CPNP-PC Mnemonics: 12 Memory Tricks for Pediatric NPs

Live vaccines and true contraindications

“Live four, and a cold is not a contraindication”

The live vaccines on the routine childhood schedule are MMR, varicella, rotavirus and the nasal influenza vaccine (LAIV). Live vaccines are withheld for severe immunodeficiency and pregnancy, and two live injected or nasal vaccines not given on the same day must be at least 28 days apart. For any vaccine, the true contraindication is a severe allergic reaction (anaphylaxis) to a previous dose or a component. Mild illness with or without low-grade fever, current antibiotics, prematurity, breastfeeding, a pregnant household contact and egg allergy are not reasons to delay.

Use it when: When a parent asks whether their child can be vaccinated today, or an item lists conditions and asks which one is a valid reason to defer a vaccine.

Careful: Rotavirus has its own contraindications: severe combined immunodeficiency and a history of intussusception. PNCB states candidates are not expected to memorize vaccine schedules, and the federal schedule is in flux: a court stayed the CDC's January 2026 childhood schedule changes in March 2026 and the case is on appeal, while the AAP publishes its own schedule. Expect counseling and contraindication items, not timing trivia.

Car seat and booster stages (AAP)

“Rear as long as the seat allows, boost to 4 feet 9, back seat to 13”

Keep infants and toddlers rear-facing as long as possible, until they reach the highest weight or height their convertible seat allows. Then use a forward-facing seat with a harness as long as the seat allows. Then a belt-positioning booster until the vehicle lap-and-shoulder belt fits, usually at a height of 4 feet 9 inches, between about 8 and 12 years. Children under 13 ride in the back seat.

Use it when: When an item asks which restraint fits a child of a given age, weight and height, or what anticipatory guidance to give at a well visit.

Careful: The old rule 'rear-facing until age 2' was dropped by the AAP in 2018 in favor of the seat's limits, so 'turn the seat around at the second birthday' is the wrong answer. A child who has outgrown a booster by age is not done; belt fit decides.

Well-child screening schedule (AAP/Bright Futures)

“9-18-30 develop, 18-24 autism, 12-24 lead”

Standardized developmental screening at 9, 18 and 30 months. Autism screening (M-CHAT-R/F) at 18 and 24 months. Blood lead testing at 12 and 24 months for children on Medicaid or at risk. Add: maternal depression screening (e.g. EPDS) at the 1-, 2-, 4- and 6-month visits, hemoglobin at 12 months, universal lipid screening once at 9-11 years and again at 17-21, and annual depression screening from age 12.

Use it when: When an item asks which screening is due at a given well visit, or which tool fits the age.

Careful: Developmental surveillance happens at every visit; the 9-18-30 rule is for the formal, standardized tool. A passed screen does not override a parent's concern or a lost skill, both of which need evaluation at any age. Maternal depression screening is done at the infant's visit even though the parent is the one being screened.

Order of puberty (sexual maturity ratings)

“Girls: Breasts, Pubes, Grow, Flow”

1. BBreast budding (thelarche, SMR 2) is usually the first sign in girls
2. PPubic hair (pubarche)
3. GGrowth spurt: peak height velocity comes early in girls, around SMR 2-3
4. FFlow: menarche, usually about 2-3 years after breast budding, at SMR 3-4

Use it when: When an item describes a child's pubertal findings and asks whether development is normal, early or late, or what comes next.

Careful: Boys differ: testicular enlargement (volume 4 mL or more) comes first and the growth spurt comes late, around SMR 3-4. Workup thresholds: breast development before 8 or testicular enlargement before 9 is early; no breast development by 13 or no testicular enlargement by 14 is delayed. In some girls pubic hair appears before breast budding.

Developmental milestones (CDC 2022 checklists)

“Sit at 9, walk at 18, two words together at 2, fifty words at 30 months”

On the CDC's revised checklists, by 9 months a baby sits without support; by 18 months walks without holding on and tries to say three or more words besides mama and dada; by 2 years puts at least two words together ('more milk'); by 30 months says about 50 words.

Use it when: When a stem describes what a child can and cannot do and asks whether development is on track or which finding needs referral.

Careful: The 2022 milestones are set at the age most (75% or more) children reach them, so they are later than the average ages many textbooks give (for example, walking 'at 12 months'). Missing a 2022 milestone is a reason to screen and refer, not to wait. Crawling was removed as a milestone.

The numbered childhood exanthems

“Most Sick Rugrats Don't Fancy Rashes”

1. MMeasles (1st): cough, coryza, conjunctivitis, Koplik spots, rash spreads head to toe
2. SScarlet fever (2nd): group A strep, sandpaper rash, strawberry tongue, Pastia lines
3. RRubella (3rd): mild, tender posterior auricular and occipital nodes
4. DDukes disease (4th): historical, no longer considered a distinct illness
5. FFifth disease: parvovirus B19, 'slapped cheek' then lacy rash on the limbs
6. RRoseola (6th): HHV-6, several days of high fever, rash appears as the fever breaks

Use it when: When an item describes a febrile child's rash and its timing and asks for the diagnosis, the contagious period, or the complication to counsel about.

Careful: Scarlet fever is the only bacterial one and needs penicillin or amoxicillin. A child with fifth disease is no longer contagious once the rash appears, but parvovirus is a risk in pregnancy and in sickle cell disease (aplastic crisis). Roseola is the classic cause of febrile seizures; the rash after the fever, not with it, is the clue.

Kawasaki disease criteria (AHA 2017)

“CRASH and Burn”

1. CConjunctivitis: bilateral, non-exudative, limbal sparing
2. RRash: polymorphous
3. AAdenopathy: cervical, usually one node 1.5 cm or more, often one-sided
4. SStrawberry tongue and red, cracked lips (oral mucosal changes)
5. HHands and feet: redness and swelling, later peeling of fingers and toes
6. BurnFever for 5 days or more

Use it when: When a child has a prolonged fever with some of these features and the item asks for the diagnosis or the next step (echocardiogram, IVIG and aspirin).

Careful: Classic Kawasaki is fever plus 4 of the 5 features. Infants under 6 months often have incomplete Kawasaki with fewer features and the highest risk of coronary aneurysms, so fever of 7 days or more without explanation in a young infant needs labs and an echo. Give IVIG ideally within 10 days of fever onset.

Adolescent psychosocial interview

“HEEADSSS”

1. HHome: who lives there, relationships, safety at home
2. EEducation and employment: school performance, attendance, bullying
3. EEating: body image, dieting, disordered eating
4. AActivities: friends, sports, screen and social media use
5. DDrugs: tobacco and vaping, alcohol, cannabis, other substances
6. SSexuality: activity, orientation, contraception, STI risk
7. SSuicide and depression: mood, self-harm, suicidal thoughts
8. SSafety: violence, seat belts, firearms, online safety

Use it when: When an item asks how to structure an adolescent visit, which question to ask first, or how to respond to a disclosure.

Careful: Interview the teen alone for part of the visit after explaining confidentiality and its limits: risk of serious harm to self or others and abuse must be disclosed. Start with less sensitive topics (home, school) before drugs and sexuality. Pair with validated tools on the PNCB outline such as CRAFFT, PHQ and the Ask Suicide-Screening Questions.

Everyday weight-based doses

“15 for acetaminophen, 10 for ibuprofen, 90 for high-dose amoxicillin”

Acetaminophen 10-15 mg/kg per dose every 4-6 hours, no more than 5 doses in 24 hours. Ibuprofen 5-10 mg/kg per dose every 6-8 hours, for infants 6 months and older, maximum 40 mg/kg per day. High-dose amoxicillin for acute otitis media 80-90 mg/kg per DAY, divided twice daily. Never exceed the adult maximum dose.

Use it when: When an item gives a child's weight and asks for the correct dose or volume, or spots a dosing error.

Careful: The classic trap is per dose versus per day: amoxicillin 90 mg/kg is the total daily dose, not each dose. Convert pounds to kilograms first (divide by 2.2). Avoid aspirin in children with viral illness (Reye syndrome); Kawasaki disease is the exception.

Acute otitis media: treat or observe (AAP 2013)

“Bulge, Age, Sides, Severity”

1. BBulge: moderate-to-severe bulging of the eardrum (or new otorrhea) makes the diagnosis
2. AAge: under 24 months leans toward antibiotics; the guideline covers 6 months to 12 years
3. SSides: bilateral AOM at 6-23 months gets antibiotics; unilateral non-severe may be observed
4. SSeverity: otalgia for 48 hours or more or temperature 39 C or higher gets antibiotics at any age

Use it when: When an item asks whether to prescribe now, offer observation with follow-up in 48-72 hours, or which antibiotic to choose.

Careful: Observation is a shared decision with guaranteed follow-up, not 'no treatment'. First line is high-dose amoxicillin; switch to amoxicillin-clavulanate if amoxicillin was taken in the past 30 days, with purulent conjunctivitis, or after amoxicillin failure. A red eardrum without bulging or effusion is not AOM.

Bruising that suggests abuse

“TEN-4-FACESp”

1. TENTorso, Ear or Neck bruising
2. 4in a child under 4 years, or ANY bruise in an infant under 4 months
3. FACESFrenulum, Angle of the jaw, Cheeks (fleshy part), Eyelids, Subconjunctivae
4. ppatterned bruising (hand, loop, object marks)

Use it when: When an item describes a bruise in a young child and asks whether further evaluation or a report is needed.

Careful: It is a screening rule, not proof: a positive finding needs an abuse evaluation (for example skeletal survey in a young child) and you report suspicion, not certainty, to child protective services as a mandated reporter. Bruises on shins and foreheads of cruising toddlers are expected; a bruise on a baby who cannot cruise is not.

Fluoride varnish in primary care

“First tooth, first varnish”

Primary care clinicians apply fluoride varnish to all infants and children starting when the first primary tooth erupts and continuing through age 5 (USPSTF, grade B). The AAP recommends reapplying every 3-6 months. Fluoride application is one of the procedures listed on the CPNP-PC content outline.

Use it when: When an item asks what oral-health intervention is due at a well visit, or when to start fluoride varnish.

Careful: Do not wait for the first dental visit or for a cavity; varnish starts at tooth eruption. Varnish is different from oral fluoride supplements, which depend on the fluoride level of the water supply and whose guidance has been changing; check current recommendations before answering supplement questions.