Pediatric Nursing

Developmental Milestones

Age	Gross Motor	Fine Motor	Language	Social/Cognitive
2 months	Lifts head prone	Hands open	Coos	Social smile
4 months	Rolls front to back, head control	Reaches for objects	Laughs, squeals	Recognizes parent
6 months	Sits with support, rolls both ways	Transfers objects hand to hand, raking grasp	Babbles	Stranger anxiety begins
9 months	Sits unsupported, crawls, pulls to stand	Pincer grasp developing	Mama/Dada (nonspecific)	Object permanence, separation anxiety peaks
12 months	Walks with assistance (cruising)	Pincer grasp, bangs blocks	1–2 words, follows simple commands	Separation anxiety (peaks 15–18 months)
18 months	Walks independently, runs stiffly	Stacks 3–4 blocks, scribbles	10–20 words, points to body parts	Parallel play begins
2 years	Runs, kicks ball, walks up stairs	Stacks 6 blocks, turns pages	2-word phrases, 50+ words	Parallel play, egocentric, autonomy vs shame
3 years	Rides tricycle, jumps	Copies circle, uses scissors	3–4 word sentences, knows name/age	Associative play, imaginary friends
4 years	Hops on one foot, skips	Copies cross/square, draws person (4 parts)	Tells stories, knows colors	Initiative vs guilt, cooperative play begins
5 years	Skips, catches ball	Ties shoes, prints letters	Complex sentences, 2000+ words	Cooperative play, understands rules
School Age (6–12)	Sports skills refine	Writes cursive by 8	Reading/writing develop	Industry vs inferiority; peer relationships vital
Adolescent (12–18)	Adult motor skills	Fine motor mature	Abstract thinking	Identity vs role confusion; peer pressure, body image

Recommended Immunization Schedule (Key Vaccines)

Vaccine	Schedule	Notes
Hepatitis B	Birth, 1 month, 6 months	First dose within 24 hours of birth
DTaP	2, 4, 6, 15–18 months, 4–6 years	Tdap booster at 11–12 years. Side effects: fever, irritability, soreness
IPV (Polio)	2, 4, 6–18 months, 4–6 years	Inactivated; safe for immunocompromised
MMR	12–15 months, 4–6 years	Live vaccine; contraindicated in pregnancy, immunocompromised, gelatin/neomycin allergy
Varicella	12–15 months, 4–6 years	Live vaccine; avoid aspirin for 6 weeks (Reye syndrome risk)
Hib	2, 4, 6, 12–15 months	Protects against H. influenzae type b meningitis/epiglottitis
PCV13	2, 4, 6, 12–15 months	Pneumococcal conjugate vaccine
Rotavirus	2, 4, (6) months	Oral, live vaccine; do not restart series if delayed
Influenza	Annually from 6 months	First year: 2 doses 4 weeks apart
HPV	11–12 years (2 doses)	Prevents cervical, anal, oropharyngeal cancers
Meningococcal	11–12 years, booster at 16	MenACWY; MenB available for high-risk 16–23 year olds

Common Pediatric Conditions

• Epiglottitis: Medical emergency. Tripod position, drooling, muffled voice, high fever. Do NOT examine throat (risk of complete obstruction). Keep child calm; prepare for intubation
• Croup (Laryngotracheobronchitis): Barking/seal-like cough, stridor, hoarseness. Cool mist humidifier, racemic epinephrine, corticosteroids (dexamethasone)
• RSV/Bronchiolitis: Wheezing in infants < 2 years. Contact precautions. Palivizumab (Synagis) for prophylaxis in high-risk infants. Supportive care
• Kawasaki Disease: Fever ≥ 5 days + 4 of 5: bilateral conjunctivitis, oral changes (strawberry tongue), rash, extremity changes, cervical lymphadenopathy. Treatment: high-dose aspirin + IVIG. Risk: coronary artery aneurysms
• Pyloric Stenosis: Olive-shaped mass RUQ, projectile non-bilious vomiting, visible peristaltic waves. Electrolyte imbalance: metabolic alkalosis. Surgery: pyloromyotomy
• Intussusception: Current jelly stools, intermittent severe colicky pain (draws legs up), sausage-shaped mass. Diagnosis/treatment: air/barium enema reduction; surgery if unsuccessful

Normal Pediatric Vital Signs by Age

Age	Heart Rate (bpm)	Respiratory Rate	Systolic BP (mmHg)
Newborn	120 – 160	30 – 60	60 – 80
Infant (1–12 months)	100 – 150	25 – 40	72 – 104
Toddler (1–3 years)	90 – 130	20 – 30	86 – 106
Preschool (3–6 years)	80 – 120	20 – 25	89 – 112
School Age (6–12 years)	70 – 110	18 – 22	97 – 120
Adolescent (12–18 years)	60 – 100	12 – 20	110 – 131

Pediatric Safety Reminders

• Calculate all medication doses by weight (mg/kg)
• Use a length-based resuscitation tape (Broselow) for emergencies
• Avoid aspirin in children (Reye syndrome) except for Kawasaki disease
• Palatable forms of medications; allow choices when possible for age-appropriate cooperation