Pediatric Growth & Development
At what age should a child be able to sit unsupported?
What is 6 months?
At what ages are routine well-child visits typically scheduled during the toddler stage?
What is the 15, 18 month; 2, 2 and a half, and 3 years visits?
A 2-year-old presents with ear tugging, fever, and irritability. The tympanic membrane is bulging, erythematous, and immobile. What is the most likely diagnosis?
What is Acute Otitis Media (AOM).
Persistent middle ear effusion may require referral to this specialist.
Who is an otolaryngologist (ENT)?
A preschool child presents with redness of the sclera, mild discharge, and crusting on the lashes in the morning. Vision is normal. What is the most likely diagnosis, and what is the first-line treatment?
What is bacterial conjunctivitis; treat with topical antibiotic drops such as polymyxin-trimethoprim (Polytrim).
A 3-year-old can ride a tricycle, use 3-word sentences, and stack 9 blocks. What developmental domain do these milestones represent?
What is gross motor, language, and fine motor development?
At what age should autism-specific screening be performed?
What are 18 and 24 months?
A 7-year-old presents with “barking cough” and inspiratory stridor that worsens at night. What is the likely diagnosis?
What is croup?
During a 4-year-old’s well-child visit, the FNP notes an absent red reflex in the right eye. What should the provider do next?
Refer immediately to ophthalmology — may indicate a serious disorder such as retinoblastoma or congenital cataract.
A 9-year-old presents after getting sand in his eye at recess and complains of pain, tearing, and a foreign-body sensation. What is the best method to assess for a corneal abrasion?
What is perform fluorescein staining and examine the eye under a cobalt blue light (Wood’s lamp or slit lamp)
The average birth weight triples by this age.
What is 1 year?
Which term describes the ongoing process of monitoring a child’s developmental progress through observation and parent discussion at every well visit?
What is developmental surveillance?
A 12-year-old swimmer presents with ear pain, itching, and tenderness when the tragus is touched. The canal is red and swollen with debris. What is the diagnosis and first-line treatment?
What is otitis externa (“swimmer’s ear”); treat with topical fluoroquinolone/steroid ear drops and keep the ear dry.
A 2-year-old with no spoken words should be referred for this type of evaluation.
What is a speech and hearing evaluation?
A 10-year-old has watery discharge, burning, and preauricular lymphadenopathy after a recent cold. What is the most likely cause of her symptoms?
What is Viral conjunctivitis (most often adenovirus).
At what age should a child have 50% of speech intelligible to a stranger?
What is 2 years?
A 2-year-old fails the communication section of the ASQ-3 but has otherwise normal development. What is the FNP’s most appropriate next step?
What is refer for a speech-language and hearing evaluation and continue developmental surveillance at future visits.
A 5-year-old has a history of ear infections. Otoscopy reveals a retracted tympanic membrane with visible air-fluid levels but no acute infection. What is the diagnosis and appropriate management?
What is otitis media with effusion (serous otitis); observe and recheck in 3 months — antibiotics are not indicated.
During a school vision screening, a 7-year-old is found to have 20/50 vision in both eyes. The remainder of the exam is normal. What should the FNP do next?
What is refer the child to an optometrist or ophthalmologist for a complete eye examination and likely corrective lenses.
A 3-year-old has a positive corneal light reflex test showing asymmetric reflection and fails the cover-uncover test. What is the likely diagnosis and appropriate next step?
What is Strabismus; refer to pediatric ophthalmology to prevent amblyopia (“lazy eye”). Early correction is essential for visual development.
A 6-year-old is beginning to take pride in completed schoolwork and asks for reassurance about right and wrong. According to Erikson, what stage of psychosocial development is this?
Industry vs. Inferiority.
Which components make up an effective developmental surveillance system in primary care, according to the AAP?
Eliciting parental concerns
Documenting developmental history
Making accurate observations
Identifying risk/protective factors
Maintaining a longitudinal record and referral system
An 18 year old with allergic rhinitis has boggy, pale turbinates and nasal congestion. What first-line medication should be prescribed?
What is an intranasal corticosteroid?
Delayed or asymmetric Moro reflex in an infant may indicate this neurologic condition.
What is brachial plexus injury or cerebral palsy?
At what age should formal visual acuity testing begin during well-child visits?
What is 3 years old?