Peds Ch. 31 The Infant and Family

What are the primary goals in the nutritional management of children with failure to thrive (FTT)? Select all that apply. 1 Allow for catch-up growth 2 Correct nutritional deficiencies 3 Achieve ideal weight for height 4 Restore optimum body composition 5 Educate the parents or primary caregivers on child's nutritional requirements 6 Educate the parents or primary caregivers that the child will need tube feedings first

1, 2, 3, 4, 5 The goal is to provide sufficient calories to support "catch-up" growth, which is a rate of growth greater than the expected rate for age. Accurate assessment of the child's initial weight and height is important, as well as the daily recording of weight, food intake, and feeding behavior. Correction of nutritional deficiencies is another goal that may require multivitamin supplements and dietary supplements with high-calorie foods and drinks in addition to treating coexisting medical problems to optimize body composition. A goal is to provide education to the parents or primary caregiver of the child's nutritional requirements along with appropriate feeding methods.

The most appropriate recommendation for relief of teething pain is to instruct the parents to do what? 1 Rub gums with aspirin to relieve inflammation 2 Apply hydrogen peroxide to gums to relieve irritation 3 Give child a cold teething ring to relieve inflammation 4 Have child chew on a warm teething ring to encourage tooth eruption

3 Cold reduces inflammation and should be used for relief of teething irritation. Gums should not be rubbed with aspirin. It can be dangerous if the child aspirates aspirin. Hydrogen peroxide would not be effective. Cold, not warmth, reduces inflammation.

The nurse is educating a group of parents about safety promotion and injury prevention in the infant. Which statement made by a parent indicates effective teaching? 1 "The mattresses in the house should be covered with plastic." 2 "It is okay to give the child colored latex balloons at playtime." 3 "Diaper pins should be kept closed and away from the infant." 4 "Infant formula should be microwaved before feeding the child."

3 The nurse instructs the parents that diaper pins should be kept closed and away from the infant because it may cause injury to the baby. Mattresses in the house should not be covered with plastic as it increases the infant's chances of suffocation. Latex balloons should not be given to the child for playing because these increase the risk of suffocation in the infant. Infant formula should not be microwaved before giving to the infant as it can cause burns because of uneven warming.

As the nurse is assessing an infant, the nurse notices that the teeth are erupting and the infant's skin color is bluish. After assessing oxygenation, the nurse reviews the laboratory report and finds that the infant has methemoglobinemia. What would be the probable reason for this? 1 Application of topical anesthetics 2 Excessive use of cold teething ring 3 Administration of aspirin (Acuprine) 4 Excessive consumption of hard candy

1 During teething, the infant may feel pain and discomfort as the crown of the tooth breaks through the periodontal membrane. Topical anesthetic ointments can be applied to relieve the pain. These ointments generally contain benzocaine as an active ingredient. Benzocaine causes methemoglobinemia, which is characterized by a bluish skin coloration. Excessive use of cold teething rings, administration of aspirin (Acuprine), and excessive consumption of hard candy do not cause methemoglobinemia. Hard candy may cause accidental choking or aspiration in the infant.

Which fine motor activity does the nurse observe in a 6-month-old infant? 1 The infant can hold a milk bottle. 2 The infant drops a cube in the cup. 3 The infant is able to hold two cubes. 4 The infant grabs a bell by the handle.

1 A 6-month-old infant is able to hold the milk bottle. Holding two cubes, dropping a cube in cup, and grabbing a bell by the handle requires more muscle coordination, which is not developed by the age of 6 months. A 7-month-old infant can hold the two cubes more than momentarily. A 12-month-old infant can release cubes in a cup. A 10-month-old infant can grasp a bell by the handle.

The parents of a 7-month-old infant report to the nurse that the solid food they feed to the baby passes through the gastrointestinal tract unchanged. Which response of the nurse would help to relieve the parent's anxiety? 1 "It is a normal finding at this age." 2 "It indicates an intestinal infection." 3 "The infant has slow development." 4 "The infant has a metabolic disorder."

1 In a 7-month-old infant, the digestive processes are immature and solid food is not completely digested. As a result of underdeveloped digestion, solid foods pass through without being digested into feces. It is a normal finding at this age. By the end of the first year, the infant will be able to digest food. Therefore it is not a symptom of an intestinal infection, nor does it indicate that the infant has metabolic disorder or slow development.

The nurse is educating a group of parents about the dental health for infants. Which statement made by the parent indicates effective learning? 1 "Fruit juices should be given to the child in a bottle." 2 "Milk bottles should be given to the child in the bed." 3 "A damp cloth can be used to wipe the child's teeth." 4 "Fluoridated toothpaste should be used for the child."

3 Tooth decay is a common problem during the early childhood. The nurse should suggest that the parents use a damp cloth to clean the child's teeth by wiping. It prevents accumulation of plaque and keeps the teeth clean. A milk bottle should not be given to the child in the bed because it increases risk of early childhood dental caries. Fruit juices should not be given to the child in a bottle before 6 months of age. This increases the chances of tooth decay. Fluoridated toothpaste should not be used for the child because infants may swallow the toothpaste, which can cause fluoride toxicities.

The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of what? 1 Trust 2 Industry 3 Initiative 4 Separation

1 The task of infancy is the development of trust. Industry vs. inferiority is the developmental task of school-age children. Initiative vs. guilt is the developmental task of preschoolers. Separation occurs during the sensorimotor stage as described by Piaget.

The nurse is teaching nursing students about vaccine administration. Which statement made by the nursing student indicates effective learning? 1 "Vapocoolant spray should apply to the skin after administering the vaccine." 2 "The influenza vaccine should not be administered to the patient with asthma." 3 "All vaccines should be given to adults by using a 25-mm (1-in) length needle." 4 "A 16-mm (5/8-inch) length needle is used to administer the vaccine to newborns."

4 A 16-mm (5/8-inch) length needle is used for vaccine administration in newborn infants. Needle length is an important factor for administration of vaccine to ensure that the medication gets into the muscle. The proper needle length should be selected to get the medication in the infant's muscle. Influenza vaccines should be administered to patients with asthma because they are at higher risk of developing influenza. Vapocoolant spray should be applied to the skin 15 seconds before the vaccination for minimizing pain, not after. All vaccines should not be administered to adults by using 25-mm (1-inch) length needle. The needle length should be selected on the basis of muscle development, size, and age of the person.

A 3-month-old bottle-fed infant is allergic to cow's milk. What is the nurse's best option for a substitute? 1 Goat's milk 2 Soy-based formula 3 Skim milk diluted with water 4 Casein hydrolysate milk formula

4 The milk protein is broken down in casein hydrolysate milk formulas. The milk protein in goat's milk cross-reacts with cow's milk protein. Soy-based formula is avoided because of the cross-reaction with soy. The cow's milk protein is also found in skim milk.

The nurse is teaching a group of parents about therapeutic management for preventing plagiocephaly in the infant. What instructions should the nurse give to the parents? Select all that apply. 1 "Alternate the infant's head position." 2 "Place the infant prone when awake." 3 "Use soft bedding in the infant's crib." 4 "Place the infant in side-lying position." 5 "Use a protective helmet for the infant."

1, 2, 5 Plagiocephaly means an oblique or asymmetric head. Plagiocephaly is a condition acquired due to cranial molding during birth and infancy. Prolonged pressure on one side of the skull produces an asymmetrical distortion of the skull. The nurse should instruct the parents to use a helmet for the infant for decreasing the pressure on the skull. The infant's head position should be alternated to avoid pressure on the skull as well. The nurse should instruct the parents to place the infant in prone position when awake for preventing plagiocephaly and facilitating development of upper shoulder girdle strength. Placing the infant in the side-lying position may put pressure on one side of the head and lead to plagiocephaly. Using soft bedding may be more comfortable, but it can increase the risk of sudden infant death syndrome (SIDS).

The nurse should provide further teaching about sudden infant death syndrome (SIDS) prevention when hearing the mother of an 8-week-old make which statement? Select all that apply. 1 "I only smoke in the kitchen." 2 "I put my baby to sleep on her back." 3 "I have my baby sleep with me instead of alone in the crib." 4 "I make sure my baby wears a flannel sleeper and has two blankets to keep warm in her crib." 5 "I always leave my baby's favorite stuffed bunny rabbit in the crib to keep her from crying at night."

1, 3, 4, 5 Maternal smoking increases the risk of SIDS. Smoking anywhere in the home with an infant present is not recommended. The Back to Sleep Campaign is given credit for reducing the rate of SIDS in the United States. Co-sleeping increases the risk of SIDS. Overheating increases the risk of SIDS. Leaving a stuffed animal in the crib is a suffocation risk but still needs to be addressed as a safety hazard.

The nursing student who is posted in the pediatric unit asks the nurse, "Which behaviors would be expected in 8-month-old infants?" Which appropriate answers does the nurse state to the nursing student? Select all that apply. 1 "The child can play peek-a-boo." 2 "The child can drink from a cup." 3 "The child exhibits stranger anxiety." 4 "The child can remove some clothing." 5 "The child can stand by holding furniture."

1, 3, 5 At this age the infant can play peek-a-boo. It is a typical behavior of an 8-month-old infant. The infant can easily understand that the person is still there even when the person is out of sight. An 8-month-old infant exhibits stranger anxiety. Stranger anxiety shows a good relationship between infant and parent. At this age the infant can stand by holding furniture. An 8-month-old infant is not able to drink from a cup or remove clothes. These activities require more muscle coordination, which will not be achieved by the infant at this age. A 12-month-old infant is able to drink from a cup. An 18-month-old infant is able to remove clothes.

The nurse is assessing a 12-month-old child during a well-child visit. The nurse notices that the child's birth weight has tripled, birth length is increased by 50%, head and chest circumference are equal, and the child has six deciduous teeth. What does the nurse conclude that the child has from these findings? 1 A calcium deficiency 2 Normal development 3 Delayed development 4 Excessive weight gain

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During the assessment of a 12-month-old infant, the nurse finds that the infant's head and chest circumference are equal, the length of the infant has increased by 50% since birth, and the weight is triple that of the birth weight. What does the nurse interpret from these findings? 1 The infant has slow development. 2 The infant has normal development. 3 The infant has inadequate weight gain. 4 The infant has insufficient dietary protein.

2 A 12-month-old infant has equal head and chest circumference. In a 12-month-infant, there is an increase in birth length by 50% and increase in weight three times that of birth weight. So, the nurse should interpret from these findings that the infant has normal development. Inability to gain weight indicates slow development. Development of the infant is normal according to standard parameters. Thus it does not indicate that the infant lacks dietary protein.

A parent asks the nurse in the well-baby clinic, "Which toy should be given to the 3-month-old infant?" Which toy does the nurse suggest to the infant's parent? 1 Push-pull toy 2 Soft stuffed toy 3 Play telephone 4 Large plastic ball

2 A soft stuffed toy should be given to the child for playing. At this age infants show more discriminate interest in stimuli and may begin to play alone with a soft stuffed toy. At this age, the infant's skills are not well-developed and the infant may not be able to play with a push-pull toy or large plastic ball. An 18-month-old infant is able to play with a push-pull toy or large plastic ball. Playing with a telephone helps to promote imitative play, but a 3-month-old infant is too young for a play telephone. It is not a suitable toy for a 3-month-old infant.

A 4-month-old infant is scheduled for heart surgery. Which nursing action is most appropriate to follow 2 hours before the surgery? 1 Give a doll to the infant to play with 2 Place a pacifier in the infant's mouth to suck 3 Give a toy cell phone to the infant to play with 4 Place a bottle of milk in the infant's mouth to suck

2 In this situation, the nurse should place a pacifier in the infant's mouth to suck because satisfying the sucking need is the priority at this age. Although giving a doll to play with or giving a mobile phone to watch is age appropriate, the sucking need is the priority. The nurse should not place a bottle of milk in the infant's mouth to suck because the infant should receive nothing by mouth before surgery.

The parents of a 6-month-old infant report to the nurse that the infant is not sleeping properly and is refusing to eat solid foods. The infant is also biting on hard objects and sucking his fingers continuously. What should the nurse interpret from these symptoms? 1 The child has digestion problem. 2 The child shows signs of teething. 3 The child has a bacterial infection. 4 The child has a vitamin D deficiency.

2 Not sleeping properly, refusing to eat solid foods, biting on hard objects, and sucking on fingers continuously are all signs of teething. The child feels discomfort as the crown of the tooth breaks through the periodontal membrane. If the child has a bacterial infection, he or she would present with a fever. If the child has digestive problems, he or she would present with nausea and vomiting. Vitamin D deficiency would present with hypocalcemia.

During a home visit, the parents report to the nurse that they are worried about their 3-year-old child's behavior. The child lacks discipline and writes on the walls. Which nursing advice would be helpful for the parents for limiting the child's behavior? 1 "Send the child to his or her bedroom for a time-out." 2 "Instruct the child to stand in play yard for some time." 3 "Seclude the child in the store room for a punishment." 4 "Scold the child in a firm, loud tone for the misbehavior."

2 The child's motor skills and mobility increase as the child gets older, so the child becomes more active. The child does not differentiate between good and bad behavior because of lack of understanding. The nurse should advise the parents to discipline the child by using the time-out method. The nurse teaches the parents to select an area for time-out that is safe, convenient, and unstimulating and where the child can be monitored. After staying in an isolated place, the child may feel bored and change his or her behavior to get out of time-out. Therefore the parents should instruct the child to stay in time-out for some time. The parents should not seclude the child in his or her room or store room because there are chances that the child could get hurt. The parents should not scold the child in a firm, loud tone in order to maintain good and friendly relationship with the child.

A parent of an 8-month-old infant tells the nurse that the baby cries and screams whenever he or she is left with the grandparents. The nurse's reply should be based on knowledge that what is true? 1 The infant is most likely spoiled. 2 This is a normal reaction for this age. 3 This is an abnormal reaction for this age. 4 The grandparents are not responsive to that infant.

2 The infant is experiencing stranger anxiety, which is expected for a child of this age. Whether or not the infant is spoiled or the grandparents are not responsive is irrelevant.

An infant's parent reports to the nurse that the infant is very irritable, has difficulty sleeping, and refuses to eat solid foods due to teething. What nursing interventions should the nurse include in the plan of care to make the infant comfortable? 1 Provide hard candy for the infant 2 Give ibuprofen (Advil) to the infant 3 Use frozen liquid-filled teething rings 4 Rub the infant's gums with salicylates

2 The infant is very irritable, has difficulty sleeping, and refuses to eat solid foods. Therefore the nurse should administer Ibuprofen (Advil) to the infant. Ibuprofen (Advil) is a systemic analgesic that helps to relieve pain related to teething. It is not administered for more than 3 consecutive days to the infant. The nurse should not give hard candy to an infant because it may cause accidental choking or aspiration. The nurse should not rub the gums with salicylates because it can cause aspiration. The nurse should not give a frozen liquid-filled teething ring to the infant because it may rupture or crack. This can lead to a chemical leak that is harmful for the infant.

The nurse advises the parents of a 2-year-old child to vaccinate their child with the influenza vaccine (inactivated influenza vaccine [IIV]). The child's parents ask the nurse, "My child had the same vaccine last year. Why does my child need another one?" Which response should the nurse give to the child's parent? 1 "All children require influenza booster shots every year up to 12 years of age." 2 "Different strains of influenza are used to manufacture the vaccine each year." 3 "The effectiveness of the influenza vaccine decreases 6 months after the dose." 4 "The child needs to receive the influenza vaccine early due to lack of immunity."

2 The influenza vaccine (inactivated influenza vaccine [IIV*]) is administered yearly because different strains of influenza are used every year for manufacturing the vaccine. It is developed on the basis of flu strains that are likely to be in circulation, thus an influenza vaccine is administered yearly. The child does not require booster shots up to the age of 12 years. Effectiveness of influenza vaccine does not reduce after 6 months; it is effective even after 6 months. The vaccine is required for developing immunity against new strains of the flu virus and is administered yearly to develop immunity against new viral strains.

Cooper is an 8-year-old who is very excited about attending Lacrosse camp this summer. His mother has received registration forms along with a request for a physical examination and recommendations to have all immunizations up to date. The nurse is preparing the examination room for Cooper's visit and is responsible for administering the necessary boosters. Using the chart below, determine which catch-up doses Cooper will need. He is not considered high risk. Select all that apply. 1 Hib 2 TdaP 3 MMR 4 Varicella 5 Rotavirus 6 Hepatitis B

2, 3, 4, 6 According to the Centers for Disease Control and Prevention, Tdap, MMR, Varicella, and Hepatitis B are the recommended boosters necessary for Cooper to attend camp. Rotavirus vaccine is administered in a series during infancy and boosters are unnecessary. Hib should be administered only to children up to the age of 4.

Which normal findings (age and developmentally appropriate) does the nurse find during the assessment of a 5-month-old child? Select all that apply. 1 Startle reflex 2 Tooth eruption 3 Babinski reflex 4 Tonic neck reflex 5 Doubling of birth weight

2, 3, 5 The nurse should find a Babinski reflex, tooth eruption, and doubling of birth weight in the child. Babinski reflex is present in the child throughout the first 12 months of life. At the 5th month, signs of tooth eruption may appear and the weight of child becomes double that of the birth weight. By 4 months of age the tonic neck and startle reflexes disappear.

The nurse is assessing a 5-month-old infant. Which behavior does the nurse observe in the infant? 1 Taking out objects hidden under a pillow 2 Transferring toys from one hand to the other 3 Picking up a toy and putting it into the mouth 4 Grasping the feet and pulling them toward mouth

3 A 5-month-old infant is able to pick up a toy and put it into the mouth. At this age infants tend to explore objects by putting them into the mouth. This is called the palmar grasp, which develops before eye-hand-mouth coordination. A 5-month-old infant is unable to perform an activity such as grasping the feet and pulling them to the mouth or transferring objects from one hand to the other. The infant may not be able to pursue the object they observe being hidden under a pillow as the child lacks the motor abilities to grasp objects completely. A 6-month-old infant is able to grasp the feet and pull them to the mouth. In a 7-month-old infant, transferring the objects from one hand to the other is observed. A 10-month-old infant is able to pursue the object observed being hidden under a pillow. It is a concept of object permanence. It indicates that a locomotion skill of the infant has increased.

At what age should the nurse advise parents to expect their infant to be able to say "mama" and "dada" with meaning? 1 4 months 2 6 months 3 10 months 4 14 months

3 At 10 months, infants say sounds with meaning. At 4 months, consonants are added to infant vocalizations. At 6 months, babbling resembles one-syllable sounds. Fourteen months is late for the development of sounds with meaning.

Which fine motor activity can be observed in a 4-month-old infant? 1 Holding a bottle 2 Grasping objects 3 Playing with a rattle 4 Taking objects directly to mouth

3 At the age of 4 months, the infant's fine motor skills are not fully developed, but the child is able to play and shake a rattle. Holding a bottle, grasping objects such as picking up a rattle when dropped, and taking objects directly to mouth are fine motor activities and require muscle coordination that is not developed at the age of 4 months. A 6-month-old child can hold a bottle. A 5-month-old child is able to grasp objects and take objects directly to mouth.

The health care provider has prescribed a liquid iron supplement for an infant with iron deficiency. What advice does the nurse give to the parents to prevent the infant's teeth from staining from the liquid iron supplement? 1 Use a supplement with a low iron content 2 Mix the iron with any kind of citrus fruit juice 3 Use a dropper toward the back of the mouth 4 Dilute with whole cow's milk or milk products

3 Liquid iron supplements may stain the teeth, so the nurse should advise the parents to administer the liquid iron supplement with a dropper toward the back of the mouth. The nurse should instruct the parents not to switch to a low-iron-containing formula because the child already is deficient in iron. The parents can administer the liquid iron supplement with citrus fruit juice, but it does not solve the problem of teeth staining. The nurse should advise the parents to not administer the liquid iron supplement with whole cow's milk or milk products as these products bind with free iron and prevent its absorption.

The parents of a 9-month-old infant tell the nurse that they are worried about their baby's thumb-sucking. What is the nurse's best reply? 1 A pacifier should be substituted for the thumb. 2 Thumb-sucking should be discouraged by age 12 months. 3 There is no need to restrain nonnutritive sucking during infancy. 4 Thumb-sucking should be discouraged when the teeth begin to erupt.

3 Nonnutritive sucking reaches its peak at about 18 to 20 months of age. Evidence is inconclusive regarding whether a pacifier or thumb is better for satisfying sucking needs. Thumb-sucking and the use of pacifier should be stopped after 4 years of age.

Which characteristic of fine motor skills does the nurse expect to find in a 5-month-old infant? 1 Neat pincer grasp 2 Strong grasp reflex 3 Able to grasp object voluntarily 4 Able to build a tower of two cubes

3 The ability to grasp an object voluntarily is appropriate for a 5-month-old infant. A strong grasp reflex is characteristic of a 1-month-old infant. A neat pincer grasp is characteristic of an 11-month-old infant. The ability to build a tower of two cubes is characteristic of a 15-month-old infant.

The nurse is assessing a 6-month-old infant who smiles, coos, and has a strong head lag. What should the nurse recognize is true? 1 This assessment is normal. 2 The child is probably cognitively impaired. 3 A developmental/neurologic evaluation is needed. 4 The parent needs to work with the infant to stop head lag.

3 The child requires evaluation before interventions can be determined. A 6-month-old infant should have social interaction beyond smiling and cooing. The head lag should be almost gone by four months of age.

The primary health care provider (PHP) prescribed HepB (Recombivax HB) vaccine for a child. Which question should the nurse ask the child's parents to ensure it is safe to administer the vaccine? 1 "Does your child have a history of respiratory tract infection?" 2 "Does your child have a history of any urinary tract infections?" 3 "Does your child have a history of being hypersensitive to yeast?" 4 "Does your child have a history of skin infections such as impetigo?"

3 The nurse should assess for a history of yeast hypersensitivity in the child before administering the HepB (Recombivax HB) vaccine. HepB (Recombivax HB) vaccine is prepared from yeast cultures, so this vaccine should not be administered to the child who has yeast hypersensitivity. It may produce a severe anaphylactic reaction in the child. History of skin infections, urinary tract infections, and respiratory tract infections is not necessary because it does not have any impact on the vaccination.

The nurse is caring for an infant who has an iron deficiency. The primary health care provider (PHP) has prescribed oral iron supplements to the infant. What instruction should the nurse give to the infant's parents for the safe administration of the supplement? 1 Administer the medication mixed with fluids 2 Administer the medication with all the meals 3 Administer the medication in between meals 4 Administer the medication with milk products

3 The nurse should instruct the parents to administer the supplement to the infant between meals for enhanced absorption. Iron supplements should not administered with food, drink, or milk products because these substances bind to free iron and prevent absorption. This results in an insufficient concentration of iron in the body.

The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." What is the nurse's best response? 1 "It's important to let him make a mess. Just try not to worry about it so much." 2 "It's important not to give in to this kind of temper tantrum at this age. Simply ignore the behavior and the mess." 3 "You need to try different types of utensils, bowls, and plates. Some are specifically designed for young children." 4 "Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."

4 At 12 months, the child should be self-feeding. Because children this age eat primarily finger foods, it is useful to offer the parent suggestions for keeping the mess to a minimum. The child is developmentally ready for self-feeding. Ignoring the behavior and not allowing the child to self-feed is not fostering the child's development. The parent should not force the use of the spoon but should substitute finger foods. This response minimizes the parent's concerns about the mess created by self-feeding.

While assessing an infant, the nurse notices a typical bald spot, a symmetric distortion of the skull, and torticollis. What should the nurse interpret from this assessment? 1 The infant has a bacterial infection. 2 The infant has a vitamin E deficiency. 3 The infant has a vitamin C deficiency. 4 The infant has positional plagiocephaly.

4 Positional plagiocephaly is a condition in which the infant has an oblique or asymmetric head. The fontanels in the skull of an infant are not closed, which makes the skull pliable. The posterior occiput flattens over time if the infant is placed on his or her back during sleep. This leads to the development of an atypical bald spot, asymmetric distortion of the skull, and tightening of sternocleidomastoid muscle leads to torticollis in the infant. The symptoms of a bacterial infection are fever, malaise, and irritability. Vitamin E deficiency is rare and does not cause these symptoms. Most infant formulas are fortified with Vitamin C, so a deficiency is rare. It also does not cause these symptoms.

A 4-month-old infant is brought to the clinic by his parents for a well-baby checkup. What should the nurse include at this time concerning injury prevention? 1 "Keep doors of appliances closed at all times." 2 "Never shake baby powder directly on your infant because it can be aspirated into his lungs." 3 "Do not permit your child to chew paint from window ledges because he might absorb too much lead." 4 "When your baby learns to roll over, you must supervise him whenever he is on a surface from which he might fall."

4 Rolling over from abdomen to back occurs between 4 and 7 months. This is the appropriate anticipatory guidance for this age. Not shaking baby powder directly onto the infant is appropriate guidance for a first-month appointment. Not permitting the child to chew paint from window ledges should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand. Keeping doors of appliances closed at all times should be included at the 9-month visit when the infant is beginning to crawl and pull to a stand.