Question

Sally is a 24 month old. She has a 1 month old brother. Her mother has brought her to the pediatrician’s office for a routine check-up. Mother relates concerns with her refusal to toilet train. She has been demonstrating more frequent tantrums and is waking again during the night. She tells you she did not have any trouble with her birth, she weighed 7 #, and was 19 inches long. She tells you that Sally breastfed until 9 months and then with the advice of her family weaned her to the cup. And she believes this is why she has no allergies. Right now she is a picky eater, and seems to avoid foods that have rougher texture, this has made feeding more challenging as mom states that her diet is limited to pudding, sliced hot dogs, milk and juice. The family has no significant medical history, and immunizations are up to date. She plays often by herself, even on play dates. Mom states that she was worried at one point that Sally could not hear well as she was not speaking much. However, she notes that Sally responds appropriately when spoken to, but she does not initiate conversation. She took her to the dentist once and though it is a battle, tries to brush her teeth daily.

Vital signs: T – tympanic – 99.0, Pulse (apical) – 90, RR –

Upon entering the room, you attempt to interact with Sally. She hides under the table and will not make eye contact. She is resistant to your assessment and holds her hands near her face, moving her fingers.

What are some tools and team members that may be beneficial to this child’s care??

Answer 1

Sally is hesitant to co operate and is hiding under the table. You can ask her mother so as what does she like whether it is eatables, toys , music, cartoons etc. Provide her with the favourite things and wait for Sally to come . Physical examination of the ears can be done using otoscope and use sounds of different intensities in different directions to check her reactions to confirm if she can hear.

Since, Sally is walking at night again which means she had done it earlier too and plays alone even during the playdates . She has to be referred to Paediatric Psychiatrist, Psychologist, Language therapist, Counsellor and Family therapist. They together as a team can develop a relation with child and family to identify , plan and intervene Sally in the friendly environment.

Thank you.