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S01 5Y$
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STUDY GUIDE – MODULE 1
Infancy and Early Childhood (1-4 Years) with Immunizations (birth – age 6 years)
BIRTH – 4 years old: DEVELOPMENTAL TASKS / MILESTONES (Hays – Table 3-1)
AUTISM SPECTRUM DISORDERS (Pg. 89-92 – Hays)
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Two Core Features: persistent deficits in social communication and social interaction across multiple contexts AND restricted repetitive patterns of
behavior, interests, or activities
Defined: neurological disorder; DSM-5 combines autism, PDD, and Asperger syndrome into ASDs
• Typical features or signs may not be present until social demands become greater and may be difficult to recognize in an individual who has
learned compensatory strategies
• Typical features / signs MUST cause "clinically significant impairment" with the social communication component impaired in comparison to the
individual's "general developmental level"
• Severity ranges from level I (requiring support); level II (requiring substantial support); level III (requiring very substantial support)
• ASDs are common (1 in 68 children, with males being overrepresented about 4.5:1); prevalence of ID is higher in girls
• Strong familial component; parents of 1 child with autism of unknown etiology have 7-23% chance of having 2nd child with autism
Evaluation / Management: often not diagnosed until age 3-4years; may be able to be recognized in the 1st 12-18mo of life. Most common early
characteristics are consistent failure to orient to ones name, regard people directly, use gestures and develop speech. Sharing affect or enjoyment is
an IMPORTANT precursor to social interaction. Restricted interests and repetitive behaviors sometimes do not emerge until after age 2 but usually
are present before age 2.
EARLY INTERVENTION IS KEY = M-CHAT, designed for children 16-30 months of age; parent report measure with 20 Y/N questions; AUTISM SPECIFIC
SCREEN is recommended at 18 and 24-30months
• Other Tests: metabolic screening, lead level, thyroid studies; neuro imaging is NOT routinely done
• Refer if +Autism: local early intervention program, speech / language pathologist (formal audiology eval)
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UNIVERSAL SCREENINGS – BRIGHT FUTURES
BRIGHT FUTURES: national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP) and supported, in part, by the US department of Health
and Human services.
AGE UNIVERSAL SCREENING PRIORITIES FOR VISITS
Hearing: before discharge or by 1 month old Attend to concerns of parents
Bilirubin: before discharge or first NB visit if born at home/birth facility Living situation / family support
Blood: PKU, congenital hypothyroidism, sickle cells Maternal health/nutrition, transition after discharge, sibling relationship
Newborn Congenital Heart Disease: using pulse ox before discharge or first NB visit if Baby care (skin/cord care, illness prevention, calming baby)
General guidance on feeding (breastfeeding vs. formula)
born at home Car seat safety, safe sleep, pets
Hearing: if not yet done OR any NB who fail the initial screen must be referred Attend to concerns of parents
immediately for a diagnostic audiologic assessment. Hearing status should be Living situation / family support
Parent/family health (transition home, sibling adjustment)
confirmed by 3 months old
3-5 days Blood: (verify screening was obtained/review results of state metabolic
Early brain development, temp taking, CPR, handwashing, sun exposure
Weight gain, holding/burping, hunger cues; feeding (breastfeeding vs. formula)
screening test; unavailable/pending results must be obtained immediately. Car seat safety, heatstroke prevention, safe sleep
Abnormal results retest with necessary referrals made to subspecialists
Hearing (if not done yet, should be completed) Attend to concerns of parents
Blood (verify documentation of newborn blood screening results; follow-up Living situation, environmental tobacco exposure, radon, pesticides
on any positive results with as needed referral) Postpartum checkup, maternal depression, family relationships
1 month Sleeping/waking, fussiness/attachment, media, playtime
Feeding plans/choices, feeding (breastfeeding vs. formula)
Maternal Depression screen Car seat safety, safe sleep, preventing falls
Hearing Attend to concerns of parents
Blood (verify documentation of newborn blood screening results; follow-up Living situation, food security, family support/childcare
2 month Postpartum checkup, depression, sibiling relationships
on any positive results with as needed referral)
Parent/infant relationship and communication, sleeping, media, playtime
Maternal Depression screen
General guidance on feeding / delaying solid foods, hunger/satiety cues
Car seat safety, safe sleep, safe home environment: burns, falls, drowning
Maternal Depression screen Attend to concerns of parents
Living situation (risks for lead), family support/childcare
4 month Infant self-calming, parent-infant communication, consistent routines, playtime
Maternal oral health, teething/drooling, no bottle in bed
Feeding choices (avoid grazing), delaying solid foods, hunger/satiety cues, supplements,
OTC meds
Car seat safety, safe sleep, safe home environment
Maternal Depression Attend to concerns of parents
Oral Health: oral health risk assessment; apply fluoride varnish after first Living situation (tobacco, ETOH, drugs, parental depression), family support/childcare
tooth eruption Parents as teachers, communication, early literacy, emerging infant independence, putting
6 month self to sleep
Oral health (fluoride, soft toothbrush, no bottle in bed)
**Verify entry into Early Intervention services no later than 6 months of age if Feeding (solid foods, pesticides in veggies/fruits)
hearing loss is confirmed Car seat safety, safe sleep, safe home environment: burns, sun exposure, choking,
poisoning, drowning, falls)
Developmental screen Attend to concerns of parents
Oral Health: oral health risk assessment; apply fluoride varnish after first Living situation (intimate partner violence), family support
Infant changing sleep pattern, mobility/cognitive development, interactive
tooth eruption
9 month learning/communication
Discipline (parent expectations of child’s behavior)
Self-feeding, mealtime routines, transition to solid foods, cup drinking, plans for weaning
(breastfeeding)
Car seat safety, heatstroke prevention, firearm safety, burns, poisoning, drowning, falls
Anemia: Hct & HgB Attend to concerns of parents
Lead blood test (high prevalence area or insured by medicaid) Living situation (tobacco, ETOH, drugs); social connections family/friends, child care
Oral Health (in absence of dental home): apply fluoride varnish after first Establishing routines (adjusting to child’s developmental changes/behavior, family time,
12 month tooth eruption and every 6 months naptime, teeth brushing, media)
Self-feeding, transition to family meals, nutritious foods
Establishing a dental home (1st dental checkup / dental hygiene)
Car seat safety, drowning prevention, sun protection, pets, poisoning)
Oral Health (in absence of dental home): apply fluoride varnish after first Attend to concerns of parents
tooth eruption and every 6 months Communication / social development (individuation, separation, finding support, attention
to how child communicates wants/needs)
15 month Sleep routines/issues (regular bedtime, night waking, no bottle in bed)
Temperament, development, behavior, discipline (conflict predictors/distraction)
Healthy teeth (brushing teeth, reducing caries)
Car seat safety, parental use of seatbelts, poisoning, falls, fire safety
Autism spectrum disorder screen Attend to concerns of parents
Developmental screen Temperament, development, toilet training, behavior, discipline (anticipation of return to
separation anxiety, managing behaviors with limits, recognize signs of toilet training)
Oral Health (in absence of dental home): apply fluoride varnish after first
18 month Communication (encouragement of language, use simple words/phrases, reading, playing,
tooth eruption and every 6 months talking, singing)
TV viewing / media (promote reading, physical activity, safe play)
Healthy nutrition (water, milk, juice, expressing independence through food likes/dislikes)
Car seat safety, parental use of seatbelts, poisoning, falls, fire safety
Autism spectrum disorder screen Attend to concerns of parents
Lead blood test (high prevalence area or insured by medicaid) Living situation (intimate partner violence, ETOH, drugs, tobacco), family support
Oral Health (in absence of dental home): apply fluoride varnish after first Temperament, development, promotion of physical activity, safe play, limits on media use
2 year tooth eruption and every 6 months Assessment of language development (how child communicates/expectations for
language, promotion of reading)
Toilet training (techniques, personal hygiene)
https://www.stuvia.com/user/nursecare
S01 5Y$
0a1u]e $ ‡S )
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
STUDY GUIDE – MODULE 1
Infancy and Early Childhood (1-4 Years) with Immunizations (birth – age 6 years)
BIRTH – 4 years old: DEVELOPMENTAL TASKS / MILESTONES (Hays – Table 3-1)
AUTISM SPECTRUM DISORDERS (Pg. 89-92 – Hays)
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
Two Core Features: persistent deficits in social communication and social interaction across multiple contexts AND restricted repetitive patterns of
behavior, interests, or activities
Defined: neurological disorder; DSM-5 combines autism, PDD, and Asperger syndrome into ASDs
• Typical features or signs may not be present until social demands become greater and may be difficult to recognize in an individual who has
learned compensatory strategies
• Typical features / signs MUST cause "clinically significant impairment" with the social communication component impaired in comparison to the
individual's "general developmental level"
• Severity ranges from level I (requiring support); level II (requiring substantial support); level III (requiring very substantial support)
• ASDs are common (1 in 68 children, with males being overrepresented about 4.5:1); prevalence of ID is higher in girls
• Strong familial component; parents of 1 child with autism of unknown etiology have 7-23% chance of having 2nd child with autism
Evaluation / Management: often not diagnosed until age 3-4years; may be able to be recognized in the 1st 12-18mo of life. Most common early
characteristics are consistent failure to orient to ones name, regard people directly, use gestures and develop speech. Sharing affect or enjoyment is
an IMPORTANT precursor to social interaction. Restricted interests and repetitive behaviors sometimes do not emerge until after age 2 but usually
are present before age 2.
EARLY INTERVENTION IS KEY = M-CHAT, designed for children 16-30 months of age; parent report measure with 20 Y/N questions; AUTISM SPECIFIC
SCREEN is recommended at 18 and 24-30months
• Other Tests: metabolic screening, lead level, thyroid studies; neuro imaging is NOT routinely done
• Refer if +Autism: local early intervention program, speech / language pathologist (formal audiology eval)
https://www.stuvia.com/user/nursecare
,https://www.stuvia.com/user/nursecare
UNIVERSAL SCREENINGS – BRIGHT FUTURES
BRIGHT FUTURES: national health promotion and prevention initiative, led by the American Academy of Pediatrics (AAP) and supported, in part, by the US department of Health
and Human services.
AGE UNIVERSAL SCREENING PRIORITIES FOR VISITS
Hearing: before discharge or by 1 month old Attend to concerns of parents
Bilirubin: before discharge or first NB visit if born at home/birth facility Living situation / family support
Blood: PKU, congenital hypothyroidism, sickle cells Maternal health/nutrition, transition after discharge, sibling relationship
Newborn Congenital Heart Disease: using pulse ox before discharge or first NB visit if Baby care (skin/cord care, illness prevention, calming baby)
General guidance on feeding (breastfeeding vs. formula)
born at home Car seat safety, safe sleep, pets
Hearing: if not yet done OR any NB who fail the initial screen must be referred Attend to concerns of parents
immediately for a diagnostic audiologic assessment. Hearing status should be Living situation / family support
Parent/family health (transition home, sibling adjustment)
confirmed by 3 months old
3-5 days Blood: (verify screening was obtained/review results of state metabolic
Early brain development, temp taking, CPR, handwashing, sun exposure
Weight gain, holding/burping, hunger cues; feeding (breastfeeding vs. formula)
screening test; unavailable/pending results must be obtained immediately. Car seat safety, heatstroke prevention, safe sleep
Abnormal results retest with necessary referrals made to subspecialists
Hearing (if not done yet, should be completed) Attend to concerns of parents
Blood (verify documentation of newborn blood screening results; follow-up Living situation, environmental tobacco exposure, radon, pesticides
on any positive results with as needed referral) Postpartum checkup, maternal depression, family relationships
1 month Sleeping/waking, fussiness/attachment, media, playtime
Feeding plans/choices, feeding (breastfeeding vs. formula)
Maternal Depression screen Car seat safety, safe sleep, preventing falls
Hearing Attend to concerns of parents
Blood (verify documentation of newborn blood screening results; follow-up Living situation, food security, family support/childcare
2 month Postpartum checkup, depression, sibiling relationships
on any positive results with as needed referral)
Parent/infant relationship and communication, sleeping, media, playtime
Maternal Depression screen
General guidance on feeding / delaying solid foods, hunger/satiety cues
Car seat safety, safe sleep, safe home environment: burns, falls, drowning
Maternal Depression screen Attend to concerns of parents
Living situation (risks for lead), family support/childcare
4 month Infant self-calming, parent-infant communication, consistent routines, playtime
Maternal oral health, teething/drooling, no bottle in bed
Feeding choices (avoid grazing), delaying solid foods, hunger/satiety cues, supplements,
OTC meds
Car seat safety, safe sleep, safe home environment
Maternal Depression Attend to concerns of parents
Oral Health: oral health risk assessment; apply fluoride varnish after first Living situation (tobacco, ETOH, drugs, parental depression), family support/childcare
tooth eruption Parents as teachers, communication, early literacy, emerging infant independence, putting
6 month self to sleep
Oral health (fluoride, soft toothbrush, no bottle in bed)
**Verify entry into Early Intervention services no later than 6 months of age if Feeding (solid foods, pesticides in veggies/fruits)
hearing loss is confirmed Car seat safety, safe sleep, safe home environment: burns, sun exposure, choking,
poisoning, drowning, falls)
Developmental screen Attend to concerns of parents
Oral Health: oral health risk assessment; apply fluoride varnish after first Living situation (intimate partner violence), family support
Infant changing sleep pattern, mobility/cognitive development, interactive
tooth eruption
9 month learning/communication
Discipline (parent expectations of child’s behavior)
Self-feeding, mealtime routines, transition to solid foods, cup drinking, plans for weaning
(breastfeeding)
Car seat safety, heatstroke prevention, firearm safety, burns, poisoning, drowning, falls
Anemia: Hct & HgB Attend to concerns of parents
Lead blood test (high prevalence area or insured by medicaid) Living situation (tobacco, ETOH, drugs); social connections family/friends, child care
Oral Health (in absence of dental home): apply fluoride varnish after first Establishing routines (adjusting to child’s developmental changes/behavior, family time,
12 month tooth eruption and every 6 months naptime, teeth brushing, media)
Self-feeding, transition to family meals, nutritious foods
Establishing a dental home (1st dental checkup / dental hygiene)
Car seat safety, drowning prevention, sun protection, pets, poisoning)
Oral Health (in absence of dental home): apply fluoride varnish after first Attend to concerns of parents
tooth eruption and every 6 months Communication / social development (individuation, separation, finding support, attention
to how child communicates wants/needs)
15 month Sleep routines/issues (regular bedtime, night waking, no bottle in bed)
Temperament, development, behavior, discipline (conflict predictors/distraction)
Healthy teeth (brushing teeth, reducing caries)
Car seat safety, parental use of seatbelts, poisoning, falls, fire safety
Autism spectrum disorder screen Attend to concerns of parents
Developmental screen Temperament, development, toilet training, behavior, discipline (anticipation of return to
separation anxiety, managing behaviors with limits, recognize signs of toilet training)
Oral Health (in absence of dental home): apply fluoride varnish after first
18 month Communication (encouragement of language, use simple words/phrases, reading, playing,
tooth eruption and every 6 months talking, singing)
TV viewing / media (promote reading, physical activity, safe play)
Healthy nutrition (water, milk, juice, expressing independence through food likes/dislikes)
Car seat safety, parental use of seatbelts, poisoning, falls, fire safety
Autism spectrum disorder screen Attend to concerns of parents
Lead blood test (high prevalence area or insured by medicaid) Living situation (intimate partner violence, ETOH, drugs, tobacco), family support
Oral Health (in absence of dental home): apply fluoride varnish after first Temperament, development, promotion of physical activity, safe play, limits on media use
2 year tooth eruption and every 6 months Assessment of language development (how child communicates/expectations for
language, promotion of reading)
Toilet training (techniques, personal hygiene)
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