Toddler & Preschooler

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Expect and support autonomy — Erikson’s autonomy versus shame and doubt. Negativism and ritualism are developmental, not naughtiness.
• Offer limited real choices: two shirts, not “what do you want to wear”.
• Keep routines and rituals intact in the hospital — they are how a toddler feels safe.
• Parallel play is normal at this age; toddlers play alongside, not with.
• Prepare a toddler for a procedure immediately before, not hours ahead.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Doses are weight-based — always in kg, always double-checked.
• Liquid formulations with an oral syringe; never a kitchen spoon.
• Give a choice about how, never about whether.
• Never call medicine candy or a treat.
• Teach parents that acetaminophen and ibuprofen doses differ and are not interchangeable by volume.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Toilet training when the child is physiologically and psychologically ready, usually 18–30 months — readiness, not age.
• Rear-facing car seat as long as the seat allows.
• Regression during illness or hospitalization is expected; do not shame it.
• Therapeutic play with dolls and equipment before procedures.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Pediatrician or family provider for well-child visits and the immunization schedule.
• Dentist — first visit by age 1 or within 6 months of the first tooth.
• Dietitian for faltering growth, obesity, or a very restricted diet.
• School nurse and teachers for chronic conditions and learning concerns.
• Social work for food, housing and safety; early intervention for developmental delay.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Injury is the leading cause of death — drowning, road traffic, burns, falls, poisoning.
• Magical thinking means a preschooler may believe illness is punishment for something they did.
• Choking, and access to unlocked medicines, cleaning products and firearms.
• Growing independence outdoors without matching judgment about traffic and water.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Lead screening and hemoglobin per local schedule.
• Vision and hearing screening before school entry.
• No routine bloods otherwise at a well-child visit.
• Explain in concrete terms: “a small pinch, then it is finished”.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Initiative versus guilt — support doing and making; criticism lands hard at this age.
• Prepare 1–3 hours before a procedure — longer creates fear, shorter creates ambush.
• Use associative play, dolls and medical play; let them handle the equipment.
• Never say “this will not hurt” if it will. Trust lost here does not come back.
• Correct the belief that illness is a punishment — say it out loud, because they will not raise it.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Weight-based dosing, checked in kg.
• Preschoolers can swallow chewables; whole tablets usually still difficult.
• Let the child hold the syringe or choose the plaster — control reduces resistance.
• Reinforce that medicine is given by an adult only, and store everything locked.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Booster seat once outgrowing the harness; back seat until 13.
• Swimming lessons and constant supervision near water.
• Screen limits and consistent sleep routine.
• Therapeutic play and drawing to express what they cannot say.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Pediatrician or family provider for well-child visits and the immunization schedule.
• Dentist — first visit by age 1 or within 6 months of the first tooth.
• Dietitian for faltering growth, obesity, or a very restricted diet.
• School nurse and teachers for chronic conditions and learning concerns.
• Social work for food, housing and safety; early intervention for developmental delay.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Unintentional injury, the leading cause of death in this group.
• Dental caries from bottle or juice use and poor brushing.
• Obesity beginning in the preschool years.
• Delayed recognition of hearing or vision problems, which then present as behavior or learning difficulty.
• Regression and separation anxiety with hospitalization.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• True contraindication: anaphylaxis to a previous dose or to a vaccine component.
• Live vaccines (MMR, varicella, rotavirus, live influenza) are avoided in significant immunosuppression and in pregnancy.
• Moderate or severe acute illness defers a dose; a mild cold with or without low fever does not.
• Recent blood product or immunoglobulin can blunt the response to a live vaccine.
• Egg allergy is not a contraindication to routine influenza vaccination, and a family history of reaction is not one either.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Expected after a vaccine: low-grade fever, fussiness, and soreness, redness or a small lump at the site, for 1–2 days.
• A small nodule at the injection site can persist for weeks and is harmless.
• MMR and varicella may cause a mild rash or fever 7–12 days later, not immediately — parents need warning or they think it is unrelated illness.
• Not expected: high fever, widespread hives, wheeze, facial or tongue swelling, or collapse. That is anaphylaxis.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• No routine bloodwork is needed before immunizing.
• Titres may be checked to confirm immunity — rubella, varicella, hepatitis B — in health-care students and staff.
• Hepatitis B surface antibody after the series in an infant of a positive mother.
• Immune function testing before live vaccines where immunodeficiency is suspected.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• None — immunization is a clinical decision from history and the schedule.
• Review the record and use the catch-up schedule where doses are missing.
• A lapsed schedule is resumed, never restarted.
• Check the minimum interval between doses; too-early doses do not count.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Site by age: vastus lateralis for infants and toddlers, deltoid once the muscle is big enough, usually from about 3 years.
• Needle length and gauge by age and muscle mass; 25 mm is common for infants.
• Different vaccines go in different sites, or at least 1 inch apart, and are documented separately.
• Epinephrine must be immediately available whenever vaccines are given.
• Never mix vaccines in one syringe unless the product is licensed as a combination.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Comfort measures reduce distress and improve return rates: breastfeeding, sucrose, skin-to-skin for infants.
• Hold the child securely with a parent’s help; give the injection quickly.
• Observe for 15 minutes afterwards.
• Older children: distraction, topical anesthetic, sitting up rather than lying down.
• Give the most painful injection last.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Give the Vaccine Information Statement before each vaccine — this is a legal requirement, not a courtesy.
• Expect soreness and low fever; a cool compress and weight-appropriate acetaminophen or ibuprofen if needed.
• Do not give an antipyretic prophylactically before the vaccine — it can reduce the immune response.
• Return immediately for difficulty breathing, facial swelling, hives, or a child who becomes limp or unresponsive.
• Keep the record and bring it to every visit; a lost record often means repeated doses.

From this module — built from the notes above on this page, not a section of the ATI chapter.

• Provider for the schedule and for judging true contraindications.
• Pharmacist for storage and the cold chain — a break in it wastes the whole batch.
• Public health for outbreak response, reporting and catch-up campaigns.
• School nurse for entry requirements and exemptions.
• Report significant adverse events through the national reporting system.