Developmental Management in Pediatric Primary Care PDF

Chapter 8 Developmental Management in Pediatric Primary Care Copyright © 2021 by Elsevier, Inc. All rights reserved. 2 Developmental Management in Pediatric Primary Care  Primary Care Providers  Monitor overall physical, cog...

Chapter 8 Developmental Management in Pediatric Primary Care Copyright © 2021 by Elsevier, Inc. All rights reserved. 2 Developmental Management in Pediatric Primary Care  Primary Care Providers  Monitor overall physical, cognitive, and psychosocial development  Offer anticipatory guidance as children grow  Key players helping families adjust to life changes  Need strong background in child development  Suggest diverse approaches to childrearing  Provide this support at all types of office visits Copyright © 2021 by Elsevier, Inc. All rights reserved. 3 Developmental Principles (1 of 3)  Principle 1 – growth & development are orderly and sequential  Rates/timing vary, while stages/phases are predictable  Principle 2 – pace of growth & development is specific for each child  May vary considerably; represents uniqueness of each child  Principle 3 – development occurs in a cephalocaudal and proximodistal direction  e.g., infants gain head control before sitting/walking  Controlled movements occur first toward midline; progress to extremities Copyright © 2021 by Elsevier, Inc. All rights reserved. 4 Developmental Principles (2 of 3)  Principle 4 – growth & development become increasingly integrated  Behaviors occur as a result of numerous small changes and skills (e.g., feeding)  Principle 5 – developmental abilities increasingly organize and differentiate  Behaviors/responses to internal/external cues become more regulated, organized, differentiated  Principle 6 – the child’s internal and external environments affect growth & development  Play, social norms, cultural values, family traditions influence child development  Children influence their environment Copyright © 2021 by Elsevier, Inc. All rights reserved. 5 Developmental Principles (3 of 3)  Principle 7 – certain periods are critical during growth & development  These periods particularly susceptible to alterations from internal/external influences  Principle 8 – development is a continual process, often without smooth transitions  Periods of change, growth, stability plateaus Copyright © 2021 by Elsevier, Inc. All rights reserved.  6 Theories of Child Development (1 of 16)  Cognitive-Structural Theories:  Behavioral Theories: Human Language and Thought Actions and Interactions  Psychoanalytic Theories:  Humanistic Theories Personality and Emotions  Ecologic Theories  Role of Social Interaction  Behavioral Economics  Parent Development Family Development: Family Systems Evolutionary Life Copyright © 2021 by Elsevier, Inc. All rights reserved. 7 Theories of Child Development (2 of 16)  Cognitive-Structural Theories: Language and Thought  Piaget (1969) – how children incorporate experiences into mental/physical being over time (Table 8.1)  Sensorimotor Stage (Birth to 2 Years) – learn about world through actions/sensory and motor movements  Key concepts: object permanence, spatial relationships, causality, use of instruments, combination of objects  Framework for learning is the self Copyright © 2021 by Elsevier, Inc. All rights reserved. 8 Theories of Child Development (3  ofCognitive-Structural 16) Theories: Language and Thought  Piaget (1969)  Preoperational Stage (2 to 7 Years) – attempt to make sense of the world  Egocentric: able to reason only with connections to real objects  Flawed cause & effect reasoning  Emerging intuitive reasoning Copyright © 2021 by Elsevier, Inc. All rights reserved. 9 Theories of Child Development (4 of 16)  Cognitive-Structural Theories: Language and Thought  Piaget (1969)  Concrete Operational Stage (7 to 12 Years) – use symbols to represent objects/perform mental tasks  Able to organize experiences/classify complex information  Flexibility of thought, declining egocentrism, logical reasoning, greater social cognition Copyright © 2021 by Elsevier, Inc. All rights reserved. 10 Theories of Child Development (5 of 16)  Cognitive-Structural Theories: Language and Thought  Piaget (1969)  Formal Operational Stage (13 Years through Adolescence) – abstract thinking/imagination of different solutions to problems  Increased awareness of health/illness and how their behaviors affect this  Renewed egocentrism gives way to appreciation of differences in judgment Copyright © 2021 by Elsevier, Inc. All rights reserved. 11 Theories of Child Development (6 of 16) Psychoanalytic Theories  Freud (1938) – sought links between conscious mind/body and unconscious mind  Interactions of id, ego, superego  Table 8.1  Anna Freud (1974) – focused on children  Psychoanalytic theory to help parents gain insight into potential harm during critical development depending on how needs met Copyright © 2021 by Elsevier, Inc. All rights reserved. 12 Theories of Child Development (7 of 16)  Psychoanalytic Theories  Erikson (1964) – described stages of individual throughout life span  Each stage has a problem to master; if not resolved, would be revisited in future stages  Sullivan (1964) – importance of self-concept and environmental influences  Parents/home most crucial cultural environment  Communication skills/integration of social experiences influence progression to mature relationships Copyright © 2021 by Elsevier, Inc. All rights reserved. 13 Theories of Child Development (8  ofPsychoanalytic 16) Theories  Mahler & colleagues (1975) – development of infant’s evolving independence by study of mother/infant dyad  Three stages: autism, symbiosis, separation-individuation  Steady increased awareness of self and individuation  Stern (1985), Emde & Buchsbaum (1990), Rogoff (1990) – quality/consistency of infant-caregiver relationship helps infant develop sense of self  Trevarthen & Aitken (2001) – infant’s capacity for self- regulation based in operation of intrinsic motive formation (IMF) leading to “purposive consciousness” Copyright © 2021 by Elsevier, Inc. All rights reserved. 14 Theories of Child Development (9 of 16) Role of Social Interaction  Kohlberg (1969) -moral development and socialization; children learn the expectations and norms of their society and culture  Gilligan (1982) - female thoughts and actions involve significantly different objectives and goals; girls tend to think more in terms of caring and relationships  Fowler (1981) - spiritual dimension of human life, or the development of faith; process of developing meaning in daily life.  Vygotsky (1978) -as children interact with others, they develop as individuals within cultural contexts. Copyright © 2021 by Elsevier, Inc. All rights reserved. 15 Theories of Child Development (10 of 16)  Behavioral Theories: Human Actions and Interactions  Skinner (1953) – learning controlled through operant conditioning – behavior modification therapy  Bandura (1962) – social learning theory – imitation and modeling as means of learning  Bijou & Baer (1965) – child’s responses to environment dependent on genetics and personal history Copyright © 2021 by Elsevier, Inc. All rights reserved. 16 Theories of Child Development (11 of 16)  Humanistic Theories  Maslow (1971), Buhler & Allen (1972), Mahrer (1978) – development through life span  Maslow’s hierarchy of needs from deficiency needs to self-actualization needs  Ecologic Theories  Bronfenbrenner, 1979  Emphasis on interdependence between environment and developing child  Children are dynamic; increasingly restructure settings where they live  Environments influence children, leading to mutual accommodation/reciprocity Copyright © 2021 by Elsevier, Inc. All rights reserved. 17 Theories of Child Development (12 of 16)  Behavioral Economics  World Bank Group, 2015; Gennetian et al., 2016–  human behavior that comes from a blending of sociology, psychology and economic theory  Three influences:  automatic thinking  cultural influences and norms  social contexts and past experiences (models) Copyright © 2021 by Elsevier, Inc. All rights reserved. 18 Theories of Child Development (13 of 16)  Family Theories  Bowen, 1966  Differentiation of self and emotional fusion are key concepts  Lampis et al., 2017  anxiety and/or tension between two family members is passed on to a third family member: explains how parental relationship problems can result in child behavior difficulties  Hengartner, 2017  families evolve over time and learned family behaviors have genetic influences Copyright © 2021 by Elsevier, Inc. All rights reserved. 19 Theories of Child Development (14 of 16)  Family Theories  Family systems theory (Bowen, 1960)  How family dynamics influence behaviors  Differentiation of self – ability to recognize self as individual while developing emotional connections to others  Emotional fusion – emotional interactions without conscious thought/speaking  High fusion with poor differentiation can cause family dysfunction Copyright © 2021 by Elsevier, Inc. All rights reserved. 20 Theories of Child Development (15 of 16)  Family Theories  Evolutionary life history theories  Explain influence of family environment on conflict/child development  Families evolve over time/learned behaviors inherited  Genetic influences of behavior driven by biologic imperative to reproduce  Social skills learned through interactions with family  Cool parent-child relationships occur when parents less focused on parenting Copyright © 2021 by Elsevier, Inc. All rights reserved. 21 Theories of Child Development (16 of 16)  Parent Development Theory  Mowder, 2005; Sperling and Mowder, 2006:  the parent is the individual who assumes the responsibility of caring for and raising a child.  Six characteristics of parenting are identified that vary in their importance based on the child's developmental needs (See Table 8.2)  Parenting evolves as a child ages Copyright © 2021 by Elsevier, Inc. All rights reserved. 22 Cultural Influences on Development  Cultural/ethnic traditions influence development  Normal differences occur between cultural groups  Parental responses vary by culture  Use genogram, eco-map, family-functioning model to identify family strengths, beliefs, practices  Be aware of own cultural biases Copyright © 2021 by Elsevier, Inc. All rights reserved.  23 Management Strategies in Child Development (1 of 6)  Promoting Parent Development and Parent-Child Interaction: Anticipatory Guidance  Information about normative development/best practices for managing development  Anticipatory guidance to help plan for changes/increase parenting skills/confidence  Child development/parent knowledge of development  Assessing parents’ comfort/experience  Assessing parents’ problem-solving skills  Information about normative development  Assisting with realistic expectations  Education about parenting strategies Copyright © 2021 by Elsevier, Inc. All rights reserved. 24 Management Strategies in Child Development (2 of 6)  Promoting Parent Development and Parent-Child Interaction: Anticipatory Guidance (Cont.)  Challenging in practice when time limited  Use of consistent framework is essential:  Bright Futures(Brazelton & Sparrow, 2006)  Bright Futures (Hagan et al, 2008)  Healthy Steps (Minkovitz et al, 2007)  Family Centered Care  Each family's cultural values, learning styles, and health beliefs and practices must be respected  See Table 8.3 Copyright © 2021 by Elsevier, Inc. All rights reserved. 25 Concerns About Delayed Development (3 of 6)  Developmental Red Flags (Box 8.2)  Development is varied and differences are normal  Be aware of red flags  Use standardized developmental screens at every well visit  Consider any causes of delays  Vulnerability and resilience significantly impact health/wellness and development Copyright © 2021 by Elsevier, Inc. All rights reserved. 26 Concerns About Delayed Development (4 of 6)  Talking with Parents About Developmental Delays  Should be routine, ongoing  PCP should listen, be sensitive to concerns  Strength-based approach best when problems found  Be familiar with referral resources  Be honest, positive, realistic Copyright © 2021 by Elsevier, Inc. All rights reserved. 27 Concerns About Delayed Development (5 of 6)  Talking with Parents About Developmental Delays (Cont.)  School Intervention Resources  Public Law 94-142 – addresses needs of children >3 years  IEP – individualized education plan; special education services in public schools  PCP should be aware of plan/assist with health care concerns  Family-Centered Care  NAPNAP, AAP, Public Law 99-457 all emphasize importance of family-centered care Copyright © 2021 by Elsevier, Inc. All rights reserved. 28 Concerns About Delayed Development (6 of 6)  Talking with Parents About Developmental Delays  Care Coordination  Children with special health care needs are “those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who also require health and related services of a type or amount beyond that required by children generally.” – Maternal and Child Health Bureau (MCHB) and AAP definition Copyright © 2021 by Elsevier, Inc. All rights reserved.  29 Discussion Questions 1. List strategies that might be used by a pediatric primary care provider to incorporate developmental anticipatory guidance into the following sick visits: (1) an 18-month-old with an acute upper respiratory infection, (2) a 4-year-old with stool withholding and constipation, (3) a 9-year-old with chronic headaches, (4) a 15-year-old with dysmenorrhea. 2. Using the developmental theorists (where appropriate), explain the following child behaviors: a 3-year-old child has nighttime fears of the dark; an 8-year-old girl wants to be involved in a scouting group and is an avid collector of snow globes; a 13-year-old male wants to go to a camp sponsored by his religious denomination with a group of friends from school. 3. Conduct a developmental assessment on a child of your choice. Be sure to look at physical, developmental, social, and emotional growth. What changes to the assessment would you anticipate in 1 year? In 3 years? 4. You receive a phone call from a parent of a 4-year-old who fits the following temperament: high activity, high rhythmicity, low adaptability, low threshold of response, high intensity of reaction, outgoing and friendly mood, and high distractibility. His parent reports that the child is acting out against his Copyright younger sibling © 2021 by by Elsevier, Inc.kicking, hitting, and yelling. What All rights reserved. anticipatory guidance related to discipline and parenting are appropriate