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Adolescent assessment, including immunizations
- -provide privacy.
- - physical exam= assess puberty changes, ht, wt, vs, & growth done yearly.
- -vaccines = meningococcal, pneumococcal, flu & varicella booster tetanus & diptheria (done 10 yr after pre-k dose). Hep B
- -screen for scoliosis & goiter
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Preschooler assessment
- -physical exam, ht, wt, vision, hearing & bp yearly
- -immunizations: boosters for dtap, polio & mmr
- -tb required before school
- -lead testing if indicated
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Preschooler development
- -discipline w time outs, consistency, firm limits, & short explanations
- -consistent routines, allow imaginative play, limit tv
- -read to child daily, teach proper hand washing
- -usu gain 5 lb/yr, grows abt 3" /yr (by age 5 at 1/2 expected adult ht)
- -by age 3: vocab 300-500 words, use 3-4 word sentences, can walk run and jump well, climb stairs, ride 3 wheel bike, balance on 1 foot briefly. stacks 9-10 blocks, copy circles, draw a cross.
- -by age 4: use abt 1500 words, ask why a lot, make up stories, can learn songs, catch a ball w both arms, skip, walk downstairs, hop on 1 foot, climb playground, lace shoes, use scissors, copy a square, trace a diamond, draw a stick figure w 3 parts.
- -by age 5: vocab of 2100 words, rec& names abt 4 colors, days and months, can tie shoes, copy diamond & triangle, skip usuing alternate feet, jump rope, and more parts to stick figure, print numbers & letters. can enjoy sports.
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School age child assessment
- -every 2 yrs from 6 to 10, then yearly. physical exam, dietary intake, ht, wt, hearing, vision, bp, hr,rr
- -inquire alchol, drug, tobacco pt & family
- -assess home & family dynamics, extracurricular activies, changes in thoughts, academics, sexuality
- -screeen for tb
- -tetanus booster age 11 or 12
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Normal motor development of infant up to 1 yr
- birth- full head lag when pulled by arms,
- 1 mo- when prone can lift head & turn side to side, grasp sm objects
- 3 mo- lose grasp reflex & will grasp obj put in hand, hold it then release it
- 4 mo - minimal head lag & can sit w support
- 5 mo- roll from front to back, grasp obj placed in front of him & pass them to other hand
- 6mo- c sit up while using hands to support self, can stand bearing his own wt while being held
- 7&8mo- c sit wo support, uses thumb & forfinger to grasp
- 8 mo- bear his own wt while standing wo being held, crawling on belly
- 10 mo- can crawl, pull self up to standing position, cruises while holding furniture, pincher grasp, can hold crayons
- 12mo- walking while holding someones hand
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normal motor dev of toddler 1 to 3
- 15 mo- walking alone, builds tower w 2 blocks, scribble w crayons
- 18 mo- stacks 3-4 blocks, walks up stairs w help
- 24 mo- walk up stairs holding rail one step at time
- 30 mo- stacks 8 blocks, kick a ball, jump w both feet, dress self, brush teeth, hold crayons, draw cross, ride tricycle
- 36 mo- gross & fine motor control much steadier
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Normal growth patterns of toddler (1-3yrs)
- -Ht: grow 3"ea year
- -wt: gain abt 5lb per yr. 2.5yr quadrupled birth wt.
- -HC: 1-2yr old hc and chest circ will be same, increasing by abt 1".
- -lg abdomens
- -bow legs
- -poor muscle tone
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Normal growth patterns school age child (6-12 yr)
- -ht: grow abt 2" per yr
- -wt: gain 5 to 6 lb per yr
- -boys slightly taller and weigh more
- -age 12 girls usu taller and weigh more
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normal growth patterns adolescent (12 -21yr)
- -growth spurt
- -females grow 2-8" and gain 15-55lbs.
- -males grow 4-12" and gain 15-65lb
- -puberty for girls lasts abt 3 years
- -puberty for boys starts btwn 9&16 and is over by 19
- -females: menarche begins abt 2.5yrs after puberty begins (breast buds & pubic hair)
- -male puberty: inc muscle mass, penis size & testicle size, appearance of body & facial hair & deep voice
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normal vitals for children
- newborns: hr 100-180; rr 30-50; temp 99.4-99.7
- infant to 2 yr: hr 80-130; rr 20-30; bp-age +90 sys (if 1-7yrold) +56dia (if 1-5yrold)
- -2 to 10yr: hr 70-110, rr 20-28, bp (2xage in yrs)+83 (sys 8-18yrs) & age in yrs +52 (dia 6-18yr), temp 98.6 to 99 (3-5 yrs) and 98.1-98.3 (7-9 yrs)
- 10 yr-adult: hr 60-100, rr 12-20, temp 97.8 to 98.3
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normal growth patterns of infant to 1 yr
- length: birth to 6 mo, 1"per mo. from 6 to mo, an increase of 50% of length is normal
- weight: birth to 6 mo, gain of 1.5lb per mo. birth wt doubles by 5 mo. avg wt by 6 mo is 16lb. from 6 to 12 mo wt gain slows to 3/4lb /mo. by 12 mo the infant should have tripled his birth wt & weigh avg of 21.5 lb
- HC: inc 1.5cm ea mo thru 6 mo, avg size 17", from 6-12 a gain of 1/2cm per mo to avg of 18"
- Chest circumference: avg 1" smaller than HC
- Teeth: primary teeth erupt around 6 mo.
- Fontanel: anterior fontanel at birth 2" wide & posterior fontanel will be 1/2" wide. anterior fontanel closes btwn 12 & 18 mo, posterior fontanel is closed by 2mo
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newborn reflexes of eyes, nose and throat
- blinking reflex: blink at obj near eye or sudden bright light; persist thru adulthood
- pupillary reflex: contract at bright light, persists thru adulthood
- dolls eye reflex: when head moved one side to other eyes will lag behind & adjust slowly to new position of head. disappears as infant dev ability to fixate on objects
- sneeze reflex: sneeze in response to obsstruction or irriatation to nose, persists thru adulthood
- glabellar reflex: when tapped on bridge of nose child will close eyes tightly
- yawn reflex: lack of sufficient o2 will cause baby to yawn, persist thru adulthood
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Mass reflexes of newborn
- Placing Reflex: when held upright & top of foot is against edge of table, baby will lift his foot onto table top. fades by 4mo of age.
- Tonic neck reflex: when supine & head is turned to 1 side, arm & leg on that side will extend & arm & leg on opposite side will flex. fades by 3-4 months
- Trunk incurvation reflex: when back stroked along one side of the spine, body will curve in that direction. fades by 4wk old
- Moro rreflex: changing position suddenly wil cause to extend extremities, form a c w thumb & forefinger, then draw extremities towrd midline: may cause crying; fades after 3-4 mo
- Crawl reflex: when on abd will make crawling motion w arms & legs. gone by abt 6 wks
- Startle reflex: sudden loud noise will result in arms flailing outward w elbows flexed & hands clenched. fades by 4 mo old
- Dance reflex: when held upright & bottom of foot placed on flat surface legs will flex up & down as if walking. fades after 3-4 wks
- Perez reflex: when prone & stroked along spine from tailbone to neck, infant will cry, flex arms & legs & lift head and pelvis off table; may urinate or defecate. fades by 4-6 mo
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localized newborn reflexes
- Grasp reflex: if palms of feet or hands are touched near base of fingers or toes, they will flex; palmar grasp fades after 3 mo, plantar grasp fades after 8 mo
- Babinski reflex: if outside of sole of foot is stroked upward & across ball of foot, toes will extend, flare outward & big toe will hyperextend. disappears after 1 yr
- Ankle clonus- while holding knee in flex position, foot is rapidly flexed w toes towrd knees, 2 beats of foot will be felt; grad disappears.
- sucking reflex: obj placed on lips will attempt to suck, persists thru infancy
- gag reflex: posterior pharynx stimulated will gag, persists thru adulthood
- cough reflex: laryngeal or tracheobronchial mucous mem are irritated, will cough. persist thru adult
- extrusion reflex: tongue pressed on will force tongue outward. persist 1st 3 mo of life
- rooting reflex: outside of cheek is touched will turn head toward and try to suck. disappears by 3-4 mo
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immunizations
- birth: opthalmic drops(prevent blindness from gonorrhea) and vit k (prevent hemorrhagic dz)
- phenylkeotnuria, hypothyroid testing before dc
- HEP B: birth, 1-2 mo and 6-18 mo
- DTAP: 2,4,6, and 15-18 mo
- HIB: 2,4 and after 12 mo
- POLIO: 2,4 and between 6 and 18 mo
- MMR: 12 to 18 months
- VARICELLA: 12 months
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