Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
193 Cards in this Set
- Front
- Back
|
Pediatric Stages
|
0-1: Infancy
1-2 Toddler 2-5 preschoolers 5-12 school-age 13-21 adolescence |
|
|
What is Kohlbergs pre-conventional level of moral development?
|
stage 1: punishment/obedience orientation The child assumes that powerful authorities hand down a fixed set of rules which he or she must unquestioningly obey.
Stage2:Individualism and Exchange - naively egotistic orientation: Only wants to fulfill own needs does not think of others. At this stage children recognize that there is not just one right view that is handed down by the authorities. Different individuals have different viewpoints. Respondents at stage 2 are still said to reason at the preconventional level because they speak as isolated individuals rather than as members of society. They see individuals exchanging favors, but there is still no identification with the values of the family or community. |
|
|
What is Kohlbergs conventional level of moral development?
|
Stage 3: Good Interpersonal Relationships. (good/boy) right & wrong perceived by peers. this stage children--who are by now usually entering their teens--see morality as more than simple deals. They believe that people should live up to the expectations of the family and community and behave in "good" ways. Good behavior means having good motives and interpersonal feelings such as love, empathy, trust, and concern for others.
Stage 4: Maintaining the Social Order the respondent becomes more broadly concerned with society as a whole. Now the emphasis is on obeying laws, respecting authority, and performing one's duties so that the social order is maintained. subjects make moral decisions from the perspective of society as a whole, they think from a full-fledged member-of-society perspective |
|
|
What is Kohlbergs Postconventional, autonomous or principle level of moral development?
|
Stage 5: Social Contract and Individual Rights
respondents basically believe that a good society is best conceived as a social contract into which people freely enter to work toward the benefit of all They recognize that different social groups within a society will have different values, but they believe that all rational people would agree on two points. First they would all want certain basic rights, such as liberty and life, to be protected Second, they would want some democratic procedures for changing unfair law and for improving society. Democracy. Stage 6: Universal Principles Ethics & morality: respondents are working toward a conception of the good society. They suggest that we need to (a) protect certain individual rights and (b) settle disputes through democratic processes. the principles by which we achieve justice. The principles of justice guide us toward decisions based on an equal respect for all. |
|
|
Human figure drawings - what should a child going to kindergarten be able to do? Ask them to draw a picture of themselves
|
age 3 child should be able to draw a circle if not big red flag. 4 points = 1 year of age. Base score is 3 and then 1 point for each item on child. then divide by 4
|
|
|
What is a genogram
|
a graphic representation of a family tree
|
|
|
What is an ecomap
|
focuses on relationships outside of hte family - church, work, friends, organizations
|
|
|
What are components of comprehensive family assessment?
|
need to know: who lives together, where do they lie, who works, what is occupation, daycare, schools, afterschool arrangements, what do they do together, who does mom call for advice. Family History Form
|
|
|
What is Erickson's stage trust vs. mistrust?
|
age 0-1 Hope dependency or paranoia. when the parents present consistent, adequate, and nurturing care, the child develops basic trust and realizes that people are dependable and the world can be a safe place. The child develops a sense of hope and confidence; this is a belief that things will work out well in the end
|
|
|
What is Erickson's stage Autonomy vs Shame & Doubt
|
ages 2-3 Will Obsessive/Impulsive or Avoidant
-if parents guide children gradually and firmly, praise and accept attempts to be independent, autonomy develops. The result will be a sense of will which helps us accomplish and build self-esteem as children and adults -if parents are too permissive, harsh, or demanding, the child can feel defeated, and experience extreme shame and doubt, and grow up to engage in neurotic attempts to regain feelings of control, power, and competency. This may take the form of obsessive behavior; if you follow all rules exactly then you will never be ashamed again. If the child is given no limits or guidance, the child can fail to gain any shame or doubt and be impulsive. Some is good, as it causes us to question the outcomes of our actions, and consider others' well-being. This may also result in Avoidance; if you never allow yourself to be close to others, they can never make you feel ashamed |
|
|
What is Erickson's stage Initiative vs Guilt?
|
ages 4-5 Purpose Constricted or Antisocial/Narcissistic
-the child becomes curious about people and models adults. Erickson believed the child does attempt to possess the opposite sex parent and experience rivalry toward the same sex parent; however, a true Oedipal Complex only develops in very severe cases -if parents are understanding and supportive of a child's efforts to show initiative, the child develops purpose, and sets goals and acts in ways to reach them -if children are punished for attempts to show initiative, they are likely to develop a sense of guilt, which in excess can lead to inhibition. Too much purpose and no guilt can lead to ruthlessness; the person may achieve their goals without caring who they step on in the process |
|
|
What is Erickson's stage Industry vs. Inferiority
|
Ages 6-12 Competency Helplessness or Shallowness
-occurs during Latency, but Erickson did not think this was a rest period; the child begins school and must tame imagination and impulses, and please others. If adults support the child's efforts, a sense of competence develops -if caretakers do not support the child, feelings of inferiority are likely to develop. Too much inferiority, and inertia or helplessness occurs (underachievers). Too much competency and the child becomes an adult too fast, and develops either into a Histrionic or Shallow person |
|
|
What is Erickson's stage Identity vs. Role Confusion
|
Age 13-19 Fidelity Identity Diffusion or Fanaticism
-young adults attempt to develop identity and ideas about strengths, weaknesses, goals, occupations, sexual identity, and gender roles. Teens "try on" different identities, going through an identity crisis, and use their friends to reflect back to them. Marcia offers four resolutions: Identity Achievement (crises and commitment), Moratorium (crises and commitment later), Foreclosure (commitment without crises), and Identity Diffusion (no crises, no commitment) -if they resolve this crisis, they develop fidelity, "the ability to sustain loyalties freely pledged in spite of the inevitable contradictions of value systems" (can be friends with very different people) -if they fail to resolve the crisis, they develop identity diffusion; their sense of self is unstable and threatened; too little identity and they may join cults or hate groups, too much identity and they may show fanaticism |
|
|
Summary of Kohlberg's Theory
|
At stage 1 children think of what is right as that which authority says is right. Doing the right thing is obeying authority and avoiding punishment. At stage 2, children are no longer so impressed by any single authority; they see that there are different sides to any issue. Since everything is relative, one is free to pursue one's own interests, although it is often useful to make deals and exchange favors with others.
At stages 3 and 4, young people think as members of the conventional society with its values, norms, and expectations. At stage 3, they emphasize being a good person, which basically means having helpful motives toward people close to one At stage 4, the concern shifts toward obeying laws to maintain society as a whole. At stages 5 and 6 people are less concerned with maintaining society for it own sake, and more concerned with the principles and values that make for a good society. At stage 5 they emphasize basic rights and the democratic processes that give everyone a say, and at stage 6 they define the principles by which agreement will be most just |
|
|
Define Piaget's stages of cognitive development Sensory Motor Period (0 - 24 months)
|
Reflexive Stage (0-2 months)
Simple reflex activity such as grasping, sucking Primary Circular Reactions(2-4 months Reflexive behaviors occur in stereotyped repetition such as opening and closing fingers repetitively. Secondary Circular Reactions (4-8 months) Repetition of change actions to reproduce interesting consequences such as kicking one's feet to more a mobile suspended over the crib Coordination of Secondary Reactions (8-12 months) Responses become coordinated into more complex sequences. Actions take on an "intentional" character such as the infant reaches behind a screen to obtain a hidden object. Tertiary Circular Reactions (12-18 months) Discovery of new ways to produce the same consequence or obtain the same goal such as the infant may pull a pillow toward him in an attempt to get a toy resting on it. Invention of New Means Through Mental Combination (18-24 months) Evidence of an internal representational system. Symbolizing the problem-solving sequence before actually responding. Deferred imitation. |
|
|
Define Piaget's stages of cognitive development The Preoperational Period (2-7 years)
|
Preoperational Phase
(2-4 years) Increased use of verbal representation but speech is egocentric. The beginnings of symbolic rather than simple motor play. Transductive reasoning. Can think about something without the object being present by use of language. Intuitive Phase (4-7 years) Speech becomes more social, less egocentric. The child has an intuitive grasp of logical concepts in some areas. However, there is still a tendency to focus attention on one aspect of an object while ignoring others. Concepts formed are crude and irreversible. Easy to believe in magical increase, decrease, disappearance. Reality not firm. Perceptions dominate judgment. In moral-ethical realm, the child is not able to show principles underlying best behavior. Rules of a game not develop, only uses simple do's and don'ts imposed by authority. |
|
|
Define Piaget's stages of cognitive development Period of Concrete Operations (7-12 years
|
Evidence for organized, logical thought. There is the ability to perform multiple classification tasks, order objects in a logical sequence, and comprehend the principle of conservation. thinking becomes less transductive and less egocentric. The child is capable of concrete problem-solving.
Some reversibility now possible (quantities moved can be restored such as in arithmetic: 3+4 = 7 and 7-4 = 3, etc.) Class logic-finding bases to sort unlike objects into logical groups where previously it was on superficial perceived attribute such as color. Categorical labels such as "number" or animal" now available |
|
|
Define Piaget's stages of cognitive development Period of Formal Operations (12 years and onwards)
|
Thought becomes more abstract, incorporating the principles of formal logic. The ability to generate abstract propositions, multiple hypotheses and their possible outcomes is evident. Thinking becomes less tied to concrete reality.
Formal logical systems can be acquired. Can handle proportions, algebraic manipulation, other purely abstract processes. If a + b = x then a = x - b. If ma/ca = IQ = 1.00 then Ma = CA. Prepositional logic, as-if and if-then steps. Can use aids such as axioms to transcend human |
|
|
Bandura Social and cognitive theory
|
Learning through
modeling of behavior What we see we do, |
|
|
What is the PEDS Test?
|
Parents' Evaluation of Development Status
• Paper and pencil "test" really a survey • Give to parents at well child check and have them fill out • Use up to 8 years of age, takes about 2 minutes, about 74-80% sensitivity and a 70-80% specificity. No training needed, 60cents to administe |
|
|
What are some Gross Motor developmental milestones?
|
Walking by 10–14 months
• Climbing by 2½ years • Throwing and kicking a ball by 2 years • Pedaling a tricycle by 3 years • Hopping by 4 years • Skipping by 6 year |
|
|
What are some Fine Motor developmental milestones?
|
Stacking three or four blocks
by 18 months • Completing simple form boards by 2 years • Threading beads by 3½ years • Cutting a piece of paper by 3 years • Copying geometric shapes by 4 years • Tying shoelaces by 5 years • Printing legibly by 6 year |
|
|
What are Speech and language
achievement milestones? |
Speaking single words by
12 months • Making word combinations by 2 years • Making clear, simple sentences and being interested in books and stories by 3 years • Making conversation clear to others by 3 or 4 years • Reading by 5 to 6 year |
|
|
What are Social achievements milestones?
|
Dressing by 2 years
• Self-feeding using cutlery by 3 years • Being toilet-trained by 3½ years • Playing cooperatively in groups by 3 years • Playing team games by 7 year |
|
|
What is a genogram?
|
a graphic representation of a family tree that displays detailed data on relationships among individuals. It goes beyond a traditional family tree by allowing the user to analyze hereditary patterns and psychological factors that punctuate relationships. Genograms allow a therapist and his patient to quickly identify and understand various patterns in the patient's family history which may have had an influence on the patient's current state of mind. The genogram maps out relationships and traits that may otherwise be missed on a pedigree chart
|
|
|
What is an Eco map?
|
Focuses on major systems that are part of
the family's life. So not limited to just family members, but their relationships to church, work, friends, organizations |
|
|
HUman figure drawings - what should child be able to draw when going to Kindergarten?
|
Goodenough-Harris Draw Test Ask child to draw picture of themselves. Need to have at least 6 parts by age 5. If only see scribbling at age 5 not ready for kindergarten
|
|
|
When should be normal well child care checks
|
2 weeks
2 months 4 months 6 months 9 months 12 months 15-18 months 3-4 yrs 5 yrs 11 years and then? |
|
|
What are contraindications of continuing DTAP
|
immediate anaphylactic rx, 2nd encephalopathy witin 7 days, Precautions to further administer would include convulsion within 3 days of immunizing, persistent inconsolable screaming within 48 hours, collapse or shocklike state within 48 hours and unexplained fever of higher than 104.8 within 48 hours
|
|
|
What are contraindications for the flu vaccine?
|
children with severe anaphylactic reaction to chickens or egg protein
|
|
|
Which children should not be immunized?
|
Children with neurological disorders with a progressive developmental delay should not be immunized
|
|
|
What are contraidications for MMR?
|
pregnancy, anaphylactic reaction to gelatin, egg, neomycin or prior MMR vaccines and febrile illness. Complications or encephalopathy and encephalitis are rare
|
|
|
Common side effects with vaccines
|
fever - (do not give tylenol before vaccine given as can block early stage of immune response, malaise, HA, Loca: pain, swelling redness
|
|
|
What are the car seat rules?
|
Birth to 1 year and up to at least 20 pounds rear-facing in rear seat
Under 1 year but 20-35 pounds rear-facing convertible seat 1-4years and 20 to 40 pounds convertible seat, forward facing Ages 4 to 8 years and more than 40 pounds & under 4ft9in. belt positioning booster seat Older children and height greater than 4ft 9in. belt positioning without booster |
|
|
When are solid foods OK for baby?
|
none for first 6 months including cereal in bottle
|
|
|
What are recommendations for dental care for children?
|
examined by a dentist by 1 year of age or within 6 months of the eruption of the first tooth.
|
|
|
What is involved in normal newborn screenings
|
PKU, congenital hypothyroidism, galactosemia, hemoglobin
type, homocystinuria, tyrosinemia, maple syrup urine disease, sickle cell trait, cystic fibrosis, congenital adrenal hyperplasia, hearing screening |
|
|
Exam of newborn
|
compare sides - are both side even? - abnormal findings need to be evaluated objectively iwth labs, tests
|
|
|
When should suture lines be unpalpable?
|
Suture lines should
not be palpable after age 5-6 month |
|
|
When does anterior fontanelle & posterior fontanelle close?
|
Anterior fontanel is diamond shaped &
closes by age 9 to 19 months • Posterior fontanel may be absent at birth. If not usually closes by 1 to 2 month |
|
|
Innocent murmurs of child
|
PDA closes 2 days/birth,
– Peripheral Pulmonic Stenosis or Peripheral Pulmonary Branch Artery Stenosis: Usually disappears by 3 months of ag |
|
|
When is the foreskin fully retractable?
|
3 years of age
|
|
|
When does Moro reflex disappera?
|
should be gone by 4 months
|
|
|
When does stepping reflex disappear?
|
6-8 weeks
|
|
|
Rooting & sucking reflexes
|
Rooting: Appears at birth,
disappears at 3-4 month, Sucking: Appears at birth, disappears at 3-4 month |
|
|
Palmar and Plantar grasps
|
Palmar grasp: Appears at
birth, disappears at 3-6 month, • Plantar grasp: Appears at birth, disappears at 8 – 10 month |
|
|
Babinski reflex
|
Appears at birth and disappears within 2
years |
|
|
asymmetric Atonic Neck
|
Appears at birth and disappears between
4 & 6 month - also known as fencing |
|
|
Newborn stage of development
|
trust vs. mistrust
Parents who attend to the child’s need of food, rest, and hygiene assist in ego development When basic needs are not met then a negative resolution of fear develop |
|
|
Red Flags with Newborns
|
Jaundice
• Lack of weight gain • Screenings not done or not reviewed • Hearing tests • Maternal depressio |
|
|
What are developmental milestone for 2 month old?
|
• Gross Motor
– Head bobs – + Head lag – + Moro reflex – + asymmetrical tonic neck reflex • Fine Motor – Grasp reflex is waning – Hands unfisted ~50% time – May briefly hold object • Language – Reciprocally coos • Cognitive – Piaget: Sensorimtor – Tracks objects >180 degrees • Emotional – Erikson: Trust vs. Mistrust • Social – Reciprocal social smile – Bonding with parent – Eyes follow moving perso |
|
|
Red Flags for Infants 2 month exam
|
Rolling over before age 3 may indicate
hypertonia • Fisting after age 3months is an early indicator of neuromotor dysfunction • Irritability • Delay in social smile may be sign of visual or cognitive impairment or maternal depressio |
|
|
When should infants have motor eye control?
|
Check red reflex & for strabismus
– Eyes usually aligned by 2 month visit & definitely by 4 month visit – Visual acuity at 2 months 20/200 – Increased abililty to follow objects verticall |
|
|
What to check for for hips in infant exam?
|
hip clicks, are hip fold symmetrical, Barlow test hip joint out and down, Ortolani externally rotate
|
|
|
Guidance for 2 months check
|
Growth & Development
– Gains ~ 1 oz./day & .5 to 1 inch/month • Sleep – Will become more organized – Sleep on back or side • Stimulation • Dental Issues – Not an issue yet – Do not prop bottle • Nutrition – Encourage to delay introduction of solid foods till next visit (6 months of age) • Discipline & Parenting – Discipline is not needed to ~ 6 months – Holding & cuddling does not spoil the infant • Illness Care • Safety – Tap water & bath water temp – Do not leave alone in bath – Car seat rear facing – Small objects – Smoke alarm |
|
|
4 month old milestones
|
A time of increasing interaction with the
environment • Schedule of feeding, elimination, & sleeping becoming more organized • More primitive reflexes are disappearing • Colic type symptoms typically have ease Gross Motor – Moro reflex gone – Tonic neck reflex gone – Rolling front to back – Head lag gone • Fine Motor – Reaching for objects – Holds objects • Language – Laughs out loud – Orients to voice – Cry more distinctive to need – Coos – Listens to speaker • Cognitive – Piaget: Sensorimotor – Objects to mouth – Hand regard – Regards objects when in hand • Emotional – Erikson: trust vs. mistrust – Expresses joy, anger, pleasure & displeasure • Social – Recognizes primary caregiver – Attachment by the infant to caregiver – Smiles spontaneousl |
|
|
Red Flags at 4 month visit
|
Poor head control
• Persistent fisting • Absence smile • Failure to reach for and grasp objects at age 4‐5 month Physical Assessment: Same as 2 month old, with the following adjustments: – Eyes should be aligned – Visual acuity is now 20/100 or better – Posterior fontanel should be closed – Anterior fontanel is ~ 2cm in diameter (closes between 9 & 18 months |
|
|
What reflex appears at 3 months
|
Landau
• Appears at 3 months and disappears between 15 months and 2 years • When held supine, infant should lift both head and legs • Neck Righting: Appears at 6 months and disappears at 2 years of age • When infant is supine and head is turned the infant’s trunk rotates in direction of the head |
|
|
Anticipatory guidance at 4 months
|
Growth & Development
– Weight usually doubles by age 4‐5 months • Safety – Increased mobility brings falls – Car seat rear facing – Smoke alarm – Water temperature – Discuss dangers of walkers • Dental Issues – Increase in drooling: starts around 3 months – First teeth erupt ~6 months • Nutrition – Encourage no solid foods till 6 months of age |
|
|
6 Month Well child Visit
|
Gross Motor
– No head lag – Sits with support – Rolls over in both directions – Bears weight when standing – Stands with support • Fine Motor – Grasping objects with both hands – Transfer objects from hand to hand – Rakes small objects – Shakes, bangs, drops objects • Emotional – Fear – Emerging self identity • Language – Babbling – Responds to name – Using sound to get attention – Responds to friendly vs. angry tone • Cognitive – Object Permanence developing: looks after dropped object • Social – Stranger awareness – Differential facial expressions – Person preference |
|
|
Red Flags for 6 months visits
|
Poor head control
• Persistent fisting • Hand dominance • Failure to reach for objects • Absence of babbling • Absence of stranger awareness |
|
|
When start flu shots
|
age 6 months on if healthy
|
|
|
Anticipatory guidance for 6 months
|
Growth & Development
– Infant likely to be mobile by next visit – Start hearing “mama or dada” • Nutrition – Solid foods may be introduced when good head control is present – Begin with iron fortified cereal – Singly add fruits & vegetables next – Avoid overfeeding – Foods to avoid • Peanuts, popcorn, hotdogs/sausage, raw vegetables/fruit, whole grapes, raisins, & hard candy • Sleep – 75% will sleep in 6‐8 hour stretches – Maintain regular bedtime routine • SAFETY/SAFETY/SAFETY – Electric outlets, cords, stairs, cupboards, crib mattress level, small objects, car seat, and many others • Parenting – Discipline is simple & consistent, especially for safety due to being more mobile • Dental – First teeth erupt – Begin cleaning teeth with a soft toothbrush – Discuss fluoride supplementation • Depends on whether there is fluoride in the water supply |
|
|
When do first teeth erupt?
|
lower teen - 6-10 months, & upper 8-12 months
|
|
|
9 month old well child visit
|
Gross Motor
– Sits independently – Crawling or creeping – May pull to stand – Weight bearing with standing – Parachute response • Fine Motor – Maturing grasp/may use fingertips – Able to point & pick up small object – May isolate index finger & poke – Feeds self with fingers • Social – Stranger awareness – Separation anxiety – Sense of self • Language – Responds to own name – Imitate sounds of others – May say mama & dada – Associating words with meanings – Integrate babble & intonation – Responds to no – Looks where the finger is pointing to, rather than looking at the pointer • Cognitive – Bangs object on surface – Object permanence – Plays peek‐a‐boo • Emotional – Avoidance reaction Lead screenings & HGB, check immunizations Can try finger foods continue ot breast feed & formula |
|
|
Red Flags at 9 months
|
• Persistent standing on tip‐toes
• Scissors motion of lower extremities • Persistence of primitive reflexes • Inability to localize sound |
|
|
Reflexes at 9 months
|
Yes, this is parachuting
• Appears at 6‐8 months • Never disappears • Demonstrates that balance & equilibrium are developing normally • Infants with CNS damage are slow to show the reflex • Any scissoring of lower extremities requires further investigation |
|
|
12 month visit & milestones
|
tripled weight, increased height by 50%, 1st steps range 9-15 months, appear bowlegged, protruding belly
• Plays ball • Imitates activities • Drinks from a cup • Waves bye‐bye • Puts block in cup • Fine pincer grasp • Stands, cruises, & takes a few steps • Says 2 or 3 words • Says mama & dada • Follows simple command |
|
|
15 month milestones
|
Helps in house
• Removes garments • Uses fork or spoon • Scribbles • Dumps raisin‐ sized objects • Builds tower of 2 cubes • Messy self‐feeding • Walks well • Stoops & recovers • Walks backwards & sideways • Climbs • Bounces to music • Uses 3 to 6 words • Naming • Point |
|
|
18 month milestones
|
A Time for Confusion for the Parents
• Can be happy one minute and on the floor in a crying heap the next • Have a need to exert their will and a desire for closeness • Extra patience is needed May also begin exploring an interest toileting – Most are not toilet trained till age 2 ½ year • Little impulse control • Temper tantrums start • Feeds doll • Undresses self • Brushes teeth with help • Builds tower of 4 cubes • Hand dominance • Feeds self • Walks up steps • Runs • Kicks ball forward • Uses 6 to 20 words • Verbalizes wants • Knows 3 body parts • Receptive language development • Understands & follows commands • Point to 2 picture |
|
|
24 month milestones
|
weight - 4 x birthweight, Body stance has less
lordosis & protuberance of abdomen • Legs straighten out • Percent of body fat decreases • Emerge as leaner, more muscular preschooler Launguage increases to 500 words can see stuttering - don't worry until 4 yo Washes & dries hands • Puts on clothing • Builds tower of 6 cubes • Turns pages in book • Imitates circle & horizontal line • Jumps up • Throws ball overhand • Walks up & down stairs with 2 feet per step • Combines words • Names a picture • Points to 4 pictures • Knows 6 body parts • 25 to 50% speech understandable • Simple imaginary pla |
|
|
increased Hx to ask with toddler exams?
|
– Any allergies
– Types of foods – Milk intake – Inquire about transition from bottle to cu |
|
|
Screening for toddler exams
|
anemia, lead screening, vision screening (cover/uncover test for strabismus)
|
|
|
What is milk anemia?
|
Seen in toddlers milk intake greater than 24oz/day
|
|
|
Red Flags for Toddlers - Related to Parenting
|
Parents who have been abused themselves
• Differing temperament between the child & parent • A parent with a rigid personality who expresses little tolerance for conflic |
|
|
Preschool Milestones & developmental issue
|
Preschoolers fear disruption of bodily integrity
• Understand social rules but cannot always initiate self‐control Capable of feeling guilty about bad behavior • Live in a rich imaginary world • Play is important • Developing gender identity & self esteem• Thinking is concrete & literal • Tend to make inappropriate generalizations – Difficult to logically reason cause & effect • Sense of purpose & direction achieved by: – Receiving praise – Accomplishing small tasks – Being allowed to make small decisions – Becoming more independent 3 year old – Copy a circle & draw a person with 2 or 3 parts – Should be able to pick the larger line of 2 lines side by side – Hop & broad jump – Ride a tricycle – Stand on 1 foot for 3‐5 seconds – Wash & dry their hands – Dress & undress with supervision • 4 & 5 year old – Can copy a cross – By age 5 copy a square & draw a person with 6 parts – Skip – Walk on heels & tip‐toes – Use alternating feet when descending stair 1000 words |
|
|
Stick figure drawing by 4-5 yo
|
draw a person with 6 parts
|
|
|
Red Flags for Preschool Aged children
|
Is timid, withdrawn, fearful
• Has trouble relating to or communicating with people • Eating, sleeping or toilet training difficulties • Moody, irritable, oversensitive • Too passive, aggressive, or impulsive • Cannot complete tasks • Has speech, language or motor difficulties |
|
|
Anticipatory guidance for preschool
|
Sleep
– Still 10 to 12 hours per night with nap is norm – Advise to develop bedtime rituals • Bedwetting – 97% nonpathogenic causes • Drinks to much before bedtime • Is not able to wake up • Has inability to delay urination with small bladder capacity Nightmares – Child awakens from sleep remembering dreams that are disturbing – Child is awake & frightened and able to describe the fears • Night terrors – Child is not fully conscious – Not able to remember the dream but rather the emotion of fear is felt • Parents should give comfort, reassurance and a sense of security and not dismiss the fear as imaginary Safety & injury prevention - leadign cause of death is accidents - esp drownings & burns |
|
|
School Age Child Milestones
|
• Think more logically
• Understand instructions • Thinking becomes more organized & rational • Less egocentric & more flexible in thinking • Acquire skills of conservation, transformation, reversibility seriation & decentration • Acquisition of those skills enables to learn to add & subtract, to write, spell, read & understand, & solve problems mentally Increased attention span • Asks questions • Seek cause & effect • Independence & esteem are boosted by success • They can become bored & irritable if not doing something meaningful • 6 years old can express feelings & follow at least 3 commands • By 8 to 10 years most have developed language pattern Gross motor skills: • 6 years of age: – Skip – Hop – Roller skate – Catch a bounced ball • By 10 years of age: – Eye‐hand coordination good enough to play games such as softball • Fine motor skills: • 6 years of age: – Print neatly – Eat neatly – Dress themselves – Draw a circle touching a square – Tie shoes – Draw a person with 12 parts, including facial features & trunk • By years of age: – Be able to use scrip |
|
|
Red Flags for School Aged Children
|
Children who have difficulty with expressive or
receptive skills present with impaired social interactions – May fight, have temper tantrums, ignore, back talk, or clown around • If a child is unable to learn new skills or perform tasks successfully they feel inferior – May lose interest in learning – Become passive – Afraid to try new tasks – Lack self esteem & self confidence – Will exhibit a variety of behavior problem |
|
|
School Age anticipatory guidance
|
Safety!!!
– Safety equipment when rollerblading, biking, skateboarding, scootering, etc. – Supervision when swimming – Discuss strangers – Firearm safety – Fire safety/fire plan Car seat: Booster seat ages 4 to 8 or more than 40 pounds and height less than 4ft 9inches Dental, nutrition |
|
|
Adolescents
|
begins at age 11 or 12 when secondary sex characteristics begin & end between 19-21 years. Reached physical peak but struggle with emotional, social, cognitive
|
|
|
Passage to adulthood for adolescent
|
Encompasses at least 4 Phases
– Completion of growth, including sexual development – Completion of school – Becoming an individual, enabling adolescent to separate from family – Setting goals for a way to make money through a caree |
|
|
Early Adolescence - 11-14 years old
|
Rapid growth spurt
– Peer acceptance is important – “Am I normal?” – Searching for self identity – Concrete thinker – Sexual organ & pubic and axillary hair growth – May cause self concept changes & cause them to feel unsure of themselves – Appear antiadult; parents are an embarrassment |
|
|
Middle Adolescence 15-17
|
May still struggle with their new bodies
– Emotionally immature teens with adult bodies – Experience mood swings – Start to think abstractly |
|
|
Late Adolescence 18-21
|
Show decline in narcissistic
– Start to look outside the peer group to create more relationships – Nearly 50% of all teens in America have had a sexual relationship by age 18 |
|
|
What influences adolescents?
|
• Peers
• Parents • Culture • Media exposure – TV, movies, video games, Internet, cell phones, iPods, iPhones, text messaging • Alcohol & drug Main reason seek medical care: injury, sports or school physical May ask about sex & birth control - put beliefs aside and talk to teen - do not be judgmental do not need parental consent |
|
|
What does HEADSS stand for with r/e well child of adolescent?
|
Home
– Education – Eating behaviors – Activities – Drugs – Sex – Suicide Ask about diet hx, sexual and substance abuse |
|
|
Exam for adolescent
|
Height & weight
– Growth spurts peak at age 12 for girls & age 14 for boys – Plot height & weight on growth charts – Organs double in size, except lymph tissue which decreases in mass – If teen is below 50 th percentile & parents are small, most likely is normal growth for this tee |
|
|
Normal Sexual growths for adolescents?
|
Sexual changes
– Girls • Earliest sign of puberty is widening of pelvic girdle & breast budding • Followed by pubic hair growth • Menarche occurs on average of 12.7 years • Delayed development is absence of breast buds by age 13 or lack of menses 4 years after breast buds Sexual changes – Boys • Test icular growth average age of 11.5 years • This is followed by penile length growth and then pubic hair • The sexual growth is followed by height growth spurts • Delayed adolescent development is lack of testicular growth by age 14 |
|
|
Red Flags for adolescents?
|
Anorexia & Bulimia
• Overweight • Behavior problems • Deterioration in family life, athletics or school performance • Depression • Recent rejection by a person • An arrest or some kind of failure • Withdrawn from friends & friends • Abrupt change of friends • Suicide attempt |
|
|
Anticipatory guidance for adolescents
|
Healthy diet
• Parenting • Safety – Experimentation with speed, sports, sex and weapons does not seem threatening because of narcissistic ideas • Discuss risk behaviors – Bulimia & anorexia, drugs, alcohol Discuss peer pressure • Need for sleep • Sunscreen/tanning Discuss Sex & risks & BCP if needed |
|
|
Infant nutrition normals
|
Lose up to 10% of birth weight after delivery
• By 2 weeks weight should be back to birth wt • Infants gain 1/2 to 1 ounce a day or 2.2lbs a month for the first six months • From 6-12 months gain 1lb a month Weight tripled by one year - Liquid diet for 1 year no solid til 6 month |
|
|
When is breast feeding contraindicated?
|
HIV, galactoasemia, TB active, chemo
|
|
|
What does supplement does baby need of mom is a Vegan?
|
vitamin B12 supplement
|
|
|
What suppliment does baby need if baby never given any tap water?
|
fluoride @ 6 months
|
|
|
What supplement needed for breastfed babies?
|
vit D 400 IU by drops start first days of life - polyvisol vitamen - Vit D is in formula, iron rich foods by 6 month sof age - this is in cereal or can become anemic
|
|
|
When to change formula if needed?
|
change to lactose free or soy if fussy, constipated, diarrhea, reflux, gas (all controversial) pure lactose deficiency rare
Usually don't need more than 26 oz formula/day |
|
|
Formula rules
|
Estimate formula needs: kg X 105(kcal)
per 24 hours. So if formula is 20 kcal per ounce 3kg baby X 105 = 315 /20 = 17 ounces or 510cc. This is a rule of thumb. Typically infant should not use more than 26 ounces a day - no need for water or juice, 1 oz white grape juice watered down can be given if constipated |
|
|
What is Milk Anemia?
|
Early introduction of cow's milk
• Exclusive breast feeding and no solids after six months • Too much milk in toddlers (coming next) • Infants have stores from mom until around 4 - 6 months. • All formula is iron fortified |
|
|
When to introduce whole milk?
|
after 12 months of age or can get milk anemia
|
|
|
What to do with Iron Deficiency Anemia?
|
At 9-12 months if high risk do a hemoglobin and
hematocrit • If Hemoglobin is less than 11g/dl • Nutrition counseling • Start iron 6 mgm/kg/day • Don't get on any teeth, give with juice • Prepare for constipation • Recheck in 2 weeks, as hemoglobin should rise • Keep on for 3 months after return to normal for replacement of iron stores |
|
|
What are food requirements of food for toddlers?
|
1-4 years growth is slow 4-6 lbs a year, 3 inches a
year, – Calorie needs = yr X 100 + 1000 = calories • 3 year old X 100 = 300 + 1000 = 1300 – judge nutrition based on a week not a day – metabolism is very different than adult Need 1 T of each food at dinner Low metabolism - early preventative measure for weight control |
|
|
What are big culprits for poor eating in child?
|
sippy cups or bottles of milk or juice
|
|
|
Adolescence growth rate & nutrition/day
|
at age 11 there is a rapid growth spurt and skeletal
maturation. Girls require a critical level of fat (17% to begin their menses, and 22% to get regular). Calcium, Vit D, and Iron, fruits and vegetables are not met by most Calcium: 1300 mgm day – Vit D: 400 IU day – Iron: (females) 15 mgm/day Vit C - > 45/day Need fluoride - bottled water does not have this |
|
|
Risk for obesity
|
Risk for Overweight: BMI = > 85th
percentile for ht/wt < 95th • Overweight : BMI = > 95th percentile for ht/w 17% of children in the U.S. are at risk of being overweight (overweight) and 17% are Overweight (Obese). = 34% either at risk for being overweight or overweight 80% will continue their weight trend into adulthood 1/2 of all new cases of diabetes in children today is Type 2 and associated with wt • Seeing adult problems in kids because of weight |
|
|
HOw to prevent obesity
|
Delay introduction of solid foods
Avoid cajoling, begging , promising, wheedling,& guilt to get a child to eat. Kids won't starve - don't give milk & juice all the time 3) Watch portion size 4) It's a family affair - family must be part of treatment program |
|
|
What is non-organic failure to thrive?
|
withholding of food
– ignorance of needs – bad temperaments or physical disabilities that make eating difficult maternal depravation – low intensity infant – distractible children |
|
|
What is Organic Failure to Thrive?
|
Chronic gastrointestinal problems
• chronic infection • congenital malformations • intrauterine growth retardation cystic fibrosis |
|
|
How to define Failure to Thrive
|
change in weight below 5th percentile or drops 2 major percentiles
Children refrain from making eye contact, gaze avoidance, do not like to be held or cuddled, tense muscles |
|
|
What to do with Failure to Thrive
|
CBC - for anemia, Cath UA- pyleonephritis, lead screen, serum
lytes, sweat test, thyroid, blood sugar, kidney function, GI for malabsorption, look for substance abuse, drugs, check out family - do you trust family? need referral. Always recheck in 1 week |
|
|
universal screening of hemoglobin is now recommended at one year of age by the AAP
|
true
|
|
|
What is normal weight gain for infant til 6 months?
|
0.5-1 oz/day
|
|
|
What is normal weight gain from 6 months-1 years?
|
1 lb a month - one year triple their weight
|
|
|
Know Teen CA, Vit & Iron needs
|
find
|
|
|
What percentile are kids at risk for being obese
|
85-95% this percentile considered overweight
|
|
|
What is the obese percentile
|
> 95%
|
|
|
What to with failure to thrive
|
repeat measurements to make sure accurate, increase calories and see where weight is in one week
|
|
|
Which is not a live vaccine
|
Prevnar (PCV)
|
|
|
What is HGB level is considered anemic 12 through 35 months?
|
11.0 mg/dL - 12-35 months,
|
|
|
Where do infants 0-12 receive their iron?
|
80% comes from what mom intakes during 3rd trimester, if mom anemic, hypertensive or diabetic then baby can be anemic
|
|
|
How much iron supplementation should be given to infants 7-12 months?
|
(1mg/kg/day) - avg 11mg/day no supplementation needed 0-6 months
the recommended dietary allowance for iron for children from 1 through 3 years of age is 7 mg/day |
|
|
When should universal screening be done for anemia?
|
At one year
|
|
|
why is Vitamin D important in infants?
|
Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. Rickets peaks between 3-18 months. Darker skinned people need more exposure to sun to absorb adequate Vit D
|
|
|
What is daily minimum intake of Vit D for infants and children?
|
400 IU/ daily needed New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer.
|
|
|
How much supplement of Vit D should be given to breastfed babies?
|
A supplement of 400 IU/day of vitamin D should begin within the first few days of life and continue throughout childhood Any breastfeeding infant, regardless of whether he or she is being supplemented with formula, should be supplemented with 400 IU of vitamin D. Formula fed babies get adequate Vit through the formula and no other supplementation is needed
|
|
|
when should newborn screening be done?
|
48-96 hours after birth - if too soon can show false positve hypothyroidism or false neg metabolic results
|
|
|
How much sleep per 24 hours do babies and children need?
|
babies 16-17 hours, 12 months 14 hours, age 2 13 hours,8-9 during adolescence.
|
|
|
What can cause infant inability to stay asleep at night
|
Parents rocking infant to sleep or holding infant til falls asleep and infants do not learn skills to self calm and initiate sleep on own so when wake up they need to be rocked again to fall asleep.
|
|
|
When see night terrrors and sleep walking?
|
Night terrors (occur in deep sleep - whereas nightmares occur in REM sleep) in begin in preschool age& may continue to school age and sleep walking in school age
|
|
|
When see obstructive sleep apnea in children?
|
large tonsils, reduced neuromuscular tone of upper airway during sleep. obesity, craniofacial anomalies
|
|
|
How many baby teeth and when see them erupt?
|
20 with 32 permanent teeth - 1st tooth 6-9 months - usually lower central incisors, then 1 tooth a month average. all teeth in between 24-30 months. some can have neonatal teeth that erupt after birth or natal teeth that they are born with
|
|
|
What is early sign of tooth decay in children
|
white, opaque ares at the gumline
|
|
|
How to prevent dental carries in a child?
|
topical fluoridated water (topical and systemic) & toothpaste (works better than systemic fluoride drops) & sealants. lower used of carbohyrdrates no juice when sleeping
|
|
|
How does development proceed in a baby?
|
cephlocaudal
|
|
|
What vaccine is a live vaccine?
|
MMR, varicella, rotovirus, flumist, OPV (kids usually get IPV)
|
|
|
Who is more prone to SIDS?
|
boys in winter months, higher in blacks, highest incidence @ 2-3 months decreasing after 6 months. Higher incidence in smokers mom, premature, IUGR, maternal youth, bed sharing, soft bedding
Need to have child sleep on back |
|
|
What is stabismus?
|
abnormal in ocular alignment in or out. Test doing cover test and they will have asymmetrical corneal light reflex test. Normal in infants 2-3 months & will resolve on own.
|
|
|
Car & booster seat guidelines
|
rear facing infant seat - start at term infant to 20 lbs and at least 1 year:
Forward-facing car seat: start - 1 year/20lbs continue to 4 years - 40 lbs & 40 inches toall Booster Seat: start 40 lbs & 40 inches tall continue til 80 lbs & 57 inches tall |
|
|
When to introduce infant car seat, smoke detectors & crib safety?
|
at birth or prenatally
|
|
|
When to introduce choking prevention?
|
2 months
|
|
|
What are some recent AAP recommendations re safety?
|
do not give ipecac, shopping carts need safety belt, ban infant walkers - stationary activity center safer, no child under 16 should drive 2 or 4 wheeled motor bikes or snowmobiles, swimming pools fenced in, do not pull children behind mowers or 4 wheeler on tubes, all children in plane need seatbelt, never use trampolines
|
|
|
When is a child neurologically ready for toilet training?
|
12-18 months & cooperation between 12-15 months, most ready to start training by 2 yo
|
|
|
Define colic
|
excessive crying begins at 2 weeks, peaks at 6 weeks and decreases to 1 hour/day by 12 weeks, more in evenings. Resolves at 3-4 months. Rule of threes: cry > 3 hours/day, for more than 3 days/week & more than 3 weeks
|
|
|
Child with colic - what to check for in exam?
|
fx long bones, bruising or marks, digits and penis for hair tourniquets, retina hemorrhage, evert eyes to look for foreign bodies
|
|
|
When see temper tantrums?
|
2-3 years when cannot express self well verbally - children with language delays, >5/day not normal, persistent, destruction during tantrums, harm to self or other negative mood and are problematic tantrums
|
|
|
What are some underlying causes of tantrums?
|
marital discord, abuse to child, substance abuse, depression, inappropriate parental expectations, Child: developmental or learning disabilities: hearing loss, speech delay, autism spectrum, ADD, temperament, illness
|
|
|
What are breath holding spells?
|
child get angry or has pain and cries that culminates in noiseless expiration and apnea, child turns blue, passes out & see rhythmic jerking of extremities then rapid restoration to activity,. Benign. most between 12-18 months. Experience several spells/week. some children also are anemic with BHS so test hbg. No treatment - parental support and reassurance needed. Resolve by 4-6.
|
|
|
What are 2 types of BHS (breath holding spells)
|
cyanotic: more common, provoked by upsetting event - anger or frustration. Pallid spells provokes by minor injury or pain or fear & children become pale rather than cyanotic
|
|
|
When see stranger anxiety?
|
start 6 months and peak at 2 years. Age of anxiety 2-5 scared of many things
|
|
|
What is strabismus?
|
abnormality in ocular alignment whether eye goes in or out. Have an asymmetrical corneal light test reflex test. Do cover test
|
|
|
What screenings should be done at every well child check?
|
height, weight, head cirum til 18 month, hearing, vision, dental, developmental milestones, VS, ego development, nutrition, cognitive level,
|
|
|
How to assess an newborn
|
Compares side for symmetry, pulses both sides absence of femoral can indicate coarctation of aorta, VS (do not use tympanic thermometers on newborn d/t debris in ear canal), HR & RR irreg, head, chest, height weight,
|
|
|
When do suture lines disappear?
|
Should not be palpable by 5-6 months of age, anterior fontanel close 9-9 months & post close 1-2 months - abnormal size or shape of fontanel can indicate thyroid problems
|
|
|
What is some anticipatory guidance for newborns?
|
no discipline needed - cannot spoil newborn, feed q3-4 hours 1-2 oz, need iron fortified formula, no microwave, breast feed q2h, cirucumcisim, cradle cap, stools, no powder or oils on skin,
|
|
|
When should infancy well child checks be done?
|
1-2 weeks, 2 months, 4 months, 6 months,
|
|
|
Anticipatory guidance for 2 month check
|
1st set of immunizations, child should start to roll over in 2 months -safety of child on changing tables and bed - can fall off, can offer infant rattle to grasp, need regular feeding and sleeping schedule,stimulation good, safety of water temp, car seats, no solid foods
|
|
|
Anticipatory guidance for 4 month check
|
2nd set of immunizations visual acuity 20/100, head up when on stomach, reaches for objects, infant should learn to sit & reach for object, mimic sounds, safety important, reduce fall risk, never leave alone in bath
|
|
|
Anticipatory guidance for 6 month check
|
3rd set of immunizations, first teeth erupt soon, growth slows, infant more mobile, stranger awareness, most can sleep 6-8 hours, can introduce solid foods, cereal, breast milk or formula major source of nutrition do not give peanuts, popcorn, hotdogs or sausage, raw vegies or fruit, whole grapes or raisins, hard candy (aspiration hazard) whole eggs or strawberries (allergy)
|
|
|
Anticipatory guidance for 9 month check
|
iron screen if high risk, lead screen if risk (housing before 1977), infant will soon learn to walk and talk, no cows milk til 12 months, can give small amts juice, introduce cup, wean from bottle
|
|
|
15 month red flag
|
unable to understand familiar words or simple commands
|
|
|
Screening for 24 months
|
anemia, lead
|
|
|
Anticipatory guidance for 12 month check
|
let feed self, walking, more words, read books to child, look at hazards from child perspective, cover electrical outlets, toddlers pull items off shelves & counters, chemicals out of reach, if 20 lbs can turn car seat forward facing, supplemental fluoride if none in water, sun screen
|
|
|
Anticipatory guidance for 24 month check
|
if delayed speech suspect hearing problem, neglect or MR - speech delay red flag, can use low fat milk or 2% now, growth slowed, OK that child eat irregularly, time out 1 min for each year of life
|
|
|
Anticipatory guidance for 18 month check
|
Need whole milk til 2 years old, toddler eat irregular and OK, toilet training ahead- cues of readiness - can undress self, show interest in toileting, imitates toileting behavior, aware of wet or messy diaper, inc periods of dry diaper > 2 hours
|
|
|
Nutrition in preschoolers
|
look at weekly food log and not daily, do not force food, 1 T per year of age of 3 foods, do not use food as reward
|
|
|
School age exam & guidance
|
avg growth 4-6 lbs/year, 2 in/year, draw a person with 12 parts, immunizations due before school, Dtap, 4th IVP, MMR & varicella,
|
|
|
Nutrition in adolescents
|
anorexia or bulimia, check for bulimia s/s scar on dorsal finger, rotted teeth, obesity, vegan diets - not enough protein in diet, Vit B12 and Vit D
|
|
|
Anticipatory guidance for adolescents
|
mortality and violence, friends, sex
|
|
|
When can you give the flu vaccine?
|
at 6months shot. Can get flu mist @ 2yrs-49. importnat for under 2 to get vaccine
|
|
|
What is Hib vaccine -
|
conjugate vaccine against Haemphalis B - do not need if did not get before 2 years. schedule 2mo, 4mo, 6mo, & 12mo
|
|
|
What is immunizations are given at birth
|
Hep B 1st shot, 2nd at 1-2 month, 2nd dose 6 month
|
|
|
What are the 2 month immunizations
|
DtaP (1 of 5),, Hib(1 of 4), Rotavirus(1 of 3), PCV (Pneumococcal) (1 of 4), IPV(1 of 4) (polio), 2nd dose Hep B
|
|
|
What are the 4 month immunizations
|
DtaP Hib, Rotavirus, PCV (Pneumococcal), IPV (polio)
|
|
|
What are 6 month immunizations
|
DtaP Hib, Rotavirus, PCV (Pneumococcal), flu vaccine, IPV (6-18 months), 3 dose Hep B
|
|
|
What are 12 - 15 month immunizations
|
Hib (last dose), PCV (last dose), MMR & VAricella (1 of 2), 1st dose Hep A
|
|
|
What are 15-18 month immunizations?
|
Dtap (4 of 5), 2nd & last dose Hep A
|
|
|
What are 4-6 immunizations
|
DtaP, IVP, Hib, PCV, Rotovirus
|
|
|
What should 11-12 yo immunizations?
|
Tdap , MCV (Meningococcal conjugate), HPV begin series (1 month, 2 months & 6 months)
|
|
|
What are contraindications for getting immunized?
|
anaphylaxis to any component of vaccine (pregnancy & cancer or immunodeficient with varicella, MMR & rotovirus - any live vaccine no one can get if immunocompromised), Cannot give HiB under 6 wks old
|
|
|
Side effects with vaccines
|
fever (HiB - 1-3 days), redness or swelling at site, fussiness, rash (MMR), drowsy - loss of appetite or hard red tenderness at site (PCV13), diarrhea or vomiting (rotovirus)
|
|
|
What allergy would preclude someone from getting IPV vaccine?
|
neomycin, streptomycin or plymyxin B
|
|
|
What should normal weight gain & height be in infancy?
|
0-3 : 25-35g/day (failure to gain weight can be d/t malnutrition not feeding enough, malabsorption)
3-6: 12-21g/day 6-12: 10-13g/day 1-6: 5-8g/day 7-10 5-11g/day Height: 0-12: 10 inches/year 13-24: 5 inches/year 2 yr - puberty: 2.5 inch/year Double birth weight by 6 moths and triple by 1 year |
|
|
What is normal weight loss for newborn?
|
10% of weight - should regain it by 2 weeks
|
|
|
How much Vit D should breastfeed babies be given each day?
|
400 IU - need FESO4 after 6 months & fluoride 0.25mg/day at 6 months
|
|
|
When should vitamin supplementation be given to toddlers, anorexic teens, failure to thrive or vegan diets?
|
When they are picky eaters need vitamins otherwise do not need
|
|
|
What nutrients are commonly lacking in a Vegan diet
|
Vit D, B12, iron & zinc
|
|
|
How many wet and messy diaper should a breast fed baby have a day?
|
3-5 wet diapers and 3-4 stools
|
|
|
Hgb lower limit levels
|
birth -4 years: 11
5-7: 11.5 8-11: 12 12-17 girls: 12 12-14 boys: 12.5 15-17 boys: 13 |
|
|
How much cows milk can cause milk anemia
|
if more than 24 oz/day too much
Iron replacement shoudl be 6mg/kg/day divided up to 2-3 doses. Take 6-8 weeks to get back to normal |
|
|
What BMI is considered at risk for overweight & obese?
|
85-95% at risk for overweight (obese)
> 95% obese |
|
|
How to manage obesity in children?
|
Look at fam hx of obesity - if 3-5 yo has obese parent has large risk of becoming obese. If child overweight at age 5 the has 50% chance of being obese adult. Best to slow weight gain so as grow taller will thin out. Need behavior and lifestyle modification, healthy eating and increased activity. Family support. prevent obesity
|
