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113 Cards in this Set

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Birth - 6 months growth
Doubles birth weight, grows 1" per month (2.5cm/month)
6-12months growth
Birthweight triples by end of first year.
Height 0.5"/month
Toddlers Growth
BW quadruples by age 2.5
Height is 50% of adult height by age 2
Preschoolers Growth
Yearly gain of 2-3 kg(4.5-5.5 lbs/year)
Height: 2-3"/year
School Age Children
Weight 2-3kg/year
Height 2" (5cm)/year
Pubertal Growth Spurt
Females
10-14 years
Mean weight gain of 38 1/4lbs
Height 2-10"/4 years
Approx 95% of adult height by onset of menarche (approx age 13)
Pubertal Growth Spurt
Males
11-16 years
Weight: 15 1/4lbs
Height: 4-12"
95% mature height by 15 years
Adrenarche
appearance of pubic hair
Gynecomastia
breast enlargement and tenderness in males
Menarche
onset of menses in girls
Physiologic Leukorrhea
an increase in normal vaginal discharge occuring in early puberty
Pubertal Growth Spurt
Females
10-14 years
Mean weight gain of 38 1/4lbs
Height 2-10"/4 years
Approx 95% of adult height by onset of menarche (approx age 13)
Tanner staging- Females
Stage I: No signs of breast changes or pubic hair
Stage II: Small breast buds with enlargement of the areola & dark, straight pubic hair
Stage III: Increase of breast & areola areas; Coarse, curly pubic hair
Stage IV: Secondary mound occurs in the breast at the areola; Pubic hair is adult like
Stage V: Breast buds now mature; Pubic hair adult-like.
Pubertal Growth Spurt
Males
11-16 years
Weight: 15 1/4lbs
Height: 4-12"
95% mature height by 15 years
Tanner staging-Males
Stage I: No pubic hair or changes in genitals
Stage II: Initial enlargement of the scrotum & testicles with reddening & textural change in scrotum; fine, straight hair at base of penis
Stage III: Further enlargement of penis with continued changes in scrotum; Pubic hair darker & coarser & extends across pubis
Stage IV: Penis continues to grow in diameter with development of glans larger & broader; Hair curly & more abundant; scrotum darker
Stage V: Adult appearance
Adrenarche
appearance of pubic hair
Birth to 1 year Developmental
Role of primary care givers significant
Gynecomastia
breast enlargement and tenderness in males
Early childhood development
1-6 years
Toddler 1-3
Preschool 3-6
Characterized by intense activity, curiosity and discovery.
*Acquire language and social skills
Begin to develop self-concept
*Increasing awareness of dependence & independence
*Gaining self-control and mastery imp!
Menarche
onset of menses in girls
Physiologic Leukorrhea
an increase in normal vaginal discharge occuring in early puberty
Tanner staging- Females
Stage I: No signs of breast changes or pubic hair
Stage II: Small breast buds with enlargement of the areola & dark, straight pubic hair
Stage III: Increase of breast & areola areas; Coarse, curly pubic hair
Stage IV: Secondary mound occurs in the breast at the areola; Pubic hair is adult like
Stage V: Breast buds now mature; Pubic hair adult-like.
Tanner staging-Males
Stage I: No pubic hair or changes in genitals
Stage II: Initial enlargement of the scrotum & testicles with reddening & textural change in scrotum; fine, straight hair at base of penis
Stage III: Further enlargement of penis with continued changes in scrotum; Pubic hair darker & coarser & extends across pubis
Stage IV: Penis continues to grow in diameter with development of glans larger & broader; Hair curly & more abundant; scrotum darker
Stage V: Adult appearance
Birth to 1 year Developmental
Role of primary care givers significant
Early childhood development
1-6 years
Toddler 1-3
Preschool 3-6
Characterized by intense activity, curiosity and discovery.
*Acquire language and social skills
Begin to develop self-concept
*Increasing awareness of dependence & independence
*Gaining self-control and mastery imp!
Middle childhood 6-11 years
Developmental age periods
Frequently referred to as “school age”

*Child is directed away from the family group towards activities with peers

*Interested in developing skill competencies

*Moral development begins to have relevance for later life stages
Later childhood 11-19 years
Pre-pubertal: 11 to 13
Adolescence: 13 to 18
Tumultuous transitional period of rapid changes

*Early years focus on group identity.

*Later years focus on individual identity.
In late adolescence, the young person begins to internalize all previously learned values
Trust vs Mistrust
Eriksons Theory of Psychosocial development
Age: birth to 1 year
*Positive resolution:
*Learns to trust others
Achieved through consistency of care from the caregivers
Autonomy vs Shame and doubt
Eriksons Theory of Psychosocial development
Age: 1 to 3 yrs.
*Positive resolution:
*Learns self control without loss of self-esteem.
The ability to cooperate. Shame develops when child’s attempts are unsuccessful or when he/she is forced to be dependent
Initiative vs Guilt
Eriksons Theory of Psychosocial development
Age: 3 to 6 years
*Positive resolution:
*Learns the degree to which assertiveness & purpose influence their environment.
Learning to evaluate own behavior.
Developing conscience.
Discipline without shaming is important
Industry vs. Inferiority: School Age
Eriksons Theory of Psychosocial development
Age: 6 to 12 yrs.
*Positive resolution:
*Develops a sense of competence and perseverance. Focus of stage is achievement & accomplishment.
Learns to compete, to cooperate, & to follow rules.
Setting goals that are too high causes child to develop sense of inadequacy
Identity vs. Role Confusion: Adolescence
Eriksons Theory of Psychosocial development
Age: 12 to 20 yrs.
*Positive resolution:
*Develops coherent sense of self
*Able to actualize one’s abilities.
*Focus on appearance
*Preoccupation with peer acceptance.
Develop own values within their own culture.
Late in stage become focused on choice of occupation.
Cognitive development:

Piaget
Cognitive development:
Consists of age-related changes that occur in mental activities

Piaget’s theory the most respected in this area
Piaget
Basic concepts:
Intelligence is what enables an individual to adapt to their environment in ways that increase their chance of survival

Through intelligent behavior, individuals establish & maintain equilibrium with their environment
Piaget's stages
* Sensorimotor: Birth to 2 yrs
Progress from reflexive behavior & simple repetition of behaviors through imitation of behavior.

Develops a sense of cause & effect through trial and error.

Rituals are important.

Uses simple language efficiently at end.
Piaget's Stages
Pre-Operational: Pre-Conceptual Thought: 2 to 4 yrs
Egocentrism: an inability to perceive the point of view of another. “It is ALL about me!”
Thinking is concrete. Cannot reason beyond the observable.

Engage in fantasy and can have difficulty differentiating the fantasy from the real world
Piaget's Stages
Preoperational: Intuitive Thought Phase: 4 to 7 yrs
Egocentrism diminishes
Includes others in the environment
Thinks of one idea at a a time

Words express thoughts well
Piaget's Stages
Concrete Operations:7 to 11 yrs
Logic is beginning to emerge.
Can solve concrete problems.

Able to classify & sort information
Helps them problem solve
Love to collect things…

Less egocentric
Can consider another’s point of view
Piaget's Stages
Formal Operations: 11 to 15 yrs.
Can now think in abstract terms and resolve conflict
They can make hypotheses and test them
Idealistic: “It’s not fair!”
Difficult time with injustice
Kohlberg Theory of Moral Development
*3 Stages:
Preconventional level
Conventional level
Postconventional level
Kohlberg Theory of Moral Development
Preconventional Level
1 to 7 yrs
Determine goodness or badness of a behavior in terms of it’s consequences

Avoidance of punishment is always the goal
Kohlberg Theory of Moral Development
Conventional Level
7-11 years
Concerned with loyalty to family and peers.

*“Good boy/good girl” orientation

Behavior that meets with approval and pleases or helps others is considered to be good
Kohlberg Theory of Moral Development
Post Conventional
11-15 years
Correct behavior now defined in terms of individual rights and societal standards

“It’s not fair!”

Interested in the possibility of changing standards

Very idealistic
Infancy
Developmental Age Period:
Infancy (Birth to 12 months)
Erikson: Trust vs. mistrust

Piaget: Sensorimotor

Kohlberg:
No stage applies
Toddlers
Developmental Age Period:
Early Childhood Toddler 1-3 yrs
Erikson: Autonomy vs. shame & doubt

Piaget: Sensorimotor to Preoperational (preconceptual thought phase)

Kohlberg: Preconventional
Preschool
Developmental Age Period: Early Childhood (Preschool 3-6 yrs.)
Erikson: Initiative vs. guilt

Piaget: Preoperational thought continues (intuitive thought phase)

Kohlberg: Pre-conventional
School Age
Developmental Age Period: Middle Childhood (6- app. 11 yrs.)
Erikson: Industry vs. inferiority stage

Piaget: Concrete operations

Kohlberg: Conventional
Adolescence
Developmental Age Period:
Later Childhood
Prepubertal: 11-13 Adolescence: 13-18
Erikson: Identity vs. role confusion

Piaget: Formal operations

Kohlberg: Post-conventional
Nutrition
The single greatest influence on growth & development!!
Poverty
A more powerful influence on child health & wellness than ethnicity or education!!!!!!
Remember the difference!
Heredity
Intelligence determines your ability to learn
All 3 determine how the world interacts with you, as well as how you interact with the world
“Beauty & the Geek”… how has the physical beauty, intelligence and/or personality of each of these individuals affected their individual development?
Directs the pattern of physical growth

Directs the behavior of others towards us:
Role Identity
Gender Identity
Socioeconomic Level
At all ages, children from upper and middle class families are taller than comparative children of families in the lower socioeconomic strata

School achievement is consistently less for children falling under poverty guidelines
Interpersonal Relationships:
Emotional deprivation
Old study on homeless infants in institution. Infants who did not receive consistent nurturing care :
Failed to gain weight even with an adequate diet
Were pale listless, and immobile
Were unresponsive to stimuli that usually would elicit a response such as smiling or cooing in normal infant
Types of Screening Tools
Denver Developmental Screening Test (DDST-II)
Quick, easy, accurate & objective results when done by trained administrator of test.
Parents Evaluation of Developmental Status (PEDS) A parental self report-> errors!
Early Language Milestone Scale (ELMS)
Batelle Developmental Inventory
For full eval.
Excellent, but requires hours to administer
Depression Medication: Response to meds varies in kids
Many issues the same as adult anti-depression meds
SSRI’s:
Fluoxetine (Prozac) the only drug FDA approved for depression in children, but many others used
Sertraline (Zoloft) used
Celexa, Lexapro used in adolescents
NO PAXIL: (Increased Suicide risk)
Bipolar NOS
as well as genetics
The diagnosis of Bipolar NOS has increased X 40 in the last 10 yrs.
If one parent has bipolar disorder, the risk to child is 15-30%
If both parents have bipolar disorder, the risk is 50-75%
In identical twins, if one has it, the other has a 70% likelihood of having it, too
Bipolar Disorder In Kids
*Different from adults…
*Ongoing continuous mood disturbance that is a mix of mania and depression
*Rapid and severe cycling between moods produces chronic irritability****
Extreme elevation of mood or extreme irritability
Laughing uncontrollably at things no one else finds funny
Mad over nothing
Decreased ability to concentrate
Racing speech & pressure to keep talking
Risky activities & poor judgment
Bipolar Disorder Medication
Lithium is the ONLY medication currently approved by the FDA for mania in adolescents (12 yrs and older)
Because lithium has a NARROW therapeutic index, blood level monitoring is required to avoid toxicity.

Significant Adverse RXNS:
Cardiac dysrhythmia, tremor, sedation, blurred vision
Suicide in children
Prevalence in Children:
Children ages 10 to 14 — 0.9 per 100,000
Adolescents ages 15 to 19 — 6.9 per 100,000
Nearly five times as many males as females ages 15 to 19 died by suicide.
Suicide in Teens
When there is a hand gun in the house, the teen is six times more likely to commit suicide

Substance overdose (83%), self-inflicted laceration, and hanging are the most common means used in teen suicide

Tends to happen in “clusters”
Suicide in Teens: Risk factors
Substance abuse
Child abuse
Recent suicide in school
Chronic conflict with parent
Poor communication and coping skills
Depression
History of being bullied
Social isolation
Access to weapons
Suicide: What to do
Talk with them about it.
Don’t be afraid to ask if they are contemplating suicide…
People often think they will “plant the idea”…false
If no one talks to them, it leaves the child locked into their dark world without others to discuss problems with.
Bringing the thought out into the open can expose it for the “false fix” that it is.
Oppositional Defiant Disorder (ODD)
DSM-IV: ODD is characterized by *two different sets of problems*:
Aggressiveness
A tendency to purposefully bother and irritate others.
ODD DSM-IV Definition
A pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which at least 4 of the following are present:
OFTEN loses temper
OFTEN argues with adults
OFTEN actively defies to comply with rules
OFTEN blames others
OFTEN touchy
OFTEN angry and resentful
OFTEN spiteful and vindictive
*Each concept is defined in concrete terms
ADHD
Is inherited...several genes are implicated. Now viewed as a neuro-developmental disorder rather than a behavioral disorder. IT IS SO IMPORTANT TO BE THE CHILD’S INFORMED ADVOCATE IF THEY HAVE ADHD!
Teachers dislike them!
Parents are afraid of the medications.
Other kids isolate them!
They can be helped!
Failure to thrive
Organic vs. non-organic: important
Organic = there is a real physical reason within the child that makes the child unable to absorb calories for growth

Non-organic = they are just not being fed enough… unable to obtain calories for growth
Failure to thrive - Factors
AND Tx
Organic
Cerebral Palsy, GERD, metabolic disorder

Non-Organic
Maternal child attachment disorder
Poverty
Lack of knowledge
Insufficient breast milk
Tx? Find the cause!!
HOW MUCH IS ENOUGH??
Newborn: Needs 24 oz/24 hrs.

This increases to 32 oz/24 hrs. by 4-6 months

From 9-12 months, taking on more calories from table foods, but formula needs remain >24 oz/24 hr day
Downs Syndrome
The most common chromosomal abnormality, occurring in 1/800-1000 live births

Attributed to an extra chromosome 21; called Trisomy 21

Usually diagnosed @ birth.
Downs Syndrome- serious chronic problems
Congenital heart defects
Hypotonicity of muscles, including the chest muscles
Increased resp. infections
Narrower nose & airway passages
Immune system dysfunction
Hearing defects (75%)
Congenital hypothyroidism
Increased incidence of leukemia
Downs Syndrome- Characteristics
Smaller stature
Slower mental development
Delayed language & walking
Flattening of the back of the head
Almond shade eyes with one lid a little droopy
Poor Vision
Depressed nasal bridge
Smaller ears, lower set
Small mouth and jaw with large tongue
Decreased muscle tone
Loose ligaments
Transverse palmar crease, curved little fingers
Small hands and feet with gap between 1 and 2 toe
Working With Families With A Downs Child
Emphasize the positive…Delightful affectionate children

Monitor respiratory status, development & growth closely

Make appropriate referrals to spec
Autism & Autism Spectrum Disorders
Autism is now viewed as a group of disorders that are linked by significant developmental delays.
It is now spoken of as “on the spectrum”, meaning there is a variety of disorders that fall into this category.

Many research dollars are currently dedicated to research of ASD’s.
Autism is now viewed as a group of disorders that are linked by significant developmental delays.
It is now spoken of as “on the spectrum”, meaning there is a variety of disorders that fall into this category.
Many research dollars are currently dedicated to research of ASD’s.
Autism Spectrum Disorders
Autism

Aspergers Syndrome

Rett’s Disorder

Pervasive Developmental Disorder
Dx of Autism
DSM-IV Criteria: At least 8 out of 16 identifying characteristics must be positively identified (See ATI)

**However, 3 general categories of impairment:
Marked impairment in social interaction
Restricted or repetitive behavior
Delay in or total lack of verbal communication
S&S of Autism
Lack of interest in touch or cuddling
Violent reactions to attempts of physical closeness
Blank response and lack of expression to verbal stimulation
No fear of separation from parents
Severe tantrums
Fascination in strange repetitive behaviors and rituals
Self destructive acts such as hand biting and head banging
Slow speech development
Echolalia
Retreats in own world
Nutritional Issues:
Autism
More than half of children with struggle with problem eating behaviors, including
Selective or obsessive eating
Insistence on specific nonfunctional mealtime routines
Oral aversion
Sleep Issues
Autism
Children with autism are more likely (prevalence between 44 and 83%) to have sleep disturbances, including:
Trouble with sleep latency (falling asleep)
Sleep maintenance (staying asleep)
Dx and Tx
Autism
Diagnosis
Complete neurological exam
Developmental tests of speech, intelligence & behavior
Treatment
Therapy can help!
Reassure parents by telling them that early intensive behavioral or developmental interventions are effective
Asperger Syndrome
May be seen as children who are “normal, but different”
Frequently accompanied by tic disorders, attention problems, & mood disorders
Core Symptoms
Social deficits… can’t maintain friendships
Just don’t understand the “rules” of social interaction, such as personal space, eye contact & initiating & terminating interactions
Flat or inappropriate affect
Lack empathy
Peers find them to be overly rule governed
Asperger Syndrome: OCD
Display rigid behavior & become distressed when a routine is interrupted
Becomes upset when mom drives home from school a different way
Distinguishing Features of AS
*Restricted Interests: Fact based
EX: Excessive interest in dinosaurs, computers…
*Language: Odd Patterns
Vocabulary may be advanced but odd
*Motor Abilities: Clumsy & poor coordination
*Presentation: Friendship problems after 3 yrs.
*Gender Ratio: Male:Female ratio is 15:1
*Prognosis: Educational outcomes better
Aspergers syndrome: Note about restricted interests
One isolated & obsessive area of interest in which they are immersed; i.e. math, science, computers…

More rote than meaning

Repetitive adherence to rules
Rett’s Disorder Another one of the autism spectrum disorders
Less common than autism or asperger
*Occurs almost exclusively in girls

*Development starts off normally and then regresses
Impairment in social skills & communication begins
Non-purposeful hand movements begin to appear
A gene on the X chromosome was recently discovered
Pervasive Developmental Disorder (NOS)
Children with significant delay in ALL functions…
Language
Fine Motor
Gross Motor
Personal/social
Emotional
Intellectual
Heart Rates
Newborn: 100-160

Infant: 80-100

School age child: 70-115

Adolescent: 65-105
Murmur: Intensity Grading
Grade I… Barely audible
Grade II… Soft but easily heard
Grade III… Moderately loud but no thrill
Grade IV… Louder with a thrill
Grade V… Audible with the stethoscope barely on the chest; thrill detectable
Grade VI… Audible with the stethoscope off the chest; thrill detectable
Polio
Before Immunizations:
50,000 cases of polio per year in US alone

After Immunizations:
NO POLIO IN WESTERN HEMISPHERE
Smallpox
WHO declared it eradicated in 1980 after immunizations given.
Haemophilus Influenzae Type b Meningitis
Before Immunizations:
Most common cause of bact. men. in infants/children US
Affected 1/200 children under age 5
Killed 1/600
HIB Meningitis... After Immunizations:
Incidence has declined by 98%!
1994-1998, fewer than 10 fatal cases
Few new pediatricians/ARNP’s have ever seen it
Current Immunizations: 2011 Recommended by age 7
5 doses of diptheria vaccine
5 doses of tetanus vaccine
5 doses of pertussis vaccine
4 doses of Hib vaccine
4 doses of pneumococcal vaccine
4 doses of injectible polio vaccine
2 doses of measles vaccine
2 doses of mumps vaccine
2 doses of rubella vaccine
3 doses of hep B vaccine
2 doses of hep A vaccine
2 dose of varicella (chicken pox vaccine)
3 doses of rotavirus vaccine (an oral vaccine)
Yearly influenza vaccine after 6 mos of age… live nasal form now approved for kids as young as 2 yrs.
Current Immunizations:2011
Recommended 7-18 years
1 TDaP vaccine
3 HPV4 vaccines
New last year: Males now take the vaccine
1 meningococcal vaccine
Yearly influenza
Diptheria…
Skin lesions, Bull Neck, Airway Swelling
An acute infection of the upper respiratory tract caused by a toxin-producing bacteria

Toxin is absorbed into the mucous membranes-forms a grayish color to tonsils, pharynx, or larynx.

May result in injury to heart muscle, liver, kidneys

Causes inflammatory response with…airway swelling!!!!!
Schedule:
2 mos, 4 mos, 6 mos, 15-18 mos, 4-6 yrs
Required for kindergarten entry in Ks.

1 booster @ 11-12 yrs (Tdap)
Tetanus
Caused by a bacilli that produces a neurotoxin following contamination of a wound by soil with animal manure or animal bite

Toxin reaches the CNS & results in intense, often fatal, muscle contractions then paralysis.

Pt. remain fully conscious & lucid as paralysis progresses…
Schedule: Same as diptheria
REQUIRED for kindergarten entry in KS.

1st booster @ 11-12
Pertussis (Whooping cough)
Highly contagious infection of the respiratory tract

Characterized by severe bronchitis and/or bronchiolitis with a “whoop” cough. Cough lingers 4-6 wks.

Most severe in infancy as airway passages are so small
Schedule: Same as diptheria & tetanus
Required for kindergarten entry
Measles (Rubeola)
Viral infection
Lasts 7-10 d. Contagious 5d after exposure to 5d after rash appears
High fever (up to 105), hacky cough, conjunctivitis, lethargy, reddish brown maculopapular rash, photophobia, “Koplik’s Spots”
Schedule:
1st dose @ 12-15 mos.
2nd dose @ 4-6 yrs.
Required for kindergarten entry
Mumps
Viral Infection

Primarily involves parotid salivary gland. Most common complication is nerve deafness… usually unilateral
Schedule: Same as Measles
1st dose @ 12-15 mos.
2nd dose @ 4-6 yrs
Rubella aka German measles, 3 day measles
Rubella
Caused by rubella virus
Maculopapular rash beginning on face & rapidly spreading to entire body.
Rash disappears by 4th day.
Usually mild in children

Dangerous in pregnant women: leads to serious and significant birth defects
Schedule: Same as Measles & Mumps
Again… 2 doses of vaccine…
12-15 months
4-6 yrs
Congenital Rubella Syndrome (when infants are born with rubella from mom)
Common Triad of Symptoms:
Cataracts/congenital glaucoma, and/or retinopathy

Congenital heart disease

Loss of hearing.
Purpura
Splenomegaly
Jaundice
Microcephaly with, mental retardation,
Meningoencephalitis,
Bone disease-
MMR info
A live vaccine

Should not be given to:
Pregnant women
Children who are moderately to severely ill
Immune compromised
Anyone who has had life threatening reaction to gelatin or the antibiotic neomycin
Poliomyelitis (polio)
Caused by polio virus
Subclinical in 95% of cases
S & S:
Initially fever, myalgia, sore throat, and headache for 2-6 days
Several symptom free days are then followed by return of fever & HA, stiff neck, spinal rigidity & nausea
Mild cases resolve completely
More severe cases result in asymmetric paralysis which affects swallowing, speech, and cardio-respiratory function
Paralysis usually complete by the time temperature resolves
Most improvement of muscle paralysis will take place within 6 months… after that, a permanent disability
Now available as injectible only
Used to be oral (OPV): was a live vaccine which caused disease in 1:1,000,000 cases. Paralysis in 1:10,000,000 children. Never used anymore.
Injectible is a killed vaccine
Schedule:
Primary series of 4 shots:
2 mos, 4 mos, 6-18 mos., & 4-6 yrs.

No booster required
Hib
Name of a bacteria that causes different types of disease processes
Is NOT the name of a disease itself

Most common cause of bacterial menningitis & epiglottitis before immunization.

Can also cause cellulitis, septic arthritis, pneumonia, & bacteremia
Schedule:
4 doses
2 mos, 4 mos, 6 mos, 12-18 mos

The most dramatic impact on disease of any recent vaccine!

Hib menningitis and epiglottitis are rarely seen today.
Hep B
Hepatitis B in Children
Infant & children @ highest risk of developing lifelong infection.

25% of kids who become infected with hepatitis B virus are expected to die of related liver disease as adults

12,000 infants born to hepatitis B infected mothers were infected each year before vaccine
Schedule:
3 shot series
Ideally: Birth, 1-2 mos., & 6 mos.
MUST be 24 wks before 1st dose and 3rd dose
Can be given in 4 doses with combination vaccines
Hep A
Fever, anorexia, vomiting, HA, abdominal pain
Jaundice follows these sx’s within 5-10 days

Darkening of the urine & stools become light or clay colored

Hepatomegaly

Self-limiting, acute illness

Death rare
Schedule:
2 doses:
1st @ 1-2 yr
2nd 6 mos later
Chicken Pox
highly contageous viral infection. varicella or herpes zoster virus. Incubation period 10-20 days. Virus lingers in latent form in sensory ganglia & can reappear at a later time as herpes zoster (shingles) in 10-15% of individuals
Schedule:

Given @ 12 months

Booster @ 4-6 years
Chicken pox s&s
S & S:
Mild fever & mild malaise
Crops of red macules that rapidly become tiny vessicles with surrounding erythema. Process occurs over 24 hrs. Vessicles then slowly crust over.
New crops occur for about 5 days, then stops.

Can occur in the anus, vagina and respiratory tract…”varicella pneumonia
Pneumococcal Infection: streptococcus pneumoniae
The most common cause of bacterial respiratory disease, including otitis media and sinusitis.

More than 20 serotypes… PCV immunization protects against 7 common valents

Some concern emerging that serotype replacement is going on since vaccine… emergence of different serotypes than previously knownPneumococcal disease begins as early as the 2nd month of life & becomes progressively more common as maternal antibodies decline
Pneumococcal Immunization: PCV & PPV
PCV is a conjugated vaccine… better protection especially for younger children.

If PCV has not been given in infancy…
then single dose PPV is recommended for high risk groups only.. .and only after age 2.

PCV became known as the “ear infection vaccine”… not accurate
Schedule: PPV
Single Dose 2-6 yrs.
High risk population if PCV missed


Schedule PCV:
4 doses:
2 mos, 4 mos, 6 mos, & 12-15 mos
Meningococcal Vaccines: MPSV4 & MCV4
2 vaccines available:
Meningococcal polysaccharide vaccine (MPSV4)
Has been available since the 1970’s.
Recommended for high risk groups under the age of 11.
MPSV4 cannot be given under age 2
Meningococcal conjugate vaccine (MCV4)
Recommended at 11-12 year exam

Can be given @ high school entry or college entry if not previously vaccinated

Congugated (MCV4) form can be given age 2-10 with certain hi-risk criteria
Both vaccines work well…

but the conjugated form (MCV4) is expected to give longer lasting protection
Rotovirus Vaccine
An oral vaccine… not an injection
98% of kids who get vaccine are protected form severe diarrhea; 70% do not get the virus at all after vaccine
Do not start the series later than 12 wks. Do not administer a dose later than 32 wks.

Schedule : 3 doses (2, 4 & 6 mos.)
Influenza
Infection of the respiratory tract caused by Influenza A or B

Especially dangerous in young children
Characterized by high fever, difficult cough, malaise & extreme fatigue
Often accompanied by respiratory distress… especially in young asthmaticsRecommended annually for:
All Children > 6 mos. of age
Anyone with close contacts for infants 0-5 months
Children aged 6mos -9 yrs. receiving 1st dose:
0.25 ml. dose with 2nd dose 4 wks. later
Children who have had before:
0.5 ml dose
HPV vaccine Gardacil
HPV 4 (Quadrivalent)…
Protects against 4 serotypes, which together cause:
90% of genital warts
70% of cervical cancer
(HPV 2 also available for girls but does not provide protection for genital warts)
Available for young women & young men for the 1st time this year

Immunization Schedule
1st dose: females 11-12 yrs
2nd dose: 1-2 mos after 1st dose
3rd dose: 6 mos after 1st dose

Interesting note: CDC does not list this as recommended for males, just as available. Studies have shown the best way to prevent is by vaccinating females…
Common Side Effects of Most Immunizations
Don’t Be Concerned: It’s ok!
Low grade fever
Irritability for 24-48 hrs.
Pain @ injection site
Knot @ injection site
Rash with varicella vaccine