111 terms

Pediatric Nursing

Examples of stress experienced by toddlers
1. separation anxiety from parents, grief reactions
2. regression
3. refusal to eat
4. difficulty sleeping
Three phases of separation anxiety and behavioral responses exhibited during each phase
1. protest; clings to parent to force them to stay
2. despair, inactive + withdrawn and regress
3. detachment, denial, after prolonged separation , denies need for parents lvoe, affection to nurses
Nursing interventions to reduce separation anxiety
1. encourage family contact
2. familiar belonging brought from home
3. provide therapeutic play
4. accept regression
5. consistent routine with familiar staff
6. extra cuddling and holding
Example of a coping strategy found amongst toddlers when in stress
throwing games
List the major developmental tasks for toddlers
1. development of autonomy
2.. control environment
3. act of movement with no restraining
Identify examples of collaborative efforts to assist toddlers with control and mobility
1. assist child with ambulation within their control
2. throwing games, vent frustrations
3. child life specialist, modified toys
4. physical therapist, promote strength and flexibility
List nursing interventions used to prepare a toddle for a procedure
1. brief explanations, 5-10 mins, emphasize what the child will see, hear, taste, or feel
2. see age appropriate videos with parents
3. comfort by use of bandages to stop bleeding, avoid deception to gain compliance
Identify the initial step to effective pain management and special considerations made for a toddler
1. assessment, meaning of hurt, what word is used for pain
2. prior pain experience
3. what does your child do when she/he is hurting
4. anything special that need to know about the child in pain
List behavioral cues demonstrated by a a toddler when experiencing pain
1. frowning
2. crying
2. restlessness
List physiological cues demonstrated by a toddler when experiencing pain.
1. rapid pulse
2. rapid respiration
3. perspiration
Identify nursing interventions used for pain management with a toddler
1. form of relaxation, deep breaths
2. form of distraction
3. transport to treatment room for treatments
4. medical personnel restrains, not parents
5. the parents presence
6. explain in a a few simple words
7. administration of pain meds
Provide examples of fostering autonomy and independence when planning for discharge
1. select favoring snacks
2. help with dressing change
3. allow playing if on bed rest ( can play near bed)
4. continue to perform toileting and hygiene skills
5. toys for psychosocial development
6. give independence and allow exploration within safe guidelines
List seven reliable devices for accurately measuring and administering oral meds
*measuring spoon
*plastic syringes
*calibrated nipple
*plastic medicine cup
*calibrated dropper
*hollow handles medicine spoon
*medicine bottle used to delivery oral meds via syringe
Six methods of med administration that encourage child's acceptance
1. flavored ice pop/small ice cube to suck to numb tongue
2. mix drop with a small about (1tsp) of sweet tasting substance
NO honey until age 1 year
3. give a chase of water, juice, soft drink
4. if n/v is a problem, give a carbonated beverage poured over finely crushed ice before or after
5. when unpleasant tastes pinch the nose and drink med thru a straw
6. have pharmacist prepare drug in a flavored chewable lozenge
7. infants will suck forma needless syringe
What two types of meds should never be crushed and why?
*enteric or protected coating; could irritate the stomach; this type of tables is absorbed by small intestine
*Slow release- could be absorbed more rapidly
If med must be crushed what type of food should never be used?
Honey in infants due to botulism
2 methods of restraining for infant or toddler receiving IM injection in vastus lateralis
1. body of larger infant can be securely held between the nurses arm and body
2. swaddle baby leaving the part of the extremity out that is receiving the injection
List six meds that should be reviewed by 2 profession nurses before administration to infant/child
*chemotherapeutic agents
According to Ericksons theory of development why would a toddler view hospitalization as a punishment?
Ritualism the need to maintain sameness and reliability provides sense of comfort. without ritu8als little opportunity to exert autonomy. consequently regression and dependency occurs
Hearing test for newborn
OAE- Otoacoustive Emission measures intensity sound from the cochlear hair cells in response to clicks from a probe placed in the ear canal
does not detect neural damage
Detects inner hearing loss
does not detect damage to cranial nerve
Parallel play
two toddlers playing side by side, no interaction or sharing
What to you give to a child who has taken too much tylenol
Parenting Styles
High control, low warmth
Highly controlling/expect to be obeyed/little communication
permits little independence
Child outcome:
no negotiation skills, no ability to direct and initiate own activities, frustrated in efforts to achieve autonomy, girls passive, boys aggressive
Moderately high control, high warmth
sets reasonable limits on behavior
accepts and encourages growing autonomy
open communication
flexible rules
Child outcome: willingly excepts restriction, more self reliant, self controlled, socially competent, better school performance
Low control, Low warmth
no limit setting
lacks affection for child ; focused on stress in own life
may show hostility toward or neglect of the child
Child outcome: may become rebellious, aggressive, socially inept, impulsive, may be creative, active, outgoing
Guidelines for acceptable behavior in children
*set realistic expectations based on child's age
consistently enforce the expected directions and behaviors
*focus on promoting appropriate and desirable behavior in child
model behavior
review expected behavior for special situations
help distinguish between inside and outside voice
Praise or reward child
*Tell child of inappropriate behavior as soon as it begins
*when reprimanding, focus on behavior rather that the child
*be alert for when situations arise that may led to misbehaving (tired, hungry)
*friendly reminders to help child gain self control
Cephalocaudal development
development that proceeds from the head toward the feet
Proximodistal developemtn
development that proceed from the center of the body outward extremities
Developmental Age groups
Infancy- birth to 12 months
high level of care in daily activities
Toddlerhood- 1-3 years. increased motor ability and independent behavior
Preschool- 3-6 years. the preschooler refinees gross and fine motor ability and language skills and often participates in a preschool learning program
School age- 6-12 years. begins with entry to school sys. growing intellectual skills, physical ability, and independence
Adolescence- 12-18 years. begins with entry into the teen years. Mature cognitive thought, formation of identity, and influence of peers import characteristic of adolescence.
Freud Stages
Oral- birth to 1 year
pleasure from the mouth, sucking and eating primary
Anal- 1-3 years
childs pleasure centered in anal area
Phallic- 3-6 years
sexual energy center / child works out relationships with parents of same/opposite sexes
Latency- 6-12 years
sexual energy is at rest in passage between earlier stages and adolescence
Genital - 12- adulthood
mature sexuality is achieved physical growth is completed/relationships with other occure
Common defense Mechanisms used by children
Regression- return to early behavior
Repression- involuntary forgetting of uncomfortable situations
rationalization- attempt to make unacceptable feelings acceptable
fantasy- creation of the mind to help deal with unacceptable fear
Erickson Theory (psychosocial)
Trust vs Mistrust (birth to 1 year)
Autonomy vs Shame (1 to 3 years)
Initiative vs guilt (3 to 6 years)
Industry vs inferiority (6 to 12 years)
Identity vs Role confusion (12 to 18 Years)
Trust vs Mistrust
birth to 1 yr
Task of first year of life is to establish trust, fostered by provision of food, clean clothing, touch , and comfort

If needs not met, infant learns to mistrust others
Autonomy vs Shame and doubt
1-3 yrs Toddlers sense of autonomy or independence si shown by controlling body excretions, saying NO, and directing motor activity

Children who are consistently criticized for expressions of autonomy or for lack of control (ex toilet training) will develop a sense of shame about themselves and doubt their abilities
Initiative vs Guilt
3-6 yrs. initiates new activities and considers new ideas. interest in exploring creates a child who is busy and involved

constant criticism, leads to feeling of guild and a lack of purpose
Industry vs inferiority
6-12 yrs. middle years are characterized by development of new interests and by involvement in activities. takes pride in accomplishments

If child cant accomplish what is expected the result will be a sense of inferiority
Identity versus role confusion
12-18 yrs. adolescence body matures and thought process become more complex; new sense of identity or self is established

adolescence who is unable to establish a meaningful definition of self will experience confusion in one or more roles of life
Piaget's Cognitive development
Child's view of the world is influenced largely by age and maturational ability; Nurturing experiences , childs ability to learn matures naturally
Piaget's stages
Sensorimotor (birth - 2 yrs)
Preoperational (2-7 yrs)
Concrete Operational (7-11 yrs)
Formal Operational (11- adulthood)
Sensorimotor (Piaget)
infants learn through the senses and motor activity.
*use of reflexes up to 1 month- sucking, rooting, grasping
*Primary circular reactions (1-4 months) pleasure gained causes repetitions of behavior
*Secondary Circular reactions (4-8 months). awareness of the environment; begins to connect cause and effect. ex: sound of a bottle preparation will lead to excited behavior.
*coordination of secondary schemes (8-12 mo)
learned behavior is observed; object permanence; but not fully developed
*tertiary circular reaction (12 to 18 months). curiosity, exploration, experimentation
*mental combination (18-24 months). Language a new tool for toddler to understanding the world.
Preoperational (piaget)
2-7 yrs
*preconceptual (substage) 2-4 egocentrism
*intuitive substage 4-7- transductive reasoning : drawing conclusions from one general fact to another
(magical thinking, cause and effect, centration, animism (life to inanimate objects
Concrete operational (Piaget)
7-11 yrs
Transductive reasoning to a more accurate understanding of cause and effect. Conservation: matter does not change when form is altered learned at this age.
Formal operational (Piaget)
11 to adulthood
fully mature intellectual thought has now been attained. think abstractly consider different alternatives or outcomes
Kohlberg's theory of moral development
Pre-conventional (4-7yrs). decisions are based on the desire t please other and avoid punishment

Conventional (7-11 yrs). conscience or an internal set of standards becomes important. rules are important.. "be good"
Postconventional (12 yrs and older) individual has internalized ethical standards on which to base decisions. Social responsibility is recognized
Infants first year - Physical Growth
*birth weight double by 5 months and triples by end of first year
*Height increases by approximately 1 foot during this year.
*teeth begin to erupt at about 6 months
by the end of first yr has 6-8 deciduous teeth
Infants first year - Cognitive development
*eyes widen to response to sound
* 1 yr old turns .to sound and recognizes its significance
*2 month old cries and coos
1 yr old say a few words and understands many
6 wk old grasp a rattle for the first time
1 yr old reaches for toys and self feeds
Infants first year - Psychosocial development
Birth to 3 months-
Visual stimuli of mobiles, black and white patterns,
Auditory stimuli music boxes, tape players soft voices
Responds to rocking and cuddling
Moves legs and arms while adult sings and talks
Coos, babbles, cries

3-6 months-
prefers noise/rattles
enjoys soft animals/soft toys with contrasting color
Laughs, cries less, squeals and make pleasure sounds
babbles: mamamamamamama

6-9 months
likes teething toys
desires social interaction
soft toys
increases vowel and consonant sounds; links syllables; speech like rhythm when vocalizing with others

9-12 months
lge blocks; toys that pop apart; laughs jack in the box; peek a boo/ uses puss and pull toys
Understands "NO", and simple commands
says dada and mama
Learn one or two other words; receptive speech

Play begins in a reflexive manner, the pleasure they experience lead to purposeful performance.
Play then manipulative. examines toys closely, looking, touching, and placing in mouth
Respiratory rate ranges
Respiratory Rate Ranges (Table 5-10) p 178
Resp Rate per Min. Age
30-55 Newborn
25-40 1 year
20-30 3 years
16-22 6 years
16-20 10 years
12-18 17 years
Heart rate ranges
Heart Rate Ranges (Table 5-12) p 183
HR Range (bpm) Average HR (bpm) Age
100-170 120 Newborns
80-130 110 Infants- 2 years
70-120 100 2-6 years
60-110 90 6-10 years
60-100 80 10-16 years
Temper tantrums
Screaming, crying, pounding objects, kicking, showing anger.
Child becomes increasingly agitated & upset- try holding & distracting.
Separate child from others ("time-out") to eliminate reinforcement.
Remain calm- hold child firmly if needed.
Avoid "positive reinforcement"- giving in (rewarding with food, toys)
Talk calmly to child, verbalizing their feelings, explain what they need to do to calm down.
After control is obtain- briefly reward (praise) child.
Don't punish child every time they say "no." Don't ignore behavior.
Must set limits on behavior.
Toilet training
Should begin around 18-24 months (when can tell diaper is wet)
Encourage child to sit on potty for about 5 minutes.
Teach using potty for Bowel movement first (bladder control comes latter)
Infants sleep in short cycles (30 min to 3 hours)
Parents should adopt their schedule to anticipate infant night wakings
Try swaddling (Avoid time consuming comfort measures- Infant will begin to expect them)
Allow infant to self regulate. If awakens wait to see if they will resettle.
Don't allow infant to cry more than 5-10 minutes
Place infant on back to sleep. Avoid co-parenting
Toddler 1-3 years Physical growth and devel.
By 2yrs birth weight has quadrupled; and is about 1/2 adult size
body proportion changes: legs longer and head smaller
pot bellied; stands with feet apart;
by 33 months deciduous teeth is complete , 20 teeth present
1-2 YRS gains 8oz or more per month; 3.5 to 5 in during this year; anterior fontanel closes (18 months)
builds tower of 4 blocks; scribbles on paper; undress sefl; throws ball (fine motor)
runs; growing ability to walk; and then walks with ease; walks up and down stairs a few months after learning to walk with ease; likes push and pull toys (Gross motor)
visual acuity: 20/50

2-3 yrs gains 3-5 lbs /year; grows 2-2.5 in/yr
draws a circle and other rudimentary forms; learns to pour; learning to dress self (fine motor)
jumps, kicks ball, throws ball overhand (gross motor)
Toddler 1-3 years Cognitive development
Moves from sensorimotor to preoperational stage.
1 yr the ability to think about object or people when absent
2 yr increasing use of words as symbols enable use preoperational thought, creative thought, understand cause and effect now possible
Toddler 1-3 Psychosocial development
asserts autonomy; separate self from caregiver

PLAY- parallel play; stack blocks; bang pegs imitative behavior; various kinds of play object should be provided ; turns pages of books
PERSONALITY AND TEMPERAMENT- may respond negatively to stimuli; Use of word "no"
1 yr may use 4-6 words in addition ot mama/dada
End of toddlerhood 3 yr old vocab of up to 1000 words.
temper tantrum a form of cummunication
Toddler 1-3 Psychosocial dev
Play/Toys Refines fine motor skills by use of cloth books, large pencil and paper, wooden puzzles. Facilitates imitative behavior by playing kitchen, grocery shopping, toy telephone. Learns gross motor activities by riding Big Wheel tricycle, playing with soft ball and bat, molding water and sand, tossing ball or bean bag. Cognitive skills develop by educational television shows, music, stories and books.

Communication Increasingly enjoys talking. Exponential growth of vocabulary especially when spoken and read to . Needs to release stress by pounding board, frequent gross motor activities, and occasional temper tantrums. Likes contact with other children and learns interpersonal skills
Preschool child (3-6 yrs)
language skills well developed; child able to understand and speak clearly
Preschool 3-6 yrs Physical growth and dev
Gain 3-5 lb/yr; grow 1 1/2 to 2 1/2 in/yr
use scissors; draw circles, square, cross, draw at least a six part person enjoys art projects; stringing beads; using clay; tie shoes at end of preschool yrs; buttons clothes; brush teeth; use knife, fork, spoon (FINE MOTOR)
Throws ball overhand; climbs well; rides tricycle (GROSS MOTOR)
Sensory ability: visual acuity continues to improve; can focus on and learn letters and numbers
Preschool 3-6 Cognitive dev
characteristics of preoperational thought; symbols or words are used to represent objects and people; milestone in intellectual development; but has some limits in thought
Preschool 3-6 Psychosocial development
Associative play is facilitated by simple games, puzzles, nursery rhymes, songs. Dramatic play is fostered by dolls and doll clothes, play houses and hospitals, dress-up clothes, puppets. Stress is relieved by pens, paper, glue, scissors. Cognitive growth is fostered by educational television shows, music, stories, and books

Communication All parts of speech are developed and used, occasionally incorrectly. Communicates with a widening array of people. Play with other children is a favorite activity. Health professionals can: verbalize and explain procedures to children, use drawings and stories to explain care, use accurate names for bodily functions, allow the child to talk, ask questions, and make choices
School aged 6-12 yrs Physical growth/dev
*last period girls and boys are close in size and body proportion
*first deciduous tooth lost at 6 years
*physical skill refined begin to play sports
*nutritional needs increase dramatically with this spurt
*22-26 of the 32 permanent teeth erupt by age 12
School aged 6-12 yrs cognitive
concrete operational thought at about 7 yrs
consider alternative solutions and solve problems
continue to rely on concrete experiences and materials to form thought content
learns conservation
School aged 6-12 Psychosocial
Gross motor development is fostered by ball sports, skating, dance lessons, water and snow skiing/boarding, biking. A sense of industry is fostered by playing a musical instrument, gathering collections, starting hobbies, playing board and video games. Cognitive growth is facilitated by reading, crafts, word puzzles, school work. cooperative play

Communication Mature use of language. Ability to converse and discuss topics for increasing lengths of time. Spends many hours at school and with friends in sports or other activities. Health professionals can: assess child's knowledge before teaching, allow the child to select rewards following procedures, teach techniques such as counting or visualization to mange difficult situations, include both parent and child in healthcare decisions
School age and sexuality
mostly dealt with during school age; need info about their body changes to develop a healthy self image; appropriate and inappropriate touch should be discussed
Adolescent 12-18 yrs
End of child hood and beginning of adulthood
Adolescent 12-18 yr growth and development
Puberty near the end of school age period;
Formation of self identity is a psychological process but is closely connected with the body changes.
School age years growth and dev milestones
gains 3-5 lbs /yr grows 21 1/2 to 2 1/2 in/yr
enjoys craft projects; plays card and board games (FINE MOTOR)
Rides a two wheeler; jumps rope; roller skates or ice skates

Sensory ability- can read; able to concentrate for longer periods; filter out surrounding sounds
Adolescent 12-18 Cognitive
beginning of Piagets last stage- formal operational thought;
no longer depends on concrete experiences as the basis of thought but develops ability to reason abstractly
seek own identity and values
Adolescent growth and devel milestones
growth varies; girls spurt gain 15-55 lbs; grow 2-8 in
boys spurt: gain 15-65 lbs and grow 4 1/2- 12 inches

Skills well developed (fine motor)
new sports activities attempted and muscle development continues
some lack of coordination (common during spurt)

Sensory ability- fully developed
Adolescence Psychosocial (12 to 18)
PLAY: Sports-ball games, gymnastics, water and snow skiing/boarding, swimming, school sports. School activities-drama, yearbook, class office, club participation. Quiet activities-reading, school work, television, computer, video games, music.

Communication Increasing communication and time with peer group-movies, dances, driving, eating out, attending sports events. Applying abstract thought and analysis in conversations at home and school
How to build rapport with family (pedi assessment)
*introduce self
*explain the purpose of the interview
*provide privacy
*direct the focus of the interview with open-ended questions
*ask one question at a time
*involve the child in the interview
*be hones with the child when answering questions
*Choose the language style that is best understood
*Use an interpreter to improve comm if needed
Developmental approach to EXam NB to 6 months
• Keep parent present to provide security to infant.
• Keep sequence of exam flexible.
• Provide physical comfort during exam (feeding, pacifier, cuddling, changing diaper.
• Distracting by rocking or clicking noises if begins to get distressed.
• Auscultate when infant is quiet or asleep.
Developmental approach to EXam over 6 months
• Keep older infant with parent (prevent stranger anxiety). May be afraid of being touched
• Start with feet or hands before moving to trunk to decrease fears.
• Examined on parent's lap (also use of therapeutic hug).
• Won't object to having clothing removed (keep room warm).
• Smile & talk soothingly to infant, use toys to distract older infant.
• Use bottle or pacifier to quiet child when necessary.
Developmental approach to EXam toddlers
• Keep older infant with parent (prevent stranger anxiety).
• May be active, curious, shy, cautious, or slow to warm up.
• Exam on parents lap. Also therapeutic hug, or in between parents legs
• Start with cranial nerve & developmental assessment to gain cooperation
• Start with feet or hands before moving to trunk to decrease fears.
• Use instruments to examine eyes & ears last (they cause most fear)
• Tell child what you will do at each step of exam
• Let child have some control.
• Let child hold security object (blanket)
• Demonstrate use of equipment on parent or security object.
Developmental approach to EXam preschoolers
• Assess willingness of child to be separated from the parent.
• Most children are willing to undress, but leave underpants on.
• Most children this age are cooperative with exam.
• Allow child to touch and play with equipment.
• Give simple explanations about assessment procedures.
• Allow choices when possible.
• Use distraction to gain child's cooperation (ask child to count, name colors, etc).
• Give child positive feedback when they cooperate.
Developmental approach to EXam school age
• Allow older child to determine if exam conducted in privacy, with parent or older sibling.
• Anticipate the developing of modesty, and offer a pt gown to cover underwear.
• Children are willingly cooperative. Good time to teach how body works.
• A head-to-toe exam can be done.
• Demonstrate how equipment is used, and allow child to handle if they like.
• During exam explain to child what you are doing and why.
• Allow choices when possible.
Developmental approach to EXam adolescents
• Provide for adolescent's modesty by providing a private place to undress/dress.
• Perform without parent/sibling unless adolescent requests them.
• If parent/sibling not present, provide a chaperone during exam.
• Keep body covered with gown except when assessing that area.
• Use head-to-toe and same procedures as used for adults.
• When appropriate provide reassurance about secondary sexual characteristic development, and what further changes to expect.
General pedi assessment APPRAISAL
*Anthroppometric measurements: Measure child's weight, length or height, and head circumference

INFANT/TODDLER: under 2 yrs length in supine position; weight: infants weighed with all clothes removed on a platform scale (supine or sitting); head circumference: measured at regular intervals until 2 -3 years

height: after 2 - 3 yrs stadiometer; weight: standing scale; BMI
Vision Assessment defined
Important sense for learning and assessment is essential to detect any serious problems
Vision assessment infants and toddlers
infant: test blink reflex by moving hand quickly toward infants eyes; quick blink normal; absence of blink reflex can indicate blindness
to test tracking ability hold a toy 6 in from eyes; once fixated move it slowly to each side. infant shld follow w/ eyes and moving head
Under 3 yrs old- ability to find and pick up sm toys is a good indicator of vision
Standardized vision charts
3-4 yrs can be used to test vision: Snellen chart, picture chart,
10-20 feet
further assessment if: VA 20/40 or less in either eye by 3-5 yrs of age
20-30 or less in either eye by 6 yrs of age
Hearing assessment defined
essential for normal speech and learning
Hearing assessment infants and toddlers
*select noisemakers with different frequencies (rattle, bell, tissue paper); stand behind infant (2ft) fr infant ear but outside the infants vision; have parent observe for : widening the eyes, briefly stopping active to listen, turning head toward the sound
Hearing assessment preschool and older children
*use whispered words over 3 yrs of age: position your head 12 inches from child's ear, but out of range of vision, use words easily recognized and ask child to repeat
Hearing assessment Bone and air conduction of sound
Tuning fork to evaluate in school age children who can follow directions.
*****hold handle light tap tines to begin vibration
bone conduction: place handle of the tuning fork on the child skull.
air conduction: place vibrating tines close to the child's ear
Hearing loss indicators in infant/young child
*no startle reaction loud noises
*does not turn toward sounds by 4 months of age
*babbles as young infant but stops babbling and does not develop speech sounds after 6 months of age
*no speech by 2 yrs of age
*speech sounds are not distinct at appropriate ages
Weber test
place vibrating tuning fork on top of the child's skull in midline
ask child to say where the sound is heard best, either both ears equally or in one ear (should be heard in both ears...
Rinne test
place vibrating tuning fork handle on mastoid process behind ear. ask child to say when the sound is no longer heard
immediately move the tuning fork so that the vibrating tines are held about 1-2 in for he same ear. Ask child to indicate when sound is not longer heart. Normally hears the air conducted sound twice as long as the bone conducted sound. repeat other ear
**whn sound is heard longer by bone conduction than air, the affected ear may have conductive hearing loss
**whn sound is heard longer by air conduction than bone but less than twice as ling, affected ear may have sensorineural hearing loss
Gross Motor milestones for age
Gross Motor Development (Table 5-15) p199
Gross Motor Milestones Age Attained
Rolls over from prone to supine position 7 months
Sits without support 6 months
Pulls self to standing position 10 months
Creeps or crawls 10 months
Walks alone well 15 months
Climbs on furniture 24 months
Walks up stairs one step at a time 24 months
Rides tricycle 36 months
Expected language development for age
Language Milestones Age Attained
Babbles speech like sounds, p,b,m 3-4 months
Says Mama, Dada, 2 other words; 12 months
Increased word each month, 2 word combo
"where baby", Want cookie 1-2 years
Uses 2 - 3 word sentences to ask for things or talk about thing, lg vocab, speech understood by fam. 2-3 yrs
Sentences may have 4 or more words, speech understood by most people 3-4 yrs
Says sounds correctly except like l, s, r, v , z, ch, sh , the; tells stories and uses same grammar as family 4-5 yrs.
expected balance development for age
Balance Milestones Age Attained
Stands without support briefly 12 months
Walks alone well 15 months
Walks backwards 2 years
Balances on one foot for 5 seconds 4 years
Hops on one foot, heel-toe walking 5 years
Heel-toe walking backwards 6 years
Expected fine motor development for age
Fine Motor Development (Table 5-19) p204
Fine Motor Milestones Age Attained
Transfers objects between hands 5-6 months
Thumb pincer grasp 10 months
Feeds self with spoon 15 months
Scribbles with crayon or pencil 18 months
Builds 2-block tower 18 months
Builds 6-block tower 24 months
Primitive relfexes
Primitive Reflex Technique & Normal Finding Appearance/Disappearance
Moro Startle infant with sudden noise or position change. The arms extend and fingers form a C as they spread then slowly move together as in a hug. Legs make a similar motion. Present- at birth, decreases in strength by 4 months
Disappears- by 6 months
Palmer grasp Place finger across infant's palm, avoid touching thumb. A strong grip around the finger is normal. Present- at birth
Disappears- by 3 months
Plantar grasp Placed finger across foot at base of toes. The toes normally curl as if gripping the finger. Present- at birth
Disappears- at about 8 months
Placing Hold infant erect and touch top of one foot with the edge of a table or chair. The infant normally lifts the foot, as if to step up onto the surface. Present- within days of birth
Disappears- at various times
Stepping Hold infant erect and touch bottom of one foot on the surface of a table or chair. The feet lift in an alternating pattern as if to walk Present- at birth
Disappears- between 4-8 weeks
Tonic Neck Place infant in supine position and when relaxed turn head to one side. Repeat by turning head to opposite side. The arm and leg on the face side normally extend and the opposite arm and leg flex. Present- about 2 months, decreases by 4 months
Disappears- no later than 6 months, must disappear before infant can turn over.
Newborn development milestones area/growth/dev
Newborn Development Milestones Area of Growth/Dev
• Weight: Baby may looses up to 1/10 of birth wt in the first week of life. Birth wt should be re-attained by 10 days. Wt gain is about 2/3 of an oz per day thereafter.
• Length increases by 1 to 1 ½ inches
• Head Circumference increases by about 1 inch Growth
• Focuses 8-12 inches away
• Eyes wander and may cross
• Prefers Black & White or High Contrast patterns
• Prefers the human face to all other patterns Vision
• Fully mature hearing
• Recognizes some sounds
• May turn toward familiar sounds and voices Hearing
Female pubertal development
Breast development usually precedes other changes, however pubic hair may occur first.
Tanner stages:
I. breast budding (8-14yrs)
presence amount and distribution of pubic hair is an indication of sexual maturation.
Male pubertal development
Initial signs of puberty onsent in males enlargement of the testicles and thinning of the scrotum.
enlargement before age 9 uncommon, after age 14 need further assessment.
penile enlargement generally follows testicular enlargement
Discharge teaching for New parents
breast feeding technique formula technique
Umbilical cord care bathing and skin care
diapering/dressing NB temp assess. using therm.
*signs of NB illness: abd swelling, blue skin face lips, tongue; long pd of crying despite comforting; jaundice (head to toe); sleeping thru feedings/too tired/uninterested in eating; drainage or redness fr umbilical cord; resp distress:
fast breathing (more than 60 breaths/min
flaring of nose
grunting while breathing

*newborn safety: infant care seat use; supine sleeping position
Newborn signs of developmental delay
(2nd, third, fourth week of life)
suck poorly/feed slowly does not blink when shown bright light
*does not focus/follow a nearby object moving side to side
*rarely moves arms and legs; movement not symmetrical
*lacks muscle tone:limbs are consistently stretched out rather than flexed
*does not respond to loud sounds
Newborn physical activity
By the end of the first month:
bring hands to eyes and mouth
move head side to side when prone
attempt to lift head when prone
Health promotion teaching for NB/infant
supervised tummy time
*free movement of arms and hands- allows flexion and extension; brings hands into line of vision
*encourage appropriate toys mobile with contrasting colors and patterns; plastic mirror; music boxes; soft music
*encourage witching positions when bottle feeding; muscle dev/
*beginning at birth prevent flat spots/alternate head position
infant Developmental milestones hth promotion/maintenance 1 MONTH
• Responds to sound by startle or increased alertness
• Follow objects and human face with eyes
• Has periods of alertness and restfulness
• Comforted by touch or feeding by parent
• Has symmetrical movements and generally has arms/legs flexed
• Lifts head momentarily when prone
infant Developmental milestones hth promotion/maintenance 2 MONTH
• Previous characteristics continue
• Makes noises such as cooing in response to interaction with adult
• Smiles
• Lifts head, neck, upper chest when prone
• Has increasing head control when held in sitting position
infant Developmental milestones hth promotion/maintenance 4 MONTH
• Increasing cooing and babbling
• Smiles, laughs, makes other noises during interactions
• Supports self on hands when prone
• Rolls front to back
• Touches objects and grasps rattle placed near hand
infant Developmental milestones hth promotion/maintenance 6 MONTH
• Uses sounds in repeated speech such as bababa, dadada
• Interested in surroundings and toys
• When pulled to sitting has no head lag
• Sits with support
• Grasps objects easily and places them in mouth
• Transfers objects from one hand to the other
• Bears weight on legs when held in standing position
infant Developmental milestones hth promotion/maintenance 9 MONTH
• Understands simple words and uses more sounds in babbling
• Responds to name
• Enjoys interactive games with parent
• Moves when placed on floor by crawling, creeping, or rolling repeatedly
• Sits without support
• Stands holding on to support
• Plays with toys
• Feeds self readily with fingers and ties to use cup
infant Developmental milestones hth promotion/maintenance 12 MONTH
• Has one or more words
• Imitates sound readily
• Increasing interactions and interest in surroundings
• Follow directions such as saying or waving bye
• Pulls to standing, walks a few steps holding on
• Well-developed pincer grasp
• Able to drink from cup
Infant sleep patterns
Birth to 3 months
Infant sleeps 10-16 hours daily in about five sleep periods of 30 minutes to 4 hours; spans day and night hours

3-6 months
sleeps 14 hours daily with loner sleep at night plus two to three naps; by 4-6 wks a consistent sleep pattern emerges

6-12 months
sleeps 12-14 hrs daily with longer sleep at night plus one to two naps daily
Helping the infant sleep
*place baby to sleep in quiet/dark room
*consistent transitional object/favorite blanket ea night
*put baby to bet while still awake
do not awaken baby in NREM (quiet sleep)
*regular sleep routine and time
*if trouble ; remain in room; do not establish eye contact; place had on abd
When to contact health care provider (infant)
*rectal temp greater/equal to 100.4
*skin rash, petechiae
*change in activity or behavior
*unusual irritability, lethargy
*failure to eat
routine Immunizations recommended - infancy
hep B: at birth #1; 1-2 months #2; 6-18 mo #3
Hep A: 12 mo #1; 18 mo or @ least 6 mo after #2
Diphtheria, tetanus, acellular pertussis;
2,4,& 6 months (three doses)
HIB: 2,4, & 6 mon (three does) third not needed if PRP-OMP is used for primary series

Inactivated polio virus: 2, 4, 6-18 months (three doses)
Pneumococcal: 2, 4, 6 months (three doses)
Influenza: Annually from 6 months of age
Rotavirus: 2,4, and 6 months (three doses)