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Infant and Toddler Growth and Develop Copy Jan11
Infant and Toddler Growth and Develop Copy Jan11
Infant and Toddler Growth and Develop Copy Jan11
Growth and
Development
Elisa A. Mancuso RNC, MS, FNS
Professor of Nursing
Growth of Infant
Cephalocaudal (head toe)
Proximodistal (trunk periphery)
General Specific (Large fine muscles)
Abdominal Girth
Measure above umbilicus
Abdominal distention
R/O liver or intestinal diseases
Growth Charts
Serial exams to assess growth progress
Plotted as percentiles:
25th %, 50th %, 75th %, 95th %.
@ 95th % = Pt > 95% of kids.
Used to notice any or in weight,
height, or HC.
Specific charts for premature infants
Denver Developmental
Screening Test (DDST)
Denver II
Assesses from birth 6 years
Age divided monthly 24 months,
then q 3 mos. 6 years
Not an intelligence test
Four categories
Personal/Social
Fine motor/Adaptive
Language
Gross motor
Infant Reflexes
Moro - Startle
Loud sound = extension & abduction of
extremities
Babinski
Dorsiflexion of big toe and toes fan out
Object Permanance
Searches for items outside field of vision
Developmental Skills
9-12 months
Triple birth weight and height by 50%
Releases objects
Pulls self to feet
Sits from standing position
Walks with help
independent walking can be as late as 18
months!
Responds to name
Recognizes no
Says 4 -5 words: mama, dada, no, bye
Teething (age 6 = # of teeth)
12 mos 6 = 6 teeth
Cool cold items to chew on
Tylenol 10-15 mg/kg q 4-6 hours
Developmental Tasks
Achieve physiological equilibrium
Rest, eat, play patterns
Develop basic social interaction
Desire for affection
Manage a changing body
motor skills & eye-hand coordination
Learn to understand and control world
Develop a beginning symbol system
Communication
Immunizations
Regulated by CDC and American Academy of Pediatrics (AAP)
www.cdc.gov/nip/vacsafe
www.immunize.org
Risk patients
Sickle cell disease, HIV/immune deficiency
chronic cardiac or pulmonary etc
Must receive PPV vaccine in addition to PCV
Immunizations
DTaP - Diptheria, Tetanus and acellular Pertussis (IM)
Diptheria
Rare throat infection
Gray/yellow film
difficult to remove
Air flow obstruction
Sepsis
Tetanus
Clostridium produced in infected wounds
Severe muscle extension
Immunizations
Pertussis
Gram negative bordetella pertussis
whooping cough
Post-tussive vomiting
Cyanosis
Subconjuctival hemorrhage
Three stages:
catarrhal, paroxysmal (2 weeks) and decline
outbreaks in Adolescents and Adults
RT titers
www.pertussis.com
Immunizations
DTaP Schedule
2,4,6,15 months and 4-6 years for DTaP
Side Effect: Redness & swelling @ site
Measles
Viral illness - macular/papular rash
Kopliks spots oral mucosa
Encephalitis/pneumonia
Mumps
Inflammation salivary glands/parotid
Boys develop orichitis/sterility
Rubella
Viral illness- rash (face body extremities)
Pregnancy exposure:
Fetal deafness, cataracts, cardiac defects, encephalitis
Immunizations
MCV4/ Menactra:
One dose 11-12 years or @ high school entry or
college freshman in dormitories
(risk smoking and crowds)
MPSV4/Menomune:
Children> 2- 10 years risk factors
Sickle cell disease.
Immunizations
TIV -Trivalent Inactivated Vaccine Influenza (IM)
Influenza virus pneumonia and death
2004 -152 pediatric deaths
# of cases in February
6 mos - 5 years of age annually
> 5 years only high risk population.
0.25ml<3 years or 0.5ml>3 years
Contraindication Egg Allergy
Eat baked goods can have vaccine
SE:
Very painful
Syncope & tonic clonic movements
Pt remains seated or lies down x 15 minutes
Compliancy Issues:
Moral issues can intervene
Study with boys shows = a good immune response
Vaccinate girls RT risk of Cervical CA
Only true contraindications
to vaccine administration
Fever >102
Immunocompromised: (No MMR & Varicella)
HIV, Leukemia, Lymphoma
Alkylating agents or Antimetabolites
Daily Corticosteroids Dose:
> 2 mg/kg or 20 mg/day
Allergy to vaccine component
Vaccine Adverse Event Reporting System
(VAERS)
Congenital defects
Cleft palate
1/750 births cleft lip
3P Feeding technique
Position - upright
Pore - soft, premie nipples
enlarged opening
Patience - burp frequently
Surgery
Lip repair usually 1-3 months
Protect incision line after operation
Palate repair @ 18 months
Supine with HOB
Elbow restraints
I&O
Tracheoesophageal (TEF)
Fistula
Fistula
Opening between trachea and esophagus
Fluids enter lungs
Aspiration PN
Large amounts of air into stomach
Esophageal Atresia EA
Esophagus ends in a blind pouch
Suffocation/Aspiration
# 1 cause of fatal injuries <1 year
toys, mobiles
No H2O mattress or pillows
Falls
Walkers 45%
Burns
H2O temp @ 160 scalds skin in 10 seconds
Temp to 120
Poisonings
Plants, Cleaners, Grandmas purse meds
Cars
Car seat < 1 year back seat, facing rear
Nutrition
Vitamins for Infants
Fluoride
0.25mg/day > 6 months - 3 years
Poly-vi-flor 1cc QD
>3 years 0.50mg/day
FeSO4
0.5mg/kg/day > 6 months
if BF mother not taking supplements
after 6 months fetal stores are depleted)
Vit D
400 IU/day
if BF mother not taking supplements
Breast Milk
Contains all nutrients and
A,B, E
Immunoglobulin IgA, T and B cells
Lacks Vit C, D and Fe
Twice sugar (lactose)= laxative
effect
# of stools
lactalbumun more complete protein
caesin easier to digest
Formula
Therapy
Apply lotion, massage scalp
Fine comb remove scales
Toddler 12-36 months
Growth slows Physiological anorexia
Average weight gain 4-6 lbs/year
BW quadrupled by 2 years
Height 3 inches/year
HC growth slows
A/P diameter 1:2
Neuromuscular control
Manipulates objects & people
Psychosocial Development
Autonomy vs. Shame and Doubt
Me do stage
Intense exploration of environment
Fighting for autonomy
Negativism No
Ritualistic behavior to control their
environment
Body Image develops
Psychosocial
2nd Separation Anxiety
Cling and cry when left by parent
Be honest regarding separation do not
disappear!!
Body image develops
knows certain body parts: eye, pee pee
Begins to acquire socially accepted
behaviors
Toilet training
Holding on and letting go is very important!
Need to recognize the urge to let go
Magical thinking
Pre-operational Stage
Transitional Stage 18 - 24 mos
Trial and error
Memory and imitates actions.
sweeping floor with broom is mom cleaning
Problem solving
Egocentric- I me mine
Concrete thinking
Literal translation
A little stick for IV = tree branch
Sense of Time
Orientation RT activities
Mom will be back after nap instead of at 2 oclock.
Toddler Developmental Tasks
Differentiate self from others
Heals spontaneously
3-7 days
No therapy needed
Second Degree
Partial Thickness
Involves epidermis and upper layer of
dermis
Moist, bulla
Skin bright red
Painful
Sensation to pain
Humidified 100% O2
Assess for:
Respiratory Acidosis:
RR, retractions, nasal flaring, effort, O2
BUN Creatine = SG
Dehydration & renal failure
Pain Management
Acute
Burned skin and exposed nerves
Moaning, grimacing, restlessness, guarding,
dilated pupils, clenched fists, movement
Procedures: PAIN
Dressing changes anxiety & fear
Medicate prior to all procedures.
MSO4, Propofol, Fentanyl, Hydromorphone
Therapeutic Touch
Wound Care
Aseptic/sterile technique
risk of infection
Invasive lines, compromised immune
Protective Isolation
Debridement
Remove dead tissue
Hydrotherapy
Soaking wounds - remove old dsg
10 mins to prevent electrolyte and fluid loss
Washing area
Clean area & assess wound
color, drainage, odor, sloughing,
granulation tissue
Antimicrobial creams
Sulfa allergy
SE: Transient leukopenia
Antimicrobial creams
Silver nitrate 0.5%
Most gram (+) & some gram (-)
Painless soak
Dampen dsg q 2H or TID
Need large bulky dsgs
Stains clothing and linens -black
SE: K+ Na+ Cl+
lytes
Skin Grafts
Autograft
Patients own skin
risk for Host Versus Graft (HVG) response
Transcyte
Newborn foreskin
Bioactive skin substitute
Re-epithelialization
dsg changes hospitalization
scarring
Nutritional Support
NPO x 24 hours
Bowel sounds Abd girth N & V
Curlings Ulcer
GI perfusion occult blood via NGT & stool
Aspirin Intoxication-
# 1 most ingested drug
ASA acetylsalicylic Acid
Availability in home
Combination OTC meds:
Peptol bismal, cough and cold, wart preparations
N-acetylcystein-Mucomyst- PO
Loading dose = 140 mg/kg x 1 PO
then 70 mg/kg x 17 doses PO q 4H.
Most effective with-in 8 hours of ingestion
Must be initiated with-in 16 hours.
Mix with coke smells like rotten eggs
Charcoal may bind with mucomyst give 1 hour apart
Lead Screening
Screen at 9 months to 1 year and then 2 years
Earlier/ASAP with risk factors
Clinical signs
Most kids are asymptomatic! Level
Pb serum level > 10 is toxic
Pb > 45 = RX
Pb > 70 = Medical Emergency (RX & ICU)
90% Pb attaches to RBC
Interferes binding of iron to heme molecules
H and H , Fe
HgB = Anemia
Absorption of Pb > Excretion