Pediatric Exam 1
Growth and Development:
Factors that influence growth and development:
Intrauterine factors
Birth events (prematurity, trauma)
Chronic illness
Socioeconomic status
Parent-Child relationship
Culture
Health/genetics
Nutrition
Genetics
Temperament
Growth = size
Development = activities and behavior
Chronological age doesn’t equal developmental age
Cephalocaudal: head to lower extremities
Proximodistal: First able to control the trunk, then the arms, and later fine movements of the
fingers
Differentiation: simple to complex
Neonatal: birth – first month
- A child born younger than 28 days old is a newborn or neonate. The term newborn refers
to any preterm, or postmature infant. The infancy period comprised ages 1 month to 1
year.
- Gestation is the duration of pregnancy, measured in weeks
- The average full term baby is born between the first day of the 38th week and the first day
of the 42nd week of pregnancy.
- A preterm infant is born before the end of the 37th week of pregnancy
- A post mature infant is for after 42 weeks of pregnancy
- Viability is a term used to determine the rate of survival.
- Less than 22 weeks gestation is considered not viable
o 23 weeks gestation: 17% survive
o 24 weeks gestation: 39% survive
o 25 weeks gestation: 50% survive
o 26 weeks gestation: 80% survive
o 27 weeks gestation: 90% survive
o 28-31 weeks gestation: 90-95% survive
o 32-33 weeks gestation: 95% survive
o 34+ weeks gestation, survival is similar to that of a full term infant
- Measurements:
, o Head is ¼ of body length. 33-35 cm; about 1-2 cm greater than chest
circumference
Measure above eyebrows and around the largest part of the occiput
o Weight: 6-8 lbs (2.7-3.6 kg)
o Length: 48-50 cm, grows 2cm/month for 6 months
- Play: unoccupied with mobiles that turn and play music, mirrors
Infant: birth – 1 year
- Measurements:
o Weight: doubles birth weight within 6 months, triples by 1 year, quadruples by 2-
2.5
o Height: increases by 50% by age 1
o Head growth is rapid
o Postieror fontanel closes by 2-3 months
o Anterior fontanel closes by 12-18 months
- Gross motor development:
o Head: 2-3 months
o Rolls back to side: 4 months (AT RISK FOR FALLS)
o Rolls abdomen to back: 5 months
o Sits alone without support: 7-8 months
o Stands holding furniture: 9-12 months
o Crawls with abdomen on floor: 10 months
o Crawls with abdomen off floor: 11 months
o Cruises holding furniture: 12 months
o Walks well with one hand held: 12 months
o Walks a few steps independently: 12 months
- Fine motor development:
o 2-3 months: brings hands to midline, eyes follow to midline
o 4-6 months: holds bottle, grasps objects
o 6-8 months: transfers hand to hand, pincer begins
o 8-10 months: pincer grasp well developed
o 10-12 months: places objects into containers, begins using objects correctly
- Teeth begin to erupt around 6 months
o Cold teething rings, OTC teething gels, Tylenol/ibuprofen can help with pain
o Clean teeth using cool, wet washcloth
o No bottle in the bed: milk-mouth
- Cognitive:
o Progresses from reflexes to simple activities
o Separation: infants begin to separate themselves from objects in the environment
o Object permanence: the understanding that people and objects still exist even
when they are hidden or out of site
- Language:
o Crying is the first form of communication
o Vocalizes with cooing noises
o Turns head to sounds
o Laughs and squeals
2
, o Pronounces single syllable words
o Progresses to 2-3 word phrases
o Understand “no” by 1 year
- Social:
o Attachment/bonding
o Separation
o Stanger fear 6-8 months
o Mouth is pleasure produces
o Hands and feet are toys
o Smiling causes others to smile
- Safety:
o Cribs: mattresses down and rails up with slats no more than 2 3/8th inch apart
o Safe sleep guidelines:
No fluffy blankets, stuffed animals, pillows in crib, etc
Place on their back to sleep
Tummy time important (when awake and supervised)
o Children under 1 year of age and any child less than 20 pounds must be secured in
a child passenger restraint system in a rear facing position, meeting federal motor
vehicle safety standards in a back seat.
- Play:
o Solitary play
o Rattles, teething toys, nesting toys, pat-a-cake, playing with balls, reading books,
mirrors, brightly colored toys, playing with blocks
- Pain:
o Infants will increase BP and HR and decrease in O2 sat
o Harsh, tense, loud crying
o Facial grimacing, flinching, trashing extremities
Toddler: 1-3 years
- Anterior fontanel closed by 18 months
- Measurements:
o Weight: 4 times birth weight at 2-2.5 years
o Row in height average 3 inches per year
o Head circumference = chest circumference by 1-2 years
- Cognitive:
o May have memories of events that relate to them
o Domestic mimicry
o Can imitate previously seen activates
o Begins to show dominant hand preference
- Language:
o 1 year: 5 words
o 2 years: 2-3 word sentences
o 3 years: combines words to create simple sentences using rules of grammar
- Motor skills:
o Walk alone by 15 months
o Begin to run and kick a ball
3
, o Turn a doorknob
o Climb stairs
o Can run and jump by age 2
- Ritualism: needed to maintain sameness and reliability. Provides sense of comfort
o Reading the same book every night, ritual at bedtime
- Safety:
o Childproof home environment: stairways, cupboards, medicine cabinet, outlets
o Aspiration/poisoning: medications, store garage items out of reach
o No longer recommended to have ipecac in home as antidote for poisoning
o Have poison control number available
- Play: parallel play: playing side by side, but not with each other
o Imitate adult in play
o Blocks, wheel toys, push toys, thick crayons, filling and emptying containers,
tossing balls, finger paints, large piece puzzles
o Enjoy repetitive stories and short songs with rhythm
- Sleep:
o Average 11-12 hrs sleep per day, including one nap
o Older toddlers may not take naps
o Resistance to bedtime and fears associated with bedtime are common
o Bedtime rituals important to help child sleep
- Dental:
o Should have dental exam by 1 year
o Brushing and flossing to be done by adults
o Supplement with fluoride if water is not
- Potty Training:
o Readiness:
Able to stand and walk
Able to pull pants up and down
Recognizes the urge and able to wait until going to the potty
o Prefer their own chairs
o Place on chair for a few moments at intervals
o Reward for success
o NO PUNISHMENT FOR FAILURE
If child doesn’t understand or wont cooperate, wait a few weeks and try
again
o Hospitalized:
Make potty chair available
Know child’s words for bathroom and voiding
- Temper Tantrums:
o Very common 50-80% will have tantrums
o May be crying, kicking, hitting, screaming
o Assure that the child is safe, and ignore them (no physical or eye contact)
- Reaction to Illness and Hospitalization:
o Unpredictable routine causes distrust
o SEPERATION ANXIETY: between 6-30 months; peaks around 15 months
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