Assessment & Testing Of Infant & Child Development Flashcards
Name 3 criteria neonatal babies must meet prior to neurological assessment:
Needs to be able to tolerate gentle handling, Be in a calm alert state, on room air/ in open crib (modified assessment done when baby is on ventilator)
What do parents need to know on initial assessment?
Typical developmental milestones and newborn behaviors, Kangaroo Care, proper positioning
Proper positioning of neonatal baby:
Prone is best. Neutral head & neck position w/ slight chin tuck and slightly to the side. Scapular protraction to promote UE flexion & hands in midline. Trunk flexion w/ pelvic tilt, flex LE w/ neutral AB/Adduction
Define gestational age. Define AGA, LGA, SGA.
Gestational age: length of time baby was in the womb. AGA, LGA, & SGA: appropriate, small or large for gestational age
Define NBW, LBW, MLBW, VLBW, ELBW
NBL, LBW, MLBW, VLBW, ELBW: normal, low, moderately low, very low and extremely low birth weight
Define APGAR
Scoring system to evaluate the physical condition of newborns. APGAR: Appearance, Pulse, Grimace, Activity, Respiration; recorded at minute 1 & 5, higher number is better (8-10 is typical for healthy newborns); 6 is typically acceptable. Review test on pages 123-125 in book.
Define radiant warmer:
A type of incubator used to for babies who are very unstable or extremely premature to keep them warm
Define isolette:
An enclosed incubator where you can access infant through side port holes; keeps away sound and light.
Define nasal cannula:
Define CPAP:
Nasal cannula: Humidified gas delivered via flexible tubing inserted into nose
CPAP: Used to prevent alveolar and airway collapse, and to treat respiratory distress syndrome.
Define ECMO
Extracorporeal membrane oxygenation: heart-and-lung bypass procedure involving draining venous blood, supplementing it w/ O2, and removing CO2. Returns blood to either venous or arterial circulations.
Purpose of phototherapy
Used to reduce jaundice
Gavage or G-tube
Oral or nasogastric tube used for feeding directly into the stomach. Transpyloric tubes used when infants are at risk for aspiration
PICC
Long catheter inserted into a peripheral vein and threaded to superior vena cava. Used for prolonged parental feeding, antibiotics, or to draw blood.
Define Respiratory Distress Syndrome and list symptoms
Insufficient surfactant production & structural lung immaturity.
Symptoms: increased RR, intercostal retractions, nasal flaring, cyanosis
What is respiratory distress syndrome indicative of?
insufficient surfactant production & structural immaturity of lungs
What is the role of surfactant in infants?
prevents collapse of air space (future site of alveolar development
Symptoms of RDS
increased RR, intercostal retractions, nasal flaring, cyanosis
Patent Ductus Arteriosus (PDA)
When ductus arteriosus doesn’t close
When does ductus ateriosus usually close?
10-15 hours after birth
symptoms of PDA
murmur, increased HR, respiratory distress, failure to gain weight
Hyperbilirubinemia or “jaundice”
build of bilirubin in blood by immature liver function
symptoms of hyperbilirubinemia
dec level of arousal & activity, lethargy, hypotonia, poor sucking ability; alters visual, social-interactive and neuromotor abilities
Gastroesphageal Reflux (GER)
movement of gastric contents into esophagus and above
What does frequent GER lead to?
inflammation of esphogas & lead to poor oral feeding patterns
symptoms of GER
irritability, extension and arching of trunk to R
Necrotizing Entercolitis (NEC)
acute inflammation of immature intestines causing necrosis
risk of developing NEC is doubled with
prenatal cocaine exposure
symptoms of NEC
abdominal distention & vomiting
most common type of brain lesion in premature infants
Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)
What happens when GM-IVH extends it damage to the periventricular white matter?
significant neurological issues including CP, mental retardation, and seizures
Periventricular Leukomalacia (PVL)
Death of small areas of brain tissue around ventricles. The damage creates “holes” in the brain.
spastic diplegia
form of CP condition of hypertonia & spasticity- high constant tightness or stiffness in muslces of LEs
Premies with PVL are at high risk for developing what complications & conditions?
motor, visual, & cognitive functions; spastic diplegia, hyrdocephalus
Retinopathy of Prematurity
abnormal BV development in retina of eye
symptoms of Retinopathy of Prematurity
abnormal eye movements, crossed eyes, severe nearsightedness, white looking pupils
What are the effects of cocaine during the prenatal period?
uterine contractility, maternal hypertension, placental vasoconstriction and decreased uterine blood flow
symptoms of prenatal drug exposure
congenital anomalies, abnormal sleep patterns, tremors, poor organized response, irritability and inability to be consoled.
most common cause of preterm labor
chromioamnionitis
Chorioamnionitis
Bacteria invades amniotic cavity causing an inflammatory response
Chorioamnionitis babies at risk for
neurological impairments and brain damage
80% of bone produced between..
24-40 weeks
Large amounts of calcium and magnesium delivered in which trimester?
3rd/last trimester
full term babies in cramped uterus receive what bone density effects?
mechanical stimulation of bones–> bone growth
bone formation can be promoted by what intervention?
PROM
Most common chronic lung disease associated with prematurity
Bronchopulmonary Dysplasia (BPD)
greatest contributing factor for BPD
under-developed lungs
symptoms of BPD
bluish skin, rapid breathing, shortness of breath
Assessment / Intervention tips for BPD
- Be very cautious of symptoms of distress during assessment
- Decrease stimulation in environment
- Position child to support respiration
- Use gentle handling and mobilization techniques
- May need to provide scar massage
- Develop activities into routines and play times
What is always the first priority in assessment/intervention for BPD?
BREATHING
Congenital Diaphragmatic Hernia
Congenital malformation of the diaphragm
Congenital diaphragmatic hernia has a high incidence of..
sensorineural hearing loss, GER, failure to thrive, feeding problems, developmental delay, seizure and scoliosis
What are signs of Stress in an infant?
Skin is pale, mottled, cyanotic, gray, flushed Glassy eyes, gaze aversion, staring Grasping for air Grimacing, fussing, irregular breathing Fluctuating muscle tone Flaccidity or hyper-tonicity Frantic movements
What are things that you can do to minimize stress in the NICU?
Decrease noise/light
Minimize handling
Protect sleep states
Help parents understand behavior al cues
Promote relationship-based caregiving (skin-to-skin if possible)
Autonomic and motor subsets are foundational for ability to achieve state and attention
What can you do when families are in cricis and grieving
- Facilitate bonding process
- Reflect family’s and child’s strengths
- Use baby’s name
- Provide info that is consistent and sensitive
What does a preterm infant present with compared to a full term?
- Hypotonia
- Decreased flexor tone
- Decreased extension and head control
- Increased PROM and AROM
- Increased reactivity and startle response
- Former pre-terms may also demonstrate toe walking (have lots of room in uterus to move and not squished)
What is the evolution of Tone, Reflexes and MSK Development–When do a lot of changes happen, When does development start to slow
Sequential pattern: LE to UE, Distal to Proximal
20-26 weeks many changes happen quickly
By 32 weeks, development slows; preterm infant after 32 weeks looks more like term infant
What are some environmental and behavioral strategies for pain reduction?
- Dim lights/shade eyes
- Reduce noise
- Reduce frequency of handling
- Swaddle
- Non-nutritive sucking
- Kangaroo Care (skin to skin)
- Facilitated tucking (prone, midline and flexion with head slightly turned)
- Try to mimic uterus as much as possible!
What is our biggest sensory organ
Skin
What are examples of the tactile system
Skin
Pain, proprioception, temp, and touch
*Think 2P’s and 2T’s
When do pain receptors develop?
At 7 weeks gestational age: pain receptors first appear around mouth
At 22 weeks: pain pathways are myelinated
At 134 weeks: painful procedure in the first 2 weeks of life
Describe the Vestibular System
At 20 weeks: vestibular nerve is full-size and tracts have begn to myelinate
Womb provides constant vestibular stimulation
What are the different vestibular stimulations known to enhance states of arousal? (slow and rhythmic vs. fast and erratic)
slow and rhythmic=calming
fast and erratic=stimulating
Describe the Olfactory and Gustatory Development
- Able to smell at 28 weeks
- taste buds mature at 13 weeks
- from 24 weeks until term, fetus swallows 1L of amniotic fluid/day
- Preterm infant has g-tube and no practice swallowing making coordination of SSB (suck, swallow, breathe) difficult
Auditory Development
At 28 weeks GA: able to hear 40 dB
Normal convo: 60 dB
NICU: noise not exceed 45
Noisy NICU may cause cochlear damage as well as sleep disturbances, disrupting growth
What is normal auditory conversation? in dB?
60
At what level does NICU recommend the level of sound?
Not exceed 45 dB
Visual Development
23-24 Weeks: major eye structure and visual pathways in place
24 weeks to term: retina and visual cortex maturing
24-28 weeks: eyelids separate
34 weeks: pupillary reflex present
32 weeks: percieve 1/2” stripes at 12 in
What are the 6 states ofNeonatal behavioral Assessment? (according to Brazelton)
State 1: Deep sleep, w/o movement, breathing regularly
State 2: Light sleep, closed eyes, some corporal movement
State 3: sleepy, eyes opening and closing
State 4: awake, opened eyes, minimum corporal movement
State 5; completely awake, strong corporal movement
State 6: Cry
Omphalocele
birth defect; intestine or other abdominal organs stick out of belly button; intestines only covered by small layer of tissue
Gastroschisis
birth defect; intestines stick out of body through defect on one side of umbilical cord
Tracheal Esophageal Fistula (TEF)
abnormal connection (fistula) b/w esophagus and trachea; g-tube needed during healing after surgery
Asphyxia
lack of oxygen to organs; handle baby with care; intent is to minimize stress and avoid sensory overload
Seizues
difficult to recognize and Dx; usually manifests as chewing, lip smacking, sucking, apnea, gaze abnormalities
Medical issues in term/near term infants
Maconium aspiration syndrome; persistent pulmonary HTN of the newborn; infections; toxoplasmosis; Rubella; cytomegalovirus; Herpes simplex virus; HIV; Group B strep; fetal alcohol syndrome (FAS); Neonatal abstinence syndrome
Brachial Plexus Injury
waiter’s tip position (shoulder add and IR, elbow ext, forearm pronation, flex wrist and fingers); nerves stretched during birth; 80% spontaneous recover in first 2 months; Tx: PROM, prevent contractures, promote AROM, strengthening
Congenital Hip Dysplasia
unstable hip d/t abnormal formation of hip jt during early stages of fetal development; Ortolani test and Barlow test; tests only accurate prior to 3 months; 95% success rate with Pavlik harness if started before 7 wks
Ortolani Test
hip is abd, examiner feels clunk as femoral head moves into socket
Barlow Test
from flex and abd position, the hip is add while applying pressure in posterior direction; dislocation of femur indicates unstable hip
Metatarsus Adductus
front of foot is bent or angled in toward middle of foot, back of foot and ankle are normal; can be treated with passive stretching, taping, corrective shoes, bracing or serial casting depending on severity
Talipes Equinovarus (club foot)
affected foot appears to have been rotated internally at ankle; without tx- often appear to walk on their ankles or on side of feet; with tx- most recover completely during early childhood; Tx- serial taping and casting, splints
Arthrogryposis
congenital joint contractures in 2 or more areas of body; goal of functional ROM; Tx- serial casting, splinting, stretching, surgery
Interventions for orthopedic issues include
ROM- indicated for stable infants w/ loss of motion; taping- improve jt alignment in wrist/foot drop, club foot, not for infants
When does discharge planning begin?
1st day the child is admitted to NICU
What will qualify infant to transition home?
Weight gain pattern, normal body temp in open air, oral or tube feeding, no episodes of apnea or bradycardia in 5 days
When does NICU follow-up begin?
at 4 months AA
How often do follow-ups occur?
every 3 months for 1st year; every 6 months for 2nd year; annually until child goes to school
4 reasons for developmental testing?
- Early identification of delays
- Help determine diagnosis
- Facilitate treatment planning (where to begin)
- Re-testing provides concrete data about progress
4 methods of developmental testing?
- Parent/Child Interview
- History (review of med records)
- Clinical Observation (in child’s natural environment)
- Standardized tests
What do Norm-Referenced or Standardized Tests compare?
compare one child with the “norm” of a group of other children
What 4 things should guide your decision of which test to choose?
- Purpose of the test - diagnose, research, plan program
- Child - age, presenting limitations/disability, suspected dx
- Concerns to be addressed - gross/fine motor, speech, strength, functional tasks
- Examiner constraints - time, training, space, equipment, cost
When would you use a screening test? Examples?
To identify typical and atypical development and need for further assessment
- Denver II
- Harris Infant Neuromotor Test (HINT)
- Bayley Infant Neurodevelopental Screener (BINS)
What are the tests that specifically examine motor function?
- Test of Infant Motor Performance (TIMP)
- Alberta Infant Motor Scale (AIMS)
- Gross Motor Function Measure (GMFM)
- Peabody Developmental Motor Scales: 2nd Ed. (PDMS-2)
- Bruininks-Oseretsky Test of Motor Proficiency: 2nd Ed. (BOT-2)
When would you use comprehensive developmental scales? Examples?
When you want to look at the child across all areas of development.
- Bayley Scales of Infant and Toddler Development: 3rd Ed. (Bayley-III)
- Battelle Developmental Inventory: 2nd Ed (BDI-2)
When would you use an assessment of functional capabilities? Examples?
These tests look at the child’s ability to perform skills that are essential in their natural environment.
- Pediatric Evaluation of Disability Inventory (PEDI)
- Functional Independence Measure for Children (WeeFIM)
- School Function Assessment
What are 4 things you can do with the info gathered from the eval?
- Plan treatment program
- Identify progress/lack of progress
- Identify or rule out a specific problem
- Provide diagnostic information
When did early intervention programs emerge and board certified sub specialty of neonatology?
1970s
When were states required to provide early intervention under Education for All Handicapped Children Amendments?
1986
Describe the 4 levels of Newborn Intensive Care?
- Basic care facility for healthy newborns
- Additional personnel, able to care for infants from 32 weeks, short-term respiratory assistance, some mechanical ventilation
- Full range of subspecialties and surgical services
- > 1000g or >28 weeks
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- > 1000g or >28 weeks
