PEDIATRICS - UWorld

Trisomy 18

(Edwards syndrome) Def: is a chromosome anomaly characterized by severe cardiac defects and multiple musculoskeletal deformities. - Life expectancy for trisomy 18 is a few weeks after birth, neonates rarely survive to their first birthday. - End-of-life issues should be discussed early after the diagnosis is confirmed.

Trisomy 13

(Patau syndrome) results in early death - End-of-life issues and palliative care should be discussed early after the diagnosis is confirmed.

Holosystolic murmur

(heard during entire systole phase) at the left lower sternal border is a classic sign of a ventricular septal defect (VSD). Although abnormal, most small VSDs close spontaneously within the first 6 months of life.

Milia

(white papules) form due to plugged sebaceous glands and are frequently found on the nose and chin. They resolve without treatment within several weeks

Techniques of feeding a baby with cleft palate

- Hold the infant in an upright position, which promotes passage of formula into the stomach and decreases the risk of aspiration - Tilt the bottle so that the nipple is always filled with formula. Point down and away from the cleft. - Use special bottles and nipples, including cross-cut and preemie nipples and assisted delivery bottles. These devices allow formula to flow more freely, decreasing the need for the infant to create suction. Using a squeezable bottle allows the caregiver to apply pressure in rhythm with the infant's own sucking and swallowing - These infants swallow large amounts of air during feeding and so need to be burped more often to avoid stomach distension and regurgitation - Feeding slowly over 20-30 minutes reduces the risk of aspiration and promotes adequate intake of formula. - Feeding every 3-4 hours; more frequent feedings may be tiring for the infant and the mother. Some infants may need to be fed more frequently if they are not consuming adequate amounts of formula.

Signs of increased ICP in children

- Increased head circumference - Wide, bulging fontanelle - Prominent scalp veins - Sunset eyes (sign of CNVI palsy- paralysis of upward gaze; acute delayed sign more likely to be noted after the fontanels have closed posterior by 2 months and anterior by 18 months)

Toilet & Bladder Training

- development of neuromuscular maturity with voluntary control of the anal and urethral sphincters occurring at age 18-24 months. Bowel training is less complex than bladder training Bladder training: requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years. Readiness determined by: - Ambulate to and sit on the toilet Remain dry for several hours or through a nap - Pull clothes up and down - Understand a two-step command - Express the need to use the toilet (urge to defecate or urinate) - Imitate the toilet habits of adults or older siblings - Express an interest in toilet training - The child should have the ability to remain on the toilet for about 5 - 8 mins without getting off or crying.

What is the form of play for each age group: 0-6mo 6-9mo 9-12mo 1-3 yr

0-6mo: muscle mobile (remove when child can sit up) or any toy that is soft and large 6-9mo: cover/uncover toy, anything large they cannot swallow 9-12mo: talking toy, purposeful (e.g. rolling ball back and forth) - Always ask? is it safe, is it appropriate, is it feasible - with less than 9mo avoid words like build, make, construct, sort, stack 1-3 yr: push/pull toy, gross motor - parallel play (with another child but playing alone) Pre-schooler 3-6yrs: fine motor and balance - pretend play, cooperative play (together) School Age 7-11yrs: Creative, Collecting, Competitive Adolescents 12-18yrs: Peer associated, allow them in each others rooms unless contagious, immunosuppressed or fresh post-op

At birth if the mother was addicted to a substance always assume the newborn is in _____. If 24 hrs after birth, assume the baby is in? Ater 72 hrs of alcohol withdrawal a small minority may get?

1. Intoxication 2. Withdrawal - Downer: difficult to console, exaggerated startle, seizure risk, high pitch cry 3. Delirium Tremens (which can kill you)

When is a child able to play interactive games like peek-a-boo?

10-12mo clients age 8 months typically play solitary by maneuvering and teething soft toys

During the school-age years (6-12), sleep needs of a child depend on health status, activity level, and age. Required hours of sleep is _____-

11 hours of sleep daily at age 5 and 9 hours at age 12 - Children are often unaware of their level of fatigue. - Bedtimes should be established to prevent fatigue the next day. - Bedtime issues are usually not a concern, although many children retain bedtime rituals such as reading or listening to music. Quiet activity (eg, coloring, reading) prior to bedtime should be planned to promote restful sleep. Growth rate is slowed during the school-age years, which accounts for variations in sleep needs.

Normal newborn head circumference

12.5-14.5 in (32-37 cm). Head circumference <12.5 in or >14.5 in should be reported to the HCP

Anterior fontanelles close at

18 months

Alcohol poisoning in children can occur within _______ after consumption. Clinical indications include

30 minutes or less confusion, vomiting and seizures, difficulty breathing, flushed or pale skin, and coma secondary to low blood sugar.

Common allergenic foods (e.g. eggs, fish, peanut products) may be introduced at age ______

4-6 months

Shaken Baby Syndrome (SBS)

Abuse head injury, severe physical child abuse resulting from violent shaking of an infant by the arms, legs, or shoulders and causes bleeding within the brain or the eyes Vague & non-specific clinical findings: - vomiting, irritability, lethargy, inability to suck or eat, seizures, inconsolable crying - no external signs of trauma except occasional small bruises on the chest or upper arms where the child was held during the shaking episode Most-common reasons caregivers seek medical attention with SBS - breathing difficulty, apnea, seizures, lifelessness - typically do not offer hx of trauma or report episodes of shaking

Kawasaki Disease

Acute vasculitis that l/t formation of coronary artery abnormalities and aneurysms Etiology: unknown KD has 3 phases: 1. Acute - sudden onset of high fever that does not respond to antibiotics or antipyretics. The child becomes very irritable and develops swollen red feet and hands. The lips become swollen and cracked, and the tongue can also become red (strawberry tongue). 2. Subacute - skin begins to peel from the hands and feet. The child remains very irritable. 3. Convalescent - symptoms disappear slowly. The child's temperament returns to normal. Characteristics: 1. Polymorphous rash of the trunk and extremities - Cool compresses, unscented lotions, and loose-fitting clothing can minimize discomfort with rash 2. Lymphadenopathy (usually a single palpable anterior cervical node >1.5 cm) and splenomegaly 3. Irritability (esp during the acute phase d/t fever and inflammation) - Parents should be advised that irritability can last up to 2 months 4. Temporary joint pain and other manifestations of arthritis (eg, stiffness, decreased range of motion) - May occur and persist for several weeks. - ROM exercises and warm baths will help reduce these symptoms and minimize discomfort 5. Desquamation (skin peeling) of the hands and feet - Peeling itself is not painful but that the new skin underneath may be red and sore. 6. Coronary artery aneurysms which can l/t MI and death 7. Mucocutaneous lymph node syndrome: ≥5 days of fever, bilateral nonexudative conjunctivitis, mucositis, cervical lymphadenopathy, rash, and extremity swelling Dx: - most cases in infants and toddlers - KD is the leading cause of acquired cardiac disease in children - Echocardiography is used to monitor these CV complications Tx: Intravenous immunoglobulin (IVIG) and aspirin (anti platelet, anti-inflammatory) is used to prevent coronary aneurysms and subsequent occlusion. IVIG does is not used to treat the rash, lymphadenopathy or splenomegaly - Educate parents on risk for Reye syndrome CPR should also be taught to parents of children with coronary artery aneurysms Monitor for symptoms of HF: decreased UO, additional heart sounds, tachycardia, difficulty breathing

Parenting Styles

Authoritarian: highly controlling, expects to be obeyed, inflexible rules Authoritative: sets reasonable limits on behavior, encourages growing autonomy of child, open communication Permissive: few or no restraints, unconditional love, much freedom, little guidance, no limit setting Indifferent: no limit setting, lacks affection for the child, focused on own life

Symptoms of hypoglycemia in infant born less than 24 hrs ago

BG of <2.2 Jitters, cyanosis, tremors, pallor, poor feeding, retractions, lethargy, low oxygen saturation, and seizures.

Assessment order for infants

Before handling the infant, the nurse first observes the infant for activity level, skin color, and RR and pattern to obtain findings during a calm state Auscultation is performed next while the infant is still quiet, allowing the nurse to hear sounds clearly Palpation and percussion are then performed while the infant remains relatively still. This allows the nurse to accurately assess the abdomen while the abdominal muscles are relaxed. The fontanelles are also palpated while the infant is calm, as crying can cause temporary bulging Traumatic procedures (eg, examine eyes, ears, mouth) are performed near the end of the assessment after completing any procedures that require accurate observation or counting Elicitation of the Moro reflex is performed last because the infant is usually awake and moving around by this point

Pediatric Oncology - how to prevent compassion fatigue

Compassion fatigue: nurses who care for dying children experience many of the same feelings that the child's family does, resulting in stress Coping strategies to enhance self-care and grief resolution - attending memorial service - taking time off from work - utilizing personal and professional support systems (e.g. spouse, employee assistance programs, experienced mentors) - maintain good health through adequate rest, regular exercise and proper nutrition - maintain objectivity, but sometimes appropriate to share personal emotions or loss/sadness with the family of a dying child. honesty/personal connection supports the coping process for the nurse and family. - personal contact with the family of the deceased child for an extended period after loss is helpful for the nurse & family during grieving

Mongolian spots

Congenital dermal melanocytosis (Mongolian spots) are an expected finding. These are seen on the lower back and/or buttock more often in African American, Asian, Hispanic, and Native American infants. Although they can be mistaken for bruising and the size and location should be documented, they are not a concerning finding and usually disappear by school age.

When you auscultate a newborn's chest you should hear ______

Crackles (rales) indicate fluid in the lungs and are expected immediately after birth. Rales will clear as the neonate transitions to extrauterine life. However, wheezes, stridor, or persistence of crackles after the first few hours of birth are abnormal and should be report

Fecal incontinence

Def: (ie, encopresis, soiling) refers to the repeated passage of stool in inappropriate places by children age ≥4 years. >80% of cases, d/t functional constipation (retentive type) 20% of cases, d/t psychosocial triggers (nonretentive type). Management of fecal incontinence/constipation primarily includes 3 components: 1. Disimpaction followed by prolonged laxative therapy 2. Dietary changes (increased fiber and fluid intake) 3. behavior modification (promote and restore regular toileting habits and to gain the child's cooperation and participation in the treatment program) Behavioral interventions include the following: - Regularly schedule toilet sitting times 5-10 minutes after meals for 10-15 minutes - Provide a quiet activity for the child during toilet sitting, which will help pass the time and make the experience more "enjoyable" - Initiate a reward system to boost the child's participation in the treatment program; the reward would be given for effort, not for success of evacuation in the toilet (children with retentive encopresis have dysfunctional anal sphincters and little control over bowel movements; giving a reward for something the child has no control over would not be effective) - Keep a diary or log of toilet sitting times, stooling, medications, and episodes of soiling to evaluate the success of the treatment

Hydrocephalus

Def: A disturbance of the ventricular circulation of the cerebral spinal fluid in the brain which increases cranial pressure. S/S: - Bulging with palpation of the anterior fontanel - Dilated scalp veins - High-pitched cry, irritability, seizures - Setting Sun Sign (sign of increased ICP) - increase in head circumference - vomiting, excessive sleepiness, poor feeding Tx: Insertion of a VP (ventriculoperitoneal shunt) Post-op Care: 1) Measure the head/occipital circumference 2) Fontanel and cranial suture line assessment 3) Monitor the temperature 4) Supine positioning Hydrocephalus is often associated with a myelomeningocele. When an infant is born with Spina Bifida, protect the meningocele, do not let it rupture! The baby should be lying prone?. Cover the sack with a moist sterile normal saline dressing so it won't dry out while waiting for surgery.

Developmental dysplasia of the hip (DDH)

Def: a range of various hip abnormalities that may be present at birth or develop during the first few years of life. Risk factors: breech birth, large infant size, and family history. S/S: 1) Extra inguinal or thigh fold on affected side, asymmetric hip folds 2) Laxity of hip joint on affected side (disappear after age 2-3mo if not treated) - Ortolani Maneuver: abduction with anterior lifting of the hip - Barlow Maneuver: adduction with posterior pressure on the hip Additional s/s: - limited hip abduction occurs as contractors develop (>3mo) - affected leg may be shorter (in one-sided DDH) If left untreated: - notable limp, walking on the toes, positive Trendelenburg sign (pelvis tilts down on unaffected side when standing on the affected leg) - waddling gait, severe lordosis (if bilateral DDH) Interventions to reduce risk: - Proper swaddling technique - infants should be swaddled with their hips bent up (flexion) and out (abduction), allowing room for hip movement - Choosing infant carriers or car seats with wide bases - infant seats should allow for proper hip positioning in an abducted manner - Avoiding any positioning device, seat, or carrier that causes hip extension with the knees straight and together - Narrow infant carriers prevent proper hip abduction, putting a strain on the hip ligaments and possibly leading to DDH. - Double/triple diapering is no longer recommended as a preventive measure for DDH. This practice can cause extension of the hip, leading to abnormal development. - Infant swings, bouncers, wraps, and other similar items can cause the legs to be positioned straight and together, which can increase the risk for DDH. DDH is instability or dislocation of the hip joint that may be present at birth or develop during the first few years of life. Nonsurgical treatment methods such as the Pavlik harness are most successful when initiated during the first 6 months of life. After this time, surgery is generally required. The Pavlik harness is the most common tool used to treat early DDH. It maintains the infant's hips in a slightly flexed and abducted position (ie, legs bent and spread apart), allowing for proper hip development (Option 4). Pavlik harnesses are typically worn for 3-5 months or until the hip joint is stable. The straps are assessed every 1-2 weeks by the health care provider (HCP) and adjusted as necessary to account for infant growth. However, parents should not alter the strap placements at home as incorrect positioning can lead to damage to the nerves or vascular supply of the hip (Option 2). Care of the infant wearing a Pavlik harness includes the following: Assess skin 2-3 times daily for redness or breakdown under the straps (Option 3) Dress the child in a shirt and knee socks under the harness to protect the skin Apply diapers underneath the straps to keep the harness clean and dry Leave the harness on at all times, unless otherwise indicated by the HCP

Cystic Fibrosis

Def: an inherited autosomal recessive disorder of the exocrine glands that results in physiologic alterations in the respiratory, gastrointestinal, and reproductive systems. Patho: chloride transport alternation and resulting thickened/stickier mucus inhibit normal ciliary action and cough clearance, and the lungs become clogged with mucus. The thickened mucus harbors bacteria. Over time, airways develop chronic colonization and frequent respiratory infections result. Features - sinusitis and chronic cough r/t inability to clear the airway of sticky respiratory secretions - barrel chest r/t WOB - cachectic (physical wasting with loss of weight and muscle mass): maintaining weight is challenge d/t malabsorption of carbs, fats and proteins caused by impaired enzyme secretions in the GI tract. May also indicate lung infection. - Bronchiectasis (chronic lung disease) and recurrent lung infections (e.g. pneumonia) - at risk for rupture of damaged alveoli= pneumothorax (sudden worsening dyspnea, tachypnea, tachycardia, drop of O2 sats) - hemoptysis d/t damage to blood vessels in the airway walls secondary to infections, resolves with tx of infection - decreased O2 sats d/t damage to the lungs, 90% requires intervention - biliary cirrhosis, pancreatic exocrine insufficiency; CF related diabetes - digital clubbing r/t hypoxia - Fecal retention and impaction, inspissated stool (intestinal obstruction): d/t decreased water and salt secretions into the intestines - absent vas deferens Tx: - Bronchial hygiene therapy, such as manual chest physiotherapy - For physiotherapy, various positions are used, and this should be performed before meals to avoid a full stomach and resultant regurgitation or vomiting - High caloric diet, enteral feedings In cystic fibrosis (CF), a defective protein responsible for transporting sodium and chloride causes exocrine gland secretions to be thicker and stickier than normal. Sticky respiratory secretions accumulate, resulting in an inability to clear the airway and a chronic cough. Clients eventually develop chronic lung disease, which predisposes to recurrent infections. Chest physiotherapy (eg, percussion, vibration, postural drainage) helps open airways and break up secretions; for greater efficacy, physiotherapy is performed after bronchodilators and nebulizers (Option 1). Physical exercise enhances clearance of mucus and improves cardiovascular and muscular function. Clients are encouraged to remain as active as their condition allows (Option 5). Thick secretions block pancreatic ducts, resulting in inadequate pancreatic enzymes entering the bowel to aid digestion and nutrient absorption. Clients with CF require supplemental pancreatic enzymes with all meals and snacks, as well as supplementation of multiple vitamins (especially fat-soluble vitamins A, D, E, and K) (Option 4). (Option 2) Some clients with CF may not experience typical symptoms of lung infection (eg, fever, chest pain). The presence of anorexia, weight loss, and decreased activity levels may indicate infection and should be reported to the health care provider for management (eg, antibiotics, airway clearance therapy). (Option 3) A diet high in calories, fat, and protein is required to meet growth needs.

Hirschsprung Disease (HD) - def - symptoms - complication - tx - msg

Def: child born with some sections of the distal large intestine missing nerve cells, rendering the internal anal sphincter unable to relax. = no peristalsis, stool is not passed Symptoms of distal intestinal obstruction - failure of internal anal sphincter relaxation (tight anal sphincter) - distended abdomen - will not pass meconium within the expected 24-48 hrs - difficulty feeding - vomit green bile - enlarged colon (megacolon) - ganglionic segment lacks nerve cells and causes distal intestinal obstruction Complication Hirschsprung enterocolitis (inflammation of the colon) --> sepsis --> death - presentation: fever, lethargy, explosive foul-smelling diarrhea, rapidly worsening abdominal distension Tx - surgical removal of the defective section of bowel - colostomy may be required Nsg - Abdominal girth measurements: report increasing abd. girth - monitor for signs of enterocolitis

Spina bifida occulta

Def: defect where the bones that protect the meninges and spinal cord fail to close during gestation S/S: sacral dimple

Pyloric Stenosis

Def: gradual hypertrophy of the pylorus until symptom onset at age 3-5 weeks. - common in first-born boys and the etiology is unclear S/S - postprandial projectile vomiting (ejected up to 3 feet) followed by hunger (eg, "hungry vomiter") --> clearly distinguished from the "wet burps" infants have due to a weak lower esophageal sphincter - The emesis is nonbilious as the obstruction is proximal to the bile duct - Infants have poor weight gain - Often dehydrated (eg, sunken fontanelle, decreased skin turgor, delayed capillary refill). Dx: The amount of milk consumed (particularly with bottle feedings) along with the mother's technique (mainly adequate burping) should be assessed to ensure there is no excessive air swallowing or overfeeding as an etiology.

Autism spectrum disorders (ASDs)

Def: neurodevelopmental disorders with abnormal functioning before the age of 3 There are 2 core symptoms 1. abnormalities in social interactions and communication (verbal and nonverbal) - lack communication skills during the first 2 yrs of life - healthy 2 yr old should have vocal of 300 words, be able to string 2 or more words together in a meaningful phrase - assess language skills 2. patterns of behaviour, interests or activities that can be restricted and repetitive Each child with ASD has unique communication needs, which the nurse should incorporate into an individualized plan of care. When performing a procedure on a child with ASD, the nurse should engage the following communication techniques to ease the child's anxiety and increase cooperation: - Provide brief, concrete, and developmentally appropriate communication or demonstrations, explaining each step during the procedure. - Children with ASD may respond to pictures, as they tend to be visually oriented - Encourage caregivers to remain near the child to provide comfort and reassurance - Reduce stimulation by limiting the number of staff members in the room - Introduce staff or equipment slowly, preferably with caregivers nearby. - Children with ASD may experience stress in response to touching and eye contact. Limit physical contact until conferring with the child's caregiver to assess which actions are soothing and which may trigger behavioral outbursts. Facilitate a calming enviro: - quiet or monotone voice - eye contact, gestures carefully - moving slowly - limiting visual clutter - maintain minimal light - provide child with a single object to focus on - private room away from noise (eg. playroom, nursing station)

Intussusception

Def: one section of bowel telescopes over another, which can block the passage of intestinal contents, interrupt blood supply, and cause intestinal tears (perforation) S/S - intermittent cramping and progressive abdominal pain - inconsolable crying, drawing up the legs toward the abdomen in a child age 6-36months - currant jelly stool (from blood or mucus) and vomiting Tx: - emergency - air enema

Meningocele

Def: saclike protrusion through a bony defect that contains meninges and cerebrospinal fluid Tx: surgery (in some children, residual bowel and bladder incontinence can result despite surgery)

SIDS

Def: the sudden unexplained death of an infant age <1 year. It is the leading cause of death among infants, with the highest occurrence at 2-4 months. Risk factors: prone or side sleeping position, tobacco smoke exposure before/after birth, co-sleeping in adult bed, premature birth/low birth weight, overheating during sleep, soft sleep surface; bumper pads, toys & loose pillows/blankets Protective Factors: supine sleeping position, breast-feeding, pacifier use during sleep, up to date vaccinations, appropriate clothing (e.g. sleep sack), firm sleep surface, removal of loose items from bed *Pacifier use has been associated with an increased risk of otitis media and early cessation of breastfeeding; however, its use is also associated with a dramatic reduction in SIDS. Because the data is more beneficial for SIDS reduction, pacifiers can be used at naptime and bedtime for newborns once the breastfeeding technique has been well established (age 1 month).

Failure to Thrive (FTT)

Def: weight less than 80% of ideal for age and/or depressed weight for length, correcting for gestational age, sex and special medical conditions Cause: inadequate dietary intake Contributing factors: disturbance in feeding behaviour and psychosocial factors Nsg Observation - Child feeding or when hungry will provide the nurse the opportunity to identify potential factors contributing to insufficient intake. The nurse can observe the type of food being offered, the quantity of food consumed, how the child is held or positioned while being fed, the amount of time for feeding, the parent's response to the child's cues, the tone of the feeding, and the interaction between the child and the parent Additional observations - overall parenting skills - 24 dietary intake - check the child's height, weight, and head circumference

Trisomy 21

Down Syndrome Characteristics - Simian crease: straight palmar crease horizontally across Decreased or poor muscle tone. Short neck, with excess skin at the back of the neck (nuchal fold) Flattened facial profile and nose. Small head, ears, and mouth. Upward slanting eyes, often with a skin fold that comes out from the upper eyelid and covers the inner corner of the eye Associated with - advanced maternal age

Noting burns as abuse in children

Due to the child's short height, this is a credible explanation. A child can pull water down from a higher-level stove top. Burns that are suspicious for abuse include scalds without splash marks; scalds with a clear line of demarcation/immersion ("dunking"); scalds involving the perineum, genitalia, and buttocks; burns on the back (versus the front) of the child; mirror-image burn injury of the extremities; and cigarette burn

How to stop Epistaxis

Epistaxis, or nosebleed, is rarely serious and is usually due to mucosal irritation from dryness, local injury (eg, nose-picking), a foreign body, or rhinitis. Patho: most bleeding arises from a highly vascular network on the anterior nasal septum Tx: resolves spontaneously or with simple home treatment - have client sit upright and tilt head forward (lying down or tilting had back can l/t blood draining into mouth/throat = increased risk of swallowing/aspiration) - apply direct continuous pressure to the nose for 5-10misn - pressure should be applied to the soft, compressible area below the nasal bone (ie, the nasal alae); holding pressure on the nasal bridge does not provide effective relief - holding a cold cloth or ice pack to the bridge of the nose may also help to induce vasoconstriction - keep the child quiet and calm = help provide the adequate time and pressure necessary for clotting Prevention - avoiding local trauma - maintaining hydration of the mucosa with saline nasal spray or a humidifier When to seek emergency care - client has difficulty breathing - bleeding is excessive and not controlled with multiple attempts with home measures - bleeding resulted from an injury that may have caused a nasal fracture

Trust vs. Mistrust

Erikson's Developmental Theory Infancy (birth to 18 months) Feeding, diaper changes Children develop a sense of trust when caregiver provide reliability, care, and affection. A lack of this will lead to mistrust.

Identity vs. Role Confusion

Erikson's Developmental Theory Adolescence (12-18) Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self. e.g. Social Relationships

Autonomy vs. Shame and Doubt

Erikson's Developmental Theory Early Childhood (2 to 3 years) During this stage, the task of developing independence is accomplished through the acquisition of basic self-control skills. - allow child to have some control - foster sense of independence e.g. toilet training Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.

Initiative vs. Guilt

Erikson's Developmental Theory Preschool (3-5 years) During this stage, the task of developing initiative and self-direction is accomplished through exploration and curiosity. - Foster sense of curiosity Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt. e.g. Exploration

Industry vs. Inferiority

Erikson's Developmental Theory School Age (6-11 years) During this stage, the task of developing self-confidence is accomplished through acquiring new skills, competing, and receiving recognition. If a child feels he is inadequate as compared to others a sense of inferiority will develop. e.g. school Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority.

A child should have their first dental visit by age ____.

First dental visit within 6 months of first tooth eruption or by their first birthday A child's first tooth usually erupts around age 6 months, and the child should be seen by a dentist soon after. The purposes of the first visit include: Assessing risk for dental disease Providing dental care and treatment of dental caries Providing anticipatory guidance about dental hygiene, fluoride, diet and dietary habits, and non-nutritive sucking Establishing care with a licensed dentist and scheduling future visits Taking a child to the dentist at an early age also helps the child become accustomed to the dentist's office, oral examinations, and dental care.

Foreign body aspiration

Foreign body aspiration can be life-threatening depending on the object's location, type, and size. Objects are often - buttons - small parts of toys - food particles Manifestations - distress - choking - gagging - cyanosis (circumoral) - inability to speak when the object is lodged in the larynx Tx - removal of item - alkaline batteries can be corrosive to esophageal and intestinal mucosa, must be removed via endoscopy before perforation occurs

When can you start to offer a child honey?

Honey (especially raw or wild) should not be offered to children age <12 months because their immature gut systems are susceptible to Clostridium botulinum (botulism) infection. Botulinum toxin prevents vesicle formation so that no ACh is able to exit the neuron and reach the ACh receptor, resulting in no nerve impulse

Proper car seat use for newborns

Infants should be placed in a federally-approved, rear-facing safety seat secured in the back seat of the car The harness should be snug with the retaining clip secured near the level of the armpits. If the newborn is preterm or small, rolled blankets or car seat inserts (on both sides and under the crotch level buckles) may be used to support the trunk and reduce slouching Infants should be positioned at a 45-degree angle to prevent airway obstruction.

Fetal alcohol syndrome (FAS)

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

Toddlers exhibit behaviors associated with negativism and ritualism as they seek autonomy.

Limiting opportunities for children to express a negative response ("no") helps them learn self-control and behavior modification. For example, the parent can avoid asking, "Do you want to have dinner?" and instead offer food options or say, "It's time for dinner." - If the child refuses a meal, the parents should wait to offer food until the next snack time or mealtime - days of low intake are common as toddlers experience a slowing growth rate - It is important not to force the child to eat Bedtime temper tantrums are common in toddlers as they become more independent. Parents should learn to ignore the behavior, remain in the child's presence, and consider using time-outs as a management technique. When toddlers have been physically active immediately before mealtime, they may have difficulty sitting at the table and can be disruptive. Offering a 15- to 30-minute period to calm down promotes better eating habits.

Candida albicans infection

Manifestations of oral candidiasis (thrush) include white patches on the oral mucosa, palate, and tongue. The patches are nonremovable and tend to bleed when touched. The affected infant may have difficulty sucking or feeding due to the associated pain. Thrush is generally linked to antibiotic therapy or poor caregiver hand hygiene. The infection is usually self-limiting, but treatment with a fungicide (eg, nystatin) may hasten recovery.

Esophageal atresia and tracheoesophaeal fistula

Most common form: upper esophagus ends in a blind pouch and the lower esophagus connects to the primary bronchus or the trachea through a small fistula. Clinical manifestations include frothy saliva, choking, coughing, and drooling. Clients may also develop apnea and cyanosis when feeding. Rx: EA/TEF can usually be corrected surgically, most cases are successful. Extreme forms may require palliative care if surgical correction fails. Nsg - NPO, supine HOB 30 degrees, suction at bedside = maintain clear airway and prevent ASPIRATION! - G tube prior to surgery: release air and drainage of gastric contents to prevent aspiration; feedings or irrigations through tube are contraindicated until after surgery - parenteral nutrition

Cold stress

Neonates are unable to generate heat by shivering due to their lack of muscle tissue and immature nervous systems; they therefore produce heat by increasing their metabolic rates through nonshivering thermogenesis. Brown adipose tissue (BAT), developed during the third trimester, is metabolized for thermogenesis when available. - Once BAT is depleted, nonshivering thermogenesis is less effective and the neonate may experience cold stress, possibly leading to death. - Preterm neonates have fewer stores of BAT and are at higher risk for cold stress. - Frequent temperature monitoring is the best method to assess if an infant is cold. In cold stress, metabolism increases to generate heat, causing a greater demand for oxygen and glucose and the release of norepinephrine. - If adequate oxygenation is not maintained, hypoxia and acidemia occur. - Hypoglycemia develops when available glucose is depleted, and repletion of glucose is impaired by gastrointestinal immotility and poor oral intake. Clinical manifestations of cold stress include: CNS: altered mental status (irritability or lethargy) CV: bradycardia Resp: tachypnea early, followed by apnea and hypoxia GI: high gastric residuals, emesis, hypoglycemia MSK: hypotonia, weak suck and cry

Newborns should void and pass meconium within _______ after birth

Newborns should void and pass meconium within 24 hours after birth. Not doing so could indicate a structural anomaly.

Neonatal abstinence Syndrome

Patho: withdrawal from transplacental opiates (e.g. heroin, methadone, hydrocodone) or other CNS depressants (e.g. benzodiazepines) d/t maternal drug use - abrupt withdrawal from drug d/t delivery causes abstinence syndrome in the neonate - Typically occurs within 24-48hrs after birth Clinical manifestations: - Autonomic: stuffy nose, sweating, frequent yawning and sneezing, tachycardia, tachypnea, pupillary dilation - CNS: irritability, restlessness, jittery movements, seizures (rare), high-pitched cry, abnormal sleep patterns, hypertonicity/hyperactive primitive reflexes - GI: diarrhea, vomiting, feeding intolerance Treatment - opioid therapy (e.g. morphine, methadone) - swaddling and keeping nasal passages clear - medication and protecting the skin - newborn should be placed in side-lying position while swaddled to minimize stimulation and promote nutritive sucking - small frequent feedings - between feedings use pacifier to sooth infant and help establish an organized sucking pattern - infant should be tightly swaddled with arms flexed to minimize irritation and prevent damage skin excoriation from excessive movement - hand mittens and barrier skin protection to knees, elbows, and heels - place newborn in a quiet, dim-lit section of the nursery - cluster care to minimize stimulation - place infant on right side after feeding to promote gastric emptying and reduce the risk of vomiting

Developmentally appropriate nursing care for an adolescent client...

Pediatric clients are at increased risk for impaired psychosocial integrity during stressful experiences (eg, hospitalization, surgical procedures, medical treatment) and require developmentally appropriate care based on their age to assist with managing stress. Unaddressed or ineffectively managed developmental needs may lead to or worsen the client's anxiety, disobedient behavior, and/or social withdrawal. Developmentally appropriate nursing care for an adolescent client includes: - Encouraging interaction with peers (eg, hospital visits, internet communication), which supports the developmental need for social connection and support and reduces stress and anxiety - Involving the client in care planning to address the developmental needs for control and independence - Assisting the client to discuss emotions or fears related to treatment (eg, changes in body image, disability, possibility of death) to improve coping, support the developmental need for understanding, and decrease anxiety - Strict scheduling by the nurse reduces the adolescent's perception of control and independence, which may increase stress. Adolescents should be allowed to determine their daily schedule when possible. - Loss of privacy (eg, forced parental presence) can increase anxiety in the adolescent client. Adolescents should be asked if they want parents present for procedures and what level of parental involvement they prefer.

When you percuss the newborn's bladder you would expect to hear ____

Percussing dullness in the hypogastric area is a normal finding when the bladder is full. The neonate should void spontaneously within a few hours after birth.

Physiological vs. Pathological hyperbilirubinemia

Physiological Def: Occurs due to the newborn's immature liver that is unable to metabolize hemoglobin byproducts Onset: appears 24hrs after birth, max intensity by 4-5th day in term and 7th day preter - slow increase in bilirubin (usually <85umol/L/24hrs) Dx - Slightly elevated unconjugated bilirubin - normal healthy infant Tx - disappears without any treatment Pathological hyperbilirubinemia Onset: within 24hrs of birth Dx - Increase of bilirubin >5mg/dL, >95% for age - Direct bilirubin > 2mg/LD or >20% of TSB S/S: jaundice persisting ater 14 das in full term babies - clay/white coloured stools - dark urine, staining clothes yellow Tx: Phototherapy: is the use of fluorescent lights to treat hyperbilirubinemia or jaundice in newborns. The light is absorbed by the newborn's skin and converts bilirubin into a water-soluble form, allowing it to be excreted in the stool and urine. - The newborn should be fully exposed, except for a diaper, when placed under the phototherapy lights. - No lotions and ointments (can cause burns) - Maintaining skin integrity is important as bilirubin products in the stool can cause loose stool with frequency and produce skin excoriation and breakdown - Do not remove newborn from lights except during feedings, adequate hydration with human milk or infant formula is important as infants are prone to dehydration from phototherapy - Monitor temp of incubator, placed on a low-heat setting ] - The newborn's eyes should be covered with patches or guards to prevent retinal damage or cataracts when under the phototherapy lights.

Formal Operational Stage

Piaget's Stages of Development 12-18 yrs (Adolescents) - capable of mature, abstract thoughts. - new sense of identity of self is established. - the adolescent who is unable to establish a meaningful definition of self will experience confusion in one or more roles of life. - adolescents have abstract thinking abilities that enable introspection about their adoption. - they typically do not like differing from their peers. Open and honest communication is important at this age. Intervention - Point out body changes (as they are concerned with outward changes that may occur as a result of illness or surgery)

Concrete Operational Stage

Piaget's Stages of Development 7-11 years (School aged children) The child is capable of mature thoughts when allowed to manipulate and see objects. = development of conservatism - They begin to understand the concept of conversation - the amount of liquid in a short wide cup is equal to that in a tall skinny glass. - Thinking becomes more logical and organized, but still very concrete. - School-age children may imagine how life would be different if they were with their biological parents. - Self-esteem issues begin to develop around this time with the possible sense of loss of the biological family. - School-age children may be sensitive to physical differences between themselves and their adoptive family. Interventions - Post a daily schedule by the child's bed b/c they understand the concept of time

Preoperational Stage

Piaget's Stages of Development Age 3-6 or 2-7 yrs (Pre-school) The child shows increasing curiosity and explorative behaviour. Language skills improve. The child may feel responsible for causing illness. Infants learn that things continue to exist even though they cannot be seen (object permanence). They are separate beings from the people and objects around them. They realize that their actions can cause things to happen in the world around them. Learning through assimilation and accomodation. At age 5, children are not able to fully understand cause and effect and will therefore ascribe inappropriate causes to phenomena (eg, scraped knee was caused by earlier misbehavior). Five-year-olds are developmentally capable of understanding adoption on a basic level; however, it may be difficult for them to understand the concept of having another family. The child might notice that friends are not adopted. Preschool-age children may also believe they are responsible for being adopted and may develop separation issues and fear abandonment.

Sensorimotor Stage

Piaget's Stages of Development Birth to 2 yrs e.g. Baby learns from movement and sensory input Infants learn that things continue to exist even though they cannot be seen (object permanence). They are separate beings from the people and objects around them. They realize that their actions can cause things to happen in the world around them. Learning occurs through assimilation and accommodation. Children age 3 and under are unable to understand differences between adoptive and biological parents. The age at which to begin discussions about being adopted is debatable, but use of positive language is always encouraged. The terms "given up" or "put up" for adoption or someone's "real" parents are inappropriate and should be avoided. Age 1-3= EGOCENTRIC APPROACH, strive for autonomy - attempt to control experiences through intense EMOTIONAL DISPLAYS (e.g. temper tantrums, saying "no") Hospitalization: results in regressive behaviour, l/t separation anxiety - nursing care activities similar to home routines (e.g. providing preferred snacks, anticipating nap time, give options rather than asking yes/no questions to limit negative responses, encourage parent participation)

Developmental milestones of preschoolers

Preschool-age children (age 3-6) begin to master more gross motor activities while rapidly increasing their fine motor abilities. The 4-year-old should have the fine motor skills to manipulate small tools (eg, scissors, pencil) and therefore be able to draw simple shapes (eg, circle, square) and perform more self-care activities (eg, eating with a spoon and fork) The 4-year-old's gross motor skills and balance improve, allowing for more independent, complex movements (eg, walking up and down stairs) A preschooler does not have the gross motor ability to jump rope with both feet.

Proper Breastfeeding technique

Proper breastfeeding technique ensures adequate intake for the infant while promoting bonding and comfort for the mother. Breastfeeding should be on demand, whenever the infant displays behaviors of hunger (eg, crying, rooting reflex). Most newborns will feed at least 8-12 times a day. The infant should be fed approximately 15-20 minutes per breast, with both breasts offered at each feeding (Option 2). As growth occurs, the infant will become more proficient and total feeding time will decrease. Key principles of proper breastfeeding and latch technique include: Hold infant "tummy to tummy," with the mouth positioned in front of the nipple. The head should be facing forward keeping the body in alignment. Common breastfeeding positions include clutch hold, cradle, cross-cradle, and side-lying. The infant needs to grasp both the nipple and part of the areola to ensure proper latching. If the infant grasps the nipple only, breastfeeding will be painful due to pinching. If the infant latches incorrectly or needs to be removed from the breast, the client should insert a finger to break the suctionprior to moving the infant away. If the infant is pulled off the breast incorrectly, nipple trauma may occur, leading to sore nipples and painful breastfeeding. Proper Latch - nose of infant close to breast - chin touching breast - lips sealed completely around most of areola - lower lip turned outward against breast

Anencephaly

Severe neural tube defect (NTD) resulting in little to no brain tissue or skull formation in utero. Many newborns with anencephaly are stillborn, and those born alive are not compatible with life. Comfort care for the newborn and emotional support for the family is priority at the time of birth. Drying, bundling, and placing the newborn skin-to-skin provides warmth, and administering oxygen may decrease discomfort to the newborn. Allowing the family to hold the newborn will assist with the grieving process.

Injury patterns in non accidental trauma to children

Signs of abuse: - Shaken baby syndrome (ie, irritability or lethargy, poor feeding, emesis, seizures) - Burns in the shape of household items (eg, iron, spatula), from cigarettes, or from immersion in scalding liquid - Repeated injuries in varied stages of healing (eg, bruises, burns, fractures) - Injuries to genitalia - Lapsed time between the injury and the time when care is sought - Inconsistency between the injury and the caregiver's explanation of the injury (eg, client's developmental age, mechanism of injury) s/s - long bone fractures in the humerus or femur - linear type immersion burns - frenulum tears and gingival lesions - retinal hemorrhage on funduscopic examination - subdural & epidural hematomas (coup-contrecoup injuries) Toddlers and young children are prone to many accidental injuries (eg, aspiration or poisoning from foreign objects in the mouth, climbs onto and falls from furniture, pulling of objects from the table) - The injuries and caregivers' explanations are reasonable for these clients. - Prior to discharge, the nurse should instruct caregivers on child safety measures within the home to prevent future injury.

Nursing interventions for a newborn immediately after delivery include...

Standard precautions - The unbathed newborn is covered in maternal blood and bodily fluid. Standard precautions (eg, gloves) are implemented when contact with blood or bodily fluid is anticipated. Maintain a clear airway - Suction the pharynx first followed by the nasal passages to prevent aspiration if the newborn gasps with nasal suctioning. Thermoregulation (97.5-99 F [36.4-37.2 C]) reduces oxygen and stored calorie consumption. Hypothermia predisposes the newborn to metabolic acidosis, hypoxia, and shock. A radiant warmer is used while performing assessments and interventions. Use pre-warmed linens, an infant stocking cap, and a thermal skin sensor for monitoring. Skin-to-skin contact aids in thermoregulation. Vitamin K is administered intramuscularly in the vastus lateralis (midanterior lateral thigh) within 6 hours of birth to prevent bleeding due to absence of vitamin K-producing intestinal bacteria. Ophthalmic ointment - Prophylactic antibiotic eye ointment for Neisseria gonorrhoeae is legally required; application may be delayed up to 1 hour after delivery. Initial bathing of the newborn is limited to removing blood, bodily fluids, or meconium. Vernix caseosa, a waxy, white coating, protects the skin and should not be vigorously removed

Bacterial Meningitis in infants and children <2 - symptoms - acute complication

Symptoms: fever, restlessness, seizures, high-pitched cry Acute complication: hydrocephalus (increase in ICP) resulting from obstruction of cerebrospinal fluid flow - can progress to permanent hearing loss, learning disability, brain damage - S&S: bulging/tense fontanels, increasing head circumference, prominent scalp veins, sunset eyes

Developmental milestones of toddlers

TODDLERS 12 months Gross motor: walks first steps independently, crawls up stairs Fine motor: uses 2 finger pincer grasp, hits 2 objects together Language: says 3-5 words, uses non-verbal gestures (e.g. waving goodbye) Social/cognitive: may have separation anxiety, searches for hidden objects 18 months Gross motor: walks up/down stairs with help, throws a ball overhand, jumps in place Fine motor: builds 3-4 block tower, turns 2-3 book pages, scribbles, uses cup & spoon Language: 10+ word vocabulary, identifies common objects Social/cognitive: has temper tantrums, understands ownership ("mine"), imitates others 2 years Gross motor: walks up/down stairs alone, 1 step at a time; runs without falling, kicks ball Fine motor: builds 6-7 block tower, turns 1 book page, draws a line Language: 300+ word vocabulary, 2-3 word phrases, states own name Social/cognitive: begins parallel play, begins to gain independence from parents PRESCHOOL (mastering gross motor skills, it is normal for preschool-age children to be unable to sit quietly for longer than 15 minutes at a time) 3 years Gross motor: walks up stairs with alternating feet, pedals a tricycle, jumps forward Fine motor: draws a circe, feeds self without help, grips a crayon with fingers instead of fist Language: 3-4 word sentences, asks "why" questions, states own age Social/cognitive: begins associated play; toilet trained, except wiping Age 4 (manipulating fine motor skills) Gross motor: walks down stairs with alt feet, balances on 1 foot, catches a ball Fine motor: draws a square, cuts with scissors, ties a simple knot Language: names 2+ colors, likes telling stories Social/cognitive: begins imaginative/group play, recognizes analogies, often focused on self Age 5 Gross motor: skips, walks backward, uses jump rope Fine motor: draws a triangle, ties shoelaces, prints letters-numbers-words Language: counts to 10, speaks full sentences, names coins and day fo the week Social/cognitive: independently dress & bathes, identifies real from pretend SCHOOL-AGED CHILDREN Jumping rope is a developmental milestone that is reached in school-age children (age 6-12).

Neonatal Heel Stick

The neonatal heel stick (heel lancing) is used to collect a blood sample to assess capillary glucose and perform newborn screening for inherited disorders (eg, congenital hypothyroidism, phenylketonuria). Proper technique is essential for minimizing discomfort and preventing complications and includes: Select a location on the medial or lateral side of the outer aspect of the heel. Avoid the center of the heel to prevent accidental insult to the calcaneus. Puncture should not occur over edematous or infected skin. Warm the heel for several minutes with a warm towel compress or approved single-use instant heat pack to promote vasodilation. Cleanse the intended puncture site with alcohol. Sucrose and nonnutritive sucking on a pacifier may reduce procedural pain Use an automatic lancet, which controls the depth of puncture. Lancing the heel too deeply can result in penetration of the calcaneus bone, leading to osteochondritis or osteomyelitis. An acceptable alternate method of blood collection in the neonate is venipuncture (ie, drawing blood from a vein). Venipuncture is considered less painful and often requires fewer punctures to obtain a sample, especially if a larger volume is needed

Reye Syndrome

The nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate (same class as aspirin) and could possibly cause Reye syndrome. Cause: aspirin or other salicylate (e.g. Pepto-Bismol) during or after recent viral infection, influenza or varicella infection in children S/s: - encephalopathy/cerebral edema d/t acute fatty liver failure/hepatic dysfunction

Pincer Grasp develops at age ______

The pincer grasp, a thumb to forefinger movement, develops at age 8-10 months. This is the time to start offering small finger foods, such as crackers or cut-up pieces of nutritious foods. Caregivers should inform their health care provider if the infant does not achieve this significant milestone in fine motor development

Posterior Fontanelles

The posterior fontanel is located at the intersection of the sagittal and lambdoid sutures. It is triangle-shaped and smaller than the anterior fontanel, which is diamond-shaped and located at the intersection of the frontal and parietal sutures It closes at 2 months

Safe sleep practices for newborns

The supine position is recommended for infants in the first few months of life. This practice is associated with a lower incidence of SIDS. Infants should sleep in the crib in clothing such as a sleep sack - These lower the risk of suffocation by keeping the infant warm while preventing the head from being covered. Parents should remove loose bedding and other objects (eg, blankets, bumper pads, stuffed animals, pillows) from the crib. Crib slats should be no more than 2 ¼ inches apart to prevent the infant's head from becoming lodged between them.

Toddler refusing oral antibiotic medication, what do you do?

Toddlers (age 1-3) begin to demand autonomy and have a strong desire for independence. - offer limited choices to give a sense of control (e.g. choose b/w orange or apple juice to improve cooperation) DO NOT - Ask questions requiring yes or no, negativism behaviour at this age - hide meds in the child's favourite foods or beverages besides pancreatic enzymes that can be mixed in applesauce for CF - refer to medication as candy, increases risk for toxic ingestion - call HCP before trying age-appropriate techniques first

Head and neck strength develops by what age?

Typically, infants display head lag (ie, head falling behind the shoulders when raised from a supine to a sitting position) from birth through age 4-6 months. Head lag remaining after age 6 months is an abnormal finding often associated with cerebral palsy or autism

When choosing snacks and meals for toddlers (age 1-3), what are the 3 factors to consider?

When choosing snacks and meals for toddlers (age 1-3), 3 factors must be considered: 1. Safety - small, hard, sticky and/or slippery foods pose a choking risk and should not be offered to children under age 3. Examples include hot dogs, grapes, nuts, raw carrot sticks, popcorn, peanut butter, hard candy, and raisins. 2. Nutrient density (the nutrients a food provides relative to the number of calories it contains). The snack should be of high nutritional value rather than "empty calories." 3. Potential for food-borne illness - children are at higher risk for developing a food-related infection if given raw, unpasteurized foods such as juice, partially cooked eggs, raw fish, or raw bean sprouts Healthy snacks include pieces of cheese, whole-wheat crackles, banana slices, yogurt, cooked vegetables, mini pizzas, cottage cheese with cut-up fruit

Moro Reflex

aka Startle Reflex - elicited by quickly lowering the infant's head relative to the body/ sudden dropping simulating a falling sensation - response to sudden loud noises and jarring of the crib Normal reflex: newborn extends and raises the arms with fingers fanned out and then curls into the fetal position Absence of reflex: indicates an underdeveloped or damaged brain or spinal cord and should be reported to the HCP present till age 3-6mo

Children age <7mo receive immunization/vaccine in the

anterolateral thigh (vastus lateralis) The gluteus medius muscle (muscle injected with a ventrogluteal injection) is developed through crawling and walking. The muscles are not developed enough at this age to be used as an acceptable site The needle length and injection site for IM injections are dependent on a client's age and muscle mass. The vastus lateralis muscle in the anterolateral middle portion of the thigh is the preferred IM injection site for newborns (age <1 month) and infants (age 1-12 months). Selection of the most appropriate needle length is an important factor in ensuring immunization success and minimizing local reactions to vaccine components. If the needle is too short, the IM vaccine is injected into subcutaneous fat, resulting in vaccine failure due to poor mobilization of the antigen within adipose tissue. Infants typically require a 1-in (25-mm) needle for IM injections

Extrusion Reflex

baby's reflex to push any food placed on their tongue out the front of their mouth The extrusion reflex and a decreased gag reflex in infants less than 4 months old increase the risk for choking and aspiration. Instilling the medication using a syringe at the back of the cheek decreases the risk for choking and ensures that the correct amount of medication is consumed.

Introduction of foods in babies

birth --> 6 mo: exclusive breastfeeding 4-6mo: start with iron-fortified infant cereal (rice/oatmeal) which can be mixed with breast milk, formula or water. Note: when introducing new foods allow 5-7 days b/w foods to observe for allergies/triggers 6 mo: introduction of pureed foods 6-8mo: pureed fruits and vegetables introduced - mashed portions of soft fruits/vegs (carrots, peas, bananas) are better homemade than commercially prepared - offer simple finger foods (teething crackers, small pieces of fruit, soft vegetables or cheese) = develop motor skills, learn to chew even before they have teeth 1 year: introduction of cow's milk (lack's crucial vit/minerals for appropriate growth, more difficult for infant to digest)

Kernicterus

elevated in a newborn= 10-20 toxic in a neonate= 20 Bilirubin > 20 and in the CSF= brain damage S/S Opisthotonos: position of hyperextension, place them on their side if present Tx - call doctor - draw bilirubin level - increase the IV rate and start billi lights

Erythema toxicum neonatarum

firm, white or yellow papule or pustules surrounded by erythema idiopathic rash which closely resembles flea bites appears in the first few days after birth resolves within 5-7 days no additional systemic effects, no treatment required

Nocturnal Enuresis

in children > 5 yrs 1. Behavioral Treatment - Encourage fluids during the day, but restrict to small sips after the evening meal - Have the child void before going to bed. - Use positive reinforcement and motivation (eg, a calendar showing wet and dry nights) - Avoid punishing, scolding, or ridiculing the child. - Avoid the use of disposable training pants and diapers at bedtime, as these discourage the motivation to get up to void - Have the child assist with wet linen changes but reassure that this is not a punishment - Awaken the child at a specified time each night to void - Use an enuresis alarm (ie, a moisture-sensitive alarm that is worn on the child's sleep clothes and will awaken the child if the child starts to void). 2. Pharmacological Interventions (little/or not response to behavioural approaches and/or short-term improvement of enuresis is desired for attending sleepovers or overnight camp) - trial of the drug for at least 6 weeks before camp to determine appropriate drug dose and effectiveness - high risk of relapse once the drug is d/c Medications a) Desmopression reduces urine production during sleep b) tricyclic antidepressants (e.g. imipramine, amitryline, desipramine) improve functional bladder capacity

Following a target, usually a bright-colored object or a human face, is a method of testing visual acuity and fixation in what age group?

infants. If visual fixation and following are not present by age 3-4 months, referral to a formal ophthalmic examination is needed.

Sepsis neonatorum

is a medical emergency. Newborns may not exhibit obvious signs of infection but instead may have elevated temperature or be hypothermic. Subtle changes such as irritability, increased sleepiness, and poor feeding should be considered red flags. Blood, urine, and cerebrospinal fluid cultures should be obtained immediately and broad-spectrum antibiotics started.

Duchenne muscular dystrophy

is an X-linked recessive (carried by females and affecting males) disorder that causes the progressive replacement of dystrophin, a protein needed for muscle stabilization, with connective tissue. - The proximal lower extremities and pelvis are affected first. - In response to proximal muscle weakness, the calf muscles hypertrophy (pseudohypertrophy) initially and are later replaced by fat and connective tissue. Client reports - child raises themselves to a standing position using the classic Gower sign/maneuver (placing hands on the thighs to push up to stand) - child walk on tiptoes - Parents may also report frequent tripping and falling

Key teaching for Infant's taking formula

is readily available in 3 forms: ready-to-feed, concentrated, and powder. Parents who feed their infants commercial formula should closely follow the manufacturer's recommendations for preparation, particularly if the product requires dilution or reconstitution. Parents should also adhere to basic guidelines for safe storage and handling. Key teaching points include: - Keep bottles, nipples, caps, and other parts as clean as possible, either by boiling or washing in the dishwasher - Wash the tops of formula cans prior to opening to prevent contamination - Prepared formula or opened cans of ready-to-feed or concentrated formula should be kept in the refrigerator and discarded after 48 hours if unused. There is a risk of bacterial growth after this time. - Prepared bottles can be warmed by placing in a pan of hot water for several minutes - Test temperature on the inner wrist before serving to the infant; formula should feel lukewarm, but never hot - Never microwave formula as it can cause mouth burns - Formula should never be diluted or concentrated. Dilution of the formula does not allow the infant to receive the appropriate amount of calories, vitamins, and minerals needed for normal growth and development. Overconcentration of the formula can cause excessive proteins and minerals to be ingested that exceed the excretory ability of the infant's immature kidneys. - Any formula left in a bottle after a feeding should be discarded immediately because the infant's saliva has mixed with it. This will encourage bacterial growth.

Nursemaid's elbow

nursemaid's elbow is a due to the mechanism (swinging by the arms) by which the injury occurred. This condition is common in children and characterized by a subluxation of the radial head. It can seem like an urgent condition due to the suddenness of the child's inability to use the arm. A simple reduction of the arm by a health care provider should reposition the radial head.

Pediatric clients consuming a vegan diet are at increased risk for _____ d/t rapid growth and development. What education should you provide?

nutritional deficiencies (e.g. protein, calories, calcium, vit D, iron, vit B12) Iron: Plant sources of iron, which are in smaller quantities and difficult to absorb, should be supplemented with fortified cereals and breads to decrease risk of iron-deficient anemia Vitamin C: Iron absorption is improved when dietary sources of iron and vitamin C are taken together Calcium: Without animal sources of calcium (eg, dairy, eggs, fish), vegan diets require supplementation of calcium and vitamin D for bone health Many plant-based proteins (e.g. legumes, grains) do not contain all the essential a.a. to support growth/tissue repair, need further teaching on combinations of protein sources

Separation or stranger anxiety occurs for children aged ____ to ___.

occurs when the primary caregivers leave the child in the care of others who are not familiar to the child. This behavior starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. Separation anxiety produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, this reaction is normal and resolves as the child approaches age 3 years.

hydrocele

painless new onset bilateral testicular swelling This infant has signs of a hydrocele, a fluid-filled testicular mass. Most hydroceles resolve before the first birthday and are not a medical emergency.

Babinski Reflex

present up to age 1-2

Epstein pearls

small white cysts found on the hard palate of newborns common findings disappear a few weeks after birth

Cryptorchidism

undescended testicle at birth not concerning most undescended testes descend spontaneously by age 6 mo

Infant growth is fast paced during the first year of life, by 6 months weight should increase by ____ and by ______ once 12 months. Length increases by ______ within first 12 months. Head circumference versus chest circumference ratio is ____ by 12 months.

with birth weight doubling by age 6 months and tripling by age 12 months. During the first year, birth length increases by approximately 50%. At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months.