Peds Exam #2

• Toddlers are 13 months to 3 years
• erikson theory (toddlers): autonomy vs shame/ doubt

  • toilet training
• piaget theory (toddler): sensorimotor stage ends and preoperational stage begins

  • object permanence is well developed
• nutrition for toddlers

  • whole milk until 2 years old and <24 oz
  • avoid foods that can cause choking
  • grazers (not growing excessively; eat here and there)
  • do not force feed (phases of only eating one food)
• language and communication for toddlers

  • expressive language (>200 words)
  • communicate wants and needs better
  • imitate (in play and in general, vacuum, sweeping, play kitchen; repeats everything)
  • no's (to everything, even if they want it)
  • why's (begins after repeating everything)
• gross and fine motor skills for toddlers

  • ~24 months (kick a ball, scribble and paint more finely, turn and reach knobs)
  • ~3 years (fully turn knobs, runs easily, turns pages in a book, copy a circle when drawing)
• play in toddlers

  • parallel play (sitting and playing the same with without interacting)
  • very curious, let them explore, but safely
• toys and appropriate activities for toddlers

  • household items (plastic cups, play kitchen, lawnmower, telephone)
  • blocks, cars, animals, trains, figurines, simple dolls, stuffed animals, balls, doll beds, and carriages
  • manipulative toys (knobs, wind-ups, buttons, pegs, stacking, large puzzles, taken apart and put back together)
  • play gym, push and pull toys, wagons, tricycle, tunnel
  • music and musical instruments
  • chalk, large crayons, finger paints, play-doh, washable markers
  • squeaking, floating, and squirting toys for the bath
• safety for toddlers

  • burns (use back burner and keep away from grills and ovens)
  • falls (do not climb, supervise, gates by stairs, wear helmets)
  • poisoning (lock up medications, cleaning supplies, alcohol, and tobacco)
  • choking (cut up and supervise)
  • drowning (fence around pools, supervise, close toilets)
  • firearms (in a safe with ammo separate)
  • motor vehicles (forward facing ~2 years and in a 5 point harness)
• discipline in toddlers

  • reward good behaviors
  • ignore bad unless it is a safety issue
  • test boundaries ~15-18 months
  • time out 1 min for each year they are
• preschoolers are 3 to 6 years old
• erikson theroy (preschool): initiative vs guilt

  • develop a conscious
  • feel remorse
• piaget theory (preschool): preoperational stage progresses

  • animism
  • egocentric but declines ~4 years
  • active imagination
  • imitate and observe
• kohlberg theory (preschool): preconventional stage begins
• nutrition for preschoolers

  • discourage grazing
  • regularly scheduled meals and snacks
• gross and fine motor skills for preschoolers

  • use a spoon or fork independently at the table
• play for preschoolers

  • associative play, more interactive
  • interacts with others by playing games and role-playing
• toys and appropriate activities for preschoolers

  • blocks, simple jigsaw puzzles, peg boards, wooden beads with string
  • supples for art (chalk, large crayons, finger paint, play-doh, clay, washable markers, paper, paint and brush, scissors, glue)
  • puppets, dress-up clothes, and props
  • play kitchen with empty food boxes
  • squeaking, floating, and squirting toys for the bath
  • dolls that can be dressed and undressed
  • tricycle, jungle gym, swing set, hula hoop
  • blocks, legos, cars, plastic animals, trains, stuffed animals, balls
  • music and musical instruments
  • simple card and board games
• language for preschoolers

  • increase in socialization
  • exaggerated story-telling
  • 3-4 word sentences
  • lying part of imagination (avoid showing wrong doing)
• social development for preschoolers

  • imaginations/ magical thinking (know between real and fake)
  • fears (alone and dark; let them play with equipment)
  • increase in self-care (take turns, take off shoes, change their own clothes)
• discipline for preschoolers

  • bedtime routine (bath, book, snacks)
  • 1 nap until ~5 years
  • masturbation is normal, do not punish
• autism (characteristics)

  • ongoing social problems (difficult communicating and interacting with others)
  • repetitive behaviors and limited interests and activities
  • recognized ~2 years
  • symptoms that hurt the individual's ability to function socially
• autism has no known specific cause
• autism is typically apparent by 3 years old

  • impairment in social interactions
  • communication difficulties (speech delays)
  • resistant to physical touch
  • echolalia
  • stereotypy
  • difficulty with new situations, sensory overload
• people with autism may have an abnormal response to stimuli

  • hypo or hyper response to pain or touch
  • certain fabrics, loud noises, or bright lights
• echolalia is repeating sounds
• stereotypy is obsessive ritualistic behavior

  • rocking or flapping
• communication and speech issues in autism

  • absence of babbling by 1 year
  • absence of 2 word phrases by 2 years
  • regression of previous language skills
• impairment in social interactions in autism

  • limited eye contact
  • does not point to objects
  • rarely smiles
  • likes to be alone
• autism screening

  • starts at 18 and 24 month maintenance visits
  • rule out other disorders/ illnesses (hearing, vision, neuro, lead toxicity)
• nursing considerations for autism

  • early intervention
  • individual/ family therapy (have resources)
  • adjust communication techniques
  • maintain home routine as much as possible
• ADHD is one of the most common mental health disorders
• ADHD is the alteration in CNS processing that leads to impulsive, inattentive, and hyperactive-impulsive symptoms
• ADHD does not have an identifiable cause

  • genetics (boys 4x more than girls)
• ADHD symptoms but be occurring at both home and at school

  • initially get written off
• ADHD clinical manifestations

  • increased motor activity
  • difficulty completing tasks
  • impulsiveness
  • low-self esteem
  • interrupts others
  • difficulty paying attention
  • sleep disturbances
  • difficulty making and maintaining peer relationships
• ADHD may coexist with developmental learning disorders, motor disorders, and aggressive behaviors
• ADHD environmental treatment

  • decreased stimulation and distractions
  • smaller classroom size
  • consistent limits with clear expectations and routines
• ADHD pharmacotherapy treatment

  • assess for decreased appetite and rapid weight loss
  • insomnia
  • increase in tics
  • increased compulsive behavior
  • give drugs early in the day and give holidays on long breaks
• depression is only recently recognized in children