Toddlers typically learn bowel control before bladder control, with boys often taking longer to complete toilet training than girls. Readiness to begin toilet training depends on the individual child. In general, starting before age 2 (24 months) is not recommended. The readiness skills and physical development the child needs occur between age 18 months and 2.5 years.

Option A: Many children are not trained until 36 months and this should not cause concern. Later training is rarely caused by psychological factors and is much more commonly related to individual developmental maturity. Timing is important. Toilet training should not be started when the child is feeling ill or when the child is experiencing any major life changes such as moving, new siblings, new school, or new child-care situation.
Option B: Bowel control is first achieved before bladder control. Start a routine with regular reminders beginning with one time a day—after breakfast or maybe at bath time when the child is already undressed. Watch for behavior, grimaces, or poses that may signal the need for a bowel movement, and ask the child if he or she needs to go.
Option D: Reprimanding the child will not speed the process and may be confusing. Accidents are common and should be expected in the training process. Praise the child whenever he or she tells you that he/she needs to go and when the child tells you without being reminded.

Babies and toddlers should not fall asleep with bottles containing liquid other than plain water due to the risk of dental decay. Wean one ounce a night. Let’s say the child takes three 4 oz bottles a night. Take the last bottle and reduce it by an oz on night one. On night 2, reduce bottle 2 by 1 oz. On night 3 reduce Bottle #1 by 1 oz. When a bottle gets down to 2 oz, substitute a bottle of water. After this step, get rid of the bottle. Don’t ever wake up the child if they sleep through a feeding– that is the goal.

Option A: If they skip a feeding one night but wake up the following night for that feeding, it is OK to give them the scheduled bottle. Limit the water bottles to 2 oz, simply to reduce the amount of urine produced and wet diapers to deal with. If the child doesn’t want the water, that is fine. But don’t give in and give the milk.
Option B: Sugars in juice remain in the mouth during sleep and cause caries, even in teeth that have not yet erupted. Make slow incremental changes over time. These changes are relatively easy to make and the child will tolerate them well.
Option D: The child could have a bottle of water in the crib with close supervision. Bottle fed infants typically can wean off night feeding by 6 months of age. Breast fed infants tend to take longer, up to a year of age. The American Academy of Pediatrics recommends exclusive breastfeeding for six months, with the addition of complementary foods continuing up to a year, or longer “as desired by mother and infant”. It’s important to note that night weaning can lead to weaning altogether.

Infants under 6 months may not be able to sleep for long periods because their stomachs are too small to hold adequate nourishment to take them through the night. After 6 months, it may be helpful to let babies put themselves back to sleep after waking during the night, but not prior to 6 months. By 6 months of age, most babies are physiologically capable of sleeping through the night and no longer require nighttime feedings. However, 25%-50% continue to awaken during the night. When it comes to waking during the night, the most important point to understand is that all babies wake briefly between four and six times. Babies who are able to soothe themselves back to sleep (“self-soothers”) awaken briefly and go right back to sleep.

Option A: Infants should always be placed on their backs to sleep. Research has shown a dramatic decrease in sudden infant death syndrome (SIDS) with back sleeping. Babies should always sleep Alone, on their Backs, in a Crib. Place your baby on his or her back for every sleep, night time and nap time. Do not put your baby to sleep on his side or tummy. Once your baby can roll from his back to tummy and tummy to back, your baby can stay in the sleep position that he assumes. But always place your baby to sleep on his back.
Option C: Eye contact and verbal engagement with infants are important to language development. Establish a consistent bedtime routine that includes calm and enjoyable activities that you can stick with as your baby gets older. Examples include a bath and bedtime stories. The activities occurring closest to “lights out” should occur in the room where your baby sleeps. Also, avoid making bedtime feedings part of the bedtime routine after 6 months.
Option D: The best diet for infants under 4 months of age is breast milk or infant formula. The American Academy of Pediatrics recommends exclusive breastfeeding for about 6 months, and then continuing breastfeeding while introducing complementary foods until the child is 12 months old or older. This provides the child with ideal nutrition and supports growth and development.

A daily bowel movement is not necessary if the patient is comfortable and the bowels move regularly. Moderate exercise, such as walking, encourages bowel health, as does generous water intake. A diet high in fiber is also helpful. Check on the usual pattern of elimination, including frequency and consistency of stool. It is very crucial to carefully know what is “normal” for each patient. The normal frequency of stool passage ranges from twice daily to once every third or fourth day. Dry and hard feces are common characteristics of constipation.

Option A: Urge patient for some physical activity and exercise. Consider isometric abdominal and glute exercises. Movement promotes peristalsis. Abdominal exercises strengthen abdominal muscles that facilitate defecation.
Option B: Encourage the patient to take in fluid 2000 to 3000 mL/day, if not contraindicated medically. Sufficient fluid is needed to keep the fecal mass soft. But take note of some patients or older patients having cardiovascular limitations requiring less fluid intake.
Option C: Assist the patient to take at least 20 g of dietary fiber (e.g. raw fruits, fresh vegetable, whole grains) per day. Fiber adds bulk to the stool and makes defecation easier because it passes through the intestine essentially unchanged.
Option D: Laxatives should be used as a last resort and should not be taken regularly. Over time, laxatives can desensitize the bowel and worsen constipation. The use of laxatives or enemas is indicated for short-term management of constipation.
Option E: Protein-rich foods could cause constipation. A balanced diet that comprises adequate fiber, fresh fruits, vegetables, and grains. Twenty grams of fiber per day is suggested. A regular period for elimination and an adequate time for defection. Successful bowel training relies on routine. Facilitating regular time prevents the bowel from emptying sporadically.

Rheumatic fever is caused by an untreated group A B hemolytic Streptococcus infection in the previous 2-6 weeks, confirmed by a positive antistreptolysin O titer. ASO is a test used to detect streptococcal antibodies directed against streptococcal lysin O. An elevated titer is proof of a previous streptococcal infection. It is usually more elevated after a pharyngeal than skin infection, while the ADB is typically elevated regardless of the site of the infection.

Option A: Rheumatic fever is characterized by a red rash over the trunk and extremities. The individual lesions of erythema marginatum are evanescent, moving over the skin in serpiginous patterns. Likened to smoke rings, they have a tendency to advance at the margins while clearing in the center.
Option B: Although estimates vary, only 35%-60% of patients with rheumatic fever recall having any upper respiratory symptoms, most commonly, sore throat, in the preceding several weeks. Studies in developed countries have established that rheumatic fever followed only pharyngeal infections and that not all serotypes of group A streptococci cause rheumatic fever.
Option D: Other symptoms of rheumatic fever include fever. The average duration of an untreated ARF attack is 3 months. Chronic rheumatic fever, generally defined as disease persisting for longer than 6 months, occurs in less than 5% of cases.