Toddler Sleep Strategies

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Questions and Answers

What is the recommended daily supplementation of vitamin D for breastfed infants under one year old who are not receiving human milk?

600 IU

200 IU

800 IU

400 IU (correct)

Which of the following is a potential risk factor for iron deficiency anemia?

Consumption of fortified cereals

Low birth weight babies (correct)

Excessive intake of Vitamin C

Lack of access to dairy products

What is one of the critical functions of iron in the body?

Metabolism of neurotransmitters (correct)

Production of vitamin A

Regulation of blood sugar levels

Facilitation of calcium absorption

At what age group does initial presentation of iron deficiency typically occur?

9-24 months Signup and view all the answers

Which of the following dietary sources is NOT high in iron?

White rice Signup and view all the answers

What is food insecurity?

An inability to afford nutritious food Signup and view all the answers

What is the daily recommended vitamin D intake for children aged 1-3 years?

600 IU Signup and view all the answers

Which dietary combination helps to increase iron absorption?

Iron with foods rich in vitamin C Signup and view all the answers

What is food insecurity primarily characterized by?

Limited or uncertain availability of nutritional adequate and safe foods Signup and view all the answers

Which of the following is NOT a risk factor for food insecurity?

High educational attainment Signup and view all the answers

Children from food insecure households are at risk for developing which of the following nutrient deficiencies?

Vitamin D, Calcium, and Iron Signup and view all the answers

Which social determinant of health does NOT impact rates of childhood obesity?

Physical activity levels Signup and view all the answers

Which health outcome is associated with elevated BMI in children?

Hypertension Signup and view all the answers

How can adequate health insurance affect childhood obesity prevention?

It provides access to preventive care and education Signup and view all the answers

What approach should be used when discussing elevated BMI with pediatric patients?

Body positive, patient-centered approach Signup and view all the answers

Which of the following adverse childhood events is related to food insecurity?

Worrying about food Signup and view all the answers

What is one recognized factor that can increase the rate of unintentional firearm injuries in minors?

Easy access to firearms Signup and view all the answers

Which of the following social determinants is associated with gun violence?

Income inequality Signup and view all the answers

Which statement accurately reflects a risk regarding firearms in homes with children?

Children living in homes with guns have a higher suicide rate. Signup and view all the answers

What environmental factor can help reduce drowning risks for children?

Pool gates with locks and lifeguards Signup and view all the answers

Recognizing one's limitations in and around water contributes to swimming safety. Which of the following is NOT related to this?

Knowledge of local swimming events Signup and view all the answers

What is the most effective sleeping position for a newborn to minimize the risk of SIDS?

Back-sleeping Signup and view all the answers

At what age must a child transition from a rear-facing car seat to other types of car seats according to safety guidelines?

2 years and 30 lbs Signup and view all the answers

What is a key safety measure to prevent drowning in toddlers?

Constant supervision around any water Signup and view all the answers

Which of the following is NOT a recommended practice for a safe sleep environment for a newborn?

Using a crib with drop rails Signup and view all the answers

Which of these is a recognized high-risk site for toddler drowning?

Swimming pools Signup and view all the answers

What is the recommended method to mitigate choking hazards during a toddler's meal?

Cut food into small pieces Signup and view all the answers

At what age should a child transition from a booster seat to a regular seatbelt?

8 years and 60 lbs Signup and view all the answers

What is an important safety consideration when arranging playdates for school-age children?

Having a parent present in the home Signup and view all the answers

What is the primary focus when addressing adiposity in childhood?

Promoting positive body image and fostering autonomy Signup and view all the answers

Why is it important to identify BMI > 95% in children?

It carries increased lifetime risk of preventable diseases. Signup and view all the answers

What is the recommended frequency for screening measures in patients ages 10+ with BMI > 95%?

Every two years Signup and view all the answers

Which of the following is NOT a screening measure recommended for patients with BMI > 95%?

A physical fitness assessment Signup and view all the answers

What role does genetics play in adiposity among individuals?

It may increase the likelihood of higher body mass. Signup and view all the answers

What societal factor can impact the risk of elevated BMI in children?

Access to healthy foods Signup and view all the answers

Which of these factors is associated with an increased incidence of tooth enamel defects in young children?

Children with congenital and genetic diseases Signup and view all the answers

Which group of children is at greater risk for tooth decay due to enamel defects?

Children with chronic illnesses Signup and view all the answers

At what age is it expected for an infant to begin cooing?

2-4 months Signup and view all the answers

Which of the following tests is typically administered first during newborn hearing screening?

Otoacoustic Emissions (OAE) Signup and view all the answers

What is the primary goal of universal hearing screening in newborns?

To determine the hearing ability of all infants regardless of risk factors Signup and view all the answers

What is the recommended follow-up time for referred babies after failing the initial newborn hearing screening?

1 month Signup and view all the answers

Which condition is NOT a factor placing infants at risk for hearing loss?

Advanced maternal age Signup and view all the answers

Study Notes

Sleep

Nightmares occur during REM sleep
75% of children have nightmares in the last third of the night

Toddler Sleep Refusal

Parent Education/Prevention: Bedtime routine of 4-5 consistent, quiet activities lasting 20-30 minutes. Use a mantra such as "good night, I love you" before leaving the room.
Extinction: A bedtime routine of 4-5 consistent, quiet activities lasting 20-30 minutes. Use a mantra such as "good night, I love you" before leaving the room.
Cry it Out: Takes about 4-7 days for the process to have a consistent result.
Graduated Extinction: Gradually increasing the time between checks and reassurances.
Positive Routines/Faded Bedtime: Use rewards for desired behaviors. Substitute physical presence with positive associations.
Leaving the Room (and Retucking): Parents exit the room before the child falls asleep. If the child leaves the room, parents should return the child to the crib and tuck them in.
Avoid Arguing: No talking while the child is crying.
No Sleeping with Parents: Children should not sleep with their parents in this instance
Associated with sleep environments:
- Not placing the infant on their back to sleep.
- Using items other than the standard bedding set on the crib.
- Placing blankets on an infant.

Sudden Unexpected Infant Death (SUID)

Possible causes associated with sleep environment
- Infants not placed on their backs to sleep
- Using an unsuitable mattress in the crib
- Placing blankets in cribs

Nutrition & Food Scarcity

The appropriate age to introduce complementary foods in infancy is 6 months of age. Ideally, complementary foods should not be introduced any earlier than 4 months to decrease risk of allergies.
Do not introduce one particular food group first. Focus on all food groups for the best outcomes.
Introduce one new food at a time with a minimum of 3 days in between each new food. Monitor for allergic reactions.
Food groups with potential risk such as peanuts, nuts, eggs, shellfish should be introduced one at a time
- No specific food group needs to be introduced first.
Introduce ONE new food at a a time for at least 3 days. Monitor for allergic reactions

Vitamin D Intake

Infants: 400 IU per day
Children (1-3 years old): 600 IU per day
Children (4-8 years old): 600 IU per day

Iron Deficiency

Common Ages: Infants 9-24 months old
Risk Factors: Premature babies; low birth weight; babies given cow or goat milk before the age of 1; breastfed babies not given complementary foods containing iron after 6 months
Dietary Sources: Red meats, poultry, and fatty fish

Food Insecurity

Defined: Limited or uncertain access to nutritionally adequate and safe food.
Risk Factors: Low income, unemployment, race/ethnicity and disabilities.
Associated Risks: Cardiovascular disease, hyperlipidemia, diabetes, low levels of vitamins D, calcium, and iron

Elevated BMI in Children

Adverse health outcomes associated include Type II diabetes, fatty liver disease, dyslipidemia, sleep apnea, and hypertension.

Education access and quality
Healthcare access and quality
Neighborhood
Built environment
Social and community context
Enough money to purchase enough food
Adequate health insurance for preventing obesity
Sufficient health insurance coverage to receive necessary preventative care

Pediatric BMI Concerns

Patient centeredness: Maintaining a patient's well-being and self-esteem is important

Recommended Screening for 10+ Year Olds with BMI of 95% or Higher

Every two years: Fasting blood glucose/HgA1c; fasting lipid panel (consider non-fasting if not feasible), ALT, AST, and GGT; 25OH Vitamin D; sleep study; liver ultrasound; uric acid; fasting serum insulin and urine microalbumin/creatinine (urine protein to creatinine); C-peptide; hs-CRP

Tooth Enamel Defects

Factors associated with increased incidence: Lower socioeconomic status (SES); Premature births; Genetic disorders; Cerebral palsy

First Dentist Visit

AAP Recommendations: Children should have a first visit to a dentist within 6 months of their first teeth erupting. It should ideally happen by 12 months of age. This establishes a base for risk assessment, assessment of dental health, and education for parents.

Juice Intake for Infants and Toddlers

Infants (<12 months): Avoid giving fruit juice as it does not provide nutritional benefit at this age.
Toddlers (1-3 years): Limit fruit juice to 4 ounces maximum per day.
Children (4-6 years old): Limit fruit juice to 4-6 ounces or 1/2 to 1/4 cup per day
Older Children (7-18 years): Limit fruit juice to 1 cup or 8 ounces per day.

Fluoride Supplements

Optimal level: 0.7 ppm in water
Consideration: Optimally fluoridated water is recommended for oral health.

Injury Prevention

Newborns*: Highest risk is falls, SIDS, and unintentional injuries. Constant supervision is crucial. Safe sleep environment with proximity to the infant. Back to sleep/safe sleep.
Toddlers*: Most common injuries include drowning, falls, ingestion, choking, motor vehicle accidents, and injuries from pets. High supervision required.
School-age children*: Supervision, and knowing where the child is at all times. Safe water access is critical. No running unsupervised in areas with no supervision.
Pre-adolescents*: Understanding and responding to peer pressure, influence of social media. Addressing the possibility of the use of alcohol and recreational drugs is also important.

Preventing Drowning

Swimming lessons: For children 1 and older to build proficiency.
Recognizing high-risk situations: Rips, currents, extreme temperatures for water safety.
Knowledge of water safety devices: Devices like life preservers give safety to swimmers so they do not lose their lives in the water.
Identify swimmers in distress: Recognizing and responding to others who are in need.
Environmental barriers: Use gates, fencing and lifeguards for pools and other water environments.

Unintentional Firearm Injuries in Minors

High rates: States with easy access to firearms have higher rates of unintentional and intentional injuries.
Home environment: Having a gun in the home increases risks

Income inequality
Residential economic and racial segregation
Intergenerational social mobility

Toilet Training

Cross-cultural differences: Some cultures begin toilet training in infancy, others later.
Infancy perceived benefits: Hygiene and reduced illnesses.
Older toddler perceived benefits: Pre-school readiness and independence
Practices for family struggling with toilet training: Show techniques; observe the process, let the child learn and develop the process on their own terms.

Constipation in Children

Red flags: Passage of meconium after 48 hours of birth in infants, constipation starting within the first year, family history Hirschsprung's disease, ribbon-like stools, blood in stool without anal fissures, Failure to thrive, bilious vomiting, severe abdominal distention, abnormal thyroid gland, abnormal anal position, decreased cremasteric reflex, tuft of hair on spine, gluteal cleft deviation, and anal scares, extreme fear during rectal examinations.
Initial evaluation: Assess bowel patterns; consider changes in diet; assess medications; assess for diarrhea; consider encopresis.

Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome: In this obstructive sleep disorder, episodes of apnea occur that affect bladder function and control.
Diagnosis: Stress-related enuresis and behavioral changes are symptoms that need to be closely monitored.
Enuresis red flags: Weight loss, decreased linear growth, nausea, increased thirst, elevated urine glucose, difficulty voiding, etc. This warrants a diagnosis in conjunction with a complete physical assessment

Hearing and Speech

Cooing: 2-4 months
Babbling: 6 months
Hearing tests: Otoacoustic emissions (OAE), Auditory Brainstem Response (ABR)

Hearing Loss Risk Factors

Family history: A crucial factor in identifying children at risk for hearing loss.
Prematurity: Infants who spend a considerable amount of time (greater than 5 days) in the NICU are monitored more closely after leaving the NICU

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Description

This quiz explores various strategies and routines to help toddlers with sleep refusal issues. Learn about techniques like 'cry it out,' graduated extinction, and the importance of a consistent bedtime routine. Assess your knowledge on improving children's sleep habits for better nights.