Module One:Physical and Developmental Assessment of the Child
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Resources for Module #1 혰 This slide deck 혰 Multiple Slide decks on growth and development that you
were required to review from our 1st clinical-listed under Lesson Tab Week 1. 혰 Your book, especially the charts with G&D specifics. 혰 Our discussions in class.
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Principles of Growth & Development Growth is in increments, replacement, hyperplasia
& hypertrophy Development is orderly, patterned & predictable Proximodistal- center – out word Cephalocaudal – head to tail General to specific
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— Growth & development are affected by both genetic make-up
and environment — Rate of achievement in one area may not be parallel in another
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Who and/or what influences a child’s growth and development? Parents Caregivers Teachers Peers Extended Family Community Media Heredity Environment
Factors that may affect G & D High Risk Children Chromosomal abnormalities Chronic disease
Environmental risk Poverty, culture Overpopulation Maternal mental health issues
Biological risk Heredity, maternal illness, malnutrition Prenatal exposure to drugs/alcohol LBW/prematurity Image retrieved from http://www.thepregnancyzone.com/wp-content/uploads/2013/03/Signsof-Chromosomal-Abnormalities-in-Fetus.jpg on May 18, 2015
Principles of Development Development is orderly, not random. Development is a continuous and gradual process. Development is most rapid during the early stages of
infancy and the adolescent years. Not all children develop at the same pace. Not all children possess the same temperament. Development occurs within a larger context. Development is a multi-faceted concept.
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Developmental milestones
Gross motor: using large groups of muscles to sit, stand, walk, run, etc., keeping balance, and changing positions. Fine motor: using hands to be able to eat, draw, dress, play, write, and do many other things. Language: speaking, using body language and gestures, communicating, and understanding what others say. Cognitive: Thinking skills: including learning, understanding, problem-solving, reasoning, and remembering. Social: Interacting with others, having relationships with family, friends, and teachers, cooperating, and responding to the feelings of others.
Psychosocial developmental Theories
Erikson…. The most acceptable theory of personality development. It emphasizes on a healthy personality as opposed with
pathologic conditions, each stage can not be accomplished unless the previous one attained .
Toddler: 1-3 years —
Erikson: Autonomy vs Shame & Doubt Psychomotor skills: Gross to fine Egocentric, no right/wrong Wants independence but fears separation
Health Concerns: Accidents (ingestion of poison, drowning), ear and upper respiratory infections
Pre schooler: 3-6 years — Erikson: Initiative vs Guilt
lower physical growth with increased muscle coordination Concrete thinking: Ask "why?" Fear bodily harm Pretend play: Parallel to cooperative Health Concerns: Accidents, speech disorders
School-age: 6-11 years — Erikson: Industry vs Inferiority
Fine tuning of body systems Intense cognitive development Moving toward abstract thinking Developing problem solving: "What if?" Independence: same sex peers Developing moral code: Right/Wrong Health Concerns: Accidents, learning disabilities, infectious disease, cancer
Adolescence: 13-21 years — Erikson: Identity vs Role Confusion
Sexual maturation: Primary and secondary sex characteristics Logical decision-making Internalized moral code Need close peer relationships Health Concerns: Accidents, substance abuse, pregnancy, STDs, eating disorders
General Approaches Toward Examining the Child Head-to-toe sequence for assessing adult clients
Sequence for pediatric assessments
generally altered to accommodate child’s developmental needs
Stage
Erikson
Infancy
Trust vs mistrust Toddler Autonomy vs shame and doubt Early childhood Initiative vs guilt Middle childhood Adolescence
Industry vs inferiority Identity vs role confusion
Outcome Optimist Self control and self power Direction and purpose competence Devotion and fidelity .
Cognitive development theory (PIAGET) It’s a thinking theory . Intelligence enables individuals to make adaptations to the
environment that increase the probability of survival and maintain equilibrium.
AGE
PIAGET
Birth to 2 years
Sensorimotor
2 - 4 years
Preoperational thoughts Transduction reasoning (specific to specific).
4 - 7 years
Preoperational thoughts, intuitive , deductive phase (general to specific).
7-11 years
Concrete operations, inductive reasoning and beginning logic.
11-15
Formal operations , deductive reasoning
Developmental Assessment Screening procedures/tools 혰 To identify children whose developmental level is below normal for chronologic age and who therefore require further investigation 혰 Ages & Stages include 19 age-specific surveys that ask parents about developmental skills common in daily life. It has been used successfully throughout North Carolina in the ABCD Project (PEDIATRICS Vol. 118 No. 1 July 2006, pp. e183-e188). 혰 The Child Developmental Inventories are included in this list as their validity is comparable to that of other tools. They are less widely used, likely due to the time commitment required by both parents (30 minutes) and providers (10 minutes). However, for some practices they may be a good fit. 혰
— The Denver II Test uses both parent observation and
direct observation and has long been the standard for developmental screening. It is available in English and Spanish and covers children 2 weeks to 6 years of age, but only up to 50% of those with developmental needs will be identified. Most children (up to 99%) who have no needs will pass, so the false positive rate is low. For the complete test, 20 minutes is required. Many items are required for the Denver to be completed, which may be difficult to maintain and access in a busy practice.
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There is no single scoring method yielding adequate
sensitivity and specificity. If "no opportunity" is scored as a fail, most affected children will be referred but with substantial over-referrals. If "no opportunity" is scores as a pass, then over-referrals are minimized but many children with needs will be missed.
A Child Development Review-Parent Questionnaire is also
available; 32 questions require 10-20 minutes to complete. The PEDS consists of ten “carefully constructed” questions targeting parental concerns. It is designed to detect children eligible for special education. The same form is used for all age ranges and it is available in several languages. Parents can complete the form in five minutes and it takes providers two minutes to complete scoring and interpret the results.
Denver Developmental Screening Test II AKA “Denver II” Widely used, standardized measures
Examiners must be specifically trained and certified
in use of the tools Interpretation of test Recommendations/referrals The following are two examples of using the DENVER II http://www.youtube.com/watch?v=xZ3FRBb9FFk https://www.youtube.com/watch?v=oBAE5XJtM1U
Goals of Pediatric Assessment Minimize stress and anxiety associated with assessment
of various body parts. Foster trusting nurse-child-parent relationships. Allow for maximum preparation of child. Preserve security of parent-child relationship. Maximize accuracy of assessment findings.
Preparation of the Child Child’s perception of painful procedures Cooperation usually enhanced with parent’s presence Age-appropriate techniques
Physical Examination Growth measurements Recumbent length for infants up to age 36 months + weight and head circumference Standing height + weight after age 37 months Plot on growth chart By gender and prematurity if appropriate <5th or >95th percentile considered outside expected parameters for ht,
wt, head circ.
Physical Assessment General appearance and behavior
Facial expression Posture/movement Hygiene Behavior Development: grossly fits the guidelines for age
Physical Assessment
Skin, hair, nails Head, neck, lymph nodes; fontanels Eyes, nose throat…look at palate and teeth Chest: auscultate: lungs and heart sounds Breasts (Tanner’s scale) Abdomen Genitalia: (Tanners Scale) Musculoskeletal: (Ortaloni maneuver) Feet/legs/back/gait
Tanner Scale of Development
Growth and Development Â&#x2014; Follow this link for an interactive lesson on growth and development in
children http://www.wisc-online.com/Objects/ViewObject.aspx?ID=NUR3303
A few electronic Resources AAP Childrens Health topics: Developmental stages:
http://www.aap.org/healthtopics/stages.cfm
National Dissemination center for children with disabilities
http://nichcy.org/disability/milestones
CDC- learn the signs and act early… http://www.cdc.gov/ncbddd/actearly/index.html