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DRT > Toddlers & Preschool Health > Flashcards

Toddlers & Preschool Health Flashcards

1
Q

Toddlers & Preschool Health
- Ages

A

-Toddler = 1-3 years
-Preschool = 3-5 years

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2
Q

Toddlers & Preschool Health
- Theorists

A

-Jean Piaget
*Preoperational thinking (2-7 years) = egocentrism, animism (inanimate objects have feelings), pretend play
*Intuitive thinking (substage that starts at 4 years, to 7 years) = children learn by asking questions

-Erik Erikson
*Toddler = autonomy vs. shame and doubt - develop greater sense of personal control which promotes confidence - start introducing discipline to curb aggression and encourage impulse control
*Preschool = initiative vs. guilt - child asserts power and control over the world via directing social interactions such as play

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3
Q

Toddlers & Preschool Health
- Screenings

A

-PPD for both age groups, if indicated

-Toddler = lead screening performed at 6, 9, 12, 18, and 24 months, and annually during ages 3-6 years
-Preschool = cholesterol screenings around 2 years if indication (family history, premature CV disease)

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4
Q

Toddlers & Preschool Health
- Dental Screening

A

-Should be done between the age of eruption of the first tooth and no later than 12 months

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5
Q

Toddlers & Preschool Health
- Well-Child Visit Schedule

A

-Toddler = 12, 15, 18, 24, 30, and 36 months
-Preschool = annually at 3, 4, and 5 (check them before they go to school - immunizations, vision, hearing)

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6
Q

Toddlers & Preschool Health
- Overview

A

-Toddlers strive for independence
-Tantrums are common
-Fears start emerging at this age
-Allow child to touch equipment when assessing
-Perform non-invasive to invasive assessments

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7
Q

Toddlers & Preschool Health
- BMI

A

-Start in children 2 years and older
-It is the best clinical standard for defining obesity
-Measures the proportion between the child’s weight and height

BMI = weight in kg over height in m squared

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8
Q

Toddlers & Preschool Health
- Dental Development

A

-Primary tooth development = 6 months
-Permanent tooth development = 6 years

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9
Q

Toddlers & Preschool Health
- Vital Signs

A

-Toddler:
*Pulse = 70-110 bpm
*Respirations = 20-30 breaths
*Blood pressure = SBP 90-105 mmHg, DBP 55-70 mmHg

-Preschool:
*Pulse = 65-110 bpm
*Respirations = 20-25 breaths
*Blood pressure = SBP 95-107 mmHg, DBP 60-71 mmHg

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10
Q

Toddlers & Preschool Health
- Fontanels

A

-Anterior fontanel = closed by 18 months
-Delayed closure = think underlying condition - hypothyroidism or Down syndrome

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11
Q

Toddlers & Preschool Health
- Chest & Head Circumference

A

-Equal at 1 year of age, but by age 2, eventually grows 5 cm > head

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12
Q

Toddlers & Preschool Health
- Eye Exam

A

-Consider referral:
*Excessive squinting
*Difficulty picking up small objects
*Head tilting
*Strabismus (intermittent, refer after 3 months; constant, refer immediately)

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13
Q

Toddlers & Preschool Health
- Tympanic Membrane

A

-Red is normal if baby is crying

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14
Q

Toddlers & Preschool Health
- Voice

A

-Check voice quality :
*Nasal quality - think enlarged adenoids or tonsils
*If it sounds like they have marbles in their mouth - order a lateral neck XR to investigate further
*Raspy voice, think laryngitis

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15
Q

Toddlers & Preschool Health
- Mouth Breathing can indicate…

A

-Allergic rhinitis

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16
Q

Toddlers & Preschool Health
- Cardiac

A

-Eyelid or orbital edema is a sign something is wrong… at this age, kids do not have dependent edema
-Squatting during play or sleeping in knee-to-chest position - sign of Tetralogy of Fallot
-PMI is at 4th ICS, midclavicular line

17
Q

Toddlers & Preschool Health
- Abdomen

A

-Spleen should not be palpable by this age
-Periorbital edema is a presenting symptom in almost all children with nephrotic syndrome (condition that causes the kidneys to leak large amounts of protein into the urine)

18
Q

Toddlers & Preschool Health
- Musculoskeletal

A

-Genu varum (bow-legged) = normal until age 2… if persists longer, refer
-Genu valgum (knocked knees) = normal until age 7… if persists longer, refer - “gum” makes knees stick together

-Femoral anteversion = in-toeing, normal until adolescence
-Tibial torsion = self-resolves by age 4 - if not resolved by age 9 or 10, surgery may be recommended

19
Q

Toddlers & Preschool Health
- Lymph nodes

A

-Shotty nodes (very small, scattered nodes that feel like shotgun pellets under the skin) and 1-2 cm enlargement may be normal in inguinal or neck area - usually present post-infection
-Enlarged supraclavicular lymph nodes are a cause for concern and require aggressive investigation - lymphoma

20
Q

Toddlers & Preschool Health
- Gross Motor Skills

A

-2 years
*Go up and down stairs
*Kicks a ball
*Runs with wide gait

-3 years
*Up and down stairs with alternating feet
*Rides tricycle - 3 wheels at 3 years

-4 years
*Hops and stands on one foot
*Rides bicycle with training wheels - 4 wheels at 4 years

-5 years
*Skips
*Uses fork and spoon

21
Q

Toddlers & Preschool Health
- Fine Motor Skills

A

-2 years
*Tower - 8 cubes

-3 years
*Draws circle

-4 years
*Cuts paper with child-safe scissors
*Tower - 10 blocks
*Draws a person with 2 body parts

-5 years
*Draws a person with 5 body parts (age 5, 5 parts)
*Prints letters
*Dresses independently

22
Q

Toddlers & Preschool Health
- Visual Acuity

A

-By age 5, visual acuity is 20/30 (think 2+3=5)

23
Q

Toddlers & Preschool Health
- Language Development

A

-2 years
*2-word sentences (2 words by 22 months)
*Up to 50-word vocabulary
*Can follow simple commands

-3 years
*200+ word vocabulary
*About 75% of words can be understood by strangers (think 3 years/4 - 75%)

-4 years
*Sings a song, recites poem, tells stories
*Can say first and last name

-5 years
*Vocabulary >2,000 words
*Speaks clearly and uses sentences regularly (if they are not speaking in full sentences and conversing by age 5, this is a RED FLAG)
*Recites full name and address

-TIP:
-2 words together by 2 years
-3 words together by 3 years
-4 words together by 4 years
-5 words together by 5 years

24
Q

Toddlers & Preschool Health
- Play

A

-Toddler = parallel play, onlooker play
-Preschool = associative, cooperative, dramatic, and physical play

25
Q

Toddlers & Preschool Health
- Standardized Testing

A

-Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)
*Start screening at 16-30 months
*Score of >2 needs follow up

-Bayley Scales of Infant and Toddler Development, third edition (BAYLEY-III)
*Gold standard for recognizing and diagnosing developmental delays in infants and toddlers up to 42 months of age

-Denver II
*Screens development up to 6 years
*Does not test intelligence

-Ages and Stages Questionnaire
*Screens children 4 months to 5 years
*Done by parents

26
Q

Toddlers & Preschool Health
- Nutrition/Feeding

A

-Drinking from a cup by 6 months
-Weaned from the bottle by 1 year, prevents tooth decay
-Encourage use of utensils (spoon by 10-12 months)
-Avoid sugary snacks and drinks
-Should use forks AND spoons by 18 months

27
Q

Toddlers & Preschool Health
- Dental Health

A

-Brush teeth after meals and before bed
-First dental exam by age 1

28
Q

Toddlers & Preschool Health
- Sleep

A

-Should sleep 10-12 hours with a daily nap
-Nightmares begin by age 3
-Night terrors begin between ages 4-12 - more dramatic, kids will be terrorized, won’t wake up, won’t remember what happened, will look right through you

29
Q

Toddlers & Preschool Health
- Toilet Training

A

-Physiologic and psychologic readiness begins at around ages 1.5-3 years
-Average daytime control should be achieved by 3-4 years
-Nighttime control lags 1 year, and should be achieved by 4-5 years

-Do not start in times of stress
-Do not punish for accidents, reward good efforts

30
Q

Toddlers & Preschool Health
- Screen Time

A

AAP Recommendations
-No alone screen time until 18 months
-18 months-2 years = very limited media use with parental supervision
-2-5 years = limit to no more than 1 hour per day

31
Q

Toddlers & Preschool Health
- Developmental Warning Signs

A

-1 year
*Is not babbling or imitating sounds
*Does not stand when supported
*Does not learn gestures

-18 months
*Does not copy others
*Does not notice or mind when parent/caregiver leave

-2 years
*Does not feed self with spoon
*Is not using 2-word sentences
*Does not follow simple instructions

-3 years
*Not aware of external environments
*Has trouble with stairs
*Drools, speech is unclear
*Does not speak in sentences

-4 years
*Does not speak in sentences
*Is not toilet trained
*Does not draw a human figure

-5 years
*Still has magical thinking
*No impulse control

32
Q

Toddlers & Preschool Health
- Stuttering

A

-Abnormal speech patterns - repetitions and pauses in speech (dysfluencies)
-If stuttering for more than 6 months, are older than 6 years old, or if child avoids or has a fear of speaking, refer

33
Q

Toddlers & Preschool Health
- Autism Spectrum Disorder (ASD)

A

-Most common PDD

-S/S
*Impaired social interactions or social communication
*Repetitive behaviors

-M-CHAT-R = score >2, follow up

-Classification
*Must impede functioning, especially in school and occupational areas

-Management
*Refer to ASD specialist, developmental therapists (PT, OT), family counseling
*Aripiprazole and risperidone = PCP does not prescribe or refill these, they are antipsychotics, and can only be prescribed or refilled by ASD specialist or psych

DRT (11 decks)

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