DEVELOPMENTAL MILESTONES

1 – 12 MONTHS

Age Gross Motor Fine Motor Language Social/Cognitive

Attempts to hold Maintains fisted Cries when Ga es on parent s
1 month head up when prone hands upset/hungry face when parent
speaks
Begins to hold Holds object Makes cooing Begins to smile at
head up when placed in and gurgling people as a
2-3 months Makes smoother hand sound response
movements with Turns head mechanism
extremities toward sounds
Hold head steady Hold objects with Laughs Cries when playing
and unsupported palmar grasp Begins to stops
Rolls from Brings hands to babble and Copies smiling
stomach to back mouth copies sounds expression
Sits with support Can swing at heard Calmed by parent s
4-5 months
dangling toys Distinction voice
between cries
for different
needs

Rolls in both Moves objects Takes turns Knows who is

directions from one hand to with parent familiar and who is
(stomach to back, the other while making a stranger
vice versa) sounds (stranger anxiety)
Sits without Responds to Responds to the
6-9 months assistance own name emotions of others
Begins to crawl Strings together
Will bounce when vowels
standing Begins to say
BIRTH WEIGHT consonants
DOUBLED
Pulls to stand Begins to use 2 Understands Plays peek-a-boo
Walk with finger grasp to “no Watches the path
10-12 assistance pick things up Makes a lot of of something as it
months (pincer grasp) different sounds falls
Copies gestures
of others
 DEVELOPMENTAL MILESTONES
1 – 4 YEARS
Age Gross Motor Fine Motor Language Social/Cognitive
Walks holding 2 finger pincer MAMA/DADA May have separation
furniture grasp Says 3-5 words anxiety
May walk first Hits 2 objects Waves goodbye Shy with others
steps alone together Shake head n Shows fear
Crawls upstairs Copies gestures Tries to mimic words Search for hidden
12 months Cooperate with Put/take out things being said objects
dressing by offering from a container Follows simple directions
arm or leg Pokes with index Peek-a-b !
BIRTH WEIGHT finger (Think:
TRIPLED pokes is with ONE
finger)
Always walks alone Builds tower with Says 10+ words Temper tantrums
Walks up and 3-4 blocks Identifies common Ownership MINE!
downstairs with Turns 2-3 pages at objects Imitates others
help a time Points to show what Plays pretend
18 months Throws a ball Scribbles he/she wants Explores alone with
overhand Drinks from a cup Follows 1 step verbal parents close by
Jumps in place Eats with a spoon commands i
Will help undress d n
self
Walks up and Builds tower with Vocabulary 300+ PARALLEL PLAY
downstairs alone 6-7 blocks words Begins to gain
1 step at a time Turns 1 page at a Can form 2-3 word independence from
Run without falling time phrases (Think: 2 parents
2 years words = 2 years old)
Kicks ball Draws line Gets excited with other
States own name children around
Points to things or
pictures that are named
Walks upstairs Draws a circle Can form 3-4 word Begins ASSOCIATIVE
alternating feet Feeds self without sentences (Think: 3 PLAY
Pedals a tricycle assistance words = 3 years old) Toilet trained except for
(Think: Tri for 3 Grips marker with Ak h wiping (Think: 3 for pee-
3 years years) fingers instead of States age pee)
Jumps forward fist Follows 2-3 steps Has imaginary friends
instructions (Think: 3
steps for 3 years old)
Hops on one foot Draws a square Sings a song from Plays mom and dad
(Think: of your feet (Think: a square memory Would rather play with
in a flamingo shape has 4 sides) Tells stories other children than
looks like a 4) Pours liquid States first and last alone
4 years
Climbs and jumps Cuts with name Begins creative/make
Catches a ball 50% supervision C ec l e he and believe play
of the time Mashes own food he
 NCLEX IMMUNIZATION SCHEDULE
A simplified schedule of the most important immunizations for exams

IMMUNIZATION AGE
Hepatitis B (HepB) Birth, 1-2 months, 6-18 months
Inactivated Polio Virus (IPV) 2 months, 4 months, 6-18 months, 4-6 years
2 months, 4 months, 6 months, 15-18
DTaP (<7 years old)
months, 4-6 years
Pneumococcal Conjugate Vaccine (PVC) 2 months, 4 months, 6 months, 12-15 months
Haemophilus influenzae type b (Hib) 2 months, 4 months, 6 months, 12-15 months
Influenza 6 months, yearly routine
MMR (Measles, Mumps, Rubella) 12-18 months, 4-6 years
Varicella 12-15 months, 4-6 years
Hepatitis A (HepA) 12-24 months, 6 months after first dose
Meningococcal B Recommended at 16 years

Minimum age for Hepatitis B vaccine Birth

Minimum age for DTaP vaccine 6 weeks
Minimum age for IPV 6 weeks
Minimum age for Hib 6 weeks
Minimum age for PCV 6 weeks
Minimum age for influenza vaccine 6 months
Minimum age for MMR 12 months
Minimum age for varicella 12 months
Minimum age for Hepatitis A vaccine 12 months
Minimum age for Human Papillomavirus (HPV) vaccine 9 years
11-12 years for routine vaccine
Minimum age for Tdap >7 years old
7 years for catch-up vaccine
 PEDIATRIC VITAL SIGNS CHEAT SHEET

HEART RATE
AGE HEART RATE
Neonate (1-28 days) 110 – 180 bpm
Infant (1-12 months) 110 – 160 bpm
Toddler (1-3) 80 – 110 bpm
Preschool Child (3-6) 70 – 110 bpm
School-age Child (6-12) 65 – 105 bpm
Adolescent (12-18) 60 – 100 bpm

RESPIRATORY RATE
AGE RESPIRATORY RATE
Neonate (1-28 days) 30 – 60 breaths/min
Infant (1-12 months) 30 – 60 breaths/min
Toddler (1-3) 24 – 40 breaths/min
Preschool Child (3-6) 22 – 34 breaths/min
School-age Child (6-12) 18 – 30 breaths/min
Adolescent (12-18) 12 – 18 breaths/min

BLOOD PRESSURE
SYSTOLIC
AGE SYSTOLIC DIASTOLIC
HYPOTENSION
Neonate (1-28 days) 60-90 20-60 <60 (0 – 28 days old)
Infant (1-12 months) 70 – 105 35 – 55 <70 (1mo – 12mo)
Toddler (1-3) 85 – 105 40 – 65 <70 + (age in years x 2)
Preschool Child (3-6) 90 – 110 45 – 70 <70 + (age in years x 2)
School-age Child (6-12) 97 – 120 55 – 70 <70 + (age in years x 2)
Adolescent (12-18) 110 – 130 65 – 80 <90

TEMPERATURE
AGE TEMPERATURE
Rectum: 97.9°F (36.6°C) – 100.4°F (38°C)
Infants – children <5 years old
Oral: 95.9°F (35.5°C) – 99.5°F (37.5°C)
(the younger the child, the higher the baseline
Axillary: 97.8°F (36.5°C) – 99.5°F (37.5°C)
temperature)
Ear: 96.4°F (36.7°C) – 100.4°F (38°C)
Children >5 years old 98.6°F (37°C)

OXYGEN SATURATION
GOAL ALWAYS: >95% SpO2

*Ranges will vary in each nursing program

 CHILDHOOD SYNDROMES
NAME INHERITANCE SIGNS/SYMPTOMS
Intellectual disability, small head, small eyes, cleft
Pa a S ndrome Trisomy 13
lip, clenched hands, malformed ears

Intellectual disability, small head, small jaw,

clenched hands, overlapping fingers, malformed ears
Ed ard S ndrome Trisomy 18
Typically die in utero; many born will die
within 1st week of life

Intellectual disability, flat face, almond

Down Syndrome Trisomy 21
shaped/upward slanting eyes, single palmar crease

Lack of development in testes, breast growth, tall

47 XXY
Klinefel er S ndrome stature, skeletal and cardio abnormalities, lack of
ONLY MALES
testosterone, absent facial/body hair
Webbed neck, short stature, small breasts, infertility,
45 X or XO
T rner S ndrome small hips, hypertension, hypothyroidism, visual
ONLY FEMALES
problems
Long face, long ears, large testes, mild to moderate
Fragile X Syndrome X linked
autistic behavior, attention deficit, shyness
Hypothalamic dysfunction, severe obesity, constant
Inactive paternal copy
Prader Willi Syndrome hunger, short stature, low muscle tone, behavior
Chromosome 15
problems

Inactive maternal copy Severe intellectual disability, ataxia, convulsions,

Angelman Syndrome
Chromosome 15 excessive laughing, almost absent speech
 HEPATITIS
INFLAMMATION OF THE LIVER CAUSED BY A VIRAL INFECTION

A B C D E
Acute ONLY Acute & Chronic Acute & Chronic Acute & Chronic Acute ONLY
“B” is in the middle 75-85% turn chronic “B” and “D” are
of “A” and “C” Best buDs
Transmission Fecal-Oral Route Body fluids, Body fluids, Blood Body fluids, Blood Fecal-Oral Route
Blood, Birth, Sex Most Common: IV Most Common: (uncooked meats, 3rd
Drug Use middle east, world countries)
Mediterranean,
Europe

Signs and • N/V/D

Symptoms • Abd pain
• Jaundice
• Dark Urine
• Joint Pain
• Fever/Fatigue
Diagnostic Anti-HAV: Anti-HBs: Acute <6mo Anti-HDV: Anti-HEV:
testing antibodies detected previous/immune antibodies detected antibodies detected
Chronic: Anti-HCV:
(+) IgM – active HBsAg – active antibodies detected
infection infection
(+) IgG = “Gone” –
recovered or
immune
Treatment Acute: none Acute: none Acute: Rare but Acute: none Acute: none
Recover on own Recover on own treated like chronic Recover on own Recover on own
Chronic: Chronic: Chronic:
• Antivirals • Antivirals • Antivirals
• Interferons (ribavirin) in • Interferons
(Peginterferon- conjunction with
alpha 2a) an interferon
Prevention 1. HepA vaccine: 1. HepB vaccine: NO VACCINE OR 1. HepB vaccine: NO VACCINE!
pediatric schedule pediatric PEP! occurs in the 1. Cook meat
2. If exposed: PEP schedule, jobs, 1. Hand hygiene presence of B! 2. Hand hygiene
within 24hr adults with 2. Sharp precautions 2. Hand hygiene
3. Hand hygiene diabetes 3. Blood and organ
2. If exposed: PEP donor screening
within 24 hours
3. Hand hygiene
4. Safe sex

Function of the liver: Teach:

• Filter blood • H: hand hygiene
• Metabolize drugs • E: eat low fat/high carbs
• Bile production for fat • P: personal hygiene products do NOT share
• Stores sugar, vitamins, minerals • Rest for the liver
• Coagulation • Small meals
• Breaks ammonia into urea • Avoid alcohol, aspirin, acetaminophen, sedatives
• SubQ interferon injections
 ALL ABOUT INSULIN
RAPID-ACTING SHORT-ACTING INTERMEDIATE-ACTING LONG-ACTING
1. Aspart AKA: Regular Insulin AKA: NPH KEY: NO PEAK
THINK: “Move your
KEY: This is the ONLY KEY: If given with • CAN’T BE MIXED
Ass” Ass-part WITH OTHER
insulin type given IV regular insulin, draw up:
2. Lispro route clear-to-cloudy INSULIN!
THINK: “Let’s go!!” 1. Detrimir
• Can be given with NPH THINK: R-N Regular
Lispro THINK: “Lasts all year”
at the same time in the before NPH (clear before
3. Glulisine cloudy) lasts a long time
same syringe
THINK: Glue dries fast • Can be given with 2. Lantus
• Given 2x/day
long-acting at the same THINK: “Lantern”
Onset: 15 MIN! time in a different lanterns burn for a long
Peak: 30-90 minutes syringe time
Duration: 3-5 hours 3. Glargine
Onset: 30-60 minutes THINK: “Large” lasts
Peak: 2-4 hours for a large amount of
Duration: 5-8 hours time
Onset: 60-120 minutes
Peak: 4-12 hours
Duration: 14 hours
(hence, given 2x/day) Onset: 60-120 minutes
WHEN DO YOU EAT? Peak: NO PEAK
Duration: 24 hours
1. Rapid-acting: Covers insulin needs for meals eaten at the same time
of injection
2. Short-acting (Regular): Covers insulin needs for meals eaten within
REMEMBER
30-60 minutes of injection TYPE 1: YOU HAVE
3. Intermediate-acting (NPH): Covers insulin needs for half the day NONE
or overnight; typically given morning and night • NO insulin being produced
4. Long-acting: Covers insulin needs for the full day; can be combined • Patients will need insulin!
with other insulin but never mixed TYPE 2: THE PROBLEM
IS YOU
RULES OF INSULIN • Encourage healthy diet and
exercise
• Watch for signs and symptoms of hypoglycemia shaky, clammy,
pale, sweaty • Potential oral medication
o THINK: “Cool and clammy, give me candy” use
o IF AWAKE: Ask the patient to eat (candy, juice, low fat milk) • Insulin (last resort)
o IF UNCONSCIOUS: Stab with IV D50
• Regular insulin: ONLY insulin given IV
• NPH: If mixed, clear-to-cloudy (NPH is cloudy)
• Long-acting: Do not mix; NO PEAK
• Rotate injection sites do not aspirate/massage
• Always increase insulin with: (glucose with any type of stress) INSULIN PUMP
o Stress • Give a steady dose of insulin for
o Sepsis Type 1 DM
o Sickness • Check BG 4x/day
o Steroids • Push bolus at meals
 PIAGET’S STAGES OF DEVELOPMENT
Age Piaget’s Stage Developmental Qualities
SENSORIMOTOR STAGE – • Object permanence
the newborn is experiencing the • Stranger anxiety
Birth – 2 years old world through senses and • Behaviors to noises
actions • Develop our senses
PREOPERATIONAL STAGE • Irreversibility
– representing the world • Pretend play
2 – 6 years old symbolically (objects with • Egocentrism
words and images) but lacking • Language development
logical reasoning
CONCRETE • Conservation (something can
OPERATIONAL STAGE – stay the same in quantity but
development of logical thought look different)
about concrete events and grasps • Reversibility
7 – 11 years old concrete analogies • Mathematics
“If nothing is added or taken
away, then the amount of
something stays the same”
• No longer limited by what is
FORMAL OPERATIONAL seen or heard
STAGE – able to think in an • Can transcend a concrete
12 years – Adulthood abstract manner (ex: beauty, situation and think about the
love, freedom, morality) future
• Moral reasoning

TYPES OF PLAY BY AGE GROUP

Age Type of Play Description
Solitary alone; child plays on their own even
0 – 2 years old Solitary Play
in a room full of children
Spectate watch; child observes other children
2 – 2.5 years old Spectator Play
playing
Parallel “next to;” child will play next to other
2.5 – 3 years old Parallel Play
children but not with them
Associate same; child will be playing the
3 – 4 years old Associate Play same activity as others but not
working/associating together
Cooperate interact with others; children learn
4 – 6 years old Cooperative Play
to play with others; using social skills to interact
 ERIKSON S STAGES OF DE ELOPMENT

Important Outcome (Favorable and

Age Basic Conflict
Events Unfavorable)

Favorable: Children develop a

sense of faith in the environment
Infancy: and to caregivers love and
Trust vs Mistrust Feeding
Birth 18 months affection
Unfavorable: Suspicion and fear
of people/events

Favorable: Children develop

personal control over behavior
Early Childhood: Autonomy vs Shame and actions. Child feels adequate
Toilet Training
2 3 years and Doubt and independent
Unfavorable: Feelings of shame
and self-doubt

Favorable: Ability of the child

to take initiative and be assertive.
Preschool:
Initiative vs Guilt Exploring Leads to a sense of purpose
3 5 years
Unfavorable: Feeling guilty and
inadequate

Favorable: Ability to learn and

School Age: Industry vs Attending grow socially/academically
6 11 years Inferiority School (feeling competent)
Unfavorable: Feeling inferior

Favorable: Abili o ee one

self as unique. Develop a sense
Adolescence: Identity vs Role Social of personal identity while staying
12 18 years old Confusion Relationships true to yourself
Unfavorable: Feeling lonely,
isolated and confused
 PEDIATRIC CPR
INITIAL STEPS
1. Scan the environment for safety
2. Check for response:
INFANT (<1 year old) Flick the bottom of the foot to elicit a response
CHILD (1 Puberty) A e o oka ?
3. Call for help
Delegate someone else to call 911
Delegate someone else to get AED
In hospital initiate rapid response
4. Assess breathing
Remove clothes if possible
For children AND infants: unresponsive, no breathing, gasping not normal
No more than 10 SECOND assessment
5. Assess pulse
Infant: BRACHIAL
Child >1 year old: CAROTID
No more than 10 SECOND assessment

INITIATE CHEST COMPRESSIONS

Child ine i o ed on a fi m face
Rate: 100 120 compressions/minute
Cycle: 30:2 30 compressions; 2 breaths; repeat FIVE cycles
Minimize compression interruptions to <10 seconds when assessing for pulse in between cycles
Attach and use AED as soon as possible resume compressions immediately after each shock
Breaths: head-tilt/chin lift position
o Observe rise in chest when initiating a breath ha ho o kno ho fo cef l o
should be
Infants: lower sternum, midline, below the nipples (draw an imaginary line)
Typically use two fingers
Depth: 1.5in/4cm
Breaths: use your mouth to cover infant mouth AND nose to initiate rescue breaths
Child 1-8 years old: lower half of the sternum
Typically use heel of one hand or two hands interlocked depending on size of child
Depth: 2in/5cm (THINK: 2 hands or 5 fingers)

AED TIPS
If NO pediatric pads available, adult pads can be used on a child 1 8 years old placement may
be different:
o <1 year old manual defibrillator is encouraged
o 1 8 years old place one adult pad on the front of chest and one on the back of chest
o >8 years old pad placement is the same as adults (high right/low left)