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PNCB CPNP-PC > Toddler & Preschool Health > Flashcards

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
  1. preoperational - preconceptual
  2. Autonomy vs shame & doubt
  3. preoperational - Intuitive
  4. Initiative vs guilt
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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
  1. head circumference
  2. up to 2
  3. blood pressure
  4. 3 years old
  5. vision (snellen or LEA)
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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
  1. Tb
  2. ASQ
  3. 6- years
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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
  1. H&H
  2. Pb screening
  3. 6-24 month-WCC except 15 mo.
  4. annually
  5. 3-6 years
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5
Q

Toddlers & Preschoolers

Tb: screen at ages -2-, then -3- from age -4- onward

A
  1. 1, 6, & 12 months
  2. annually
  3. 2 years
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6
Q

Toddlers & Preschoolers
Screening
-1- around -2-; test if indicated (e.g., -3- or -4-)

A
  1. cholesterol screening
  2. 2 years
  3. family history of dyslipidemia
  4. premature cardiovascular disease
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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
  1. autonomy
  2. potty training
  3. articulation barrier
  4. non-invasive to invasive (ears last)
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8
Q

Toddlers & Preschoolers - Physical Exam
-1- starts at age 2 years
Record percentile on -2-
-3- continues; -4-

A
  1. BMI
  2. growth chart
  3. Dental development (6 months for primary tooth dev; 6 years for secondary)
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9
Q 
Toddlers & Preschoolers - Vitals
As children grow, -1-
2. Pulse range
3. RR avg
4. BP avg
A
  1. The values decrease
  2. 65-110
  3. 24
  4. 100/65
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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
  1. fontanel closed
  2. 18 months
  3. and head circumferences
  4. equal
  5. 1 year
  6. grows 5 cm > head
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11
Q

Toddlers & Preschoolers Eye exam

Assess for: -1- & -2-

A
  1. Red reflex

2. inward/outward turning (strabismus; int’t refer after 3 months, con’t refer immediately)

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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
  1. crying
  2. neck masses (swollen/shotty nodes acceptable postinfection)
  3. allergic rhinitis
  4. age 2
  5. seasonal allergies
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13
Q

Toddlers & Preschoolers
Nasal quality - shallow, could be -1-
> Voice - “-2-“ need to -3-

A
  1. enlarged adenoids
  2. marble mouth
  3. x-ray
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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
  1. orbital edema
  2. cardiac symptom
  3. specific to toddlers (no dependant edema)
  4. during play
  5. Tetralogy of Fallot
  6. innocent murmurs
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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
  1. palpable 1-2 cm
  2. right costal margin
  3. non-palpable in this
  4. Phimosis
  5. Don’t pull back
  6. it should resolve
  7. will need surgery
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16
Q

Genu varum: -1- (-2-)

Genu valgum: -3- (-4-)

A
  1. “rum” gives you a swagger
  2. Bow-legged (physiologic variant)
  3. “gum” sticks your legs together
  4. Knock-knees (physiologic variant)
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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
  1. anteversion
  2. in-toeing
  3. physiologic
  4. adolescence
  5. resolves by 8 yo
  6. W shape
  7. falls
  8. externally rotated gait
  9. minus 5 degrees
  10. observation
  11. non-urgent referral to orthopedics
  12. > 70 degree medial
  13. <10 degree lateral hip
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18
Q

Tibial -1-: -5-

self-resolves by -2-; if still persistent by age -3-, then -4- may be recommended

A
  1. torsion
  2. age 4
  3. 9 or 10
  4. surgery
  5. pigeon-toeing
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19
Q

Toddlers & Preschoolers - PE

Lymph nodes: -1- nodes require -2-

A
  1. supraclavicular

2. aggressive investigation/ED visit

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20
Q

Toddlers & Preschoolers - Gross Motor
2 y: -1- quasi-independently; -2-
3 y: Up & down stairs with -3-; rides a -4-

A
  1. Up & down steps
  2. two-footed hopping
  3. alternating feet
  4. tricycle
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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
  1. hops and stands
  2. one foot
  3. bicycle
  4. training wheels
  5. fork and spoon (sometimes knife)
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22
Q

Toddlers & Preschoolers - Fine Motor
2 y: -1-
3 y: -2-
4 y: -3-

A
  1. 8-cube tower (and vertical line)
  2. copies a circle
  3. cuts with child-safe scissors
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23
Q

Toddlers & Preschoolers - Fine Motor

5 y: Draws -1- with -2- -3-; -4- (w/ some help -5-)

A
  1. person
  2. 5
  3. distinguishable body parts
  4. dresses independently
  5. tying shoelaces
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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
  1. concentration
  2. focus is
  3. one thing at a time
  4. egocentrism
  5. their own pov
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25
Q

Toddlers & Preschoolers - Cognitive Dev

Preoperational & Intuitive (Piaget): -1- begins, projecting the ability to -2-; -3- are capable of -4-

A
  1. Animism
  2. think/feel like the child
  3. inanimate objects
  4. feeling/thinking
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26
Q

Toddlers & Preschoolers

Visual acuity to -1- by -2- years old

A
  1. 20/30
  2. 5
    (2 + 3 = 5)
27
Q 
Toddlers & Preschoolers
Hearing
At -1-, babies begin linking sound and language
Play -2-: typically is utilized at -3-
Over -4-: should experience -5-
A
  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
Q 
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-
A
  1. 50-word vocabulary
  2. 2-word phrases
  3. 75%
  4. Sings songs from memory; tells stories
  5. first & last name
29
Q

Toddlers & Preschoolers
Language dev
5 y: Speaks clearly and -1-; if not, -2-; recites -3-

Meaningful word usage in sentences: ages -4-, -5-

A
  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
Q 
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-
A
  1. of discipline
  2. impulse control
  3. Play
  4. parallel
  5. Associative, cooperative
31
Q

Standardized screenings appropriate for Toddlers & Preschoolers
Bayley Scales of I & T Dev; ASQ; Denver II; and the -1- screening at -2- of age

A
  1. Modified Checklist for Autism in Toddlers (MCHAT)

2. 16-30 months

32
Q

Toddlers & Preschoolers
Intake & Nutrition
-1- should be introduced at -2-; child should be -3- by the end of the -4-
Physiological, self-limited -5-

A
  1. Drinking from a cup
  2. 6 months
  3. weaned from the bottle
  4. first year
  5. food “jags” are common
33
Q

Toddlers & Preschoolers
Dental Health
-1- after meals and before bed
First -2-

A
  1. Brushing teeth

2. dental appointment before 12 months

34
Q 
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
A
  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
Q

Toddlers & Preschoolers
Toilet training
Readiness begins between …

A

…1.5 and 3 years (average 2; smaller bladders = less success)

36
Q

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-

A
  1. Avoid solo media use
  2. 2 years
  3. limited and high-quality
  4. 2-5 years
  5. 1 hour per day
37
Q

Toddlers & Preschoolers
Screen Time
For school-age children (-1-): maintain -2- on -3-

A
  1. 6+ years
  2. consistent limitations
  3. time spent and media quality
38
Q

Toddlers & Preschoolers
Dev Warning Signs
12 mo: is -1- or -2-; does not -3- when -4-; does not learn -5-

A
  1. not babbling
  2. imitating sounds
  3. stand
  4. supported
  5. gestures (pointing, nodding)
39
Q

Toddlers & Preschoolers
Dev Warning Signs
At 18 months: Doesn’t -2-; Doesn’t -3- when -4-

A
  1. copy others
  2. notice or mind
  3. caregiver leaves
40
Q

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-

A
  1. using 2-word phrases
  2. follow simple instructions
  3. self-stimulation behaviors
  4. drools, speaks unclearly
  5. speak in sentences
41
Q

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-

A
  1. speak in sentences
  2. head banging
  3. rocking
  4. not toilet trained
  5. a human figure
42
Q

Toddlers & Preschoolers
Dev Warning Signs
At 5 years: -1- is still a -2-; there is -3-

A
  1. Magical thinking
  2. dominant presence
  3. no impulse control
43
Q

Stuttering in Toddlers & Preschoolers
Lasts for -1-, but often -2- (-3-)
DDx: -4-, or -5-

A
  1. several weeks to 6 months
  2. resolves w/o intervention
  3. 75% spontaneous recovery
  4. Hearing impairment
  5. visual impairment
44
Q

Stuttering management in Toddlers & Preschoolers

-1- stuttering lasts -2-, develops -3-, or child has a -4-

A
  1. Refer if
  2. > 6 months
  3. problems at school
  4. fear of speaking
45
Q

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)

A
  1. interaction/communication impairment
  2. reciprocal and social
  3. restrictive and repetitive
  4. 16-30 mo.
  5. score > 2
46
Q

ASD classification in Toddlers & Preschoolers

must impede functioning especially in -1- and -2- (requires -3-)

A
  1. school
  2. occupational
  3. occupational resource services/support
47
Q

ASD mgmt in Toddlers & Preschoolers
Referrals
-1- as needed (e.g., -2-, -3-, or -4- therapy)

A
  1. Developmental therapists
  2. speech
  3. motor
  4. sensory
48
Q

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-

A
  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
Q

-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.

A
  1. Childhood disintegrative disorder
  2. Rett Syndrome
  3. Asperger’s syndrome
  4. Angelman syndrome
  5. Down syndrome
50
Q

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.

A
  1. developmental screening instruments
  2. clinical impressions
  3. children’s developmental status
  4. Standardized questions
  5. growth charts
51
Q

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-.

A
  1. pervasive development disorders
  2. about the causes
  3. sooner a child
  4. symptoms begins treatment
  5. early diagnosis
  6. treatment improve outcomes
52
Q

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-.

A
  1. autism
  2. communication
  3. activities and interests
  4. mental retardation
53
Q

Children with -1- display a relatively good grasp of -2-, unlike children with suspected -3-.

A
  1. Asperger’s syndrome
  2. language
  3. autism
54
Q

-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-.

A
  1. Fragile X syndrome
  2. female patients
  3. severely affects
  4. single X chromosome
  5. ASD
55
Q

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.

A
  1. most common extracranial
  2. commonly diagnosed malignancy
  3. 22 months
  4. 5 years
56
Q

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.

A
  1. any SNS site
  2. adrenal glands
  3. hard to diagnose
  4. over 1 year
  5. long bones/skull/bone marrow
57
Q

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-.

A
  1. tumor site
  2. fever
  3. bone pain
  4. masses/bowel obstruction
  5. spinal cord compression
58
Q

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.

A
  1. embryonal malignancy (not diagnosed in toddlers/preschoolers)
  2. an abdominal mass
  3. older children
59
Q

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.

A
  1. two to three
  2. about 50 words
  3. bilingual homes
  4. two languages
  5. milestones should fall
60
Q

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.

A
  1. delays in vocabulary
  2. same evaluation
  3. pediatric speech pathologist
  4. access to translators
  5. address the needs
61
Q

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-.

A
  1. at age 2
  2. language delay
  3. appropriate element
  4. pediatric speech pathology
62
Q

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.

A
  1. comprehensive or symptom-focused
  2. current situation
  3. onset
  4. current home management
  5. similar occurrences
63
Q

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.

A
  1. prenatal/birth/neonatal
  2. past medical history
  3. only components likely
  4. diagnosis and treatment
  5. 24-hour recall
64
Q

Poor Weight Gain HPI

While the presence of -1- in the family history is pertinent, this is -2- than obtaining details about caloric intake.

A
  1. congenital GI disorders (such as celiac disease)

2. initially less important

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