Exam 1 — Pediatric client care and the four age groupsWeek 4
📚 Reading: Growth, development, screening, risk
💡 The one idea
School age = industry vs inferiority (they need to achieve and be competent).
Adolescence = identity vs role confusion (they need to belong).
Peers matter more than parents from here on.
School age 6–12
Adolescent 12–18
Needs
To do things well; rules and fairness
To fit in; independence
Play / activity
Cooperative, team games, collecting
Peer group, identity exploration
In the hospital
Give tasks and choices; explain equipment; privacy matters
Privacy and confidentiality; involve them in decisions; peer visits
Fear
Loss of control, being left out
Being different; body image
🚨 The leading cause of death in adolescents
Unintentional injury — mainly motor vehicle crashes, then suicide and homicide.
Risk-taking peaks because the reward system matures before the judgment system does.
Always ask an adolescent about mood and self-harm directly and in private. Asking does not plant the idea.
⭐ Tanner staging, in one line
Girls: the first sign of puberty is breast budding (thelarche), and
menarche comes last, roughly 2 years later.
Boys: the first sign is testicular enlargement.
Girls start about 2 years earlier than boys, which is why the growth spurt timing differs.
✅ Scoliosis screening
Screened in early adolescence, at the growth spurt. The test is the forward bend
test — look for a rib hump and uneven shoulders, scapulae and hips.
Brace treatment is worn most of the day and works only while the child is still growing
— which is exactly when body image makes adherence hardest. Address that openly.
⭐ High-yield — what the exam actually asks
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Vitals: school-age HR 60–110, RR 20–25. Adolescent HR 50–100, RR 16–20, BP under 120/80.
Growth slows to about 5 lb and 2 inches per year in school-age. Adolescence delivers 20–25% of adult height.
Erikson industry vs inferiority, then identity vs role confusion. Piaget concrete operational (conservation, classification, logic about concrete things), then formal operational (abstract, hypothetical).
Scoliosis screening yearly after age 8. Innocent murmurs are common as the heart outgrows the chest.
Tanner sequence: boys start with testicular enlargement, girls with breast budding. Menarche comes late in the girls' sequence, and growth stops 2–2.5 years after it.
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Vaccines at 11–12: Tdap (then every 10 years), HPV 2 doses 6–12 months apart, meningococcal with a booster at 16.
ADHD stimulants: give with food, first dose in the morning, second dose before 6 PM if BID. Monitor insomnia, appetite loss, tachycardia/HTN, mood.
Booster seat until 4'9". Screen time capped around 2 hours and off before bed.
Adolescents are most commonly deficient in calcium, iron and zinc. Menstruating girls need annual anemia screening.
Leading cause of adolescent death is unintentional injury (MVCs, firearms, drowning). Screen for depression and suicide risk.
School-age growth: about 4.4–6.6 lb (2–3 kg) and 2.4–2.8 in (6–7 cm) a year. Sleep 9–12 hours a night; adolescents need 8–10.
First permanent teeth at about 6 years. Puberty changes begin around 10, earlier in girls.
Peak growth velocity is about 11.2 years in females and 13.5 years in males. Menarche follows breast and pubic hair development by roughly 2.6 years.
Vaccines at 11–12: Tdap, HPV, meningococcal — with the second meningococcal dose at 16.
Piaget: concrete operational in the school-age child. Conservation is learned in order: mass first, then weight, then volume.
Safety: back seat until 12 years, never in a pickup bed, and stand 10 feet from the curb at the bus.
Depression needs findings present 2 weeks to diagnose; fluoxetine is first-line and can take about 2 weeks to work. ADHD manifestations appear before age 12; give the last stimulant dose at least 6 hours before bed.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 32 (school-age) · ch. 33 (adolescent).
School-age thinking is concrete operational, so explanations work best when they are literal and specific.
⚠️ Exam traps
School-age wants facts and control; adolescents want privacy and peer contact. The wrong intervention for the wrong stage is the classic distractor.
Concrete vs formal operational thinking determines how you teach a procedure, not just what you say.
🧠 Mind maps 1
One per disorder, built from the structure of your ATI chapter.
Psychosocial Issues of Infants, Children, and Adolescents
🎯 Who gets it
Depression: family history and traumatic events
PTSD: possible genetic predisposition, a traumatic or repeated trauma, existing mental health disorder, natural disaster, sexual assault, witnessing homicide, suicide, or other violence
ADHD: familial tendency, exposure to toxins or medications, chronic otitis media, meningitis, or head trauma
Autism spectrum disorder: possible genetic component with cause unknown
👀 What you see
Depression: sad expression, staying alone, withdrawal from family, friends, and activities, fatigue, tearfulness, feeling ill, worthlessness, weight loss or gain, sleep changes, lost interest and falling performance in school, statements of low self-esteem, hopelessness, suicidal ideation
Suicide assessment: ask directly about suicidal thinking, which does not plant the idea; clues may be overt ('There is no reason to go on') or covert ('Things look pretty grim')
Suicide plan assessment: whether a plan exists, its lethality, whether the child can describe it exactly, and whether they can access the method; a sudden shift from sadness to calm happiness can signal intent
PTSD: flashbacks, hypervigilance, anger outbursts following a traumatic event
🧪 What confirms it
CBC, urinalysis, and tests for sexually transmitted infections or bleeding
Guided by findings and injuries — radiographs and CT or MRI
🩺 What you do
Individualize the plan of care and obtain health, growth, and developmental history
Assess for substance use and for actual or potential risk to self, including plan, lethality, and access to means
Assist with coping strategies, encourage peer group discussion, mentoring, and counseling, and interview the child directly
Monitor for adverse effects and suicidal ideation on SSRIs or SNRIs and refer to psychotherapy
💊 Drugs
Fluoxetine is first-line for acute depressive disorders in children and adolescents; if it fails, try a second SSRI such as sertraline, escitalopram, or citalopram
Selective norepinephrine reuptake inhibitors may be used case by case
Methylphenidate and dextroamphetamine: titrate the dose gradually to effect, give the last dose at least 6 hr before bedtime to prevent insomnia, and monitor height and weight because of growth suppression
Stimulant adverse effects: insomnia, anorexia, nervousness, hypertension or hypotension, tachycardia, anemia; avoid caffeine and store the drug securely because of misuse potential
💬 What you teach
Watch for adverse effects, expect up to 2 weeks for therapeutic effect, and never stop the medication abruptly
Failure to thrive: recognize and respond to the infant's hunger cues and mix formula exactly per written step-by-step instructions
Bullying: observe for signs, ask questions, obtain family support, refer to counseling and bully-prevention programs, follow investigation and reporting procedures, and refer for mental health evaluation since bullying can signal an emerging mental health disorder
⚠️ What goes wrong
Extreme malnourishment — prepare child and parents for tube feedings or IV therapy
Maltreatment types: physical (shaken baby syndrome, fractures, factitious disorder imposed on another), sexual (sexual contact without consent, any sexual behavior toward a minor, adolescent dating violence), emotional (humiliating, threatening, or intimidating a child and undermining self-worth), and neglect (failure to provide for the child's needs)
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
🎥 Lecture recordings 2
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Sport and bicycle injury; road traffic as a pedestrian and passenger.
Bullying, in person and online.
Obesity, inactivity and screen time.
Dental caries and untreated orthodontic need.
Chronic illness beginning to affect school attendance and peer belonging.
Assessment — Expected Findings
Weight gain 2-3 kg (4.4-6.6 lb) per year; height gain 6-7 cm (2.4-2.8 in) per year
Prepubescence usually in preadolescence, physiologic changes starting about age 10 and earlier in girls
Rapid height and weight gain; growth and maturation rates visibly diverge between sexes; little visible sexual maturation in boys yet
Permanent teeth erupt and bones continue to ossify
Piaget concrete operations: perceptual to conceptual thinking; conservation mastered in order of mass, then weight, then volume; tells time, classifies complex information, takes another's perspective, solves problems
Erikson industry vs inferiority: accomplishment through skill-building, cooperation, and competition; reward systems tied only to mastery breed inferiority in those who cannot keep up
Early school-age morality: right is what adults say, judgment tied to reward and punishment, accidents may be read as punishment
Later school-age morality: judges intent rather than outcome, grasps differing viewpoints, treats others as they wish to be treated for acceptance
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Lipid screening once between 9 and 11 years.
Hemoglobin, and lead where risk persists.
Vision and hearing screening at school.
Blood pressure at every visit — interpreted against age, sex and height percentiles, not adult numbers.
Diagnostic Procedures
Not in your ATI chapter — filled from CDC, n.d..
Body mass index should be assessed at least once a year for every child starting at age two.
BMI-for-age percentile is meant as a screening tool, not a stand-alone way to diagnose a weight problem.
Centers for Disease Control and Prevention · Screening for Child Obesity · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Industry versus inferiority — competence and achievement matter enormously. Give jobs they can succeed at.
Prepare days in advance; explain with diagrams and real words.
Protect privacy and modesty — it becomes acutely important now.
Cooperative play and rules; peer contact matters during hospitalization.
Include the child in decisions where there is genuine choice.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Most can swallow tablets by this age — teach the skill rather than assuming.
Weight-based dosing still applies until adult weight.
Begin teaching the child about their own medicines, with the parent still responsible.
Arrange school administration plans for asthma inhalers, insulin and epinephrine autoinjectors.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Booster seat until the adult belt fits properly, then back seat until 13.
Helmets for cycling, skating and scooters — every time.
60 minutes of activity daily; consistent sleep.
Sport physical assessment before the season.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from AAP, n.d..
Current AAP guidance favors judging the quality of a child's media use over enforcing strict daily time limits.
Families are encouraged to build a household media plan addressing content, co-viewing, and communication around devices.
A properly fitted bicycle helmet sits level on the head, covers the forehead, and has a snug chin strap.
American Academy of Pediatrics · Screen Time Guidelines · open the source →
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Pediatrician or family provider for well-child visits and the immunization schedule.
Dentist — first visit by age 1 or within 6 months of the first tooth.
Dietitian for faltering growth, obesity, or a very restricted diet.
School nurse and teachers for chronic conditions and learning concerns.
Social work for food, housing and safety; early intervention for developmental delay.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Injury remains the leading cause of death.
Obesity and its early metabolic consequences.
Anxiety, depression and the effects of bullying.
School absence and falling behind with chronic illness.
Unrecognized learning difficulty presenting as behavior.
📋 Health Promotion of Adolescents (12 to 20 Years6 parts
ATI Active Learning Template — System DisorderHealth Promotion of Adolescents (12 to 20 Years)
Filled from ATI chapter 7, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 3 cite a source, 6 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Growth, sexual maturation, psychosocial development, and anticipatory guidance for ages 12 to 20.
Health Promotion & Disease Prevention
Catch-up doses of anything missed at 11-12 years
Annual influenza (IIV or LAIV, recommendation may be season-specific); COVID-19 per current CDC guidance
Meningococcal second dose at 16 years if the first was given at 11-12 years
Annual screenings: scoliosis (idiopathic scoliosis risk), height/weight for BMI, blood pressure, hemoglobin and hematocrit, universal lipid screening, STI screening if sexually active
Rapid growth and high metabolism raise needs for calcium, protein, and nutrient-dense foods
Erikson identity vs role confusion: role experimentation builds a unique self; success yields loyalty and commitment to personal ideals
Mood swings and outward emotional expression common in early adolescence; social demands peak in middle adolescence; emotional stability and anger management usually settle by late adolescence
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from USPSTF, n.d..
The USPSTF gives a Grade B recommendation to screen all sexually active females age 24 and younger for chlamydia and gonorrhea.
Infection rates for these two STIs are highest among adolescents and young adults aged 15 to 24.
U.S. Preventive Services Task Force · Chlamydia and Gonorrhea: Screening · open the source →
Diagnostic Procedures
Not in your ATI chapter — filled from USPSTF, n.d..
Adolescents aged 12 through 18 should be screened for major depressive disorder, per a Grade B recommendation.
Evidence remains insufficient to support routine suicide-risk screening for children and teens at this time.
U.S. Preventive Services Task Force · Depression and Suicide Risk in Children and Adolescents: Screening · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Identity versus role confusion — peer group is the reference point, not the family.
Offer confidential time without the parent present at every visit. It is the single most useful thing you can do.
Ask directly about mood, self-harm and suicidal thoughts. Asking does not plant the idea.
Address body image, sexual health and substance use plainly and without reaction.
Adolescents are present-focused — frame risk in terms of now, not at 50.
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Adult dosing once adult weight is reached.
Adherence is the central problem — ask how many doses were missed this week, not whether they take it.
Discuss contraception and emergency contraception, and know the local rules on confidentiality.
Screen for interactions with alcohol, cannabis, energy drinks and supplements.
Acne treatment: isotretinoin is teratogenic and requires strict pregnancy prevention.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
HPV vaccination, plus meningococcal and Tdap boosters.
Sport physical assessment; scoliosis screening.
STI screening per risk; confidential access matters more than the schedule.
Driving safety agreement: no phone, no passengers early on, always the belt.
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Teach testicular self-examination monthly, and breast awareness.
Sexual health: consent, contraception, STI prevention. Only condoms prevent infection.
Substance use, including vaping, and how it is marketed to them.
Where to get help confidentially, and what you would have to share and with whom.
Sleep — adolescents need 8–10 hours and almost none get it.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Pediatrician or family provider for well-child visits and the immunization schedule.
Dentist — first visit by age 1 or within 6 months of the first tooth.
Dietitian for faltering growth, obesity, or a very restricted diet.
School nurse and teachers for chronic conditions and learning concerns.
Social work for food, housing and safety; early intervention for developmental delay.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Unintentional injury, homicide and suicide are the leading causes of death in this group.
Depression, anxiety, self-harm and eating disorders.
Substance use and its consequences.
Unintended pregnancy and STIs.
Any disclosure of suicidal intent is acted on immediately, not filed for the next appointment.
📋 Immunizations6 parts
ATI Active Learning Template — System DisorderImmunizations
Filled from ATI chapter 34, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Vaccines stimulate antibody production against a specific disease using a killed or weakened form of the organism. The Advisory Committee on Immunization Practices sets the schedule. Preterm infants receive each vaccine at the same chronologic age as full-term infants. A catch-up schedule on the CDC website covers missed doses. Goals are to reduce or eliminate infectious diseases in the population and to prevent those diseases and their complications.
Health Promotion & Disease Prevention
Hepatitis B: minimum age birth, 3 doses at birth, 1-2 months, and 6-18 months; at least 4 weeks between doses 1 and 2 and 8 weeks between doses 2 and 3; final dose no earlier than 24 weeks of age and at least 16 weeks after the first; withhold for preterm infants under 2,000 g if the mother is hepatitis B negative
Rotavirus: minimum age 6 weeks, 2 doses of Rotarix (2 and 4 months) or 3 doses of RotaTeq (2, 4, 6 months); do not start the series at 15 weeks0 days or older and give the last dose by 8 months0 days
DTaP: minimum age 6 weeks, 5 doses at 2, 4, 6 months, 15-18 months, and 4-6 years; at least 6 months between doses 3 and 4; dose 4 may be given as early as 12 months; dose 5 is unnecessary if dose 4 was given at 4 years or older and at least 6 months after dose 3
Tdap: minimum age 11 years, one dose at 11-12 years then Td booster every 10 years; one dose in each pregnancy between 27 and 36 weeks regardless of prior timing; for wounds, give Tdap or Td if a minor clean wound and over 10 years since the last dose, or over 5 years for all other wounds
Hib: minimum age 6 weeks, 4 doses (ActHIB, Pentacel, Vaxelis) at 2, 4, 6 months and a 12-15 month booster, or 3 doses (PedvaxHIB); use a different Hib product for the booster; only 1 dose is needed for unimmunized children 15 months or older
PCV13: minimum age 6 weeks, 4 doses at 2, 4, 6, and 12-15 months; follow current dual-series guidance with PPSV23 for high-risk conditions
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
True contraindication: anaphylaxis to a previous dose or to a vaccine component.
Live vaccines (MMR, varicella, rotavirus, live influenza) are avoided in significant immunosuppression and in pregnancy.
Moderate or severe acute illness defers a dose; a mild cold with or without low fever does not.
Recent blood product or immunoglobulin can blunt the response to a live vaccine.
Egg allergy is not a contraindication to routine influenza vaccination, and a family history of reaction is not one either.
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Expected after a vaccine: low-grade fever, fussiness, and soreness, redness or a small lump at the site, for 1–2 days.
A small nodule at the injection site can persist for weeks and is harmless.
MMR and varicella may cause a mild rash or fever 7–12 days later, not immediately — parents need warning or they think it is unrelated illness.
Not expected: high fever, widespread hives, wheeze, facial or tongue swelling, or collapse. That is anaphylaxis.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
No routine bloodwork is needed before immunizing.
Titres may be checked to confirm immunity — rubella, varicella, hepatitis B — in health-care students and staff.
Hepatitis B surface antibody after the series in an infant of a positive mother.
Immune function testing before live vaccines where immunodeficiency is suspected.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
None — immunization is a clinical decision from history and the schedule.
Review the record and use the catch-up schedule where doses are missing.
A lapsed schedule is resumed, never restarted.
Check the minimum interval between doses; too-early doses do not count.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Obtain guardian consent before administration
Give the vaccine information statement and review it with guardians and older children, documenting each VIS publication date
Reassure caregivers that MMR is not associated with autism
IM route: vastus lateralis for infants and young children, deltoid for older children and adolescents
Subcutaneous route: outer upper arm or anterolateral thigh
Choose needle size by route, site, age, and volume — adequate length reduces injection site swelling and tenderness
Use comfort strategies to minimize discomfort
Effectiveness is shown by development of immunity and by local reactions resolving without pain, fever, or swelling
Anaphylaxis to any vaccine contraindicates further doses of that vaccine or any vaccine containing that substance
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Site by age:vastus lateralis for infants and toddlers, deltoid once the muscle is big enough, usually from about 3 years.
Needle length and gauge by age and muscle mass; 25 mm is common for infants.
Different vaccines go in different sites, or at least 1 inch apart, and are documented separately.
Epinephrine must be immediately available whenever vaccines are given.
Never mix vaccines in one syringe unless the product is licensed as a combination.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Comfort measures reduce distress and improve return rates: breastfeeding, sucrose, skin-to-skin for infants.
Hold the child securely with a parent’s help; give the injection quickly.
Observe for 15 minutes afterwards.
Older children: distraction, topical anesthetic, sitting up rather than lying down.
Give the most painful injection last.
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Give the Vaccine Information Statement before each vaccine — this is a legal requirement, not a courtesy.
Expect soreness and low fever; a cool compress and weight-appropriate acetaminophen or ibuprofen if needed.
Do not give an antipyretic prophylactically before the vaccine — it can reduce the immune response.
Return immediately for difficulty breathing, facial swelling, hives, or a child who becomes limp or unresponsive.
Keep the record and bring it to every visit; a lost record often means repeated doses.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Provider for the schedule and for judging true contraindications.
Pharmacist for storage and the cold chain — a break in it wastes the whole batch.
Public health for outbreak response, reporting and catch-up campaigns.
School nurse for entry requirements and exemptions.
Report significant adverse events through the national reporting system.
⚠️ What goes wrongComplications
Complications
DTaP mild: injection site redness, swelling, and tenderness, poor appetite, vomiting, low fever, drowsiness, irritability, anorexia
DTaP moderate reactions: crying that cannot be consoled lasting 3 hr or longer, temperature reaching 40.6 C (105 F) or above, seizures with or without fever, and a shock-like state
DTaP severe: acute encephalopathy, rare; encephalopathy within 7 days of a prior dose contraindicates further doses
LAIV: allergic reaction, vomiting or diarrhea, nasal congestion and runny nose
📋 Psychosocial Issues of Infants, Children, and Adolescents6 parts
ATI Active Learning Template — System DisorderPsychosocial Issues of Infants, Children, and Adolescents
Filled from ATI chapter 44, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Nurses care for pediatric clients with psychosocial as well as physical problems; psychosocial issues such as depression may result from physical illness, exist independently, or cause physical symptoms. Covers depression and suicide, posttraumatic stress disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, failure to thrive, bullying, and child maltreatment. Depression is easily missed in school-age children because they cannot articulate feelings well, and findings must persist 2 weeks to diagnose major depressive disorder. ADHD inattentiveness, hyperactivity, and impulsiveness usually appear before age 7. Autism spectrum disorder is a group of complex neurodevelopmental disorders affecting communication and social interaction. Maltreatment occurs across all economic and educational backgrounds and includes physical, sexual, and emotional abuse and neglect.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Screen for depression and anxiety routinely in adolescence, and ask about self-harm directly.
Ask about bullying, including online, and about who the child would tell.
Support secure attachment in infancy; parenting support for families under strain.
Screen for adverse childhood experiences and connect families to support rather than only recording them.
Confidential time for adolescents at every visit.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Depression: family history and traumatic events
PTSD: possible genetic predisposition, a traumatic or repeated trauma, existing mental health disorder, natural disaster, sexual assault, witnessing homicide, suicide, or other violence
ADHD: familial tendency, exposure to toxins or medications, chronic otitis media, meningitis, or head trauma
Autism spectrum disorder: possible genetic component with cause unknown
Intellectual disability: familial, social, environmental, organic, or unknown causes; congenital rubella or syphilis, fetal alcohol syndrome, chronic lead ingestion, brain trauma, gestational disorders
Intellectual disability from preexisting disease: cerebral palsy, Down syndrome, hydrocephaly, microcephaly, metabolic disorders, and mental health disorders
Failure to thrive: prematurity with low birth weight or intrauterine growth restriction, poverty, family stress, resistance to feeding, weak maternal-child attachment, and caregiver neglect, inexperience, or health and childrearing beliefs
Failure to thrive, organic causes: prematurity, congenital heart disease, cerebral palsy, Down syndrome, cystic fibrosis, celiac disease, hyperthyroidism, hepatic disease, chronic kidney failure, and gastresophageal reflux
Assessment — Expected Findings
Depression: sad expression, staying alone, withdrawal from family, friends, and activities, fatigue, tearfulness, feeling ill, worthlessness, weight loss or gain, sleep changes, lost interest and falling performance in school, statements of low self-esteem, hopelessness, suicidal ideation
Suicide assessment: ask directly about suicidal thinking, which does not plant the idea; clues may be overt ('There is no reason to go on') or covert ('Things look pretty grim')
Suicide plan assessment: whether a plan exists, its lethality, whether the child can describe it exactly, and whether they can access the method; a sudden shift from sadness to calm happiness can signal intent
PTSD: flashbacks, hypervigilance, anger outbursts following a traumatic event
ADHD inattention: careless mistakes, difficulty sustaining attention, not seeming to listen, not following through, disorganization, avoiding tasks requiring mental effort, losing things, distractibility, forgetfulness
ADHD hyperactivity: fidgeting, not staying seated, running inappropriately, difficulty with quiet play, constant busyness, excessive talking
Autism spectrum: delays in social interaction, social communication, or imaginative play before age 3, distress at routine changes, unusual attachment to objects, inability to start or sustain conversation, gestures instead of words, delayed or absent language, grunting or humming
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
CBC, urinalysis, and tests for sexually transmitted infections or bleeding
Diagnostic Procedures
Guided by findings and injuries — radiographs and CT or MRI
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Individualize the plan of care and obtain health, growth, and developmental history
Assess for substance use and for actual or potential risk to self, including plan, lethality, and access to means
Assist with coping strategies, encourage peer group discussion, mentoring, and counseling, and interview the child directly
Monitor for adverse effects and suicidal ideation on SSRIs or SNRIs and refer to psychotherapy
PTSD: monitor for behavior changes, help child and family with coping, allow expression of feelings, and work to prevent or reduce long-term effects
ADHD: obtain medical, developmental, and behavioral history and use behavioral checklists with adaptive scales
ADHD approach: calm, firm, and respectful, model acceptable behavior, get the child's attention before giving short clear directions, set consistent limits on unacceptable behavior, and plan physical activity that channels energy into success
Autism: assist with screening tools such as the Modified Checklist for Autism in Toddlers, and refer to early intervention, physical, occupational, and speech-language therapy
Autism behavior program: positive reinforcement, increasing social awareness, teaching verbal communication, reducing unacceptable behaviors, realistic goals, structured opportunities for small successes, and clear rules
Medications
Fluoxetine is first-line for acute depressive disorders in children and adolescents; if it fails, try a second SSRI such as sertraline, escitalopram, or citalopram
Selective norepinephrine reuptake inhibitors may be used case by case
Methylphenidate and dextroamphetamine: titrate the dose gradually to effect, give the last dose at least 6 hr before bedtime to prevent insomnia, and monitor height and weight because of growth suppression
Stimulant adverse effects: insomnia, anorexia, nervousness, hypertension or hypotension, tachycardia, anemia; avoid caffeine and store the drug securely because of misuse potential
Atomoxetine, a selective norepinephrine reuptake inhibitor, titrated gradually with monitoring for suicidal ideation
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Therapy matched to the problem: CBT, family therapy, play therapy for younger children.
Behavioral interventions and consistent limits before medication for behavior.
Safety planning where there is self-harm or suicidal thinking, including means restriction at home.
School involvement — a plan the school knows about is worth more than one that stays in the notes.
Refer for eating disorder assessment early; delay worsens the outcome markedly.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Watch for adverse effects, expect up to 2 weeks for therapeutic effect, and never stop the medication abruptly
Failure to thrive: recognize and respond to the infant's hunger cues and mix formula exactly per written step-by-step instructions
Bullying: observe for signs, ask questions, obtain family support, refer to counseling and bully-prevention programs, follow investigation and reporting procedures, and refer for mental health evaluation since bullying can signal an emerging mental health disorder
Interprofessional Care
Initiate social services referrals
Bullying types: verbal (teasing, name calling, inappropriate sexual comments, taunting, threatening), social (deliberate exclusion, spreading rumors, public embarrassment), and physical (hitting, kicking, pinching, spitting, tripping, pushing, rude gestures)
Bullying occurs during or after school on the bus, playground, en route to school, or in the neighborhood; cyberbullying happens on phones, computers, and tablets during gaming, social media, or texting
⚠️ What goes wrongComplications
Complications
Extreme malnourishment — prepare child and parents for tube feedings or IV therapy
Maltreatment types: physical (shaken baby syndrome, fractures, factitious disorder imposed on another), sexual (sexual contact without consent, any sexual behavior toward a minor, adolescent dating violence), emotional (humiliating, threatening, or intimidating a child and undermining self-worth), and neglect (failure to provide for the child's needs)
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Vitals: school-age HR 60–110, RR 20–25. Adolescent HR 50–100, RR 16–20, BP under 120/80.
Growth slows to about 5 lb and 2 inches per year in school-age. Adolescence delivers 20–25% of adult height.
Scoliosis screening yearly after age 8. Innocent murmurs are common as the heart outgrows the chest.
Tanner sequence: boys start with testicular enlargement, girls with breast budding. Menarche comes late in the girls' sequence, and growth stops 2–2.5 years after it.
Vaccines at 11–12: Tdap (then every 10 years), HPV 2 doses 6–12 months apart, meningococcal with a booster at 16.
ADHD stimulants: give with food, first dose in the morning, second dose before 6 PM if BID. Monitor insomnia, appetite loss, tachycardia/HTN, mood.
Booster seat until 4'9". Screen time capped around 2 hours and off before bed.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
