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.
PE w bronchial asthma
B, C
Healthy PE
A
Healthy, attending additional sport trainings in school sport club PE
As
Wearing glasses bc of vision errors PE
B, Bk, C or C1
W shorter one limb PE
B, Bk
W Down sd PE
B, Bk
W DM PE
B, C, Cr
W allergy to dust mites PE
B, C
W speech problems PE
B
What are the aim of evaluation of newborn through interview and PE?
- Psychoemotional well being of the family
- Newborns behavior
- Breastfeeding
- Somatic status of the newborn
- Neurological development of the newborn
- Development of vision and hearing
- Socio-economic conditions
- Disease burden in the family
1st parental counseling should consist of
- Detailed and clear summary of PE, explanation of disturbing signs, abnormal behavior (stool frequency, regurgitation, skin care)
- Loss of body weight reassurance
- Centile chart discussion
- Navel/cord stump hygiene
- Directions for VitD supplementation
- Counseling on safety issues: SIDS, falls, aspiration
- Healthy eating in breastfeeding women, lactation consultation
- Explain conditions for earlier appointments
- Info on vaccination schedule
0-2 years, sensorimotor stage
- We exist only here and now
- Coordinationg experiences: vision, hearing w physical interactions w objects
- Fear of pain, being abandoned by parents
- Careful observation of metacommunication
3-6 years, pre operational stage
- Domination of egocentricity, irreversibility, magical and symbolic thinking
- Immannet justice, breaking rules always effects in punishment ( triggering ideal behavior or stubbornness, inobediance, anger)
- Fear of pain, being abandoned by parents
- Careful observation of metacommunication
7-11 years, concrete operational stage
- Simple cause - effect relations (illness = bacteria)
- Fantasizing mind, lack of information
- Regression
- Verbal and physical aggression
> 12 y, formal operational stage
- Ability for hypothetical and abstraction thinking
- Will be involved in decision making, responsibility, fulfilling needs of others
- Conflicts w adults, internal isolation
- Testing forbidden / illegal / illicit active substances
- Appareance and physical agility very important
What are the gross motor development of newborn and 6-8w?
Newborn: Limbs flexed, symmetrical posture, marked lag on pulling up
6-8w: Raises head to 45 degrees in prone
What are the gross development of 6-9m?
6m: Sits w/o support w round back
8m: sits w straight back
8-9m: crawling
What are gross motor development at 10, 12 and 15 months?
10m: Stands independently, cruises around furniture
12: Walks unsteadily, broad gait, hands apart
15: Walks steadily
What are the limit age for head control?
4m
What are the limit age to sit unsupported?
9m
What are the limit age for standing w support?
12m
What are the limit age to walk independently?
18m
How is the normal gross motor development?
1) Acquisition of tone and head control
2) Primitive reflexes disapear
3) Sitiing
4) Locomotor pattern
5) Standing, walking, running
6) Hopping, jumping, peddling
How is the vision and fine motor development
1) Visual alertness, fixing and following
2) Grasp reflex, hand regard
3) Voluntary grasping, pincer, points
4) Handles objects w both hands, transfers from hand to hand
5) Writing, cutting, dressing
How is vision and fine motor development at 6w?
Follows moving object or face by turning the head
Vision and fine motor development at 4-10 months
4m: Reaches out for toys
4-6m: Palmar grasp
7m: transfers toys from one hand to another
10m: mature pincer grip
How are drawing ability from 16m - 5y?
16-18m: makes marks w crayon 2y: make a line 3y: make a circle 4y: make a square 5y: make a triangle (ability to draw w/o seeing how it is done. Can copy 6m earlier)
How are ability to make towers from 14m -4y?
18m: Tower of three
2y: Tower of six
2,5y: Tower of eight or a train w four bricks
3y: Brigde (from a model)
4y: Steps
Limit age for fixes and follows visually
3m
Limit age reaches objects
6m
Limit age for transfers objects
9m
Pincer grip limit age
12m
How is the hearing and speech development?
1) Sound to recognition, vocalization
2) Babbling
3) Single words, understands simple requests
4) Joining words, phrases
5) Simple and complex conversation
Hearing, speech and language in newborn
Startles to noises
H/S/L development in 3-4m
Vocalises alone or when spoken to, coos and laughs
H/S/L in (6) 7- 12 m
(6) 7m: Turns to soft sounds out of sight
7m: Sounds used indiscriminately
10m: Sounds used discriminately to parents
12m: Two three words other than mama or dada
H/S/L in 18m - 3y
18m: 6-10 mords, show two parts of the body
20-24m: Joins two or more words to make simple phrases
2,5-3y: Talks constantly in 3-4 words sentences (push me fast dady)
What is limit for polysyllabic babble?
7 m
Limit for consonant bable
10m
Limit for saying 6 words w meaning
18m
Limit for joining words
2y
Limit for 3-word sentences
2,5y
How is the social/ emotional / behavior development?
1) Smiles
2) Fear of strangers
3) Feeds self/spoon
4) Symbolic play
5) Interactive play
What is S/E/B development at 6w
Smiles responsively
What is S/E/B development at 6-18m
6-8m: Puts food in mouth
10-12m: Waves bye bye, plays peek-a-boo
12m: Drinks from cup w two hands
18m: Holds spoon and gets food safely to mouth
What is S/E/B development at 18m-3y
18-24m: Symbolic play
2y: Dry by day, pulls of some clothing
2,5-3y: Parallel play. Interactive play evolving. Takes turn.
Limit age for smile
8w
Limit age for fear for strangers
10m
Limit age for feeding self/spoon
18m
Symbolic play limit age
2-2,5y
Interactive play limit age
3-3,5y
What are the environmental physical needs for normal development ?
- Warmth, clothing, shelter
- Good vision and hearing
- Food
- Activity w rest
- Good health
What are the environmental psychological needs for normal development?
- Personal identity, self-respect and independence
- Security
- Role models
- Affection and care
- Play
- Opportunity to learn from experience
What are the ways to become a “walking toddler” ?
- Immobile infant -> commando crawl -> walking
- Immobile infant -> crawling on all fours -> walking
- Immobile infant -> bottom shuffling -> walking
What is the primitive reflexes?
Moro, grasp, rooting, stepping, ATNR, Sucking. All appears at birth and disappears at 4-6m
What are the postural reflexes?
Parachute( appears at 6-8m) , labyrinthine righting (6-7w to perfect) , postural support (bounce) and lateral propping
