Pedi assessment 1

• Growth

  Physical growth
• Development

  Increase in function that occurs through growth, maturation and learning
• Developmental milestones


  Predictable patterns/stages that are sequential, orderly and progressive
• Infancy


  1 month to 1 year old
• Anterior fontanel

  • Closes by 18 months
• Posterior fontanelle


  • Closes by 2-3 months
• Infant weight


  • Doubles by 4-6 months
  • Triples by 1 year old
• Infant length


  • Increases by 1 inch per month for first 6 months
  • Increases by 1/2 inch per month for next 6 months
  • Increases by 50% by 1 year old
• Infant teeth


  • First tooth 6-10 months old
  • 6-8 teeth by 1 year old
• Motor development


  1. Moro, tonic neck and rooting reflexes disappear by 3-4 months

  2. Rapid acceleration in 5th and 6th month - can reach, grasp, turn from belly to back

  3. 6-7 months - transfer object hand to hand

  4. 6-9 months - start to explore by crawling
• Piaget's sensorimotor stage


  (Birth to 2 years) Progresses from reflexive to simple repetitive to imitative activities. Infants experience the world through senses and attempts to control environment

  
• Egocentrism


  Child's self-absorption and inability to see the world from anyone else's point of view
• Object permanence


  Develops 8-12 months - object exists even when out of sight
• Mental processing


  Instead of randomly selecting approaches, they choose actions that were successful in the past
• Erikson's "Trust vs Mistrust"


  Develops in first year based on quality of caregiver-infant relationship and care received
• Stranger anxiety


  Strong feelings of attachment enable infant to differentiate caregivers from strangers, peaks at 6-7 months and again in toddler years
• Language development


  1. Strong cry

  2. Cooing

  3. Responds to sound

  4. Turns head at sound

  5. Laughs and smiles

  6. Social smile by 12 weeks

  7. 8-9 months - strings vowels, first words

  8. 9-12 months - 2-3 word vocabulary

  9. Comprehends "no" by 1 year
• Vital signs


  • Rectal temp is gold standard for infants
  • Temporal temp best for over 3 months
  • No tympanic for under 2 years
  • Apical pulse for 1 full minute under 2 years
  • Irregular respiratory rates in infants, best to count when sleeping or quiet
• Infant temperature

  • 97.7-99.3°F axillary
• Infant pulse

  • 80-150 bpm
• Infant respirations

  • 25-55 per minute
• Infant oxygen saturation

  • Greater than 97%
• Infant blood pressure

  • Systolic 65-100 mmHg
  • Diastolic 45-65 mmHg
• Nutrition 1-6 months


  • Exclusive breastfeeding or iron-fortified formula
  • No cow's milk
  • No honey
  • 100% fruit juices 4-6 oz/day after 6 months
  • Start solids 4-6 months - iron-fortified cereal first
• Readiness cues for starting solids

  Sitting up, birth weight doubled, opening mouth, extrusion reflex gone
• Nutrition 7-12 months


  • Citrus fruits, meats, eggs, 100% fruit juices
  • 4-6 months - cup interest
  • 6-8 months - veggies and fruits
  • Breastmilk/formula decreases as solids introduced
  • 9 months - chopped, unseasoned table food
  • Honey allowed after 1 year
• Finger foods 9-10 months


  • Ripe bananas, toast strips, graham crackers, cheese cubes, noodles, small chunks of apples, pears and peaches
• Weaning readiness

  Throwing bottle down, chewing on nipple, refusing the breast
• Early introduction of solid foods leads to overweight, obesity and food allergies
• Most common allergenic foods

  • Eggs
  • Milk
  • Peanuts
  • Soybean
  • Wheat
• Infant sleep

  • Newborn sleeps 17-20 hours/day
  • Nighttime sleep established by 3-4 months
  • 1-2 naps/day by 12 months
  • Put infant in crib before asleep for self-soothing
  • Firm mattress, no soft bedding, supine position to reduce SIDS
• Bathing


  • After umbilical cord falls off or circumcision heals
  • Brush teeth with smear of fluoride toothpaste after eruption
• Crib safety

  • Slats no more than 2.5 inches apart
  • Mesh openings smaller than 1/4 inch
  • Standard size mattress with no gaps
  • Wood surfaces free of splinters and cracks
  • Corner posts less than 1/16 inch high
• Colic

  Unexplained paroxysmal crying or fussiness for more than 3 hours, 3 days, 3 weeks
• Infant play


  • Alone/solitary
  • Interpersonal contact and educational stimulation
  • Short attention span
  • Hands and feet - rattle, teething toys, balls, blocks, books, mirrors, bright toys
  • Pat-a-cake and peek-a-boo
• Toddler


  12-36 months, age of change
• Toddler physical growth


  • Slows down
  • Gains 5 lbs and 3 inches
  • Baby fat disappears, appetite decreases
  • Prominent "pot belly"
  • Bowed legs
  • Exaggerated lumbar curve
  • 20 deciduous teeth by 2.5-3 years
  • Chest circumference larger than head circumference
• Toddler vital signs

  • Temp 97.5-98.6°F axillary
  • Heart rate 70-110 bpm
  • Respirations 20-30/min
  • BP systolic 90-105 mmHg
  • BP diastolic 55-70 mmHg
  • Tympanic temps okay after 2 years
• Piaget's sensorimotor stage (up to 24 months)


  Discover new ways through trial and error, pretend/imitation
• Piaget's preoperational stage (2-7 years)


  Symbolic thought, change situations to fit thoughts, learn problem solving