Kaplan MN 580 Unit 1 Discussion Growth and Development
Kaplan MN 580 Unit 1 Discussion Growth and Development
This week’s Discussion will address the growth and development of the child from neonate to adolescents, cultural considerations, and the importance of communication with the child and family in respect to age and developmental considerations. This will build a solid knowledge base for the provider when caring for the child.
Your professor will assign you a case to present and, in return, you will reply to your classmates in the other cases in order to promote a robust discussion.
Please complete each initial post in APA format following the Discussion Board grading rubric to include, but not limited to the following:
Apply a principle of human growth and development related to appropriate age group
Apply developmental theory related to age group
Discuss developmental milestones related to the age
Discuss developmental assessment tool related to the age
Apply cultural consideration and cultural assessment to presentation
Case 1: A 6-month-old Haitian male, both parents present at the appointment and the third child for both parents. Child was born at 40 weeks, last seen at 4-month visit and no concerns at that time. Child is smiling, babbling, rolls both from abdomen to back and back to abdomen and sits with support.
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Case 2: A 2-year-old Hispanic female, mother and grandmother present at the appointment, first child for mother, sixth grandchild for grandmother. Mother speaks English as primary language; grandmother speaks Spanish as primary language. Last well visit was at 18 months of age and was speaking 20 words total, about 10 in English and 10 in Spanish. Now, mother states that child has about 50 words, with some in English and some in Spanish.
Case 3: A 4-year-old African American male, with mother, father, and paternal grandmother present. Child is here for well check for school entry. Child speaks approximately 100 words and only 50% intelligible.
Also Read: Kaplan MN 580 Unit 2 Discussion Topic 1: Pediatric Health Maintenance Exam and PPE
Case 4: A 7-year-old Mexican American male with mother and maternal grandmother present. Mother has no concerns except grandmother feels the child is “too skinny.”
Case 5: A 14-year-old Caucasian female from single-parent family with father present. Father states that “she has always been healthy but I am worried that something is wrong because she doesn’t talk to me anymore.”
Growth & Development PHYSICAL DEVELOPMENT MOTOR DEVELOPMENT LANGUAGE, COMMUNICATION DEVELOPMENT SOCIAL, EMOTIONAL DEVELOPMENT COGNITIVE DEVELOPMENT 1 I Human Announcement Three Cases (unit 2, Unit 3, Unit 9) Cases cannot be reopened once closed Take advantage of all the Available help topics Home page Graduate help videos documents 2 Stages of Development Infancy (birth – 12 months) Toddler (1-3) Early childhood (3 – 5 years) Middle Childhood (6-12) Adolescence (13-17) Young Adult (18-21) Read this chapter. Focus on adolescent behaviors such as reacting to stress 3 By 2 months: Tries to look at his or her parent and pays attention to faces. By 4 months: Copies facial movements, such as smiling or frowning, and responds to affection. By 6 months: Likes to look at himself or herself in the mirror and brings objects to mouth. By 9 months: Has favorite toys and picks up small items between the thumb and forefinger. Around 12 months: Puts out arm or leg to help with dressing and follows simple directions. At 18 months: Explores alone if a parent is nearby and points to a body part when asked. By 2 years: Gets excited to see other children and begins sorting shapes and colors. By 3 years: Is able to dress himself or herself and completes puzzles with three or four pieces. 4 Copyright © 2021 by Elsevier, Inc. All rights reserved. Recommendations for Preventive Pediatric Health Care Updated March 2020 BRIGHT FUTURES/AAP PERIODICITY SCHEDULE https://brightfutures.aap.org/Pages/def ault.aspx 5 Developmental Monitoring (Surveillance) Regular Well visits Interim history Parent concerns Observation of child’s behaviors Measurements (growth charts, percentages, wt, ht, head circumference, etc) Nutrition Immunizations Milestones i.e. 4 month old should be able to roll from front to back Anticipatory guidance Full physical examination 6 CDC uses the 5th and 95th percentiles as cut off points for normal (length for weight) Velocity of growth (slowed or increase) Consistency Normal growth followed by change in percentile range Copyright © 2021 by Elsevier, Inc. All rights reserved. 7 First Newborn Wellness Vist (3-5 days) HISTORY initial or interim MEASUREMENTS Length/Height and Weight Head Circumference Weight for Length Blood Pressure SENSORY SCREENING Vision Hearing DEVELOPMENTAL/BEHAVIORAL HEALTH Developmental Surveillance Psychosocial/Behavioral Assessment PHYSICAL EXAMINATION Immunization Anticipatory Guidance 8 Questions How much weight is normal for a newborn to lose in the first few days of life? A. 1 – 2% B. 3–4% C. 5-10 % D. 10 -15% 9 C. 5-10% Copyright © 2021 by Elsevier, Inc. All rights reserved. 10 In the first 3-5 days, 5-10% weight loss is considered normal. 11 Example A normal 3 day old newborn is discharged from the hospital. At birth the child’s weight was 7 lbs. Upon discharge the infant’s weight was 6.5 lbs. What percentage of weight did the infant lose? A. 7% B. 6% C. 5% D. 4% 12 A 7% Copyright © 2021 by Elsevier, Inc. All rights reserved. 13 When should all birth weight be regained? 14 True or False At one week Copyright © 2021 by Elsevier, Inc. All rights reserved. 15 False Copyright © 2021 by Elsevier, Inc. All rights reserved. 16 At first week visit, child with a birth weight of 7, now weighs 6.8 lbs. The parent is concerned that the child is losing weight. What should the NP do? 17 Recheck weight at A. 3 days B. 10 days C. 7 days D. 14 days Copyright © 2021 by Elsevier, Inc. All rights reserved. 18 C. Seven Days Copyright © 2021 by Elsevier, Inc. All rights reserved. 19 Assessment is a continual process of observing, gathering, recording, and interpreting information Copyright © 2021 by Elsevier, Inc. All rights reserved. 20 Discussion Question What are normal developmental behaviors of a 6 month old? Identify developmental behaviors of a 6-month-old infant that would raise a red flag? 21 Begins passing objects (like toys) from one hand to the other. Rolls from front to back, and back to front. Sits without support1 Bounces when in a standing position. Bears more weight on legs. Rocks back and forth on hands and knees. Starts to “scoot” backward. Tries to crawl. Copyright © 2021 by Elsevier, Inc. All rights reserved. 22 Recommended Schedule of Well Visits The first week visit (5 to 7 days old) 1 month old 2 months old 4 months old 6 months old 9 months old 12 months old 15 months old 18 months old 2 years old (24 months) 2 ½ years old (30 months) 3 years old 4 years old Then Yearly up to 21 years of age 23 Why Developmental Screening? Screening provides a quick snapshot of a child’s health and developmental status and indicates whether further evaluation is needed. Screenings are designed to identify risk or potential developmental issues. Screening only indicates the possible presence of developmental delay or difference and cannot definitively identify or describe the nature or extent of a disability. If abnormals are found, a more comprehensive and formal evaluation process is needed in order to confirm or disconfirm any red flags raised 24 Screening strategies for infants (Table 10.2) Standardized instruments at 2-, 4-, 6-, 9-, 12-month wellchild visits Ages & Stages Questionnaire (ASQ) Parents’ Evaluation of Developmental Status (PEDS) Other tools for specific areas of concern RED FLAG: refer for further screening if delays 25 Screening Tool/Ages Purpose/Description Number of Items Time Frame Website Ages and Stages Questionnaires, edition 3 (ASQ-3) 1 month-5½ years Developmental milestones 30 items 10-15 www.brookespublishing.com Measures: communication, plus overall min to gross and fine motor, concerns complete problem-solving, social, and overall development Written at the 4th- to 6thgrade level Bright Futures 2 days-21 years Age appropriate child 14 items questionnaire that focuses plus overall on developmental concerns milestones, nutrition, safety, and child and family’s emotional well-being Child Development Inventories (CDI) 3-72 months Measures gross and fine 60 yes/no motor, language, social, and questions comprehension skills Parents’ Evaluations of Developmental Status (PEDS) Birth-8 years Screening/surveillance of 10 items 2-10 min www.pedstest.com development/socialemotional/behavior/mental Copyright © 2021 by Elsevier, Inc. All rights reserved. health. Written at the 4th- https://www.healthychildre n.org Less than https://childdevrev.com/spe 10 min cialiststools/childdevelopment-inventory 26 Red Flags for Infant Development Potential problems need close surveillance Referrals necessary when clear indicators present RED FLAG: referral to behavioral or developmental specialist if autism suspected: Baby or toddler doesn’t: Make eye contact, such as looking at you when being fed or smiling when being smiled at. Respond to his or her name, or to the sound of a familiar voice. Follow objects visually or follow your gesture when you point things out. Point or wave goodbye, or use other gestures to communicate. See Table 10-4 for specific red flags 27 Developmental Management in Early Childhood 12 months- 4 years Changes subtle but highly significant Enter toddlerhood as babies Emerge as accomplished children with sophisticated skills Refine abilities/add to skills Become stronger, bigger Increased social, emotional, and intellectual capabilities Copyright © 2021 by Elsevier, Inc. All rights reserved. 28 Developmental Assessment of Early Childhood (3 of 4) Screening Strategies During Early Childhood (Cont.) Motor Skills Development Ask parents about development Ages & Stages Questionnaire-3 (ASQ-3) Communication and Language Development History of pattern of learning Physical exam for essential structures for speech Early Language Milestone (ELM) tool Evaluate expressive and receptive skills Table 11.10 Copyright © 2021 by Elsevier, Inc. All rights reserved. 29 Developmental Assessment of Early Childhood (4 of 4) Screening Strategies During Early Childhood (Cont.) Social and Emotional Development Family roles, interactions with peers, feelings of contentment/security Social-emotional section of ASQ (ASQ:SE-2), 3 months to 5 years Pediatric Symptom Checklist (PSC) at age 4 years Cognitive Development Symbolic language Make-believe in toddlers Pretend and fantasy in preschoolers Copyright © 2021 by Elsevier, Inc. All rights reserved. 30 Red flags at Two Years Doesn’t respond to loud sounds Doesn’t watch things as they move Doesn’t smile at people Doesn’t bring hands to mouth Can’t hold head up when pushing up when on tummy Copyright © 2021 by Elsevier, Inc. All rights reserved. 31 Common Developmental Issues in Early Childhood (1 of 4) Sibling Rivalry Patterns vary/affected by age, gender, temperament, attachment, family interactions, types of discipline, child’s perception of how parents treat each child Toddlers/preschoolers may regress when a new baby arrives Parents should promote support, loyalty, friendship Response to new sibling depends on developmental stage of child Copyright © 2021 by Elsevier, Inc. All rights reserved. 32 Common Developmental Issues in Early Childhood (2 of 4) Temper Tantrums Chapter 15 Toilet Training Introduce at 18 months; usually complete by 3 ½ to 4 years Guidelines for readiness (Table 11.11) Culture plays a role First nocturnal then daytime bowel control; daytime then nocturnal bladder control Copyright © 2021 by Elsevier, Inc. All rights reserved. 33 Common Developmental Issues in Early Childhood (3 of 4) Child Care and Preschools Child Care Significant source of parental concern See Box 11-2 for advice on how to select provider Preschool Social skills/ability to separate Language skills Physical size Copyright © 2021 by Elsevier, Inc. All rights reserved. 34 Anticipatory Guidance for Early Childhood (2 of 8) Regulation and Sleep-Wake Patterns Consistent sleep/naptime, transition between states Allow choices/maintain rituals Allow opportunities for rest but do not force Form good sleep routines Copyright © 2021 by Elsevier, Inc. All rights reserved. 35 Anticipatory Guidance for Early Childhood (1 of 8) Anticipatory Guidance for Early Childhood AAP and Bright Futures Guidelines suggest anticipatory guidance in these areas: Family support Child development Mental health Healthy weight Healthy nutrition Physical activity Oral health Healthy sexual development/sexuality Safety and injury prevention Community relationships/resources Copyright © 2021 by Elsevier, Inc. All rights reserved. 36 Anticipatory Guidance for Early Childhood (3 of 8) Strength and Motor Coordination Range of safe play activities Allow children to take lead in play Parallel Play is Common Age-appropriate materials Constant adult supervision necessary Safety of environment Car seat use/modeling safe behavior Copyright © 2021 by Elsevier, Inc. All rights reserved. 37 Anticipatory Guidance for Childhood 8) Early Nutrition, Self-Care, (4 andof Safety Healthy foods/3 meals, 2 nutritious snacks Parents responsible for providing healthy foods, children responsible for choices from these options, including how much to eat “Food jags” normal Developmental changes affect eating habits Encourage self-feeding Injury is a leading cause of morbidity and mortality Copyright © 2021 by Elsevier, Inc. All rights reserved. 38 Anticipatory Guidance for Early Childhood (5 of 8) Communication and Language Read to children daily Model appropriate language Talk to child about what is happening Listen and respond to child Provide opportunities to interact verbally with other children and adults Limit TV/videos to 1-2 hours/day. No TV before age 2 years Watch TV with children and talk about what is happening Need for constant reinforcement of speech/language efforts Copyright © 2021 by Elsevier, Inc. All rights reserved. 39 Common Developmental Issues in Early Childhood (4 of 4) Safety Safety-proof all environments Still must have adult supervision at all times Copyright © 2021 by Elsevier, Inc. All rights reserved. 40 Anticipatory Guidance for Early Childhood (6 of 8) Social and Emotional Growth Balance between dependence/independence in constant flux Must identify/control feelings about anger, joy, love, frustration Learn to make and keep friends, share and cooperate, and live socially in a family Learn to handle separation Copyright © 2021 by Elsevier, Inc. All rights reserved. 41 Anticipatory Guidance for Early Childhood (7 of 8) Social and Emotional Growth (Cont.) Reemphasize role of parents as guides Encourage opportunities to expand social skills Differentiate discipline/punishment Clarify each parent’s expectations of behavior Copyright © 2021 by Elsevier, Inc. All rights reserved. 42 Early Child Development Red Flags Signs of delayed/abnormal development (1 of 3) Minor problems can become major if not treated Careful monitoring essential for children/families at high risk Premature infants History of violence Chronic medical/mental health problems Some single-parent families See Table 11-12 Copyright © 2021 by Elsevier, Inc. All rights reserved. 43 Early Child Development Red Flags (2 of 3) Physical Disorders Failure to meet growth milestones Not following normal growth pattern Cognitive Disorders Screening tools necessary Prompt referral when delays identified Language Disorders Best indicator of cognitive development Receptive vs expressive delays Copyright © 2021 by Elsevier, Inc. All rights reserved. 44 Early Child Development Red Flags (3 of 3) Language Disorders (Cont.) Language Improper uses/meanings of words, Inappropriate grammatical patterns Speech Articulation, Fluency, Voice control Unusual confusions, reversals, telescoping Loss of previously acquired skills Monotone, excessive loudness, inaudible, Pitch inappropriate to age/gender See Table 11.10 Copyright © 2021 by Elsevier, Inc. All rights reserved. 45 Overview of the School-Age Preventive Health Visit Occurs annually reviewing the child’s progress, validating caregiver efforts, and providing education and guidance History – vague, intermittent symptoms with normal function in between episodes (Box 12.1) Physical examination Physical Examination (Box 12.2) Diagnostic Screening (Table 12.1) Anticipatory Guidance (Tables 12.3 and 12.4) 46 Developmental Management of Middle Childhood (5-10 years of age) School-age children are busy, active, curious Advanced physical activities Master reading, writing, math, science Become skilled socially Preschool innocence changes to adolescent complexity Copyright © 2021 by Elsevier, Inc. All rights reserved. 47 Physical Development (see Table 12.5) History Physical Examination Sexual organ development Anticipatory Guidance (see Table 12.3) Motor Development Gross motor skill refinement Run, jump, climb, hop, skip, overhand motions Balance and coordination improve Fine motor skill mastery Improved dexterity allows use of scissors, writing tools, dressing self, drawing Hand-eye coordination better in late childhood Copyright © 2021 by Elsevier, Inc. All rights reserved. 48 Communication and Language Development Improved receptive/expressive skills Stuttering should resolve by school age Speech/language disorders among most common developmental delays See Table 12.6 Copyright © 2021 by Elsevier, Inc. All rights reserved. 49 Social and Emotional Development Must develop social interactions skills to: Interpret meaning/social cues of others Initiate interactions Terminate interactions positively Gain impulse control/manage emotions Resolve conflicts Mastery of skills allows: Refinement of role in/separation from family Development/maintenance of friendships Development of positive relationships with adults Strengthening of sense of self Copyright © 2021 by Elsevier, Inc. All rights reserved. 50 Social and Emotional Development Peer relationships Social cognition results from parent-child relationship Develop “best friends” and talk like peers Special-friend phase at age 10; intense attachment to samegender child Talking on phone/sleepovers Morality From determination by consequences to development of true concern for others Lack cognitive maturity to deal with complex social pressures Copyright © 2021 by Elsevier, Inc. All rights reserved. 51 Social and Emotional Development Body image Curious about bodies/sensitive to others Modesty characteristic of this age Coping skills Ability to manage feelings improved but limited Impulse control learned by school age Stressors such as violence, bullying, divorce Increased responsibilities Table 12-2 Copyright © 2021 by Elsevier, Inc. All rights reserved. 52 Developmental Approach to Health Assessment and Promotion 6 of 7 Cognitive Development New social skills appear with the ability to understand the viewpoints of others and the ability to share and understand another’s feelings, emerges Capacity to make deep friendships Development of a personal sense of competence Copyright © 2021 by Elsevier, Inc. All rights reserved. 53 Developmental-Behavioral Screening Tools for Middle Childhood Screening Tool Target Population Purpose Caregiver’s Evaluation of Developmental Status (CEDS) Birth to 8 years old Elicits caregiver concerns for their child’s language, motor, self-help, language, behavioral and socioemotional abilities Pediatric Symptom Checklist (PSC) Children 4 through 16 years old (Y-PSC for youth 11 years old and over) Generalized cognitive, emotional, and behavioral problems Copyright © 2021 by Elsevier, Inc. All rights reserved. 54 Patient Health Questionnaire (PHQ-2, PHQ-9, PHQ-9 Adolescent) 12 years old and up Depression and suicidality Screen for Child AnxietyRelated Disorders (SCARED) Children 8-18 years old Childhood anxiety disorders NICHQ Vanderbilt Assessment Scale Children 6-12 years old Caregiver and teacher evaluation of inattention, hyperactivity, conduct disorders, and anxiety or depression Copyright © 2021 by Elsevier, Inc. All rights reserved. 55 Red Flags for School-Age Children See Table 12-8 High-risk behaviors Chronic illness Accidents/injuries Vision/hearing problems Change in school performance Change in language Socialization/antisocial behavior Family circumstances 56 Developmental Assessment of Middle Childhood 1 of 5 Monitoring, screening, anticipatory guidance for developmental, emotional, behavioral issues Developmental surveillance essential Physical, nutritional, oral health Neurodevelopmental, psychosocial Emotional, behavioral Evaluate family’s ability to help child separate and become more independent Copyright © 2021 by Elsevier, Inc. All rights reserved. 57 Developmental Assessment of Middle Childhood 3 of 5 Screening Strategies for School-Age Children Motor skills development Strength and coordination Table 12-4 Communication and language development Articulation, vocabulary, grammar Social interactions, writing skills Copyright © 2021 by Elsevier, Inc. All rights reserved. 58 Developmental Assessment of Middle Childhood 4 of 5 Screening Strategies for School-Age Children Social and emotional development Life stress, anxiety, depression, self-esteem issues, parent-child relationships Success in making friends/peer relationships Cognitive development Standardized tests/school performance Diagnostic Studies As indicated if problems occur Copyright © 2021 by Elsevier, Inc. All rights reserved. 59 Developmental Assessment of Middle Childhood 5 of 5 Parent Development Adjustment to children in school Internet risks Allowing new freedoms/responsibilities Regulation and Sleep-Wake Patterns Family routines important for self-regulation Family traditions and rituals Adjusting child’s school schedules/routines Copyright © 2021 by Elsevier, Inc. All rights reserved. 60 Anticipatory Guidance for Middle Childhood 1 of 7 Strength and Motor Coordination Encourage participation in exercise Provide fun family activities requiring cognitive/social skills Include children’s friends in family activities Support healthful activities Encourage hobbies, fitness, increasing motor skills Help prevent overscheduling Limit screen time Let child “own” activity – it should be fun Copyright © 2021 by Elsevier, Inc. All rights reserved. 61 Anticipatory Guidance for Middle Childhood 2 of 7 Nutrition, Self-Care, and Safety Nutrition 31% of school-age children are overweight or obese Deficiencies of iron, vitamin C/high-fat snacks Children learning to choose nutritious foods Parents advised to: Ensure 3 nutritious meals, 2 nutritious snacks per day Understand food jags are common Establish routine – one meal daily with family Monitor food choices/teach importance of healthy foods Encourage participation in planning, shopping for, preparing food Copyright © 2021 by Elsevier, Inc. All rights reserved. 62 Anticipatory Guidance for Middle Childhood 3 of 7 Nutrition, Self-Care, and Safety Self-care Supervise personal hygiene – brushing teeth, combing hair/less supervision in older school-age children Set clear expectations for hygiene, exercise, sleep Be flexible/discuss noncompliance Encourage shared decision-making; allow experimentation Encourage discussion about sexuality, drugs, alcohol, tobacco Model healthy behaviors Copyright © 2021 by Elsevier, Inc. All rights reserved. 63
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