Physical Growth, teething,safety

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Physical Growth, teething,safety immunizations
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Height vs. length Whats 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.

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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.

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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.

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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
• Tommys dad is 64 tall. His mom is 55 tall.
  What is Tommys estimated adult height?
• A) 511
• B) 6
• C) 61
• D) 64
• Tommys current height places him in the 25th
  percentile. His mother asks if this is normal.
  How do you respond?

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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 61.
• 3. Since no other measurements are available to
  plot you should tell Tommys 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 Tommys previous health care
  provided.

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What did you learn?

• 1. Tomikas birth weight was 8 3 oz. She is now
  six months old. What would you expect Tomika to
  weigh?
• A) 16
• B) 16 6 oz
• C) 15 11 oz
• D) unable to determine base on information given
• 2. What is Tomikas 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 Tomikas weight gain at birth, six
  month and 12 months. What can you tell Tomikas
  mother about her weight gain?

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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. Tomikas
  weight gain is within the same range during the
  first year of life. Her weight gain can be
  considered normal.

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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 lt 1.25cm (1/2) per year
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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.?

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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.
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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.

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Teething signs, symptoms, and management

• Contrary to popular belief fever gt101, vomiting,
  or diarrhea are NOT symptoms of teething
• However low-grade fever lt101 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.

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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.

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What have you learned?

• 1. Teething infants have their first tooth by 10
  months of age.
• True
• False
• 2. Using the rule of thumb calculation an
  eighteen months old child would likely have how
  many teeth?
• A) 10
• B) 12
• C) 14

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What have you learned?

• 3. Dental visit should begin at what age?
• A) 12 months
• B) 24 months
• C) 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
  childs mouth?
• A) true
• B) false

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How did you do?

• Bteething generally starting around 6 months
• B
• A
• Going to sleep with a bottle should be strongly
  discouraged in order to decrease the risk of
  dental caries
• A

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Injury prevention in infancy

• Read pages 552-553. Review Box 12-6 on page
  553-554. Answer the following questions.
• Baby powder can cause aspiration.
• A) True
• B) False
• 2. Mylar balloons are a potential source of
  suffocation.
• A) True
• B) False

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Injury prevention in infancy

• In order to get a child to take a medicine it is
  O.K. to tell him the medicine is candy.
• A) True
• B) False
• Which of the following is the leading cause of
  injury in infants under one year of age.
• Falls
• Burns
• Aspiration and suffocation
• Poisoning

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How did you do?

• A
• B it is latex balloons that have the potential
  for causing aspiration/suffocation.
• B
• C

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Injury Prevention in toodlerhood

• Read pages 630-640 in your textbook. Review table
  14-8 on page 631. Answer the following questions.
• Unrestricted freedom achieved through locomotion
  makes toddlers at great risk for injury.
• A) True
• B) False
• 2. Toddlers are too young to be taught to obey
  traffic regulations.
• A) True
• B) False

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Injury Prevention in toodlerhood

• 3. Because of their small size they cannot reach
  poisons placed in the highest cabinet in the
  kitchen.
• A) True
• B) False
• 4. Teaching swimming to children under age four
  years provides the child with drown proofing
• A) True
• B) False

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How did you do?

• A
• B
• B
• B

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Injury prevention in the school-aged child

• Read pages 682-696 in your textbook. Answer the
  following questions. Write this National Poison
  Control Center telephone number down next to your
  telephone [phone] or for Atlanta
  404-616-9000
• (located at Hughes Spalding Childrens Hospital).
• WWW.Georgiapoisoncenter.org
• Which of the following is a commonly ingested
  poison?
• A) Cosmetics
• B) Cleaning products
• C) Analgesics
• D) all of the above
• Continued on next slide

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Injury prevention in the school-aged child

• Identify at least four common signs of poisoning.
• What should be the first Emergency treatment
  provided for a poison victim?
• A) Identify the poison
• B) Induce vomiting
• C) Assess the victim
• D) Contact the Poison Control Center

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Injury prevention in the school-aged child

• 4. 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 ride
• A) with traffic
• B) against traffic so you can see oncoming cars
• C) either way is acceptable

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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 charcoal
• B) Saline gavage
• C) N acetylcysteine (NAC) (Mucomyst)
• D) syrup of ipecac

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How did you do?

• D
• See Box 16-7 on page 685
• C
• A
• A
• B
• C

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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

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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

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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.

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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).

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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.

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Immunizations Test your knowledge

• When should the third dose of Hepatitis B be
  given?
• A) Eight weeks after the first dose
• B) at least 16 weeks after the first dose
• C) before six months of age
• D) any age is O.K.

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Immunizations Test your knowledge

• 2. The second dose of MMR is routinely
  recommended at what age?
• A) age 2 years
• B) age 3 years
• C) age 4-6 years
• D) any time after the first birthday

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Immunizations Test your knowledge

• 3. Mild illness is a reason to withhold
  vaccination.
• True
• False
• 4. If there is an immunosuppressed child in the
  household, siblings should receive MMR and
  varicella vaccines
• True
• False

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ImmunizationsTest your knowledge

• 5. Two month old Terri was born prematurely. Her
  mother wants to know when Terri will receive her
  immunizations. You advise Terris mother that
  premature infants receive immunizations
• Based on number of weeks born premature
• Based on chronologic age
• Based on how well the infant is doing
  developmentally
• Based on corrected age for prematurity

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How did you do?

• 1. B
• 2. C
• 3. B
• 4. B
• 5. B

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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.ht
  m

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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 nurses 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

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

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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 theyre have to be
  rescheduled. There has to be a full four weeks
  between the first and second vaccines

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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 age
• B) by 24 weeks of age
• C) by 16 weeks of age
• D) by 12 weeks of age
• The answer is A