CPN CLE cheat sheet

Weight: doubles by 4-6 months, triples by 12 months; birth weight is regained by 10-14 days of life.

Length increases about 50% by 12 months (approx. 25 cm in year 1); head circumference grows ~2 cm/month in the first 3 months, then slows.

Head circumference at birth averages 33-35 cm; anterior fontanel closes at 9-18 months, posterior fontanel by 2-3 months.

Erikson stages: trust vs mistrust (infancy), autonomy vs shame/doubt (1-3 y), initiative vs guilt (3-6 y), industry vs inferiority (6-12 y), identity vs role confusion (adolescence).

Piaget: sensorimotor (0-2 y, object permanence by 8-9 months), preoperational (2-7 y, egocentric, magical thinking), concrete operational (7-11 y, conservation), formal operational (11+ y, abstract thought).

Primitive reflexes: Moro and rooting disappear by 3-4 months, palmar grasp by 4-6 months, tonic neck by 4 months, Babinski until 12-24 months.

Gross motor sequence: head control (2-3 mo), rolls front-to-back (4-5 mo), sits unsupported (6-8 mo), crawls (9 mo), pulls to stand (9-10 mo), walks alone (12-15 mo).

Language milestones: cooing 2 months, babbling 6 months, first words 12 months, 2-word phrases 18-24 months, 50+ words and 2-word sentences by 24 months.

Red flags: no social smile by 3 months, no babbling by 6 months, no sitting by 9 months, no words by 16 months, no 2-word phrases by 24 months, any loss of skills at any age.

Newborn screening: bloodspot at 24-48 h after birth (before discharge), repeat at 1-2 weeks if drawn before 24 h; hearing screen before discharge; critical congenital heart disease pulse oximetry screen at 24-48 h.

Immunization schedule anchors: 2, 4, 6, 12-15, and 18 months; 4-6 years; 11-12 years (Tdap, HPV series, meningococcal); annual influenza from 6 months; 16-year booster.

Lead screening: universal risk assessment at 9-12 months and again at 24 months; blood lead level >=5 mcg/dL requires follow-up, >=45 mcg/dL is urgent.

Anemia screening: hemoglobin at 12 months (universal); AAP recommends risk-based screening for lipid disorders between 9-11 and 17-21 years.

Autism screening with M-CHAT at 18 and 24 months; developmental surveillance at every well visit.

Vision/hearing: red reflex at every newborn and well visit; visual acuity screening from 3-4 years; hearing screening at school entry and whenever risk factors exist.

Anticipatory guidance by age: injury prevention (car seat, water, falls) dominates 0-4 y; safety and school issues 5-12 y; risk behaviors, mental health, and driving 13-18 y.

BMI percentile: >=85th overweight, >=95th obesity; screen for hypertension annually from age 3 with BP percentile by height, age, and sex.

Dental: first dental visit by first tooth or first birthday; fluoride varnish from 6 months at eruption of first tooth.

Family-centered care pillars: dignity and respect, information sharing, participation, and collaboration; the family is the constant in the child's life.

Communication with children by developmental stage: use concrete language and play for preschoolers, simple cause-and-effect explanations for school-age, and privacy/autonomy for adolescents.

Teach-back confirms understanding: ask the caregiver to explain the plan in their own words rather than asking "Do you understand?".

Interpreters are required for limited-English-proficiency families; never use a child as interpreter; document interpreter use.

Breaking bad news: prepare, use plain language, pause, allow questions, and provide written follow-up; avoid medical jargon.

Adolescent confidentiality: discuss limits (harm to self/others, abuse) before obtaining sensitive history; many states allow confidential care for STI, mental health, and contraception.

Nonverbal cues matter: match eye level with the child, use a calm tone, and allow a comfort object; pain is what the child reports, not what the clinician expects.

Shared decision-making uses a two-way exchange: elicit family goals and values, present options with risks/benefits, and confirm agreement.

Cultural humility includes asking about health beliefs, traditional remedies, and decision-making roles within the family; avoid assumptions based on ethnicity.

Order of exam in infants: observe first, then auscultate heart/lungs while quiet, then palpate and percuss; save invasive steps (ears, throat) for last.

Normal pediatric vital signs: newborn HR 100-160, RR 30-60; infant HR 100-160, RR 30-60; toddler HR 90-150, RR 24-40; school-age HR 70-120, RR 18-30; adolescent HR 60-100, RR 12-20.

Hypotension is a late sign in children: systolic BP below the 5th percentile for age (roughly <70 + 2 x age in years for children 1-10 y) indicates decompensated shock.

Growth plotting: use WHO charts for 0-2 years and CDC charts for 2-20 years; crossing two major percentile lines warrants evaluation.

Head-to-toe sequence: general appearance, skin, HEENT (fontanel, red reflex, tympanic membranes), neck, chest, heart, abdomen, GU, extremities, back, neurologic.

Abdominal exam in children: auscultate before palpation; palpate the liver edge (normal up to 2-3 cm below the right costal margin in infants) and spleen tip.

Murmurs: innocent murmurs are soft, systolic, grade 1-2/6, and vary with position; any diastolic murmur, harsh quality, or associated symptoms requires referral.

Neurologic exam includes level of consciousness, pupil response, motor/sensory, reflexes, and age-appropriate milestones; the infant's anterior fontanel is a window to hydration and intracranial pressure.

Otoscopy in infants: pull the pinna down and back (up and back in children >3 years); the tympanic membrane should be pearly and mobile.

Asthma: classify by impairment and risk; step-up therapy when not controlled; short-acting beta-agonist is rescue, inhaled corticosteroid is controller; use a spacer for all ages.

Bronchiolitis: supportive care (hydration, oxygen, suctioning); no routine bronchodilators, corticosteroids, or antibiotics; palivizumab is prophylaxis for high-risk infants.

Otitis media: watchful waiting for 6-23 months with unilateral nonsevere disease; antibiotics (high-dose amoxicillin) for severe symptoms, bilateral disease in <24 months, or failure at 48-72 h.

Group A strep pharyngitis: treat with penicillin or amoxicillin for 10 days; confirm with rapid antigen test or culture; do not treat without testing.

Kawasaki disease: fever >=5 days plus 4 of 5 criteria; treat with IVIG 2 g/kg and high-dose aspirin; obtain echocardiogram; risk of coronary aneurysms.

Type 1 diabetes: check ketones with illness, monitor for hypoglycemia with exercise; target HbA1c individualized, generally <7% when achievable without hypoglycemia.

Chronic illness management: use a medical home, written care plan, transition planning to adult care starting in early adolescence, and school accommodations (504/IEP).

Febrile seizures: simple (generalized, <15 min, once in 24 h) need no treatment; evaluate source; complex features warrant further workup.

UTI in children: obtain urine by catheter or suprapubic aspiration in infants; treat febrile UTI promptly; renal ultrasound after first febrile UTI in infants <24 months.

Weight-based dosing: verify weight in kg, calculate dose (mg/kg/dose) and maximum daily dose; recheck high-alert medications (insulin, opioids, heparin) with a second nurse.

Pediatric pharmacokinetics: higher water content and lower protein binding increase the volume of distribution for water-soluble drugs; immature hepatic enzymes and renal function in neonates prolong half-life.

Oral syringes are preferred for liquid medications; never use household spoons; measure to the nearest marked increment.

IV push rates and concentrations must follow institutional standards; use a buretrol or infusion pump for small volumes; check compatibility before Y-site administration.

Immunization injection sites: vastus lateralis for infants, deltoid for children >=3 years (or per current guidance); 22-25 gauge needle, 1-1.25 inch for IM depending on age and weight.

Five rights plus two: right patient (two identifiers), drug, dose, route, time, documentation, and reason; verify allergies each time.

Therapeutic drug monitoring: check trough levels for vancomycin and aminoglycosides; adjust for renal function; document timing relative to dose.

Adverse drug event reporting: document, notify provider, and report to the institutional system and FDA MedWatch; naloxone for opioid toxicity.

Car seats: rear-facing until at least 2 years or the seat's height/weight limit; forward-facing with harness until 5-point harness limit; booster seat until seat belt fits (approx. 4 ft 9 in, 8-12 y); rear seat until 13 years.

Safe sleep: supine on a firm flat surface, no loose bedding, room-sharing without bed-sharing, breastfeeding and immunization reduce SIDS risk.

Water safety: supervise within arm's reach; four-sided pool fencing; life jackets on open water; drowning is a leading cause of unintentional injury death in 1-4 years.

Suffocation/strangulation hazards: no crib bumpers, remove window blind cords, avoid plastic bags and small objects under 3 years (choking).

Burns: set water heater <=120 F (49 C), keep pot handles turned inward, sunscreen, and smoke alarms on every level.

Child maltreatment red flags: injury inconsistent with developmental stage or history, delay in seeking care, repeated injuries, patterned marks, and inconsistent caregiver accounts.

Mandatory reporting: nurses are mandated reporters; report reasonable suspicion to child protective services, document objective findings, and do not investigate independently.

Screening for abuse: bruising in infants who are not mobile, sentinel injuries (ear, neck, torso), and fractures in nonambulatory infants warrant evaluation.

Poison prevention: store medications and household products locked, keep Poison Control number (1-800-222-1222 in the US) accessible, and use child-resistant packaging.

4-2-1 rule for maintenance fluids: 4 mL/kg/h for first 10 kg, 2 mL/kg/h for next 10 kg, 1 mL/kg/h for each kg above 20; daily equivalent 100/50/20 mL/kg/day.

Holliday-Segar deficit: deficit (mL) = % dehydration x weight (kg) x 10; replace over 24-48 h along with maintenance.

Dehydration assessment: mild <5% (infant), moderate 5-10%, severe >10%; signs include delayed capillary refill, decreased urine output (<1 mL/kg/h), sunken fontanel, and lethargy.

Isotonic fluid (0.9% NaCl) is used for initial boluses (20 mL/kg) in shock; hypotonic fluids are avoided for maintenance in most hospitalized children due to hyponatremia risk.

Potassium correction: never give IV push; maximum concentration and rate per institutional policy; ensure urine output before adding potassium.

Hypoglycemia in neonates: <40 mg/dL in first 4 h, <45 mg/dL after 4 h; treat with feeding or IV dextrose; recheck glucose.

Breastfeeding: exclusive for about 6 months, continue with complementary foods to 12 months and beyond; vitamin D 400 IU/day for breastfed infants.

Iron: breastfed infants need 1 mg/kg/day iron supplement from 4 months; whole milk is avoided before 12 months; introduce iron-rich foods at 6 months.

Failure to thrive: weight for age <5th percentile or crossing two major percentile lines; evaluate intake, absorption, and increased losses.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin; forms the first impression before vital signs.

CPR: compression-to-ventilation ratio 30:2 for single rescuer, 15:2 for two rescuers in children; rate 100-120/min; depth at least one-third of chest diameter.

Epinephrine for anaphylaxis: 0.01 mg/kg IM (max 0.5 mg) of 1:1000 into the anterolateral thigh; repeat every 5-15 min as needed.

Shock: recognize tachycardia, delayed capillary refill, and narrowed pulse pressure before hypotension; give 20 mL/kg isotonic crystalloid boluses and reassess.

Status epilepticus: benzodiazepine first (lorazepam 0.1 mg/kg IV or midazolam IM/buccal), then second-line antiepileptic; check glucose.

Respiratory distress vs failure: distress shows tachypnea, retractions, and nasal flaring; failure adds bradycardia, cyanosis, and decreased respiratory effort.

DKA: isotonic fluid resuscitation, insulin infusion after fluid start, monitor potassium (total body depletion despite normal serum), and treat cerebral edema with mannitol or hypertonic saline.

Trauma: primary survey ABCDE, cervical spine precautions, and weight-based dosing for resuscitation medications; hypothermia prevention in children.

Poisoning: stabilize airway/breathing/circulation, identify toxin, contact Poison Control; activated charcoal only if within 1 h and airway protected.

Informed consent: parent/guardian consent for minors; emancipated minors and mature minors may consent to specific services per state law; assent is obtained from children developmentally able to participate.

Emergency exception: treatment may proceed without consent when delay would risk life or limb; document the rationale.

Confidentiality: HIPAA permits disclosure for treatment, payment, and operations; minors' confidentiality varies by state and service type.

Mandatory reporting of suspected child abuse overrides confidentiality; report to designated authorities and document.

Scope of practice: follow state nurse practice act, institutional policy, and delegation rules; the RN cannot delegate assessment, teaching, or evaluation to unlicensed assistive personnel.

Ethical principles: autonomy, beneficence, nonmaleficence, justice; apply in resource allocation and end-of-life decisions.

Documentation: objective, timely, and factual; record assessments, interventions, and the child's response; late entries are labeled as such.

Research ethics: IRB approval, informed consent/assent, and minimization of risk; children are a protected population.

Advocacy: nurses advocate for the child's best interests, including pain management, family presence, and appropriate referrals.