Well Visit: Toddler and Preschool (CMPP)

Timing for Preschool Well Visits

15 mo

18 mo

24 mo

30 mo

3 years, then Annually

What should be asked about in preschool well visits

Temper tantrums

Daycare/school

Playing with others

Understands simple commands

Structured routine (AM, PM)

NO bottle or pacifier

Urine output / BM

Diet / level of activity

Allergies (meds/foods) / Medications

Hospitalizations/Surgery

Fluoride / Vitamin

When should bottles stop for peds

12M

Temper Tantrums

extreme frustration/anger exceed the toddler’s cognitive abilities to manage them

When should temper tanturms stop

School Age

How are temper tantrums management

Ignore, not speak to child, try to reason

ignore, may cause escalation, if keep ignoring behavior over time, it will lessen and disappear

When to do we refer for temper tantrums

multiple settings with multiple caregivers

, result in impairment in functioning in those settings & with peers,

occurs in situations with parent mental illness or family dysfunction,

Oppositional defiant disorder

Breath-Holding Spells

Sudden cessation of breath in response to a strong EMOTIONAL STIMULUS

Types of Breath-Holding Spells

Cyanotic Episode = Involuntary hold breath during expiration

Frightened = During inspiration to Gasp to Pale/Limp. (CN X overreact causes Slow HR )

Fear

is a protective mechanism

Goal for Fear

: Teach healthy ways of dealing with common fears,

Acknowledge & Respect the Fear.

Phobia

Specific fears that are developmentally inappropriate.

care for phobia

Mental health professional.

Behavior modification program

Medications

Onset for Nightmares

3y

tx for Nightmare

: Reassurance & Return child to bed

Peak age for night terrors

3-8y

When does night terrors occur

Deep NREM in early night

Presentation of night terrors

Cry, kick, flail, yet unresponsive.

Eyes open & inconsolable.

Awaken & no memory.

Complications from Pacifiers

Speech delays

“Pacifier teeth” = Protruding front teeth

otitis media

Sleep disruptions when become lost (Parent, kid)

If start prior to breastfeeding = Nipple confusion

Heavy use >12M = Dependence.

Most Common Cause of Peds Abd Pain

Constipation

ENCOPRESIS

Inability to control BM

Associated with Chronic Constipation

Development Milestones for Early Childhood

15M = Walking alone

18 M = Spoon Use

Toddler = Name

Preschool = Imaginary Play

When is Autism screened

18M

24M

Diet Advancement for Toddlers

Picky Eater

Offer new foods

Avoid battle at meal

Diet Advancement for Preschool

3 main meals

Limit Snacks and Sugar intake

5 or more servings of fruits/veg

Vitals for 1-3y

BP = 90-105/55-70

HR = 70 -110

RR = 20-30

Vitals for 3-6y

BP = 94-110/60-75

HR = 65-110

RR = 20-25

When is BP started

3 years

How frequent should a peds patient see a dentist

6 months

When do we screen hearing in preschool

4 years

HTN in the preschool age is liekly

Secondar

What is assessed in the skin for preschool age

Exanthems

Signs of abuse

Poison Ivy (Oils )

Scabies/Lice/Bed bugs

Tinea

Herpes

Coxsackie virus (Hand, Foot, Mouth)

Impetigo (Staph or GABS)

Molluscum Contagiosum

Allergic rashes

Eczema

Where is eczema seen in preschool age

Popliteal fossa

Antecubital Foss

tx for peds eczema

Hydrocortisone

When are sinuses fully formed

2y

Most Common Cause for Preschool Epitaxis

Picking nose

Tx for peds Epistaxis

Vaseline BID

What is asssed in preschool HEENT

Nasal polyps

Parents’ impression of visual acuity and hearing

Tonsil size (Huge)

Underbite/overbite = (Dentist)

Strep throat

How does gait change with age

wide-based 1st year of life = genu varum

Mature gait by age 3

In preschool years = genu valgum & possible pes planus

How will preschool growth occur

Torso slims

Legs elongate

Established handedness

Neuro Preschool Exam

rapid language development between ages 2-5

Determine if Receptive vs. Expressive Language is age-appropriate

Receptive occurs 1st

Magical thinking

Play become governed by rules

Morning and bedtime routine

Recurrent preschool UTI and Vaginits may be caused by

Bubble Vathes

Causes of Preschool Constipation

Refuse to defecate,

drink too much milk,

diet,

dehydration,

level of activity

How and when is toilet training done

In preschool age

toilet every 2 hours

Anticipatory Guidance (Preschool)

Dental care

Socialization

Sleep patterns/naps/night terrors

Read to child

Toilet Training

Fall risk (Where see bruising?)

Limit TV/Phone exposure to <2 hours/day

Exercise / Activity

Use Sunscreen

Booster seat

Consistency in parenting

Speech or language evaluation

Stay out of street & “Stranger Danger”

School readiness

Able to separate from parents