Exam 2 Flashcards
Immunizations during toddlerhood:
vaccines begin to slow down
Last round is at 18 months
does not start back up until 4
What age is toddlerhood?
18 months - 3 years
Erikson: toddlerhood
Autonomy vs doubt/shame
Autonomy: being own person
less dependent on parents
lack confidence because of not being able to do things
Growth: toddlerhood
Height: 2- 4 inches per year
Weight: 4 -6 pounds
toddler height at 2 is 50% of adult height
” big Belly”
Lumbar Lordosis: curving inward of lower back that put pressure on entire back
anterior fontanelle closes at 18 months
overall growth slows down
start to shed baby fat
posture straightens
Milestones for toddlers:
large range of milestones
mobility = trouble
climbing stairs
tricycles
running
kicking
throwing
hold spoon + fork
scribble
copy a circle
Examination of Toddlers:
need to have some level of control
hold equipment
blow out otoscope light
let them listen to heart w stethocope
distraction
jokes
Exam done on parents lap
No head- to-toe assessment: get creative
painful things should be last
establish trust
Poisoning: toddlerhood
greatest risk from 1-2 years
explore the world with mouth
Medication, household products, plants, cigarettes, alchol, cosmetics
If suspected call posion control
Child Abuse Signs:
Parental delay in seeking help and reluctance to provide information
Bare spots and broken hair
Inconsistences in story + old fracture
Pattern injuries
Burn marks
Bruises (especially on back of body)
Lack of guilt
Vision: toddlerhood
About 20/40 (worse than adults)
EOMS can be an issue (strabismus)(cross eyed)
Kids may need glasses or surgery to correct
If untreated: result in amblyopia (lazy eye)(permanent issues) (visual acuity)
Diminished or loss of vison in one eye
Brain favors normal eye
Management focused on making child use one eye to reduce vision (lazy eye)
Use a patch
Tantrums: Toddlerhood
more common
Say No because they can
Big temper tantrum
Ignore the behavior
Set limits and stick to them
Routine simple and predictable
Trick them into thinking they have control
Waking hours are at play
Do not have verbal skills to communicate needs
Not good at sharing (parallel plays) play side by side; not together
Potty Training: Toddlerhood
Usually starts with bowel then urine training
18-24 months; start when psychological able to: before leads to frustration
Skill needed: walking, stooping down to sit on the potty, have to stay dry for at least 2 hours;
Need to Sit for 2-3 minutes intermittently
Incentive charts (get treat when they go on the potty)
Daytime dryness starts before nighttime dryness
Major parental concern
Nurse Role:
Provide anticipatory guidance
Assist with toileting program
Discuss with parents their understanding of children attitude and readiness
Allergies: toddlerhood
Toddlerhood is when they begin
Show as hives (red wheals)
High risk foods (TEST QUESTIONS)
Nuts
Shellfish
Dairy (eggs + milk)
Gluten
Soy
Sleeping: toddlerhood
Need for sleep decreases: 12 hours a day; 1-2 naps a day
Schedules are helpful to avoid overfatigue
Bedtime rituals are very important; brush teeth, story, bath, need predictable
Night terrors:
Can develop
Recall a frightening dream
Often not awake completely
Usually falls back to sleep in 5- 10 minutes
Avoid awakening: speak softly
Will eventually grow out of night terror
Dental: toddler
All 20 baby teeth erupt by the end of toddlerhood
Brushing teeth is very important
Start visiting the dentist
Fluoride supplement if not in the water (controversial)
Prevent dental caries: bedtime bottle should be water only; no juice
Car Seats:
Proper installation of safety seat- best to have a certified care seat technician.
Laws vary from state to state
Rear facing until AT LEAST 2 yrs old, then forward facing with 5 point harness. Stay in seat with 5 point harness until as long as possible according to manufacturers guidelines for height and weight.
Transition to booster seat when outgrow manufacturers rec in terms of height and weight
Then Booster seat until 8-12 yrs AND 4’9”
Kids in back seat of car until at least age 13!! (airbag dangers!!)
Autism:
1 in 37 boys: 1 in 151 girls
Boys are 4x more likely to have autism
Most children are being diagnosed after 4; can be diagnosed starting at 2
Autism affects all ethnic and socioeconomic groups
Minority groups tend to be diagnosed later and less often
Early intervention affords best opportunity to support healthy development and deliver benefits throughout the lifetime
No medical detection for autism
Diagnosis:
Behavioral: inappropriate social interaction, poor eye contact, compulsive behavior, impulsivity, repetitive movement, self-harm, persistent repetitive of words/ actions
Developmental: learning disability or speech delay
Cognitive: intense interest of limited number of things or problem paying attention
Psychological: unaware of other emotions or depression
Lack of social smile
What is the most common way for a toddler to get injuried?
Climbing is most common
What temp should the water heater be set to for toddlers?
120- 125 degrees
Reyes Syndrome:
Rare: can be extremely deadly
ASA can transfer vis breast milk
Aspirin no longer recommended for routine use in children: watch Pepto Bismol, Alka Seltzer: education parent to avoid this
Aspirin usage/ product that contain aspirin (acetyl salicylic acid) + a viral infection
Brain swelling + liver damage
Most often seen in children 4-12
Symptoms: vomiting irritablity, confusion, brain swelling, fatty liver and if untreated coma and death
Immunizations: Pre school children
getting boosters
Dtap: 4th year
MMR: 4-6
Varicella: if they did not get
Concerns:
relgious
safety
importance of accurate information
Erikson: Pre school Age:
Initiative vs guilt
encourage child to create and try new things
teach them to make mistakes do not make them bad,
allow childs ambition, abilites, idea, opinion
let them do things on own
Lead posioning:
can cause irreversible brain damage
old paint, old toys, pottery
Prevention- teach parents about risks, encourage diet low in fat because
lead is retained in fat, encourage Vit C, calcium, and iron intake
Can cause neurological delays
Affects blood brain barrier
Cosmetic imports
Absorption is a lot easier
Developmental delays
Prevention: Handwashing, wash toys, see where toys are imported from, Run Cold Water: Older plumbing,
Poisoning:
No number is safe: 0 is what we want
Special Diet:
encourage diet low in fat because lead is retained in fat, encourage Vit C, calcium, and iron intake
Vison: pre school aged:
Should approach 20/20 by 6 years of age
Possibility of developing amblyopia decreases
Depth and color vision becomes fully established
Visual capacity can deteriorate rather than improve, however
Early detection with Snellen Screening tests in school and well-child check-ups
Can use the Snellen now
Color blind:
Can be problematic in school because many cues depend on color recognition
Ishihara Test: used to test for color blindness
Food allergies: Pre school
With increase in food choices, food allergies also emerge
Up to 8% of children have food allergies
I million preschoolers are affected and approx. 1/3 of these are life threatening allergies
High-risk allergens: milk, eggs, peanuts, tree nuts, soybeans, fish, shellfish, glutens, seeds
Growth: Pre school
remains steady
4 pounds and 2 inches a year
Milestones for 3 year olds:
Opens doors
Kicks ball, runs, jumps
Knows own name, gender and age
Describes action in picture books
Able to put on some clothing and shoes
Eats without assistance
Milestones for 4 year olds:
Climbs ladder
Throws a ball overhand
Holds pencil
Asks why, when, how, and the meaning of words
Washes and dries hands – can brush teeth
Draws a person with two or three parts
Rides with training wheels
Milestones for 5 year olds:
Names four or five colors
Can cut and paste
Knows address and telephone number
Prints some letters
Draws a person with head, body, arms and legs
Engages in make believe, dress-up, role playing
6 year old Milestones:
Bounces a ball 4-6 times
Can skate and ride bike
Ties shoelaces
Understands right from left
Draws a person with 6 body parts with figure with clothing on
Sleep for Pre school:
Sleep 8 – 12 hours/night
Often naps are not needed anymore
Pro-long bedtime routines
May become resistant to bedtime routine
Nightmares, sleep walking can continue
Night terrors become more intense
Dental: Pre school
Primary teeth should all be in. Initial permanent teeth may begin to erupt by the end of pre-school years
Still need assisting brushing, flossing
May need fluoride supplements/sealants
Low-income families may not have resources for prevention
Immunizations: school aged children
(late childhood/early adolescence): Parent and school nurse partners to ensure up to date-
Meningococcal vaccination (age 11 to 12)
Hepatitis B series, if not completed in early childhood
Human papilloma virus (HPV)
Varicella (if no history of chickenpox)
DTap (booster)
Annual Flu Shot
Erikson: School Age children
Industry vs. inferior
Industry: success in personal, social + sense of self worth
Inferiority: continuous failure + no support of family
Task: full mastery of whatever child is doing
Self-perception- Self concept
Asthma
Incidence- More rapid rate increase in preschool group than other ages
Inner city kids have higher rates of asthma: air quality
Biggest cause of missed school days
Inhaler twice a day: control inhaler + rescue inhaler for emergency: carry them all the time
Increase the diameter of the lungs
Causes
Genetic predisposition, allergens, respiratory infections such as RSV as infant, pets, stress, exercise, MOLD/Moisture
Precipitants: infections, exercise, weather, stress
Exacerbation factors
Tobacco smoke, pollutants, allergens, water/moisture/mold!
Vision: school aged children
Optimal capacity by age 7
Continue Snellen screening
Good peripheral vision + should know colors
-myopia
Nearsightness: can’t see far away
-astigmatism
2 eyes can’t focus: general blurriness
Glasses can correct this
Growth: School Aged Children
BP values lower than adults, much slower growth rate than
other stages (about 2 inches/yr, 4-6 lbs/yr), mature nervous system, good coordination and balance, lose about 4 teeth/yr
Illness: school aged Children
Common illnesses- URI, OM, Strep, gastroenteritis (stomach bug)
Strep (group A): can affect heart from not being treated (rheumatoid fever)
Sore throat, fever
Go on antibiotics: need to be on them for 24 hours.
Transmission occurs where there is close personal contact
Sleep: school aged children
- 8-12 hours needed
- not napping anymore
- Sleep walking:
- immature CNS
- more often in boys than girls: can happen with Enuresis - rates drop with maturity - ensure the child is safe, use gate if needed, sharp objects out of reach, fall risks
Dental: school aged children
Tooth loss patterns: 4 teeth a year
Cavities: greatest common disease
Low-income family higher risk for cavities
Loss first tooth at 6
All teeth should be out by 13 (should have 28 teeth)
Can see eruption of wisdom teeth (17-22)
Enuresis
loss of bladder control at night
Kids can outgrow this.
Boys (7%) higher risk
Primary: never had control at all
Secondary: accidents happen on sometimes
Bedwetting at least 1 time per month
Fluid intake, genetic, spinal cord development issue, bladder size, psychological issue (stress, family issues. Sexual abuse, new baby in family)
First thing to do: test for a UTI.
Limit fluid intake,
Encopresis
involuntary passing of stool after age 4
Not link to psychological issue
Constipation linked: most common cause.
Not as large of an issue
Obesity: school aged children
Overweight/obesity definition
Obesity: BMI >95th percentile for age/gender or BMI >30
Overweight: BMI >85th but <95th percentile
1/3 of children are overweight/obese
Factors:
Genetic
Environmental: use of food as reward; lack of physical activity, living conditions, financial constraints
Impact of sleep- inadequate sleep associated w/decreased activity
Impact: health risks, low self-esteem, increased risk depression, bullying, ridicule
by peers.
Surpasses alcohol and drugs as an issue
What’s the relationship between being overweight and bone density?
Being overweight decreases bone density
Quality of bone is impacted: lower bone mass
