Which essential questions will you ask this pediatric patient or his/her caregiver during this well-child check? Why are these questions important? What lab tests or diagnostic studies will you order and why?
Benjamin is a 3-year-old male that came in for a well-child check-up with his mother. The essential questions and data that need to be acquired during this visit are the patient’s weight and height, calculating BMI, and plotting the measurements on growth charts. Important questions begin with inquiring about the child feeding/eating pattern and how often, what they are eating (Burns et al., 2017). Toilet training is another aspect that needs to be assessed. The preschooler may be potty trained or using the potty during the day. It is common for kids this age to have an occasional accident during the day and still need a diaper at night (Burns et al., 2017). The next important question is about the sleeping pattern; preschoolers should sleep about 10-13 hours a night and may still nap during the day. The application of developmental assessment tool ASQ at 30 months and MCHAT for autism are both essential to assess growth and developmental delays (Burns et al., 2017).
For this case study, Benjamin is a picky eater making him at risk for anemia; thus, simple Fingerstick hemoglobin is recommended as a screening test for anemia. The complete blood count is a better option but costlier and more inconvenient. Benjamin is positive with rashes in both antecubital fossae of the possible elbow Eczema. A radioallergosorbent test (RAST) is a blood test used to determine to which allergens a person is sensitized (Yang et al., 2018). Lead poisoning screening test is essential in children living in a lead-contaminated environment, especially patient ages between 6 months and 36 months due to mouthing behavior that happen throughout this developmental period.
What diagnoses would you give the patient in this case? Include the findings that support the diagnoses.
The first diagnosis is Iron Deficiency Anemia (IDA), possibly due to inadequate nutritional intake. The patient’s Capillary hemoglobin is 9.5g/dl. IDA is the most common nutritional disturbance in pediatrics and the number one cause of anemia in the pediatric population (Davis et al., 2018). As part of the prevention approach, parents should provide a diet high in Iron such as cereals, green vegetables, meat, and chicken, but it is a bit challenging for a picky eater like Benjamin. Iron deficiency and anemia are associated with impaired neurocognitive development and immune function in young children (Davis et al., 2018). The condition significantly increases the risk of developmental delays and behavioral disturbances in the pediatric population (Davis et al., 2018). The second diagnosis is Atopic Dermatitis, an inflammation of the skin described by dry, pruritic skin with a chronic worsening progression (Yang et al., 2018). The condition can affect all age groups, but it is prevalent in children ages five years old and below. Parents with eczema are more likely to have children with eczema, and different triggers can make eczema worse, including environmental stress, allergies, sweating, and cigarette smoke. Of children who have eczema, most will show signs of eczema in the first year of life, and 85 percent will show signs of eczema within the first five years, but the condition is not contagious (Yang et al., 2018). The patient came in with rash in both of his antecubital areas that the mother has been applying moisturizing cream once daily and over-the-counter hydrocortisone 1% cream for the past couple of weeks.
What is your treatment recommendation and education for the patient and family? Why? Include anticipatory guidance.
With regards to the Iron Deficiency Anemia (Hgb 9.5g/dl), that is probably related to iron deficiency from poor nutrition. The patient is positive for insufficient vegetable and iron intake through his diet, excess milk and juice intake every day, consuming a bottle at sleep, and sipping on juice throughout the day has been the major contributing factor of patient’s anemia (Gupta, Perrine, Zuguo, & Scanlon, 2016). As a treatment recommendation and education for the patient’s anemia managing the cause is essential rather than putting the patient in an iron supplement. Encouraging Mrs. Jones about Benjamin’s Eating Habits by giving leverage on a few fundamental changes involving the eating process rather than focusing on details of the child’s diet is a more practical approach towards the case since the provider is working as a team with the parents (Gupta, Perrine, Zuguo, & Scanlon, 2016). Giving the mother simple strategies that can be applied sequentially and emphasizing the importance of consistency is an effective way to change the child’s nutrition patterns. With regards to improving patient nutrition, bottle-feeding must be stopped and limiting three meals and two snacks per day will improve the patient’s nutrition intake and boost his appetite. Introducing new food will gradually eliminate some unhealthy food intake (Kerling et al., 2016).
For the Atopic Dermatitis (AD), the goal for managing the condition is by protecting the skin by lubricating extensively, applying topical anti-inflammatories, and lastly treating related skin infections aggressively in which Mrs. Jones has been applying moisturizing cream once daily and over-the-counter hydrocortisone 1% cream (Thanai, 2017). I will continue the current treatment, which is Steroid cream over the counter: Hydrocortisone Topical ointment: 1% apply in the affected sites Twice Daily and Aveeno Eczema Moisturizing cream post-shower/bath. To control the itchiness of the rash, Diphenhydramine (Topical) Apply 1% concentration to affected area up to 3 to 4 times/day (Thanai, 2017). AD is a chronic disease that has multiple relapses. The chronicity of the disease should be highlighted to Mrs. Jones. As the best prevention measures of the flares are the religious use/application of emollients or moisturizers, proper skin care is necessary to control disease activity and enhance life quality (Thanai, 2017).
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., Garzon, D. L., & Gaylord, N. M. (2017). Pediatric primary care (6th ed.). St. Louis, MO: Elsevier, Inc.
Davis, K. E., Xilong Li, Adams-Huet, B., Sandon, L., & Li, X. (2018). Infant feeding practices and dietary consumption of US infants and toddlers: National Health and Nutrition Examination Survey (NHANES) 2003-2012. Public Health Nutrition, 21(4), 711.
Gupta, P. M., Perrine, C. G., Zuguo Mei, & Scanlon, K. S. (2016). Iron, Anemia, and Iron Deficiency Anemia among Young Children in the United States. Nutrients, 8(6), 330. https://doi-org.su.idm.oclc.org/10.3390/nu8060330
Kerling, E., Souther, L., Gajewski, B., Sullivan, D., Georgieff, M., & Carlson, S. (2016). Reducing Iron Deficiency in 18-36-months-old US Children: Is the Solution Less Calcium? Maternal & Child Health Journal, 20(9), 1798–1803. https://doi-org.su.idm.oclc.org/10.1007/s10995-016-1982-4
Yang, E. J., Sekhon, S., Sanchez, I. M., Beck, K. M., & Bhutani, T. (2018). Recent Developments in Atopic Dermatitis. Pediatrics, 142(4), 1–12. https://doi-org.su.idm.oclc.org/10.1542/peds.2018-1102
Siu, A. L. (2015). Screening for Iron Deficiency Anemia in Young Children: USPSTF Recommendation Statement. Pediatrics, 136(4), 746–752. https://doi-org.su.idm.oclc.org/10.1542/peds.2015-2567
Thanai Pongdee. (2017). Efficacy and Safety of Crisaborole Ointment, a Novel, Nonsteroidal Phosphodiesterase 4 (PDE4) Inhibitor for the Topical Treatment of Atopic Dermatitis (AD) in Children and Adults. Pediatrics, 140, S207. https://doi-org.su.idm.oclc.org/10.1542/peds.2017-2475III