Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
Which essential questions will you ask this pediatric patient or their caregiver during this well-child check? Why are these questions important? What lab tests or diagnostic studies will you order and why?
In this case study, the child is not at the appropriate weight. The parent did address that he is a selective eater. Therefore, I would begin with questions regarding his diet. How often is he eating? What is he eating? Does he eat vegetables or fruit? Is he still using a bottle? It is expected that children who still use bottles obtain most of their calories from milk or juice, which deters them from eating solid foods. I would inquire about how many ounces of milk does he drink a day? Does he drink water? It would be essential to address if he is meeting his developmental milestones. At three years old, he should be able to speak in 3-word sentences 75% of the time, feed himself, brush his teeth, use a cup, spoon, and crayon (Burns et al., 2019). He should draw a circle, build a tower of 6-8 cubes, ride a tricycle, and throw a ball overhand. These assignments help identify any areas of concern and activate early intervention if needed. The child’s safety would need to be assessed. Does the child sit in a car seat, booster, or wear their seat belt? Is there a gun in the house, and is it kept in a locked area? Is he potty trained or in training? In addition, I would inquire about the child’s sleep and if he exhibits healthy sleeping habits. Does he get the appropriate 10-13 hours a day that a preschooler should be obtaining each day? (Burns et al., 2019) Does he go to sleep at a reasonable hour? Does he wake during the night? I would also ask if there were any concerns with his behavior. Parents are typically to first to identify any medical or psychosocial problems. Does she have any concerns about the child’s hearing and vision? In addition, I would ask if there has been a change in his routine at home? Does he go to daycare? If so, for how long? A change in family routine can affect the child’s eating habits. I would ask if there has been any recent trauma or trips to the emergency department since the last visit? These questions are essential to help form a history and physical, diagnosis and treatment plan. The laboratory test I would obtain is the finger stick for hemoglobin and hematocrit. This will help identify if the child has anemia. Anemia is vital to assess in children that are nutrition deficit. This is a common medical condition, especially in children who are not eating adequate amounts of iron. Iron is required to form hemoglobin, allowing red blood cells to carry oxygen to other cells (Mantadakis et al., 2020).
What diagnoses would you give the patient in this case? Include the findings that support the diagnoses.
I would diagnosis this child with iron deficiency anemia (D50.9) because his hemoglobin result was 9.5 g/dL (100 g/L). The typical range is between 6 months old and six years old: 10.5-14 g/dL (105-140 g/L) (Mantadakis et al., 2020). The signs and symptoms include pale skin, weakness, cold intolerance, and dizziness. Furthermore, I would diagnose him with a nutritional deficiency (E63.9) due to his poor diet. Finally, I would diagnose him with eczema (L20.9) due to his persistent rash on the antecubital fossae of the elbow for several weeks.
What is your treatment recommendation and education for the patient and family? Why? Include anticipatory guidance.
The treatment plan would begin with replacing his iron by starting daily iron supplements. It is recommended to continue iron therapy for six months after correcting hemoglobin levels to replenish tissue stores (Mantadakis et al., 2020). If the treatment plan is followed accordingly, the anemia should be remedied within two months. The parents will be educated to stop using the bottle and encourage the child to drink water, and limit juice. This encourages the child to eat more solid food. In addition, the parents will be educated to reduce the amounts of desserts and unhealthy snacks to healthier food selections. To help the child’s eczema the parents will be educated to use topical anti-inflammatory agents for outbreaks (Gür Çetinkaya, & Şahiner, 2019). It will be essential to keep put a daily moisturizer on the child’s skin to prevent outbreaks.
Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN:9780323581967
Gür Çetinkaya, P., & Şahiner, Ü. M. (2019). Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turkish journal of medical sciences, 49(4), 963984. https://doi.org/10.3906/sag-1810-105
Mantadakis, E., Chatzimichael, E., & Zikidou, P. (2020). Iron Deficiency Anemia in Children Residing in High and Low-Income Countries: Risk Factors, Prevention, Diagnosis and Therapy. Mediterranean journal of hematology and infectious diseases, 12(1), e2020041. https://doi.org/10.4084/MJHID.2020.041