Master pediatric nursing for the NCLEX! This comprehensive guide covers growth and development, common pediatric conditions, safety protocols, and critical nursing interventions that are frequently

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What You'll Master

 Age-specific growth and development milestones  Pediatric medication calculations and safety

 Common childhood illnesses and nursing interventions  Immunization schedules and contraindications

 Emergency pediatric conditions and priorities  Family-centered care principles

???? Growth & Development by Age Group

Infants (0-12 months)

Physical Development 0-3 months:

  ✅ Lifts head when prone

  ✅ Follows objects with eyes

  ✅ Social smile (2-3 months)

  ✅ Birth weight doubles by 6 months

3-6 months:

  ✅ Rolls over (4-6 months)

  ✅ Sits with support

 ✅ Babbles and coos

  ✅ Reaches for objects

6-12 months:

 ✅ Sits without support (6-8 months)

  ✅ Crawls (8-10 months)

 ✅ Pulls to stand (9-12 months)

 ✅ First words (10-12 months)

  ✅ Birth weight triples by 12 months

Safety Priorities

  SIDS prevention: Back to sleep, firm mattress, no loose bedding

  Aspiration risk: Small objects, choking hazards

  Fall prevention: Never leave unattended on elevated surfaces

Nursing Considerations

 Stranger anxiety peaks around 8-9 months  Separation anxiety begins around 6 months

  Assess primitive reflexes (should disappear by 12 months)

Toddlers (1-3 years)

Physical Development

  ✅ Walks independently (12-15 months)

 ✅ Runs and climbs stairs (18-24 months)

  ✅ Vocabulary grows from 10-50 words to 1000+ words

 ✅ Toilet training readiness (18 months-3 years)

  ✅ Height increases 3-5 inches per year

Behavioral Characteristics

  Parallel play: Plays alongside but not with other children

 Negativism: "No" is a favorite word

  Temper tantrums: Normal part of development

  Ritualistic behavior: Needs routine and consistency

Safety Priorities

  Poisoning prevention: Cabinet locks, poison control number

  Drowning prevention: Never leave alone near water

  Motor vehicle safety: Rear-facing car seat until age 2

Nursing Considerations

 Use simple, concrete language

  Provide choices when possible ("Do you want to take your medicine with apple juice or water?")

  Allow comfort items during procedures

Preschoolers (3-5 years)

Physical Development

  ✅ Rides tricycle (3 years)

 ✅ Hops on one foot (4 years)

 ✅ Skips (5 years)

  ✅ Fine motor skills improve (drawing, buttoning clothes)

 ✅ Height increases 2.5-3 inches per year

Cognitive Development

 Magical thinking: Believes thoughts can cause events  Animism: Gives life-like qualities to inanimate objects  Centration: Focuses on one aspect at a time

 Beginning understanding of time and sequence Safety Priorities

  Injury prevention: Teaching safety rules about streets, strangers

  Fire safety: Teaching stop, drop, and roll

  Bicycle safety: Always wear helmet

Nursing Considerations

 Explain procedures in simple terms  Use play therapy and medical play  Address fears and misconceptions

 Allow child to help with care when possible

School-Age Children (6-12 years)

Physical Development

  ✅ Steady growth (2 inches/year in height, 4-7 lbs/year in weight)

 ✅ Permanent teeth begin erupting (6 years)

  ✅ Improved coordination and strength

  ✅ Sexual maturity may begin (girls 8-10, boys 9-11)

Cognitive Development

  Concrete operational thinking: Logical thought about concrete objects

  Classification abilities: Can group and sort

  Conservation understanding: Quantity remains same despite shape change

 Cause and effect relationships

Social Development

  Peer relationships: Friends become very important

 Team sports and group activities  Rule-oriented play and games

 Industry vs. inferiority (Erikson) Nursing Considerations

  Include child in healthcare decisions

 Provide honest, age-appropriate explanations  Respect need for privacy

  Encourage questions and expression of feelings

Adolescents (13-18 years)

Physical Development

 Puberty: Rapid physical and hormonal changes  Growth spurts: May grow 4+ inches in one year  Secondary sexual characteristics develop

  Brain development continues (prefrontal cortex not fully mature until mid-20s)

Cognitive Development

  Formal operational thinking: Abstract reasoning abilities

  Idealistic thinking: Sees world in absolutes

  Personal fable: Believes they are unique and invulnerable

  Imaginary audience: Feels constantly watched and judged

Psychosocial Development

  Identity formation: "Who am I?"

  Peer influence: Conformity to group norms

 Risk-taking behaviors

 Struggle for independence

Nursing Considerations

 Provide confidential care when appropriate  Respect autonomy while ensuring safety

 Screen for risky behaviors (substance use, sexual activity)  Support healthy identity formation

Pediatric Immunizations

Standard Immunization Schedule (Key Ages)

Birth - 2 Months

  Hepatitis B: Birth, 1-2 months, 6-18 months

 Vitamin K: Given at birth to prevent hemorrhagic disease

2 Months

 DTaP (Diphtheria, Tetanus, Pertussis)

 IPV (Inactivated Polio Vaccine)

  Hib (Haemophilus influenzae type b)

 PCV13 (Pneumococcal)

 RV (Rotavirus)

4 Months

  Repeat: DTaP, IPV, Hib, PCV13, RV

6 Months

  Repeat: DTaP, IPV, Hib, PCV13, RV

  Influenza (yearly, starting at 6 months)

12-15 Months

 MMR (Measles, Mumps, Rubella)

 Varicella (Chickenpox)

 Hib (final dose)

 PCV13 (final dose)

15-18 Months

 DTaP (4th dose)

4-6 Years (School Entry)

 DTaP (5th dose)

 IPV (final dose)

 MMR (2nd dose)

 Varicella (2nd dose)

11-12 Years

  Tdap (Tetanus, diphtheria, pertussis booster)

  HPV (Human Papillomavirus) - 2-3 doses

 MenACWY (Meningococcal)

Contraindications and Special Considerations Live Vaccines (MMR, Varicella, Nasal FluMist) Contraindicated in:

  ✅ Immunocompromised children

 ✅ Pregnancy

 ✅ Severe illness with fever

  ✅ Recent blood product administration

General Contraindications

  Previous severe allergic reaction to vaccine or component

  Moderate to severe acute illness

  For DTaP: Previous encephalopathy within 7 days

Important Nursing Actions

 ✅ Verify parental/guardian consent

  ✅ Check immunization history and catch-up schedules

  ✅ Assess for contraindications and allergies

  ✅ Have epinephrine available for severe reactions

  ✅ Provide VIS (Vaccine Information Statements)

  ✅ Document date, lot number, site, and route

???? Common Pediatric Conditions

Respiratory Conditions

Croup (Laryngotracheobronchitis) Signs & Symptoms:

 Barking cough (classic sign)

 Stridor (inspiratory noise)

 Hoarse voice

 Low-grade fever  Worse at night

Nursing Interventions:

  ✅ Cool mist therapy

  ✅ Corticosteroids (dexamethasone)

 ✅ Monitor respiratory status

  ✅ Keep child calm (crying worsens symptoms)

  ✅ Racemic epinephrine for severe cases

Epiglottitis (Medical Emergency!) Signs & Symptoms:

 High fever (>39°C/102°F)  Difficulty swallowing

 Drooling

 Tripod position  Muffled voice

 Toxic appearance

Critical Nursing Actions:

  ⚠ DO NOT examine throat or use tongue depressor

 ⚠ DO NOT lay child flat

  ✅ Allow position of comfort

  ✅ Prepare for emergency intubation

  ✅ Have tracheostomy equipment ready

 ✅ IV antibiotics (usually ceftriaxone)

Bronchiolitis (RSV) Signs & Symptoms:

 Wheezing and crackles  Nasal congestion

 Poor feeding  Irritability

 Tachypnea

Nursing Interventions:

  ✅ Contact isolation

  ✅ Supportive care (hydration, oxygen)

 ✅ Monitor respiratory status

  ✅ Suction nasal passages

  ✅ Small, frequent feedings

Gastrointestinal Conditions

Pyloric Stenosis Signs & Symptoms:

 Projectile vomiting (non-bilious)  Olive-shaped mass in epigastrium  Visible peristalsis

 Failure to thrive  Dehydration

Nursing Care:

 ✅ NPO before surgery

 ✅ Monitor fluid and electrolyte balance

  ✅ Position on right side after feeding

  ✅ Post-op: gradual feeding progression

Intussusception Signs & Symptoms:

 Severe cramping abdominal pain

 Vomiting

  Currant jelly stools (blood and mucus)

 Palpable mass

 Lethargy between episodes

Nursing Care:

 ✅ NPO

  ✅ IV hydration

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