NUR 202Bates Chapter 18 - Infancy to Adolescence

Bates Chapter 18: Assessing children: Infancy through adolescence o Perform less invasive maneuvers early and potentially distressing maneuvers later in the exam. For example, palpate head and neck early and listen to ...

Bates Chapter 18: Assessing children: Infancy through adolescence o Perform less invasive maneuvers early and potentially distressing maneuvers later in the exam. For example, palpate head and neck early and listen to abdomen later in the exam o If a child c/o pain in one area, examine that area LAST. General principles of Child Development: o Childhood is a period of remarkable physical, cognitive, and social growth—by far the greatest in a person's lifetime – in a few short years they grow 20 fold, acquire language and reasoning, complex social interactions and mature towards adults. Four Principles of Child Development: 1. Child development proceeds along a predictable pathway –governed by the maturing brain. Loss of milestones is ALWAYS concerning. 2. The range of normal development is wide – there is a normal broad developmental range of cognitive, physical and social development. 3. Various physical, social, and environmental factors, as well as diseases, can affect child development and health – ex: child abuse and poverty. Children with physical or cognitive disabilities may not follow the age-specific developmental trajectory. 4. The child's developmental level affects how you conduct the history and physical examination- before starting the assessment, attempt to ascertain developmental level and adopt your physical exam to that level. Health Promotion in children: o Prevention and health promotion at a young age can result in improved health outcomes for decades. o Every interaction with a child and family is an opportunity for health promotion – each time you see a family you have 2 tasks: detect clinical problems and promote health (age-appropriately – reading, music, gross/fine motor skills). Demonstrate relationship between health lifestyle and physical health  exercise can prevent obesity. o PARENTS are the major agents of health promotion and clinicians’ advice is implemented through them. o Childhood immunizations are a mainstay for health promotion and have been heralded as the most significant clinical achievement in public health worldwide – always look at CDC and AAP (American academy of pediatrics) to stay up to date since the guidelines are always changing. Key Components of Pediatric Health Promotion 1. Age-appropriate developmental achievement of the child o Physical (maturation, growth, puberty) o Motor (gross and fine motor skills) o Cognitive (developmental milestones, language, school performance) o Emotional (self-regulation, mood, temperament, self-efficacy, self-esteem, independence) o Social (social competence, self-responsibility, integration with family and community, peer interactions) 2. Health supervision visits o Periodic assessment of clinical and oral health o More frequent health supervision visits for children with special health care needs 3. Integration of physical examination findings with health promotion 4. Immunizations 5. Screening procedures 6. Anticipatory guidance4,8 o Healthy habits o Nutrition and healthy eating o Safety and prevention of injury o Physical activity o Sexual development and sexuality o Self-responsibility, efficacy, and healthy self-esteem o Family relationships (interactions, strengths, supports) o Positive parenting strategies o Emotional and mental health o Oral health o Recognition of illness o Sleep o Screen time o Prevention of risky behaviors (e.g., tobacco, alcohol and drug use, unprotected sex) o School and vocation o Peer relationships o Community interactions 7. Partnership among health care provider, child/adolescent, and family ASSESSING THE NEWBORN (0-28 days): *post neo-natal: 29 days – 1 year. Tips for Examining Newborn