Toddler health supervision: 1 to 3 years — formative SAQs

SAQ 1 (10 marks)

An 18-month-old attends for a toddler well-child visit. The caregiver mainly wants “the needles done.” [1]

1. List the essential domains you will cover beyond immunisation status. (4) [1] [2]
2. How will you approach developmental and autism-risk assessment at the bedside? (3) [2] [3] [4]
3. Outline your safety-net if you refer after a positive developmental or autism screen. (3) [21]

Model answer

Domains: growth trajectory (weight, length/height, WHO plotting); developmental surveillance; autism-specific screening at recommended ages; oral health/lift-the-lip and fluoride; injury prevention matched to motor skills (including passenger safety); feeding, iron-rich diet and bottle weaning; sleep; media limits; positive discipline; iron and lead risk assessment; social determinants and safeguarding. [1] [2] [5] [6] [8] [9] [10] [12]

Bedside approach: open caregiver concerns; observe gait, joint attention, words/phrases, pointing and play; use evidence-informed milestones; deploy validated general screens and M-CHAT-R/F with follow-up where indicated; document domains and sources. [2] [3] [4]

Safety-net: written plan, red-flag symptoms for earlier return, how to chase appointments, interim communication strategies, and clear review timing if waitlists are long. [21]

SAQ 2 (10 marks)

A 26-month-old has picky eating, few word combinations, early dental white spots and the family reports running out of food before payday. An interpreter is needed. [5] [8] [22]

1. What concurrent problems must you not miss while discussing diet? (3) [2] [5] [6]
2. Give non-shaming anticipatory guidance priorities. (4) [5] [8] [10] [11] [12]
3. How do language access and closed-loop care shape your plan? (3) [22] [21]

Model answer

Do not miss language/hearing pathways, autism or global delay red flags, iron deficiency risk, lead risk where housing warrants, oral caries progression, growth trajectory and food insecurity while focusing on “fussy eating” alone. [2] [5] [6] [8]

Guidance: protect iron-rich foods and limit milk crowding; fluoride toothpaste and dental home; age-banded injury safety; positive discipline without corporal punishment; limit solo screens and promote play; concrete food-resource linkage without blame. [5] [8] [10] [11] [12]

Use a professional interpreter for history and counselling; never the child. Safety-net referrals with teach-back and a chase plan. [22] [21]