ATI Nursing Care of Children

What is instrumental exchange?

"I'll help you if you'll help me"

number of doses for Haemophilus influenzae type B (Hib)

-4 (ActHIB, MenHibrix or Pentacel) -3 (PedvaxHib or COMVAX)

minimum age for Haemophilus influenzae type B (Hib)

-6 weeks (all except Hiberix) -12 months (Hiberix)

Haemophilus influenzae type B (Hib) considerations

-Administer Hiberix as a booster dose at 12 months-4 years old only if a prior dose of Hib was received -Only 1 dose is recommended for children who are 15 months or older, and not immunized

Hepatitis B (HepB) schedule

-Birth -1-2 months -6-18 months

Human papillomavirus (HPV) considerations

-HPV2, HPV4, HPV9 are approved for females -HPV4 and HPV 9 are approved for males

LAIV precautions

-Occurrence of Guillain-Barre syndrome w/in 6 weeks of prior influenza vaccine -treatment w/antiviral medication w/in 48 hr prior to immunization (avoid taking antivirals for 14 days following immunization) -certain chronic conditions

Tetanus, diphtheria, and acellular pertussis (Tdap); tetanus and diphtheria (Td) considerations

-administer one dose to adolescents who are pregnant (w/each pregnancy) regardless of timing of previous Td or Tdap vaccine (btwn 27 and 36 weeks gestation) -Booster w/Td every 10 years after administration of Tdap -Administer Tdap or Td according to recommendations for wounds other than clean, minor if 5 years old or longer since previous dose of tetanus toxoid

Measles, mumps, rubella (MMR) considerations

-administer one dose to infants age 6-11 months if traveling internationally. However, a two-dose series is still recommended starting at 12-15 months -dose 2 of the series can be given prior to age of 4 years if it has been at least 4 weeks since 1st dose

Hepatitis A (HepA) considerations

-administer the final dose 6-18 months after the 1st dose -two-dose series is recommended for anyone over the age of 2 years who needs immunity to hepatitis A virus

RV precautions

-chronic GI disease -spina bifida -bladder exstrophy -immunocompromised (other than SCID)

purpose of immunizations

-decrease or eliminate certain infectious diseases in society -prevent infectious diseases and their complications

Pneumococcal conjugate (PCV13) considerations

-give one time dose to children who are 14-59 months and received age-appropriate dosing of PCV7 -follow current recommendations for dual vaccinations series w/PCV13 and PPSV 23 for children who have high-risk conditions

RV contraindications

-history of intussusception -Severe combined immunodeficiency (SCID)- a rare inherited disorder

MMR precautions

-history of thrombocytopenia or thrombocyopenic purpura -anaphylactic reactions to eggs, gelatin, or neomycin -transfusion w/blood product containing antibodies w/in the prior 11 months -simultaneous tuberculin skin testing

RV adverse effects

-irritability -mild temporary diarrhea or vomiting -intussusception

LAIV contraindictions

-less than 2 years old -pregnancy

Rotavirus (RV) considerations

-maximum age of 1st dose is 14 weeks, 6 days -maximum age of last dose is 8 months, 0 days -series should not be initiated for children 15 weeks, 0 days or older

Hepatitis B (HepB) considerations

-minimum of 4 weeks btwn doses 1 and 2 -minimum of 8 weeks btwn doses 2 and 3 -final dose no earlier than age of 24 weeks of age and at least 16 weeks after 1st dose -Should be withheld for infants born prematurely and weighing less than 2,000 g if mom is negative for HepB

Diphtheria, tetanus, and acellular pertussis (DTaP) considerations

-minimum of 6 months btwn doses 3 and 4 -dose 4 can be given as early as 12 months of age -dose 5 dose is not needed if dose 4 was given at age 4 or older

Inactivated influenza vaccine (IIV) considerations

-must be 2 years or older to get live, attenuated influenza vaccine (LAIV) -children who have medical conditions that predispose them to influenza should not receive LAIV -administer starting w/availability, usually in early fall -administration recommendations can change yearly b/c the vaccine is created w/different influenza strains each year

DTaP precautions

-occurrence of Gillain-Barre syndrome w/in 6 weeks of prior dose of tetanus toxoid -Progressive neurologic disorders- uncontrolled seizures -Fever 40.6 C (105 F) or higher w/in 48 hr of prior dose -shock-like state w/in 48 hr of prior dose -seizures w/in 3 days prior to dose -inconsolable crying for 3 hr or more w/in 48 hr of prior dose

VAR contraindications

-pregnancy -anaphylactic reaction to gelatin or neomycin

HPV2 contraindications

-pregnancy -severe allergy to latex

HPV4 and HPV9 contraindications

-pregnancy -severe allergy to yeast

MenACWY adverse effects

-redness and tenderness at the injection site -fever

HPV4 and HPV9 adverse effects

-redness, swelling, tenderness at infection site -mild to moderate fever -headache -fainting (shortly after receiving vaccine)

HPV2 adverse effects

-redness, swelling, tenderness at injection site -temp of 37.7 C (99.9 F) or higher -headache -fatigue -nausea, vomiting, abdominal pain -myalgia -fainting (shortly after receiving vaccine)

Hib adverse effects

-redness, swelling, warmth and tenderness at injection site -fever greater than 37.8 C (101 F) -vomiting, diarrhea, crying

PCV13 adverse effects

-swelling, redness, and tenderness at injection site -fever -irritability -drowsiness -anorexia

IIV adverse effects

-swelling, redness, and tenderness at injection site -hoarseness -fever -malaise -headache -cough -aches -increased risk for Guillain-Barre syndrome -increased risk of seizures in young children receiving PCV13 and/or DTaP simultaneously

HepA adverse effects

-tenderness at injection site -headache -anorexia -malaise

HepB adverse effects

-tenderness at injection site -temp of 37.7 C (99.9 F) or higher

VAR precautions

-transfusion w/blood product containing antibodies w/in the prior 11 months -treatment w/antiviral medication w.in 24 hrs prior to immunization (avoid taking antivirals for 14 days following immunization) -treatment w/corticosteroids, or other medications that affect the immune system, for 2 weeks or longer -cancer

LAIV adverse effects

-vomiting, diarrhea -cough -fever -headache -malaise -nasal congestion, runny nose

number of doses for Meningococcal conjugate (MenACWY)

1 dose

Injury Prevention: Falls

1. Doors and windows should be kept locked. 2. Crib mattresses should be kept in the lowest position with the rails all the way up. 3. Safety gates should be used across the top and bottom of stairs.

Injury Prevention: Poisoning

1. Exposure to lead paint should be avoided. 2. Safety locks should be placed on cabinets that contain cleaners and other chemicals. 3. The phone number for a poison control center should be kept near the phone. 4. Medications should be kept in childproof containers, away from the reach of toddlers. 5. A working carbon monoxide detector should be placed in the home.

Injury Prevention: Motor-vehicle injuries

1. Infants and toddlers remain in a rear-facing car seat until the age of 2 years or the height recommended by the manufacturer. 2. Toddlers over the age of 2 years, or who exceed the height recommendations for rear-facing car seats, are moved to a forward-facing car seat. 3. Safest area for infants and children is the backseat of the car. 4. Do not place rear-facing car seats in the front seat of vehicles with deployable passenger airbags.

Injury Prevention: Suffocation

1. Plastic bags should be avoided. 2. Crib mattresses should fit tightly. 3. Crib slats should be no farther apart than 6 cm (2.375 in). 4. Pillows should be kept out of cribs. 5. Drawstrings should be removed from jackets and other clothing.

Injury Prevention: Bodily harm

1. Sharp objects should be kept out of reach. 2. Firearms should be kept in locked boxes or cabinets. 3. Toddlers should not be left unattended with any animals present. 4. Toddlers should be taught stranger safety.

Injury Prevention: Aspiration of foreign objects

1. Small objects (grapes, coins, candy) that can become lodged in the throat should be avoided. 2. Toys that have small parts should be kept out of reach. 3. Age-appropriate toys should be provided. 4. Clothing should be checked for safety hazards (loose buttons). 5. Balloons should be kept away from toddlers. 6. Parents should know emergency procedures for choking.

Injury Prevention: Burns

1. The temperature of bath water should be checked. 2. Thermostats on hot water heaters should be turned down to 49° C (120° F) or below. 3. Working smoke detectors should be kept in the home. 4. Pot handles should be turned toward the back of the stove. 5. Electrical outlets should be covered. 6. Toddlers should wear sunscreen when outside.

Injury Prevention: Drowning

1. Toddlers should not be left unattended in bathtubs. 2. Toilet lids should be kept closed. 3. Toddlers should be closely supervised when near pools or any other body of water. 4. Toddlers should be taught to swim.

minimum age for Tetanus, diphtheria, and acellular pertussis (Tdap); tetanus and diphtheria (Td)

10 years

Human papillomavirus (HPV) schedule

11-12 years 1-2 months after first dose 24 weeks after first dose

Meningococcal conjugate (MenACWY) schedule

11-12 years 16 years (booster)

number of doses for Tetanus, diphtheria, and acellular pertussis (Tdap); tetanus and diphtheria (Td)

11-12 years then a booster every 10 years (Td)

minimum age for Measles, mumps, rubella (MMR), Varicella (VAR), and Hepatitis A (HepA)

12 months

Measles, mumps, rubella (MMR) and Varicella (VAR) schedule

12-15 months 4-6 years

Hepatitis A (HepA) schedule

12-23 months 6-18 months following

Girls stop growing around __ to __ years of age

16 to 17

Boys stop growing around __ to __ years of age.

18 to 20

School-aged children grow about _ inches per year.

2

number of doses for Rotavirus (RV)

2 (RV1) or 3 (RV5) doses

Rotavirus (RV) dosing schedule

2 and 4 months (Rotarix [RV1]) OR 2, 4, and 6 months (RotaTeq [RV5])

number of doses for Measles, mumps, rubella (MMR), Varicella (VAR), and Hepatitis A (HepA)

2 doses

Diphtheria, tetanus, and acellular pertussis (DTaP) schedule

2 months 4 months 6 months 15-18 months 4-6 years

Pneumococcal conjugate (PCV13) schedule

2 months 4 months 6 months 12-15 months

Haemophilus influenzae type B (Hib) schedule

2 months 4 months 6 months (only if four-dose series) 12-15 months (booster dose w/any Hib-containing vaccine)

Inactivated poliovirus (IPV) schedule

2 months 4 months 6-18 months 4-6 years

minimum age for Meningococcal conjugate (MenACWY)

2 months (MenACWY-CRM) 9 months (MenACWY-D)

Adolescents gain the final __ to __ % of height during puberty.

20 to 25

number of doses for Hepatitis B (HepB)

3 doses

number of doses for Human papillomavirus (HPV)

3 doses

number of doses for Pneumococcal conjugate (PCV13) and Inactivated poliovirus (IPV)

4 doses

Immunizations

4 to 6 years- Diphtheria and tetanus toxoids and pertussis (DTaP); measles, mumps, and rubella (MMR); varicella; and inactivated poliovirus (IPV). Yearly seasonal influenza vaccine.

School-aged children gain about _ to _ pounds per year.

4 to 7

number of doses for Diphtheria, tetanus, and acellular pertussis (DTaP)

5 doses

minimum age for Inactivated influenza vaccine (IIV)

6 months

minimum age for Rotavirus (RV), Diphtheria, tetanus, and acellular pertussis (DTaP), Pneumococcal conjugate (PCV13), and Inactivated poliovirus (IPV)

6 weeks

minimum age for Human papillomavirus (HPV)

9 years

A nurse is talking with parents of a school-age child who describe several issues that concern them. Which of the following problems the parents verbalized should the nurse identify as the priority for further assessment and intervention? A. "We just don't understand why our son can't keep up with the other kids in simple activities like running and jumping." B. "Our son keeps trying to find ways around our household rules. He always wants to make deals with us." C. "We think our son is trying too hard to excel in math just to get the top grades in his class." D. "Our son is always afraid the kids in school will laugh at him because he likes to sing and write little poems."

A

A nurse is planning diversionary activities for children on an inpatient pediatric unit. Which of the following should the nurse incorporate as appropriate play activities for school-age children? (Select all that apply.) A. Building models B. Playing video games C. Reading books D. Using toy carpentry tools E. Shaping modeling clay

A, B, C

A nurse at an elementary school is planning a health promotion and primary prevention class. Which of the following topics are appropriate to include for the parents of school-age children? (Select all that apply.) A. Childhood obesity B. Substance use disorders C. Scoliosis screening D. Front-seat seatbelt use E. Stranger awareness

A, B, C, E

A nurse is preparing a wellness presentation for families at a community center. When discussing health screenings for adolescents, which of the following information about scoliosis should the nurse include? (Select all that apply.) A. Scoliosis is more common among girls than it is among boys. B. Loss of height is often the first sign of scoliosis. C. Scoliosis screening is essential during the adolescent growth spurt. D. Slouching is a common cause of scoliosis, especially in adolescents. E. Scoliosis is a forward curvature of the spine.

A, C

A nurse is planning diversionary activities for children on an inpatient pediatric unit. Which of the following should the nurse incorporate as appropriate play activities for preschoolers? (Select all that apply.) A. Assembling puzzles B. Pulling wheeled toys C. Using musical toys D. Using finger paints E. Coloring with crayons

A, C, E

A nurse is caring for a 5-year-old client whose parents report that she fears painful procedures, such as injections. Which of the following strategies should the nurse use to try to help ease the child's fear? (Select all that apply.) A. Invite the child to assist with mealtime activities. B. Cluster invasive procedures whenever possible. C. Assign caregivers with whom the child is familiar. D. Have the parents bring in a favorite toy from home. E. Engage the child in pretend play with a toy medical kit.

A, D, E

Misconceptions in thinking during this stage include:

Artificialism- Everything is made by humans. Animism- Inanimate objects are alive. Imminent justice- A universal code exists that determines law and order.

A nurse is talking with parents of a preschooler who describe several issues that concern them. Which of the following problems the parents verbalized should the nurse identify as the priority for further assessment and intervention? A. "Our son will only eat a few things, like burgers and bananas, and pretty much refuses everything else." B. "Our son has these temper tantrums every time we tell him to do something he doesn't want to do." C. "We think our son truly believes that his toys have personalities and talk to him, especially at night." D. "We feel bad when we see our son trying so hard to button his shirt. We just tell him this is something he'll just have to learn to do."

B

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with the parents of two preschoolers. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Haemophilus influenzae type b B. Varicella C. Polio D. Hepatitis A E. Seasonal influenza

B, C, E

A nurse is reviewing the Centers for Disease Control and Prevention's (CDC's) immunization recommendations with the parents of an adolescent. Which of the following recommendations should the nurse include in this discussion? (Select all that apply.) A. Rotavirus B. Varicella C. Herpes zoster D. Human papilloma virus E. Seasonal influenza

B, D, E

A nurse on a pediatric unit is caring for an adolescent who has multiple fractures. Which of the following interventions are appropriate for this client? (Select all that apply.) A. Suggest that his parents room in with him. B. Provide a television and DVDs for him to watch. C. Limit visitors to immediate family. D. Devise a regular schedule for inpatient routines. E. Allow him to perform his own morning care.

B, E

A nurse is talking with an adolescent who describes having difficulty dealing with several issues. Which of the following problems the client verbalized should the nurse identify as the priority for further assessment and intervention? A. "I kind of like this girl in my class. She doesn't like me back, though, not that way." B. "I like hanging out with the guys in the science club, but the jocks pick on them." C. "I just don't seem to be any good at anything. I can't play any sports at all." D. "My dad wants me to be a lawyer like him, but I don't want to learn all that stuff."

C

A nurse is talking with the father of a 12-year-old boy who is concerned that he hasn't observed any indications that his son is approaching puberty. The nurse should explain that the first sign of sexual maturation in boys is A. the appearance of downy hair on the upper lip. B. hair growth in the axillae. C. enlargement of the testes and the scrotum. D. deepening of the voice.

C

A nurse is talking with the father of a 4-year-old child who states that his daughter goes to bed at 8:30 p.m. and wakes up at about 7:30 a.m., but she often lies in bed talking to herself or gets up a few times before falling asleep 40 min later. At her preschool, the children take a 2-hr afternoon nap. Which of the following recommendations should the nurse make to help improve the child's sleep behavior? A. Offer the child a snack of her favorite treat right before bedtime. B. Allow the child to watch an extra 30 min of TV in the evening. C. Change the child's bedtime to 9 p.m. on days she napped. D. Request that the preschool staff limit her nap time to 1 hr.

C

A nurse is talking with the parents of a 10-year-old child who express concern that their son is suddenly becoming secretive, for example, closing the door when he showers, dresses, and does his homework in his room. Which of the following responses by the nurse is appropriate? A. "Perhaps you should try to find out what he is doing behind those closed doors." B. "Suggest that he leave the door ajar for his own safety." C. "At this age, children tend to become more modest and value their privacy." D. "Tell him it's okay to close the door when he is undressed, but he has to do his homework where you can see him."

C

A nurse is reviewing nutritional guidelines with the parents of an 11-year-old child. Which of the following parents' statements should indicate to the nurse that they understand the guidelines for school-age children? A. "She wants to eat as much as we do, but we're afraid she'll soon be overweight." B. "She skips lunch sometimes, but we figure it's okay as long as she has a healthy breakfast and dinner." C. "We limit fast-food restaurant meals to three times a week now." D. "We reward her school achievements with a point system instead of a pizza or ice cream."

D

What are age-appropriate activities for toddlers?

Filling and emptying containers Playing with blocks Looking at books Push-pull toys Tossing balls Finger paints Large-piece puzzles Thick crayons

3 years old

Gross: Rides a tricycle; jumps off bottom step; stands on one foot for a few seconds.

5 years old

Jumps rope; is capabel of walking backward with heel to toe; moves up and down stairs easily.

Language Development

Language increases to about 300 words by the age of 2 years. 1 year - use one-word sentences, or holophrases 2 years - use multiword sentences by combining two to three words 3 years - combine several words to create simple sentences using grammatical rules

MMR adverse effects

Mild: -Local reactions (rash, fever, swollen glands in cheeks and/or neck) Moderate: -Joint pain and stiffness lasting for days-weeks -febrile seizure -low platelet count Severe: -Transient thrombocytopenia -deafness -long-term seizures -brain damage

VAR adverse reactions

Mild: -Tenderness and swelling at injection site -fever -rash (mild) possible for up to 1 month after vaccination Moderate: -seizures Severe: -pneumonia -low blood count (extremely rare) -severe brain reactions (extremely rare)

DTaP adverse effects

Mild: -redness, swelling, tenderness at injection site -low fever -behavioral changes (drowsiness, irritability, anorexia) Moderate: -Inconsolable crying for 3 hrs or more -Fever 40.6 C (105 F) or higher -Seizures (w/or without fever) -Shock-like state Severe: -acute encephalopathy (rare)

Identify the developmental stage

Piaget: Preoperational Stage Erikson: Autonomy vs. shame and doubt

Piaget

Preschoolers are still in the preoperational phase of cognitive development. They participate in preconceptual thought (from 2 to 4 years of age) and intuitive thought (from 4 to 7 years of age).

Intuitive thought

Preschoolers can classify information and become aware of cause-and-effect relationships.

4 years old

Skips and hops on one foot; Throws ball overhead.

Time

The preschooler begins to understand the concepts of the past, present, and future. By the end of the preschool years, the child may comprehend days of the week.

Weight

The preschooler should gain about 2 to 3 kg (4.5 to 6.5 lb) per year.

Height

The preschooler should grow about 6.2 to 7.5 cm (2.5 to 3 inches) per year.

Language

The preschooler's vocabulary continues to increase. The preschoolers can now speak in sentences, is able to identify colors, and enjoys talking.

Nutrition

Toddlers begin developing taste preferences, and are generally picky eaters who repeatedly request their favorite foods.Physiologic anorexia occurs, resulting in toddlers becoming fussy eaters because of a decreased appetite. Toddlers should consume 24 to 30 oz of milk per day, and may switch from drinking whole milk to drinking low-fat milk after 2 years of age. Juice consumption should be limited to 4 to 6 oz per day. Trans fatty acids and saturated fats should be avoided. Diet should include 1 cup of fruit daily. Food serving size should be 1 tbsp for each year of age, or ¼ to 1/3 of an adult portion. Toddlers generally prefer finger foods because of increasing autonomy. Regular meal times and nutritious snacks best meet nutrient needs. Snacks or desserts that are high in sugar, fat, or sodium should be avoided.Foods that are potential choking hazards (nuts, grapes, hot dogs, peanut butter, raw carrots, tough meats, popcorn) should be avoided. Adult supervision should always be provided during snack and mealtimes. Foods should be cut into small, bite-size pieces to make them easier to swallow and to prevent choking. Toddlers should not be allowed to engage in drinking or eating during play activities or while lying down.

Hib contraindications

age younger than 6 weeks

HepB contraindications

anaphylactic allergy to yeast

PCV13 contraindications

anaphylactic reaction ot any vaccine containing diphtheria toxoid

IPV contraindications

anaphylactic reaction to neomycin, streptomycin or polymyxin B

minimum age for Hepatitis B (HepB)

birth

In adolescence, plans for ______ and ______ begin to solidify.

career and college

Adolescents are capable of __________ reasoning.

deductive

Varicella (VAR) considerations

dose 2 of the series can be given prior to the age of 4 years if it has been at least 3 months since the 1st dose

______ disorders commonly develop during adolescence, more in girls that boys.

eating

Inactivated poliovirus (IPV) considerations

final dose should be administered on or after the age of 4 years and at least 6 months from the previous dose

Meningococcal conjugate (MenACWY) considerations

follow recommendations for earlier administration to children who have high-risk considerations or who travel to areas w/hyperendemic or epidemic rates of meningococcal disease

Adolescents are _________ orientated.

future

Adolescents' stage of psychosocial development is _______ vs ________ according to Erikson.

identity vs role confusion

The first sign of physical sexual maturation in boys is typically

increase in size of testes and scrotum

School-aged children's stage of psychosocial development, according to Erikson is _________ vs________

industry vs inferiority

HepB precautions

infant weights less than 2 kg (4 lbs, 6.4 oz)

What are the nutrients that tend to be deficient during adolescence?

iron, calcium, vitamins A and C

Scoliosis is a __________ curvature of the spine.

lateral

Can school-aged children be belted safely in the front seat?

no

Does the CDC recommend immunizations against pneumococcal infections for all school ages children?

no

Is food an appropriate reward for school-aged children?

no

IIV precautions

occurrence of Guillain-Barre syndrome w/in 6 weeks of prior influenza vaccine

DTaP contraindications

occurrence of encephalopathy w/in 7 days following prior doses of the vaccine

____ ______________ develop as a support system.

peer relationships

HepA precautions

pregnancy

IPV precautions

pregnancy

MMR contraindications

pregnancy

Changes related to _________ begin in both girls and boys.

puberty

HepA contraindications

severe allergy to latex

IPV adverse effects

tenderness of injection site

The first sign of physical sexual maturation in girls is typically

the appearance of breast buds

number of doses and schedule for Inactivated influenza vaccine (IIV)

yearly

Does the CDC recommend immunization against the human papillomavirus?

yes

If a 10 year old boy is suddenly becoming secretive, should the nurse advise the parent to allow the child to keep their bedroom door closed?

yes

Is it appropriate for an 11 year old child to eat the same amount of food as an adult?

yes

Is scoliosis most evident during adolescence?

yes

Identify all physical development that occurs in this stage

• Anterior fontanels close by 18 months of age. • Weight - At 30 months of age, toddlers should weigh four times their birth weights. • Height - Toddlers grow about 7.5 cm (3 in) per year. • Head circumference and chest circumference are usually equal by 1 to 2 years of age

Identify the cognitive development that occurs in this stage

• Piaget - The sensorimotor stage transitions to the preoperational stage around the age of 19 to 24 months. • The concept of object permanence becomes fully developed. • Toddlers have and demonstrate memories of events that relate to them. • Domestic mimicry (playing house) is evident. • Preoperational thought does not allow for toddlers to understand other viewpoints, but it does allow them to symbolize objects and people to imitate previously seen activities

Psychosocial Development: Erikson- Autonomy versus Shame and Doubt

■ Independence is paramount for toddlers, who are attempting to do everything for themselves. ■ Toddlers often use negativism, or negative responses, as they begin to express their independence. ■ Ritualism, or maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them.

Immunizations

■12 to 15 months - Inactivated poliovirus (IPV) (third dose between 6 to 18 months); Haemophilus influenzae type B (Hib); pneumococcal vaccine (PCV); measles, mumps, and rubella (MMR); and varicella ■12 to 23 months - Hepatitis A (Hep A), given in two doses at least 6 months apart ■15 to 18 months - Diphtheria and tetanus toxoids and pertussis (DTaP) ■12 to 36 months - Yearly seasonal trivalent inactivated influenza vaccine (TIV); live, attenuated influenza vaccine (LAIV) by nasal spray (at 2 years of age)