An 18-month-old girl is brought to the office for a well-child visit. The girl speaks 15 words, can run, and follows simple commands. The parents place her in a rear-facing car seat in the back seat and brush her teeth with fluoride-based toothpaste twice a day. She enjoys fruits and vegetables, including whole grapes, strawberries, bananas, and raw carrots. The patient's diet also includes meats, grains, and dairy. The family has gates at the top and bottom of staircases and keeps household cleaners under the sink in a locked cabinet. They have a small backyard and are interested in ideas for summer water activities. The patient takes no medications, and vaccinations are up to date. Routine anticipatory guidance for toddlers is discussed. Which of the following is the most appropriate advice for this family?

Question

An 18-month-old girl is brought to the office for a well-child visit.  The girl speaks 15 words, can run, and follows simple commands.  The parents place her in a rear-facing car seat in the back seat and brush her teeth with fluoride-based toothpaste twice a day.  She enjoys fruits and vegetables, including whole grapes, strawberries, bananas, and raw carrots.  The patient's diet also includes meats, grains, and dairy.  The family has gates at the top and bottom of staircases and keeps household cleaners under the sink in a locked cabinet.  They have a small backyard and are interested in ideas for summer water activities.  The patient takes no medications, and vaccinations are up to date.  Routine anticipatory guidance for toddlers is discussed.  Which of the following is the most appropriate advice for this family?

Quizplus · Accepted Answer

11ec25c8_d5fd_3214_bc81_91f2c7edd9e9_MD0003_00 Infant and toddler well-child visits are opportunities for age-appropriate anticipatory guidance and education on household dangers. Airway foreign bodies are potentially fatal and most common in toddlers due to mouthing behaviors, increased mobility, and small airway diameter. The most common foreign body in this age group is food, particularly items that are round or cylindrical, smooth, and firm, features that make aspiration and obstruction more likely. Foods that are choking hazards should be avoided in children age <4: These include whole grapes, raw vegetables, uncut hot dogs, hard candy, nuts (eg, peanuts), seeds, and popcorn. Whole grapes and hot dogs can be cut lengthwise so that they are no longer cylindrical. In addition, while eating, children should be supervised and sitting upright, avoiding activities such as running or playing. Other small, nonfood items that can cause choking (eg, latex balloons, marbles, coins) should also be avoided. Additional anticipatory guidance for the home includes covering electrical outlets, installing gates on the top and bottom of staircases, and mounting televisions and furniture to the wall. Medications and household cleaners should be locked away and out of a child's reach; placing unsafe objects in open, elevated shelving is discouraged because children can climb and access these items (Choice D). (Choice A) Children should never be unsupervised while playing in any body of water (eg, pool, lake, ocean). Those age <4, particularly infants, can drown in <2 inches of water and should be within arm's reach when near water, including bathtubs, baby pools, or buckets. (Choice B) Beginning with development of the first tooth, children should brush twice a day with a small amount of fluoride-containing toothpaste. (Choice E) A rear-facing car seat protects the head and spine in a collision and should be used from birth until a child reaches the maximum height or weight limit of the particular car seat. The transition to a forward-facing car seat should not occur before age 2, and many children can remain rear-facing until age 4. Educational objective: Airway foreign bodies are most common in toddlers due to mouthing behaviors, increased mobility, and small airway diameter. Anticipatory guidance includes avoidance of foods that can choke, including hot dogs, peanuts, whole grapes, and raw vegetables, until age 4. References: Airway foreign bodies. (http://www.ncbi.nlm.nih.gov/pubmed/30969578)

An 18-Month-Old Girl Is Brought to the Office for a Well-Child