FNP pediatrics: well-child care, developmental milestones, and common pediatric illnesses

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) schedule: Newborn, 2–5 days, 1, 2, 4, 6, 9, 12, 15, 18, 24, 30 months, then annually 3–21 years.

Key developmental milestones and screening tools:

• 2 months: Social smile, tracks objects, coos (vowel sounds), lifts head 45°
• 4 months: Laughs, holds head steady, rolls front to back
• 6 months: Sits with support, babbles consonants, reaches for objects
• 9 months: Crawls, pincer grasp developing, stranger anxiety, says "mama/dada" nonspecifically
• 12 months: Cruises, may walk, 1–3 words, waves bye-bye, points
• 18 months: Walks well, 10–25 words, uses spoon, symbolic play
• 24 months: Runs, 50+ words, 2-word phrases, parallel play

Developmental screening tools: M-CHAT-R/F (Modified Checklist for Autism in Toddlers) at 18 and 24 months. ASQ-3 (Ages and Stages Questionnaire) at all routine visits. Developmental surveillance (asking parents about concerns) at every visit — formal screening at 9, 18, 30 months.

Autism red flags requiring immediate referral: No babbling/pointing/gesturing by 12 months; no single words by 16 months; no 2-word phrases by 24 months; any loss of previously acquired language/social skills at any age.

Birth through 6 months: HepB (birth, 1–2 months, 6–18 months), RV (rotavirus — 2, 4, 6 months), DTaP (2, 4, 6 months), Hib (2, 4, 6 months), PCV15/20 (2, 4, 6 months), IPV (2, 4, 6–18 months).

12–18 months: MMR #1 (12–15 months), Varicella #1 (12–15 months), Hib booster (12–15 months), PCV booster (12–15 months), HepA #1 (12–23 months), DTaP booster (15–18 months).

4–6 years: DTaP, IPV, MMR #2, Varicella #2, HepA series completion.

Adolescent vaccines (11–12 years): Tdap, MenACWY (meningococcal), HPV series initiation. Annual influenza for all ages ≥6 months. COVID-19 per updated ACIP guidance.

FNP contraindication knowledge: MMR contraindicated in: immunocompromise (except HIV with CD4 ≥200), pregnancy, severe egg allergy (actually a precaution, not absolute contraindication — administer in supervised setting). Live vaccines (MMR, varicella, LAIV) contraindicated within 4 weeks of each other unless given simultaneously.

Acute otitis media (AOM): Diagnosis requires: middle ear effusion AND signs of inflammation (otalgia, erythematous/bulging TM) AND acute onset. Management: Age <6 months → antibiotics. Age 6–23 months with severe AOM (fever ≥39°C, otalgia ≥48h, bilateral AOM) → antibiotics. 24+ months or mild unilateral AOM → 48–72 hour observation option with safety-netting. First-line: amoxicillin 90 mg/kg/day × 5–7 days. Penicillin allergy: cefdinir or azithromycin. Failure at 48–72h: amoxicillin-clavulanate.

Streptococcal pharyngitis: Modified Centor/McIsaac criteria: exudate, anterior cervical LAD, fever >38°C, no cough (each +1 point); age 3–14 (+1), age ≥45 (-1). Score ≥3: throat culture or RADT. Treat confirmed GAS: amoxicillin 50 mg/kg/day × 10 days (first-line in children). Penicillin allergy: amoxicillin-clavulanate or azithromycin. Goal: prevent rheumatic fever, reduce symptoms, prevent spread.

Childhood asthma: GINA stepwise therapy in children follows same principles as adults. ICS are first-line controller therapy. Montelukast (leukotriene modifier) as adjunct or alternative to low-dose ICS in mild persistent asthma. FEV1/FVC ratio <0.85 in children supports diagnosis (different threshold than adults). Spacer device required with MDI in children — improves drug delivery, reduces oral deposition.