Toddler & Preschool Health Flashcards
Developmental Stages > Toddlers (2-4 years) >> Piaget: -1- >> Erikson: -2- > Preschoolers (4-7 years) >> Piaget: -3- >> Erikson: -4-
- preoperational - preconceptual
- Autonomy vs shame & doubt
- preoperational - Intuitive
- Initiative vs guilt
Anthropometrics in
Toddlers: length, weight, height, -1- percentile [-2- year(s) old]
Preschoolers: height, weight, -3- (starting at -4-, then each year), -5-
- head circumference
- up to 2
- blood pressure
- 3 years old
- vision (snellen or LEA)
Screening in Toddlers & Preschoolers -1- screening not universally done; based on risk Dev screening (-2- or equivalent) for children -3- of age
- Tb
- ASQ
- 6- years
Labs in Toddlers
- 1- if at risk for iron deficiency/anemia
- 2-: to be performed at -3- of age, and -4- during ages -5-
- H&H
- Pb screening
- 6-24 month-WCC except 15 mo.
- annually
- 3-6 years
Toddlers & Preschoolers
Tb: screen at ages -2-, then -3- from age -4- onward
- 1, 6, & 12 months
- annually
- 2 years
Toddlers & Preschoolers
Screening
-1- around -2-; test if indicated (e.g., -3- or -4-)
- cholesterol screening
- 2 years
- family history of dyslipidemia
- premature cardiovascular disease
Toddlers & Preschoolers - Interview Specifics
Toddler is striving for -1-, as with -2-
Tantrums are common due to -3-
Continue progression of -4- exam
- autonomy
- potty training
- articulation barrier
- non-invasive to invasive (ears last)
Toddlers & Preschoolers - Physical Exam
-1- starts at age 2 years
Record percentile on -2-
-3- continues; -4-
- BMI
- growth chart
- Dental development (6 months for primary tooth dev; 6 years for secondary)
Toddlers & Preschoolers - Vitals As children grow, -1- 2. Pulse range 3. RR avg 4. BP avg
- The values decrease
- 65-110
- 24
- 100/65
Toddlers & Preschoolers - PE
Anterior -1- by -2-
Chest -3- are -4- until -5- of age; chest eventually -6- by age 5/6
- fontanel closed
- 18 months
- and head circumferences
- equal
- 1 year
- grows 5 cm > head
Toddlers & Preschoolers Eye exam
Assess for: -1- & -2-
- Red reflex
2. inward/outward turning (strabismus; int’t refer after 3 months, con’t refer immediately)
Toddlers & Preschoolers - PE
Tympanic membrane may be red due to -1-
Assess for -2-
Mouth breathing: could be due to -3- (-5- develop at -4-)
- crying
- neck masses (swollen/shotty nodes acceptable postinfection)
- allergic rhinitis
- age 2
- seasonal allergies
Toddlers & Preschoolers
Nasal quality - shallow, could be -1-
> Voice - “-2-“ need to -3-
- enlarged adenoids
- marble mouth
- x-ray
Toddlers & Preschoolers - Cardiac
> Eyelid or -1- as a -2- is -3-
> Squatting -4- is a sign of -5-
> This age group is also known for -6-
- orbital edema
- cardiac symptom
- specific to toddlers (no dependant edema)
- during play
- Tetralogy of Fallot
- innocent murmurs
Toddlers & Preschoolers - PE
Abdomen: Liver edge -1- below the -2-; Spleen is -3- age group
Penis: -4- AG: -5- foreskin, -6- or it -7-
- palpable 1-2 cm
- right costal margin
- non-palpable in this
- Phimosis
- Don’t pull back
- it should resolve
- will need surgery
Genu varum: -1- (-2-)
Genu valgum: -3- (-4-)
- “rum” gives you a swagger
- Bow-legged (physiologic variant)
- “gum” sticks your legs together
- Knock-knees (physiologic variant)
Femoral -1-: -2-, -3- until -4-, but typically -5-
> Sits in a -6-
> frequent -7- when walking
> Physical exam reveals a wide-based -8-, with a foot progression ankle of -9-.
> Appropriate management includes -10-, and -11- is warranted if there is -12- or -13- rotation.
- anteversion
- in-toeing
- physiologic
- adolescence
- resolves by 8 yo
- W shape
- falls
- externally rotated gait
- minus 5 degrees
- observation
- non-urgent referral to orthopedics
- > 70 degree medial
- <10 degree lateral hip
Tibial -1-: -5-
self-resolves by -2-; if still persistent by age -3-, then -4- may be recommended
- torsion
- age 4
- 9 or 10
- surgery
- pigeon-toeing
Toddlers & Preschoolers - PE
Lymph nodes: -1- nodes require -2-
- supraclavicular
2. aggressive investigation/ED visit
Toddlers & Preschoolers - Gross Motor
2 y: -1- quasi-independently; -2-
3 y: Up & down stairs with -3-; rides a -4-
- Up & down steps
- two-footed hopping
- alternating feet
- tricycle
Toddlers & Preschoolers - Gross Motor
4 y: -1- on -2- for up to 2 seconds; rides -3- with -4-
5 y: Uses -5-
- hops and stands
- one foot
- bicycle
- training wheels
- fork and spoon (sometimes knife)
Toddlers & Preschoolers - Fine Motor
2 y: -1-
3 y: -2-
4 y: -3-
- 8-cube tower (and vertical line)
- copies a circle
- cuts with child-safe scissors
Toddlers & Preschoolers - Fine Motor
5 y: Draws -1- with -2- -3-; -4- (w/ some help -5-)
- person
- 5
- distinguishable body parts
- dresses independently
- tying shoelaces
Toddlers & Preschoolers - Cognitive Dev
Preoperational & Intuitive (Piaget): -1- occurs as -2- on -3-; -4-: the tendency of children to cognize their environment only in terms of -5-
- concentration
- focus is
- one thing at a time
- egocentrism
- their own pov
Toddlers & Preschoolers - Cognitive Dev
Preoperational & Intuitive (Piaget): -1- begins, projecting the ability to -2-; -3- are capable of -4-
- Animism
- think/feel like the child
- inanimate objects
- feeling/thinking
Toddlers & Preschoolers
Visual acuity to -1- by -2- years old
- 20/30
- 5
(2 + 3 = 5)
Toddlers & Preschoolers Hearing At -1-, babies begin linking sound and language Play -2-: typically is utilized at -3- Over -4-: should experience -5-
- 6-9 months (babbling, turning to sound)
- audiometry screening
- 2-3 years of age
- 3 years
- pure tone audiometry
Toddlers & Preschoolers Language dev 2 y: up to a -1- with -2- 3 y: about -3- of words can be understood by strangers 4 y: -4-; can say -5-
- 50-word vocabulary
- 2-word phrases
- 75%
- Sings songs from memory; tells stories
- first & last name
Toddlers & Preschoolers
Language dev
5 y: Speaks clearly and -1-; if not, -2-; recites -3-
Meaningful word usage in sentences: ages -4-, -5-
- uses sentences regularly
- RED FLAG - speech referral
- First & last name, and address
- 2-5
- 1-word/year of age-phrases (2-word phrases by age
2, 3-word phrases by age 3, etc)
Toddlers & Preschoolers Psychosocial Dev > Introduction -1- > Aggression and -2- > -3- is a major psychosocial medium >> T: Onlooker and -4- -3- >> P: -5-, dramatic, physical -3-
- of discipline
- impulse control
- Play
- parallel
- Associative, cooperative
Standardized screenings appropriate for Toddlers & Preschoolers
Bayley Scales of I & T Dev; ASQ; Denver II; and the -1- screening at -2- of age
- Modified Checklist for Autism in Toddlers (MCHAT)
2. 16-30 months
Toddlers & Preschoolers
Intake & Nutrition
-1- should be introduced at -2-; child should be -3- by the end of the -4-
Physiological, self-limited -5-
- Drinking from a cup
- 6 months
- weaned from the bottle
- first year
- food “jags” are common
Toddlers & Preschoolers
Dental Health
-1- after meals and before bed
First -2-
- Brushing teeth
2. dental appointment before 12 months
Toddlers & Preschoolers Sleep > Sleeps -1- per night with -2- > -3- begin around age -4- >> -5- typically occur between -6- years, most outgrow as they get older
- 10-12
- daily naps
- Nightmares (kids wake up upset, are able to remember/recount nightmare)
- 3
- Night terrors (screaming in sleep/eyes open, don’t remember events)
- 4 and 12
Toddlers & Preschoolers
Toilet training
Readiness begins between …
…1.5 and 3 years (average 2; smaller bladders = less success)
Toddlers & Preschoolers
Screen Time
<18 mo: -1-
18 mo to -2-: Media use should be -3-, and alongside adults
Children -4-: Limit screen use to no more than -5-
- Avoid solo media use
- 2 years
- limited and high-quality
- 2-5 years
- 1 hour per day
Toddlers & Preschoolers
Screen Time
For school-age children (-1-): maintain -2- on -3-
- 6+ years
- consistent limitations
- time spent and media quality
Toddlers & Preschoolers
Dev Warning Signs
12 mo: is -1- or -2-; does not -3- when -4-; does not learn -5-
- not babbling
- imitating sounds
- stand
- supported
- gestures (pointing, nodding)
Toddlers & Preschoolers
Dev Warning Signs
At 18 months: Doesn’t -2-; Doesn’t -3- when -4-
- copy others
- notice or mind
- caregiver leaves
Toddlers & Preschoolers
Dev Warning Signs
At 2 years: Does not feed self with spoon; Is not -1-; Does not -2-; Is initiating -3-
At 3 years: Is not aware of external environment; falls down or has trouble with stairs; -4-; Does not -5-
- using 2-word phrases
- follow simple instructions
- self-stimulation behaviors
- drools, speaks unclearly
- speak in sentences
Toddlers & Preschoolers
Dev Warning Signs
At 4 years: does not listen to a story; Does not -1-; engages in -2- or -3-; is -4-; does not draw -5-
- speak in sentences
- head banging
- rocking
- not toilet trained
- a human figure
Toddlers & Preschoolers
Dev Warning Signs
At 5 years: -1- is still a -2-; there is -3-
- Magical thinking
- dominant presence
- no impulse control
Stuttering in Toddlers & Preschoolers
Lasts for -1-, but often -2- (-3-)
DDx: -4-, or -5-
- several weeks to 6 months
- resolves w/o intervention
- 75% spontaneous recovery
- Hearing impairment
- visual impairment
Stuttering management in Toddlers & Preschoolers
-1- stuttering lasts -2-, develops -3-, or child has a -4-
- Refer if
- > 6 months
- problems at school
- fear of speaking
ASD in Toddlers & Preschoolers
Dx
Continuous -1- that are -2- in nature; patterns of activities, interests, and behaviors that are -3-
Toddlers (-4-): M-CHAT-R to screen, (-5- indicates need for follow-up)
- interaction/communication impairment
- reciprocal and social
- restrictive and repetitive
- 16-30 mo.
- score > 2
ASD classification in Toddlers & Preschoolers
must impede functioning especially in -1- and -2- (requires -3-)
- school
- occupational
- occupational resource services/support
ASD mgmt in Toddlers & Preschoolers
Referrals
-1- as needed (e.g., -2-, -3-, or -4- therapy)
- Developmental therapists
- speech
- motor
- sensory
ASD mgmt in Toddlers & Preschoolers
-1- and -2-: approved for management of irritiability and aggression. These are -3-, but a -4-
Close monitoring required for -5-: -6-
- Aripiprazole
- risperidone
- not prescribed by PNP-PC
- psychiatrist or developmental pediatrician
- antipsychoitc side effects
- weight gain, dyslipidemia, tardive dyskinesia
-1- presents with seemingly normal development until the age of 2; the child begins to exhibit deteriorating motor, language, and social skills. -2- is exclusively seen in females. -3- does not present with deterioration of language. -4- is often accompanied by seizures, as well as uncontrolled movement. Children with -5- present with a whole array of physical findings including microcephaly, a flat nose, and protruding tongue, among others.
- Childhood disintegrative disorder
- Rett Syndrome
- Asperger’s syndrome
- Angelman syndrome
- Down syndrome
The screening process is best done by using -1-; these are brief, standardized tests used to identify children who require further in-depth examination. When physicians use only -2-, such as an interview, estimates of -3- are often inaccurate. -4- and -5- are part of -1- that are utilized, but alone, they make for a less comprehensive gathering of information.
- developmental screening instruments
- clinical impressions
- children’s developmental status
- Standardized questions
- growth charts
It is not possible to predict or prevent -1- until more is known -2-. However, the -3- with -4-, the better he or she will do in the long run, as -5- and -6-.
- pervasive development disorders
- about the causes
- sooner a child
- symptoms begins treatment
- early diagnosis
- treatment improve outcomes
Children with -1- have problems with social interaction, pretend play, and -2-. They also have a limited range of -3-. Nearly 75% of children with -1- also have some degree of -4-.
- autism
- communication
- activities and interests
- mental retardation
Children with -1- display a relatively good grasp of -2-, unlike children with suspected -3-.
- Asperger’s syndrome
- language
- autism
-1- is not as prominent in -2- as the reverse, as this condition -3- those with a -4-. Thus, although this disorder causes symptoms similar to -5-, it is not an initial consideration for -2-.
- Fragile X syndrome
- female patients
- severely affects
- single X chromosome
- ASD
Neuroblastoma is the -1- solid tumor in children and the most -2- in early childhood. The median age at diagnosis is -3-, and approximately 90% of cases have been diagnosed by -4- of age.
- most common extracranial
- commonly diagnosed malignancy
- 22 months
- 5 years
Neuroblastoma may develop at -1- with over half developing in the -2-. Symptoms may mimic many other disorders and can be -3-. Metastasis of neuroblastoma typically occurs in children -4- of age and most commonly includes the lymph nodes, -5-, liver, and skin.
- any SNS site
- adrenal glands
- hard to diagnose
- over 1 year
- long bones/skull/bone marrow
Signs and symptoms of neuroblastoma reflect the -1- and extent of disease, but may include -2-, failure to thrive, -3-, cytopenia, orbital proptosis, -4-, or -5-.
- tumor site
- fever
- bone pain
- masses/bowel obstruction
- spinal cord compression
Wilms tumor is an -1- of the kidney that can also present with -2-. Sarcomas of the extremities are more likely to occur in -3- than toddlers or preschoolers.
- embryonal malignancy (not diagnosed in toddlers/preschoolers)
- an abdominal mass
- older children
Language and speech development are critical areas to address at preventative exams. At two years of age a child should be speaking short phrases of -1- words with a vocabulary of -2-, of which 25% are intelligible to strangers. Children from -3- tend to develop language more slowly, mixing words and phrases from the -4-; -5- within expected ranges.
- two to three
- about 50 words
- bilingual homes
- two languages
- milestones should fall
Bilingual children with significant -1- require the -2- as monolingual children in similar situations.
The first step in management for children with -1- is referral to a -3- with -4-. Having older siblings monitor speech at home is not culturally appropriate and does not -5- of the child.
- delays in vocabulary
- same evaluation
- pediatric speech pathologist
- access to translators
- address the needs
Daily reading does help with language development and should be a part of the anticipatory guidance -1-; however, this child is showing signs of -2-. A hearing evaluation is an -3- of assessing speech and language delays, but the initial step is referral to -4-.
- at age 2
- language delay
- appropriate element
- pediatric speech pathology
The HPI is one component of a -1- visit. The HPI questions that a provider asks in the latter will focus on the -2- and seek details about -3-, associated symptoms, characteristics, duration, exposures, -4-, and -5- in the past.
- comprehensive or symptom-focused
- current situation
- onset
- current home management
- similar occurrences
Poor Weight Gain HPI
A comprehensive health history includes -1- history, -2-, family history, and review of systems.
The history for a symptom-focused visit includes -3- to contribute to -4-. The gestational age and the duration of breast/formula feeding provide -1- and -2-. A -5- provides detailed information about the present caloric and nutritional intake that may be contributing to poor weight gain.
- prenatal/birth/neonatal
- past medical history
- only components likely
- diagnosis and treatment
- 24-hour recall
Poor Weight Gain HPI
While the presence of -1- in the family history is pertinent, this is -2- than obtaining details about caloric intake.
- congenital GI disorders (such as celiac disease)
2. initially less important
