Health Promotion in Toddler and Preschooler.pptx

UNIT : XIII
HEALTH
PROMOTION IN
TODDLERS AND
PRESCHOOL
AGED
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Pediatric Nursing, BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar, Bangladesh.
1

INTRODUCTION
• Ensuring and promoting the health and well-being of toddler and
Preschooler is an important goal for all communities, since factors
that result in poor health outcomes for children can lead to health
concerns in adulthood. Health promotion focuses on improving and
protecting the health of different populations and communities,
including children and their families. Health promotion programs
aim to reduce health disparities and improve health outcomes.
Programs that focus on improving the health and well-being of
children in early childhood may be implemented in homes, childcare
settings, and other community-based settings.
2

DEFINITION OF HEALTH
PROMOTION
• The World Health Organization defines health
promotion as: “The process of enabling people to increase
control over, and to improve, their health. It moves beyond a
focus on individual behavior towards a wide range of social
and environmental interventions.”
• O’Donnell (1987) has defined health promotion as “the
science and art of helping people change their lifestyle to
move toward a state of optimal health”.
3

Objectives Of Health
Promotion
 Promoting optimal growth and development of preschool
age children
 Coping with concerns related to normal growth and
development
 Promoting optimal health during the preschool years
 To provide anticipatory guidance-care of family
 Identify changes in development in preschool age from
school aged, infant and toddler
 To provide parental education for caring their pre-school
aged children.
 For disease and injury prevention
 To promote appropriate discipline
4

HEALTH
PROMOTIO
N IN
TODDLERS
5

Organ System Maturation
in Toddler
Neurologic
System
 Neurologic System Brain growth continues through toddlerhood, and the brain
reaches about 80% of its adult size by 3 years of age .
 Myelinization of the brain and spinal cord continues to progress and is complete
around 24 months of age.
 Myelinization results in improved coordination and equilibrium as well as the
ability to exercise sphincter control, which is important for bowel and bladder
mastery
 Rapid increase in language skills is evidence of continued progression of
cognitive development.
Respiratory
System
 The respiratory structures continue to grow and mature throughout toddlerhood.
The alveoli continue to increase in number, not reaching the adult number until
about 7 years of age.
 The tongue is relatively large in comparison to the size of the mouth. Tonsils and
adenoids are large and the Eustachian tubes are relatively short and straight.
6

in Toddler
Cardiovascular
System
 The heart rate decreases and blood pressure increases in toddlerhood.
 Blood vessels are close to the skin surface and so are compressed easily
when palpated.
Gastrointestinal
System
 The stomach continues to increase in size, allowing the toddler to
consume three regular meals per day.
 Pepsin production matures by 2 years of age. The small intestine
continues to grow in length, though it does not reach the maximum length
of 2 to 3 meters until adulthood.
 Stool passage decreases in frequency to one or more per day. The color of
the stool may change (yellow, orange, brown, or green) depending on the
toddler’s diet.
 Bowel control is generally achieved by the end of the toddler period.
7

in Toddler
Genitourinary
System
 Bladder and kidney function reach adult levels by 16 to 24 months of age.
 The bladder capacity increases, allowing the toddler to retain urine for
increased periods of times.
 Urine output should be about 1 mL/kg/hour.
 The urethra remains short in both the male and female toddler, making
them more susceptible to urinary tract infections compared to adults.
Musculoskeletal
System
 During toddlerhood, the bones increase in length and the muscles mature
and become stronger.
 The abdominal musculature is weak in early toddlerhood, resulting in a
pot-bellied appearance.
 The toddler appears to have a swayback along with the potbelly. Around 3
years of age, the musculature strengthens and the abdomen is flatter in
appearance. 8

Early Childhood Developmental Chart
(1-5 Years)
• Health professionals should assess the achievements of the child and
provide guidance to the family on anticipated tasks. The effects are
demonstrated by health supervision outcomes
9
Achievements During Early
Childhood
Tasks for the Child Health Supervision
Outcomes
■ Regular sleeping habits
■ Independence in eating
■ Completion of toilet
training
■ Ability to dress and undress
■ Ability to separate from
parents
■ Learn healthy eating habits
■ Practice good oral hygiene
■ Participate in physical
games and play
■ Develop autonomy,
independence, and
assertiveness
■ Early autonomy
■ Optimal growth and
development
■ Establishment of good
health habits
■ Optimal nutrition
■ Injury prevention

(1-5 Years)
10
Childhood
Tasks for the Child Health Supervision Outcomes
■ Progression from parallel
to interactive play and
sharing
■ Loving relationships and
good communication with
parents and siblings
Clear communication of
needs and wishes
■ Expression of such
feelings as joy, anger,
sadness, and frustration
Respond to limit-setting
and discipline
■ Learn self-quieting
behaviors and self-
discipline
■ Learn appropriate self-
care ■ Make friends and
meet new people
■ Play with and relate well
to siblings and peers
 Immunizations
■ School readiness
■ Promotion of
developmental potential
■ Prevention of behavioral
problems
■ Promotion of family
strengths
■ Enhancement of parental
effectiveness

(1-5 Years)
11
Childhood
Tasks for the Child Health Supervision Outcomes
■ Self-comforting behavior
■ Self-discipline
■ Intelligible speech
■ Positive self-image
■ Demonstration of
curiosity and initiative
■ Demonstration of
imaginative, make-believe,
and dress-up play
■ Learn to understand and
use language to meet needs
■ Listen to stories
■ Learn how to handle
conflicts without violence

Child Family Community
■ Has good physical health
and nutrition
■ Has good appetite
■ Has good sleeping habits
■ Has regular oral health
care
Meets child’s basic needs
(food, shelter, clothing,
health care)
■ Enjoys child and provides
strong, nurturing family
■ Provides safe, childproof
environment (e.g., smoke
alarms, car safety seat)
■ Provides preschools and
public libraries
■ Provides quality schools
and educational
opportunities for all families
■ Provides parent education
classes
12
Strength During Early
Childhood (1-4 Years)
Health professionals should remind families of their strengths during the health
supervision visit. Strengths and issues for child, family, and community are interrelated
and interdependent.

■ Engages in physical
activities
■ Has positive, cheerful,
friendly temperament
■ Feels parents’ unconditional
love
■ Trusts parents
■ Relates warmly to and
communicates well with
parents
■ Is developing social
competence
■ Responds to child’s
developmental needs
■ Encourages speech and
interacts with child
■ Spends individual time with
child
■ Praises and takes pride in
child’s efforts and
accomplishments
■ Has consistent expectations
of child
Provides support for families
with special needs (e.g., WIC,
early intervention programs,
Head Start, community
outreach)
■ Provides out reach to
identify uninsured or
underinsured children and
facilitates enrollment in health
insurance programs and access
to care
13

■ Has had many joyful
experiences
■ Accepts limits
■ Has good attention span
■ Has normal cognitive
ability
■ Asks questions
■ Demonstrates curiosity and
initiative
■ Plays with toys
■ Achieves developmental
milestones
■ Offers emotional support
and comfort
■ Has knowledge of child
development
■ Encourages safe exploration
and emerging independence
■ Sets appropriate limits
■ Offers choices to child when
appropriate
■ Provides good role model
■ Provides affordable, quality
child care
■ Provides an environment
free of hazards
■ Ensures that neighborhoods
are safe
■ Provides affordable housing
and public transportation
■ Promotes physical activity
(e.g., provides safe
playgrounds, parks)
14

■ Promotes good relationships
and cooperation among
siblings
■ Has support of extended
family and others
■ Promotes moral/ethical
development
■ Develops integrated systems
of health care
■ Fluoridates drinking water
■ Promotes community
interactions (neighborhood
watch programs, support
groups, community centers)
■ Promotes positive
ethnic/cultural environment
15

Issues During Early
■ Sleeping concerns (resistance
to going to bed, night waking,
sleeping with bottle,
nightmares, night terrors)
■ Eating concerns (decreased
appetite, “picky” eating, food
jags, pica)
■ Parents or other family
members with serious problems
(depressed, mentally ill, abusive,
overly critical, overprotective,
incarcerated)
■ Severe marital problems
■ Poverty
■ Inadequate housing
■ Environmental hazards
■ Unsafe neighborhoods
■ Discrimination and
prejudice
■ Community violence
■ Few opportunities for
employment 16
Health professionals should address problems, stressors, concerns, and other issues
that arise during health supervision. Strengths and issues for child, family, and
community are interrelated and interdependent

Issues During Early
■ Behavioral concerns (lack of
control, demanding or
aggressive behavior, biting,
hitting, temper tantrums,
episodes of holding the breath,
impulsiveness)
■ Emotional concerns (shyness,
fears, separation problems and
anxiety)
■ Speech or language concerns
(speech delay, speech that is not
clear or fluent)
■ Domestic violence (verbal,
physical, emotional, or
sexual abuse)
■ Frequently absent parent
■ Rotating “parents”
(parents’ male or female
partners)
■ Inadequate child care
arrangements
■ Family health problems
(illness, chronic illness,
disability)
■ Lack of affordable, quality
child care and preschool
programs
■ Lack of programs for
families with special needs
(early intervention, Head
Start)
■ Inadequate outreach to
uninsured and underinsured
children and failure to
facilitate enrollment in health
insurance programs and 17

Issues During Early
■ Autism
■ Few relationships with
peers and/or difficulty in
relating to peers
■ Infections, illnesses
■ Early childhood caries
(baby bottle tooth decay)
■ Lead poisoning
■ Iron-deficiency anemia
■ Chronic illness
■ Developmental delay
■ Substance use (alcohol,
drugs, tobacco)
■ Financial insecurity
■ Homelessness
■ Family transitions
(moves, births, divorce,
remarriage, incarceration,
death)
■ Lack of knowledge
about child development
access to care
■ Isolation in a rural
community
■ Lack of educational
programs and social
services for adolescent
parents
■ Lack of social,
educational, cultural, and
recreational opportunities
18

Issues During Early
■ Lack of parenting skills,
parental self-esteem, or self-
efficacy
■ Intrusive family members
■ Social isolation and lack of
support
■ Neglect or rejection of child
■ Lack of access to
immunizations and to
medical and oral health
services
■ Inadequate public
services (lighting,
transportation, garbage
removal)
■ Inadequate fluoride in
drinking water 19

Anticipatory Guidance
• Meaning:
Anticipatory guidance is given by the health care provider to assist parents or
guardians in the understanding of the expected growth and development of
their children.
Importance of Anticipatory Guidance:
• Caregiver understanding of child development and thus anticipating the
child’s needs and understanding behavior
• Educating caregivers about injury prevention
• Enables nurse to guide parents regarding childrearing practices that will
help prevent problems. Ideally, discuss risks before each age group occurs.
20

1, Promotion of Healthy and Safe Habits
• Wash your toddler’s hands and your own frequently, especially after
diaper changes and before eating.
• Clean your toddler’s toys with soap and water.
• If your toddler is in child care, provide personal items (e.g., blankets,
cups) for individual use.
• Limit television and video viewing to less than 1 hour per day. Be sure
the programs are appropriate and watch them with your toddler.
• Expect your toddler to sleep through the night in her own bed. Reinforce
good sleeping habits. Maintain a regular bedtime routine.
21
Anticipatory Guidance For Families
with Toddlers

• Participate in physical activities as a family (e.g., taking walks, playing at a
playground).
2 Years:
• Participate in physical activities as a family (e.g., taking walks, hiking, biking,
playing tag).
1,a. Injury Prevention
• Switch to a forward-facing safety seat if your toddler weighs at least 20
pounds (9 kg). Move the harness straps to the upper slots and install it in the
back seat according to the manufacturer’s instructions and the vehicle owner’s
manual.
22
with Toddlers

• Never place your toddler’s safety seat in the front seat of a vehicle with
a passenger air bag. The back seat is the safest place for children of any
age to ride.
• Get down on the floor and check for new hazards now that your toddler
is walking.
• Be sure that the hot water heater thermostat is set lower than 120ºF.
Continue to test the water temperature with your wrist to make sure it is
not hot before bathing your toddler.
• Supervise your toddler constantly whenever she is near water (bathtub,
play pool, buckets, toilet). Do not expect young siblings to supervise
your toddler (e.g., in the bathtub, house, or yard). 23
with Toddlers

• Continue to empty buckets, tubs, or small pools
immediately after use. Children should be supervised
by an adult whenever they are near water.
• Be sure that swimming pools in your community,
apartment complex, or home have a four-sided fence
with a self-closing, self-latching gate.
• Continue to keep your toddler’s environment free of
smoke. Keep your home and car nonsmoking zones.
• Do not leave heavy objects or containers of hot liquids
on tables with tablecloths that your toddler might pull
down.
24
with Toddlers

• Turn pan handles toward the back of the stove. Keep
your toddler away from hot stoves, fireplaces, irons,
curling irons, and space heaters.
• Remove dangling telephone, electrical, blind, or drapery
cords near your toddler’s play or sleep areas. Keep
small appliances out of reach and place plastic plugs in
electrical sockets.
• Keep all poisonous substances, medicines, cleaning
agents, health and beauty aids, and paints and paint
solvents locked in a safe place out of your toddler’s
sight and reach. Never store poisonous substances in
empty jars or soda bottles. 25
with Toddlers

• Check your home for lead poisoning hazards (e.g., chipped lead paint, lead
dust, lead water pipes, poorly glazed pottery). Keep cigarettes, lighters,
matches, and alcohol out of your toddler’s sight and reach.
• Do not give your toddler plastic bags, latex balloons, or small objects such
as marbles.
• Continue to use gates at the top and bottom of stairs and safety devices on
windows. Supervise your toddler closely when she is on stairs.
• Bolt bookcases, dressers, or cabinets to the wall.
• Confine your toddler’s outside play to areas within fences and gates,
especially at a child care facility, unless she is under close supervision.
• Learn first aid and child cardiopulmonary resuscitation (CPR). 26
with Toddlers

1, b. Nutrition
• Feed your toddler three meals and two or three planned nutritious snacks a day.
• Include your toddler in family meals by providing a highchair or booster seat at table
height.
• Make mealtimes pleasant and companionable. Encourage conversation.
• Encourage your toddler to feed herself. Toddlers learn to like foods by touching and
mouthing them repeatedly.
• Encourage your toddler to sit while eating to avoid choking.
• Offer your toddler a variety of nutritious soft table foods and let her decide how
much to eat. Toddlers will eat a lot one time, not much the next.
• Anticipate that your toddler’s rate of weight gain will be slower than in the first year.
27
with Toddlers

• If you are breastfeeding: Talk with the health professional about weaning
from the breast when desired.
• If you are bottle feeding: Change from formula to whole pasteurized milk.
Milk requirements decrease to 16 to 24 ounces per day. Begin to wean
your toddler from the bottle.
• Avoid giving your toddler foods and drinks that are high in sugar.
• Be sure that your toddler’s caregiver provides nutritious foods.
• Avoid giving your toddler foods that can be inhaled or cause choking
(e.g., no peanuts, popcorn, chips, hot dogs or sausages, carrot sticks, whole
grapes, raisins, hard candy, large pieces of raw vegetables or fruit, or tough
meat). 28
with Toddlers

18 Month
• Give your toddler two or three planned nutritious snacks a day.
Provide snacks rich in complex carbohydrates, and limit sweets and
high-fat snacks.
• Continue encouraging your toddler to feed herself with her hands or
a spoon and to drink from a cup. Encourage your toddler to
experiment with foods, deciding what and how much to eat from the
nutritious foods that you offer.
• Let your toddler develop food likes and dislikes.
29
with Toddlers

2 Years
• Offer your child a variety of nutritious foods, particularly those
containing iron, and let him decide what and how much to eat.
Children will eat a lot one time, not much the next.
• Begin to serve your child low-fat dairy products, including milk,
yogurt, and cheese.
• Choose the menu, do not let your child dictate it. Most children will
eat a considerable variety of foods.
• Enforce reasonable mealtime behavior, but do not force eating
30
with Toddlers

1,C. Oral Health
• Brush your toddler’s teeth with a small, soft toothbrush and
water only (no toothpaste).
• Do not put your toddler to bed with a bottle containing juice,
milk, or other sugary liquid. Do not prop the bottle in her
mouth, or allow drinking from a bottle at will during the
day.
• Encourage your toddler to drink from a cup. Give your
toddler fluoride supplements as recommended by your
dentist, based on the level of fluoride in your drinking water.
31
with Toddlers

• Make an appointment for your toddler’s first dental examination.
• Bacteria that cause early childhood caries (baby bottle tooth decay)
can be passed on to your baby through your saliva. To protect your
baby’s teeth and prevent decay, practice good family oral health
habits (e.g., brushing, flossing).
2 Years
• Begin brushing your child’s teeth with a pea-size amount of
fluoridated toothpaste.
1, d. Sexuality Education (2 Years)
• Anticipate your child’s normal curiosity about his body
parts, including genitals. Use correct terms for genitals.
32
with Toddlers

2, Promotion of Social Competence
• Praise your toddler for good behavior. Encourage your toddler’s language
development by reading and singing to her, and by talking about what you and she
are seeing and doing together.
• Encourage initiative and safe exploration.
• Encourage your toddler to play alone as well as with playmates, siblings, and
parents.
• Teach your toddler to avoid hitting, biting, and other aggressive behaviors.
• Limit the number of rules and consistently enforce them. Develop rules for all
family members.
• Anticipate and avoid unnecessary conflict situations. 33
with Toddlers

• Use discipline as a means of teaching and protecting, not
punishing.
• 18 Month
• Model appropriate language. Encourage your toddler’s language
development by reading and singing to her, and by talking about
what you and she are seeing and doing together.
• Recognize that toilet training is part of developmentally
appropriate learning.
• Delay toilet training until your toddler is dry for periods of
about 2 hours, knows the difference between wet and dry,
can pull his pants up and down, wants to learn, and can
give a signal when he is about to have a bowel movement.
34
with Toddlers

• Encourage self-expression.
• Promote a sense of competence and control by inviting your
toddler to make choices whenever possible. (Be sure you
can live with the choices— e.g., “red pants or blue?”).
• When correcting her, make a verbal distinction between
your toddler and her behavior: “I love you, but I don’t like it
when you do _____.”
• When possible, give your toddler a “yes” as well as a “no.”
(For example: “No, you can’t play with the remote control,
but you can play with the blocks.”)
35
with Toddlers

3, Promotion of Constructive Family
Relationships and Parental Health
• Show affection in your family. Take some time for yourself and
spend some individual time with your partner.
• Hold and cuddle your toddler and talk with her.
• Spend some individual time with each child in your family.
• Create opportunities for your family to share time together
and for family members to talk and play with your toddler.
• If you are thinking about having another baby in the next year or
so, talk with the health professional about taking folic acid
supplements. 36
with Toddlers

18 Month
• Listen to and respect your toddler
• Help your toddler express such feelings as joy, anger, sadness, fear, and
frustration.
• Acknowledge conflicts between siblings. Whenever possible, attempt to resolve
conflicts without taking sides. For example, if a conflict arises about a toy, the
toy can be put away. Do not allow hitting, biting, or other aggressive behavior.
• Keep family outings relatively short and simple. Lengthy activities tire your
toddler and may lead to irritability or a temper tantrum.
• If you are thinking about having another baby in the next year or so, talk with
the health professional about taking folic acid supplements. 37
with Toddlers

4, Promotion of Community Interactions
• Learn about and consider participating in parent toddler play groups.
• Consider attending parent education classes or parent support groups.
• Maintain or expand ties to your community through social, religious, cultural,
volunteer, and recreational organizations or programs.
• Talk with the health professional about possible programs for the child:
preschool, early intervention programs, Head Start, swimming and other
exercise programs, or other community programs.
• Find out what you can do to make your community safer. Advocate for and
participate in a neighborhood watch program.
38
with Toddlers

Common Developmental
Concerns in Toddlers
• Sibling Rivalry : Toddlers are normally egocentric, bringing a new
baby into the home may be quite disruptive. To minimize issues with
sibling rivalry, parents should attempt to keep the toddler’s routine as close
to normal as possible. Spend individual time with the toddler on a daily
basis. Involve the toddler in the care of the baby
• Negativism: It is common in the toddler period As the toddler separates
from the parent, recognizes his or her own individuality, and exerts
autonomy, negativism abounds. Parents should understand that this
negativism is a normal developmental occurrence and not necessarily
deliberate defiance Avoid asking yes-or-no questions, as the toddler’s usual
response will be “no, 39

• Temper Tantrums : Temper tantrums are a natural result of the frustration that
toddlers experience. The temper tantrum may be manifested as a screaming and
crying fit or a full-blown episode in which the toddler throws himself or herself on
the floor kicking, screaming, and pounding, perhaps even holding the breath.
Parents need to learn their toddler’s behavioral cues in order to limit activity that is
frustrating. When the parent notes the beginnings of frustration, a friendly warning
might be given. Intervening early with an activity change might prevent a tantrum.
Use distraction, refocusing, or removal from the situation.
• Regression: Some toddlers experience regression during a stressful event (e.g.,
the birth of a sibling, hospitalization). Stress in a toddler’s life affects his or her
ability to master new developmental tasks. During regression, the toddler may
want to go back to an earlier stage. 40

Toilet Teaching: When myelinization of the spinal cord is achieved around age 2 years,
the toddler is capable of exercising voluntary control over the sphincters. Girls may be ready for
toilet teaching earlier than boys. Toddlers are ready for toilet teaching when:
 Bowel movements occur on a fairly regular schedule.
 The toddler expresses knowledge of the need to defecate or urinate. This may be through
verbalization, change in activity, or gestures such as: Looks into or grabs diaper, Squats,
Crosses legs, Grimaces and/or grunts, Hides behind a door or the couch when defecating
 The diaper is not always wet (this indicates the ability to hold the urine for a period of
time).
 The toddler is willing to follow instructions.
 The toddler walks well alone and is able to pull down his or her pants.
 The toddler follows caregivers to the bathroom.
 The toddler climbs onto the potty chair or toilet
41

HEALTH
PROMOTION
IN
PRESCHOOL
AGED
CHILDREN
42

Organ System Maturation in
preschool Children
Neurologic
System
 Myelination of the spinal cord allows for bowel and bladder control to
be complete in most children by age 3 years
Respiratory
System
 The respiratory structures continue to grow and mature throughout
toddlerhood. The alveoli continue to increase in number, not reaching
the adult number until about 7 years of age.
 Eustachian tubes remain short and straight.
Cardiovascula
r System
 Heart rate decreases and blood pressure increases slightly during the
preschool years.
 An innocent heart murmur may be heard upon auscultation, and
splitting of the second heart sound may become evident.
Dental  The preschooler should have 20 deciduous teeth present. 43

Gastrointestinal
System
 The small intestine is continuing to grow in length. Stool passage usually
occurs once or twice per day in the average preschooler.
 The 4-year-old generally has adequate bowel control.
Genitourinary
System
 The urethra remains short in both boys and girls, making them more
susceptible to urinary tract infections than adults.
 Bladder control is usually present in the 4- and 5-year-old child, but an
occasional accident may occur, particularly in stressful situations or when
the child is absorbed in an interesting activity
Musculoskeletal
System
 The bones continue to increase in length and the muscles continue to
strengthen and mature.
 However, the Musculoskeletal system is still not fully mature, making the
preschooler susceptible to injury, particularly with overexertion or excess
activity.
44
Organ System Maturation in
preschool Children

Of Toddler
Genitourinary
System
 Bladder and kidney function reach adult levels by 16 to 24 months of age.
 The bladder capacity increases, allowing the toddler to retain urine for
increased periods of times.
 Urine output should be about 1 mL/kg/hour.
 The urethra remains short in both the male and female toddler, making
them more susceptible to urinary tract infections compared to adults.
Musculoskeletal
System
 During toddlerhood, the bones increase in length and the muscles mature
and become stronger.
 The abdominal musculature is weak in early toddlerhood, resulting in a
pot-bellied appearance.
 The toddler appears to have a swayback along with the potbelly. Around 3
years of age, the musculature strengthens and the abdomen is flatter in
appearance. 45

Anticipatory Guidance For
Families with Preschool
Children
1,Promotion of Healthy and Safe Habits
• Help your child wash her hands after diaper changes or toileting and before
eating. Continue to wash your own hands.
• Teach your child to wipe her nose with a tissue and then wash her hands.
• Clean potty chairs after each use. If your child is in child care, continue to
provide personal items (e.g., blankets, clothing) for individual use.
• Limit television and video viewing to less than 1 hour per day. Be sure the
programs are appropriate. Watch and talk about them with your child.
• Continue to reinforce good sleeping habits. Maintain a regular bedtime routine.
• Take time out for family physical activities (e.g., walking, biking, swimming,
playing outdoor games). 46

4 Years
• Remind your child to wash his hands before eating and after toileting and wiping
his nose. If your child is in child care, continue to provide personal items (e.g.,
blankets, clothing) for individual use.
• Take time out for family physical activities (e.g., walking the dog, raking leaves,
riding bikes, playing catch).
5Years
• Be a role model for your child by living a healthy life. Teach your child about
personal care and hygiene
• Be sure that your child gets adequate sleep. For children through 5 years of age, the
suggested bedtime is 7–8 p.m.; 47
Children

1,a. Injury Prevention
• Continue to use a weight-appropriate forward facing safety seat that is properly
installed in the back seat according to the manufacturer’s instructions and the
vehicle owner’s manual.
• When your child reaches 40 pounds (18 kg), switch to a belt-positioning booster
seat, which must be used with the vehicle lap and shoulder belt across the child
in the back seat.
• Never place your child in the front seat of a vehicle with a passenger air bag.
The back seat is the safest place for children of any age to ride.
• Children should be supervised by an adult whenever they are near water.
48
Children

• Be sure that swimming pools in your community, apartment complex, or home have
a four-sided fence with a self-closing, self-latching gate.
• Continue to put sunscreen (SPF 15 or higher) on your child before she goes outside.
• Continue to keep your child’s environment free of smoke. Keep your home and car
nonsmoking zones.
• Keep cooking utensils, hot liquids, knives, and hot pots on the stove out of reach.
• Be sure there are no dangling telephone, electrical, blind, or drapery cords in your
home.
• Keep small appliances out of reach. Place plastic plugs in electrical sockets.
• Keep cigarettes, lighters, matches, alcohol, and electrical tools locked up and/or out
of your child’s sight and reach. 49
Children

• Remove poisons and toxic household products from the home or keep them in locked
cabinets. Have safety caps on all medications.
• Never leave your child alone in the car, bathtub, house, or yard.
• Do not expect young siblings to supervise your child.
• Supervise all play near streets or driveways.
• Be sure that your child wears a helmet when riding on a tricycle or in a seat on an
adult’s bicycle. Wear a helmet yourself. Be sure that playgrounds are safe and
carefully maintained. Check for impact- or energy-absorbing surfaces under
playground equipment.
• Choose caregivers carefully. Talk with them about their attitudes and behavior in
relation to discipline. Do not permit corporal punishment.
• Teach your child not to talk to strangers. 50
Children

4 Years:
• Make sure your child learns how to swim and reinforce water
safety rules.
• Teach your child pedestrian and neighborhood safety skills.
• Teach your child about playground safety
• Teach your child safety rules regarding strangers.
1,b. Nutrition
• Serve your child three nutritious meals a day. Provide a highchair
or booster seat at table height during family mealtimes. Expect
her to feed herself, but provide help when needed.
• Make family mealtimes pleasant and companionable. Encourage
conversation.
51
Anticipatory Guidance For Families with
Preschool Children

• Give your child two or three planned nutritious snacks a day.
Be sure the snacks are rich in complex carbohydrates and
limit sweets and high-fat snacks. Offer your child a variety
of nutritious foods. Let her decide what and how much to
eat.
• Serve your child low-fat dairy products, including milk,
yogurt, and cheese.
• Continue to serve foods that your child may not accept at
first. Prepare them in different ways and try again.
• Be sure that your child’s caregiver provides nutritious foods.
• Help your child learn about food through stories and songs. 52
Preschool Children

1,C. Oral Health
• Teach your child to brush her teeth with a pea-size amount of
fluoridated toothpaste.
• Ask your child’s oral health professional when and how to floss
your child’s teeth.
• Give your child fluoride supplements as recommended by your
dentist, based on the level of fluoride in your drinking water.
• Schedule a dental appointment for your child every 6 months or as
indicated by your child’s individual needs or susceptibility to disease.
• 4 Years:
• Be sure that your child brushes his teeth twice a day with a pea-size
amount of fluoridated toothpaste. Regularly supervise tooth brushing. 53
Preschool Children

1,D. Sexuality Education
• Anticipate your child’s normal curiosity about
genital differences between boys and girls.
• Use correct terms for genitals. Answer questions
about “where babies come from.”
• Introduce the notion that certain parts of the body
(those areas normally covered by a bathing suit) are
private and should not be touched without his
permission.
54
Preschool Children

2,Promotion of Social Competence
• Praise your child for good behavior and accomplishments.
• Encourage your child to talk with you about her preschool, friends, experiences,
and observations.
• Encourage interactive reading with your child. Spend individual time with your
child, doing something you both enjoy.
• Provide opportunities for safe exploration.
• Provide opportunities for your child to socialize with other children in play groups,
preschool, or other community activities.
• Promote physical activity in a safe environment.
55
Children

• Give your child opportunities to make choices (e.g., which clothes to wear, books to
read, places to go).
• Reinforce limits and appropriate behavior. Try to be consistent in expectations and
discipline.
• Use “time out” or remove the source of conflict for unacceptable behavior.
• Encourage self-discipline.
• Anticipate that your child may have many fears, including night terrors.
4 Years:
• Provide opportunities for your child to help with household chores (e.g., helping to
set the table, picking up toys).
56
Children

• Enlarge your child’s experiences through trips and visits to parks and
other places of interest.
5 Years:
• Help your child learn how to get along with her peers.
• Encourage self-discipline and impulse control.
• Teach your child to respect authority.
• Begin to teach your child the difference between right and wrong.
• Help your child to manage anger and resolve conflicts without
violence. 57
Children

3, Promotion of Constructive Family Relationships and Parental
Health
• Take some time for yourself and spend some individual time with your
partner.
• Choose babysitters and caregivers who are mature, trained, responsible,
and recommended by someone you trust.
• If you are expecting another baby, talk with the health professional about
how to prepare your child for the new baby.
• Spend some time playing with your child each day. Focus on activities
that she expresses interest in and enjoys. 58
Children

• Listen to and respect your child.
• Show interest in your child’s preschool or child care activities.
• Show affection in your family.
• Spend some individual time with each child in your family. Participate in games
and other activities with your child. Create opportunities for your family to share
time together and for family members to talk and play with your child.
• Handle anger constructively in your family.
• Encourage the development of good sibling relationships.
• Acknowledge conflicts between siblings. Whenever possible, attempt to resolve
conflicts without taking sides. Do not allow hitting, biting, or other violent
behavior. 59
Children

• If you are thinking about having another baby in the next year or so, talk with the
health professional about taking folic acid supplements.
4, Promotion of Community Interactions
• Consider attending parent education classes or parent support groups.
• Maintain ties to your community through social, religious, cultural, volunteer, and
recreational organizations or programs.
• Talk with the health professional about your current child care arrangements and
how they meet your family’s needs. Find out what you can do to make your
community safer.
• Visit your child’s preschool or other child care program unannounced.
• Advocate for and participate in a neighborhood watch program. 60
Children

5 Years :
• Volunteer regularly for school or community activities that require adult supervision.
• Recommend that schools provide early and regular comprehensive health education and
services that encourage healthy lifestyles.
• Advocate for adequate and safe play spaces and playgrounds
5, Promotion of Successful School Entry (5 Year)
• Meet with your child’s teachers.
• Prepare your child for school.
• Talk about new opportunities, friends, and activities at school.
• Tour your child’s school with her.
• Become involved with your child’s school, perhaps as a volunteer. 61
Children

Common Developmental Concerns in
Preschoolers
• Lying : Lying is common in preschool children. It may occur
because the child fears punishment, has gotten carried away with
imagination, or is imitating what he or she sees the parent do. The
parent should ascertain the reason for the lie before punishing the
child. If the child has broken a rule and fears punishment, then the
parent must determine the truth. The child needs to learn that lying is
usually far worse than the misbehavior itself. The punishment for the
misbehavior should be lessened if the child admits the truth. The
parent should remain calm and serve as a role model of an even
temper
• Sex Education: Preschoolers are very inquisitive and want to
learn about everything around them; therefore, they are very likely to
ask questions about sex and where babies come from. Before
attempting to answer questions, parents should try to find out first
what the child is really asking and what the child already thinks about
that subject. Then they should provide a simple, direct, and honest
answer 62

Preschoolers
• Fears: A great number and variety of real and imagined fears are
present during the preschool years, including fear of the dark, being
left alone (especially at bedtime), animals (particularly large dogs),
ghosts, sexual matters (castration), and objects or persons associated
with pain. The exact cause of children's fears is unknown The best
way to help children overcome their fears is by actively involving
them in finding practical methods to deal with the frightening
experience.
• Stress : Although minimal amounts of stress are beneficial during
the early years to help children develop effective coping skills,
excessive stress is harmful The best approach to dealing with stress is
prevention—monitoring the amount of stress in children's lives so
that levels do not exceed their coping ability. In many instances,
structuring children's schedules to allow rest and preparing them for
change, such as entering school, are sufficient measures. 63

Preschoolers
• Aggression: The term aggression refers to behavior that attempts
to hurt a person or destroy property. Reinforcement can also shape
aggressive behavior. Sometimes the reward for aggression is negative
(e.g., punishment) yet reinforcing.
• Speech Problems The most critical period for speech
development occurs between 2 and 4 years old. During this period,
children are using their rapidly growing vocabulary faster than they
can produce the words. Failure to master sensorimotor integrations
results in stuttering or stammering as children try to say the word
they are already thinking about. This dysfluency in speech pattern is
common during language development in children 2 to 5 years old
The best therapy for speech problems is prevention and early detection.
Common causes of speech problems include hearing loss,
developmental delay, autism, lack of environmental stimulation, and
physical conditions that impede normal speech production 64

COMMON
DISEASE
PREVENTION IN
TODDLER AND
PRE- SCHOOL
AGE
CHILDREN 65

Health Problems of Toddlers and
Preschoolers
1, Sleep Problems
The preschool years are a prime time for sleep disturbances. Children may have trouble
going to sleep, wake during the night, have difficulty resuming sleep after waking
during the night, have nightmares or sleep terrors, or prolong the inevitable bedtime
through elaborate rituals.
Causes Of Sleep Problems:
• Increasing autonomy, negative sleep associations, nighttime fears, inconsistent
bedtime routines, and lack of limit setting, and Media use.
Consequences Of Sleep Problems:
• Daytime tiredness, behavior changes, hyperactivity, difficulty concentrating,
impaired learning ability, poor control of emotions and impulses, and strain on
family relationships 66

Preschoolers
Management:
• Counseling consistent bedtime ritual and emphasizing the normalcy of this type of
behavior in young children.
• Other measures that may be helpful include keeping a light on in the room,
providing transitional objects such as a favorite toy, or leaving a drink of water by
the bed.
• One approach is to establish soothing, limited rituals that signal readiness for bed,
such as a bath or story.
• Parents can reinforce the pattern by stating, “After this story, it is bedtime,” and
consistently carrying through the routine.
• If anticipated extra stimulation (e.g., having visitors arrive at the children's bedtime)
disrupts this routine, it is advisable to settle children in bed beforehand.
67

Preschoolers
2, Contact Dermatitis
• Contact dermatitis is an inflammatory reaction of the skin to chemical substances,
natural or synthetic, that evoke a hypersensitivity response or direct irritation. The
initial reaction occurs in an exposed region, most commonly the face and neck,
backs of the hands, forearms, male genitalia, and lower legs
Causes
 Primary irritant or a sensitizing agent. A primary irritant is one that irritates any skin.
 Agents that produce contact dermatitis include animal irritants (wool, feathers, and
furs), metal (nickel found in jewelry and the snaps on sleepers and denim), vegetable
irritants (oleoresins, oils, and turpentine), pet dander, dyes, cosmetics, perfumes, and
soaps (including bubble baths). 68

Preschoolers
Manifestation:
• Sharp demarcation between inflamed and normal skin that ranges from a faint,
transient erythema to massive bullae on an erythematous swollen base. Itching is a
constant symptom
Management:
• Treatment of the lesions includes application of calamine lotion,
• Topical corticosteroid gel is effective for prevention or relief of inflammation,
3, Arthropod Bites and Stings
• Arthropods include insects and arachnids, such as mites, ticks, spiders, and
scorpions
69

Preschoolers
Mechanism and Characteristic Manifestations Management
Insect Bites: Flies, Gnats,
Mosquitoes, Fleas :
Mechanism: Foreign protein in
insects' saliva introduced when skin
is penetrated for a blood meal
Distribution: Almost everywhere—
fleas, mosquitoes, ants
Suburbs and rural areas—bees
Urban areas—hornets, wasps,
yellow jackets
Hypersensitivity
reaction Papular
urticaria Firm
papules; may be
capped by vesicles
or excoriated Little
or no reaction in
non-sensitized
person
Treatment: Use antipruritic
agents and baths. Administer
antihistamines. Prevent secondary
infection.
Prevention: Avoid contact.
Remove focus, such as treating
furniture, mattresses, carpets, and
pets, where insects may live.
Apply insect repellent when
exposure is anticipated. 70
Skin Lesions Caused by Arthropods

Preschoolers
Mechanism and
Characteristic
Manifestations Management
Chiggers: Harvest
Mites
Mechanism: Attach with
claws and secrete a
digestive substance that
liquefies the host's
epidermis
Erythematous papules
Intense itching Favor
warm areas of body,
especially intertriginous
areas and areas covered
with clothing
Treatment: May require systemic
steroids for extensive bites.
Prevention: Avoid contact, especially
in areas of tall grass and underbrush.
Apply insect repellant when exposure
is anticipated. Spray insecticides such
as diazinon in yards.
Hymenopterans: Bees,
Wasps, Hornets, Yellow
Jackets, Fire Ants
Local reaction: Small
red area, wheal, itching,
and heat
Treatment: Carefully scrape off
stinger or pull out stinger as quickly as
possible. Cleanse with soap and water
71

Preschoolers
Mechanism and
Characteristic
Mechanism: Injection
of venom through
stinging apparatus
Venom contains
histamine; allergenic
proteins; and often a
spreading factor,
hyaluronidase Severe
reactions caused by
hypersensitivity or
multiple sting
Systemic
reactions: May be
mild to severe,
including
generalized edema,
pain, nausea and
vomiting,
confusion,
respiratory
impairment, and
shock
Apply cool compresses. Apply common household
product (e.g., lemon juice, paste made with aspirin or
baking soda). Administer antihistamines. Severe
reactions: Administer epinephrine, corticosteroids; treat
for shock.
Prevention: Teach child to wear shoes; to avoid wearing
bright clothing, flowery prints, shiny jewelry, or perfumed
grooming products (cologne, scented hairspray), which
might attract the insect; and to avoid places where the
insect may be contacted. Hypersensitive children should
wear medical identification to indicate allergy and therapy
needed; family should keep emergency medication and be
taught its administration. 72

Preschoolers
Mechanism and
Characteristic
Scorpions
Mechanism: Venom
injected via a hooked
caudal stinger Venom of
more venomous species
contains hemolysins,
endotheliolysins, and
neurotoxins
Characteristics: Usual
habitat southwestern
United State
Intense local pain, erythema,
numbness, burning, restlessness,
vomiting Ascending motor paralysis
with seizures, weakness, rapid pulse,
excessive salivation, thirst, dysuria,
pulmonary edema, coma, and death
Some species produce only local
tissue reaction with swelling at
puncture site (distinctive) Symptoms
subside in a few hours Deaths occur
among children younger than 4 years
old, usually in first 24 hours
Treatment: Delay
absorption of venom by
keeping child quiet; place
involved area in dependent
position. Administer
antivenin. Relieve pain.
Admit to pediatric intensive
care unit for surveillance.
Prevention: Teach children
to avoid possible nesting
sites.
73

Preschoolers
Mechanism and Characteristic Manifestations Management
Ticks
Mechanism: In process of sucking blood,
head and mouth parts are buried in skin
Characteristics: Feed on blood of
mammals Significant in humans because
of pathologic organism carried May be
vectors of various infectious diseases, such
as Rocky Mountain spotted fever, Q fever,
tularemia, relapsing fever, Lyme disease,
tick paralysis Must attach and feed for 1 to
2 hours to transmit disease Usual habitat is
wooded area
Tick usually
attached to skin,
head embedded
Firm, discrete,
intensely pruritic
nodules at site of
attachment May
cause urticaria or
persistent localized
edema
Treatment: Grasp tick with tweezers
(forceps) as close as possible to point of
attachment. Pull straight up with steady,
even pressure; if bare hands, use a
tissue to touch tick during removal;
wash hands thoroughly with soap and
water. Remove any remaining part
(e.g., head) with sterile needle. Cleanse
wounds with soap and disinfectant.
Prevention: Teach children to avoid
areas where prevalent. Inspect skin
(especially scalp) after being in wooded
areas.
74

Health Problems of Toddlers
and Preschoolers
4, Pet and Wild Animal Bites
Animal bites are common in childhood primarily dog bites. Cat bites are
less frequent, although cat scratches are extremely common
Management:
• General wound care consists of rinsing the wound with copious
amounts of saline or lactated Ringer solution under pressure via a
large syringe and of washing the surrounding skin with mild soap.
• A clean pressure dressing is applied, and the extremity is
elevated if the wound is bleeding.
• Medical evaluation is advised because of the danger of
tetanus and rabies, although dogs in most urban areas must
75

and Preschoolers
Be immunized against rabies.
• Bites from wild animals, such as bats, raccoons, foxes, and
skunks, are potentially dangerous. Prophylactic antibiotics are
indicated for puncture wounds and wounds in areas where
infection could result in cosmetic (face) or functional impairment
(hand).
• Extensive lacerations are debrided and may be loosely sutured to
allow drainage in the event of infection.
• Tetanus toxoid is administered according to standard guidelines ,
and rabies protocol is followed in case of a wild animal bite .
• Injuries to poorly vascularized areas, such as the hands, are
more likely to become infected than those in more 76

and Preschoolers
vascularized areas, such as the face; puncture wounds are
more likely to become infected than lacerations.
5, Human Bites
Children often acquire lacerations from the teeth of other humans in
rough play, during fights, or as victims of child abuse. Because
human dental plaque and gingiva harbor pathogenic organisms, all
human bites should receive immediate medical attention. Delayed
treatment increases the risk of infection.
Management:
• The wound is washed vigorously with soap and water, 77

and Preschoolers
and a pressure dressing is applied to stop bleeding.
• Ice applications minimize discomfort and swelling.
• Tetanus toxoid is needed if the child is insufficiently immunized.
• Wounds larger than 6 mm should receive medical attention.
6, Burns
• Burn injuries are usually attributed to extreme heat sources but
may also result from exposure to cold, chemicals, electricity,
or radiation. Most burns are relatively minor and can be
treated in an outpatient setting
78

and Preschoolers
• When burns are categorized according to the patient's age
and type of injury, the following patterns become apparent:
(1) hot-water scalds are most frequent in toddlers,
(2) flame-related burns are more common in older children,
(3) children playing with matches or lighters account for 1 in
10 house fires, and
(4) nonaccidental burns indicate maltreatment.
Nonaccidental injury due to maltreatment most commonly
occurs in children 3 years old and younger. With
nonaccidental injury, scald burns are the most common
followed by contact burns. 79

and Preschoolers
Type of Injury
• Thermal Injuries : Thermal agents, such as a flame,
hot surfaces, or hot liquids
• Electrical injuries: caused by household current have
the greatest incidence in young children, who insert
conductive objects into electrical outlets and bite or
suck on connected electrical cords
• Chemical burns: The severity of injury is related to
the chemical agent (acid, alkali, or organic
compound) and the duration of contact
80

and Preschoolers
Management:
Minor Burns : The burn is cleansed with a mild soap and tepid water.
• Debridement of the burn includes removal of any embedded debris,
chemicals, and devitalized tissue
• Blisters should be broken if the burn is due to a chemical agent to
control absorption.
• Mostly Apply antimicrobial ointment to reduce the risk of infection
and to provide some form of pain relief. The dressing consists of non-
adherent fine-mesh gauze placed over the ointment and a light wrap
of gauze dressing that avoids interference with movement. This helps
keep the burn clean and protect it from trauma.
• Some practitioners prefer an occlusive dressing, such as a
hydrocolloid, which is placed over the burn after cleansing. Hydrogel
dressings, which are soothing and non-adherent, may also be used 81

and Preschoolers
Management:
The first priority is airway maintenance.
• When respiratory involvement is suspected or evident, 100% oxygen is
administered and blood gas values, including carbon monoxide levels, are
determined.
• When severe edema of the face and neck is anticipated, intubation is
performed before swelling makes intubation difficult or impossible
• When full-thickness burns encircle the chest, constricting eschar (dead tissue)
may limit chest wall excursion, and ventilation of the child becomes more
difficult Escharotomy of the chest, where the eschar is incised through to the
fatty tissue, relieves this constriction and improves ventilation
82

and Preschoolers
Fluid replacement therapy:
The objectives of fluid therapy are to (1) compensate for water and sodium lost to
traumatized areas and interstitial spaces, (2) reestablish sodium balance, (3)
restore circulating volume, (4) provide adequate perfusion, (5) correct acidosis,
and (6) improve renal function.
Nutrition : A high-protein, high-calorie diet is encouraged. Zinc is also
supplemented because of its important role in burn healing and epithelialization.
Medication: Morphine sulfate is the drug of choice for severe burn injuries
Management of the burn wound Primary excision : Debridement, Topical
antimicrobial agents , Permanent skin coverings, Dermal replacements Cultured
epithelium
83

and Preschoolers
7, Sunburn
Sunburn is a common skin injury caused by overexposure to UV light waves—either
sunlight or artificial light in the UV range They are also responsible for premature
aging of the skin and potentiate the effects of ultraviolet B (UVB) waves, which are
shorter and are responsible for tanning, burning, and most of the harmful effects
attributed to sunlight, especially skin cancer.
Management:
• Treatment involves stopping the burning process, decreasing the inflammatory
response, and rehydrating the skin.
• Local application of cool tap water soaks or immersion in a tepid-water bath
(temperature slightly below 36.7° C [98° F]) for 20 minutes or until the skin is cool
limits tissue destruction and relieves the discomfort. 84

and Preschoolers
• After the cool applications, a bland oil-in-water moisturizing lotion can be applied.
• Acetaminophen is recommended for relief of discomfort.
Prevention: Application of Sun Screen Lotion
8, Ingestion of Injurious Agents
The most frequently ingested poisons include the following
• Cosmetics and personal care products (deodorants, makeup, perfume, cologne,
mouthwash)
• Medications (acetaminophen, acetylsalicylic acid, ibuprofen, opioids)
• Household cleaning products (bleaches, laundry pods, disinfectants)
• Foreign bodies, toys, and miscellaneous substances (desiccants, thermometers,
bubble-blowing solutions)
85

and Preschoolers
Poison Clinical Manifestation Management
Corrosives (Strong
Acids or Alkalis):
Drain, toilet, and
oven cleaners Electric
dishwasher detergent
(liquid because of
higher pH, is more
hazardous than
granular), Mildew
remover, Batteries,
Clinitest tablets,
Denture cleaners,
Bleach.
Severe burning pain in the
mouth, throat, and stomach
White, swollen mucous
membranes; edema of the
lips, tongue, and pharynx
(respiratory obstruction)
Coughing, hemoptysis
Drooling and inability to
clear secretions, Signs of
shock Anxiety and
agitation
* Inducing emesis is contraindicated (vomiting re-
damages the mucosa).
* Do not neutralize. Neutralization can cause an
exothermic reaction (which produces heat and
causes increased symptoms or produces a thermal
burn in addition to a chemical burn).
* Maintain patent airway as needed. Administer
analgesics. Give oral fluids when tolerated.
* Esophageal stricture may require repeated
dilations or surgery.
* Contact the PCC immediately. If the PCC or
medical advice and treatment not immediately
available, it may be appropriate to dilute corrosive
with water or milk (usually ≤120 ml [4 oz]).
86

and Preschoolers
Hydrocarbons
Gasoline Kerosene
Lamp oil Mineral
seal oil (found in
furniture polish)
Lighter fluid
Turpentine Paint
thinner and
remover (some
types)
Gagging, choking, and
coughing Burning throat
and stomach Nausea
Vomiting Alterations in
sensorium, such as
lethargy Weakness and
Respiratory symptoms
of pulmonary
involvement includes
Tachypnea , Cyanosis ,
Retractions , Grunting
• Inducing emesis is generally
contraindicated.
• Gastric decontamination and emptying are
questionable even when the hydrocarbon
contains a heavy metal or pesticide; if
gastric lavage must be performed, a cuffed
endotracheal tube should be in place
before lavage because of a high risk of
aspiration.
• Symptomatic treatment of chemical
pneumonia includes high humidity,
oxygen, hydration, and acetaminophen.
87

and Preschoolers
Aceta
minop
hen
Occurs in four stages post ingestion:
1. 0 to 24 hours • Nausea • Vomiting •
Sweating • Pallor
2. 24 to 72 hours • Patient improves • May
have right upper quadrant abdominal pain
3. 72 to 96 hours • Pain in right upper
quadrant • Jaundice • Vomiting • Confusion
790 • Stupor • Coagulation abnormalities •
Sometimes renal failure, pancreatitis
4. More than 5 days • Resolution of
hepatoxicity or progress to multiple organ
failure • May be fatal
• Antidote N-acetylcysteine
(Mucomyst) is equally effective
given intravenously or orally.
When given orally may first be
diluted in fruit juice or soda
because of the antidote's offensive
odor. An antiemetic may be given
if vomiting occurs.
• Given as 1 loading dose followed
by 17 additional doses in different
dosages. IV administration is
given as a continuous infusion.
88

and Preschoolers
Aceta
minop
hen
Occurs in four stages post ingestion:
1. 0 to 24 hours • Nausea • Vomiting •
Sweating • Pallor
2. 24 to 72 hours • Patient improves • May
have right upper quadrant abdominal pain
3. 72 to 96 hours • Pain in right upper
quadrant • Jaundice • Vomiting • Confusion
790 • Stupor • Coagulation abnormalities •
Sometimes renal failure, pancreatitis
4. More than 5 days • Resolution of
hepatoxicity or progress to multiple organ
failure • May be fatal
• Antidote N-acetylcysteine
(Mucomyst) is equally effective
given intravenously or orally.
When given orally may first be
diluted in fruit juice or soda
because of the antidote's offensive
odor. An antiemetic may be given
if vomiting occurs.
• Given as 1 loading dose followed
by 17 additional doses in different
dosages. IV administration is
given as a continuous infusion.
89

and Preschoolers
9, Child Maltreatment:
The broad term child maltreatment includes intentional physical abuse or neglect,
emotional abuse or neglect, and sexual abuse of children, usually by adults.
Warning Signs of Abuse
 Child has physical evidence of abuse or neglect, including previous injuries.
 History is incompatible with the pattern or degree of injury, such as bilateral skull
fractures after being dropped.
 Explanation of how injury occurred is vague or the parent or guardian is reluctant
to provide information.
 The patient is brought in with a minor, unrelated complaint, and significant trauma
is found. 90

and Preschoolers
 Histories are contradictory among caregivers.
 The mechanism of injury provided is not possible given age or developmental level
of the patient, such as 6-month-old turning on hot water.
 Bruising or other injury is present in a non-mobile patient.
 The patient's affect is inappropriate in relation to the extent of injury.
 Evidence of abusive or neglectful parent–child interaction is present.
 The parent, guardian, or custodian disappears after bringing in the patient for trauma
or a patient with suspicious injury is brought in by an unrelated adult.
 The patient has multiple fractures of differing ages. There was a delay in seeking
care.
 The parent or caregiver discloses that abuse has or may have occurred.
 The patient makes an outcry of abuse or neglect. 91

and Preschoolers
Preventing and Dealing with Sexual Abuse of Children
 Pay careful attention to who is around children. (Unwanted touch may come from
someone liked and trusted.)
 Back up a child's right to say no.
 Encourage communication by taking seriously what children say.
 Take a second look at signals of potential danger.
 Refuse to leave children in the company of those who are not trusted.
 Include information about sexual assault when teaching about safety.
 Provide specific definitions and examples of sexual assault.
 Remind children that even “nice” people sometimes do mean things.
 Urge children to tell about anybody who causes them to be uncomfortable. 92

and Preschoolers
 Prepare children to deal with bribes, threats, and possible physical force.
 Virtually eliminate secrets between children and parents.
 Teach children how to say no, ask for help, and control who touches them and
how.
 Model self-protective and limit-setting behavior for children. If it ever becomes
necessary to help a child recover from a sexual assault:
 Listen carefully to understand the child.
 Support the child for telling through praise, belief, sympathy, and lack of blame.
 Know local resources and choose help carefully.
 Provide opportunities to talk about the assault.
 Provide opportunities for the entire family to go through a recovery process.93

and Preschoolers
 Sexual assault affects everyone. To help deal with this social problem:
 Provide care and support to those who have been victimized.
 Recognize that offenders may not change behavior even with
intervention.
 Organize neighborhood programs to support each other's efforts to
protect children.
 Encourage schools to provide information about sexual assault as a
problem of health and safety.
 Organize community groups to support educational treatment and law
enforcement programs. 94

Common Disease Prevention
Strategies for Toddlers and
Preschoolers
Surveillance of Development
Physical assessment
Health Screening
Immunization
Promoting Health Development
Promoting mental health
Promoting Healthy weight
Promoting Healthy nutrition
Promoting physical activity
Promoting oral health
Promoting healthy and safe use of social media
Promoting safety and injury prevention
Promoting Good Hygiene in children 95

Common Disease Prevention Strategies
for Toddlers and Preschoolers
• Social Language and Self-help
• Verbal Language (Expressive and
Receptive)
• Gross Motor
• Fine Motor
Surveillance of Development :
96

Preschoolers
97
Measure and plot on appropriate
Growth Chart
– Recumbent length / height
– Weight
– Head circumference
– Weight-for-length
■ Eyes – Assess ocular motility. –
Examine pupils for opacification and
red reflexes. – Assess visual acuity using
fixate and follow response.
Physical Examination :
■ Mouth – Observe for dental irregularities like
caries, plaque, demineralization (white spots),
and staining.
■ Abdomen – Palpate for masses.
■ Neurologic – Observe gait if walking. –
Observe hand grasp and strength.
■ Genitals – Determine whether testes are fully
descended. – Determine whether labia are open.
■ Skin – Observe for nevi, café-au-lait spots,
birthmarks, or bruising.

Preschoolers
98
Health Screening:
Universal Screening Action
Anemia Hematocrit or hemoglobin
Oral Health Apply fluoride varnish after first tooth eruption and every 6 months.
Autism ( 18 Month , 2
Years)
Autism spectrum disorder screen
Development ( 18, 24,
&30 month )
Developmental screen
Vision (4 Yrs) Objective measure with age-appropriate visual acuity measurement using
HOTV or LEA symbols. Instrument-based measurement may be used for
children who are unable to perform acuity testing.
Hearing Audiometry

Preschoolers
99
Health Screening:
Selective Screening Action if Risk Assessment Positive (+)
Blood Pressure Blood pressure measurement
Hearing Referral for diagnostic audiologic assessment
Tuberculosis Tuberculin skin test
Vision Ophthalmology referral
Oral Health Referral to dental home or, if not available, oral health risk assessment
Primary water source is deficient in fluoride. Oral fluoride
supplementation
Dyslipidemia ( 2&4
years)
Lipid profile

Preschoolers
100
Follow the National Immunization Schedule or AAP current immunization schedule
appropriately
Immunization:
Promoting Health Development
In actuality, chronic diseases often get seeded and begin their pathological trajectories during
gestation or childhood, sometimes decades before clinical manifestations create functional
limitations Every health supervision encounter with children involves promoting healthy child
development. Understanding child development and the application of its principles sets the
care of children apart from that of adults.
Monitoring Healthy Child and Adolescent Development is the key concept to promote health
Development

Preschoolers
101
Comprehensive child development surveillance may include
■ Eliciting and attending to the parents’ concerns
■ Maintaining a developmental history
■ Making accurate and informed observations of the child
■ Identifying the presence of risk and protective factors
■ Periodically using screening tests
■ Documenting the process and findings
Promoting Mental Health
Mental health in early childhood is tightly bound to healthy development in the child, healthy
relationships within the family, and strong support for both child and family in the community

• Within the context of a positive and supportive parent-child relationship,
this new growth toward autonomy and self-determined initiative forms the
basis for self-esteem, curiosity about the world, and self-confidence.
102
Promoting Healthy Weight
• Promoting healthy weight using a responsive parenting approach during early
childhood continues building on the self-feeding and self-regulation skills initiated
during infancy. Healthy food choices divided into 3 meals and 2 to 3 snacks daily
should provide adequate macronutrients and micronutrients for growth.
Preschoolers

• Ensuring adequate nutrition during early childhood focuses on promoting normal
growth by selecting appropriate amounts and kinds of foods and providing a
supportive environment that allows the child to self-regulate food intake. Mealtime
provides opportunities for wonderful parent-child interactions. These opportunities
exist for the toddler, who may be fed before the family meal, as well as for young
children, who may participate in the family routine and sit at the table for a short
time. Finger foods should be encouraged because they foster competence, mastery,
and self-esteem. Even when the parent is doing the feeding, the child also should
be given a spoon.
103
Promoting Healthy Nutrition
Preschoolers

Preschoolers
A primary reason for promoting physical activity during early childhood is to
help young children master basic motor skills. Most children develop gross
motor skills in a typical sequence: walking, marching, galloping, hopping,
running, traveling around obstacles, and skipping. Children are motivated to
participate in physical activity by having fun, by feeling competent, and
through variety. Feelings of failure, embarrassment, and boredom, as well as
rigid structure, discourage participation. shows age-appropriate activities in
which children should be engaged and skills to be developed during middle
childhood 104
Promoting Physical Activity

Preschoolers
 It covers a range of health promotion and disease prevention concerns, including
dental caries; periodontal (gums) health; proper development and alignment of facial
bones, jaws, and teeth; other oral diseases and conditions; and trauma or injury to the
mouth and teeth. Oral health is an important issue requiring continued health
supervision from the health care professional
 Fluoride plays a key role in preventing and controlling caries. Fluoride helps reduce
the loss of minerals from tooth enamel (demineralization) and promotes the
replacement of minerals (remineralization) in dental enamel that has been damaged
by acids produced by bacteria in plaque. Regular and frequent exposure to small
amounts of fluoride is the best way to protect the teeth against caries. 105
Promoting Oral Health

 Social media offer many beneficial opportunities for families with young children.
Parents may find it useful to connect with and learn from other parents, and young
children may benefit from talking online with grandparents or family members
who live far away. However, social media also can present challenges, including
exposure to excessive screen time for young children instead of focused adult-child
interactions, which enhance language and social development, or exposure to
inappropriate content when they watch their parents use social media.
 Remind them that device use before bedtime may interfere with sleep, and the
AAP recommends that TVs not be in children’s bedrooms. The AAP encourages all
screens, including tablets, be turned off at least 1 hour before bedtime 106
Preschoolers
Promoting safe and Healthy Social Media

 Young children are especially vulnerable to many of the preventable injuries because their
physical abilities exceed their capacities to understand the consequences of their actions.
 Water safety is critical at these ages, when the ability to swim safely is not developed. Parents
and other caregivers should be aware of potential hazards in their home, including common
household chemicals (eg, dishwasher detergent, pesticides), medications, heavy objects (eg,
televisions [TVs]), furniture tip-overs, and family or neighborhood pets, and should create a
safe environment that will allow the young child to have the freedom he needs to explore.
Parents can teach their child about personal safety at an early age. Parents should train their
child how to approach authority figures (eg, teachers, police, and salesclerks) and ask them
for help in the event he becomes lost or temporarily separated from his parents.
107
Preschoolers
Promoting Safety and Injury Prevention

Preschoolers
108
• Promote Good Hygiene in Children: There are steps that can be taken to create a
healthy environment for children. You can reduce your child's risk of contracting
these viruses by doing the following:
• Nutrition – A well-balanced diet should include carbs, fats, proteins, vitamins, and
minerals
• Adequate hydration should be maintained in children of all age groups
• Vaccination – the child should be vaccinated as per the immunization schedule and
any missed doses need to catch up which can be discussed with the pediatrician
• Hygiene – hand hygiene is the most important measure that needs to be taken
seriously in order to avoid the transmission of harmful germs
• Proper hygiene also ensures a decrease in worm infestation, skin and ear infections

Preschoolers
109
• Teach the children to cover their mouths with tissue paper when coughing or sneezing
• Clean the toys regularly
• Both child and caregiver should frequently wash their hands with soap
• Keeping your household germ-free can go a long way in reducing your child's risk of
contracting a contagious infection
• Do not share eating utensils or drinking cups when the child is sick
• Periodic Health Check – The child's weight, height, body mass index (BMI), and other
growth parameters, along with the completion of developmental milestones, should be
monitored at regular intervals, and any deviation, if observed, should be addressed.
• Health care visits should also be used to educate and reinforce good health practices in
children and parents

for Toddlers and Preschoolers
• Disease Prevention Strategies for Toddlers and preschoolers:
Handwashing:
Handwashing is the most important method to prevent cold. Children
should be taught to wash their hands before and after meals, after
playing with other children or with pets, before and after wiping the
nose, etc. Younger children tend to put toys in their mouth. These toys
should be washed and cleaned regularly
Vaccination:
It provide the best possible defense against serious illness and disease.
Cover coughs and sneezes
Children should be taught to cover the nose and mouth while sneezing
or coughing.
110

Common Disease Prevention for
Toddlers and Preschoolers
• Common Disease Prevention Strategies for Toddler:
Nutrition and supplements:
Feed the children fruits, veggies, yogurt (containing active
cultures), and fortified dairy products and they are likely to
get micro and macro nutrients substances naturally which are
essential to fight against the infection and boost the immune
system.
Sleep:
Another common sense approach to keeping your kids healthy
is to ensure they get enough sleep. Since sleep enhance
immune system function.
Avoid tobacco:
Kids whose parents smoke get sick more often than those
whose parents don’t smoke.
111

• Common Disease Prevention Strategies for Toddler:
Exercise:
Less active kids get sick more often. When kids increase their activity level
they are less likely to get respiratory infections. So keep your kids moving.
Reduced household air pollution:
Household air pollution cause Lower respiratory infection especially
pneumonia
Safe Drinking Water:
Ensure Safe drinking water since unsafe water cause Diarrhea, Typhoid and
other water born diseases 112
Common Disease Prevention for

COMMON
INJURY
PREVENTION IN
TODDLER AND
PRE- SCHOOL
AGE 113

Risk of Injury Injury Prevention
Motor Vehicle:
• Walks, runs, and climbs
• Able to open doors and gates
• Can ride tricycle Can throw ball
and other objects
• Supervise child while playing outside.
• Do not allow child to play on curb or behind a parked car.
• Supervise tricycle riding; have child wear helmet.
• Lock fences and doors if not directly supervising children.
• Teach child to obey pedestrian safety rules
Drowning
• Able to explore if left
unsupervised
• Has great curiosity
• Helpless in water; unaware of its
danger; depth of water has no
significance
• Supervise closely when near any source of water, including
buckets.
• Never, under any circumstance, leave unsupervised in
bathtub.
• Keep bathroom doors closed and lid down on toilet.
• Have fence around swimming pool and lock gate.
114
Common Injury Prevention for

Burns:
• Able to reach heights by
climbing, stretching, and
standing on toes
• Pulls objects
• Explores any holes or
opening
• Can open drawers and
closets
• Unaware of potential
sources of heat or fire
• Plays with mechanical
objects
• Turn pot handles toward back of stove.
• Place electric appliances, such as coffee maker and popcorn machine, toward
back of counter.
• Store matches and cigarette lighters in locked or inaccessible area; discard
carefully.
• Place burning candles, incense, hot foods, and cigarettes out of reach.
• Do not let tablecloth hang within child's reach.
• Do not let electric cord from iron or other appliance hang within child's reach.
• Cover electrical outlets with protective plastic caps. Keep electrical wires
hidden or out of reach.
• Do not allow child to play with electrical appliance, wires, or lighters.
• Always check bathwater temperature; adjust water heater temperature to 49°
C (120° F) or lower; do not allow children to play with faucets.
• Apply a sunscreen when child is exposed to sunlight (all year round)
115

Accidental Poisoning:
• Explores by putting
objects in mouth
• Can open drawers,
closets, and most
containers
• Climbs
• Cannot read labels
• Does not know safe
dose or amount
• Place all potentially toxic agents, including cosmetics, personal care
items, cleaning products, pesticides, and medications, out of reach or in a
locked cabinet. Climbs Cannot read labels Does not know safe dose or
amount
• Caution against eating nonedible items, such as plants.
• Replace medications or poisons immediately in locked cabinet; replace
child-guard caps promptly.
• Administer medications as a drug, not as a candy.
• Do not store large surplus of toxic agents.
• Promptly discard empty poison containers; never reuse to store a food
item or other poison.
• Teach child not to play in trash containers.
• Never remove labels from containers of toxic substances.
116

Falls
Able to open
doors and some
windows
Goes up and down
stairs Depth
perception
unrefined
• Use window guards; do not rely on screens to stop falls.
• Place gates at top and bottom of stairs.
• Keep doors locked or use childproof doorknob covers at entry to stairs,
high porch, or other elevated area, including laundry chute.
• Ensure safe and effective barriers on porches, balconies, decks.
• Remove unsecured or scatter rugs.
• Apply nonskid decals in bathtub or shower.
• Keep crib rails fully raised and mattress at lowest level.
• Place carpeting under crib and in bathroom.
• Keep large toys and bumper pads out of crib or play yard (child can
use these as “stairs” to climb out) and then move to youth bed when
child is able to climb out of crib. 117

Falls • Avoid using mobile walker, especially near stairs.
• Dress in safe clothing (soles that do not “catch” on floor, tied
shoelaces, pant legs that do not touch floor).
• Keep child restrained in vehicle; never leave unattended in vehicle
or shopping cart.
• Never leave child unattended in high chair.
• Supervise at playgrounds; select play areas with soft ground cover
and safe equipment
Choking and
Suffocation
Puts things in mouth
• Avoid large, round chunks of meat, such as whole hot dogs (slice
lengthwise into short pieces).
• Avoid fruit with pits, fish with bones, hard candy, chewing gum,
nuts, popcorn, grapes, and marshmallows 118

May swallow hard or
inedible pieces of food
• Choose large, sturdy toys without sharp edges or small removable
parts.
• Install smoke and carbon monoxide alarms; change batteries every 6
months.
• Keep automatic garage door transmitter in an inaccessible place.
• Select safe toy boxes or chests without heavy, hinged lids.
• Keep venetian blind cords out of child's reach.
• Remove drawstrings from clothing; shorten essential drawstrings to
15.24 cm (6 inches) or less.
• Avoid contact with round, hollow, semirigid plastic items such as half
of a plastic ball.
Bodily Injury • Avoid giving sharp or pointed objects (e.g., knives, scissors, or
toothpicks) especially when walking or running 119

Still clumsy in many skills
Easily distracted from
tasks
Unaware of potential
danger from strangers or
other people
• Do not allow lollipops or similar objects in mouth when walking or
running.
• Teach safety precautions (e.g., to carry knife or scissors with pointed end
away from face).
• Store all dangerous tools, garden equipment, and firearms in locked
cabinet.
• Be alert to danger of unsupervised animals and household pets.
• Use safety glass on large glassed areas, such as sliding glass doors.
• Teach stranger safety:
• Avoid personalized clothing in public places.
• Never go with a stranger.
• Tell parents if anyone makes child feel uncomfortable in any way.
• Always listen to child's concerns regarding others' behavior.
• Teach child to say “no” when confronted with uncomfortable situations. 120

121
• The healthy preschooler is slender and agile, with an upright posture. The
formerly clumsy toddler becomes more graceful, demonstrating the ability to
run more smoothly. Athletic abilities may begin to develop. Major
development occurs in the area of fine motor coordination. Psychosocial
development is focused on the accomplishment of initiative. Preconceptual
thought and intuitiveness dominate cognitive development. The preschooler is
an inquisitive learner and absorbs new concepts like a sponge absorbs water.
CONCLUSION

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