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Pediatric Primary Care Exam 2 > Development and Behavior of Toddler and Preschoolers > Flashcards

Development and Behavior of Toddler and Preschoolers Flashcards

1
Q

15 month old priorities for visit (6)

A
  1. First priority is to attend to the concerns of the parents

Second priority is for the following topics:
2. Communication and social development (individuation, separation, attention to how child communicates wants and interests, signs of shared attention)

  1. Sleep routines and issues (regular bedtime routine, night waking, no bottle in bed)
  2. Temper tantrums and discipline (conflict predictors, distraction, praise for accomplishments, consistency)
  3. Healthy teeth (brushing teeth, bottle usage)
  4. Safety (care seats, parental use of seat belts, poison, fire safety)
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2
Q

Selective Screening for 15 month old visit (3)

A
  1. Blood pressure for children with specific risk conditions or change in risk
  2. Vision screening if parents are concerned or if there is an abnormal fundoscopic exam or cover/uncover test (refer to ophthalmology if positive)
  3. Hearing if positive on risk screening questions (referral for diagnostic audiologic assessment)
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3
Q

18 Month Old Priorities for Visit (6)

A
  1. First priority is to attend to the concerns of the parents

Second priority is for the following topics:
2. Family support (parental well-being, adjustment to toddler’s growing independence and occasional negativity)

  1. Child development and behavior (adaptation to nonparental care and anticipation of return to clinging)
  2. Language promotion/hearing (encouraging language, use of simple words/phrases, engagement in reading/singing/talking)
  3. Toilet training readiness (recognizing signs of readiness, parental expectations)
  4. Safety (care seats, falls, fires, poison control, guns, etc)
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4
Q

Average age of toilet training (3)

A
  1. 2.5-3 years old; reassure if it’s not done by 2 years old
  2. Toilet training is directly related to myelination; if they learned to walk at 15 months they won’t walk at 18 months
  3. Takes 9 months from learning to walk to being able to toilet train
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5
Q

18 Month Old Screening at Visits (8)

A
  1. Autism
  2. Oral health - check for dental homes and that primary source of water is deficient in fluoride (if deficient, give supplementation)
  3. Blood pressure
  4. Vision screening if parents are concerned or if there is an abnormal fundoscopic exam or cover/uncover test (refer to ophthalmology if positive)
  5. Hearing if positive on risk screening questions (referral for diagnostic audiologic assessment)
  6. Anemia (Hct and Hgb)
  7. Lead screen
  8. Tuberculosis screen via skin test
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6
Q

2 Year Old Priorities for Visit (6)

A
  1. Parental concerns
  2. Assessment of language development (how child communicates, etc.)
  3. Temperament and behavior
  4. Toilet training (what parents have tried, techniques, personal hygiene)
  5. Television viewing (limits on viewing, promotion of reading and physical activity)
    * TV should be non-existant until age 2, limited TV after that
  6. Safety
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7
Q

2 Year Old Screening at Visits (9)

A
  1. Autism
  2. Lead screen
  3. Oral health - check for dental homes and supply with oral fluoride if it isn’t in primary water source
  4. Blood pressure
  5. Vision screening if parents are concerned or if there is an abnormal fundoscopic exam or cover/uncover test (refer to ophthalmology if positive)
  6. Hearing if positive on risk screening questions (referral for diagnostic audiologic assessment)
  7. Anemia
  8. Tuberculosis
  9. Dyslipidemia screening via fat lipid profile
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8
Q

When does neurodevelopmental screening occur

A

9, 18 and 30 months

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9
Q

Priorities for 2.5 year old visit (5)

A
  1. Parental concerns
  2. Family routines (parental consistency, day and evening routines, family activities)
  3. Language promotion and communication (interactive communication through song, play and reading)
  4. Promoting social development (play with other children, imitation of others, choices)
  5. Preschool considerations (readiness for early childhood programs, playgroups, playdates)
  6. Safety (water and care safety, outdoor health safety pools play areas etc, pets, fires and burns)
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10
Q

Screening for 2.5 Year Old Visit (5)

A
  1. Development screening
  2. Oral health - dental home and supplement for fluoride if necessary
  3. Blood pressure
  4. Vision if parental concern or abnormal fundoscopic or cover/uncover test
  5. Hearing if positive on risk screening questions
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11
Q

Priorities for 3 year old visit (6)

A
  1. Parental concerns
  2. Family support (family decisions, sibling rivalry, work balance)
  3. Encouraging literacy activities (singing, talking, describing, observing, reading)
  4. Playing with peers (interactive games, play opportunities)
  5. Promoting physical activity (limits on inactivity)
  6. Safety (car safety seats, pedestrian safety, falls from windows, guns)
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12
Q

Screening for 3 year old visit (7)

A
  1. VISUAL ACUITY - age appropriate visual acuity measures, Snellen letters and numbers, picture test such as Allen figures or LEA symbols)
  2. Oral health - dental home or fluoride supplementation
  3. Vision if parental concern or abnormal fundoscopic or cover/uncover test
  4. Hearing if positive on risk screening questions
  5. Anemia if positive on risk screening tests
  6. Lead if no previous screen and positive on risk screening questions or change in risk
  7. Tuberculosis if positive on risk screening questions
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13
Q

Priorities for 4 year old visit (6)

A
  1. Parental concerns
  2. School readiness (structured learning experiences, opportunities to socialize with others, fears, friends, fluency)
  3. Developing healthy personal habits (daily routines that promote health)
  4. TV/media (limited viewing, promoting physical activity)
  5. Child and family involvement and safety in the community (activities outside home, community projects, educational programs, etc)
  6. Safety (belt positioning booster seats, supervision, outdoor safety)
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14
Q

4 Year Old Screening at Visit (6)

A
  1. Visual acuity - age appropriate acuity measures, snellen chart, etc.
  2. Anemia if positive on risk screening questions
  3. Vision if parental concern or abnormal fundoscopic or cover/uncover test
  4. Hearing if positive on risk screening questions
  5. Tuberculosis if positive on risk screening questions
  6. Dyslipidemia if positive risk screening questions
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15
Q

5 Year Old Priorities at Visit (6)

A
  1. Parental concerns
  2. School readiness (established routines, after-school care, parent-teacher communication, friends, bullying, maturity, etc)
  3. Mental health (family time, routines, temper problems, social interactions)
  4. Nutrition and physical activity (healthy weight, appropriate well-balanced diet, etc)
  5. Oral health (regular visits with dentist, daily brushing and flossing, adequate fluoride)
  6. Safety (pedestrian safety, booster seat, safety helmets, swimming, fire escape plan/drill, etc)
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16
Q

Screening at 5 Year Old Visit (5)

A
  1. Vision - objective measure with age appropraite visual acuity
  2. Hearing - audiometry test
  3. Anemia if positive on risk screening questions
  4. Lead if no previous screening or at risk
  5. Tuberculosis if positive on risk screening questions
17
Q

Typical Toddlers (7)

A
  1. AGE: 1-3 years
  2. Advances in language/intrapersonal skills/development of pretend play
  3. Temperament becomes more evident
  4. Oral motor behavior from 1-2
  5. Emerging independence
  6. Difficult behaviors at times
    - Terrible 2s: Temper tantrums
    - Negative 3s
  7. When toddlers don’t get what they want they throw themselves on the floor; cannot give into this and parents must understand not to reinforce certain behaviors, but also disciplining should not be there but rather limit setting (i.e. no hitting etc)
18
Q

Psychosocial and emotional development of toddlers

A
  1. Autonomy vs. Shame and Doubt
    * Striving for independence/autonomy from caregivers
    * Wants to gain daily control over environment
  2. Results in temper tantrums
    * Delayed language will also display with more frustrated behaviors because the child can’t say what they want
19
Q

Developmental Tasks of Toddlers (4)

A
  1. Language acquisition
  2. Toilet training
  3. Discipline and limit setting
  4. Day care/pre-school entry
20
Q

Cognitive Development of Toddlers (5)

A
  1. Sensorimotor [0-2 years] to preoperational [2-7 years ] thought
    * Toddler (late sensorimotor)
  2. Touching, looking, listening
  3. Beginning to understand function of things
  4. Oral motor behavior persists
    * Lead poisoning occurs due to putting things in their mouth
  5. Object permanence (things do not exist if not seen)
21
Q

Cognitive Development of Preschooler (5)

A
  1. Develop language skills
  2. Symbolic/action thought
  3. Egocentric
  4. Magical thinking
  5. Imaginary friends
22
Q

Preschoolers (5)

A
  1. AGE: 3-5 yrs
  2. Initiative vs. guilt; Preschoolers love to be praised (initiative vs. guilt) i.e. a PNP should be that’s really good, etc. because they feel very proud
  3. Continuation of language/motor skills
  4. More interpersonal; It is all about them
    * Pre-schooler is self-centered; thinks they cause death of child, caused a housefire, etc. (blames everything on themself); “it’s all about me”
  5. Anticipates consequences of actions
  6. Socialization; Encourage group situations
23
Q

Preschooler Tasks (4)

A
  1. School readiness
  2. Verbal ability
  3. Preschoolers must get ready for school; need ability to separate from parent and brush teeth and wash themselves alone
  4. Learn how to wipe themselves alone around 4 years old (teach wiping around pre-school years)
24
Q

Preschooler Readiness (4)

A
  1. Separation anxiety; Ability to separate from parents
  2. Verbal ability
  3. Self-care skills
  4. Follow directions
25
Q

Stages of Play: Onlooker (4)

A
  1. A behavior; watches from a distance
  2. Engage in it
  3. The child may talk with others about the play, without actually joining in the activity
  4. More common in younger children under 2 years**
26
Q

Stages of Play: Solitary (4)

A
  1. Independent play
  2. Child is alone and maintains focus on its activity.
  3. Uninterested in or is unaware of what others are doing.
  4. More common in younger children (age 2–3) opposed to older children
27
Q

Stages of Play: Parallel (5)

A
  1. Adjacent play, social coaction
  2. Plays separately from others but close to them and mimicking their actions
  3. Stage between socially immature solitary and onlooker type of play, to a more socially mature associative and cooperative type of play
  4. First observed in children aged 2–3, but can be seen in preschoolers
    * Parallel play can first be observed around 3 y/o but is common in pre-school; play side by side but rather than a group; it is a transition stage to associative play
28
Q

Stages of Play: Associative (4)

A
  1. Associative play has some interaction but it isn’t exactly in sync
  2. No organized activity but the child is interested in playing but does not coordinates their activity with others.
  3. Substantial amount of interaction involved, but the activities are not in sync
  4. Preschoolers (3-5 years of age)
29
Q

Stages of Play: Cooperative (6)

A
  1. For 6 years and older
  2. Child wants to play with people and likes the activity
  3. Organized, with assigned roles
  4. Increased self identification with a group and group identity emerges
  5. Uncommon in the preschool and kindergarten years, because it requires more social maturity and more advanced organization skills.
  6. Cooperative play = plays in games with other kids (5-6, closer to 6 y/o) i.e. play a game of kickball or soccer
30
Q

Rituals with Preschoolers (5)

A
  1. Peak from 1-2 yrs.
  2. Mealtime
    * Mealtime must be regular!
    * Eating together promotes positive adolescence
  3. Bedtime
  4. Fears
  5. Security blanket
    * Children have security blankets; parents should buy two so that when the original one gets really disgusting they can switch it out (should wear out the second one a bit before giving it)
31
Q

Sexuality and Masturbating (7)

A
  1. Why? – Curiosity
  2. Self-exploratory behavior
  3. Toilet-training
  4. Masturbation is not a sign of sexual assault
  5. 18 months first discover their genitals (b/c diaper isn’t being used anymore) and will begin touching themselves down there which is totally normal
  6. When you raise issue in course of anticipatory guidance parents appreciate it
  7. A little masturbation is normal between toddler and pre-school years, but child needs to be taught not to do it in public

Pediatric Primary Care Exam 2 (12 decks)

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