Physical Growth, teething,safety & immunizations

Physical Growth in Height

AGE Height

Infants

Birth -6mo Monthly gain=2.5cm(1”)

6-12mo Monthly gain=1.25cm(1/2”)

Toddlers Height at 2yr is~50%of ventual adult height. Gain during 2ndyr ~12cm (4 3/4”). Gain during 3rdyr. ~6-8 cm (2 -3”)

Physical Growth in Height

Age HeightPreschoolers Birth length doubles by age 4yr.

Yearly gins=5-7cm(2-3”)

School-Age Children Yearly gain after age 7yr = 5cm (2”).

Birth length triples by ~ age 13yr

Pubertal Growth Spurt

Females ~95% of mature height achieved by onset of menarche or skeletal growth of

age 13yr.

Males ~95% of mature height achieved by skeletal age of 15yr.

Height vs. length – What’s the difference?

Height – measurement taken in the standing position. Used on children three years of age and greater.

Length – measurement taken with the child in the supine/recumbent position. Used in children birth to three years.

Here is an important concept to remember!

More important than a single plot in height, weight, or head circumference is the pattern of velocity in growth over time; whether or not growth has continued in a steady pattern or has had a downward slid or a jump upward over time.

When determining if growth in height, weight, or head circumference is ”normal” for age at least three plotted measurements are necessary.

How tall am I going to be? Using the following formula a close

estimation of adult height potential can be calculated:

Boys: Paternal height + maternal height (in inches) + 5 divided by 2

Girls: paternal height +maternal height – 5 divided by 2.

What have you learned so far? Tommy was 19.5” in length at birth. How tall would you expect

him to be at age 4 years?A) 37.5”B) 32”C) 39”D) 35”

Tommy’s dad is 6’4” tall. His mom is 5’5’’ tall. What is Tommy’s estimated adult height?A) 5’11”B) 6’C) 6’1”D) 6’4”

Tommy’s current height places him in the 25th percentile. His mother asks if this is “normal”. How do you respond?

Did you get it right? #1. 19.5 x 2 = 39” (remember height generally

doubles by age 4 years.)

#2. 76” + 65” + 5” = 146”/2 = 73” or 6’1”.

#3. Since no other measurements are available to plot you should tell Tommy’s mother that while his growth appears within normal range you cannot determine if his growth is progressing as expected within additional measurements. His mother should be encouraged to bring in growth charts from Tommy’s previous health care provided.

Physical Growth in Weight

Age WeightInfants

Birth-6mo weeklygain140-200gms (5-7oz)

6-12mo B.W doubles by end of first 4-7mo

Toddlers B.W quadruples by age 2 1/2yr

yearly gain ~2-3kg(4-6lbs)

Preschoolers yearly gain 2-3kg

School-Age yearly gain 2-3kg

Pubertal growth spurt

Females 7-25kg(15-55lbs)

Males 7-30kg (15-65lbs)

What did you learn? 1. Tomika’s birth weight was 8# 3 oz. She is now six months old. What

would you expect Tomika to weigh?A) 16#B) 16# 6 ozC) 15# 11 ozD) unable to determine base on information given

2. What is Tomika’s expected weight at 12 months of age?A) 24# 9 oz.B) 24# 6 oz.C) 24# 3oz.D) unable to determine base on information given

3. Using the growth chart on page 1888 in your textbook plot Tomika’s weight gain at birth, six month and 12 months. What can you tell Tomika’s mother about her weight gain?

Did you get it right? 1. B 2. A 3. B.W. in the 90th%; 6 month weight

in the 75th%; 12 month weight in the 90th%. Tomika’s weight gain is within the same range during the first year of life. Her weight gain can be considered normal.

Physical Growth in Head Circumference

Age Head Circumference Birth to 3 months Increases approximately 2cm cm (3/4”) per month.

4 month-6 month Increases 1 cm(1/2”) per month.

6month-12months Increases 0.5 cm(1/4”)per month

Second year of life Total increase of 2.5cm(1”)

3-5 years Increase of < 1.25cm (1/2”) per year

More on Head Circumference Head growth is an indirect measurement of brain growth. By 1 year of age head circumference has increased 33%. A decrease in growth velocity of the head circumference

is a RED FLAG suggesting a problem with brain growth and ultimate cognitive and motor development.

An increase in growth velocity of the head circumference is a RED FLAG suggesting possible increased fluid (hydrocephalus) or possibly a mass.

Being the good Georgia Baptist nurse that you are you will be sure to always take the time to measure and plot head circumference until the age of 36 months.

Teething

A guide to deciduous tooth eruption

Tooth location Age at eruption

Central incisors 6-8mo

Lateral incisors 7-10mo

Canine 16-20mo

First molars 10-16mo

Second molars 10-16mo

Teething

A guide guide to assessment of deciduous teethduring the first 2 years is: age of the child inmonths-6=number of teeth.

More on teething

While the previous slide offers a “rule of thumb” to calculate tooth eruption, teething is highly variable and can begin as early as three months of age to as late as 12 months of age.

Tooth eruption process Growth of root, dentin, and pulp of

tooth occurs in utero and early infancy.

Pressure is exerted on the periodontal tissue

Possible hormonal control of pituitary growth hormone and thyroid hormone.

Teething signs, symptoms, and management

Contrary to popular belief fever >101, vomiting, or diarrhea are NOT symptoms of teething

However low-grade fever <101 may occur. Symptom relief include:

Dose appropriate Tylenol (ibuprofen may also be used in infants older than six months)

Frozen teething ring or ice wrapped in a washcloth Over the counter topical anesthetic ointment may

be used cautiously according to package instructions but must not be overused.

Tips on dental hygiene Begins with the first tooth eruption.

Water is recommended over toothpaste initially to avoid potential ingestion and fluoride toxicity.

By the end of the preschool period the eruption of the deciduous (primary) teeth is generally complete.

First visit to the dentist should be around one year of age to allow the child to become accustom the dental office environment.

Going to sleep while sucking on a bottle of milk, juice or any other liquid other than water should be strongly discouraged in order to avoid a condition referred to as “bottle caries” caused by sugar containing liquid coating the teeth during sleep.

Emergency treatment for avulsed tooth

1. Recover tooth

2. Hold tooth by crown,avoiding touching root area

3. If tooth is dirty, rinse gently under running water or saline; be sure toinsert stopper in sink to avoid tooth loss.

4. Insert tooth into socket

5. Have child maintain tooth in place

6. Transport child to dentist immediately

If reluctant to reimplant tooth

Place tooth in suitable medium for transport - either cold milk or saliva(under child’s or parent’s tongue)

What have you learned?1. Teething infants have their first tooth by 10

months of age.A) TrueB) False

2. Using the “rule of thumb” calculation an eighteen months old child would likely have how many teeth?A) 10B) 12C) 14

What have you learned?3. Dental visit should begin at what age?

A) 12 monthsB) 24 monthsC) 36 months

4. How would you council a parent who reports her child goes to sleep with bottle?

5. If possible a tooth that has bee knocked out with trauma should be placed back in place in the child’s mouth?A) trueB) false

How did you do?

1. B–teething generally starting around 6 months

2. B3. A4. Going to sleep with a bottle should be

strongly discouraged in order to decrease the risk of dental caries

5. A

Safety

• Automobiles/bicycles

• Burns

• Poisonings

• Play

• Swimming/drowning

• Suffocation/aspiration

Injury prevention in infancyRead pages 552-553. Review Box 12-6 on

page 553-554. Answer the following questions.

1. Baby powder can cause aspiration.A) TrueB) False

2. Mylar balloons are a potential source of suffocation.A) TrueB) False

Injury prevention in infancy3. In order to get a child to take a medicine it

is O.K. to tell him the medicine is candy.A) TrueB) False

4. Which of the following is the leading cause of injury in infants under one year of age.

A) FallsB) BurnsC) Aspiration and suffocationD) Poisoning

How did you do?

1. A2. B – it is latex balloons that have the

potential for causing aspiration/suffocation.

3. B4. C

Injury Prevention in toodlerhood

Read pages 630-640 in your textbook. Review table 14-8 on page 631. Answer the following questions.

1. Unrestricted freedom achieved through locomotion makes toddlers at great risk for injury.A) TrueB) False

2. Toddlers are too young to be taught to obey traffic regulations.A) TrueB) False

Injury Prevention in toodlerhood

3. Because of their small size they cannot reach poisons placed in the highest cabinet in the kitchen.A) TrueB) False

4. Teaching swimming to children under age four years provides the child with “drown proofing”A) TrueB) False

How did you do?

1. A2. B3. B4. B

Injury prevention in the school-aged childRead pages 682-696 in your textbook. Answer the following

questions. Write this National Poison Control Center telephone number down next to your telephone: 1- 800-222-1222 or for Atlanta 404-616-9000

(located at Hughes Spalding Children’s Hospital).WWW.Georgiapoisoncenter.org

1. Which of the following is a commonly ingested poison?A) CosmeticsB) Cleaning productsC) AnalgesicsD) all of the above

Continued on next slide

Injury prevention in the school-aged child2. Identify at least four common signs of

poisoning.

3. What should be the first Emergency treatment provided for a poison victim?A) Identify the poisonB) Induce vomitingC) Assess the victimD) Contact the Poison Control Center

Injury prevention in the school-aged child4. Water Temperature for how what heater

should be set at what temperature?A) 120o

B) 130o

C) 140o

D) any temperature is o.k.

5. When riding a bicycle a child should rideA) with trafficB) against traffic so you can see oncoming carsC) either way is acceptable

More injury prevention in the school-aged child

6. Which of the following is a clinical manifestation of acetaminophen poisoning?

A. Hyperpyrexia B. Hepatic involvement C. Severe burning pain in stomach D. Drooling and inability to clear secretions

7. The antidote for acetaminophen poisoning is A) activated charcoalB) Saline gavageC) N –acetylcysteine (NAC) (Mucomyst)D) syrup of ipecac

How did you do?

1. D2. See Box 16-7 on page 6853. C4. A 5. A6. B7. C

2006-07 Immunization schedule

The scheduled printed in your textbook on page 536-537 is dated 2006.There are currently no changes for 2007.

The latest immunization schedule can always be obtained from the CDC.gov website

Immunizations: What you need to know Infants & children with mild illness

(with or without fever) may receive immunizations.

Infants & children considered to be moderately to severely ill (with or without fever) should wait to be immunized until their illness has resolved

Immunizations: What you need to know  Varicella vaccine should not be

administered to a person with a family history of congenital or hereditary immunodeficiency in parents or siblings unless that person's immune competence has been clinically substantiated or verified by a laboratory.

Immunizations: What you need to know The appropriate age for initiating

vaccinations in the prematurely born infant is the usual chronologic age (same dosage and indications as for normal, full-term infants).

Immunizations: What you need to know The great majority of persons with

chronic illnesses should be appropriately vaccinated. The decision whether or not to vaccinate these persons, and what vaccines to give, should be made on an individual basis.

Immunizations: Test your knowledge1. When should the third dose of Hepatitis B be

given?A) Eight weeks after the first doseB) at least 16 weeks after the first doseC) before six months of ageD) any age is O.K.

Immunizations: Test your knowledge2. The second dose of MMR is routinely

recommended at what age?A) age 2 yearsB) age 3 yearsC) age 4-6 yearsD) any time after the first birthday

Immunizations: Test your knowledge 3. Mild illness is a reason to withhold

vaccination.A) TrueB) False

4. If there is an immunosuppressed child in the household, siblings should receive MMR and varicella vaccines

A) TrueB) False

Immunizations:Test your knowledge 5. Two month old Terri was born

prematurely. Her mother wants to know when Terri will receive her immunizations. You advise Terri’s mother that premature infants receive immunizations:

A) Based on number of weeks born prematureB) Based on chronologic ageC) Based on how well the infant is doing

developmentallyD) Based on corrected age for prematurity

How did you do?

1. B 2. C 3. B 4. B 5. B

Human Papillomavirus (HPV) & Rotovirus Vaccines

Assess the link below and click on vaccine information about

1)Humanpapilloma virus 2)Rotovirus

After reading the information answer the questions on the following slides

http://www.cdc.gov/nip/publications/VIS/default.htm

Human Papillomavirus vaccine (Gardisil)

While in the office for a well child check up the mother of a 11 year ask if her child should receive Gardisil. The nurse’s best response is which of the following?

A) the vaccine is given to all children beginning at the age of nine

B) the vaccine is given to girls between the ages of 11-13

C) the vaccine is given to boys between the ages of 11-13

D) the vaccine is given only to sexually active teens

Human Papillomavirus vaccine A child receives her first dose of Gardisil on February 20,

2007. The nurse instructs the family to return for her next vaccine when?

A) the week of March 19th 2007B) the week of March 26th, 2007C) at least four weeks after February 20,2007D) all of the above

How did you do 1. B. While females as young as 9 and

as old as 60 can receive the vaccine the target age for initial vaccination is 11-13 years.

2. B or C. ‘A’ would be incorrect because if they came before March 20th they’re have to be rescheduled. There has to be a full four weeks between the first and second vaccines

RotaTeq Rotovirus vaccine

1. A mother of a two month old ask the nurse when her child should have completed the rotovirus vaccines. The best response is which of the following?

A) by 32 weeks of ageB) by 24 weeks of ageC) by 16 weeks of ageD) by 12 weeks of age

The answer is A