3-year old well-child Flashcards
Vision and hearing screen
Before 3 years –> asking parents about problems with vision/hearing
- vision by 3
- hearing by 4
3-year old health maintenance visit
- Social - can detect delays
- Nutrition - ask about typical diet
- Exercise - both structured and imaginative play
- Toilet training - may not be completely independent but should be getting close
- Dental - should have first visit soon
- Safety - car seats/home
Early Childhood Assessment
Process of observing and taking history from parents
1. Surveillance - helps determine areas of concern (Bright Futures)
3-year old milestones
Social - brushes teeth, feeds self
Communication - 2-3 word sentences
Cognitive - knows name and uses words correctly
Physical - rides trike, copies circle, builds 6-8 blockss
4-year old milestones
Social - know gender and age, plays with kids
Communication - first and last name, sings song
Cognitive - knows colors, plays board games
Physical - hops on 1 foot, balances, cuts and mashes food
5-year old milestones
Social - listens and attends, shows sympathy
Communication - articulates, tells story, count to 10
Cognitive - draws person (stick), copies square and triangle
Physical - hops and skip, tie knot, pencil grasp, dress/undress
Interacting with toddler
at 3 years old, some are accomadating, some apprehensive, some need parental assurance
- be nice and smile, keep them entertained
Giving feedback to parents
important to praise parents for all the things they are doing right
- positive validation gives them security
Eczema (atopic dermatitis)
“the itch that rashes” - cycle of irritation and rashing
- more common with history of allergies and family history
DDx for atopic dermatitis
Psoriasis - rare in young kids but can happen
Seborrhea - cradle cap
Treatment of eczema
- lubricate intensively
- anti-inflammatories for short bursts
- treat associated skin infections aggressively
Toilet training
- consistency is important!
- avoid punishing, use positive reinforcement
Single parenting
More stress, inconsistent messages, lack of affordable care, more depression
*maternal depression can lead to child mood or behavior problems
Common dietary issues
- Inadequate nutrition - needs fruits/veggies, iron
- Milk/Juice intake - lack intake of 100% juice and milk, too much sugary juice/soda (extra calories)
- Dental caries - using a bottle increases risk of caries
- Control battles over food
Examining for strabismus
- Cover/uncover test
2. Hirschberg light reflex
PE in toddler
Auscultate first
- do everything you can while you can
Neurodevelopment of 3 year old
Gross motor - hop, ride tricycle
Fine motor - holds pencil, copies circle
Social/communcation - speaks short sentences
Cognitive - draws stick person with 3 body parts
Injuries in childhood
car accidents, swimming pools, falls, firearms, fires, poisonings
Risk factors for lead poisoning
- young age –> exploring environment with mouth
- lead-base paint used in house
- not being born in U.S.
Anemia screening
done at 12 months and kindergarten
- do again if risk factors
Possible causes of anemia
Iron deficiency (lack of intake)
Lead poisoning
Malnutrition
Oxidative stress to predisposed individuals
Microcytic
Iron deficiency, thalassemia, chronic illness, lead poisoning
Normocytic
acute blood loss, hereditary spherocytosis, G6PD, sickle cell, renal disease
Macrocytic
B12 deficiency, folate deficiency, liver disease, hypothyroidism, neoplasms
Counseling on eating habits
- Straightforward simple strategies
- Support and reassurance
- Prepare parent for handling issues
Improving toddler diets
- No bottles
- 3 meals and 2 snacks per day
- No bargaining
- Gradually change diet
