HEALTH PROMOTION OF TODDLERS Kristen Auckland, BSN, Jamie Lumsden, ME, and Emily Williams, SPT

Objective

● To work as a member of an interdisciplinary team to provide our class with information regarding health promotion of toddlers.

● To describe the roles of nurse practitioner, counselor, and physical therapist in relation to toddler health promotion.

● To provide the class with an evaluation tool to utilize in screening families with toddlers.

Overview1,2,3

• Toddler = 12 months to 3 years of age.

• Critical time for future motor skill development, psychosocial health, cognitive development, and overall growth.

• Goal of health promotion:• school readiness• will help child be a productive member of society• create a foundation for improved health across the child’s

lifespan

• Child health is a key measurement of a society’s overall health• decrease risk of future health issues into adulthood → reduce

cost on society

Incidence of Health Issues3,4,5,

Toddlers are at risk for:• Obesity

• Diabetes • “80 percent of all children and adolescents with type 2 diabetes are overweight, and

about 40 percent are clinically obese” (HealthDay, 2014)

• Common cold and other infections (i.e. dental caries)

• Child maltreatment• “Approximately 70% of children that die from abuse are under the age of 4” (Child Help,

2014)

• Developmental and behavioral disorders• musculoskeletal and neurological disorders• Autism, ADD, ADHD, etc• “About 1 in 88 children have been diagnosed with Autism Spectrum Disorder”

(HealthyPeople.Gov, 2014)

Screening Questions6,7,8,9

• Questions for the family of a toddler:• Were there any complications during the pregnancy? Was the child born full-

term? [PT, Nursing]• Does the child have routine well check appointments? [Nursing]• Is the child up to date on immunizations? [Nursing]• What are the child’s eating habits? [PT, Nursing]

• Does the child consume skim milk or eat only high fat foods? • What type of play and toys does the child gravitate toward? [PT, Nursing]• What are the child’s sleep habits? [Nursing]• Is the house child proofed? [Nursing]• Is the car seat installed correctly and appropriate for child's weight/height?

[Nursing]• Who cares for/lives with the child? [Counseling]• Does the child interact well with other children his/her age?[Counseling, PT], • Has the child met all of his/her milestones on time? [Counseling, PT, Nursing]

• When did the child start to walk? Run? Jump? (if applicable)• Is the child able to play with toys while walking?

Team Created Screening Tool

Toddler Health Screening Tool

Physical Findings- Nursing7

• Routine Well Checks • Growth and development• Vision• Dental• Vital signs

Physical Findings- Physical Therapy8,10

• Normal Development• Motor

• forwards, backwards, jumping, climbing, kicking,• walking 153 steps/min by age 3• turning pages, building block towers, small object

manipulation• Cognitive

• object matching, sings songs, able to complete multiple piece puzzle, aware of body parts

• Language• ~250-900 word vocabulary, demands response from

others, can be controlled by language, adult grammar and syntax acquired

Physical Findings- Counseling11,12

• Concerns the family may express to during well check visits in reference to mental health:• thumb sucking• trouble sleeping• picky eating

• Mental health in childhood pertains to:• Reaching milestones on time• Learning how to interact socially• Learning coping skills

It is important for professionals in any discipline to take note of any unusual bruises on a toddler. If child abuse is suspected then CPS should be contacted immediately.

Ethnic and Cultural Considerations7

• African American• Typically taller and weigh more by age 2 compared to

Caucasians• More advanced neurologically until 2 to 3 years, then typically

not noticeable• May be walking by 7-9 months compared to Caucasian at 12-

15 months • Asian

• Develop motor skills more slowly.• Caucasian

• More height increase in spring, and weight increase in fall. • Cultural

• Sleep practices vary in different cultures (i.e. U.S. working mothers)

• Religious• Many refuse to have child immunized due to religious reasons

Labs, Diagnostics, and Screening Tools13,14,15

• CBC test between 9-12 months for anemia, then as needed

• Lead blood test between 9-12 months, then annually in high risk areas

• Cholesterol at 2 years of age if family history • X-Ray, CT scan, MRIs are requested in the event of any

injury (ex: broken bones)• Screening for developmental disorders

• i.e. M-CHAT for Autism

Referrals3

• Any abnormality in physical exam should be referred to appropriate specialist.

• Counselor • Nutritionist• Physical/Occupational/Speech Therapist• Physician or other Specialist

• Communication between disciplines is important for overall health of the child and proper care.

Family Responsibilities6,16,17

• Regular visits to physician• (when? how often?)• keep immunizations up-to-date

• Proper nutrition at home• fruits, vegetables, grain, dairy,• limit fats and oils

• Home safety• locks on gates, doors, etc...

Preventing Health Issues18,19

• Prenatal and postnatal care• smoking, drugs, alcohol, poor nutrition…

• Proper nutrition

http://www.youtube.com/watch?v=dHEu9w3WSNY

• Routine check-ups

• Social exposure (engaging in play with other toddlers)

• Motor/sensory stimulation• physical activity

http://www.youtube.com/watch?v=xMbmLKmU71E

• Cognitive stimulation• often combined with physical activity

Importance of Interdisciplinary Practice3

A interdisciplinary team approach in toddler health promotion promotes:

• Knowledgeable and nurturing families/caregivers• A safe and supportive home environment• Continued preventive health care

References

1. Guyer B, Ma S, Grayson H, Frick KD, Perry DF, Sharkey A, McIntosh, J. Early childhood health promotion and its life course consequences. Academic Pediatrics. 2009; 9(3):142-149 2. Timmons BW, LeBlanc AG, Carson V, Gorber SC, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, TremblayMS. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism.2012; 37: 773-79 3. HealthyPeople.Gov. Early and Middle Childhood. Available at http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=10. Accessed on February 6th, 2014.

4. Health Day: News for Healthier Living. Type 2 Diabetes and Kids: The Growing Epidemic. Available athttp://consumer.healthday.com/encyclopedia/diabetes-13/misc-diabetes-news-181/type-2-diabetes-and-kids-the-growing-epidemic-644152.html. Accessed on February 5th, 2014.

5. Child Help. National Child Abuse Statistics. Available at http://www.childhelp-usa.com/pages/statistics. Accessed on February 5th, 2014.

6. Children’s Health Fund. Developmental and Social Emotional Screening Instruments for use in Pediatric Primary Care in Infants and Young Children. Available at www.childrenshealthfund.org Accessed on February 5th, 2014.

7. Murray RB, Zentner JP, Yakimo R. Health promotion strategies throughout the lifespan. 8th ed. Upper Saddle River, NJ: Pearson, Prentice Hall; 2009.

8. Long T, Toscano K. Handbook of Pediatric Physical Therapy. 2nd Ed. Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2002.

9. Weaver LT.  Meeting an unmet need:  Healthcare professionals and toddler nutrition and feeding.  British Nutrition Foundation. 2007; 32: 65-68.

References

10. Center for Disease Control and Prevention. Developmental Milestones. Available at http://www.cdc.gov/ncbddd/actearly/milestones/index.html. Accessed on February 5th, 2014.

11. Centers for Disease Control and Prevention. Childhood Mental Health. Available at http://www.cdc.gov. Accessed on February 10th, 2014.

12. American Family Physician. Counseling on Early Childhood Concerns. Available at www.aafp.org.

13. Medicine.Net. Toddlers: Child Development 1-3 Years Old. Available at http://www.medicinenet.com/toddlers_child_development/article.htm. Accessed on February 5th, 2014.

14. Food and Drug Administration. Radiation-Emitting Products. Available athttp://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm298899.htm. Accessed on February 8th, 2014.

15. First Signs. Recommended Screening Tools. Available at www.firstsigns.org/screening/tools. Accessed on February 13th, 2014.

16. HealthyChildren.Org. Well-child Care: A Check-up for Success. Available athttp://www.healthychildren.org/English/family-life/health-management/pages/Well-Child-Care-A-Check-Up-for-Success.aspx. Accessed on February 6th, 2014.

17. Kids Health from Nemours. Nutrition Guide for Toddlers. Available at http://kidshealth.org/parent/nutrition_center/healthy_eating/toddler_food.html. Accessed on February 11th, 2014.

18.Good for kids; good for life. Available at www.goodforkids.nsw.gov.au. Accessed on February 11th, 2014.

19. Kids Health from Nemours. Pregnancy and Newborn Center. Available at http://kidshealth.org/parent/pregnancy_newborn/pregnancy_center.html#cat32. Accessed on February 11th, 2014