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MOD 1: Study Guide Growth and Development and Immunizations:
Objectives:
Discuss major growth and development landmarks from birth to adolescence
Growth & Development landmarks
Review health promotion principles across the various developmental stages
Describe expected developmental progression for pediatric lifespan
Discuss anticipatory guidance measures for pediatric patients at various developmental
stages
Identify developmental warning signs or RED FLAGS
Know Tanner staging for boys and girls
Know nutrition requirements birth-adolescents
Know vitamin supplementation needed
Nutrition
Caloric requirements:
Birth -6 months: 120kcal/kg/day
7 months-1 year: 100kcal/kg/day
2-10 years: 100 to 70 kcal/kg/day
Adolescents: 45 kcal/kg/day
Breast feeding
Perfect food; cannot be duplicated
Decreases illness in infants
Maternal antibodies are transferred to infants
Decreased GI problems such as GERD
Decreases allergies as it contains anti-inflammatory agents
Breastfeeding during painful procedures provides analgesia
The longer the mom breastfeeds, the less chance of the child to be overweight independent of
education and socioeconomic status
Exclusive breast feeding for six months
Feed on demand
Adequate nutrition confirmed by weight gain
o 30 g/day (1 oz/day) for the first 3 months
o Gain of 15-20 g/day during subsequent 3 months
Vitamin Supplementation
o Vitamin D (400 IU per day at 2 months of age to adolescence
o Vitamin B12 for breastfeeding mothers who are strict vegetarians
Iron
o For exclusively breast-fed infants: approximately 1 mg/kg/day of iron is recommended after 6
months of age
o Bottle feeding should contain iron supplementation
o Ideally iron should come from fortified cereals
o Elemental iron supplements can be given if iron intake from diet is not adequate
Fluoride
o Supplements only when local water supply is less than 0.3 parts per million (ppm)
o Supplementation first 6 months of life
Weight gain progression
Rapid accelerating growth followed by consistent growth
, 2
o Initial 10% weight loss
o Regained within 7-14 days
o Doubles by 5-6 months of age
o Triples by 1 year of age
o Quadruples by 2 years of age
o 3-year-olds through school-age: gain 4-6 lb annually
o School-age children gain 5-7 lb annually
Growth and Development Milestones Table:
Gross Motor Months Fine Motor Months Language Months
Good head 2-3 Grasps and 2-3 Smiles and 2-3
control shakes rattle coos
Rolls back to 5-6 Reaches for 3-4 Laughs 4-5
front object
Sits alone 7 Hand-to-hand 5-6 Babbles 5-6
transfer
Pulls to stand 9-10 Raking grasp 6-7 “mama-Dada” 8-9
Stands alone 11-12 Finger grasp 7-9 Waves bye- 8-9
bye
Walks 12-14 Pincer grasp 8-10 Understands 9-10
no
Walks up and 22-24 Marks on 10-12 Points to body 15-18
down stairs paper parts
Jumps 24-28 Stacks 3 blocks 17-18 2-word 18-22
sentences
Stacks 6 to 7 22-24 30-50-word 22-24
blocks vocabulary
Milestones by age:
2-5 months
Smiles and coos
Watches a person’s face intently
Follows people and object with eyes
Laughs aloud
Lifts head/chest when on stomach
Holds head steady when pulled to sit
Grasps rattle placed in hand
Startles to loud noise
6-9 months
Turns to sound
Babbles and combines vowel/consonant sounds
Responds to name
Rolls over
Sits independently
Transfers objects
Supports weight on feet
Uses thumb and fingers to pick up objects
Crawls
, 3
10-12 months
Takes simple action on request
Purposefully says “mama” or “dada”
Sits independently and plays
Pulls to standing/cruise furniture
Communicates by reaching and pointing
Moves purposefully to get desired object
Has increasing curiosity
Recognizes people
Uses both hands well
13-18 months
Scribbles with large crayon
Walks alone
Feeds self with fingers and begins using a spoon
4-10-word vocabulary
Follows simple directions
Coordinates use of both hands
Responds to name
Points to 2 pictures upon request
Long jabbering sentences
Throw ball overhead
19-24 months
Walks up/down stairs
Jumps with both feet
Completes simple puzzles, circle shapes first
Stacks 6-7 blocks
Uses 2-word sentences
30-50-word vocabulary
Well Child Checks
Stage appropriate screenings
Specific tools of health screening
o Parent interview or history
o Physical exam
o Developmental monitoring
o Specific, stage-appropriate screenings (see lectures)
o Assessment of strengths/weaknesses
o Individualized and evidence-based interventions
Subjective data
o Nutrition/appetite
o Elimination
o Sleep
o Development
o Parent concerns
o Health since last visit
Objective data
o Physical exam
o Screening
Denver-Developmental screening Test, second edition
, 4
Denver II or equivalent for children up to 6 year of age
o Laboratory
Management
o Immunizations; initiation of primary series
o Illness management with medications
o Health promotion strategies with anticipatory guidance
Injury Prevention
Car seats
Poison control numbers
Electrical exposure protection
All poisons out of reach
Gates to barricade unsafe areas
Smoke/carbon monoxide detectors
Pool safety
Crib safety
Hot water safety
Sun safety
Passive/secondary smoke
Abuse/neglect potential
Domestic violence
Sexual abuse
Firearms
Developmental Discussion
How to perform simple tasks
When to call a health care provider
Expected responses to immunizations and procedures
Time management
Discipline
MOD 1: Study Guide Growth and Development and Immunizations:
Objectives:
Discuss major growth and development landmarks from birth to adolescence
Growth & Development landmarks
Review health promotion principles across the various developmental stages
Describe expected developmental progression for pediatric lifespan
Discuss anticipatory guidance measures for pediatric patients at various developmental
stages
Identify developmental warning signs or RED FLAGS
Know Tanner staging for boys and girls
Know nutrition requirements birth-adolescents
Know vitamin supplementation needed
Nutrition
Caloric requirements:
Birth -6 months: 120kcal/kg/day
7 months-1 year: 100kcal/kg/day
2-10 years: 100 to 70 kcal/kg/day
Adolescents: 45 kcal/kg/day
Breast feeding
Perfect food; cannot be duplicated
Decreases illness in infants
Maternal antibodies are transferred to infants
Decreased GI problems such as GERD
Decreases allergies as it contains anti-inflammatory agents
Breastfeeding during painful procedures provides analgesia
The longer the mom breastfeeds, the less chance of the child to be overweight independent of
education and socioeconomic status
Exclusive breast feeding for six months
Feed on demand
Adequate nutrition confirmed by weight gain
o 30 g/day (1 oz/day) for the first 3 months
o Gain of 15-20 g/day during subsequent 3 months
Vitamin Supplementation
o Vitamin D (400 IU per day at 2 months of age to adolescence
o Vitamin B12 for breastfeeding mothers who are strict vegetarians
Iron
o For exclusively breast-fed infants: approximately 1 mg/kg/day of iron is recommended after 6
months of age
o Bottle feeding should contain iron supplementation
o Ideally iron should come from fortified cereals
o Elemental iron supplements can be given if iron intake from diet is not adequate
Fluoride
o Supplements only when local water supply is less than 0.3 parts per million (ppm)
o Supplementation first 6 months of life
Weight gain progression
Rapid accelerating growth followed by consistent growth
, 2
o Initial 10% weight loss
o Regained within 7-14 days
o Doubles by 5-6 months of age
o Triples by 1 year of age
o Quadruples by 2 years of age
o 3-year-olds through school-age: gain 4-6 lb annually
o School-age children gain 5-7 lb annually
Growth and Development Milestones Table:
Gross Motor Months Fine Motor Months Language Months
Good head 2-3 Grasps and 2-3 Smiles and 2-3
control shakes rattle coos
Rolls back to 5-6 Reaches for 3-4 Laughs 4-5
front object
Sits alone 7 Hand-to-hand 5-6 Babbles 5-6
transfer
Pulls to stand 9-10 Raking grasp 6-7 “mama-Dada” 8-9
Stands alone 11-12 Finger grasp 7-9 Waves bye- 8-9
bye
Walks 12-14 Pincer grasp 8-10 Understands 9-10
no
Walks up and 22-24 Marks on 10-12 Points to body 15-18
down stairs paper parts
Jumps 24-28 Stacks 3 blocks 17-18 2-word 18-22
sentences
Stacks 6 to 7 22-24 30-50-word 22-24
blocks vocabulary
Milestones by age:
2-5 months
Smiles and coos
Watches a person’s face intently
Follows people and object with eyes
Laughs aloud
Lifts head/chest when on stomach
Holds head steady when pulled to sit
Grasps rattle placed in hand
Startles to loud noise
6-9 months
Turns to sound
Babbles and combines vowel/consonant sounds
Responds to name
Rolls over
Sits independently
Transfers objects
Supports weight on feet
Uses thumb and fingers to pick up objects
Crawls
, 3
10-12 months
Takes simple action on request
Purposefully says “mama” or “dada”
Sits independently and plays
Pulls to standing/cruise furniture
Communicates by reaching and pointing
Moves purposefully to get desired object
Has increasing curiosity
Recognizes people
Uses both hands well
13-18 months
Scribbles with large crayon
Walks alone
Feeds self with fingers and begins using a spoon
4-10-word vocabulary
Follows simple directions
Coordinates use of both hands
Responds to name
Points to 2 pictures upon request
Long jabbering sentences
Throw ball overhead
19-24 months
Walks up/down stairs
Jumps with both feet
Completes simple puzzles, circle shapes first
Stacks 6-7 blocks
Uses 2-word sentences
30-50-word vocabulary
Well Child Checks
Stage appropriate screenings
Specific tools of health screening
o Parent interview or history
o Physical exam
o Developmental monitoring
o Specific, stage-appropriate screenings (see lectures)
o Assessment of strengths/weaknesses
o Individualized and evidence-based interventions
Subjective data
o Nutrition/appetite
o Elimination
o Sleep
o Development
o Parent concerns
o Health since last visit
Objective data
o Physical exam
o Screening
Denver-Developmental screening Test, second edition
, 4
Denver II or equivalent for children up to 6 year of age
o Laboratory
Management
o Immunizations; initiation of primary series
o Illness management with medications
o Health promotion strategies with anticipatory guidance
Injury Prevention
Car seats
Poison control numbers
Electrical exposure protection
All poisons out of reach
Gates to barricade unsafe areas
Smoke/carbon monoxide detectors
Pool safety
Crib safety
Hot water safety
Sun safety
Passive/secondary smoke
Abuse/neglect potential
Domestic violence
Sexual abuse
Firearms
Developmental Discussion
How to perform simple tasks
When to call a health care provider
Expected responses to immunizations and procedures
Time management
Discipline
