3: 3-year-old male well-child visit Flashcards Preview

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Flashcards in 3: 3-year-old male well-child visit Deck (48)
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1
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Social

A

-The social environment plays a major part in how children develop.-It is necessary to understand the family context before giving advice.-To enter this arena, ask about changes and family stressors in a non-threatening way.

2
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Nutrition

A

-Preschoolers can suffer from poor nutrition. Inadequate fruit, vegetable, and iron intake is quite common. -Calcium and vitamin D deficiencies also are common.-Children should receive vitamin D supplementation as it is very difficult to attain the recommended daily allowance through nutritional sources or from sun exposure.

3
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Exercise

A

Numerous studies have demonstrated a positive effect of physical activity on prevention of obesity.

4
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Toilet Training

A

-Toddlers at age 3 may not have achieved full toilet “independence” - especially toddlers with intense, willful temperaments.-Requiring assistance toileting is not a clear sign of developmental delay at this age, but may preclude attendance at child care or preschool.

5
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Dental

A

(AAPD) and the AAP both state that all children should be seen within six months of the first tooth eruption or by 1 year of age.–Additionally, the AAP states that all children should be screened by 6 months old to see if they are at a higher risk of developing caries. –Many general dentists feel that the first visit should be at age 3 years.

6
Q

Important Review Topics for a 3-Year-Old’s Health Maintenance Visit: Safety

A

-Car seats are often used inappropriately; toddlers are moved too soon to booster seats.-toddlers >24 mo or who have outgrown the weight and height limits on their car seats should be in a forward-facing car seat in the car’s back seat. -Older children should stay in a booster seat until they reach a height of 4’ 9” (142 cm).-Injuries are a major morbidity in the preschool years.

7
Q

3 socio-emotional

A

-Brushes teeth (with assistance)-Feeds self

8
Q

4 socio-emotional

A

-Knows gender and age-Friendly to other children-Plays with toys/engages in fantasy play

9
Q

5 socio-emotional

A

-Listens and attends-Can tell difference between real and make- believe-Shows sympathy/concern for others

10
Q

3 communication

A

-Speaks in 2- to 3-word sentences-75% understandable

11
Q

4 communication

A

-States first and last name-Sings a song-Most speech clearly understandable

12
Q

5 communication

A

-Articulates well-Tells a simple story using full sentences-Uses appropriate tenses and pronouns-Counts to 10-Follows simple directions

13
Q

3 cognitive

A

Knows name and use of “cup, ball, spoon, crayon”

14
Q

4 cognitive

A

-Names colors-Aware of gender-Plays board games-Draws person with 3 parts-Copies a cross

15
Q

5 cognitive

A

Asking the parents about school performance is as important as the following milestones:–Draws a person with > 6 body parts –Prints some letters and numbers –Copies squares and triangles

16
Q

3 Physical

A

-Builds tower of 6-8 cubes-Throws a ball overhand-Rides a tricycle Copies a circle

17
Q

4 Physical

A

-Hops on one foot-Balances for 2 seconds-Pours, cuts, and mashes own food-Brushes teet

18
Q

5 Physical

A

-Balances on one foot -Hops and skips-Ties a knot-Has mature pencil grasp-Undresses/dresses with minimal assistance

19
Q

Eczema and Allergies

A

Although eczema often occurs without a history of allergies, such a hx would support an atopic diathesis and should prompt you to ask additional questions about allergic triggers and asthma symptoms.

20
Q

Eczema (Atopic Dermatitis): Fhx

A

While eczema tends to be familial, there is typically a multifactorial inheritance pattern and often clear environmental (allergic) triggers.

21
Q

Eczema (Atopic Dermatitis): Ddx

A

–Psoriasis: Although psoriasis can occasionally first look like eczema, it is rare in young children. When present, it occurs as a generalized rash known as guttate (droplet-shaped) psoriasis. Guttate psoriasis is usually precipitated by a strep infection.–Seborrhea: This should also be part of the differential diagnosis, especially in early infancy (e.g., cradle cap). It is unusual to have a new case of seborrheic dermatitis at age 3.

22
Q

basic tenets of the treatment of eczema

A

-Protecting skin by lubricating extensively-Using anti-inflammatories in short bursts-Treating associated skin infections aggressively.

23
Q

Eczema Pharm: Steroids

A

-Prescribe topical steroid, alternating a higher potency for severe flares with a lower potency for minor bouts.-Often over-the-counter hydrocortisone is inadequate.

24
Q

Eczema Pharm: Topical anti-inflammatories

A

-Calcineurin inhibitors are considered second-line therapy. Although effective, safety concerns remain for long term use.

25
Q

Eczema Pharm: Antihistamines

A

-non-sedating antihistamines approved for children, loratidine, fexofenadine and cetirizine may be effective.-Traditional antihistamines (with sedative side effects) such as diphenhydramine and hydroxyzine are often used at bedtime to decrease itch.

26
Q

Common Dietary Issues in Early Childhood: Inadequate nutrition

A

-only taking 80% of the recommended fruit servings/day, but only 30% of the recommended vegetable servings/day.-Iron is of crucial importance to normal development in this age group due to its role as a CNS co-catalyst. -Iron intake in toddlers occurs predominantly from meat, legumes, and iron fortified cereals.

27
Q

Common Dietary Issues in Early Childhood: Milk and Juice intake

A

no more than 4-6 ounces of juice per day

28
Q

Common Dietary Issues in Early Childhood: Early childhood caries

A

-Bathing teeth throughout the day with milk or juice from a bottle can result in early dental caries.-Early childhood caries typically have a lag time before visible decay. Thus the patterns established when a child is 1 to 3 years old may result in caries when the child is 3 to 5 years old.-routine bedtime use of the bottle can lead to cavities. -It is recommended that parents discontinue the bottle by the time the child is 12- to 15- mo.

29
Q

Common Dietary Issues in Early Childhood: Control battles about food

A

Food rewards and punishment in preschoolers may promote obesity by interfering with children’s ability to regulate their own food intake.

30
Q

Important causes of injury in a toddler include

A

-Car accidents -Swimming pools -Falls-Firearms -Poisonings -Fires

31
Q

Children and Guns

A

-52% of parents who owned guns thought that their children were “too smart” or “knew better,” even though only 40% had given specific instructions to their children regarding guns. (In this survey only 12% of parents who owned guns locked them.)-When given the opportunity, boys ages 8-12 would handle a gun (76%) and pull the trigger (48%). –Parents’ opinions about whether or not their child would handle a gun were not predictive of which boys would handle the gun.

32
Q

Lead screening

A

-lead absorption is higher in younger children than in older children and adults. -Iron deficiency, which is common in toddlers, increases lead absorption

33
Q

Common sources of lead exposure include

A

-House paint used before 1978 - and particularly before 1960. Deteriorating paint produces lead-containing dust, particularly during renovation.-Soil-Plumbing, pipes-Hobbies, occupational exposures Imported toys, ceramics, candy, cosmetics -Folk remedies

34
Q

AAP policy recommends blood lead testing for

A

-All children 12-24mo in areas where > 25% of housing was built before 1960 or where the prevalence of blood lead levels > 5 μg/dL in children is 5% or greater.-Individual children who live in or regularly visit homes/facilities built before 1960 that are in poor repair or have been renovated within the past 6 months.

35
Q

TB risk factors

A

–Spending time with an individual known or suspected to have TB disease–Being infected with HIV or another condition that weakens the immune system–Having symptoms of TB disease–Living in (or coming from) a country where TB disease is very common (most countries in Latin America and the Caribbean, Africa, Asia, Eastern Europe, and Russia)–Living somewhere in the U.S. where TB disease is more common (e.g., a homeless shelter, migrant farm camp, prison or jail, and some nursing homes) –Use of injected illegal drugs.

36
Q

Iron Deficiency Anemia: Epidemiology

A

preschoolers deficient iron stores may occur in up to 35% of low-income children (versus only 7% in other preschoolers), with up to 10% having iron-deficiency anemia.

37
Q

Iron Deficiency Anemia: Association with Cognitive Difficulty

A

association between iron deficiency in infancy and later cognitive deficits

38
Q

Iron Deficiency Anemia: Causes

A

most likely acquired cause of iron-deficiency anemia.

39
Q

Iron Deficiency Anemia: Therapy

A

In children whose anemia is mild, many providers will provide a trial of iron rather than do any further workup at this point. If the hemoglobin recovers to the normal range after a trial period, that is sufficient evidence of iron- deficiency anemia.

40
Q

Other Causes of Anemia; In children of Mediterranean, Asian or African descent, hemoglobinopathies should be considered, including:

A

-alpha thalassemia -G6PD deficiency -sickle cell disease(In these cases, the child’s newborn screening hemoglobin electrophoresis would have been abnormal.)

41
Q

more severe anemia (Hgb less than 9 g/dL (90 g/L) d/t:

A

-Decreased marrow production (e.g., aplastic anemia) -Hemolytic anemia-Vitamin deficiencies (e.g., folate and B6)

42
Q

Unusual acquired causes of anemia include chronic or severe illnesses

A

-Collagen vascular disease -Malignancy-Other chronic illnesses

43
Q

Strabismus

A

misalignment of the eyes. Strabismus can lead to amblyopia, or poor visual development if not managed.

44
Q

Two methods of assessing presence and degree of strabismus

A

-The Hirschberg light reflex -The cover/uncover test

45
Q

Physical Exam of the Toddler and Preschooler: MSK

A

-Several gait variants occur at this age. The most common is intoeing.-Intoeing in toddlers is usually caused by tibial torsion. In tibial torsion, when the patella faces straight ahead, the foot turns inward. Tibial torsion resolves naturally with weight bearing - usually by 4 years of age.-Intoeing in preschool- and school-aged children is usually caused by femoral anteversion. In femoral anteversion both the feet and knees turn inward. Femoral anteversion usually resolves spontaneously by 8-12 years of age.

46
Q

Neurodevelopmental Exam of a 3-Year-Old

A

–Language (speaks in short sentences; 75% of language is intelligible to a stranger) –Fine motor (holds a pencil or crayon; copies a circle)–Gross motor (hops; can ride a tricycle)–Cognitive (draws a person with three body parts)

47
Q

Improving Toddler Eating Habits

A

-Stop the bottle now.-Limit the child’s eating to three meals and two snacks, stopping the food and drink grazing.-No bargaining or cajoling-Gradually change his diet content

48
Q

Anemia Screening

A

-Typically, screening for anemia is done at 12 months and again at preschool or kindergarten entry.-The initial 12-month window coincides with a period in development when diet, particularly iron sources, is often in flux.-If there are risk factors for anemia, then testing may be done at any visit.-Results of a screening hemoglobin can be known immediately.-Spun hematocrit still relies on blood volume, and hydration status can falsely affect the result.

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