NR 602 Week 5 Anticipatory Guidance Handout Example

Anticipatory Guidance Handout: For the Family of a 15-Month-Old, Covering 15 to 18 Months in Four Topics, With a Separate Rationale for the Instructor

Student Name

College of Nursing, Chamberlain University

NR 602: Primary Care of the Childbearing and Childrearing Family Practicum

Instructor Name

Month Day, Year

Anticipatory Guidance Handout: For the Family of a 15-Month-Old, Covering 15 to 18 Months in Four Topics, With a Separate Rationale for the Instructor

Part 1: The Handout

Your Child From 15 to 18 Months

For M.O.'s family

In the next three months, your child will start walking well, climbing, saying more words and wanting to do things alone. Here are four things to do.

Food and milk

- Give milk in a cup, not a bottle. Stop the bedtime bottle this week.

- Keep milk to 2 or 3 cups a day (16 to 24 ounces). More milk means less appetite for food.

- Offer food first at meals, then milk.

- Give iron drops every day, as we showed you.

- Eat together at the table, three meals and two snacks a day.

Car seat

- Keep the car seat facing backward. Leave it that way until your child outgrows the seat's rear-facing weight or height limit, which for most children is well after the second birthday.

- Buckle the harness snugly every ride. You should not be able to pinch any slack at the shoulder.

Climbing and medicines

- Lock away all medicines, including vitamins and iron drops. Iron is dangerous if a child swallows a lot.

- Put cleaning products up high or behind a locked door.

- Anchor bookcases and dressers to the wall.

- Save the Poison Help number in your phone: 1-800-222-1222.

Sleep

- Keep the same bedtime routine every night: bath, book, bed.

- Put your child to bed sleepy but awake.

When to call us

Phone us that same day if your child:

- has a fever and won't drink, or has made only one or two wet diapers all day;

- is very sleepy and hard to wake;

- swallowed something and you are not sure what or how much (call Poison Help first);

- stops using words they used before, or stops looking at you when you say their name.

Call 911 if your child is having trouble breathing, has a seizure or cannot be woken.

Next visit: 18 months. We will weigh your child, check development and give vaccines.

Part 2: Rationale for the Instructor

Why this age window. Anticipatory guidance covers the months ahead, not the visit just finished. Between 15 and 18 months, toddlers walk and climb, reach higher surfaces and become able to open containers, which raises the risk of poisoning and furniture tip-overs; Bright Futures guidance for the 15- and 18-month visits places safety, feeding and sleep among its priorities (Hagan et al., 2017).

Why only four topics. A handout covering everything is read as covering nothing. The topics were chosen for this family: milk and iron because M.O.'s weight has fallen across two percentile lines with excess milk intake and a low hemoglobin; car seats because the family asked about turning the seat forward at the 1-year birthday; medicines and climbing because iron drops have just been started and are a poisoning risk; and sleep because the bedtime bottle is part of the milk problem.

Milk. Intake above about 24 ounces a day in toddlers displaces iron-containing foods and is associated with iron deficiency (Baker & Greer, 2010). The handout states the limit in cups and ounces because the family measures in bottles.

Car seats. Current pediatric policy keeps toddlers facing backward until they outgrow the seat's own backward-facing limits, with no fixed age for turning them around (Durbin & Hoffman, 2018). The family's plan to turn the seat at 1 year is addressed directly.

Iron poisoning. Iron supplements are a common cause of serious poisoning in young children; starting iron drops creates a new risk in the home, so the safety section names them specifically.

When to call. The return criteria cover the illnesses most likely in this window, dehydration with fever, and repeat the developmental warning signs so that a family notices a loss of skills between visits.

Reading level. The handout was checked at about a sixth-grade reading level, uses "you" and "your child" and avoids medical terms. The parent read it in clinic and was asked to say back, in their own words, what to do about milk; the answer was correct.

Language. The family speaks English at home, and the parent reads comfortably; a Spanish version was not needed, but the clinic has one. Delivery. The handout was reviewed line by line with the parent in the room, not handed over at the door, and a copy was sent through the patient portal. Format. The handout fits on one page, printed in a 14-point font, with headings the family can scan. What was left out. Toilet training, discipline and screen time are important at this age but were left for the 18-month visit to keep the handout short.

References

Baker, R. D., Greer, F. R., & Committee on Nutrition. (2010). Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 126(5), 1040-1050. https://doi.org/10.1542/peds.2010-2576

Durbin, D. R., Hoffman, B. D., & Council on Injury, Violence, and Poison Prevention. (2018). Child passenger safety. Pediatrics, 142(5), e20182460. https://doi.org/10.1542/peds.2018-2460

Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.