Well Child Care - Developmental assessment Flashcards
1
Q
relationship b/t circumcision and UTIs? STIs?
A
- research suggests that there MIGHT be a lower risk fo UTIs and pyelonephritis in circumcised infant until 9 months old
- Recent data shows that risk of acquiring STD is higher in uncircumcised male, also cervical CA may be more common in partners of uncircumcised males
- no definite literature to indicate clear medical recommendation to circumcise every male infant.
2
Q
Most beneficial thing about well child care?
A
- it allows you to pick up on things in a child that you might otherwise not pick up if he/she only came in when sick
3
Q
Frequency of well child care visits?
A
- 5-7 days, 2 weeks
- 2, 4, 6, 9, 12, 15, 18, and 24 mos
- then yearly until 6
- then every 2 years till age 12
- yearly ages 13-18
- do best you can to encourage parents to bring their kids in even when shots aren’t due
4
Q
approach to well child visit?
A
- have laid back attitude
- speak directly to child
- compliment child in some way
- smile and be non-threatening
5
Q
Main pts of well child exam?
A
- growth measurements
- interval Hx (assess family)
- PE (abnormalities?)
- developmental assessment
- anticipatory guidance: prevention and nutrition
- immunizations
- answer questions
6
Q
Growth measurements?
A
- ht, wt, and head circumference
- normal? compare with family background
- when to worry:
when wt falls 2 percentiles
wt below 5%, head size passing 2 percentiles - always remember to mark and refer to growth charts along with the parents and explain where this child is in relationship to his/her peer group
7
Q
Interval hx?
A
- use open ended ?s
- how are you feeling (include mother/father/sibs/relatives)
- how is baby/child doing?
- how have things gone since our last visit?
- ask appropriate f/u ?s to explore leads
8
Q
PE?
A
- be thorough
- have parent help with exam
- don’t forget all of unique elements that are particularly impt for ped pt
9
Q
Developmental assessment?
A
- much of this will be done through observation during interview and PE
- may also include specific developmental tests such as Denver II or Ages and Stages Questionnaire
- areas to be assessed:
gross motor
fine motor
language
personal-social
vision
hearing
10
Q
Developmental delays? When do they manifest themselves?
A
- age related manner
- motor delays tend to manifest in 1st year of life
- language delays tend to manifest in the toddler and preschool years of life
- learning disabilities manifest during school years
- parents tend to be good at recognizing if their child is developmentally delayed, so listen to them!
11
Q
What may motor delays signify?
A
- neuromuscular, genetic/metabolic, infectious, or other abnormality and warrants thorough eval
12
Q
What should be tested if there is a language delay?
A
- hearing assessment (any child at high risk for hearing loss should undergo screening to ID them b/f language delay)
- once it is determined that hearing is normal, assessment aimed at whether there is global problem (cognitive delay), or whether it is isolated in domain of speech and language
- language delay in preschool years is classic manifestation of mental retardation, but many kids do appear to exhibit delays that are limited to language
13
Q
Purpose of developmental assessment?
A
- can realy help ID problems early, increasing chance for more successful prognosis
- a child may be advanced in one area and delayed in another
- much of the assessment is done by H&P
- many times a standardized instrument isn’t used (may lead to delayed dx)
14
Q
Why is early detection of developmental problems so critical?
A
- children involved in early intervention programs are more likely to:
- live independently
- graduate from high school
- productively contribute to society
- save society 30,000-$100,000/child
15
Q
Types of std instruments that are used?
A
- Denver II
- ASQ (ages and stages)
- Brigance screening
- PEDS (parents’ eval of developmental status)
16
Q
Main pts of Denver II?
A
- for ages 0-6
- objective measure: ID children that may have developmental delay, and thus would benefit from further eval
- 4 areas screened include: gross motor, fine motor, personal-social, and language
- children born b/f 38 weeks gestation must have their age corrected for prematurity, up to 2 years of age
- some items can be passed by report of caregiver, others must be done by child
- first thing - take childs age and draw straight vertical line, each item that intersects or is just adjacent to age line should be scored
- items should be scored as: pass, fail, no opportunity or refused to cooperate
17
Q
Denver II scores?
A
- advanced: child passes item that falls completely to right of age line
- normal: child passes, fails or refuses item on which age line falls b/t 25th and 75th percentile
caution: child fails or refuses item on which age line falls b/t 75th and 90th percentile - delayed: child fails or refuses item that falls completely left of age line
- pass: no delays and maximum of one caution
- failure: needs referral to developmental specialist, 2 or more delays
- re-evaluate in 3 months: one delay and/or 2 or more cautions
- untestable: significant number of refusal or no opportunity test items (if untestable on 2 consecutive screenings - refer)
18
Q
Criticisms of Denver II?
A
- can take awhile to admin test
- norms established not necessarily representative of population as a whole, may not compare appropriately with other populations
- some items are difficult to test
- requires a number of items to admin test thoroughly
- high over-referral rate
- if using this test - use with discretion, see the big picture
- understand that this is a screening tool, not a test to make a final dx
- Denver II is starting to fall out of favor
19
Q
Main pts of ASQ?
A
- relies on info from parents
- screens for developmental problems
- takes 10-15 minutes to complete (done at home)
- can be used in pts 4 months - 5 years
- separate 3-4 page form for each well-child visit (age-specific)
- available in English, Spanish, Korean, and French
- std scoring procedures
- can be photocopied
- This forces parents to go through the testing with their child, good for several reasons:
gets parents involved in child’s care, helps them to become more aware of child’s abilities/limitations, saves a ton of time as test is already complete by time they come into the office
20
Q
main pts of Brigance screening?
A
- relies primarily on observation and elicitation of skills (0-2 yr age range can be administered by parent report)
- can be used in pts 0-90 months
- 9 separate forms based on age
- takes 10-15 minutes
21
Q
PEDs? (parents’ eval of developmental status)?
A
- relies solely on info from parents
- can be used in ptients birth to 8 years
- involves 10 ?s to parents (4th-5th grade reading level reqd)
- available in English, spanish, and Vietnamese
- parents can compete in waiting room or can be admin in interview format in 2 minutes
- standardized scoring procedures
22
Q
High impact anticipatory guidance for parents?
A
- NO SMOKING!!!!
this increases risk of SIDs, AOM, asthma, cough, URI, and children of smokers smoke - reading to child: proven to increase school performance, helps with bonding b/t parents and child
