Pediatrics and Adolescent Medicine PDF

Pediatrics and Adolescent Medicine Module 3: H&P; Well-Child Checks Angela Deubel, PA-C University of New Mexico Introduction to Development & Growth: Pediatric Health Maintenance From the moment a baby is born, we...

Pediatrics and Adolescent Medicine Module 3: H&P; Well-Child Checks Angela Deubel, PA-C University of New Mexico Introduction to Development & Growth: Pediatric Health Maintenance From the moment a baby is born, we begin to look for milestones in growth and development We screen to make sure nothing is wrong Resources: The American Academy of Pediatrics Bright Futures Center for Disease Control NM Department of Health CDC Development is a broad term that includes 4 domains of childhood development: 1. Physical/Motor skills 2. Cognitive skills 3. Language skills 4. Behavioral, social-emotional, and mental health domains The goal of well-child checks is to identify children early who have a developmental delay or are at risk for delay Sources: Naeyc.org 4 principles of child development Development is predictable Factors affecting development Pathway is measurable Physical Milestones Social Developmental trajectory Environmental Disease Range of norms is wide H&P is variable Age, sex Developmental level Individual rate Understanding the norms Sources: Bates’ To recognize abnormal growth, one needs to understand normal growth. Determinants of growth Parameters of growth Maternal nutrition Weight Intrauterine environment Length or height Genetics Weight-for-length or BMI Environment & diet Head circumference Chronic illness Tanner Stages Patterns of Growth Predictable Pulsatile Seasonal How do Social Determinants of Health (SDoH) affect growth and development? Early life stressors & adverse Negative effects include: childhood events (ACEs): Inadequate coping skills Maltreatment Difficulty regulating emotions Poverty Reduced social functioning Family instability Cognitive delays Unsafe neighborhoods Poor academic achievement Lead exposure Chronic diseases Racism Tobacco, alcohol and drug use U.S. Department of Health and Human Services Overcoming Adversity: Early childhood programs are essential for improving outcomes! High-quality developmental and educational programs ie Head Start and extended early childhood programs Improve health outcomes Increase learning and social skills Improve readiness for school School meals Home visitations Supportive social services Classes for parents Pre-school >> Kindergarten >> 1st grade: improves academic achievement U.S. Department of Health and Human Services Well child checks (WCC): Why? We’re totally fine!! Prevention of illness: immunizations, discussions on safety and nutrition Tracking growth and development: milestones, social behaviors and learning Raising parental concerns: sleeping, eating, development, getting along with others Team approach: builds strong trustworthy relationships, serving the needs of infants, children and adolescents AAP At a minimum, standardized developmental screening tools should be administered at the 9-month, 18-month, and 24- or 30-month WCC, and anytime concerns are raised. 1 month: chin up when prone 2 months: visual tracking of object Examples of gross motor milestones in infancy. 4 months: reaching for objects Ages are approximate. 6 months: sitting unassisted 8 months: pincer grasp 9 months: crawling 11 months: can stand and cruise Examples of developmental screening tools ASQ-3: Ages and Stages Questionnaire®, 3rd ed 1 mo-5.5yrs Communication Gross motor skills Fine motor skills Problem solving Personal-social CDC checklist Pediatric History: Infants and Toddlers (0-3yrs) Birth history Medical history Family history Social history Developmental milestones Feeding Sleeping Masterfile.com Stooling and Urination Vaccinations Examples of Infant and Toddler Norms: FYI Feeding 2 mo infant: 4-5oz formula every 3-4hrs 4-6 mo up to 8oz every 3-4 hrs 6 mo start solid foods 1 yr eating table foods, introduce milk Sleeping 0-6 mo 15-16hrs/day (newborns up to 18hrs) 6 mo- toddler years 10-11hrs/day Toddlers will start to nap less Stooling and Urination Infants may defecate once a day, several times per day, or go several days Infants: 4-6 wet diapers per day or more History: School-Aged Children (4-11yrs) Birth history if applicable Medical history Family history Social History Developmental milestones Feeding Dailygazette.com Sleeping Vaccinations School performance Pediatric Vital Signs Note: For your reference- do not memorize, but have an idea of where different age groups fall  Examples of Pediatric Growth Charts WHO for 0-2yrs CDC for 2-20yrs CDC for Down Syndrome Life Expectancy.org for CP Normal Variants in Growth: Constitutional Delay and Familial Short Stature Growth Chart Practice: 1. Plot the following children on appropriate growth chart Remember: WHO growth chart for