Pediatric Pearls

Infant Milestones-

Posterior fontanel closes by 8 weeks

Social smile occurs by 2 months

Head turns to locate sounds by 3 months

Steady head control is achieved by 4 months

Moro reflex disappears around 4 months

Able to roll from tummy to back and from back to tummy by 5-6 months

Plays “peek-a-boo” after 6 months

Able to transfer objects from hand to hand by 7 months

Able to sit unsupported at 8 months

Able to crawl at 10 months

Waves “bye-bye” at 10 months

Fine pincer grasp appears at 10-12 months and able to walk with assistance at 10-12 months

Says a few words in addition to “mama” and/or “dada” at 12 months

Toddler Milestones-

Appears bowlegged and potbellied (lordosis)

Anterior fontanel closed by 18 months

Throws ball overhand by 18 months

Kicks ball by 24 months

Feeds self with spoon and cup at 2 years

Daytime toilet training can begin by age 2 years

All primary teeth (20) are present by age 3

Two-to three- word sentences are spoken by 2 years

Own first and last name can be stated by 2 ½ to 3 years

Three-to four- word sentences are spoken by 3 years

Temper tantrums are common

SAFETY ISSUES: curious about the world round them and like to explore. Accidental poisoning is a safety
issue. Use of ipecac syrup is NO LONGER recommended. Teach parents that it is NOT recommended to
induce vomiting in any way because it may cause more damage

When does birth length double? 4 years

When does a child use scissors? 4 years

When does a child tie his/her own shoes? 5 years

When does birth weight double? 5-6 months

When does birth weight triple? 12 months

When does a girl’s growth spurt begin? As early as 10. Boys start a year later.

Concepts of bodily injury-

Infants- remember pain after 6 months

Toddlers- fear intrusive procedures

Preschoolers-fear of body mutilation

School-age: fear of loss of control over their bodies

Adolescents- concerned about change in body image

Review pain scales- remember use the same pain scale -BE CONSISTENT-do not change pain scales

Vaccines-

MMR

Contradicted in kids with a history of anaphylactic reaction to neomycin or eggs, those with
immunodeficiency, and pregnant women.

Child may develop light, transient rash 2 weeks after administration of the vaccine

Children with German measles pose a serious threat to their unborn siblings. German measles is
teratogenic in the 1st trimester

DTaP

Not given to children past their 7 th birthday. These kids will get Td ( full strength Tetanus and weaker
diphtheria protection)
When pertussis vaccine is contraindicated, give DT ( full strength Tetanus and Diphtheria protection),
without pertussis vaccine, until 7th birthday

Contraindications:

Encephalopathy within 7 days of previous dose of DTaP

History of seizures

Neurologic symptoms after receiving the vaccine

Systemic allergic reactions to the vaccine or anaphylaxis

Polio

Contraindications: history of allergic reaction or anaphylactic reaction to neomycin or streptomycin

Hepatitis B

Given shortly after birth before hospital discharge

Contraindicated in persons with anaphylactic reaction to baker’s yeast

Varicella

Safe for children with asymptomatic HIV infection

Give MMR and varicella on the same day or > 30 days apart using a separate site

TB skin testing

Screening can be initiated at 12 months of age

Nutrition

Iron deficiency anemia- most commonly occurs in children 12 to 36 months of age, adolescent females,
and females during childbearing years

Recommended amount of Vitamin D is 400IU/day PO. Vitamin D toxicity- sleepiness

Preschool and school age children do not consume enough Vitamin A, Vitamin C, Vitamin B 6, and
Vitamin B12

Child Abuse

Only suspicion is needed for reporting

Abused children have difficulty establishing trust. Select only one nurse to care for an abused child
because the child will be less anxious with a consistent caregiver.

Poisoning

Common household items that are poisonous to children if ingested: perfume and aftershave, sunburn
relief products, alcohol, cigarettes or any type of tobacco products, mouthwash.
Lead Poisoning

Every bodily system can be affected by increased lead levels- Renal, neurologic, and hematologic
systems are the most seriously affected by lead.

Lead exposure and increased levels have been linked to decreased IQ’s and anemia

Major cause of lead poisoning- deteriorating lead-based paint (older homes built before 1970s)

Chelating Agents- children with peanut allergies should not be given chelating agents such as
dimercaprol, D-penicillamine, or EDTA.

Monitor patient’s renal function and CBC while child is receiving chelating agents

Avoid giving iron during chelation because of possible interactive effects

More lead is absorbed on an empty stomach. Hot water can contain higher levels of lead because it
dissolves more quickly in hot water than cold water. Educate parents to use only cold water for
consumption (drinking, cooking , and making infant formula).