Medical checkup and normal child development Flashcards
What are the medical professionals involved in prophylactic care regarding medical checkup?
Physician, dentist, primary care midwife, school nurse, primary care nurse
What are medical professionals obliged to do regarding medical checkup?
Cooperate, inform parents/caregivers on dates and range of health surveillance visits, and keep records and provide necessary reports
What are the good environmental conditions?
Proper temp and warm hands
How should the patient be examined?
Young child should be dressed naked, older child undressed step by step, and most unpleasant parts of examination should be performed as the last
How is the schedule for surveillance in younger child
1st year: 1st-2nd w, 6-9th w, 9th month, 12th month 2nd-3rd year 4th year 5th year School age: 7y, 10y, 13y, 16y, 19y
What do you check for the first year
1-2nd w: patronage
6th-9th w: examination by physician, vaccination
3rd-4th m: examination by physician, vaccination and nurse patronage
9th m: examination by physician
12th m: examination by physician
2nd-3rd y
24th m: child health surveillance, vaccination
4th y
48th month: child health surveillance
5th y
60th m child health surveillance
Aims of CHS at in any age
- As early as possible detection of deviation in health status and development
- Physical and Psychomotor development
- Behavior evaluation
- Screening for vision, hearing, speech, posture impairment
- Presence og testes in scrotum
- physiological functions
- Family functionality, childs safety, risk of child abuse, rejection/repudiation
- adherance to vaccination schedule
- plan Mx to reduce development gaps
- co-operation w parents and health counseling/education to improve health of a child and family.
Newborn hearing impairment screening
Acoustic otoemission
Assume hearing is normal when
- Speech is developing according to inventory
- Infant respond to noise sound from 1m, eg clapping hands
- 3y/old can point to them objects on whispered commands from 3m
- Child at school age can repeat words, whispered from distance 6m
Risk factors of latent and acquired hearing impairment
- Family history
- Cong. defects of H&N, Down, cleft palate, genetic dis, metabolic dis, hormonal dis
- TORCH inf, meningitis, serious inf, recurrent/chronic otitis media
- Prematurity <33w or bw<1500g
- Mechanical vent/ICU >7d
- APGAR: <4 pts in 1st min or <6pts in 5 min
- Head trauma, acoustic injury, tinnitus, HS to sound(hyperacousis)
- Hearing vision motor coordination
- Ototoxic meds
- Neuro/psycho disorders: CP, MR, autism (?)
- Allergy w URT complications, overgrown tonsils/adenoids, chronic tonsilitis
- Speech disorders requiring specialist
- Jaundice treated w exchange transfusion
Signs of autism
- Hyperactivity/passiveness
- Oversens/undersens to sound
- Strange attachment to objects
- Lack of awareness of danger
- Inappropriate playing w toys
- Inappropriate crying/laughing
- Poor speech, lack of speech
- Difficulty dealing w change in routine
- Inability to relate to others
What are the Mx of autism
Cannot be cured. Effective therapy can reduce symptoms and allow almost normal independent existence, especially in adulthood.
What is lateralization?
Right-handedness and left-handedness
Crossed lateralization can cause…
- Disturbed vision, manual coordination (chaotic handwriting, mirrored single letters, change in order of letters and syllables alongside w correctly written words)
- Disturbed coordination in space: difficulty in pointing left or right direction
- Postural defects
What are the aims in CHS in 6y/old child?
- Physical development (posture, stature, BW, BMI).
- Psychomotor and psychosocial development.
- Arterial BP.
- Oral health, skin, mucoses, heart/lung auscultation, chest percussion.
- Vaccination schedule.
- In boys: testes in scrotum.
- Hearing loss risk factors and speech development. Hearing problems.
- Strabismus, color vision impairment, visual acuity.
- Health school maturity, qualification for range of physical activity in PE classes.
CHS at age 10, 13, 16, 19y
- Check arterial BP
- Thyroid gland
- Sexual maturation
- Possible limitation in future choice of education and profession
- Potential risk of abuse and rejection
- Lack of healthy behavior and presence of risky behavrio: substance abuse, low physical activity, unhealthy diet, not eating breakfast/fruit/vegetables, poor oral hygiene
Potential disturbances in older child CHS
- Eating: overweight, obesity, anorexia, bulemia
- Vision: affects 15-25% of population, refraction errors (nearsightedness/ farsightedness/ astigmatism) and stabismus
- Hearing: 2% of school age children, hearing impairment, tinnitus, sound hyper sensibility
- Motor system and organs: scoliosis, Scheuermanns disease (juvenile kyphosis) static deformations of lower limbs
- Risky behavior: HIV, STD, substance and illicit drug abuse
What information from parents
Parent and caregiver. Past medical conditions, hospital stays, injuries, surgical Tx, current medication, prophylactic measures (rickets) . Evaluate S&S, risk factors concerning family and social environment (substance abuse in family, unemployment, poor living conditions). Diet and eating habits: regularity of meals, snacks, elimination diets.
What are the sources of information
A. Parents
B. School nurse (screening), midwife, nurse
C. Prophylactic chart filled out by school nurse, teacher
D. Childs medical record (booklet, vaccination chart, discharge letters from hospital, records in GP office)
E. medical examination
What is school maturity?
A state of balance btw school requirements and childs ability in physical development, mental development and socio/emotional development.
School maturity evaluation of 6y old
Strabismus, visual impairment (amplyopia). Recurrent resp tract inf. Behavioral disorders, neurosis (nocturnal enuresis, stuttering, phobias). Hyperactivity or psychomotor inhibition. Low genral agility and poor manual skills. Disturbed lateralization. Unable to cooperate with peers.
