Peds: Toddler/Preschooler Health & Issues Flashcards
Toddler & Preschooler Health: Psychosocial Development
- *Piaget’s preoperational thought (2-4 preconceptual, 4-7 intuitive)- focus on one thing @ a time, egocentrism- sense of self, animism-projecting human abilities on inanimate objects;
- *toddler (autonomy) & preschool (initiative)- tantrums are common, aggression & impulse control, major fears emerge;
- **play is a major psychosocial medium- toddlers (onlooker & parallel play); preschoolers- associative, cooperative, dramatic, & physical play- assigns roles;
- ** allow child to touch equipment, progress exam from non-invasive to invasive, minimize time undressed, give choices
Toddler & Preschooler Health Ages
- *toddler- 1 to 3 yrs of age;
* *preschool- 4 to 5 yrs of age;
Toddler & Preschooler Health:
Well Child Checks (WCC)
- *subjective/objective data;
- *anthropometric measures- length, ht, wt, head circum (age 2) & blood pressure (starting @ age 3);
- *screening- TB based on risk, Denver II (< age 6);
- *toddler-HCT (@ age 2 (once between age 1 and 5 unless otherwise indicated); Lead screening (by age 2) by CDC guidelines;
- *preschooler- PPD test for TB (between age 4 and 6); cholesterol screening (@ 2 yrs if indicated by risk factors) ex. family hx, premature CV disease);
- *discuss immuniz, dental health (age 1), anticip. guidance, medications, discipline;
- **visits for toddler- (12, 15, 18, 24, 30, & 36 mos);
- **visits for preschooler- (annually 3, 4, & 5 yrs of age)
Toddler & Preschooler Health: Physical Exam Elements-
serial measurements
- *length/ht - each visit to age 2 then annually;
- *wt - each visit to age 2 then annually;
- *BMI;
- *head circumference- each visit to age 2;
- series measurements with standardized charting;
- *vital signs;
- *chest and head equal to age 1; chest grows 5 cm > head by end of period
Toddler & Preschooler Health: Physical Exam Elements-
head/neck
- *anterior fontanel - (close @ 18 mos);
- *eyes- strabismus, head tilt, squinting, periorb. edema, vision acuity- 20/30 by age 5;
- *ears- TM (red-crying), orientation to sound/lang by age 2; points to objects by 2-3 yrs of age (play auditometry); over age 3 (pure tone audiometry);
- *neck- masses, voice quality, increasing vocab, adenoids;
- *nose- discharge; **mouth- breathers- allergic rhinitis;
- *dental development- primary teeth (@ 6 mos) & permanent teeth (@ 6 yrs), assess fluoride, fissures (vit def);
Toddler & Preschooler Health: Physical Exam Elements-
cardiac, pulm, GI, genito, & musculoskeletal systems
- *cardiac/lungs- respir, eyelid/orbital edema, squatting, PMI, innocent murmurs;
- *lymph nodes- 1-2 cm enlargement-normal in inguinal/cervical region (supraventricular- evaluate further)
- *abdomen- prominent, liver edge palpable 1-2 cm before right costal margin;
- *labial adhesion;
- *phimosis- foreskin tightly stretched on head of penis/cannot be retracted, undescended testes;
- *genu varum (bowed legs)- normal in toddlerhood;
- *genu valgum (knock knees)- normal in preschool;
- *turned in foot “pigeon toed”- (femoral anteversion- inward twisting of femur making one appear “pigeon toed”- presents @ 2-4 yrs of age and resolves by 8-9 yrs of age); (tibia torsion- inward twisting of shin bone making child appear “pigeon toed”, presents in toddlers; may require corrective braces.);
Toddler & Preschooler Health: (Language Skills) Cognitive Development
- *age 2- up to 50 words, follow two-step commands, constantly talks;
- *age 3- up to 900 words,
- *age 4- understands phrases and simple analogies;
- *age 5- over 2,000 words, uses sentences regularly, knows 4 colors (on avg);
- word usage in sentences*
- 2 words together by age 2;
- 3 words together by age 3;
- 4 words together by age 4;
- 5 words together by age 5
Toddler & Preschooler Health: Anticipatory Guidance
- *off bottle/on cup;
- *not to bed with cup;
- *spoon use at 15-17 mos of age;
- *avoid junk food;
- *avoid force feeding (food jags common);
- *brush after meals/before bed, floor when 2 teeth touch, dental exam by age 1;
- *sleep 10-12 hrs/night with daily naps, rituals/consistency required @ bedtime, nightmares @ 3 yrs, night terrors between ages 2-6 common (cannot recall) and outgrows with age;
- *toilet training- readiness 1.5 to 2.5 yrs of age, daytime control by 2 yrs, nighttime control 1 yrs later, do not start during stress, do not punish, award efforts;
- *injury prevention- gates, lock meds, etc
Toddler & Preschooler Health: Common Disorders-
Stuttering
- *stuttering- repetitions/pauses in speech;
- *possibly due to development dysfluency;
- *common in males; 10% children;
- *last several weeks t- 6 mos- 50% resolve w/o intervention;
- *diff dxs- hearing and visual impairment;
- *no dx studies;
- *manaagement- ignore initial presentation, encourage parental patience
- *referral- stuttering last > 6 mos, child over 6 yrs of age, child avoids speaking
Toddler & Preschooler Health: Stage Appropriate Screening
- Bayley Scales of Infant & Toddler Development, 2nd Ed. (BAYLEY-III)- Gold Standard for dx development delays in infants/toddlers up to 42 mos of age;
- *Denver II (up to age 6);
- *Ages & Stages Questionairre (ASQ);
Toddler & Preschooler Health: (Motor Skills) Physical Development
gross motor:
**age 2- up/down stairs, kicking ball, running wide gait;
**age 3- hopping (age 3.5), riding tricycle;
**age 4- up/down stairs w/alternating feet, riding bike w/training wheels;
**age 5- skips, jumps ropes, play balls;
**age ;
fine motor:
**age 2- building tower of 8 cubes, turning doorknob;
**age 3- copying circles, building towers;
**age 4-drawing people w/4-6 parts, towering up to 10 cubes;
**age 5- copying squares/multi.shapes, printing letters, or tying shoes
Toddler & Preschoolers Health: Development Warning Signs
- *age 1- NOT imitating soudns, pulling to stand, pointing gestures;
- *age 18 mos- NOT making eye contact and feeding self with spoon;
- *age 2- NOT walking up stairs, using 2-3 word sentences, noticing cars/animals, initiating self-stimulating behaviors;
- *age 3- NOT aware of external environment, cannot ride tricycle, follow simple command, imitate adult activity; continues to use baby talk;
- *
Toddler & Preschooler Health: Common Disorders-
Pervasive Development Disorders (PDD)- Diagnostic & Statistical Manual of Mental Disorders (DSM-IViTR)- defined PDD as collection of autism spectrum disorders- altered response to environment and impaired social interactions;
**PDD- symptoms varies, DX confirmed by- onset of developmental delay before age 3; DSM-IV-TR rquires 6 behaviors from 3 categories (motor, language, communication, and social); speech/language delays or advanced speech with echolalia, cognitive/learning delays, emotional unresponsiveness/no eye contact;
**management- early screening, checklists (autism behavior, autism in toddlers, modified checklist for autism in toddlers), TX- individualized;
**Referral- community resources & family support;
- *autistic disorder- impaired social interaction w/i 1st yr; restrictive repetoire of activities (OCD), may have language delay or advanced speech with echolalia (meaningless/repetition of someone’s words)
- *asperger’s syndrome- severe impairment of social interaction, restricted/repetitive behaviors/activities (OCD); NO language delay;
- Rett’s disorder- neurodegenerative developmental regression after a period of normal functioning (noted through 1st 5 mos of life), MOST SEVERE, females impacted, unknown etiology, developmental delay, CNS irritability/hand movements/seizures/hypertonicity, loss of language/speech, scoliosis, delayed head growth;
- *Childhood Disintegrative Disorder (CDD)-regression in multiple areas of functioning noted after 2 years of normal functioning, disorder of brain in utero (no clear etiology), more in males (but in females),
