Lecture 2: 15 month and 18 month WCC Flashcards
1
Q
15 month WCC
A
- Developmental Check Up
- Vaccines (DTaP, HiB, PCV)- Different practices may give these at different times.
2
Q
growth and development - 15 mo
A
- Gross Motor- Walks well, Stoops to pick up toy, may run or walk up steps
- Fine Motor- Scribbles, Stacks 2 blocks
- Social- Uses Spoon and Fork, “Helps” in housework, Shows empathy and affection
- Language- Says 3-6 words, Follows Commands
- This is when you worry about autism – if they can read the room
3
Q
18 month WCC
A
- Development Check with ASQ
- Vaccines (Hep A)
4
Q
growth and development - 18 months
A
- Gross Motor- runs, kicks ball, walks backward, sit in appropriate sized chair
- Fine Motor- Makes Tower of 4 cubes
- Social- Imitates parents, feeds doll with bottle
- Language- says 5-10 words – speech is not all understandable to strangers. Can point to a picture in a book when asked.
5
Q
development 18 months
A
- Cognitive milestones
- mature means-end reasoning
- Finds the doll behind the blanket
- Gets the raisin out of the bottle
- Games of push the button out pops the jack-in-the-box
- mature means-end reasoning
6
Q
autism screening
A
- Recommended for all children at 18 and 24 months of age.
- Standardized tools are available:
-
M-CHAT (Modified Checklist for Autism in Toddlers is commonly used. (generally done at 2 years)
- 23 question questionnaire
- Abnormal responses trigger follow up assessments
- Additional discussion of autism in a future lecture…
- MCHAT is not diagnostic so they need to go for formal screening if they test positive
-
M-CHAT (Modified Checklist for Autism in Toddlers is commonly used. (generally done at 2 years)
- Standardized tools are available:
7
Q
anticipatory guidance
A
- 15 and 18 month visits
- Car Safety- rear-facing until 2 years of age or highest weight allowed by seat manufacturer
- Household Safety- NO Walkers, Use smoke detectors, set hot water heaters < 120 degrees, childproof the house
- Burn Prevention- Avoid hot soup/coffee around toddler
- Tantrums and behavior (separate lecture)
- Sleep routines and issues
- Drowning Prevention- fence around pools
- Discuss toilet training (this is just the start)
- Toilet training because a lot of daycares require potty training before the kid can attend
8
Q
anticipatory guidance: dental health
A
- Begin Sippy Cup, off the bottle
- See Dentist
- Give fluoride if water not fluoridated
- Fluoride varnish every 6 months. Offered in many pediatric clinics.
- The sooner you can get a kid to a regular cup, the better
- At this point they probably don’t have the hand control to drink out of a normal cup yet
9
Q
anticipatory guidance: appropriate foods
A
- Appropriate Foods
- Offer a variety of foods
- Avoid Aspiration
- 16-24 ounces of milk per day
- 30ml per oz
10
Q
ingestions
A
- The most common ingestions in children less than 6 yo is cosmetics and personal care products followed by cleaning substances.
- Most ingestions that occur in young children were able to be managed at home and did not require an ED visit.
- The detergent breaks down the cell walls and can cause very significant damage and scarring
11
Q
types of ingestions
A
- Alpha Blockers (Clonidine)-Hypotension
- Beta Blockers (Metoprolol, Propranolol)-Hypoglycemia, lesser hypotension
- Calcium Channel Blockers-Hypotension
- Opioids-CNS and respiratory depression
- Buprenorphine (Suboxone) –Respiratory depression
- Sulfonylureas- Hypoglycemia
- Toxic Alcohols (ethylene glycol)-Renal failure, metabolic acidosis
- Tricyclic antidepressants-CNS depression and prolonged QTC
- Antimalarials-Cardiogenic shock, blindness, electrolyte imbalances
- Camphor-Seizures, CNS abnormalities, respiratory failure
- Carbamates/Organophosphates (pesticides)- Cholinergic excess: SLUDGE/BBB Salivation, Lacrimation, Urination, Defecation, Gastric Emesis, Bronchorrhea, Bronchospasm, Bradycardia
- Caustics
- Imidazolines-Hypotension
12
Q
literacy promotion
A
- Late in first year is ideal time to introduce books
- allows practice with manipulating objects
- encourages developing language skills
- books are safe toys
- promotes positive parent-child interactions
- Literacy promotion programs demonstrate significantly greater literacy
13
Q
normocytic anemia and macrocytic anemia
A
- reticulocyte count
- normal & low
- iron & vitamin deficiencies (including chronic blood loss)
- chronic disease
- marrow suppression/failure
- red cell defects
- intoxications
- high
- hemorrhage
- hemolysis
- She wont test on this because this is a more nuanced point about hyperbili
- normal & low
- a “physiologic nadir” of hemoglobin (~11 g/dL) occurs near 8-10 weeks of life as erythropoiesis changes from fetal to normal
14
Q
microcytic anemia
A
- differential diagnosis
- iron deficiency anemia
- hemoglobinopathy & hemolysis
- thalassemia
- sickle cell disease
- chronic (inflammatory) disease
- lead intoxication
- copper deficiency
15
Q
iron deficiency anemia
A
- why worry?
- iron deficiency anemia associated with impaired mental and psychomotor development
- iron deficiency increases lead absorption
- We worry because of brain development – if you cant get enough O2 because you have low blood cells, you can have brain developmental delays
