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Milestones, Anticipatory guidance and
Red flags: Birth through 1 year.
Fitzgerald Pediatric questions And
Actual Answers.
The infant will initially lose how much weight after birth? - Answer 5-8% of body weight How many days should it take for an infant to regain the initial weight loss after birth? - Answer 10-14 days A weight loss of more than ____% after birth is concerning and requires closer monitoring? - Answer 10% What are the nutritional needs to promote growth in an infant? - Answer 110kcal/kg/day How many hours a day does a newborn generally sleep? - Answer 16 out of 24 hours How often should a mother be encouraged to breastfeed her NEWBORN? - Answer Every 2-3 hours, do not go more than 4 hours between feedings What could a high pitched cry in an infant signify? - Answer Hypothyroidism Cri du Chat What are primary reflexes in an infant? - Answer Sucking rooting Asymmetric tonic neck Moro Grasp What are a few ways in which newborns self-sooth? - Answer Sucking moving hand to mouth grasping at clothing
How much does length, weight and head circumference increase in an infant ages 1 month- 3 months? - Answer Approximately 1.4inches per month in height 0.5-1 ounce of weight per day 0.8inches per month in head circumference Approximately how many feedings per day should an infant ages 1 month to 3 months have? - Answer 8-10 feedings per 24 hours About how long should feeding sessions of infants take? - Answer 20- minutes Feedings < 20 minutes or >30 minutes should be evaluated How many hours do infants ages 1 month- 3 months usually sleep? - Answer Sleep cycles become more regular and last approximately 15-16 hours per day Motor skills at birth include? - Answer Fine motor- Flexion Oral movement- Sucking, tongue movement, jaw movement Motor- Momentary head control Motor skills at 1 month old? - Answer Fine motor: extension, non-direct swipes Oral: rooting Motor movement: Turns head when prone Motor skills at 4 months? - Answer Fine motor: Directed swipes, coralling, reaching. Sometime between 4-5 months- Ulnar palmar grasp, swims in prone position Motor movement: Sits with Support, begins to roll over and steady head Motor skills at 6-7 months? - Answer Fine: radial digital grasp Oral: Sucking with negative oral cavity pressure, rhythmic jaw movement, firm approx. of lips Motor: Sits independently, rolls over, rocks on hands and knees Motor skills at 7-9 Months? - Answer Scissor grasp Munching, early chewing Sits alone, may crawl
Anticipatory Guidance for Infants Birth to 1 month related to Regulation of sleep wake patterns - Answer 1. Need assistance to develop day and night cycles
- Placing infant in bassinet during naps help with an easier transistion from parent bed at night
- Infants need a variety of movement, voice and touch to move them from sleep to wake states
- Some infants benefit from external stimuli like music, voice or movement to help them calme Anticipatory Guidance for Infants Birth to 1 month related to Strength and motor coordination - Answer 1. Supine to sleep but make sure baby gets monitored tummy time (initially 2-3 minutes, 2-3x per day but should increase) Anticipatory Guidance for Infants Birth to 1 month related to Feeding and self care - Answer 1. Organizing feeding response
- Feedings should be between 20-30 minutes
- face to face feeding position encourages eye contact and bonding
- Encourage infant exploring such as fro the breast or bottle
- Understanding feeding cues and burping techniques
- Urinary output , weight gain and feeding type are used to eval adequate nutrition
- Preventing SIDS, while avoiding nipple confusion (not clear evidence that pacifiers cause nipple confusion but there is some evidence that it may prevent SIDS) begin at 1 month
- Supportive guidance with breastfeeding Anticipatory Guidance for Infants Birth to 1 month related to communication and language - Answer 1. Help understand the infants needs by crying cues, changes in alertness and non verbal cues
- Attend promptly to crying infant
- Imitating infant sounds encourages infants to vocalize and experiment Anticipatory Guidance for Infants Birth to 1 month related to Social and emotional growth - Answer 1. Help infants achieve alert stage without overstimulation
- Gentle touch and being held is important (ensure parents that this is not spoiling infant)
- Encourage overall family development with siblings
- Point out concrete ways in which the parent IS meeting their infants needs followed by supportive guidance and reassurance
Anticipatory Guidance for Infants Birth to 1 month related to Cognitive and environmental stimulation - Answer Encourage opportunities for the infant to look a things (mobiles) Anticipatory Guidance for 1 month- 3 months related to regulation of sleep and wake - Answer 1. Structure infants day
- Use repetitive stimulation
- Swaddling and sensitive movements
- Sleep location, safety position (back to sleep), establish naptime, help infant go to sleep on their own Anticipatory Guidance for 1 month- 3 months related to Strength and motor coordination - Answer 1. Place infant in different positions during playtime
- Supine position stimulates movement of the fingers, hands, feet, legs and is easier to hold toys Anticipatory Guidance for 1 month- 3 months related to Feeding and Self Care - Answer 1. Feedings will become more consistent
- Time for bonding
- Responsiveness to infants cues
- Positive reinforcement for continued breastfeeding Anticipatory Guidance for 1 month- 3 months related to communication and language - Answer 1. Talk and sing to infant
- help parents to understand and respond to cues
- Reading should be daily Anticipatory Guidance for 1 month- 3 months related to Social and Emotional Growth - Answer 1. Parental competencies grow as their skills increase and are validated
- Hand- mouth exploration
- Continue to respond to infants needs ASAP
- Help parents resolve any emerging temperaments if there are conflicts
- Infants will have increased desire to socialize but infants have a short attention span only 10-15 minutes and still tire easily Anticipatory Guidance for 1 month- 3 months related to Cognitive and Environmental stimulation - Answer 1. Infants awareness is increasing and they need more visual diversity
- Regulation of sleep wake
- Strength and motor
- Feeding and self care
- Communication and language
- Social and emotional
- cognitive and environmental - Answer 1. Sleep may be interrupted by sleep and illness
- Increased need for consistency at bedtime
- Put to bed while still awake but drowsy
- Infants are more able to wait for gratification
- Floor time is essential with emphasis on safety
- Childproofing home is becoming important
- Bath-water temp must be checked, and infant should NEVER be left alone even for a few seconds
- Active supervision is the best injury prevention
- Solids should start at 6 month
- Structured meal times
- Allow to hold cup or spoon
- for parents that are uncomfortable with messiness, help find ways to minimize mess
- cleansing the teeth
- Using names of objects, encouraging gestures, talking to infant is important
- reading to infant
- Naming body parts
- Transition objects like toy or blanket ease seperation anxiety
- Limit setting, consistent care, parental consistency
- parental responsivness, attention and support
- Toys that have cause and effect, staking and household items
- Interactive games Anticipatory Guidance for 9-12 months for
- Regulation of sleep wake
- Strength and motor
- Feeding and self care
- Communication and language
- Social and emotional
- cognitive and environmental - Answer 1. Transitional object
- Predictability of daily routine
- Infant temperament is more evidence, help solve any conflicts
- "cheer" for infant as they achieve milestones
- Childproofing the environment as curiosity increases
- Bath water temp
- Plastic bags and balloons are dangerous
- 24 hour poison control as everything goes straight to the mouth
- Active supervision is the best way to prevent injury
- Parents decide what is eaten, child decides how much
- Dental hygiene
- Practicing with spoon ect
- Consistent meal times
- Eat together as family at least once a day
- reinforce efforts to communicate through gestures, pointing and vocalizations
- Naming things such as utensils, colors, ect
- Naming body parts
- Reading is becoming more interactive
- Child has increased autonomy
- Discpline is to reinforce + behaviors
- Stranger anxiety
- Distraction is very effective to redirect infant
- parents may have difficult time finding energy
- Delegate and shared roles
- Playing with child increased bond
- parents model new activities
- Integrative game (peek-a-boo ect)
- Cycle toys to keep infant interested
- encourage messy play Common Developmental Issues for Infants - Answer Sleep Feeding Crying Spitting up Discipline and behavioral guidance
- No hand to mouth movements
- Feedings taking longer than 45 min
- Consistently waking for hourly feeding
- Does not turn to voice
- No sounds
- Lack of social smile, withdrawn
- lack of consistent safe childcare
- Lack of eye contact
- No visual tracking, not able to fix or face an object Which of the following is appropriate advice to give to a mother who is breastfeeding her 10 day old infant? a. "your milk will come in today" b. " To minimize breast tenderness, the baby should not be kept on either breast for more than 5 to 10 minutes" c. "A clicking sound made by the baby during feedings signifies a good latch and suck" d. "the baby's urine should be light or colorless" - Answer D Which of the following is appropriate advice to give to a mother who is breastfeeding her 12 hour old infant? a. " you will likely have enough milk to feed the baby withing a few hours of birth" b. "The baby might need to be awakened to be fed" c. "supplemental feeding is needed unless the baby has at least four we diapers in the first day of life" d. " The baby will likely have a seedy yellow bowel movement today" - Answer B Compared with the use of infant formula, advantages for the baby of breastfeeding include all of the following EXCEPT: a. a lower incidence of diarrhea illness b. greater weight gain in the first few weeks of life c. reduced risk of allergic disorder d. lower occurrence of constipation - Answer B A 3 weeks of age, the average-weight, formula fed infant should be expected to take: a. 2-3oz every 2-3 hours
b. 2-3oz every 3-4 hours c. 3-4 oz every 2-3 hours d. 3-4 oz every 3-4 hours - Answer A In infants, solid foods are best introduced no earlier than: a. 1-3 months b. 3-5 months c. 4-6 months d. 6-8 months - Answer C Nursing infants generally maximally receive about which percentage of the maternal dose of a drug? a. 1% b. 3% c. 5% d. 10% - Answer A Most drugs pass into breast milk through a. active transport b. facilitated transfer c. simple diffusion d. creation of pH gradient - Answer C To remove a drug from breast milk through "pump and dump" the nursing mother should refrain from taking the offending medication and the process must be continued for: a. two infant feeding cycles b. approximately 8 hours c. three to five half lives of the drug d. a period of time that is highly unpredictable - Answer C When counseling a breastfeeding woman about alcohol use during lactation, you relate that: a. drinking a glass of wine or beer will enhance the let down reflex b. because of its high molecular weight, relatively little alcohol is passed into breast milk c. maternal alcohol use causes a reduction in the amount of milk ingested by the infant
b. 60-80kcal/kg/day c. 80-100kcal/kg/day d. 100-120kcal/kg/day - Answer C Regarding physiologic jaundice in the newborn, select all that are correct a. it occurs between the first 12-24 hours of life b. it progresses from the abdomen toward the head of the infant c. Unconjugated bilirubin is elevated d. Risk for development of hyperbilirubinemia can be reduced in a breastfed infant with frequent breastfeeding every 2-3 hours per 24 hours e. it can be avoided by supplemental water and dextrose feedings between breastfeeding in the first 3-4 days of life to increase infant hydration while awaiting mothers milk to come in - Answer C and D Which of the following is most consistent with a normal developmental examination for a 3 month old infant born at 40 weeks gestation? a. sitting briefly with support b. experimenting with sound c. rolling over d. having a social smile - Answer B Which of the following is most consistent with a normal developmental examination for a thriving 5 month old infant born at 32 weeks' gestation? a. sitting briefly with support b. experimenting with sound c. rolling over d. performing had to hand transfers - Answer B A healthy full term infant at age 3 to 5 months should be able to: a. gesture to an object b. bring hands together c. reach for an object with one hand d. feed self a biscuit - Answer B A healthy infant at age 9-11 months is expected to : a. roll from back to stomach b. imitate "bye-bye"
c. play peek-a-boo d. hand toy on request - Answer C A healthy 2 year old child is able to: a. speak in phases of two or more words b. throw a ball at a target c. scribble spontaneously d. ride a tricycle - Answer A At which age would a child likely start to imitate housework? a. 18 months old b. 24 months old c. 30 months old d. 36 months old - Answer A A healthy 3 year old child is expected to: a. give his or her first and last name b. use pronouns c. kick a ball d. name a best friend - Answer A A healthy 6 to 7 month old is able to a. roll from back to stomach b. confidently feed self a cracker c. reach for an object d. crawl on abdomen - Answer A You examine a healthy 9 month old infant from a full term pregnancy can expect to find that the infant a. sits without support b. cruises c. has the ability to recognize his or her own name d. imitates a razzing noise - Answer C A healthy 3 year old child is in your office for well child care. You expect this child to be able to:
c. reaching to a desired object d. walking backward - Answer B and C It is considered a developmental "red flag" if a child does not respond to his or her name by nine moths of age? True or False - Answer False A child needs to demonstrate more than one developmental "redflags" to warrant further evaluation True or False - Answer False The presumptive diagnosis of fragile X syndrome can be confirmed by a blood test True or False - Answer True The following chromosomal syndrome is a common etiology of social and verbal developmental delays in boys. A. tay sachs b. cystic fibrosis c. fragile X d. trisomy 18 - Answer C One physical sign of fragile X syndrome in males includes: a. large eyes b. large forehead c. small head d. recessive jaw - Answer B Klinefelter syndrome is most commonly marked by: a. language impairment in males b. fine motor delay in males c. hip and breast enlargement in women d. attention deficit disorder in males - Answer A Klinefelter syndrome and risk for having a child with thihs condition can be accurately identified by (choose all that apply) a. urine test
b. literacy assessment c. amniocentesis d. blood testing for carrier state - Answer C and D At which of the following ages in an infant's life is parental anticipatory guidance about teething most helpful? a. 1-2 months b. 2-4 months c. 4-6 months d. 8-10 months - Answer C At which of the following ages in a young child's life is parental anticipatory guidance about temper tantrums most helpful? a. 8-10 months b. 10-12 months c. 12-14 months d. 14-16 months - Answer B At which of the following ages in a young child's life is parental anticipatory guidance about using "time out" as a discipline method most helpful? a. 12-18 months b. 18-24 months c. 24-30 months d. 30-36 months - Answer B At which of the following ages in a young child's life is parental anticipatory guidance about protection from falls most helpful? a. birth b. 2 months c. 4 months d. 6 months - Answer A At which of the following ages in a young child's life is parental anticipatory guidance about toilet training readiness most helpful? a. 12 months b. 15 months c. 18 months
