Toddlers Flashcards
(67 cards)
1
Q
ages 12-36 months
Rate of weight gain decreases (slimmer)
A
Toddlers
2
Q
typically are bow legged and have protruding abdomen
A
12 months
3
Q
what months should a toddler come to see the Dr?
A
12, 15, 18, 24, and 30 months. Then 3yr visit at 36 months
4
Q
What growth chart to use for toddlers?
A
WHO Growth chart until 2 years old, then switch to CDC growth chart
5
Q
When does the anterior fontanelle close? Posterior?
A
Anterior fontanelle closes 18-19 mos
Posterior fontanelle closes 12 months
6
Q
Average weight 26-28 lbs (remember avg wt is just over the age in months)
Avg height 34-35 inches
Avg head circumference 19-19.5 inches
A
24 months
7
Q
(first tooth usually erupts at _____ mos, then add one tooth per month)
6-8 teeth at______ m months
A
6 months
12 months
8
Q
Complete set of primary teeth at _______
Second molars usually erupt by _____
A
24 months
3rd year
9
Q
Visual acuity at age 2:
A
20/70
10
Q
What age?
fine motor development = pincer grasp
A
12 months
11
Q
What age?
fine motor development = tower of 4 cubes, imitates scribbling puts blocks in large holes, drinks from a cup, takes off socks,
gross= directed throwing, walks well independently, climbs into adult chair
A
18 months
12
Q
What age?
fine motor development = tower of 7 cubes, circular scribbling, folds paper once, puts blocks in large holes, turns doorknobs, turns pages one at a time, unbuttons or unzips large fasteners , puts on coat witha ssistance
A
24 months
13
Q
What age?
fine gross development = throws overhand, runs well , kicks ball, walk up and down stairs (places both feet on each step)
A
24 months
14
Q
What age?
fine motor development = tower of 9 cubes vertical and horizontal strokes, imitates circles, can button large buttons, uses fork in a fist, twists jar lids
A
30 months
15
Q
What age?
gross motor development = jumps off ground with both feet
A
30 months
16
Q
What age?
fine motor development = tower of 10 cubes, imitates bridge of 3 cubes, snips with scissors, brushes teeth (not well ), puts shoes on feet
A
36 months
17
Q
What age?
gross motor development = broad jumps, walks up stairs alternating feet, pedals tricycle, balances on one foot 2-3 seconds
A
36 months
18
Q
What age?
Gross motor= walks w/ one hand held, stands alone momentarily
A
12 months
19
Q
At _____ months, 25% of speech is intelligible to strangers
A
24 months
20
Q
Communication development is rapid between___________ months
A
12 and 36 months
21
Q
receptive language development
what age range?
Follows simple one-step commands, Understands new words weekly, Increased interest in named pictures, Differentiates environmental sounds, Points to familiar objects and body parts when named, Understands simple questions, Begins to distinguish “you” from “me”
A
12- 18 months
22
Q
Expressive language development
what age range?
All vowels and many consonants present Increased use of true words Jargon is sentence-like Shows “no” behavior Names a few pictures 10 words Imitates non-speech sounds (click, tongue click, dog bark) Names some body parts
A
12- 18 months
23
Q
receptive language development
what age range?
Follows 2-step commands
Rapidly increasing vocabulary
Enjoys simple stories
Recognizes pronouns
A
18 - 24 months
24
Q
Expressive language development
what age range?
Imitates 2-word combination Dramatic increase in spoken vocabulary Speech combines jargon and words Names self Answers some questions Begins to combine some words
A
18-24 months
25
Expressive language development
what age range?
```
Jargon reduces
2-3 word sentences
Repeats 2 numbers
Increased use of pronouns
Asks simple questions
Joins songs and nursery rhymes
Can repeat simple phrases and sentences
```
24-30 months
26
receptive language development
what age range?
Undersants prepositions in and on
Seems to understand most of what is said
Understands more reasoning
Identifies object when given function
24-30 months
27
receptive language development
what age range?
```
Listens to adult conversations
Understands preposition under
Can categorize item by function
Begins to recognize colors
Begins to take turns
Understands big and little, boy and girl
```
30-36 months
28
Expressive language development
what age range?
Answers questions
Repeats 3 words
Uses regular plurals
Can help tell a simple story
30-36 months
29
Concrete thinkers
Views the world egocentrically
Language development most sensitive indicator of cognitive development
Toddlers
30
what to look at for toddler exam?
```
Eyes:
Mouth-
abdomen
skin -
Neuro-
Genitalia-
```
```
Eyes: ocular mobility, fixate
Mouth- dental caries, plaque
abdomen
skin - bruises normal in toddlers depending on placement
Neuro- interactions and mobility
Genitalia- testes descended? Labia open?
```
31
```
Screen for early detection
Surveillance at every visit (according to AAP, no USPSTF recommendation)
ID concerning factors
Age 2 or more: refer for EI, ASD evaluation, and audiology
Age 1 -18 mos: use screening tool
Routine screening at 18 and 24 months
MCHAT-R
20 questions for caregiver to answer
Scored by HCP
f/u questions for areas of concern
www.m-chat.org/
```
Autism Spectrum Disorder
32
Healthy people goal to eliminate lead levels >= ____ ug/dL; HOWEVER there are no safe lead levels
>=10 ug/dL; HOWEVER there are no safe lead levels
33
establishes growth of breastfed infants as the norm, provides better description of physiological growth, based on high quality data
WHO growth chart
| used up to age 2... then switch to CDC
34
What PTs focus on?
Gross Motor
35
What OTs focus on?
Fine Motor
36
how much the toddler is taking in language?
receptive
37
Questions to ask about Lead?
Live or regularly visit house with peeling or chipping paint built before 1960?
Renovation or remodeling house built before 1960
Brother or sister treated or followed for lead poisoning? (>= 15 mcg/dL)
Live with adult whose job or hobby involves lead exposure?
Live near active lead smelter, battery recycling plant, or other industry likely to release lead?
38
When to screen baby for lead? what ages?
```
1 and 2
12 months
Blood test:
In high prevalence area
Insured by Medicaid
In low prevalence area or not on medicaid with positive answer on screening questionnaire
```
18 months
Lead blood test if no previous screen or change in risk
```
24 months
Blood test:
In high prevalence area
Insured by Medicaid
In low prevalence area or not on medicaid with positive answer on screening questionnaire
```
39
What age to screen for Hgb/Hct for all children?
12 months for everyone
15 months → if risk factors
18 months → if risk factors
24 months → if risk factors
30 months → if risk factors
40
Risk factors:
Low income, WIC eligible
Migrants or refugees
Pre-term or low birth weight
Fed non-fortified formula for 2 months or more
Fed cow’s milk before 12 months old
Breastfed infants with inadequate iron intake from supplemental food after 6 months
Consume more than 24 oz of milk per day after 24 months of age (cow, goat, or soy)
On medications that interfere with iron absorption
Chronic infection, inflammation, restrictive diets, or extensive blood loss
Anemia
41
screen at 24 months if: parent with dyslipidemia, high-risk conditions, other risk factors
Cholesterol Screening
42
when to screen for TB?
12 & 24 months→ skin test for any kids with risk factors
| Skin test preferred over quantiferon gold blood test until 5 years old
43
TB risk factors
Recent immigrant/ refugee status from TB common country
Crowded conditions
Family member or close contact with positive TB
44
important things to know about fevers in toddlers
```
Most common cause is viral
100.4F or higher (38C)
Rectal is gold standard
Fever enhanced immunologic response until higher than 104F
Adverse effects:
Increased metabolic rate
Increased fluid loss
Increased O2 consumption
Increased caloric requirement (may lose weight bc not hungry)
```
Febrile sz: triggered by rapid rise
Tx if uncomfortable (over 100.5)
ED if higher than 104
Fever unresponsive? ED
45
```
None under 12 weeks
Avoid multi-ingredient products (cold meds)
Dosed by weight, not age
Use a syringe for accuracy
Repeat q4-6hrs
No more than 5 doses in 24hrs
Initial drug of choice
```
Acetaminophen
46
No use under 6 months
Max daily dose 40mg/kg
Caution with decreased liver function, asthma, or coagulation disorders
Ibuprofen
47
vomiting red flags
bilious emesis, bloody emesis
48
Causes: gastroenteritis, GERD, allergies
Concern for dehydration
ID and alleviate cause
Antiemetics not recommended → better out than in
Refer to specialist if persistent or recurring
BRAT diet → banana, rice, apple, teas and toast
Maintain hydration
Oral replacement liquids → small, frequent amounts
Avoid water, juice, soda, sports drinks → more irritating, electrolyte imbalances
Monitor UOP
Vomiting
49
```
Both and parent and child should be ready
Signs child is ready:
Recognized soiled diaper; makes them uncomfortable
Interested in toilet
Says they want to go potty
Understands and follows basic directions
Stays dry for 2hrs or longer during day
Wakes from nap with dry diaper
Can pull pants up and down
```
Potty training
50
Knock knees
genu- valgum
| "gum makes yoru knees stick together"
51
bow legged
Genu- varum
| "rum makes your knees far apart"
52
Both are normal in toddler and should resolve on own by age of 3
Provide parental reassurance
Corrective footwear and splinting not recommended
Referral if not improving or affecting ability to walk
Genu- varum
(rum spreads knees apart)
Genu- valgum
(gum sticks knees together)
53
```
Causes physiologic, age related
Varies with activity and if tired
No referrals needed unless:
Significant enough to impact mobility
Unnatural extension of hip position; corrects with time; reassure parents
```
In-toeing/out toeing
54
Common
Require less food, growth rate slowed
Do not push them to eat
16-32oz of milk per day
picky eaters
55
Dependence vs. independence
Toddler mastering multiple new skills
Teach anger management and conflict resolution
Reinforce positive behaviors
Set clear, concise, and consistent limits
Punishment bad; discipline good
Comfort items helpful provide feelings of safety and security
terrible 2s
56
12 month old anticipatory guidance
Living situation and food security
Tobacco, alcohol, and drugs
Strengths and protective factors→ support system, taking breaks from the hard work of parenting
Adjustment to developmental changes and behavior → punishment and discipline. The use of distraction.
Family time
Bedtime, naptime, and teeth brushing → 12-14 hours of sleep; set bedtime and routine
Media → no more than an hour per day, research shows it may decrease development
Self feeding should be present → expect a mess
Transitioning to family meals; nutritious foods
Not too much fish with mercury
First dental visit
Car seat safety → rear facing until at least 2; if they do not exceed weight restrictions on seat
Falls
Drowning prevention and water safety → bathtub, pools
Sun protection
Pets
Poisoning
57
15 month anticipatory guidance
Allow independence and choices to promote individualization
Separation → anxiety is normal
Finding support as the parent; taking breaks
Promote communication watching what you say in front of children
Bedtime routine, night waking, no bottle in bed
Conflict predictors → distract from things that can cause conflict. Accept inconveniences that come with toddler stage
Brushing teeth, preventing caries → let child and parent brush
If parent is prone to caries they can introduce that bacteria to their children if sharing spoons and straws
Parental use of seatbelt
Falls
Poisoning
Fire safety
58
18 month anticipatory guidance
```
Return of separation anxiety, don't push your child into situations they are not comfortable with
Set consistent limits to manage behavior
Signs of toilet training; parental expectations
New sibling on the way?
Language development
Reading
Physical activity and safe play
Nutritious foods
Water, milk, and juice
Express independence through food likes and dislikes
Care safety
Poisoning
Sun protection
Firearm safety
Burns, fires
Falls
```
59
24 month anticipatory guidance
```
IPV → National domestic violence hotline 800-799-SAFE (7233)
Avoid the word “abuse” or “violence”
Living situation and food safety
Tobacco, alcohol, and drugs
Parental well-being
Development
Temperment
Encourage physical activity and safe play
Communication skills
Promote reading
Toilet training, personal hygiene
Car seat
Safety: fire, falls, firearms
```
60
30 month anticipatory guidance
```
Day and evening routines
Enjoyable family activities
Parental activities outside family
Consistency
give choices
Safety
```
61
months when dovemental screenings shoudl occur?
9. 18, 24 (or 30 months)
62
when should specific autism screenings occur according to AAP?
18 and 24 months
63
what to do if child is positive for anemia?
risk factor screen at current visit and 6 months later
64
how old must you be in order to take tylenol?
12 weeks
65
max does of acetaminophen in 24 hours?
5
66
max daily dose of ibuprofen
40 mg/kg
67
Erikson stage for toddlers?
Autonomy vs. Shame and Doubt
