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PEDS > 3: 3-year-old male well-child visit > Flashcards

3: 3-year-old male well-child visit Flashcards

1
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Social

A
  • The social environment plays a major part in how children develop.
  • It is necessary to understand the family context before giving advice.
  • To enter this arena, ask about changes and family stressors in a non-threatening way.
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2
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Nutrition

A
  • Preschoolers can suffer from poor nutrition. Inadequate fruit, vegetable, and iron intake is quite common.
  • Calcium and vitamin D deficiencies also are common.
  • Children should receive vitamin D supplementation as it is very difficult to attain the recommended daily allowance through nutritional sources or from sun exposure.
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3
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Exercise

A

Numerous studies have demonstrated a positive effect of physical activity on prevention of obesity.

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4
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Toilet Training

A
  • Toddlers at age 3 may not have achieved full toilet “independence” - especially toddlers with intense, willful temperaments.
  • Requiring assistance toileting is not a clear sign of developmental delay at this age, but may preclude attendance at child care or preschool.
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5
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Dental

A

(AAPD) and the AAP both state that all children should be seen within six months of the first tooth eruption or by 1 year of age.
–Additionally, the AAP states that all children should be screened by 6 months old to see if they are at a higher risk of developing caries. –Many general dentists feel that the first visit should be at age 3 years.

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6
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Safety

A
  • Car seats are often used inappropriately; toddlers are moved too soon to booster seats.
  • toddlers >24 mo or who have outgrown the weight and height limits on their car seats should be in a forward-facing car seat in the car’s back seat.
  • Older children should stay in a booster seat until they reach a height of 4’ 9” (142 cm).
  • Injuries are a major morbidity in the preschool years.
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7
Q

3 socio-emotional

A
  • Brushes teeth (with assistance)

- Feeds self

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8
Q

4 socio-emotional

A
  • Knows gender and age
  • Friendly to other children
  • Plays with toys/engages in fantasy play
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9
Q

5 socio-emotional

A
  • Listens and attends
  • Can tell difference between real and make- believe
  • Shows sympathy/concern for others
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10
Q

3 communication

A
  • Speaks in 2- to 3-word sentences

- 75% understandable

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11
Q

4 communication

A
  • States first and last name
  • Sings a song
  • Most speech clearly understandable
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12
Q

5 communication

A
  • Articulates well
  • Tells a simple story using full sentences
  • Uses appropriate tenses and pronouns
  • Counts to 10
  • Follows simple directions
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13
Q

3 cognitive

A

Knows name and use of “cup, ball, spoon, crayon”

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14
Q

4 cognitive

A

-Names colors
-Aware of gender
-Plays board games
-Draws person with 3 parts
-Copies a cross


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15
Q

5 cognitive

A

Asking the parents about school performance is as important as the following milestones:

  • -Draws a person with > 6 body parts
  • -Prints some letters and numbers
  • -Copies squares and triangles
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16
Q

3 Physical

A
  • Builds tower of 6-8 cubes
  • Throws a ball overhand
  • Rides a tricycle Copies a circle
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17
Q

4 Physical

A
  • Hops on one foot
  • Balances for 2 seconds
  • Pours, cuts, and mashes own food
  • Brushes teet
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18
Q

5 Physical

A
  • Balances on one foot
  • Hops and skips
  • Ties a knot
  • Has mature pencil grasp
  • Undresses/dresses with minimal assistance
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19
Q

Eczema and Allergies

A

Although eczema often occurs without a history of allergies, such a hx would support an atopic diathesis and should prompt you to ask additional questions about allergic triggers and asthma symptoms.

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20
Q

Eczema (Atopic Dermatitis): Fhx

A

While eczema tends to be familial, there is typically a multifactorial inheritance pattern and often clear environmental (allergic) triggers.

21
Q

Eczema (Atopic Dermatitis): Ddx

A
  • -Psoriasis: Although psoriasis can occasionally first look like eczema, it is rare in young children. When present, it occurs as a generalized rash known as guttate (droplet-shaped) psoriasis. Guttate psoriasis is usually precipitated by a strep infection.
  • -Seborrhea: This should also be part of the differential diagnosis, especially in early infancy (e.g., cradle cap). It is unusual to have a new case of seborrheic dermatitis at age 3.
22
Q

basic tenets of the treatment of eczema

A
  • Protecting skin by lubricating extensively
  • Using anti-inflammatories in short bursts
  • Treating associated skin infections aggressively.
23
Q

Eczema Pharm: Steroids

A
  • Prescribe topical steroid, alternating a higher potency for severe flares with a lower potency for minor bouts.
  • Often over-the-counter hydrocortisone is inadequate.
24
Q

Eczema Pharm: Topical anti-inflammatories

A

-Calcineurin inhibitors are considered second-line therapy. Although effective, safety concerns remain for long term use.

25
Q

Eczema Pharm: Antihistamines

A
  • non-sedating antihistamines approved for children, loratidine, fexofenadine and cetirizine may be effective.
  • Traditional antihistamines (with sedative side effects) such as diphenhydramine and hydroxyzine are often used at bedtime to decrease itch.
26
Q

Common Dietary Issues in Early Childhood: Inadequate nutrition

A
  • only taking 80% of the recommended fruit servings/day, but only 30% of the recommended vegetable servings/day.
  • Iron is of crucial importance to normal development in this age group due to its role as a CNS co-catalyst.
  • Iron intake in toddlers occurs predominantly from meat, legumes, and iron fortified cereals.
27
Q

Common Dietary Issues in Early Childhood: Milk and Juice intake

A

no more than 4-6 ounces of juice per day

28
Q

Common Dietary Issues in Early Childhood: Early childhood caries

A
  • Bathing teeth throughout the day with milk or juice from a bottle can result in early dental caries.
  • Early childhood caries typically have a lag time before visible decay. Thus the patterns established when a child is 1 to 3 years old may result in caries when the child is 3 to 5 years old.
  • routine bedtime use of the bottle can lead to cavities.
  • It is recommended that parents discontinue the bottle by the time the child is 12- to 15- mo.
29
Q

Common Dietary Issues in Early Childhood: Control battles about food

A

Food rewards and punishment in preschoolers may promote obesity by interfering with children’s ability to regulate their own food intake.

30
Q

Important causes of injury in a toddler include

A
  • Car accidents
  • Swimming pools
  • Falls
  • Firearms
  • Poisonings
  • Fires
31
Q

Children and Guns

A
  • 52% of parents who owned guns thought that their children were “too smart” or “knew better,” even though only 40% had given specific instructions to their children regarding guns. (In this survey only 12% of parents who owned guns locked them.)
  • When given the opportunity, boys ages 8-12 would handle a gun (76%) and pull the trigger (48%).
  • -Parents’ opinions about whether or not their child would handle a gun were not predictive of which boys would handle the gun.
32
Q

Lead screening

A
  • lead absorption is higher in younger children than in older children and adults.
  • Iron deficiency, which is common in toddlers, increases lead absorption
33
Q

Common sources of lead exposure include

A
  • House paint used before 1978 - and particularly before 1960. Deteriorating paint produces lead-containing dust, particularly during renovation.
  • Soil
  • Plumbing, pipes
  • Hobbies, occupational exposures Imported toys, ceramics, candy, cosmetics
  • Folk remedies
34
Q

AAP policy recommends blood lead testing for

A
  • All children 12-24mo in areas where > 25% of housing was built before 1960 or where the prevalence of blood lead levels > 5 μg/dL in children is 5% or greater.
  • Individual children who live in or regularly visit homes/facilities built before 1960 that are in poor repair or have been renovated within the past 6 months.
35
Q

TB risk factors

A
  • -Spending time with an individual known or suspected to have TB disease
  • -Being infected with HIV or another condition that weakens the immune system
  • -Having symptoms of TB disease
  • -Living in (or coming from) a country where TB disease is very common (most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia)
  • -Living somewhere in the U.S. where TB disease is more common (e.g., a homeless shelter, migrant farm camp, prison or jail, and some nursing homes)
  • -Use of injected illegal drugs.
36
Q

Iron Deficiency Anemia: Epidemiology

A

preschoolers deficient iron stores may occur in up to 35% of low-income children (versus only 7% in other preschoolers), with up to 10% having iron-deficiency anemia.

37
Q

Iron Deficiency Anemia:

Association with Cognitive Difficulty

A

association between iron deficiency in infancy and later cognitive deficits

38
Q

Iron Deficiency Anemia: Causes

A

most likely acquired cause of iron-deficiency anemia.

39
Q

Iron Deficiency Anemia: Therapy

A

In children whose anemia is mild, many providers will provide a trial of iron rather than do any further workup at this point. If the hemoglobin recovers to the normal range after a trial period, that is sufficient evidence of iron- deficiency anemia.

40
Q

Other Causes of Anemia; In children of Mediterranean, Asian or African descent, hemoglobinopathies should be considered, including:

A

-alpha thalassemia
-G6PD deficiency
-sickle cell disease
(In these cases, the child’s newborn screening hemoglobin electrophoresis would have been abnormal.)

41
Q

more severe anemia (Hgb less than 9 g/dL (90 g/L) d/t:

A
  • Decreased marrow production (e.g., aplastic anemia)
  • Hemolytic anemia
  • Vitamin deficiencies (e.g., folate and B6)
42
Q

Unusual acquired causes of anemia include chronic or severe illnesses

A
  • Collagen vascular disease
  • Malignancy
  • Other chronic illnesses
43
Q

Strabismus

A

misalignment of the eyes. Strabismus can lead to amblyopia, or poor visual development if not managed.

44
Q

Two methods of assessing presence and degree of strabismus

A
  • The Hirschberg light reflex

- The cover/uncover test

45
Q

Physical Exam of the Toddler and Preschooler: MSK

A
  • Several gait variants occur at this age. The most common is intoeing.
  • Intoeing in toddlers is usually caused by tibial torsion. In tibial torsion, when the patella faces straight ahead, the foot turns inward. Tibial torsion resolves naturally with weight bearing - usually by 4 years of age.
  • Intoeing in preschool- and school-aged children is usually caused by femoral anteversion. In femoral anteversion both the feet and knees turn inward. Femoral anteversion usually resolves spontaneously by 8-12 years of age.
46
Q

Neurodevelopmental Exam of a 3-Year-Old

A
  • -Language (speaks in short sentences; 75% of language is intelligible to a stranger)
  • -Fine motor (holds a pencil or crayon; copies a circle)
  • -Gross motor (hops; can ride a tricycle)
  • -Cognitive (draws a person with three body parts)
47
Q

Improving Toddler Eating Habits

A
  • Stop the bottle now.
  • Limit the child’s eating to three meals and two snacks, stopping the food and drink grazing.
  • No bargaining or cajoling
  • Gradually change his diet content
48
Q

Anemia Screening

A
  • Typically, screening for anemia is done at 12 months and again at preschool or kindergarten entry.
  • The initial 12-month window coincides with a period in development when diet, particularly iron sources, is often in flux.
  • If there are risk factors for anemia, then testing may be done at any visit.
  • Results of a screening hemoglobin can be known immediately.
  • Spun hematocrit still relies on blood volume, and hydration status can falsely affect the result.

PEDS (33 decks)

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