Overview
This lecture covered pediatric health promotion through two case studies, focusing on nutrition, development, anticipatory guidance, and practical management plans for common concerns during well-child visits.
Case Study 1: Nelson (12-month-old Male)
- Presents for a well-baby visit; main complaints are decreased appetite and occasional constipation.
- Drinks five 8oz bottles of whole milk daily, prefers bottle over food, no multivitamin intake.
- Occasional constipation relieved with prune juice, sleeps 13 hours at night, no naps.
- Developmentally on track: can stand unassisted, says a few words, walks holding furniture.
- Social history: lives with mother, grandmother, and younger sibling; receives government aid; father incarcerated.
- Physical exam: normal findings across all systems except overconsumption of milk and minor constipation.
- Differential diagnoses considered: celiac disease, hypothyroidism, vitamin D deficiency, slow GI transit, iron deficiency anemia.
- Ruled out based on exam: celiac disease, bowel obstruction, abnormal musculature.
- Key issues to address: excessive milk intake causing constipation and decreased appetite, need for dietary diversification.
Management for Nelson
- Recommend limiting milk to 20–24oz per day and encourage water and solid food intake.
- Consider multivitamin supplementation, discuss balanced diet including vegetables and whole grains.
- Educate on natural constipation remedies (prune juice) and possible use of pediatric-appropriate laxatives if needed.
- Anticipatory guidance: home safety, car seat use, daily routines, signs warranting urgent care.
- Labs: order CBC at 12 months to screen for anemia; consider vitamin D and TSH if indicated.
- Follow-up in 1–3 months, or sooner if concerns worsen.
Case Study 2: Juan Carlos (9-month-old Male)
- Presents for a well-baby visit; no concerns reported, but uses low iron formula plus breastfeeding.
- Eats a varied diet with fruits, veggies, meats; no current constipation or diarrhea.
- Developmentally appropriate: crawling, pulling up, beginning pincer grasp, says “dada.”
- Family history includes maternal asthma and diabetes; both parents present in home.
- Physical exam: normal findings across all systems.
- Main issue: use of low iron formula increases risk for iron deficiency anemia.
Management for Juan Carlos
- No standard labs at 9 months, but consider hemoglobin check due to low iron formula use.
- Educate on need for iron-fortified formula to prevent iron deficiency anemia.
- Discuss age-appropriate safety (car seat, water temperature, poison prevention, fall risks).
- Support introduction of sippy cup, encourage interactive play, limit TV before bed.
- Nutritional guidance: ensure fiber, fruits, vegetables, and iron intake; address mother’s constipation concerns.
- Routine follow-up at 12 months, or sooner if problems arise.
Key Terms & Definitions
- Well-Child Visit — Regular health check for assessment and guidance on growth, development, prevention.
- Iron Deficiency Anemia — Low red blood cells due to insufficient iron, common in infants with low iron intake.
- Anticipatory Guidance — Counseling caregivers on upcoming developmental milestones, safety, and health risks.
- Slow Transit — Reduced movement of stool through the intestines leading to constipation.
Action Items / Next Steps
- Review assigned module readings and case studies for pediatric nutrition and anticipatory guidance.
- Prepare questions for upcoming Q&A session; email them 48 hours in advance.
- Use pediatric consult resources (e.g., Nursing Central apps) for developing differential diagnoses.
- Check announcements for the Big Blue Button conference dates for further discussion.