Preschool Flashcards
Erikson Developmental Stage
Initiative v. Guilt
Initiate activity
Sensitive to criticism
Learn by giving stimuli or copying you
Piaget Developmental Stage
Pre conceptual Phase
Egocentrism
Unable to connect the reversible operation
Magical Thinking- little basis in reality
Sleep pattern
10-12 hours/night
Physical Changes
Protuberant abdomen disappears, pelvis straightens, abdominal muscles develop
All primary teeth have developed
CV system enlarges in proportion to general body growth
Legs grow faster than rest of body
Growth Rate
Gain 4 lbs. (2 kilos) of body weight per year
Gains 7cm (2 inches) of height each year
Head reaches 80% of adult size
Refer growth to visualize normal patterns
(height, weight and head circumference)
Organ Development
Kidneys reach full maturity- toilet training can only happen after 18 months
Lung capacity increases, RR decreases
Tonsils and adenoids increase in size
Refer for:
- hydrocele (swelling in testes) transillumination & shift
- undescended testes
- UTI (think anatomical problems, hygiene, sex abuse)
- frequent OM- may lead to hearing loss
Nutrition
Require: 90 kcal/kg (avg. 1800 calories daily)
- Protein: 13-19g/day
- Total fat intake: 20-30% of intake
- 5 servings of fruits and vegetables daily
3 year milestones: motor
Climbs, walks, alternates feet in stair climbing Opens doors, turns knobs Builds 9 block tower Holds pencil, draws circles Feeds self Can put on some clothing and shoes Peddles tricycle
4 year milestones: motor
Skipping/hopping on one foot, walks on tiptoes
Catches ball
Uses scissors, can cut and paste
Dresses and Undresses with supervision (no laces/zippers)
Copies squares, some uppercase letters
Brushes own teeth and washes own hands
5 year milestones: motor
Stands on one foot for 10 seconds, hops and somersaults Can print own name Copies triangle Jumps rope Dresses and undresses independently Uses eating utensils Ties shoe laces
3 year milestones: social, cognitive, emotional
Egocentric Imitates adults and playmates Plays make-believe Tolerates periods of separation from parents Has nightmares, fears Parallel and associative play Sorts objects by shape and color Follows directional commands Inquisitive and talkative
4 year milestones: social, cognitive, emotional
Better understanding of time Less egocentric Associative play Follows 3-part commands Correctly names some colors Understands concept of counting
5 year milestones: social, cognitive, emotional
Can count 10 or more objects
Associative play
Has fewer fears
Eager to please
3 year milestones: language
Vocabulary about 900 words
Speaks 4-5 word sentences
Speech mostly intelligible
Can say age, name, and sex
4 year milestones: language
Vocabulary about 1500 words
Speaks 5-6 word sentences
Tells stories
Follow basic grammatical rules
5 year milestones: language
Vocabulary about 2100 words Speak 6+ word sentences Can define some words Knows days of week, and months Prints some letters of the alphabet Uses future tense Knows address
3 year old physical: exam
Height, weight, BMI, growth chart
BP starts at age 3
Hearing & Vision Screening
Refer for dental screening (do oral exam: cavities, tooth decay, bottle feeding)
3 year old physical: lab work
Urinalysis: - pos. protein => kidney problem - leukocytes => UTI - blood - glucose => DM Hemoglobin/hematocrit (anemia screening) Lead (based on risk factors, blood test) Cholesterol screening with risk factors
Who mandates TB testing?
Entry to daycare, school, summer camp, college
How should TST be placed?
Placed intra-dermally in forearm, 2-4 inches below elbow
Use 0.1mL solution in TB syringe
Record location of TST placement, lot #, expiration date
Follow up: 48-72 hours, measure reaction in millimeters
If positive: must notify the health department
Safety Topics
Poisoning: lead, cleaning supplies, imported toys, plants, vitamins, alcohol, medications
Choking: small toys, meds, toxic materials
Traffic and street-crossing
Guns a firearms- locked
Secondhand smoke- esp. with asthma
Safety helmets
Refer for car seats
What is the most common neurobehavioral disorder in preschool?
ADHD- 4-12%
Inattention, distractibility, impulsivity and hyperactivity
Diagnosed around 4 years old
MRI- see smaller right side of the brain
Child may have trouble in school: underachievement, behavioral problems, disruptive in class, playground conflicts, aggressive behavior, daydream, short attention span
Symptoms exist in ALL settings: school, home, play
What differential diagnosis should be explored with suspected ADHD?
Look at family history and current home life Mania Bipolar Conduct or oppositional defiant disorder Learning disability Neurological disorder
What history is needed when diagnosing ADHD?
Birth hx- premie, substance use during pregnancy, trauma?
Developmental milestones- was there a delay?
Illnesses- poor vision, ear infection, head trauma?
Family hx- mental illness, substance abuse?
School performance?
What should the physical exam include when diagnosing ADHD?
Height, weight, head circumference, growth curve Hearing Vision Exam: neuro, eyes, ears, heart Lead level Behavior in our office
Referrals and treatments of ADHD
Refer to pediatric psychiatry
May refer back for EKG (b/c stimulant tx) and complete metabolic panel
Med prescribed by psych: maybe you will refill, if discussed
Treatment: stimulant + behavioral therapy
Counseling for ADHD
Routine follow-up
Diet
Refer for support networks
