UWorld Pediatrics: Growth and Development

What is valproate (depakote) use in pregnancy linked to?

Can cause neural tube defects such as spina bifida

What are some milestones/developmental expectations for a 4 year old?

Catching ball 50% of time Hopping on one foot Copy or draw square

The nurse is providing care to a 9-year-old client who is awaiting surgery. Which intervention is developmentally appropriate for this client's plan of care?

Discuss he procedure with the patient using simple diagrams and using correct anatomical terms - During preprocedural education, the nurse should use developmentally appropriate methods of teaching. Using simple diagrams with correct anatomical terminology appropriately meets the psychosocial (ie, sense of industry) and cognitive needs (ie, concrete thinking) of school-aged children.

The nurse is caring for a preschool-age child whose grandparent died 3 days ago. Which intervention is inappropriate?

Do not mention the death when the child is present

How much do infants gain per week?

During the first 6 months, infants should grow 5-7 oz (140-196 g) a week. From age 6-12 months, infants should grow 3-5 oz (84-140 g) a week.

The nurse is caring for a 7-month-old client during a well-child visit. Which of the following gross motor skills should the nurse expect to identify at this age?

1) Bears weight on feet with support 2) Sits using hands for extra support

A nurse is performing an assessment of a 12-month-old child. Which of the following findings would the nurse expect?

1) Birth weight is tripled 2) Fully developed pincer grasp 3) Sits from standing position

The nurse in a clinic is obtaining a developmental history of an 18-month-old during a well-child visit. Which activities should the child be able to perform? *** See chart on toddler development in google docs

1) Goes up stairs while holding a hand 2) Turns 2 pages in a book at a time

A nurse on a pediatric unit is reviewing interventions for a toddler with a practical nurse who will be caring for this child. Which of the following are appropriate activities to minimize the effect of hospitalization on a toddler?

1) Integrate preffered snack foods into day's routine 2) Plan quiet play prior to nap time 3) Provide 1 or 2 options for toys

The nurse is performing a well-child assessment on a sleeping 2-month-old client. Organize the assessment in the correct order based on the developmental age of the client.

1) Observe skin color and respiratory pattern 2) Auscultate heart and lungs 3. Palpate fontanelles and abdomen 4) Assess pupillary response 5) Elicit Moro reflex

When does the anterior fontanelle close?

18 months

When does the posterior fontanelle close?

2 months

When can an infant turn from abdomen to back?

4 months

The nurse assesses 4 infants. Which assessment finding would require follow-up by the health care provider?

6 month old with birth weight of 7 lb 3 oz who know weighs 12 lbs - Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months. - At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months.

When can an infant turn from back to abdomen?

6 months

When does stranger anxiety begin?

6 months

What milestones should an infant have accomplished at 18 months?

An 18-month-old should have a vocabulary of at least 10 words and be able to use a spoon. They should also be able to hold and drink from a cup.

A 15-year-old parent brings a 4-month-old infant for a well-baby checkup. The parent tells the nurse that the baby cries all the time; the parent has tried everything to keep the infant quiet but nothing works. What is the priority nursing action?

Assess the infants pattern and frequency of crying

The parents of a hospitalized 3-month-old have to leave the infant while they work. One parent fears that the baby will cry as soon as they walk out. The nurse teaches both parents about separation anxiety. Which statement by the parent indicates that the teaching has been effective?

At this age, our baby will not cry because we are leaving.

The nurse is providing teaching to the parents of a child with Marfan syndrome. Which topic is the priority for the nurse to address?

Avoiding participation in contact sports - Aortic root disease (ie, aneurysm, dissection) is the major cause of morbidity and mortality in Marfan syndrome. Therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death.

The nurse is assessing a 3-month-old during a well-child visit. Which developmental finding should the nurse expect to observe in the client?

Infant kicks legs and smiles when someone familiar comes into view

In what form do infants play?

Infants play alone (solitary)

The public health nurse conducts a teaching program for parents of infants. Which statement by a participant indicates that teaching has been successful?

My infant should be able to pick up small finger foods by 10 months - the pincer grasp develops at 8-10 months

The public health nurse has received a referral to make a follow-up home visit to a 1-year-old recently diagnosed with failure to thrive (FTT). Which intervention is the priority nursing action for this child?

Observe the child feeding - FTT is generally defined as weight less than 80% of ideal for age and/or depressed weight for length, correcting for gestational age, sex, and special medical conditions. - Observation of the child while being fed may provide information related to the cause of inadequate dietary intake, including disturbances in feeding behavior and psychosocial factors.

A 15-year-old client with type 1 diabetes mellitus (DM) is admitted to the pediatric intensive care unit with a blood glucose level of 460 mg/dL (25.5 mmol/L). The nurse understands that which factor is contributing to this client's noncompliant behavior?

Patient's psychosocial development stage - Adolescence in psychosocial development is marked by risk-taking behaviors, a sense of invincibility, the need for independence, and a strong connection to peers.

What age group experiences guilt the most? (thinks illness is caused by bad behavior)

Preschool-aged children (3-5 years)

What play behavior would the nurse be most likely to observe in a group of 4-year-old children?

Preschoolers (age 3-6) enjoy associative play, in which children engage in the same type of activity, but the play is unorganized without specific goals or rules.

The nurse cares for a 4-year-old who is on long-term, strict bed rest. Which toy is most appropriate to provide diversion and minimize developmental delays?

Preschoolers enjoy imitative games

The nurse is caring for a 10-year-old diagnosed with osteomyelitis. What is the best activity the nurse can suggest to promote age-specific growth and development during hospitalization?

Provide missed schoolwork - According to Erikson's stages of psychosocial development, school-age children (6-12) deal with the conflict of industry versus inferiority. - During this stage, unlike other developmental stages, learning is a priority and completing school work provides a sense of accomplishment and satisfaction.

What activities do the different age groups enjoy?

Puzzles would be more appropriate for the school-age child (6-12 years). Stacking blocks would be more appropriate for the toddler (age 1-3 years). 3-6 year olds (preschoolers) enjoy coloring on masks Maintaining contact with peers is important to teenagers.

The nurse is caring for a school-age child with a history of long-term, low-dose lead exposure. For which clinical finding is the client at risk?

Reading disability This may cause elevated blood lead levels, leading to neurological impairment, anemia, and gastrointestinal (eg, constipation) or renal complications in children.

How do school age children play?

School age children play together with a common goal (cooperative)

When does separation anxiety begin?

Separation anxiety starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years

At what age can an infant move from prone position to sitting?

the ability to move from a prone to a sitting position is not expected until age 10 months.

A 10-year-old weighs 99 lb (44.9 kg) and has a BMI of 24.8 kg/m2 (>95th percentile). Which is the most important assessment for the nurse to make before initiating a weight loss plan?

the family's readiness for change

A nurse in a pediatric clinic is performing a physical examination of a 30-month-old child. Which finding requires further evaluation?

Current weight is 6 times greater than birth weight - Weight gain slows during the toddler years with an average yearly weight gain of 4-6 lb (1.8-2.7 kg). By age 30 months, current weight should be approximately 4 times greater than birth weight.

What is considered a high lead level in young children?

elevated BLLs (≥5 mcg/dL [0.24 µmol/L])

A nurse in a clinic is talking with a parent about the onset of puberty in boys. What is the first sign of pubertal change that occurs?

Testicular enlargement

The nurse is teaching a group of new parents about oral hygiene for their children. One of the parents asks, "When should I take my child to the dentist?" What would be the best response from the nurse?

The first visit should be when the child's first tooth appears

When can common allergenic foods (eggs, peanut products, and fish) be introduced?

These may be introduced along with other foods starting at age 4-6 months.

When can infants transfer objects from one hand to the other?

This fine motor skill develops between 6-9 months

In what form do toddlers play?

Toddlers play next to each other (parallel)

The clinic nurse reviews teaching provided to the parent of a child being considered for growth hormone replacement therapy at home. Which statement by the parent indicates that teaching has been effective?

Treatment will require a daily injection under the child's skin

The parent of an 8-year-old client asks the nurse for guidance on how to help the client cope with the recent death of the other parent. When developing a response to the parent, the nurse considers that a school-aged child is most likely to do what?

Understand death is permanent but be curious about it

The parent of a 1-year-old says to the nurse, "I would like to start toilet training my child as soon as possible." What information does the nurse provide to the parent that correctly describes a child's readiness for toilet training?

Your child may be ready to start toilet training when they can communicate and follow directions

What is cigarette use in pregnancy linked to?

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

What are risk factors for failure to thrive?

poverty, lack of structured meal times, negative attitudes toward food, domestic violence, and substance abuse.