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Well Care Examinations for pediatrics: growth and development of babies, children and adolescents . Debbie King RN, MSN FNP, PNP, APRN. Communication in primary care pediatrics . Professional interaction, sensitive yet nonjudgmental. Include parent and child.
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Debbie King RN, MSN
FNP, PNP, APRN
Moro Reflex- allowing infants head to drop back. Disappears by 4 mos.
Rooting Reflex and Sucking Reflex
Palmer or Grasp Reflex-Disappears 3mos.
Stepping Reflex-disappears 2mos.
rooting, sucking, gag, crying
symmetry of movement
Hep B #2 today
-Warn- more immunizations at 2 months
extra focus on tone and strength
encourage team work of parents
Follow up on previous visits
past concerns ex; constipation, not sleeping much
past unmet milestones
If first visit gather all info that was needed at all previous visits.
- finger foods, new research contends “that meat be included in the food package for breast-fed infants at 6 months”
one new food every 3 days
-Same as all past with focus on
-Socializing with provider
-Add Fluoride-if on well water
-except shell fish and honey
-start whole milk, cup, self feed
-verbalizing, mobility, walking
-head to toe
- More difficult
-Be creative, playful
-May notice hand preference soon, yet could be as late as 5 years for set handedness
-testicles- should be down
-summarize this visit and growth and development since birth, seeing that areas have been covered and documented
-Choose care givers carefully (baby-sitters)
-Next visit 15 month and all basic vaccines will be completed except Hep A
- avoid juice trap, no juice is needed
- head to toe
- very difficult to do with this age
- heart first
- mouth last
- observe walking forward and backward
-can see signs of autism
In a prospective study by the high risk siblings research consortium, Dr. Zwaigenbaum suggests that head growth accelerates over the first two years of life in children with autism.
- 2 word combos starting
- Builds tower of 3 to 4 blocks
-climbs (even stairs with help)
-sustains eye contact
-enjoys being bounced/swung
-interested in other children
-play hide and seek
-points with index finger
-plays appropriately with toys
-follows two step command
-stacks 3-4 blocks
-4 to 20 word vocab
-listens to stories
-shows affection- kisses
Still measure on infant scale for height and weight and plot on infant growth chart
-toileting- may be able to verbalize needs
‘Wait’ is my advise
Know what to do- for each DX
may be helpful to keep charts in exam rooms
-head to toe exam
-add cranial nerve exam –know how!
-add walk on toes and heels
-sun block -diet
-behavior -TV time!!- increase in education of limited time spent here
Fine motor Skills
Gross motor Skills
Good head control in 2-3 months.
Rolls front to back in 4-5months.
Rolls back to front in 5-6 months.
Sits alone 5-6 mos.
Crawls 7-8 months
Pulls to stand 9-10 m
Walks backward 14-16
Walks up stairs 3yr
Walks down stairs 4 yr.
Skips 5 yrs.
Grasp/shake rattle 2-3m
Reach for object 3-4m
Rakes 4-6 months
Hand transfer 4-6 months
Pincer 9-12 months
Stack 2 blocks 14 months
Copies line 2yrs.
Copies circle 3 yrs.
Draws person 3 parts 5 yr.
Draws person 6 parts 6 yrs.
Encourage sport participation
Re-check height, weight in 3 months
research shows the only true way to correct obesity in children is to prevent it.
-girls are usually tanner IV at this age
-Hep B -Pneumococcal
-DTAP -Influenza/ FluMist
-IPV -MMR RotaTeq
Hep A -Menactra
Boostrix and ADACEL
Two new ones- for HPV- Gardasil and Cervarix
You should bring the CDC immunization guide with you for the quiz!