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Paeds Vivaspreventive-and-community-paediatrics

Paeds Vivas · preventive-and-community-paediatrics

Toddler health supervision: 1 to 3 years — branching viva

Viva on toddler preventive visit structure, autism screen pathway and safety counselling.

branching clinical structured oral1 min readVerification in progress

Target exams

RACP DCEMRCPCH Clinical
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Target exams

RACP DCEMRCPCH Clinical
Prompt
Toddler clinic: 18-month-old for well-child visit with language concern and frequent falls.

Stem

You are in clinic with an 18-month-old and caregiver for a well-child visit. Language concern and frequent falls are raised. [1] [2]

Examiner: What is toddler health supervision for? [1]

Strong answer: A structured preventive package for about 12–36 months — growth trajectory, developmental surveillance and autism screening, oral health, injury and passenger safety, feeding and sleep, iron and lead risk, immunisation review, positive discipline and social risk — not vaccines alone. [1] [2]

Examiner: How do surveillance and autism-specific screening differ? [2] [4]

Strong answer: Surveillance is continuous concern elicitation, observation and documentation every visit. Autism-specific tools such as M-CHAT-R/F with follow-up risk-stratify at supported ages; they are not diagnoses. Evaluation opens services. [2] [4] [18]

Examiner: Few words and limited joint attention. Immediate priorities? [2] [3]

Strong answer: Full domain observation, hearing pathway, complete or action autism/developmental screens, early intervention referral as indicated; do not pure wait-and-see until preschool. [2] [3] [4]

Examiner: Caregiver asks if a positive checklist alone diagnoses autism today. [4]

Strong answer: No. Tools risk-stratify; diagnosis needs comprehensive evaluation. Explain next steps calmly and arrange closed-loop referral. [4] [18]

Examiner: Name age-banded injury priorities for a newly walking toddler. [12] [9]

Strong answer: Falls, choking hazards, water safety, burns, poisoning storage and correct car restraint. Match advice to current motor skills. [12] [9]

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References15ShowHide
  1. [1]Committee on Practice and Ambulatory Medicine 2025 Recommendations for Preventive Pediatric Health Care: Policy Statement. Pediatrics, 2025.PMID 39914362
  2. [2]Lipkin PH Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening. Pediatrics, 2020.PMID 31843861
  3. [3]Zubler JM Evidence-Informed Milestones for Developmental Surveillance Tools. Pediatrics, 2022.PMID 35132439
  4. [4]Robins DL Validation of the modified checklist for Autism in toddlers, revised with follow-up (M-CHAT-R/F). Pediatrics, 2014.PMID 24366990
  5. [5]Baker RD Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 2010.PMID 20923825
  6. [6]COUNCIL ON ENVIRONMENTAL HEALTH Prevention of Childhood Lead Toxicity. Pediatrics, 2016.PMID 27325637
  7. [8]Krol DM Maintaining and Improving the Oral Health of Young Children. Pediatrics, 2023.PMID 36530159
  8. [9]Durbin DR Child Passenger Safety. Pediatrics, 2018.PMID 30166367
  9. [10]Sege RD Effective Discipline to Raise Healthy Children. Pediatrics, 2018.PMID 30397164
  10. [12]Gardner HG Office-based counseling for unintentional injury prevention. Pediatrics, 2007.PMID 17200289
  11. [13]Christian CW The evaluation of suspected child physical abuse. Pediatrics, 2015.PMID 25917988
  12. [17]WHO Multicentre Growth Reference Study Group WHO Child Growth Standards based on length/height, weight and age. Acta paediatrica (Oslo, Norway : 1992). Supplement, 2006.PMID 16817681
  13. [18]Aishworiya R Meta-analysis of the Modified Checklist for Autism in Toddlers, Revised/Follow-up for Screening. Pediatrics, 2023.PMID 37203373
  14. [21]Burvenich R Effectiveness of safety-netting approaches for acutely ill children: a network meta-analysis. The British journal of general practice : the journal of the Royal College of General Practitioners, 2025.PMID 39117428
  15. [22]Boylen S Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: a systematic review. JBI evidence synthesis, 2020.PMID 32813387
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