Module 1 (a) Flashcards
Components of the WCV
-All Components
- Vision screening
- Hearing Screening
- Developmental/Behavioral Screening
- Laboratory
- Immunizations
At each visit you will assess the need for a formal screening ** “Ask the parent”
-If Parent has a concern, you will perform a formal screening
Additionally, follow the periodicity chart to conduct recommended screenings at the identified ages**
Components of the WCV
-Vision Screening
- Age 0-3 years subjective findings (Observation) — Trouble with Eye contact and following gaze, squinting, sitting close to books or TV? Eye hand coordination, sensitivity to light, difficulty coloring w/in lines All RED FLAGS
- Age 4 and up OBJECTIVE finding — Snellen chart, Allen cards
Components of the WCV
-Hearing Screen
- Completed at birth then routinely starting at age 4, UNLESS there is a concern
Components of the WCV
-Developmental Surveillance Vs Screening **TEST
- Surveillance is (DEVELOPMENTAL HX; reviewing risk factors)
- Flexible and continuous, observation, parental concerns and history - Screening is
- Standardized test, used when surveillance detects abnormality, identifies risks, NOT DIAGNOSTIC
5 Components of Developmental Surveillance
- Eliciting and attending to parents concerns about child’s development
- Documenting and maintaining developmental history
- Making accurate observations of the child
- Identifying risks and protective factors
- Maintaining accurate records and documenting the process & findings
Environmental, genetic, biological, social & demographic factors can all increase a child’s risk for delays and development
Components of the WCV
-Labs **TEST
- Newborn screens done at birth — Ex: Cystic Fibrosis, Congenital adrenal hyperplasia, hemoglobinopathies, congenital hypothyroidism, etc.
- Lead Level - 12 m and 24 m
- Hct or hgb at 12 months
- Dyslipidemia panel 9-11 yrs
Components of the WCV
-Anemia Risk Assessment
- Check anemia risk starting at 4 months**
- Risk factors include
- Prematurity and low birth weight — 80% of iron is transferred from mother to infant in last trimester
- Human milk has low iron - Exclusively Breast fed babies need iron supplementation starting at 4 months
- Exposure to Lead is a risk for anemia - Healthy, term, breast fed only and partially breastfed babies get
- 1mg/kg/day of iron starting at 4 months until iron containing foods are introduced (including iron fortified cereal) - Full-term formula fed infants do not need iron supplementation
- Pre-term Breastfed infants require 2mg/kg/day starting in the first month of life until sufficient intake from food
Vitamin D Supplementation
- Recommendation for 400 IU per day starting “soon after birth”
- Continue until weaned to 1L of whole mild per day (12 months) — MILK not recommended under 12 months
Components of the WCV
-Risk Assessments
- Lead risk assessment at 6, 9, 18 months and 3-6 years
- Dyslipidemia risk assessments beginning at age 2
- TB risk assessment beginning at age 12 months
- Anemia risk assessment at 4, 18, and 24 months
Components of the WCV
-Vital Signs
- Growth measurements correlate directly to a child’s nutritional status (Objective)
- Linear growth — (Line straight across instead of an up curve)**
—Can be: Malnutrition, chronic illness, psychosocial deprivation, hormonal disorders, or dwarfism - Head circumference and length should correlate. Should be in the same percentile
- Measure head circumference < age 2
- Start BP > age 3
Components of the WCV
-Growth Charts
- Normal weight is anywhere from 5th - 85th percentile
- Overweight is 85th -94th percentile
- Obese is 95th percentile
Measurements correlate w/ child’s nutritional status
Components of the WCV
-Health Education and Anticipatory Guidance
- Injury and injury prevention
- Nutrition Counseling
- Emotional well-being
- Developmental milestones
Periodicity Schedule
- Published by the American academy of pediatrics
- Recommendations for preventative pediatric healthcare
- For a circle, you would screen every child
- For a star, you would only screen those who are AT RISK
- Autism screening is done at 18 months and 24 months
Examples of Screening Tools
- Developmental & Behavioral Screening tools
- Parents evaluation of Developmental status (PEDS)
- PEDS: Developmental Milestones (PEDS:DM) - Developmental-ONLY screening tools
- Ages and stages questionnaire - Behavioral screening tools
- Connors Rating Scale
- Pediatric Symptom checklist
National Childhood Vaccine Injury Act (NCVIA)
-Requirements
- Date of administration
- VIS provided
- Date on VIS
- Manufacturer and lot #
- Name, address and title of person administering vaccine
Vaccine information **
-True and False ?’s
- All vaccines are held for minor illness?? FALSE
- You do not have to restart a documented vaccine series because the time between doses was too long? TRUE
- Patients on low dose steroids should hold vaccines until steroids are complete? FALSE - only hold for high dose steroids >1mg/kg
- A temperature should be routinely checked before administering vaccines? FALSE
Puberty Definition
- Biologic process that leads to fertility
Hypothalamic-Pituitary Gonadal Axis
- Responsible for release of Estradiol and Testosterone from ovaries and testes
- Leads to growth spurt, Adult body configuration, and adult hair distribution and voice changes
Hypothalamic-pituitary Adrenal Axis (HPA)
- Responsible for the androgens DHEA and DHES
2. Leads to small role in growth spurt, adult body configuration, and adult hair distribution and voice changes
Growth Hormone Axis
- Responsible for long bone formation leading to adolescent growth spurt
Tanner Stages (Sexual maturity rating scales)
- 5 stages that categorizes secondary sexual characteristics
- Females — measurement of pubic hair and breast changes
- Males — Measurement of public hair and genitalia changes
First sign of puberty in Females & Males?
- Females — Development of breast buds
2. Males — Enlargement of the testes
Puberty Fun facts?
- Average timeframe is 4 years — can range from 1.5 yrs to 8 years
- Menarche typically occurs 2 years after breast budding
- Estrogen — biphasic effect on bone
—Causes growth and also closes growth plate — early puberty can lead to early closure of plates — Refer to endocrinology
—Early puberty is <8 years old.
Brain Development
- Pre-frontal cortex — Planning and problem solving (Myelination and synaptic pruning)
- Executive Suite — Risk and reward, emotional regulation, problem solving, self-evaluation, long term planning (Mid 20’s)
- Cerebellum — Emotional processing (girls age 11, boys age 13.
Leading Causes of Disease Worldwide
-Adolescents
- Developing Countries — HIV/AIDS and road injuries
2. Developed Countries — Mental disorders, especially depression
Leading Cause of Adolescent Death in the US?
-Ages 15-19
- Accidents
- Suicide
- Homicide
Systems to Monitor Adolescent Health
- National Survey of Children’s Health — Funded by maternal and child health bureau HHS
- Youth Risk Behavior Surveillance System — Measures risky behaviors among adolescents in the US - CDC managed
-YRBSS monitored
—Sexual behavior, high-risk substance use, Violence victimization, mental health and suicide
Trends
-Ages 10-24
- 17.8% live in poverty
- High school enrollment increased, dropout rates have decreased
- College enrollment increased 12% in the last 30 years
MVA’s
-Ages 10-24
- Mortality rate 18.8
2. Alcohol involved in 23% of drivers ages 16-20 and 41% of drivers ages 21-24.
Mental Health
-Ages 10-24
- Suicide is second leading cause of death
- Rates are higher for males
- Attempts are higher for females
Violence
-Ages 10-24
- Homicide is third leading cause of death ages 10-24
- Disproportionally affects males
- 81.6% are from firearms
Exercise, Diet and Obesity
-Ages 10-24
- Exercise levels have remained stable since 1993
- Sedentary activity (Measured by 3 or more hrs of TV per day) has decreased — 35.4%
- Fruit and veggie consumption is 21.4%
- Obesity rates have TRIPLED over past 30 years — 1/3 of adolescents were overweight or obese 31%
Worrisome Trends
- Hearing impairment
- Excessive UV exposure/tanning beds
- Illicit drugs “club drugs”
- E-cigarettes
30% of Adolescents have a chronic condition
- Asthma
- Diabetes
- Allergies
- Seizure disorder
- Cystic fibrosis
- CHD
- Inflammatory bowel disease
- Obesity, HTN, Psych
