Pediatrics NUR553 -Burns textbook

Developmental red flags: Infants Newborn - 1 month lack of return to birth weight by 2 weeks poor coordination of suck-swallow tachy/bradycardia with feeding poor habituation to external stimuli asymetrical movements/reflexes hyper/hypotonia hands held fisted absent or asymetrical palmar grasp no startle to sound or sudden noises no quieting to voice high-pitched cry diffuse nonverbal cues poor state transitions irritable doll's eyes no red-reflex poor alert state Developmental red flags: Infants 3 months poor weight gain (less than 1 lb wt gain in 1 month) head circumferance increasing more than 2 standard deviations on growth curve or showing no increase in size continuing poor suck-swallow difficulty with regulation of sleep-wake cycle fussy baby asymetrical ​movements/reflexes hyper/hypotonia no attempt to raise head when prone hands visted ​with oppositional thumb no hand-to-mouth activity feedings longer than 45 min consistently awakining​ hourly for feeding does not turn to voice, rattle, bell no sounds, coos, squeals lack of social smile withdrawn or depressed affect lack of consistent safe child care lack of eye contact no visual tracking not able on fix on face/object Developmental red flags: Infants 6 months Less than double birth weight head circumference shows no increase poor feeding or sleep regulation difficulty with self calming persistent primitive relfexes​ does nt​o attempt to sis​ with support head leg with pull to sit scissoring does not reach for objects, hold rattle, hold hands together does not grasp at clothes no babbling does not respond to voice, rattle, loud noises no smiles no responses to play solemn appearance lack of eye contact not visually alert does nto​ reach for objects does nt​​o look at caregiver Developmental red flags: Infants 9 months Parent control issues with feeding or sleep night awakening that persists offered bottle in bed for sleep difficulty with self-calming, self-regulation does not sit even in tripod position no lateral prop reflex asymmetrical crawl, handedness, or other movements no self-feeding no high chair sitting no solids does nto pick up toy with one hand lack of single- or double-consonant sounds lack of response to name or voice does not respond to any words lack of reciprocal vocilalizatio​ns intense stranger anxiety or absent stranger anxiety does nto​ seek comfort from caregiver with stress poor eyecontact ​ lack of visual awareness lack of reachign​ out for toys lack of toy exploration (visually or orally) Developmental red flags: Infants 12 months less than triple birth weight losing more than two standard deviations on growth curve for weight, length, or head circumference poor sleep-wake cycles extreme inability to seperate from parent not pulling self to stand not moving around the area to explore persistent mouthing not attemtping to feed self or hold cup not able to hold toy in each hand or transfer objects inability to localize to sound not imitating speech sounds not using two to three words does nto​ point, or uses only gesters​ or pointing no response to game playing no response to reading or interactive activities withdrawn or solemn affect poor eye contact not visually following activities int he environment Toddler age range 12-24 months Preschooler age range 2-5 years World Health Organization (WHO) growth chart weight for length in children less than 24 months Centers for Disease Control and Prevention (CDC) growth chart used after 24 months Average 24 month old weight, length and head circumference measurements 26 lbs 33.5 inches tall 18.5 inch head circumference Most kids have no palpable fontanelles by: 12 months Anterior fontanelle should completely close by 18-19 months Dominant hand evidence may appear early as 8 to 12 months generally emerges between 2-4 may not be evident until 5-6 What Age do kids use words to convey their thoughts/feelings? around 2 years at what age should speech be completely intelligiabl​e (with the exception of particularlly difficlut​ consonants)? by 4 years old how many teeth at 12 months 6-8 primary teeth how many teeth by 3 years complete set of 20 primary teeth secondary molars usually erupt Cardiovascular development of toddlers and preschoolers little change in 2nd and 3rd years 5 y.o. = heart quadrupled in size since birth; heart rate 70-110; should produce only adult hemoglobin bemoglobin level stablizes​ at 12-15 normal sinus arrhythmia may continue innocent murmers common Pulmonary development of toddlers and preschoolers abdominal respiratory movements continue until 5-6 yrs respiratory rate slows to about 30 Developmental milestones - early childhood fine and gross motor 12 months uses pincer grasp points at objects stacks two blocks clasps hands together pulls self to stand stands alone 3-5 seconds walks holding onto furniture lowers self from standing to sitting without falling rolls a ball Developmental milestones - early childhood fine and gross motor 15 months puts blocks in a cup drinks from a cup holds utensils, some attempt to use stacks two blocks stands alone well wlaks forward ad​n backward stoops and recovers climbs up stairs without alternating feet pulls a pull toy Developmental milestones - early childhood fine and gross motor 18 months builds tower of 4 cubes scribbles spontaneously puts blocks in large holes drinks from cup with little spilling removes socks stacks four to six blocks throws while aiming walks well independently pushes and pulls toys pulls toy while walking backward Developmental milestones - early childhood fine and gross motor 24 months builds tower of seven cubes circular scribbling imitates folding paper once tuns doorknob turns pages one at a time unbuttons or unzips washes hands with assistance uses a spoon throws overhand runs well climbs up on furniture kicks ball walks up adn down stairs, may not alternate walks with control runs jumps up assists with dressing able to pull pants down with help Developmental milestones - early childhood fine and gross motor 30 months (2.5 years) builds tower of NINE cubes draws vertical and horizontal lines imitates circle buttons large buttons holds fork in fist and attempts use dresses self with assistance jumps with both feet climbs stairs alternating feet stands on one foot for 1 second walks on tiptoes Developmental milestones - early childhood fine and gross motor 36 months (3 years) builds tower of NINE to TEN cubes imitates three cube bridge copies circle uses scissors brushes teeth, but not well puts on shoes feets self with utensils plays with oen to three piece puzzle puts on shoes and socks burshe​s hair imatates drawing a cross twists jar lids jumps with both feet climbs ladders may pedal tricycle balances on one foot 2-3 seconds kicks ball with direction catches a ball Developmental milestones - early childhood fine and gross motor 48 months (4 years) copies bridge from model cuts curved line with scissors dresses self independently strings small beeds demonstrates hand preference imitates a square undresses self buttons strings beads purs from small pitcher tries to skip using alternate feet catches a bouncing ball runs around corners lightly on toes and stops voluntarily stands on one foot for 5 seconds walks down stairs alternating feet throws ball underhand Developmental milestones - early childhood fine and gross motor 60 months (5 years) opens lock with key pathes self cuts out simple shapes imitates triangle prints own name puts shoes on and ties laces catches bounced ball most of the time stands on one foot for 7-8 seoconds gallops (skip/run) does a somersault hops skips successfully Developmental milestones - early childhood Language (receptive and expressive) 12-18 months follows one-step commands each week understands new words increased interest in namping pictures differentiates enviornmental sounds points to familiar objects and body parts when named unerstands simple questions begins to distinquish​ "you" from "me" uses all vowels, many consonants increased use of real words jargon is sentance​-like likes to use negatives (says "no") names a few pictures by 18 months = says 15-20 words and understands 50 imitates non-speech sounds (cough, tounge​ click) names some body parts Developmental milestones - early childhood Language (receptive and expressive) 18-24 months follows two-step commands vocab increases rabidly enjoys simple stories and songs recgonizes pronouns imitates two-word combinations dramatic increase in vocab speech combines jargon and words names self answers some questions begins to combine words starts to use pronouns Developmental milestones - early childhood Language (receptive and expressive) 24-30 months understands propositions (in and on) seems to understand most of what is said understands more reasoning ("when you are finished, then...") idnetifies object when given function (wear on feet = shoe) babbles less two to three word stndances repeats two numbers increased use of pronouns asks simple questions joins in songs and nursery rhymes can repeat simple phrases and sentances Developmental milestones - early childhood Language (receptive and expressive) 30-36 months listens to adult convos understands preposition "under" can catergorize items by function begins to recgonize​ colors begins to take turns understands "big" "little" "boy" "girl" answers questions ("wear on feet", "to bed") repeats three numbers uses regular plurals can help tell simple story Developmental milestones - early childhood Language (receptive and expressive) 36-42 months understands fast understands prepositions "behind" and "infront" repsonds to simple three part commands increasing understanding of adjactives​ and plearal​s understands "just one" understands and answers (cold? tired? hungry?) mostly three to four word sentances gives full name begins rote counting begins to relate events lots of questions some beginning prepositions Developmental milestones - early childhood Language (receptive and expressive) 42-48 months recognizes coins begins to understand future and past tenses understands number concepts - more than one uses prepositions tells stories can give function of objects prepeats more than 6 word sentanc​es repeats 4 numbers gives age good intelligibility Developmental milestones - early childhood Language (receptive and expressive) 48-60 months responds to three step commands asks "How" questions answers vrbally ​to questions like "how are you?" uses past and future tenses can us conjunctions to combine words and phrases 3-4 y.o. show hesitance in speech or stuttering. is this normal? yes! they stutter when excited or at the start of a sentance. this normal variant in speech does nto include syllable repetition or cause undue stress for the child. studdering is considered abnormal if it: causes stress for child, happen after 5 years, or if involve syllable instead of word repetition. what is the regular sequence of mispronunciations? 1) omit the new sound 2) substitute a more familiar sound for the new one (Distortion) ("wabbit" for "rabbit") 3)Addition of an extra sound ("gluad" for "glad" Lexicon definition/refers to refers to vocabulary first word in girls 8 to 11 months first word in boys about 14 months number of words in 2 yo vocabulary 200 words 4-5 yo add how many words per month to vocabulary 50 words per month Syntax definition/refers to "grammar," refers to the structure of words in sentences or phrases Upgrade to remove ads Only $35.99/year What age do children develop receptive language (i.e. they understand others who use a new word or structure before they are able to use it) 8 months what age range do children begin to use holophrases or single words to express whole ideas? (i.e. "milk" means "I want a glass of milk") between 12-18 months At what age doe children begin using telegraphic speech phrases that have many words omitted and sound like a telegram? (i.e. "get milk") around 18 months at what age do children begin to form short sentences, mimic phrases and gestures? around 2 years at what age does do children add plurals? 3 years at what age do children at past tenses to sentances? 4 years at what age do children use three to four word sentances? 3 years at what age is a Childs grammar ("Syntax") close to adult style? (they use future tense adn complete sentances five to six words long) by 5 years. Semantics definition/refers to the understanding that words have specific meaning and the child's use of words to convey specific meaning. toddlers from bilingual homes initially may show mild delays in initial spoken words and mixing o thw words and phrases from the two languages. often meet language milestones at the predicted time in their primary languange, but secondondary language may lag behind latter they have greater mental felximility and enhanced employment and lifestyle opportunities How best to introduce two languages to children? "one-parent-one-language" approach. Morality definition the ability to know right from wrong. type of play in toddlers parallel play Piaget's preoperational stage: Characteristics of preschoolers thinking (10) 1) egocentrism 2) unable to see another's viewpoint 3) mental symbolization of the environment 4) incomplete understanding of sequence of time 5) Developing sense of space 6) evelopign ability to categorize or order objects and phenomena 7) developing ability to establish causality 8) Transductive reasoning 9) developing sense of conservation of quantitiy, weight, mass 10) rigidity in thinking Ages that hearing and vision assessment is recommended 4 and 5 years First dental exam recommended at age at the time of the eruption of the first tooth and no later than 12 months Ages & Stages Questionnaire-3 assesses gross and fine motor skills, communication, problem solving, personal-socal and overall devleopment Battelle Developmental Inventory (BDI) Measures the development of children from birth to 8 years old. Domains assessed include personal-social, adaptive (self help), motor, communication, and cognition. child development inventory measures fine motor, cross motor, social skill, expressive language, language comprehension, self help, leters, and numbers for 15 months to 6 years Expressive language looks at articulation and vocabulary Receptive language looks at comprehension, repetition, and follow up of language heard (ability to follow directions) Ages and Stages questionnaire: Social-Emotional children 3 months to 5 years Pediatric symptom checklist used starting at 4 years for psychoscial issues Developmental red flags (early childhood) 12 months no big smiles or joyful expressions no babbling no recognizing name when called is not pointing or using sounds to get desired object; may just cry Developmental red flags (early childhood) 15 months no nighttime ritual difficulty with transitions parents express concerns about temperamant problems with attachment to caregiver lack of object permanence no works only single words by 16 months lack of consonant production (uses mostly voewl sounds) consistent and frequent mission of initial consonants does not imitate words no gestures or pointing no self feeding no attempts at walking Developmental red flags (early childhood) 18 months Poor sleep schedule problems with control and behavior does not pull person to show something primary play: mouthing of toys no finger exploration of objects lack of imitation not using toys as they were inteneded unable to follow simple directions ("no" "jump") excessive indiscriminante, irrelevant verbalizing does not try to scribble spontaneously unable to use spoon not yet walkign or frequently falls when walkign Developmental red flags (early childhood) 24 months falling off growth curve poor sleep schedule awakens at night; unable to put self back to sleep absent symbolic play no evidence of parallel play displays destructive behaviors always clings to mom no pretend play no meaningful two word phrases use of noncommunicative speech (echolalia, rote phrases) unable to identify five pictures unable to name body parts no jargon history of more than 10 ear infections unable to stack four or five blocks still eating pureed foods unable to imitate scribbles on paper unable to dump pellet from bottle unable to walk downstairs holding rail persistent waddle walk persistent toe walking Developmental red flags (early childhood) 30 months resistance to regular bedtime beginning behaivor issues problems with biting, hitting, playmates, parents not able to play with others cannot follow two-step commands cannot name self does not use pronouns unable to feed elf unable to build tower of SIX blocks unable to imitate circle shape unable to imitate vertical stroke unable to jump in place unable to kick ball on request Developmental red flags (early childhood) 36 months problems with toilet training unable to calm self not able to dress self does nto understand taking turns no expanded pretend play cannot name familiar colors does not understand "same" and "different" unable to recognize common objects unable to recall parts of a story unable to giev full name unable to match two colors does not use plurals does nto know two or three prepositions unable to tell as story unclear consonants unintelligible speech unable to construct a sentence unable to build a tower of TEN blocks holds grayn with fist unable to draw circle unable to balance on one foot for 1 second toeing-in causes tripping with running Developmental red flags (early childhood) 48 months lack of bedtime ritual behavior concerns: withdrawn or acting out stool holding problems iwth toilet training unable to play games/follow rules unable to follow limits or rules at home cruelty to animals/friends interest in fires, fire starting persistent fears or severe shyness inability to separate from mother unable to count three objects unable to recall four numbers unable to identify what to do in danger/fire/stranger consistently poor judgement difficulty understanding language problems understanding prepositions limited vocab unclear speech lack of self-care skills unable to button clothes unable to copy square unable to balance on one foot for four seconds unable to alternate steps when climbing stairs Developmental red flags (early childhood) 60 months continued sleep issues concerns with night terrors hair pulling (sclap or eyelashes) difficutly making and keeping firends/no friends difficulty understanding sharing, school rules cruelty to animals/friends interest in fires bullying or being bullied prolonged fighting/hiting/hurting withdrawal, sadness, extreme rituals unable to count to 10 unable to identify colors unable to follow three step commands speech pattern not 100% understandable cannot identify a penny, nickel, or dime abnormal rate or rhythem of speech unable to copy triangle unable to draw a person with a body difficulty hopping/jumping School age early childhood age range 5-7 years School age middle childhood age range 8-10 years school age late childhood age range 11-12 years The best way to evaluate a Childs growth is to monitor progress for height, weight, and BMI on growht chart Which parts of the brain are the last to develop fully? cerebral cortex (intelligence) frontal lobe (problem solving/decision making) School age hours of sleep average 10 (8-14), without naps what age is retina fully developed and visual acuity 20/20 6-7 years old what age do first primary teeth shed and first permanent teeth erupt 5-6 years Puberty begins between 10-14 years normal in any girl after 8 or male after 9 years What age can kids solve word problems 7 years what age do kids follow complex directions, and start to tell jokes? 8 years what age can kids discuss ideas and understand metaphors, ambiguities of sentance structure, word meaning? 10 years Piaget described children's cognitive development/perception of the world aroudn them 4 stages described how children actively use life experiances, incorporating them into their own mental and physical being over time emphasized how children modifiy themselves depending on their environmental experiances​ and their stage related competency Piaget's 4 stages Sensorimotor stage (birth to 2 years) Preoperational stage (2 to 7 years) Concrete operational stage (7 to 12 years) Formal operational stage (13 years through adulthood) Sensorimotor stage Piaget 1st stage birth to 2 years learn about world thorugh actions, sensory, and motor movements concepts: object permane​nc​e spatial relationships causality use of instruments comination of on​jects framework for learning: self (little connection to things outside self) Preoperational stage Piaget's 2nd stage 2-7 years attempt to make sense of the world/relaity egocentric only able to reason when there are connections to conrete objects learn cause and effect reasoning is often flawed use semiotic funcitoining (use of one thing to represent another) intuitive reasoning emerges (but reasoning remains connected to the concrete reality of the here and now) problem solving is intuitive rather than logical thought process involves magical thinking, geocentricism, contraption, syncretism, juxtaposition, animism, artificalism, participation, and irreversibility Concrete operational stage Piaget's 3rd stage 7-12 years use symbols to represent concrete objects and perform mental tasks organize experiances/classify complex info characterized by: flexibility of thought declining egocentrism logical reasoning greater social congnition Characteristics of thought process: decantation (focus on more than one thing at a time) conservation (understand weight and mass remain the same although change in appearance - like a cookie broke in half) transitivity (can deduce new relationships from sets of earlier ones) Seriation (can sequence in order) classification (can group objects based on similar features) reversibility (mentally revers a process or action) Formal operational stage Piaget's 4th (final) stage 13 years - adulthood think abstractly imagine different solutions increased awareness of health/illness recognize how behaviors can impact health renewed egocentrism early in this stage (lack of differentiation betwen what others are thinking and one's own thoughts) followed by an appreciation of the differences in judgement between adolescent and others/cultures think of abstract principles and benefits rather than focusing only on punitive aspects of laws Erikson described psychosocial development 8 total stages (6 discussed in this course that pertain to peds) took Freud's controversial theory of psychosexual development and modified it as a psychosocial theory. Erikson emphasized that the ego makes positive contributions to development by mastering attitudes, ideas, and skills at each stage of development. This mastery helps children grow into successful, contributing members of society. During each of Erikson's eight stages, there is a psychological conflict that must be successfully overcome in order for a child to develop into a healthy, well-adjusted adult. Erikson's stages trust v mistrust (0-12 months) autonomy v shame (12-18 months) inititive v guilt (3-6 yo) industry v inferiority (6-11 yo) identiy v role confusion (12-17 yo) intimacy v isolation (17-30 yo) Trust v mistrust Erikson's 1st stage 0-12 months to get; to give in return Autonomy v shame Erikson's 2nd stage 12-18 months to hold on; to let go Initiative v guilt Erikson's 3rd stage 3-6 yo to make things; to play able to initiate activities on their own begins to learn to modulate their own behaviors through development of a consciousness as to what is appropriate for parents and society Industry v inferiority Erikson's 4th stage 6-11 y.o. to make things; to complete begins to appreciate individual interests and skills, and seeks to become a more successful member of a group. internal motivation to achieve, compete, and obtain regocntition If unsuccessful, learning motivation is lost in late childhood, socialization with other children and groups, development of hobbies allows recognition of individual worth Identity v role confusion Erikson's 5th stage 12-17 yo to be oneself; to share being oneself or not being oneself Intimacy v isolation Erikson's 6th stage 17-30 yo to lose and find onself in another Cultural influences on development early milestones (easy soles, waning from breast/bottle, sleeping thorugh night, toilet training, may occur at different ages and be considered NORMAL once the child reaches KINDERGARTEN, children from all background should have similar devleopment Tools to identify family structure/strengths/resounrces/beliefs/practices in different cultures: venogram, ecomap, family functioning model childhood health assessment questionnaire and childhood healht questionnaire have been adapted to many cultureal groups​ Discipline vs punishment discipline = training or education that molds the behavior, mental capacities, or moral character of an individual. used by the parent to teach appropriate behavior punishment = loss, pain, or suffering tht is administered in repsonse to a bahavior; it is a form of retribution should focus on discipline, not punishment Developmental milestones - Infants Fine motor, oral movement, motor movement Birth flexion suckling tongue movements, extension-retraction of tounge, up and down jaw movements, low approximation of lips momentary head control when held sitting Developmental milestones - Infants Fine motor, oral movement, motor movement 1 month extension, non directed hand swipes rooting turns head when prone Developmental milestones - Infants Fine motor, oral movement, motor movement 4 months directed swipes, corralling, reaching sits with support begins to roll over head steady in sitting Developmental milestones - Infants Fine motor, oral movement, motor movement 4-5 months ulnar-palmar grasp "swims" in prone position no head lag Developmental milestones - Infants Fine motor, oral movement, motor movement 6-7 months radial-palmar grasp raking sucking with negative oral cavity pressure rhythmic jaw movements firm approximation of lips sits independently rolls over rocks on hands and knees free head lift in prone position Developmental milestones - Infants Fine motor, oral movement, motor movement 7-8 months radial-digital grasp phasic bite reflex rhythmic bite and release pattern supports weigt standing bounces when held Developmental milestones - Infants Fine motor, oral movement, motor movement 7-9 months scissors grasp munching early chewing sits alone well may CRAWL Developmental milestones - Infants Fine motor, oral movement, motor movement 9-10 months voluntary release cruises pivots while seated pulls to stand Developmental milestones - Infants Fine motor, oral movement, motor movement 12 months picks up pellet with pincer grasp chewing with spreading and rolling tongue movements tounge lateralization rotary jaw movements controlled sustaned bite walks with one hand held stands alone momitarily how much weight doe infants initially loose after birth? when should it be regained by? initially lose up to 5-8% of birth weight regain it within 10-14 days initial weight loss of more than _____ requires monitoring/evaluation 10% Infant age birth to 1 month weight gain after the initial loss averages 0.5 - 1 ounce (14-18 g) per day 2 lbs per month infant age birth to 1 month nutritional needs to promote growth is 110 kcla/kg/day Infant age 1-3 months length, head circumference and weight increases by length = 1.4 inches (3.5 cm) per month head = 0.8 inches (2 cm) per month weight = 0.5 to 1 oz (14-28 g) per day Infant age 1-3 month number of and length of feedings 8-10 feedings in 24 hours lasting 20-30 minutes each Feedings lasting longer than and shorter than what time need to be evaluated longer than 40 minutes and shorter than 20 minutes Infant 4-5 months length, head circumference, and weight increase by length = 0.8 inch per month head = 0.4 inch per motnh weight = 5 oz per week at what age should infant double birth weight between 4-6 months Sleep patterns for 4-5 month old infant sleep 12-15 hours per day begin to sleep thorugh night without feeding feeding patterns for 4-5 month old infant five feedings during day one feeding durining night Infant 6-8 months length, head circumference, and weight increase by length = 0.5-0.6 inch per month head = 0.2 inch per motnh weight = 3-4 oz per week What age does teething begin teething symptoms being at about 6 months (central inscisors emerge) and at 8 months (lateral incisors emerge) Infant 9-12 months length and weight increase by may follow a different growth curve than the one previously established length = spurts weight = 1 lb per month term newborns have cyclic arousal states (two sleep states, and four common awake states) list the different states quiet sleep active sleep (most common type of sleep) drowsy quiet but alert crying alert and active Newborn sleep times about 16 of 24 hours Developmental milestones - Infants Speech and language (receptive listed first, then expressive) 0-3 months attends to voice turns head or eyes startles to loud sounds quiets in response to voice smiles, coos, gurggles to voice undifferentiated but strong cry coos and gurgles single-syllable repetition g, k, h, and ng appear Developmental milestones - Infants Speech and language (receptive listed first, then expressive) 3-6 months actively seeks sound source may look in response to name responses may vary to angry or happy voice increased babbling, vocal play increased repetitive babbling (gaga) laughs vocalizes to toys spontaneous smile to verbal play increased intensity and nasal tone vocalizes to removal of toy experiments with own voice Developmental milestones - Infants Speech and language (receptive listed first, then expressive) 6-9 months may look at famiy member when named inhibits to "no" begins interest in pictures when named individual words begin to take on meaning bables tunefully increased sound combinations uses m, n, b, d, t initiates sounds (kiss or click) uses nonspecific "mama" and dada" Developmental milestones - Infants Speech and language (receptive listed first, then expressive) 9-12 months gives toy on request understands simple commands turns head to own name understands "hot" "wheres...?" responds with gestures to bye-bye increased imitating efforts has one word with specific reference accompanies vocalizaitons with gestures jargon increases imitates animal sounds Normal infants cry how many hours per day? 5 hours (especially in first few months of life) Normal fussy period typically starts, peaks, and lasts until what ages? starts 2 weeks peaks between 3-5 weeks lasts until 3-5 months PURPLE is an acronym for what to help explain normal crying patterns for young infants What is the most common mood disorder of middle school? anxiety hemoglobin and hematocrit checked at what age for at risk children? 5 years At what age do infants need to be allowed to self-soothe? 4-5 months exclusive breast feeding is best until 6 months earliest solid food can be introduced? what age? after 17 weeks old (but timing should be individualized) Solid foods should be introduced at this age if they have not been already 6 months what age to wan from bottle and pacifier 12 months average birth weight in term infants 7 to 7.5 lbs when to start toilet training? closer to age 3 (not before 18-24 months) should start when child and parent are ready Breastfed infant stool pattern newborn = may have many small stools per day for first few weeks (average of 6 per day) (3-4 small stools per day = indicator of adequate breast milk) second month = stool #s decrease to 1 per day older infants stool left offend (every 8-14 days) ** In exclusively breastfed infants, infrequent stools is not a problem if there are no clinical signs (i.e. abdominal dissension Breastfed infant stool characteristics soft sticky or watery curd-like texture light yellow sour but not unpleasant odor (iron supplements can darken the stools and make it firmer) Formula fed infant stool patern 1st month = 2-4 stools per day older infants = 1-3 stools (soft, semi-formed) Formula fed infant stool characteristics firmer, darker, smellier brown, greenish, or dark yellow (depending on the type and if it is iron fortified/getting iron supplements) Urinary patterns well hydrated infants, whether fed with breast or forums should urinate a minimum of 6x per day but up to 15-20 x per ay