CPN cheat sheet

Birth weight averages about 3.2 kg (7 lb); it doubles by 5-6 months and triples by 12 months.

Head circumference is about 35 cm at birth; it grows roughly 2 cm/month for 3 months, then 1 cm/month. The anterior fontanel closes at 12-18 months; the posterior fontanel closes at 6-8 weeks.

Primitive reflexes: Moro and palmar grasp disappear by 3-4 months, asymmetric tonic neck by 4 months, and Babinski by about 12 months.

Milestones: social smile 2 months, head control 3 months, sits unsupported 6-8 months, walks 12-15 months, two-word phrases 18-24 months.

Erikson: infancy trust vs mistrust; toddler autonomy vs shame and doubt; preschool initiative vs guilt; school age industry vs inferiority; adolescent identity vs role diffusion.

Piaget: sensorimotor 0-2 years, preoperational 2-7 years, concrete operational 7-11 years, formal operational 11 years and older.

Immunization schedule: DTaP at 2, 4, 6, 15-18 months and 4-6 years; MMR and varicella at 12-15 months and 4-6 years; Tdap and HPV at 11-12 years.

Expected growth velocity is about 5 cm/year in school-age children; the pubertal spurt occurs around 10-14 years in girls and 12-16 years in boys.

Typical sleep: newborn 16-18 hours/day, toddler 11-14 hours, school-age 9-11 hours, adolescent 8-10 hours.

Normal ranges: newborn/infant HR 100-160 and RR 30-60; toddler HR 90-150 and RR 24-40; preschool HR 80-140 and RR 22-34; school-age HR 70-120 and RR 18-30; adolescent HR 60-100 and RR 12-20.

The pediatric assessment triangle is appearance plus work of breathing plus circulation to skin; it is completed within seconds of first contact.

Maintenance fluids (4-2-1 rule): 4 mL/kg/h for the first 10 kg, plus 2 mL/kg/h for the next 10 kg, plus 1 mL/kg/h for each kilogram above 20 kg.

Pain tools by age: NIPS/CRIES for neonates, FLACC for 2 months to 7 years, Wong-Baker FACES for 3 years and older, numeric scale for 8 years and older.

Expected urine output is 1-2 mL/kg/h in infants and toddlers and 0.5-1 mL/kg/h in children; lower values suggest dehydration or poor renal perfusion.

Blood pressure cuff bladder width should cover about 40% of arm circumference and 80-100% of arm length; head circumference is measured until 36 months.

Weight-based dosing requires verifying mg/kg, current weight in kilograms, and the maximum adult dose; tenfold errors are the most common pediatric medication error.

Signs of dehydration include acute weight loss above 5%, sunken fontanel, capillary refill longer than 2 seconds, dry mucous membranes, and absent tears.

Stranger anxiety appears at 6-9 months and separation anxiety peaks around 12-18 months; both are developmentally normal.

Child CPR: 30:2 with one rescuer and 15:2 with two rescuers at 100-120 compressions/min; depth is at least one third of anteroposterior diameter (about 4 cm in infants, 5 cm in children).

Defibrillation energy: 2 J/kg for the first shock, 4 J/kg for the second, and at least 4 J/kg (maximum 10 J/kg) for subsequent shocks.

Epinephrine in cardiac arrest: 0.01 mg/kg IV/IO of 1:10,000 (0.1 mL/kg), maximum 1 mg; endotracheal dose is 0.1 mg/kg of 1:1,000.

Anaphylaxis: IM epinephrine 0.01 mg/kg of 1:1,000, maximum 0.5 mg, in the anterolateral thigh; repeat every 5-15 minutes as needed.

Croup: dexamethasone 0.15-0.6 mg/kg as a single dose; nebulized racemic epinephrine 0.05 mL/kg of 2.25% (maximum 5 mL) for stridor at rest.

Pediatric DKA: 10 mL/kg isotonic saline bolus, then insulin 0.05-0.1 units/kg/h with deficit replacement over 48 hours; headache with bradycardia and hypertension signals cerebral edema.

Burns: Parkland formula 4 mL/kg x %TBSA lactated Ringer over 24 hours, half in the first 8 hours; modified rule of nines gives infant head 18% and each leg 14%.

Airway obstruction: infant receives 5 back blows then 5 chest thrusts; a child older than 1 year receives abdominal thrusts.

Hypoglycemia: treat glucose below 60 mg/dL in children (below 40 mg/dL in neonates) with D10W 2-5 mL/kg IV; benzodiazepines are first-line for seizures (lorazepam 0.1 mg/kg IV, diazepam 0.5 mg/kg rectal).

Informed consent for a minor requires a parent or legal guardian signature; emancipated minors and some mature minors may consent independently under state law.

Assent is sought from children who are developmentally able, generally age 7 and older; it complements but never replaces parental permission.

Nurses report suspected abuse or neglect to child protective services based on reasonable suspicion; proof is not required and good-faith reporting is legally protected.

Five rights of delegation: right task, right circumstance, right person, right direction and communication, and right supervision and evaluation.

Family-centered care rests on four concepts: dignity and respect, information sharing, participation, and collaboration.

Teach-back requires the learner to restate or demonstrate teaching; limit sessions to 1-3 key points and use a trained interpreter rather than a family member.

VAERS accepts reports of any clinically significant adverse event after vaccination, even when causality is uncertain.

Ethical principles applied to pediatric practice: autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity.

HIPAA and state law often let adolescents consent to STI testing, contraception, and mental health care; confidentiality limits should be explained to teen and parent.