Toddler & Preschool Health Flashcards
1
Q
Developmental Stages > Toddlers (2-4 years) >> Piaget: -1- >> Erikson: -2- > Preschoolers (4-7 years) >> Piaget: -3- >> Erikson: -4-
A
- preoperational - preconceptual
- Autonomy vs shame & doubt
- preoperational - Intuitive
- Initiative vs guilt
2
Q
Anthropometrics in
Toddlers: length, weight, height, -1- percentile [-2- year(s) old]
Preschoolers: height, weight, -3- (starting at -4-, then each year), -5-
A
- head circumference
- up to 2
- blood pressure
- 3 years old
- vision (snellen or LEA)
3
Q
Screening in Toddlers & Preschoolers -1- screening not universally done; based on risk Dev screening (-2- or equivalent) for children -3- of age
A
- Tb
- ASQ
- 6- years
4
Q
Labs in Toddlers
- 1- if at risk for iron deficiency/anemia
- 2-: to be performed at -3- of age, and -4- during ages -5-
A
- H&H
- Pb screening
- 6-24 month-WCC except 15 mo.
- annually
- 3-6 years
5
Q
Toddlers & Preschoolers
Tb: screen at ages -2-, then -3- from age -4- onward
A
- 1, 6, & 12 months
- annually
- 2 years
6
Q
Toddlers & Preschoolers
Screening
-1- around -2-; test if indicated (e.g., -3- or -4-)
A
- cholesterol screening
- 2 years
- family history of dyslipidemia
- premature cardiovascular disease
7
Q
Toddlers & Preschoolers - Interview Specifics
Toddler is striving for -1-, as with -2-
Tantrums are common due to -3-
Continue progression of -4- exam
A
- autonomy
- potty training
- articulation barrier
- non-invasive to invasive (ears last)
8
Q
Toddlers & Preschoolers - Physical Exam
-1- starts at age 2 years
Record percentile on -2-
-3- continues; -4-
A
- BMI
- growth chart
- Dental development (6 months for primary tooth dev; 6 years for secondary)
9
Q
Toddlers & Preschoolers - Vitals As children grow, -1- 2. Pulse range 3. RR avg 4. BP avg
A
- The values decrease
- 65-110
- 24
- 100/65
10
Q
Toddlers & Preschoolers - PE
Anterior -1- by -2-
Chest -3- are -4- until -5- of age; chest eventually -6- by age 5/6
A
- fontanel closed
- 18 months
- and head circumferences
- equal
- 1 year
- grows 5 cm > head
11
Q
Toddlers & Preschoolers Eye exam
Assess for: -1- & -2-
A
- Red reflex
2. inward/outward turning (strabismus; int’t refer after 3 months, con’t refer immediately)
12
Q
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-)
A
- crying
- neck masses (swollen/shotty nodes acceptable postinfection)
- allergic rhinitis
- age 2
- seasonal allergies
13
Q
Toddlers & Preschoolers
Nasal quality - shallow, could be -1-
> Voice - “-2-“ need to -3-
A
- enlarged adenoids
- marble mouth
- x-ray
14
Q
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-
A
- orbital edema
- cardiac symptom
- specific to toddlers (no dependant edema)
- during play
- Tetralogy of Fallot
- innocent murmurs
15
Q
Toddlers & Preschoolers - PE
Abdomen: Liver edge -1- below the -2-; Spleen is -3- age group
Penis: -4- AG: -5- foreskin, -6- or it -7-
A
- palpable 1-2 cm
- right costal margin
- non-palpable in this
- Phimosis
- Don’t pull back
- it should resolve
- will need surgery
16
Q
Genu varum: -1- (-2-)
Genu valgum: -3- (-4-)
A
- “rum” gives you a swagger
- Bow-legged (physiologic variant)
- “gum” sticks your legs together
- Knock-knees (physiologic variant)
17
Q
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.
A
- 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
18
Q
Tibial -1-: -5-
self-resolves by -2-; if still persistent by age -3-, then -4- may be recommended
A
- torsion
- age 4
- 9 or 10
- surgery
- pigeon-toeing
19
Q
Toddlers & Preschoolers - PE
Lymph nodes: -1- nodes require -2-
A
- supraclavicular
2. aggressive investigation/ED visit
20
Q
Toddlers & Preschoolers - Gross Motor
2 y: -1- quasi-independently; -2-
3 y: Up & down stairs with -3-; rides a -4-
A
- Up & down steps
- two-footed hopping
- alternating feet
- tricycle
21
Q
Toddlers & Preschoolers - Gross Motor
4 y: -1- on -2- for up to 2 seconds; rides -3- with -4-
5 y: Uses -5-
A
- hops and stands
- one foot
- bicycle
- training wheels
- fork and spoon (sometimes knife)
22
Q
Toddlers & Preschoolers - Fine Motor
2 y: -1-
3 y: -2-
4 y: -3-
A
- 8-cube tower (and vertical line)
- copies a circle
- cuts with child-safe scissors
23
Q
Toddlers & Preschoolers - Fine Motor
5 y: Draws -1- with -2- -3-; -4- (w/ some help -5-)
A
- person
- 5
- distinguishable body parts
- dresses independently
- tying shoelaces
24
Q
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-
A
- concentration
- focus is
- one thing at a time
- egocentrism
- their own pov
25
Toddlers & Preschoolers - Cognitive Dev
| Preoperational & Intuitive (Piaget): -1- begins, projecting the ability to -2-; -3- are capable of -4-
1. Animism
2. think/feel like the child
3. inanimate objects
4. feeling/thinking
26
Toddlers & Preschoolers
| Visual acuity to -1- by -2- years old
1. 20/30
2. 5
(2 + 3 = 5)
27
```
Toddlers & Preschoolers
Hearing
At -1-, babies begin linking sound and language
Play -2-: typically is utilized at -3-
Over -4-: should experience -5-
```
1. 6-9 months (babbling, turning to sound)
2. audiometry screening
3. 2-3 years of age
4. 3 years
5. pure tone audiometry
28
```
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-
```
1. 50-word vocabulary
2. 2-word phrases
3. 75%
4. Sings songs from memory; tells stories
5. first & last name
29
Toddlers & Preschoolers
Language dev
5 y: Speaks clearly and -1-; if not, -2-; recites -3-
Meaningful word usage in sentences: ages -4-, -5-
1. uses sentences regularly
2. RED FLAG - speech referral
3. First & last name, and address
4. 2-5
5. 1-word/year of age-phrases (2-word phrases by age
2, 3-word phrases by age 3, etc)
30
```
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-
```
1. of discipline
2. impulse control
3. Play
4. parallel
5. Associative, cooperative
31
Standardized screenings appropriate for Toddlers & Preschoolers
Bayley Scales of I & T Dev; ASQ; Denver II; and the -1- screening at -2- of age
1. Modified Checklist for Autism in Toddlers (MCHAT)
| 2. 16-30 months
32
Toddlers & Preschoolers
Intake & Nutrition
-1- should be introduced at -2-; child should be -3- by the end of the -4-
Physiological, self-limited -5-
1. Drinking from a cup
2. 6 months
3. weaned from the bottle
4. first year
5. food "jags" are common
33
Toddlers & Preschoolers
Dental Health
-1- after meals and before bed
First -2-
1. Brushing teeth
| 2. dental appointment before 12 months
34
```
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
```
1. 10-12
2. daily naps
3. Nightmares (kids wake up upset, are able to remember/recount nightmare)
4. 3
5. Night terrors (screaming in sleep/eyes open, don't remember events)
6. 4 and 12
35
Toddlers & Preschoolers
Toilet training
Readiness begins between ...
...1.5 and 3 years (average 2; smaller bladders = less success)
36
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-
1. Avoid solo media use
2. 2 years
3. limited and high-quality
4. 2-5 years
5. 1 hour per day
37
Toddlers & Preschoolers
Screen Time
For school-age children (-1-): maintain -2- on -3-
1. 6+ years
2. consistent limitations
3. time spent and media quality
38
Toddlers & Preschoolers
Dev Warning Signs
12 mo: is -1- or -2-; does not -3- when -4-; does not learn -5-
1. not babbling
2. imitating sounds
3. stand
4. supported
5. gestures (pointing, nodding)
39
Toddlers & Preschoolers
Dev Warning Signs
At 18 months: Doesn't -2-; Doesn't -3- when -4-
2. copy others
3. notice or mind
4. caregiver leaves
40
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-
1. using 2-word phrases
2. follow simple instructions
3. self-stimulation behaviors
4. drools, speaks unclearly
5. speak in sentences
41
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-
1. speak in sentences
2. head banging
3. rocking
4. not toilet trained
5. a human figure
42
Toddlers & Preschoolers
Dev Warning Signs
At 5 years: -1- is still a -2-; there is -3-
1. Magical thinking
2. dominant presence
3. no impulse control
43
Stuttering in Toddlers & Preschoolers
Lasts for -1-, but often -2- (-3-)
DDx: -4-, or -5-
1. several weeks to 6 months
2. resolves w/o intervention
3. 75% spontaneous recovery
4. Hearing impairment
5. visual impairment
44
Stuttering management in Toddlers & Preschoolers
| -1- stuttering lasts -2-, develops -3-, or child has a -4-
1. Refer if
2. > 6 months
3. problems at school
4. fear of speaking
45
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)
1. interaction/communication impairment
2. reciprocal and social
3. restrictive and repetitive
4. 16-30 mo.
5. score > 2
46
ASD classification in Toddlers & Preschoolers
| must impede functioning especially in -1- and -2- (requires -3-)
1. school
2. occupational
3. occupational resource services/support
47
ASD mgmt in Toddlers & Preschoolers
Referrals
-1- as needed (e.g., -2-, -3-, or -4- therapy)
1. Developmental therapists
2. speech
3. motor
4. sensory
48
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-
1. Aripiprazole
2. risperidone
3. not prescribed by PNP-PC
4. psychiatrist or developmental pediatrician
5. antipsychoitc side effects
6. weight gain, dyslipidemia, tardive dyskinesia
49
-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.
1. Childhood disintegrative disorder
2. Rett Syndrome
3. Asperger's syndrome
4. Angelman syndrome
5. Down syndrome
50
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.
1. developmental screening instruments
2. clinical impressions
3. children's developmental status
4. Standardized questions
5. growth charts
51
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-.
1. pervasive development disorders
2. about the causes
3. sooner a child
4. symptoms begins treatment
5. early diagnosis
6. treatment improve outcomes
52
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-.
1. autism
2. communication
3. activities and interests
4. mental retardation
53
Children with -1- display a relatively good grasp of -2-, unlike children with suspected -3-.
1. Asperger's syndrome
2. language
3. autism
54
-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-.
1. Fragile X syndrome
2. female patients
3. severely affects
4. single X chromosome
5. ASD
55
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.
1. most common extracranial
2. commonly diagnosed malignancy
3. 22 months
4. 5 years
56
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.
1. any SNS site
2. adrenal glands
3. hard to diagnose
4. over 1 year
5. long bones/skull/bone marrow
57
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-.
1. tumor site
2. fever
3. bone pain
4. masses/bowel obstruction
5. spinal cord compression
58
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.
1. embryonal malignancy (not diagnosed in toddlers/preschoolers)
2. an abdominal mass
3. older children
59
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.
1. two to three
2. about 50 words
3. bilingual homes
4. two languages
5. milestones should fall
60
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.
1. delays in vocabulary
2. same evaluation
3. pediatric speech pathologist
4. access to translators
5. address the needs
61
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-.
1. at age 2
2. language delay
3. appropriate element
4. pediatric speech pathology
62
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.
1. comprehensive or symptom-focused
2. current situation
3. onset
4. current home management
5. similar occurrences
63
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.
1. prenatal/birth/neonatal
2. past medical history
3. only components likely
4. diagnosis and treatment
5. 24-hour recall
64
Poor Weight Gain HPI
| While the presence of -1- in the family history is pertinent, this is -2- than obtaining details about caloric intake.
1. congenital GI disorders (such as celiac disease)
| 2. initially less important
