Pediatric Nursing: 101 Review Bullets

Immunizations and Infection Control

1. Give IPV, not OPV, to a child with HIV-positive blood.
2. An infant born to an HIV-positive mother usually gets AZT (zidovudine) for the first 6 weeks.
3. Infants born to an HIV-positive mother still receive all scheduled immunizations.
4. Hold the MMR vaccine until one year because maternal antibodies blunt the response; the CDC schedules the first MMR dose at 12 to 15 months (CDC, Child and Adolescent Immunization Schedule).
5. Isolate a child with an undiagnosed infection.
6. Do not treat chickenpox lesions with topical corticosteroids.
7. Chickenpox lesions appear together as papules, vesicles, and crusts.
8. Fifth disease shows a "slapped face" erythema.
9. Roseola presents as discrete rose-pink macules that fade with pressure.
10. Pertussis (whooping cough) needs droplet precautions; it is highly contagious.
11. Scarlet fever shows a sandpaper rash.

Nutrition and Feeding

12. Feeding only cow's milk to infants causes iron deficiency anemia.
13. Breast milk is optimal nutrition for the first 6 months and supports immunity and development; the CDC recommends exclusive breastfeeding for about the first 6 months (CDC, Breastfeeding).
14. Serving size runs 1 tablespoon of food per year of age.
15. Infants triple birth weight by 12 months.
16. Test warmed fluids on your own skin to prevent scalding the infant.
17. Infants wet 6 to 10 diapers a day.
18. Do not microwave infant food; uneven heating causes burns.
19. Infants chew by 7 months, hold spoons by 9 months, drink from cups by 1 year.
20. Start solids around 6 months with iron-fortified cereal.
21. Toddlers are selective eaters; they need patience and dietary guidance.

Respiratory Care

22. For postural drainage, position the infant across your lap with a pillow.
23. Cystic fibrosis needs extra calories, protein, and supplements to offset malabsorption.
24. A good response to pancreatic enzymes shows as absence of steatorrhea.
25. Dehydration in infants shows as lethargy, irritability, reduced urination, dry skin, decreased tears, and increased pulse.
26. Asthma exacerbation shows wheezing, coughing, and dyspnea.
27. RSV commonly triggers bronchiolitis, especially in young infants.

Neurological Assessment

28. Frequent neuro checks in meningitis catch complications early.
29. Cerebral palsy in newborns shows reflexive hypertonicity and scissoring leg movements.
30. A bulging fontanel signals increased intracranial pressure in infants.
31. Shaken baby syndrome causes severe neurological damage: seizures, slow heartbeat, respiratory distress, and retinal hemorrhage.
32. Neonatal abstinence syndrome shows a hyperactive Moro reflex and watery stools.
33. Febrile seizures typically come with a rapid temperature rise.

Developmental Milestones

34. Developmental dysplasia of the hip can show as a limp or asymmetrical thigh folds.
35. Failure to thrive means weight and height below the 5th percentile.
36. Infants sit unsupported around 6 months.
37. Crawling starts at 8 to 10 months.
38. Pincer grasp develops around 9 to 12 months.
39. Stranger anxiety peaks around 8 to 9 months.
40. Separation anxiety is common from 6 to 18 months.

Safety and Accident Prevention

41. Mechanical obstruction is the leading cause of suffocation in infants under 1 year.
42. Infants' main risks are falls, burns, and suffocation; secure the environment.
43. Toddlers: burns, poisoning, drowning.
44. Preschoolers: playground injuries, choking, poisoning, drowning.
45. Adolescents: automobile accidents, drowning, fires, firearm accidents.
46. Bryant's traction needs the buttocks slightly elevated; use it for children under age 3 or less than 30 lb.
47. Check bathwater temperature to prevent scalding.
48. Keep small objects away from infants and toddlers.
49. Keep infants and toddlers rear-facing as long as possible, up to the height and weight limits of the seat. The AAP dropped its strict "until age 2" rule in 2018 in favor of rear-facing for as long as the seat allows (AAP, Child Passenger Safety).
50. Secure furniture against tip-over, especially around active toddlers.

Pediatric Traction and Orthopedics

51. Ninety-ninety traction stabilizes femur and tibia fractures.
52. Body weight supplies the traction force in Bryant's traction.
53. Assess skin regularly under traction devices.
54. Check neurovascular status frequently in children with casts.
55. Clubfoot correction often uses serial casting.
56. Legg-Calvé-Perthes disease typically shows as a painless limp; assess it thoroughly.

Cardiovascular and Vital Signs

57. Blood pressure is essentially the same in the arms and legs of infants.
58. Tachycardia often signals dehydration or fever in infants.
59. Bradycardia in infants may signal hypoxia.
60. Use the apical pulse for accuracy in children under 2 years.
61. Capillary refill should be under 2 seconds in a healthy child.

Gastrointestinal Care

62. Hold infants with cleft palate upright during feedings.
63. Hirschsprung disease shows chronic constipation and abdominal distention.
64. Gastroesophageal reflux disease shows frequent regurgitation and irritability.
65. Intussusception classic signs: currant jelly stools, intermittent pain.
66. Appendicitis in children commonly presents as pain at McBurney's point.

Genitourinary and Renal Care

67. Frequent urinalysis is essential to monitor pediatric renal function.
68. Hypospadias needs surgical correction around 6 to 12 months.
69. Nephrotic syndrome: edema, proteinuria, hypoalbuminemia.
70. Acute glomerulonephritis: hematuria and hypertension.

Endocrine and Metabolic Conditions

71. Monitor blood glucose regularly in pediatric diabetes.
72. Hypothyroidism in infants shows hypotonia, prolonged jaundice, and poor feeding.
73. Phenylketonuria requires lifelong dietary phenylalanine restriction.

Hematologic Conditions

74. Breastfed infants need iron supplementation after 6 months.
75. Sickle cell crisis is triggered by dehydration, hypoxia, or infection.
76. Hemophilia shows prolonged bleeding after minor injuries.

Pediatric Pain Management

77. Adolescents may hide pain; offer analgesics proactively.
78. Use an age-appropriate pain scale for accurate assessment.
79. Use nonpharmacological methods too: distraction and relaxation.

Psychosocial and Emotional Care

80. Prepare children for procedures to reduce anxiety.
81. Encourage parental involvement during hospitalization.
82. Keep normal routines to comfort hospitalized children.

Skin Conditions and Care

83. Prevent diaper dermatitis with frequent changes and barrier creams.
84. Eczema care means avoiding irritants and moisturizing regularly.
85. Impetigo needs topical or systemic antibiotics.

Additional Pediatric Nursing Bullets

86. Kawasaki disease: prolonged fever, strawberry tongue, conjunctivitis.
87. Screen hearing and vision regularly for development.
88. Start dental care when the first tooth erupts.
89. Toilet training typically begins around 18 to 24 months.
90. Avoid aspirin in children because of Reye's syndrome risk.
91. Prevent SIDS by placing infants on their backs to sleep.
92. Pediatric skin is sensitive; protect it from the sun.
93. Infant colic typically resolves by 3 to 4 months.
94. Lead poisoning requires environmental assessment and intervention.
95. Keep children hydrated during diarrhea and vomiting.
96. Monitor growth regularly to catch nutritional problems early.
97. Teach families age-specific developmental expectations.
98. Use pediatric scales and equipment for accurate assessment.
99. Encourage breastfeeding for immune support and bonding.
100. Give infants regular tummy time to build motor development.
101. Use child-friendly language when explaining procedures to reduce fear.

Frequently Asked Questions

When should a baby start solid foods?

Around 6 months, beginning with iron-fortified infant cereal, while breast milk or formula continues as the main source of nutrition. Solids before about 4 to 6 months are not recommended because the infant's gut and oral-motor skills are not ready (CDC, Breastfeeding).

How long should a child ride rear-facing in a car seat?

As long as possible, up to the height and weight limits printed on the seat. The AAP removed its specific "until age 2" milestone in 2018 because the data favored staying rear-facing for as long as the seat allows rather than graduating at a fixed age (AAP, Child Passenger Safety).

Why is aspirin avoided in children?

Because of the risk of Reye's syndrome, a rare but serious condition causing swelling of the liver and brain that has been linked to aspirin use during viral illnesses such as influenza and chickenpox. Acetaminophen or ibuprofen is preferred for fever in children.

How can families lower the risk of SIDS?

Place infants on their back to sleep for every sleep, on a firm flat surface, with no soft bedding, and keep the sleep area free of pillows, bumpers, and loose blankets. Back-to-sleep positioning is the single most effective step.

When do infants typically double and triple their birth weight?

Infants usually double their birth weight by about 4 to 6 months and triple it by 12 months. Tracking weight against growth charts helps catch nutritional or growth problems early.

Why should infant food never be heated in a microwave?

Microwaving heats unevenly and creates hot spots that can scald an infant's mouth even when the container feels cool. Warm fluids should be tested on your own skin before feeding.