milestones, screening and vaccinations Flashcards
childhood health surveillance consits of (3)
- Childhood Screening
- Immunisations
- Delivering universal health promoting activities
- Early interventions to address needs
- More effective than identifying later
- Early interventions to address needs
screening in childhood
Previously for every child
- 6-8 weeks health check
- 8 months
- 2 years
- 3-4 years
Now much more targeted and opportunistic approach
- If suspected issues – checks may be more regular
- When child presents itself to health service (at whatever age) developmental assessment made
childhood screening consits of (5)
- Check milestones
- Check vaccination is up to date
- Deliver health promotion
-
e.g. healthy eating
- and health & safety!
-
e.g. healthy eating
- Target supervision & interventions to risk groups
dental role in childhood screening
- Often children (like adults) only see doctor when they are unwell but more likely to see dentist for routine check ups – opportunity to check these*
- Dental team can ask for support from paediatric team if concerns
school entry childhood screening
done by teacher with support
- Personal social & emotional development
- Physical development
- Communication skills
- Includes hearing and vision assessment – needs to be done regularly to ensure learning opportunities grasped (can provide simple aids e.g. glasses)
can there be variation in developmental milestones
yes
- Normal for variation in children – especially in earlier stages
- Variation in ability should level out within first years
Some cognitive, some development
Can take time for cognitive process behind actions to be learned
developmental milestones
1month
- Able to raise head from surface when lying on tummy
- Using trapezius and arms
- Less able if lying on back
- Pays attention to someone’s face in their direct line of vision
- Moves arms and legs in an energetic manner
- Likes to be held and rocked
developmental milestones
2months
- Smiles and coos
- Rolls part way to side when lying on back
- Grunts and sighs
developmental milestones
3months
- Eyes follow a moving object
- Able to hold head erect most of time
- Grasps objects when placed in their hand
- Often able to do immediately after birth but is lost and regained
- Babbles
developmental milestones
4months
- Holds a rattle for an extended period of time
- Laughs out loud
- Sits supported for short periods of time
- Recognizes bottle and familiar faces
developmental milestones
5months
- Reaches for and holds objects
- Stands firmly when held
- Stretches our arms to be picked up
- Likes to play peek-a-boo
- Learned permanence – will return when out of sight
developmental milestones
6months
- Turns over from back to stomach
- Turns toward sounds
- Often happen earlier
- Sits with a little support (1 hand bracing)
- Persistently reaches for objects out of their reach
- Listens to own voice
- Crows and squeals
- Reaches for and grasps objects and brings them to mouth
- Holds, sucks, bites cookie or cracker begins chewing
developmental milestones
7months
- Can transfer object from one hand to the other
- Can sit for a few minutes without support
- Pats and smiles at image in mirror
- Creeps (pulling body with arms and leg kicks)
- Is shy at first with strangers
- more cautious of people they do not know
- can recognize family group
developmental milestones
8months
- Can sit steadily for about 5 minutes
- Crawls on hands and knees
- Grasps things with thumb and first two fingers
- Likes to be near parent e.g. when put to bed
developmental milestones
9months
- Says Ma-ma or Da-da
- Responds to name
- Can stand for a short time – need supported
- Able to hit two objects together on their own
- Copies sounds
developmental milestones
10 months
- Able to pull self up at the side of crib or playpen
- Can drink from a cup when it is held
- Trainer cup can be earlier than this
developmental milestones
11months
- Can walk holding onto furniture - injuries
- Can find an object placed under another object
developmental milestones
12 months
- Waves bye-bye
- Can walk with one hand held
- Says two words besides Ma-ma and Da-da
- Enjoys some solid foods
- Important not to start weaning too early as some evidence contributes to gut allergies
- Finger feeds self
- Likes to have an audience
developmental milestones
15 months (into second year)
- Walks by self, stops creeping around furniture
- Shows desires by pointing and gesturing
- Begins using a spoon
- Scribbles on paper after shown
- Cooperates with dressing
Many can do earlier
developmental milestones
18 months (1 and half years)
- Can build a tower with 3 blocks
- Likes to climb and take things apart
- Can say 6 words
- Tries to put on shoes
- Drinks from cup held in both hands
- Likes to help a parent
developmental milestones
2 years/24 months
- Able to run
- Walks up and down stairs using alternate feet
- Says about 50 words
- Sometimes uses 2-word sentences
- Points to objects in a book
what influences child development from ages 3+
Child development rate from 3 years + is largely dependent on stimulation
- Large variation
developmental milestones
3 years
- Can repeat 2 numbers in a row
- Knows their own gender
- Dresses self except for buttoning
- Can copy a circle
- Can follow 2 commands of on, under, or behind (ie. stand on the rug)
- Knows most parts of the body
- Jumps lifting both feet off ground
- Can build tower with 9 blocks
developmental milestones
4 years
- Can repeat a simple 6 word sentence
- Can wash hands and face without help
- Can copy a cross
- Can stand on one foot
- Can catch a tossed ball
developmental milestones
5 years
- Can follow 3 commands
- Can copy a square
- Can skip
why do we have childhood vaccinations
2 reasons key
Prevent certain infectious diseases where the risks of vaccination are lower than the risks from the disease
Reduce or eliminate infectious diseases from the community by reducing the number of susceptible vectors – herd immunity
- Risks are POPULATION risks – difficult to apply to an individual
childhood vaccinations available currently
- Increasingly growing list (19+)*
- All are appropriate for just certain children, and some for all children
- Diptheria
- Tetanus
- HIB
- Typhoid
- Polio
- BCG
- Pertusis
- Rota virus
- Pneumococcus
- HPV
- Measles
- Mumps
- Rubella
- Hepatitis A
- Hepatitis B
- Meningitis B & C
- Varicella
- Influenza
- Covid-19
recent change to polio vaccine
- Previously ORAL polio vaccine
- Now INACTIVATED polio vaccine
- Little possibility of polio type symptoms due to vaccine
recent change to meningitis vaccine
- now routinely given
- Haemophilus Influenza B
- Menincococcus B
UK standard vaccination schedule
Be familiar with as part of child surveillance
- Can identify if completed or not
Non-compliance (unless medical reason raised) concern child is being put at risk by parent
differences between countries vaccination schedules
Differences due to likelihood of infections, political etc
2 common vaccines with variations of administration
BCG
Hepatitis B
BCG vaccine
not routinely given, but can be given shortly after birth if high risk
- e.g. looked after by grandparents travelled from countries where there is endemic TB, children who have family member with active TB
hepatitis B vaccine administration
Not a routine UK vaccine
- Normal in some other countries – protection against liver cancer (usually endemic in that population)
3 doses from 6 weeks of age
3 common reasons why childhood immunisations may be refused
- Religious or Philosophical grounds
- Prevent a ‘painful assault’ on the child
- Benefits don’t outweigh the risks
what to do if childhood immunisation are being refused
- Does refusal put THE CHILD at extreme personal risk (neglect)?
- Does refusal put OTHERS at risk sufficient to warrant intervention on public health grounds
- Lowers level of immunity in population
Discuss with health visitor and/or GP
