The policy of the pediatric clinic is that head circumferences are performed at each visit, if appropriate. The nurse should plan to check head circumferences on which of the children being seen today? Standard Text: Select all that apply

Question

1. One-month-old child who is coming for his first well-child visit
2. Two-month-old child with failure to thrive
3. Nine-month-old child with otitis media
4. 18-month-old well-child visit for a child with Down's syndrome

Answer 1

1,2,3,4
Rationale 1: The fontanels are open and the head will increase in size until two years of age.
Rationale 2: The posterior fontanel is closed or closing. The anterior fontanel is open and head circumference will increase. The head circumference should be monitored to make sure the failure to thrive is not affecting brain development.
Rationale 3: The anterior fontanel is still open, and the head circumference is still increasing slightly. Failure to see the increase could indicate the sutures have closed prematurely. The otitis media diagnosis is unrelated to the general assessment findings.
Rationale 4: The anterior fontanel is closed or closing. The head circumferences should be evaluated until the child is two years old. The diagnosis of Down's syndrome does not change the need to monitor the child's progress.
Global Rationale: