to and to look at books and television programs that are age-appropriate Toys should meet the child's need for activity and inquisitiveness The child also enjoys manipulating small objects such as toy people, cars, and animals

2-week-old to 1-month-old Infant: Immunizations

Thimerosal-free hepatitis B #1 at birth and #2 at 1-2 months. Be sure to discuss side effects. Give parents information about upcoming immunizations. If planning to use a combination vaccine that contains hepatitis B, wait until 2 months for second hepatitis B.

6- to 8-year old Child: Developmental Milestones- Fine Motor

Ties shoelaces, buttons and zips clothes, dresses and undresses without help; can print, draw, color well, model clay, and cut with scissors; visual acuity if fully developed

6-month-old Infant: Dental

Tooth eruption begins with lower incisors May have some pain and low-grade fever (<101 degrees F) May be fussy Clean teeth and gums with wet cloth Do not put to sleep with a bottle Assess risk for tooth decay; begin fluoride supplementation only for infants at risk

9-month-old Infant: Elimination

Urinary and bowel patterns consistent Appearance of undigested food in stools

The 3-year-old Child: Elimination

Usually is toilet trained but not at night

2-week-old to 1-month-old Infant: Health Screening

Verify that newborn metabolic and cystic fibrosis screening has been done. Verify that hearing screen has been done Visual inspection for congenital defects

Egocentrism

Views everything in relation to self; is unable to consider another's point of view ex. Toddler takes toy away from another child and cannot understand that the other child wants (or has a right to) the toy, too.

6- to 8-year old Child: Developmental Milestones- Language/Cognitive

Vocabulary expands; understands the different properties of language: plays on words, puns, mnemonics, jokes; adapts well to changing physical properties of objects (e.g., conservation, reversibility, identity); improved long-term memory; organizes concepts and classifies in several ways; uses various memory strategies to improve schoolwork

The 4- and 5-year-old Child: Physical Measurement

Weight increases 2.25 kg (5 lb) per year Height increases approximately 7.5 cm (3 inches) per year Compute and plot BMI

2-week-old to 1-month-old Infant: Physical measurements

Weight- 7.5-8 pounds (3.4-3.6 kg) average. Loses 10% of body weight after birth but gains it back by 2 weeks. Gains on average 1/2 oz a day. Length-Average 20 inches (50 cm). Gains 1 inch (2.5 cm) a months for the first several months Head Circumference- 13-14 inches (33-35.5 cm). Gains average of 1/2 inch (1.2 cm) per month until 6 months of age. Posterior fontanel closes by 2-3 moths, anterior by 12-18 months.

12-month-old Infant: Focused Assessment

What approaches to discipline have you and your partner discussed and agreed on? Is your baby able to follow directions and carry out requests? Have you assessed your home and environment for sources of lead?

6-month-old Infant: Focused Assessement

What kind of new activities is your baby doing? Have you begun to give your baby solid foods? How is any child care working out? What have you done about child-proofing your home?

9-month-old Infant: Focused assessment

What kind of new activities is your baby doing? How has your baby reacted to solid foods? Do you live in a house built before 1978? Do you live near sources of environmental lead? Does your baby regularly come in contact with someone uses lead? Do you have a family member who has had lead poisoning?

4-month-old Infant: Focused Assessment

What new activities is your baby doing? How well does your baby settle down to sleep without needed to be consoled? How are both parents included in the baby's care? Is the mother considering going back to work in the near future?

The 15- to 18- month- Old Child: Focused Assessment

What new activities is your child doing? Can your child say single words? Put words together? Understand most of what you say? Communicate needs and wants? What kinds of foods does your child eat and how often? Do you have concerns that your child is eating items hat are not food? Is your child able to eat with little assistance? Is your child walking well? Running? Jumping? Getting up and down the stairs? How does your child behave when frustrated? How do you and your partner handle this? What kinds of activities do you enjoy doing with your child?

Physical development and play

aids in the development of both fine and gross motor activity. Children repeat certain body movements in turn aid in development of body control

Dramatic play

allows children to act out roles and experiences that may have happened to them, that they fear will happen, or that they observed in others. Spontaneous or guided and often includes medical or nursing equipment. Especially valuable for children who have had or will have multiple procedures or hospitalizations. Nurse will either choose to observe or be interactive with play

Parallel Play

associated with toddlers, although can be found in any age group. Children play side-by-side with similar toys, but there is a lack of interactive activity

Emotional development and play

can be a way of coping with emotional conflict. Play can be away to determine what is real and what is not. As significant others in lives respond to their initiation of play, children begin to learn that they are important and cared for

Associative Play

characterized by group play with out group goals. Do not set group rules and although they may all be playing with the same types of toys and may even trade toys, there is a lack of formal organization. Begins in toddlerhood and continues into preschool age

Moral development and play

children engage in play with their peers and their families, begin to learn which behaviors are/ are not acceptable. Taking turns is rewarded and cheating is not. Group play assists in recognizing the importance of teamwork, sharing, and being aware of the feeling of others

4-month-old Infant: Hygiene

continue daily routine of cleaniness

4-month-old Infant: Physical Measurements

continue to measure and plot length, weight, and head circumference posterior fontanel closed.

Social development and play

infant begins to play with others and things, a realization of self and others begins to develop, begins to experience joy of interacting with others and soon initiates behavior that involves others. Play make-believe allow child to try on different roles. Child learns boundaries, taking turns, teamwork and competition, also learn to negotiate with different personalities and the feelings associated with winning and losing

Sensorimotor (Functional or practice play)

involves repetitive muscle movements and the introduction of deliberate complication into the way of doing something. Infant plays with objects, making use of their properties (falling, making noises) to produce pleasurable effects

4-month-old Infant: Dental

may begin drooling in preparation for tooth eruption

2-Month-Old Infant: Physical measurements

measure length, weight, and head circumferences and plot on appropriate growth charts

6-month-old Infant: Developmental milestones

personal/social: Interacts readily and noisily with parents and familiar people; may be cautious with strangers Fine motor: Rakes objects with the whole hand; begins to transfer; mouths; can hold an object in each hand Language/cognitive; Begins to imitate sounds (raspberries, clucking, kissing); babbles; says single sounds; beginning object permanence; awareness of time sequence. Gross motor: tripod sitting unsupported; gets on hands and knees; bears full weight on legs; "swims" when prone

Onlooker play

present when the child observes other playing, although child may ask question of the players, does not attempt to join the play, usually during the toddler years but can be observed at any age

Colic

refers to unexplained paroxysmal crying or fussing. Most infants outgrow symptoms of colic by 3 to 4 months of age.

4-month-old Infant: Eliminations

similar to 2-month-old

Cognitive development and play

takes place as the child begins to have certain experiences, test beliefs, and understands the surrounding world. Also can increase their problem-solving abilities through games and puzzles. Pretend play can stimulate several types of learning. Language abilities are strengthened as the models significant others in role playing. Also increase their understanding of size, shape, and texture through play

Symbolic Play

uses games and interactions that represent an issue or concern to be addressed - Three elements- One or more objects, a theme or plan, and roles Games include rules and are usually played by more than one person, although can be played by oneself. Children learn to play by the rules and take turns. Older children have games with specific rules Younger children tend to change the rules

methods used to assess growth and development

• As children grow and develop, wide variations within normal limits occur. Nurses can reassure parents about normal variations in development and identify problems early, so developmental delays can be addressed as soon as possible. • Weight, length (or height), and head circumference are used to monitor growth and should be measured at regular intervals during infancy and childhood. • Developmental surveillance is performed at every well visit and includes eliciting and paying attention to parent concerns, keeping a documented developmental history, identifying protective and risk factors, and directly observing the child's development. • A formal developmental screening with a sensitive and specific screening instrument is performed when the child is 9 months, 18 months, and 24 to 30 months of age.

Various factors that affect growth and development

• As children grow and develop, wide variations within normal limits occur. Nurses can reassure parents about normal variations in development and identify problems early, so developmental delays can be addressed as soon as possible. • Weight, length (or height), and head circumference are used to monitor growth and should be measured at regular intervals during infancy and childhood. • Genetics, environment, culture, nutrition, health status, and family structure affect a child's growth and development.

Discuss the components of a nutritional assessment.

• Carbohydrates, fats, proteins, water, vitamins, and minerals are the basic nutrients in food. • A nutritional assessment should include anthropometric data, biochemical data, clinical examination, and dietary history.

Erikson's Stages of Psychosocial Development

• Erikson's theory of psychosocial development describes a series of crises emerging at specific times in a particular order. These stages occur throughout life, and each must be resolved for an individual to progress emotionally.

Discuss the etiology and prevention of childhood injuries.

• Injury prevention is a relatively new focus of health promotion. The term accident, which implies random chance or lack of responsibility, has been replaced with injury, which implies that causes can be identified and behaviors can be modified to prevent injuries.

classifications and social aspects of play

• Piaget described three types of play related to the periods of sensorimotor, preoperational, and concrete operational functioning: practice play, symbolic play, and games. • Play enhances the child's growth and development, contributing to physical, cognitive, emotional, and social development.

recommendations for scheduled vaccines.

• The manufacturer's packaging insert for vaccines includes recommendations for handling, storage, administration site, dosage, and route. Nurses responsible for handling vaccines should be familiar with storage requirements to minimize the risk of vaccine failures. • When a lapse in immunization occurs, the entire series does not have to be restarted. • In general, children who are immunologically compromised should not receive live bacterial or viral vaccines.