Your FREE CPN Flashcards 2026 – 250+ Cards

Birth weight doubles by ~6 months and triples by 12 months. Average newborn weight is ~3.4 kg.

Length increases ~50% by 1 year. By age 2, the child is about half their expected adult height.

Trust vs. Mistrust — consistent, responsive caregiving (feeding, comfort) builds trust. The nurse promotes it by meeting needs promptly and encouraging consistent caregivers.

Autonomy vs. Shame and Doubt — toddlers assert independence ('me do it,' toilet training). Offer simple choices and routines; expect negativism and ritualism.

Initiative vs. Guilt — preschoolers explore, imagine, and ask 'why.' Encourage play and curiosity; avoid shaming. Magical thinking is normal at this age.

Industry vs. Inferiority — children master skills, schoolwork, and peer activities. Support accomplishment and competence.

Identity vs. Role Confusion — teens form a sense of self and value peer acceptance and privacy. Respect autonomy and confidentiality.

The infant learns through senses and movement; the key milestone is object permanence (~8–9 months) — knowing an object exists when out of sight, which is why peek-a-boo delights them and separation anxiety emerges.

Magical thinking, egocentrism, and animism dominate; the child cannot yet reason logically. They may believe illness is punishment — reassure and use concrete, simple explanations.

Logical thinking about concrete events; the child grasps conservation, cause-and-effect, and time. Use real objects and simple diagrams when teaching.

Abstract and hypothetical reasoning develops; adolescents can think about consequences and the future. Teach as you would an adult, respecting their reasoning.

Rolls front-to-back around 4 months and back-to-front around 5–6 months.

Sits without support around 6–8 months.

Crawls and pulls to a stand around 9 months; cruises (walks holding furniture) around 10 months.

Most children walk alone around 12 months (range 9–15 months). Walking by 18 months at the latest.

A neat pincer grasp (thumb-to-finger) develops around 9–10 months — important for self-feeding and a choking-hazard teaching point.

Babbles at ~6 months, says first word ~12 months, has ~50 words and two-word phrases by 2 years; speech is ~75% intelligible by age 3.

A responsive social smile appears around 2 months of age — an early developmental marker.

Stranger anxiety begins ~6–8 months and separation anxiety peaks in toddlers (~10–18 months). Encourage rooming-in and consistent caregivers during hospitalization.

Around 6 months, when the infant can sit with support and has good head control. Introduce single-ingredient foods one at a time, a few days apart, to identify allergies.

No honey (botulism risk) before 12 months, no cow's milk as a main drink before 12 months, and avoid choking hazards (whole grapes, nuts, hot dogs, popcorn, hard candy).

Place the infant on their BACK to sleep, on a firm flat surface, alone, with no soft bedding, pillows, bumpers, or toys. Room-share without bed-sharing; avoid overheating and smoke exposure.

Use a rear-facing seat until the child reaches the seat's maximum height/weight limit — at least to age 2 and ideally longer. Rear-facing best protects the head, neck, and spine in a crash.

Forward-facing with a 5-point harness next, then a belt-positioning booster until the seat belt fits properly (usually 4'9" and 8–12 years), then a lap-and-shoulder belt. Children under 13 ride in the back seat.

Unintentional injury (accidents) — especially motor-vehicle crashes and drowning. Injury prevention/anticipatory guidance is a major Health Promotion focus.

Falls, suffocation/aspiration (small objects), and motor-vehicle safety. Never leave an infant unattended on a high surface; keep small objects out of reach.

Drowning, poisoning, and falls — toddlers are mobile and curious. Secure water, lock up medications/cleaners, and use the Poison Control number (1-800-222-1222).

Constant 'touch supervision' of young children near water, four-sided isolation pool fencing with self-latching gates, life jackets, and swim lessons. Drowning is silent and fast.

Usually 18–24 months, when the child can walk, stay dry ~2 hours, pull pants up/down, follow simple instructions, and shows interest. Readiness — not a fixed age — guides training.

Avoid screens (other than video-chat) under 18 months; limit to high-quality programming with a caregiver for ages 18–24 months; ~1 hour/day of high-quality media for ages 2–5.

Surveillance is the ongoing process of monitoring development at every visit; screening uses a validated tool (e.g., ASQ, M-CHAT for autism at 18 and 24 months) at recommended ages. Both catch delays early.

Exclusive breastfeeding for about the first 6 months, continuing alongside complementary foods to 12 months and beyond as mutually desired.

Exclusively/partially breastfed infants need 400 IU/day of vitamin D starting in the first days of life. Iron supplementation is started ~4 months in exclusively breastfed infants.

Hepatitis B (first dose). The newborn hepatitis B vaccine is given before hospital discharge.

DTaP, IPV (polio), Hib, PCV (pneumococcal), RV (rotavirus, oral), and the second hepatitis B (per schedule). The first big round of primary-series vaccines.

The first dose of MMR (measles, mumps, rubella) is given at 12–15 months — it is a live vaccine, so it waits until maternal antibodies wane. Second dose at 4–6 years.

First dose at 12–15 months, second dose at 4–6 years — a live vaccine, like MMR.

Severe immunosuppression, pregnancy, and a prior anaphylactic reaction to the vaccine. A mild illness or low-grade fever is NOT a contraindication.

Annually for everyone 6 months and older. Children under 9 receiving flu vaccine for the first time need two doses 4 weeks apart.

Routinely at age 11–12 (can start at 9). Two doses if started before age 15; three doses if started at 15 or older.

A single Tdap booster at age 11–12, then Td or Tdap every 10 years thereafter.

MenACWY at 11–12 years with a booster at 16; MenB may be given to teens 16–18 based on shared decision-making.

As a punishment for misbehavior (magical thinking) and with fear of bodily mutilation. Reassure the child that they did nothing wrong and use non-threatening explanations.

Screen high-risk children at 12 and 24 months. Lead causes neurodevelopmental harm (cognitive/behavioral problems) and anemia. Reduce exposure (old paint, dust); chelation therapy for high levels.

A heel-stick blood test (24–48 hr of age) screening for metabolic, genetic, and endocrine disorders (e.g., PKU, congenital hypothyroidism, sickle cell, CF) plus hearing and critical congenital heart disease (pulse oximetry).

Common in young children due to short, horizontal eustachian tubes. Reduce risk by avoiding bottle-propping/feeding while supine, eliminating smoke exposure, breastfeeding, and keeping vaccines (PCV) current.

Home, Education/employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, Safety — a psychosocial interview framework for adolescents, conducted confidentially.

Acute encephalopathy and liver dysfunction linked to aspirin use during a viral illness (flu, varicella). Never give aspirin to children for fever/viral illness — use acetaminophen or ibuprofen instead.

Calculate and plot BMI percentile annually; obesity is BMI ≥95th percentile for age/sex. Counsel on '5-2-1-0' (5 fruits/veggies, <2 hr screen, 1 hr activity, 0 sugary drinks) and family-based lifestyle change.

Proactive, age-specific teaching to parents about what to expect next in the child's development, nutrition, safety, and behavior — a core Health Promotion activity at well-child visits.

Visits at birth, 3–5 days, then 1, 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, then annually. Each combines growth/development surveillance, immunizations, screening, and anticipatory guidance.

Tantrums are a normal expression of frustration and the drive for autonomy. Advise parents to stay calm, ensure safety, ignore attention-seeking tantrums, avoid giving in, and offer limited choices to reduce power struggles.

Keep infants under 6 months out of direct sun; for older children use shade, protective clothing, hats, and broad-spectrum SPF 30+ sunscreen reapplied every 2 hours. Sunburns in childhood raise lifetime skin-cancer risk.

Wipe gums in infancy; brush with a smear (under 3) or pea-size (3–6) of fluoride toothpaste twice daily; first dental visit by age 1; avoid bottle in bed (early-childhood caries / 'bottle mouth').

Unintentional injury (especially motor vehicle), then suicide and homicide. Screen for risky behaviors, depression/suicide, substance use, and seat-belt/helmet use confidentially (HEEADSSS).

Daily penicillin prophylaxis in young children, keep vaccines current (including pneumococcal/meningococcal), maintain hydration, avoid extreme cold/heat and high altitude, and seek care for fever or pain crisis.

Preschoolers see death as temporary/reversible (magical thinking); school-age children understand it is permanent and may personify it; adolescents understand it abstractly and universally. Tailor communication accordingly.

Proceed with mild illness, low-grade fever, or current antibiotics. Defer for moderate-to-severe acute illness; permanently avoid only with a true contraindication (e.g., anaphylaxis to a component, severe immunosuppression for live vaccines).

Document the specific delays, perform/refer for validated developmental screening, and refer to early-intervention services. Early identification and referral improve outcomes — do not adopt a 'wait and see' approach for clear delays.

Identify and reduce triggers: tobacco smoke, allergens (dust mites, pets, pollen, mold), cold air, exercise, and respiratory infections. Trigger control plus controller medication reduces exacerbations.

Vision and hearing (newborn and periodically), lead (12 and 24 months), anemia, autism (18 and 24 months), dyslipidemia (once 9–11, again 17–21), depression (adolescents annually), and BMI/blood pressure as scheduled.

100–160 beats/min at rest (up to ~180 when crying); pediatric vital signs are age-specific and fall as the child grows.

90–160 beats/min at rest.

80–130 beats/min.

80–120 beats/min.

70–110 beats/min.

60–100 beats/min — approaching the adult range.

Newborn 30–60/min; infant 30–53/min. Count for a full minute and watch the abdomen — infants are obligate abdominal (diaphragmatic) breathers.

Toddler 22–37/min; preschooler 20–28/min.

School-age 18–25/min; adolescent 12–20/min.

Minimum expected systolic BP ≈ 70 + (2 × age in years). Below that suggests hypotension; the 50th-percentile systolic ≈ 90 + (2 × age).

Children compensate with vigorous tachycardia and vasoconstriction; blood pressure is maintained until ~25% of blood volume is lost, so hypotension means decompensated shock — act on tachycardia, poor perfusion, and weak pulses first.

Tachypnea (an increased respiratory rate) is the earliest and most sensitive sign; retractions, nasal flaring, and grunting follow.

End-expiratory grunting is the body's attempt to create its own PEEP and keep alveoli open. It signals significant respiratory distress and impending failure — a red-flag finding.

Appearance, Work of breathing, and Circulation to the skin. It is a rapid, hands-off, 'across-the-room' impression used to identify a sick child and set urgency before vital signs.

Closes by 12–18 months. A bulging fontanelle suggests increased intracranial pressure or meningitis; a sunken fontanelle suggests dehydration.

Closes by 2–3 months of age.

An observational scale (Face, Legs, Activity, Cry, Consolability), each scored 0–2 for a 0–10 total. Used for nonverbal children and infants ~2 months to 7 years.

A self-report scale of six faces from smiling (no hurt) to crying (worst hurt); used for children roughly 3 years and older who can point to how they feel.

Children ~8 years and older can usually use the 0–10 numeric rating scale, like adults. Match the pain tool to the child's developmental level.

Normal is under 2 seconds. A refill longer than 2–3 seconds is an early sign of poor perfusion or dehydration in a child.

Decreased urine output (fewer wet diapers), no tears, dry mucous membranes, sunken eyes, sunken fontanelle (infant), poor skin turgor, tachycardia, and prolonged capillary refill. Weight loss is the best objective measure.

Daily weight — a body-weight change is the most accurate measure of fluid gain or loss. Urine output (mL/kg/hr) is the next best bedside indicator.

At least 1 mL/kg/hr in infants and young children (about 0.5–1 mL/kg/hr in older children/adolescents). Less suggests inadequate perfusion or hydration.

The Pediatric GCS modifies the verbal and (for infants) motor responses for preverbal children. Total 3–15; a score of 8 or less indicates a need to protect the airway.

A bulging or tense fontanelle, widening sutures, increasing head circumference, a high-pitched cry, irritability, and poor feeding. Open sutures let infants tolerate rising pressure differently than older children.

Hypertension with a widening pulse pressure, bradycardia, and irregular respirations — a late, ominous sign. Also: altered consciousness, abnormal posturing, and a fixed/dilated pupil.

Over the abdomen or the inner thigh; tenting (slow recoil) indicates dehydration.

A 'silent chest' (no wheezing because air movement is too poor to make sound), worsening fatigue, decreasing level of consciousness, and rising CO₂ — ominous, not reassuring. Wheezing that stops can mean worsening, not improvement.

Polyuria (excessive urination, often new bedwetting), Polydipsia (excessive thirst), and Polyphagia (excessive hunger) with weight loss — the hallmark new-onset presentation in children.

Hyperglycemia with ketosis and metabolic acidosis: fruity (acetone) breath, Kussmaul (deep, rapid) respirations, abdominal pain, dehydration, and altered consciousness. A medical emergency.

Fever, severe headache, nuchal rigidity (stiff neck), photophobia, altered consciousness, and a petechial/purpuric rash with meningococcus. Positive Kernig's and Brudzinski's signs. In infants, signs are subtle: poor feeding, irritability, bulging fontanelle.

The most common childhood cancer; presents with fatigue/pallor (anemia), bruising/petechiae/bleeding (thrombocytopenia), and fever/infection (neutropenia), plus bone pain and lymphadenopathy from marrow infiltration.

Telescoping of the bowel causing colicky pain with drawing up of the legs and 'currant jelly' (blood and mucus) stools, often with a sausage-shaped mass. An air or contrast enema can be both diagnostic and therapeutic.

Projectile, nonbilious vomiting in a hungry infant (~3–6 weeks), with an olive-shaped mass in the right upper quadrant and visible peristaltic waves. Causes hypochloremic, hypokalemic metabolic alkalosis from vomiting.

Higher blood pressure and bounding pulses in the upper extremities (arms) with lower BP and weak/absent femoral (lower) pulses. Suspect it when arm-leg BP differs markedly.

Fever ≥5 days plus conjunctivitis, rash, cervical lymphadenopathy, mucosal changes (strawberry tongue, cracked lips), and extremity changes (red, swollen, peeling). The feared complication is coronary artery aneurysm; treat with IVIG and aspirin.

Follows a strep infection by 1–2 weeks: tea/cola-colored (hematuria) urine, periorbital edema, hypertension, and decreased urine output. Monitor BP, fluid balance, and daily weight.

Massive proteinuria, hypoalbuminemia, generalized edema (often periorbital and dependent), and hyperlipidemia. Managed with corticosteroids; monitor weight, edema, and for infection.

Use a soft, soothing voice and gentle touch; keep the caregiver in view; perform exams toe-to-head, saving distressing parts (ears, mouth) for last.

Do the least-invasive, least-distressing parts first (observation, heart and lung auscultation while calm) and save the most distressing (ears, throat) for last. Quiet observation before touching yields the most information.

Sexual Maturity Rating (Tanner stages 1–5) describes the progression of secondary sex characteristics in puberty — used to assess developmentally appropriate progression in adolescents.

Injuries inconsistent with the history or the child's developmental stage, patterned/multiple injuries in various healing stages, delayed care, and a history that changes. Also: fearful or withdrawn behavior. Document objectively.

A scoring tool tracking behavior, cardiovascular, and respiratory status to detect early clinical deterioration in a hospitalized child and prompt timely escalation before an arrest.

Perform a rapid assessment (airway, breathing, circulation, disability), call for help/activate the rapid-response or PEWS pathway, and stay with the child. Early recognition and escalation prevent cardiopulmonary arrest.

Respiratory in origin (hypoxia), unlike adults (usually cardiac). This is why airway and breathing are the priority and why early recognition of respiratory distress is lifesaving in children.

Failure to pass meconium within 48 hours, abdominal distension, and bilious vomiting. Aganglionic bowel cannot propel stool. Watch for enterocolitis (the dangerous complication: fever, explosive diarrhea, distension).

Congenital heart defects (especially AV canal), hypotonia, feeding difficulty, hypothyroidism, atlantoaxial instability, hearing/vision issues, and developmental delay. Provide family support and early-intervention referral.

A Brief Resolved Unexplained Event in an infant; provide reassurance, thorough assessment to rule out serious causes, education, and (when indicated) CPR teaching for caregivers and follow-up.

Plot growth on standardized charts over time (weight, length, head circumference), assess feeding/intake, caregiver-child interaction, and psychosocial factors. Look for organic and non-organic causes; involve the team.

A single point matters less than the TREND. Crossing two major percentile lines (up or down), a flattening curve, or being below the 5th/above the 95th warrants evaluation. Plot weight-for-length/BMI for proportionality.

Mild ≈ 3–5% body-weight loss, moderate ≈ 6–9%, severe ≈ 10% or more. Severe dehydration (lethargy, very prolonged cap refill, weak pulses, hypotension) needs immediate IV resuscitation.

Fever (≥100.4°F / 38°C) in an infant under ~2–3 months is treated urgently — a full sepsis workup is often done because young infants can have serious bacterial infection with few localizing signs.

Ortolani and Barlow maneuvers (clunk on abduction/adduction), asymmetric thigh/gluteal folds, and limited hip abduction. Treated early with a Pavlik harness to keep hips flexed and abducted.

Use the Adams forward-bend test, observing for rib hump and shoulder/hip asymmetry; a scoliometer confirms the curve. Screening occurs in early adolescence during the growth spurt.

Increased ICP signs: bulging fontanelle and increasing head circumference (infant), headache, vomiting, irritability, altered consciousness, and 'sunsetting' eyes. Fever suggests shunt infection — report promptly.

Distress = increased work of breathing with compensation (tachypnea, retractions, flaring). Failure = the body can no longer compensate (bradypnea, decreased effort, altered consciousness, cyanosis, rising CO₂) — an emergency requiring support.

Misaligned eyes can cause amblyopia ('lazy eye') and permanent vision loss if not corrected during the critical period of visual development. Treatment includes patching, corrective lenses, or surgery.

Paroxysmal coughing with an inspiratory 'whoop' and post-tussive vomiting; most dangerous in young infants (apnea). Use droplet precautions, give macrolide antibiotics, and protect infants via maternal Tdap and cocooning.

High fever, the 'three C's' (cough, coryza, conjunctivitis), Koplik spots, and a descending maculopapular rash. Highly contagious — use airborne precautions. Prevented by MMR vaccine.

Parvovirus B19 causing a 'slapped-cheek' facial rash followed by a lacy body rash. Usually mild; the child is most contagious BEFORE the rash, so isolation after the rash appears is not needed for healthy children.

High fever for 3–4 days that abruptly resolves, FOLLOWED by a pink maculopapular rash. The rash appears as the fever breaks; risk of febrile seizure during the fever phase.

Decreased urine output signals dehydration, poor perfusion, or renal impairment. Reassess hydration, perfusion, and intake/output, and escalate — it is an early warning of deterioration.

Often nonspecific: fever without a source, irritability, poor feeding, vomiting, or foul-smelling urine in infants; dysuria/frequency in older children. Obtain a clean catch or catheter specimen before antibiotics.

Periumbilical pain migrating to the right lower quadrant (McBurney's point), anorexia, nausea, low-grade fever, and rebound tenderness. SUDDEN relief of pain may signal perforation — an emergency, not improvement.

A large body-surface-to-mass ratio, thin skin, and limited subcutaneous fat. Keep newborns/infants warm (skin-to-skin, radiant warmer, hat); cold stress increases oxygen and glucose demand.

Physiologic jaundice appears AFTER 24 hours and peaks ~3–5 days. Jaundice within the first 24 hours of life is PATHOLOGIC and needs urgent evaluation. Treat significant hyperbilirubinemia with phototherapy.

Worsening retractions, apnea (especially in young/premature infants), poor feeding/dehydration, persistent hypoxia, and lethargy. Apnea can be the first sign in young infants — admit and monitor.

Get on the child's eye level, use simple honest language, be truthful about whether something will hurt, give choices when possible, allow the child to handle equipment, and include the caregiver.

Assessed at 1 and 5 minutes after birth: Appearance, Pulse, Grimace, Activity, Respiration, each 0–2 (total 0–10). 7–10 reassuring; <7 needs intervention/reassessment. It guides resuscitation needs, not long-term outcome.

Crying and agitation falsely raise the rate. Count respirations (and ideally heart rate) while the child is quiet/asleep, observing the abdomen in infants, for an accurate baseline.

Circumferential burns can cause a tourniquet effect, compromising circulation (extremity) or breathing (chest). Monitor neurovascular status and respiratory effort; an escharotomy may be needed to relieve pressure.

Fever or hypothermia, tachycardia and tachypnea, altered mental status, poor perfusion (prolonged cap refill, mottling), and decreased urine output. Begin the sepsis bundle: cultures, broad-spectrum antibiotics, and fluid boluses quickly.

Stridor is a harsh sound usually on INSPIRATION from upper-airway obstruction (croup, epiglottitis, foreign body). Wheezing is usually on EXPIRATION from lower-airway narrowing (asthma, bronchiolitis).

Sudden coughing, choking, stridor or wheezing, and respiratory distress, most common in toddlers (curious, incomplete dentition). Prevent by keeping small objects and choking-hazard foods away; teach back blows/chest thrusts for infants.

Croup: gradual, viral, barky cough, child can usually lie down, lower-grade illness. Epiglottitis: rapid, toxic, drooling, no cough, tripod position, high fever — a true airway emergency. Do not examine the epiglottitis throat.

A larger head and weaker neck muscles raise head-injury risk and affect positioning and the modified rule of nines for burns. It also makes neutral-airway positioning (slight sniffing, shoulder roll) important in infants.

Poor feeding, lethargy or irritability, temperature instability, color changes (pallor, mottling, cyanosis), apnea, and grunting. Young infants show illness through nonspecific behavior — take feeding and activity changes seriously.

DI: too little ADH → large volumes of dilute urine, dehydration, high serum sodium. SIADH: too much ADH → water retention, low urine output, dilutional hyponatremia. Monitor sodium, I/O, and neuro status.

Secondary sexual characteristics before age 8 in girls or 9 in boys. Concerns include accelerated bone age with reduced adult height and psychosocial impact; refer for endocrine evaluation.

Significant weight change, distorted body image, restrictive/binge-purge behaviors, amenorrhea, electrolyte abnormalities, and bradycardia/orthostasis. Monitor for refeeding syndrome when nutrition is restored; involve a multidisciplinary team.

Screen routinely and confidentially; if suicidal ideation is disclosed, ensure immediate safety, do NOT keep it confidential, stay with the child, and arrange urgent mental-health evaluation. Ask directly — it does not increase risk.

Nasal flaring, grunting, retractions (subcostal, intercostal, suprasternal), head bobbing (infants), tripod positioning, and tachypnea. The more signs present, the greater the distress — act early.

Typically every 4 hours when stable, more often if acutely ill, post-op, on continuous monitoring, or after a medication change. Always trend values against the child's age-appropriate norms and baseline.

Weigh at the same time daily, on the same scale, with similar clothing — usually before breakfast. Essential for dosing accuracy and for tracking fluid status in cardiac, renal, and critically ill children.

Use a validated observational/behavioral tool (e.g., FLACC or r-FLACC, or an individualized baseline) and the caregiver's knowledge of the child's pain cues. Behavioral changes may be the only sign of pain.

Generally maintain SpO₂ ≥ 92–94% in most acutely ill children (individualized for chronic lung or cardiac disease). Persistent hypoxia despite oxygen signals worsening — escalate care.

A weight LOSS suggests fluid deficit (dehydration); a weight GAIN with edema suggests fluid overload (renal, cardiac, or over-resuscitation). Trend the daily weight to guide fluid management.

Measure BP routinely starting at age 3 (and earlier if risk factors), using a correctly sized cuff, and interpret against age-, sex-, and height-based percentiles — not adult values.

The bladder width should be ~40% of the arm circumference and cover ~80–100% of the arm length. A too-small cuff falsely raises and a too-large cuff falsely lowers the reading.

Suspicious patterns: posterior rib fractures, spiral fractures in non-ambulatory infants, immersion/patterned burns, retinal hemorrhages (abusive head trauma), and multiple bruises in unusual or protected areas. Report suspicion.

Protest (crying, clinging), Despair (withdrawn, sad, hopeless), and Detachment/Denial (superficial adjustment). Despair and detachment can be mistaken for 'settling in.'

Quick-relief (rescue) = short-acting beta-2 agonist (albuterol) for acute symptoms. Controller (long-term) = inhaled corticosteroid (the cornerstone), taken daily to prevent inflammation — not for an acute attack.

To prevent oral thrush (candidiasis) and hoarseness. Using a spacer with a metered-dose inhaler also improves delivery and reduces deposition in the mouth.

Respiratory syncytial virus (RSV) is the leading cause; it is most serious in infants under 2. Treatment is supportive — oxygen, suctioning, hydration, and monitoring. Antibiotics do not help a viral infection.

Viral laryngotracheobronchitis with a barky 'seal-like' cough, inspiratory stridor, and hoarseness, usually worse at night. Mild croup: cool mist/humidified air and calm the child; moderate-severe: corticosteroids (dexamethasone) and nebulized epinephrine.

Drooling, Dysphagia, Dysphonia, and Distress — a child who is tripoding, drooling, and toxic-appearing. It is an airway emergency: do NOT inspect the throat or place anything in the mouth; keep the child calm and prepare for emergent intubation. Hib vaccine made it rare.

Chest physiotherapy and airway clearance, bronchodilators and dornase alfa, and aggressive treatment of pulmonary exacerbations. Thick secretions cause chronic infection — give CPT BEFORE meals to avoid vomiting, or well after.

Give pancreatic enzyme replacement (PERT) with every meal and snack, a high-calorie/high-protein diet, and fat-soluble vitamins (A, D, E, K). CF impairs fat absorption, causing steatorrhea and poor growth.

Hemorrhage. Watch for FREQUENT SWALLOWING, restlessness, and tachycardia — early signs of bleeding. Avoid red/brown fluids, coughing, straws, and throat clearing. Bleeding risk peaks at surgery and again 5–10 days later when scabs slough.

Side-lying or prone to facilitate drainage of secretions and blood and protect the airway.

Isotonic IV fluids FIRST to correct dehydration, then a regular insulin infusion, with careful potassium monitoring/replacement (insulin shifts K⁺ into cells). Lower glucose slowly to avoid cerebral edema, the most feared pediatric complication.

Shakiness, sweating, pallor, irritability/confusion, tachycardia, and hunger. Treat a conscious child with 15 g fast-acting carbohydrate (e.g., 4 oz juice), recheck in 15 minutes; give glucagon if unresponsive or unable to swallow.

Intramuscular epinephrine into the lateral thigh (vastus lateralis) is the first and most important treatment — give it immediately. Then position, give oxygen, IV fluids, and adjuncts (antihistamines, steroids) and prepare for a possible second dose.

A generalized seizure with fever in a child 6 months–5 years, usually brief (<15 min) and benign. Protect the airway, keep the child safe (do not restrain or put anything in the mouth), and treat the fever. Most children do not develop epilepsy.

Institute droplet isolation immediately on suspicion (for bacterial/meningococcal), give antibiotics promptly after cultures, and monitor neuro status and for increased ICP. A quiet, low-stimulation environment reduces seizure risk.

Pain crisis from sickled cells occluding vessels. Priorities: Hydration (IV/oral fluids), Oxygenation, pain control (often opioids), and warmth. Avoid cold, dehydration, and hypoxia, which trigger sickling. (Think 'HOP' — hydration, oxygen, pain.)

Private room, strict hand hygiene, no fresh flowers/plants, avoid raw fruits/vegetables and crowds, no live vaccines, and monitor for any fever. In neutropenia, fever is an emergency — there may be few other signs of infection.

Do NOT palpate the abdomen — palpation can rupture the encapsulated tumor and spread cancer cells. Post a sign at the bedside. It presents as a firm, nontender abdominal mass, usually in toddlers.

A hypercyanotic spell: place the infant in the knee-chest position (older child squats) to increase systemic vascular resistance and improve pulmonary blood flow, give oxygen, and calm the child. The four defects: VSD, overriding aorta, pulmonary stenosis, RV hypertrophy.

Oral rehydration solution (ORS) is first-line for mild-to-moderate dehydration; resume a normal age-appropriate diet early. Avoid sugary drinks and the old 'BRAT' diet as the sole plan. Use IV fluids for severe dehydration or persistent vomiting.

Pediatric doses are weight-based (mg/kg), calculated on an accurate, current weight in kilograms. Always verify the dose is within the safe range and does not exceed the maximum adult dose.

Multiply the recommended mg/kg/dose (or /day) by the child's weight in kg to get the safe range, then compare it to the ordered dose. If the order falls outside the range, hold it and clarify — this prevents a 10-fold error.

10–15 mg/kg/dose every 4–6 hours, not exceeding the daily maximum. Overdose causes hepatotoxicity; the antidote is N-acetylcysteine (NAC).

10 mg/kg/dose every 6–8 hours for children 6 months and older. Avoid in dehydration or renal impairment; not for infants under 6 months.

Immature organ function (hepatic/renal), a higher body-water percentage, and a smaller margin between therapeutic and toxic doses. Tiny calculation errors have large effects, so double-check high-alert drugs.

Hourly maintenance fluids: 4 mL/kg for the first 10 kg, plus 2 mL/kg for the next 10 kg, plus 1 mL/kg for each kg above 20. Example: a 25-kg child = 40 + 20 + 5 = 65 mL/hr.

Care that minimizes or eliminates the physical and psychological distress of healthcare for children and families — preventing/minimizing separation, promoting a sense of control, and minimizing pain (e.g., topical anesthetic before IV, clustering painful procedures).

Prepare just before the procedure (limited time concept), keep explanations very brief and concrete, allow comfort objects, expect resistance, and let the parent stay. Toddlers fear separation most.

Use simple, concrete words and avoid frightening/literal terms ('dye,' 'cut,' 'put you to sleep'); allow medical play and choices; reassure that the procedure is not a punishment (magical thinking). Prepare 1–3 days ahead.

Give clear, factual explanations with simple diagrams or models, prepare days in advance, allow questions, and offer choices to give a sense of control. They fear loss of control and bodily harm.

Provide detailed information, respect privacy and body image, include them in decisions, and allow time alone with the provider. They fear loss of independence, altered appearance, and being different from peers.

Therapeutic play uses dolls, puppets, and medical equipment to help a child express feelings and understand/cope with procedures. Play is essential — it is the 'work' of childhood and a key assessment and coping tool.

Infants and children DO feel pain and may under-report or be unable to verbalize it. Assess pain regularly with an age-appropriate tool, believe the child, and treat pain proactively — undertreatment is a documented problem.

Distraction, guided imagery, swaddling/positioning, nonnutritive sucking and sucrose for infants, comfort holds, music, and parental presence — used alongside (not instead of) appropriate analgesia.

Keep skin hydrated: lukewarm baths, fragrance-free moisturizers applied immediately after bathing ('soak and seal'), topical corticosteroids for flares, identify/avoid triggers, and keep nails short to reduce scratching and infection.

Small frequent feeds, thickened feeds if advised, frequent burping, and keeping the infant upright after feeds. Most physiologic reflux resolves by ~12 months; GERD (with poor growth or complications) needs evaluation.

Chronic lung injury in former premature infants on prolonged oxygen/ventilation. Care focuses on oxygenation, growth/nutrition (high calorie needs), preventing respiratory infection (RSV prophylaxis), and developmental follow-up.

A nonprogressive motor disorder from early brain injury. Focus on mobility/positioning, nutrition and safe swallowing (aspiration risk), managing spasticity and contractures, communication, and maximizing function with the interdisciplinary team.

Maintain routines, reduce sensory overload, use clear concrete communication and visual supports, allow extra time and transitions warnings, and involve caregivers who know the child's cues. M-CHAT screening occurs at 18 and 24 months.

Often from excessive cow's milk intake (limit to ~16–24 oz/day) crowding out iron-rich foods. Give iron with vitamin C (juice) to enhance absorption, between meals; expect dark stools; keep iron locked away (overdose is toxic).

Use an oral syringe for accuracy, aim toward the side/back of the cheek, give slowly to prevent aspiration, do not mix medication into a full bottle/essential food, and never call medicine 'candy.'

The vastus lateralis (anterolateral thigh) is the preferred IM site for infants and young children — it is large and away from major nerves/vessels. The deltoid is used in older children/adolescents.

An isotonic crystalloid bolus (normal saline or lactated Ringer's) of 20 mL/kg given rapidly, reassessing perfusion after each bolus and repeating as needed.

Feeding and preventing aspiration are priorities: use specialized cleft nipples/bottles, hold upright, burp frequently, and support bonding. Post-op cleft-lip repair: protect the suture line (no objects in mouth, elbow restraints, avoid crusts).

Maintain proper alignment and counter-traction, keep weights hanging freely off the floor, perform frequent neurovascular checks (the 6 P's), and provide skin/pin care to prevent breakdown and infection.

Elevate the limb, apply ice early, do frequent neurovascular checks (color, warmth, movement, sensation, capillary refill, pulses), keep the cast dry, never put objects inside it, and report increasing pain, numbness, or foul odor.

Children have a higher body-surface-to-mass ratio, so they lose fluid and heat fast and need careful weight-based fluid resuscitation. Use the modified rule of nines/Lund-Browder for pediatric body proportions (larger head).

Call Poison Control (1-800-222-1222), assess airway/breathing/circulation, identify the substance and amount/time, and follow their guidance. Do NOT routinely induce vomiting; ipecac is no longer recommended.

Liver function (the toxic effect is hepatotoxicity). Give N-acetylcysteine (NAC) per the Rumack-Matthew nomogram based on the timed acetaminophen level.

A seizure lasting >5 minutes or recurring without recovery. Protect the airway, give oxygen, position safely, and administer a benzodiazepine (lorazepam/midazolam/diazepam) as the first-line drug. Do not restrain or force anything into the mouth.

Protect the exposed sac: position prone, cover with sterile moist (saline) dressing, prevent infection and trauma, monitor for latex allergy (high risk), and assess neuro/motor function below the lesion.

Replace the deficient clotting factor, apply the RICE measures (Rest, Ice, Compression, Elevation) for bleeds, and avoid IM injections, aspirin/NSAIDs, and contact sports. Watch for hemarthrosis (joint bleeds).

Low platelets cause petechiae, bruising, and bleeding. Implement bleeding precautions (soft toothbrush, no contact sports/IM injections), monitor platelet counts, and watch for signs of intracranial bleeding.

Use the least invasive effective method, involve the caregiver, allow a position of comfort, and use distraction. A frightened, crying child increases oxygen demand — keeping the child calm IS treatment.

A low-phenylalanine diet for life: avoid high-protein foods and aspartame; use special formula. Untreated PKU causes intellectual disability — early diagnosis via newborn screening prevents it.

Thyroid hormone is essential for brain growth; untreated congenital hypothyroidism causes irreversible intellectual disability. Newborn screening enables early levothyroxine therapy to ensure normal development.

Use airborne and contact precautions. The child is contagious from ~1–2 days before the rash until all lesions have crusted over. Avoid aspirin (Reye syndrome risk).

Coxsackievirus causing fever and painful vesicles on the hands, feet, and in the mouth. Supportive care; ensure hydration (mouth sores hurt). Highly contagious via contact — emphasize hand hygiene.

Contact precautions (and droplet) — RSV spreads via respiratory secretions and contaminated surfaces. Cohort patients, emphasize hand hygiene, and protect high-risk infants.

Check pH of aspirate (gastric is acidic) and measured length, and confirm with X-ray when required by policy — auscultation of an air bolus alone is not a reliable method.

Continue insulin even when not eating, check blood glucose and ketones more often, maintain hydration, and have a plan for when to call the provider. Illness raises glucose and DKA risk — never stop insulin.

Rapid-acting (lispro/aspart): onset ~15 min, peak ~1 hr — given with meals. Long-acting (glargine/detemir): peakless basal coverage ~24 hr. Match administration timing to onset/peak to prevent hypoglycemia.

Daily weight, abdominal girth, strict intake/output, edema assessment, urine protein dipstick, and infection surveillance (these children are immunosuppressed by steroids and protein loss).

Give analgesia for pain; many cases are observed without immediate antibiotics ('watchful waiting'). If antibiotics (amoxicillin first-line) are prescribed, complete the full course. Recurrent infections may need ENT referral.

Disimpaction if needed, then maintenance with osmotic laxatives (e.g., polyethylene glycol), increased fiber and fluids, scheduled toilet sitting, and behavioral support. Address fear of painful stooling.

Airway and respiratory status, pain control with age-appropriate assessment, hydration/IO, monitoring the surgical site, early activity as allowed, and atraumatic, developmentally appropriate care with the family present.

Maximize skin exposure, protect the eyes with shields, monitor temperature and hydration (increased insensible losses), reposition frequently, and monitor bilirubin levels. Expect loose green stools.

Green = doing well (controller as scheduled); Yellow = caution/symptoms (add rescue, follow plan); Red = medical alert (rescue + seek emergency care). Teach families to recognize and act on each zone.

Tracks airflow at home; a personal best is established, then readings are compared (green ≥80%, yellow 50–79%, red <50%). A falling peak flow can precede symptoms and guide the action plan.

0.15 mg for children ~15–30 kg and 0.3 mg for ≥30 kg, injected into the lateral thigh. Teach families to use it at the first sign of anaphylaxis and to call emergency services and seek care afterward.

Weigh in kilograms on a calibrated scale, ideally without heavy clothing/diaper, at admission and routinely. Do not use a stated or estimated weight for medication calculation when an accurate weight is obtainable.

Comfort/therapeutic holding (e.g., upright on a parent's lap, a 'hug hold') keeps a child secure and calm and is preferred to supine restraint — it reduces fear and improves cooperation (atraumatic care).

Bronchodilators and mucolytics (e.g., dornase alfa) are given BEFORE airway clearance/CPT to open airways and loosen secretions, making clearance more effective.

Decreasing respiratory rate, increasing sedation (hard to arouse), and falling oxygen saturation. Monitor closely, stop/reduce the opioid, stimulate, support breathing, and have naloxone available.

Oral sucrose with a pacifier (nonnutritive sucking) is an evidence-based analgesic for minor painful procedures (heel stick, immunizations) in infants up to ~6–12 months — an atraumatic-care measure.

Reassess pain after the expected onset of the intervention (e.g., ~30–60 min for oral analgesia, ~15 min for IV) using the same age-appropriate scale, and document the response.

Position curled on the side (or sitting) to widen the intervertebral spaces; hold the child securely (therapeutic hold). Afterward, monitor the site, encourage fluids, and watch for headache or leakage.

Verify the order and patient with two nurses, use the correct filter/tubing, stay with the child for the first 15 minutes, monitor vital signs, and stop immediately for any reaction (fever, chills, rash, dyspnea, hypotension).

Keep the drainage system below chest level, ensure tubing is patent and connections secure, monitor for tidaling/bubbling per system type, assess respiratory status, and keep an occlusive dressing and clamp at the bedside.

Keep a same-size and a smaller spare tube, obturator, suction, and a manual resuscitation bag at the bedside at all times. Suction only as needed, maintain humidification, and never leave the child unattended without supplies.

Treated with daily subcutaneous growth hormone injections, usually at bedtime to mimic natural secretion. Teach injection technique and site rotation, monitor growth velocity, and provide psychosocial support about stature.

Compress at 100–120/min, about one-third the depth of the chest (~1.5 in / 4 cm in infants, ~2 in / 5 cm in children). Compression-to-ventilation 30:2 (single rescuer) or 15:2 (two rescuers, infant/child).

Conscious choking infant: 5 back blows then 5 chest thrusts (no abdominal thrusts). Child (≥1 yr): abdominal thrusts (Heimlich). If unresponsive: begin CPR and check the mouth before ventilations.

Offer realistic choices (which arm, flavor, order of tasks), keep routines, allow personal items, and involve the child in self-care. A sense of control reduces stress and improves cooperation across all ages.

Observe for ~15 minutes after administration for anaphylaxis. Manage minor reactions (soreness, low fever) with comfort measures and acetaminophen, and report serious adverse events to VAERS.

Oral rehydration therapy with an ORS given in small frequent amounts; it is as effective as IV fluids for mild-moderate cases and is less invasive (atraumatic care).

Encourage parental holding/skin-to-skin and caregiving, maintain consistency, provide developmentally appropriate stimulation and rest, and minimize separation — hospitalization should not interrupt attachment.

Use two identifiers (name and date of birth) by checking the ID band and confirming with the caregiver — never rely on a child's stated name or a parent's verbal report alone.

Enabling (creating opportunities for families to use their abilities) and empowering (families keeping control and a sense of competence). Care is a partnership that respects family strengths, choices, and culture.

The family is the constant in the child's life. Rooming-in, parental presence during procedures, and shared decision-making reduce the child's fear and separation anxiety and improve outcomes and satisfaction.

Provide time alone with the adolescent and assure confidentiality for sensitive topics, but explain its limits — you must break it for safety concerns such as suicidal/homicidal ideation or abuse. State law governs minors' consent for certain services.

Nurses are mandated reporters who must report reasonable suspicion of child abuse or neglect to child-protective authorities — suspicion is enough; proof is not required, and reporting in good faith is legally protected.

Generally a parent or legal guardian gives informed consent for a minor; the child gives developmentally appropriate ASSENT. Exceptions: emancipated minors and 'mature minor' consent for specific services (varies by state law).

Consent is the legal permission given by the parent/guardian. Assent is the child's affirmative agreement to participate, sought from school-age children and adolescents — respecting their developing autonomy even when they cannot legally consent.

Use a trained, qualified medical interpreter (in person or via phone/video) — not a family member, and especially not a child. This ensures accurate, confidential, legally valid communication and consent.

Right patient, drug, dose, route, time — plus right documentation, reason, response, and to refuse. In pediatrics, the weight-based dose check is built into the 'right dose.'

Delegate only stable, predictable tasks within the UAP's scope (e.g., vital signs on a stable child, hygiene). The nurse cannot delegate assessment, teaching, evaluation, or judgment, and remains accountable.

Integrating the best current research evidence with clinical expertise and the patient's/family's values and preferences to guide care decisions — the basis for updating unit practices and protocols.

QI applies data-driven methods (e.g., PDSA cycles) to improve a local process or outcome (like reducing CLABSI). Research aims to generate new generalizable knowledge and requires IRB oversight and consent.

Advocacy means acting on the child's and family's behalf — ensuring their voice is heard, questioning unsafe orders, protecting rights, facilitating access to resources, and supporting informed decisions, even amid disagreement.

Situation, Background, Assessment, Recommendation — a structured handoff/communication tool that standardizes nurse-to-provider and shift report, reducing errors during transitions of care.

With ALL patients regardless of diagnosis: hand hygiene and using PPE when contact with blood/body fluids is anticipated. The foundation of infection prevention.

Wash hands or use alcohol-based hand rub before and after every patient contact. Soap and water are required for visibly soiled hands and for spore-forming organisms like C. difficile.

Use the least restrictive method for the shortest time, only when necessary for safety, with an order and frequent monitoring. Prefer therapeutic holding, distraction, and parental presence over physical restraint.

Ask the caregiver to explain or demonstrate the instructions in their own words to confirm understanding, rather than asking 'do you understand?' This verifies learning and is a facilitation-of-learning best practice.

Focus on comfort, symptom management, honest developmentally appropriate communication, family support, honoring wishes and culture, and involving palliative care/child life early — care of the family is care of the child.

Provide the Vaccine Information Statement (VIS), obtain consent, document lot number, site, route, date, and the VIS edition date. Report adverse events to VAERS.

Recognize and respect a family's beliefs, practices, and language; ask rather than assume; incorporate acceptable cultural practices; and use trained interpreters. Avoid imposing personal values.

Build trust through consistency, honesty, active listening, and partnership; recognize caregiver expertise about their child; support coping and respite; and connect them with resources and peer/community support.

Record objective, accurate, timely findings (weights in kg, vital signs, intake/output, pain scores, interventions, and responses). Good documentation supports continuity, safety, legal protection, and quality improvement.

Listen respectfully, address concerns with accurate evidence-based information, use presumptive language, share the strong safety record, and build trust without coercion. Document the discussion and any refusal.

Acknowledge siblings' needs, encourage age-appropriate involvement and visiting, keep them informed, and connect the family with social work, child life, and support services — care extends to the whole family unit.

Insulin, opioids, anticoagulants (heparin), chemotherapy, and concentrated electrolytes (e.g., potassium). Two nurses independently verify the drug, dose, and pump settings before administration.

Hold the medication and clarify with the prescriber before giving it. The nurse is accountable and must not administer an order believed to be unsafe — patient safety overrides hierarchy.

Report it promptly through the incident/occurrence system in a non-punitive, just-culture environment; assess and monitor the child; and use the data for quality improvement to prevent recurrence.

Provides developmentally appropriate preparation, therapeutic play, distraction, and emotional support to help children and families cope with hospitalization and procedures — a key partner in atraumatic care.