Infant and Toddler Development: Physical Changes

• Physical growth, respiration, cardiovascular system changes, and gastrointestinal changes during development

Infant (0-1 Mental Year)

• Weight doubles by 6 months and triples by 12 months, reaching an average birth weight of 7.5 lbs
• Length increases by 50% by 12 months from an average birth length of 20 inches
• Head circumference increases by 10 cm (4 inches) by 12 months
• Breathing rate is 30-60 breaths per minute
• Breathing rate for infants is 25-30 breaths per minute
• Heart rate is newborn 110-160 bpm and infant 90-160 bpm
• Blood pressure at newborn is 64/41 mmHg
• Blood pressure for infant is 85/50 mmHg
• Infants have a larger tongue

Toddler (1-3 Years)

• Weight gain slows to 3-5 lbs/year
• Height increases by about 3 inches/year
• Head becomes proportionate to the body
• Half of the adult height is attained by age 2
• Breathing rate is 25-30 breaths per minute
• Small airways with large tonsils/adenoids
• The risk of infection increases
• The heart rate is 80-140 bpm
• Slightly increased blood pressure ~90/50 mmHg
• The stomach is growing

Preschool (3-6 Years)

• Growth continues steadily as the spinal cord becomes fully myelinated by age 3
• Full bowel and bladder control achieved
• Bones and muscles strengthen significantly
• Breathing rate is 20-25 breaths per minute
• Airways get larger
• The increase in alveoli continues
• Heart rate is 70-120 bpm
• Blood pressure slightly increases and innocent heart murmurs are common
• Have all 20 baby teeth

School-Age (6-12 Years)

• Weight increases by about 4.4-6.6 lbs/year
• Height increases by about 2 inches/year
• Prepubescence begins around age 9, especially noticeable in girls
• Breathing rate is 20-25 breaths per minute
• Lungs are larger
• Breathing is deeper, slower, and with better endurance
• Heart rate is 60-110 bpm
• Blood pressure is approximately 100/60 mmHg
• The heart becomes stronger and more efficient
• Have permanent teeth

Adolescents (12-18 Years)

• The final 20-25% of height occurs during puberty
• Females stop growing 2-2.5 years after menarche and gain roughly 2-8 inches and 5-55 lbs
• Males stop growing at 18-20 years and gain roughly 4-12 inches and 15.5-66 lbs
• Breathing rate is 16-20 breaths per minute
• Heart rate is 50-100
• Blood pressure less than 120/80
• Have a full set of teeth

Gastrointestinal and Genitourinary System Development

• Breastfeeding is encouraged because it aids latch and produces soft stools, while formula feeding results in firmer stools
• The capacity of the gastrointestinal system increases, and fewer meals are needed.
• Erratic eating patterns are common, and children should be encouraged to self-feed with small utensils and dishes
• Baby teeth are present but are replaced starting at age 6 by permanent teeth
• Appetite is stable
• Rapid metabolic growth requires proper nutrition to avoid nutrient-poor diets and obesity
• Adults must assess height, weight, and BMI yearly and to monitor for conditions like obesity, anorexia, and bulimia
• Balanced diet and physical activity(60 min/day) is essential

Genitourinary System

• Frequent urination with immature kidneys is characterized
• No water intake is recommended due to risk of overload
• Adult bladder/kidney function reached by age 2
• Short urethra is susceptible to UTIs but with better bladder control
• Girls have larger bladder capacity, with fewer GU issues

Musculoskeletal System

• Infants obtain gross motor head control and are rolling over by 5-6 months, supported sitting
• Toddlers exhibit steady walking, running, jumping, and mastering stairs along with fine motor skills
• Preschoolers exhibit running, climbing, jumping, catching, and throwing
• School-age children exhibit jumping rope, biking, competitive sports, and more refined motor skills

Cognitive, Social, and Language Development

Fine Motor Skills Development

• Infants motor skills include scribbling and stacking blocks
• Infants learn self-feeding with utensils and turn book pages one by one
• School age children exhibit complex crafts, musical instruments, and intricate puzzles

Erikson's Theory Stages

• Infants, who are in the Trust vs. Mistrust stage, learn to trust caregivers who consistently meet their needs
• Toddlers in the Autonomy vs. Shame/Doubt stage seek independence and self-control
• Preschoolers in the Initiative vs. Guilt stage explore and try new things, demonstrating magical thinking
• School-age children in the Industry vs. Inferiority stage develop skills and confidence from successful experiences versus feelings of inadequacy from failure/criticism
• Adolescents in the Identity vs. Role Confusion stage explore different roles to develop a personal identity Peer groups play a role in shaping behavior and self-concept, and the struggles with identity may cause role confusion.

Piaget's Theory Stages

• Infants who are in the Sensorimotor stage learn through senses and motor activities
• Toddlers who are in the Preoperational stage begin pretend play and symbolic thinking
• Pre-schoolers have magical thinking
• Animism is giving life to non-living things
• School aged children think with Concrete Operations, and logical thought to understand cause and effect

Language Development

• Infants start with Cooing (1-3months) and then move to Telegraphic(1-3 words), followed with 3-5 word sentences and eventual Vocabulary usage

Social and Emotional Development (All Ages)

• Infants require Attachment to caregivers and recognition of familiar faces
• Infants can experience Separation anxiety, and express pain with reflexive reactions such as crying and grimacing
• Toddlers exhibit Egocentric behaviors which seeks independence with emotional ups and downs and separation anxiety
• Toddlers develop conscience (superego)
• Preschoolers engage in Associative play, with imaginary friends, magical thinking
• Preschoolers experience social interactions
• Preschoolers learns social fairness and often stall during procedures as they fear pain and may think it's punishment to them
• School Agers develop self concept - They can describe their pain
• Adolescents' peers become crucial with Friendships and peer pressure emerging
• Adolescents can think critically and make decisions, but their impulse control is still developing, making risky behaviors more common
• Adolescents still needs parental guidance and communication should be open, respectful, and non-judgmental.
• Adolescents may underreport pain due to verbal abilities

Puberty Changes

• The "belly" is prominent and there is a swayback posture
• There is emotional lability and expression of fears
• Adolescents experience changes in the larynx and mottling of skin when cold or upset, low specific gravity urine, and risk of dehydration
• The Puberty age can be noticeable around age 9
• The immune system becomes stronger
• Coordination improves with spurts
• Menstruation and Breast development are signs of puberty
• Bodily Harm and depression/self-harm/suicidal thoughts are safety concerns during puberty
• Motor vehicle Safety includes education on seatbelts, driving practices, substance use, and texting.

Pediatric Medication Administration

• The rights of medication includes right patient, medication, dose, time, route, documentation, approach, education, refusal, and form
• To ensure safety, always verify the dosage and Convert weight to kg (lbs/2.2) and check drug reference ranges
• Slower digestion affects oral medications while weaker liver and kidneys extend drug effects

Medication Administration Tips

• Administer oral medications using a syringe or dropper
• Blend with sweet food except with formula
• While administering shots, SC route with tiny doses (<0.5mL) for upper arm/belly/thigh
• IM route with muscle shots, and use thigh (vastus lateralis) on babies and no butt shots to avoid risk of nerve damage

IV Therapy

• Can only have two attempts at the IV site
• Use small gauge needle
• Use PICC line for long term usage

Tube Feeding & IV Nutrition (TPN)

• Confirm the placement
• Watch for signs tube misplacement by observing vomiting, choking, breathing issues
• Risk of infection

Vaccine Administration and Adverse Effects

• Vaccines introduce harmless version of germ to build immunity
• Live attenuated vaccines provide long term immunity
• Inactivated need boosters

Live Attenuated examples

• MMR (Measles, Mumps, Rubella)
• Varicella
• Rotavirus

Inactivated (Killed) examples

• Hepatitis A
• Polio (IPV)
• Rabies

Toxoid examples

• Tetanus
• Diphtheria

Conjugate examples

• Hib (Haemophilus influenzae type B)
• Pneumococcal (PCV)
• Meningococcal

Recombinant Examples

• Hepatitis B
• HPV

Vaccine Schedule to remember

• Birth: Hep B
• 2 months: DTaP, RV, IPV, Hib, PCV, Hep B
• 4 months: DTaP, RV, IPV, Hib, PCV
• 6 months: DTaP, IPV, PCV, Hep B, RV, Hib, the flu shot given annually after 6 months
• 12-15 months: MMR, Varicella, Hep A
• 4-6 years: DTaP, MMR, IPV, Varicella
• 11-12 years: Tdap, HPV, meningococcal
• 16 years: Meningococcal booster

Common Pediatric Vaccine Protection

• Hep B (Hepatitis B): Prevents liver infection
• DTaP (Diphtheria, Tetanus, Pertussis): against throat swelling, muscle stiffness, and whooping cough
• RV (Rotavirus): Diarrhea and dehydration
• IPV (Inactivated Polio Vaccine): Against polio
• PSV (Pneumococcal): Pneumonia, meningitis, and ear infections
• HIB (Haemophilus influenza type B): Against severe bacterial infections like meningitis and pneumonia.
• MMR (Measles, Mumps, Rubella): Against measles, mumps. And rubella
• Varicella: Chickenpox
• Hep A: Liver infection from contaminated food/water
• HPV: Against HPV

Pediatric Safety Tips

• Infants: Be mindful of choking and suffocation
• Toddlers: Drowning prevention and lock away cleaning supplies
• Preschoolers: Road and bike skills
• School Age: Screen time and healthy eating
• Teens: Mental health and risk of drug use

What to Know About Each Vaccine

• Hep B - B for Bloodborne
• DTap - D for deadly, P for pertussis cough/throat related
• Rotavirus - R for rotavirus runs/diarrhea
• IPV - Inject to prevent virus
• PCV - P for Pneumonia
• HIB - H for head, referring to Brain Infections
• MMR - M for Multiple (referring to rashes)
• Varicella - V for very itchy
• MeninGococcal - Mind (Brain) protection
• Influenza - I for I get it yearly.

Common GI Disorders

• Some GI disorders happen suddenly, while others are long-term
• The digestive system is responsible for the following processes: food, nutrient absorbtion, waste disposal
• GI issues have symptoms such as vomiting, diarrhea, constipation, dehydration, and pain.

Risk Factors of GI

• Factors of Risk: History of Family, premature babies, chronic conditions, usage of medication, and exposure to infections.

How To Diagnose

• To diagnose, common diagnostic tests include, Ultrasound, barium, HIDA scans, stool tests, and blood tests

What To Note About Blood And Lab Tests

• Imaging tests for looking inside, Ultrasound for pyloric diagnosis, Barium swallow for swallowing, HIDA to check gallbladder function
• Blood Tests - Electrolytes measures dehydration and Liver checks health of the organ

Diagnostic Tests (Endoscopies and stool)

• Endoscopies is usage of camera to look inside GI
• Stool analysis will measure for blood, parasites, and infections

How to treat (infections)

• Bacteria, viruses, contagious foods
• Lab results and hydration are extremely key!

GI Examples of infection

• Rotavirus - Kids commonly contract for 5-7 days
• E. Coli - Bloody diarrhea
• Salmonella - Fever and blood
• C.diff - Antibiotic usage/after
• Nonovirus - GI that lasts 2-3 days

Acute Illnesses of GI

• This includes symptoms such as dehydration
• Pyloric, appendicitis and intussception
• As well as Meckel's Diverticulum

Types of Dehydration

• Milk - Cap refill of 2 Seconds - 3-5% of weight loss
• Moderate - 6-9% and dry mouth
• Severe - Oliguria and no tears

Types and Symptoms of the previously stated diseases

• Pyloric Stenosis is Infants vomiting in olive mass as result of obstruction [use a decompression before
• Intussception - Bowel telescopes inside and contains jelly stools
• Appenditis - RLQ inflammation signs

Anamolies of GI

• Includes cleft lip, GER/GERD
• Hirschsprung and Crohn’s,UC

Cleft-Lip details including prevention

• NO pacifiers / Spoons during post
• Use special bottles for feed

Differences between GI and treatment

• The main concern for Failure is a high caloric diet
• Ostmoy care, with 1/4 and change every 3-5 days and monitor for output
• Make sure low Fiber

Actions after GI surgery

• Monitor sound, NGT, and diet for protein, hydration, and infection
• Do know aspirin and use acetaminophen while resting and icing post op

Types of Meds for various GI issues

• Acid Reducers / PPI H2
• Antibiotics for bacteria
• Anti - Meds for diarrheal
• Anti Parasite - For Alben

Caring for GI

• Support education and family
• Allow support to remove anxieties

Remembers tips to help understand key points

• Hirsch : No poop / newborn and ribbon stool older child
• Appedicitis - RELIEF, MC and RLQ will rupture
• Cleft = No suck post side
• Ulcertive= Nightly stool problem

GU Disorders

• Kidney fluid and electrolytes balance
• Ultrasound and cultures, as well Urianlysis

Remember main points

• Enuresis (after 5) and Primary, Risk are family +
• Encourage behavior and therapy along with alarm in treatment

How 2 Signs

• YOung + fever for labs

Chordee: D curve, and hypospadias is under.

• UTi, infection, swelling for both, then support for education

Acute Neph Syndrome and GU

• Streo = tea urine, so treat will be low protein
• Hypo and neph have protiens.
• Anemia for EColi, so balance balance to treat and maintain and dialslis

CD and KD

• Fatigue and dialslis

Vul=Vigina treatment and epidy = inflammed

• Torsion means ✂ cuts blood
• Low pain during first signs

Always maintain fluids and diuretics

• Make sure high protein, support and manage electrolytes

Important notes for both

• UTI is infections
• Gomer Strep
• Low=neph everywhere
• TOR=Torsion SEVERE (Emergency)
• Struture; 6-12

VUR

• Flows bad UT with bacteria
• Use fluids and correct with correction
• Refulux is UTI risks

Overview of physical changes in infants and toddlers. Covers weight, height, and head circumference changes. Also includes information on breathing rate, heart rate, and blood pressure during this development stage.