Week 12: Assessing Children and Adolescents

Question 1

Primary care well visits

Answer 1

Assess growth and provide anticipatory guidance for parents about growth and development (health supervision visits)

Immunization – 7-18 yrs. old

Question 2

Sleep hygiene

Answer 2

Hours of needed sleep decrease from newborn (12-18 hrs.) to adult (7-9 hrs.)

Question 3

Eyes and acuity

Answer 3

Normal 20/20 acuity by 6 yrs. of age

Question 4

Lung sounds

Answer 4

Hyperresonance is normal in young children

Question 5

Tanner staging

Answer 5

Sexual maturity (staged 1-5)

Female (breast):
I: Preadolescent
II: Breast bud
III: Areolar diameter enlarges
IV: Secondary mound; separation of contours
V: Mature female

Male (genitalia):
I: Childhood size
II: Enlargement of scrotum/testes
III: Penis grows in length; testes continue to enlarge
IV: Penis grows in length/breadth; scrotum darkens, testes enlarge
V: Adult shape/size

Pubic hair (both):
I: None
II: Sparse, long, straight
III: Darker, circling, increased amount
IV: Coarse, curly adult type
V: Adult, extends to thighs

Question 6

Neurology: Cognitive-Social development

Answer 6

Progression of cognitive-social development:
1. Attention and listening

2. Play and interaction
3. Receptive language (understanding)
4. Expressive language (use)
5. Speech sounds

Question 7

Kohlberg’s moral development stages

Answer 7

Stages:
STAGE I: Obedience/punishment (infancy) – no difference between doing the right thing/avoiding punishment

STAGE 2: Self-interest (pre-school) – interest shifts to rewards rather than punishment (effort made to secure greatest benefit)

STAGE 3: Conformity and interpersonal accord (school-age) – “good boy/girl” level; effort made to secure approval and maintain friendly relationships

STAGE 4: Authority and social order (school-age) – orientation toward fixed rules; purpose of morality is maintaining order; interpersonal accord is expanded to include society

STAGE 5: Social contract (teens) – mutual benefit, reciprocity; moral right and legal right are not always the same; utilitarian rules that make life better for everyone

STAGE 6: Universal principles (adulthood) – morality is based on principles that transient mutual benefit

Question 8

Erikson’s psychosocial development

Answer 8

Toddler – autonomy vs. shame and doubt (developing a greater sense of self-control)

Pre-schooler – initiative vs. guilt (children assert themselves more frequently through directing play and other social interaction)

School-aged child – industry vs. inferiority (develop a meaningful social role to give back to society)

Adolescent – identity vs. role diffusion (more independent and self-directed, developing social skills, involved in school/community activity, more discriminated when making friends, and relationships with other gender)

Question 9

Freud’s psychosexual development

Answer 9

Toddler – anal stage (anus; withholding or expelling feces)

Pre-schooler – phallic stage (the penis or clitoris; masturbation)

School-aged child – latency period (little or no sexual motivation present)

Adolescent – genital stage (penis or vagina; sexual intercourse)

Question 10

Autistic spectrum disorder

Answer 10

Screened with M-CHAT

Characterized by S/S of:

1. ADD
2. ODD
3. Specific learning disabilities
4. ADHD
5. Depression & anxiety
6. Tourette’s
7. OCD
8. Developmental coordination disorder
9. Gifted
10. Sensory integration disorder
11. Auditory processing

Question 11

Puberty

Answer 11

Females: 8-11 yrs. old (Onset = Estrogen stimulates breast growth)

Males: 11-14 yrs. old (Onset = Pubic hair)