Child Growth and Development Milestones

Growth and Development

• Comparing a child's height and weight measurements to standardized percentiles assesses growth trends.
• Consistent measurements below the 5th percentile or sudden changes are cause for concern.
• Failure to Thrive (FTT) is diagnosed when a child's weight or growth is significantly below expected norms.
• Inadequate nutrition, neglect, or medical conditions are causes of FTT.
• Two hours of dryness, interest in using the toilet, the ability to follow simple instructions, and awareness of the urge to go are all signs of toilet training readiness.
• Transition objects like blankets or stuffed animals provide comfort, particularly during hospitalization or stressful situations.
• Parents should involve siblings in care, maintain routines, and provide special one-on-one time to help siblings adjust to a new baby.
• Infants engage in solitary play, toddlers in parallel play, preschoolers in associative play, and school-age children in cooperative play.
• Toddlers have a fear of separation, preschoolers of monsters and the dark, school-age children of failure and injury, and adolescents are self-conscious about appearance.
• Death has no understanding for toddlers, is reversible for preschoolers, final for school-age children, and is met with realistic understanding in adolescents.
• Onset of puberty normally occurs in girls ages 8-13 years and boys ages 9-14 years.
• Precocious puberty (14 in boys) is a sign needing referral.

Developmental Theorists

• Freud theorized psychosexual development.
• Piaget theorized cognitive development stages.
• Kohlberg theorized moral development.
• Erikson theorized psychosocial stages.
• Resilience Theory examines how children cope with adversity.
• Key developmental milestones include rolling over at 4-6 months, saying first words at 12 months, and walking at 12-15 months.

Nutrition

• Breastfeeding premature infants provides essential nutrients and immunity.
• Cup drinking should be introduced around 6-12 months during weaning.
• New foods should be introduced one at a time every 3-5 days.
• Iron-fortified formula/cereals can prevent iron deficiency.
• Phenylalanine should be avoided in the diet when managing PKU, which is screened at birth.
• Rash, vomiting, and respiratory distress are symptoms of food allergies.
• Colic presents as frequent, prolonged crying in infants.

Wellness and Patient Education

• The first dental visit should occur by 1 year old, and regular hearing tests should be scheduled.
• SIDS can be prevented with supine sleeping and no loose bedding.
• Car seats should be rear-facing until at least 2 years old.
• Stress management, avoiding substance use, and safe sex education are key aspects of adolescent health.
• WIC, Medicaid, and parenting programs are all valuable community resources.

Assessment

• Distraction techniques should be used and procedures explained when using pediatric assessment techniques.
• Pediatric vital signs have age-based normal ranges.
• The FLACC scale is used for pain assessment in infants.
• Mood changes and declining school performance are signs of adolescent substance abuse.
• Diverse pain expressions should be recognized with cultural considerations.

Fluid and Electrolytes

• Sunken fontanelle, dry mucous membranes, and poor skin turgor are signs of dehydration.
• A fluid bolus of 20 mL/kg IV is used for dehydration.
• Maintenance rate for fluids is based on weight.
• Heat exhaustion and dehydration are heat-related problems.

Abuse

• Regression and inappropriate sexual behavior are signs of sexual abuse.
• Bruises in various healing stages and spiral fractures are signs of physical abuse.
• Parental substance abuse and domestic violence are risk factors for abuse.

Hospitalized Child

• Family should be involved and therapeutic play should be used to cope with stress for a hospitalized child.
• Simple language and play therapy should be used to prepare a child for procedures.

HEENT

• Ear pain and fever are symptoms of otitis media, which is treated with antibiotics if bacterial.
• Group A Strep is a common cause of tonsillitis.
• Post-op care for tonsillitis includes pain control and hydration.
• Epiglottitis presents as drooling and stridor and is a medical emergency, while croup presents with a barking cough.

Respiratory

• Smaller airways in pediatrics increase obstruction risk.
• Nasal flaring, grunting, and retractions are signs of respiratory distress.
• Cystic Fibrosis results in thick mucus production, requiring pancreatic enzyme supplementation.
• Allergens and exercise are triggers for asthma, which is managed with bronchodilators and corticosteroids.
• Acute Respiratory Distress requires immediate intervention with oxygen and positioning.

Math

• IV drip rates are calculated by mL/hr based on weight.
• Medications and fluids use weight-based calculations.
• Calculating Ins and Outs includes fluid intake, urine output, and stool losses.