L4- Peds growth and dev/documenation

WCC components

• screening tools

• dev assessment

• risk factor identificaiton

• growth measurements

  • plottign growth chart

• physical examination

• immunizations

• safety and anticipatory guidance

AAP bright futures

• guidelines fro all preventitive care screenings and well child checks

EPSDT

• early and periodic screening, diagnostic, and treatment program

• covers WCC plus dx and tx services

• set required componenets of peds preventitive care visits

maternal depression screening

• AAP recommends that screening be done at 1,2,4, adn 6 month infant visits

baby blues

• begin few days after childbirth and last up to 2 weeks, but do NOT impair function

• sx

  • crying

  • depressd mood

  • irrritability

  • anxiety

  • confusion

postpartum depression

• PPD lasts longer than the baby blues and INTERFERES with the ability to perform daily activities

• intense sx of sadness, anxiety, and hopelessness that lasts up to one year

postpartum psychosis

• first four weeks after childbirth

• impairment is serious and may include paranoia, mood shifts, hallucinations, adn/or delusions, and suicidal and/or homicidal thoughts

• immediate, emergency mental health services if mentiosn thoughs of suicide on screenign or in convo

depression screening

• universal screening for depression at annual WCC starting at age 12

• PHQ-2 for screening

  • if positive→ PHQ-9

• consider GAD-7 (ages 13+) or SCARED (8+) if sus added anxiety

food insecurity screenign

• 2 question screen at all WCC

ASQ

• ages and stages questionaire

• developmental screening tool

• ages 0-5.5

• communication, gross motor, fine motor, problem solving, personal social

  • 10pt if yes

  • 5pt if sometimes

  • 0pt if never

• total score shows dev WNL or if there are delays or noted cocnern

• use appropriate ASQ if preemie

M_CHAT-R

• modified checklist for autism in toddlers, revised

• parent report screenign base don observed characteristics

• admin at 18month and 24month WCC

• positive screen means ealy referral for autism eval

• screenign tool will delp determine risk level and action plan

1 month dev milestones

• lifts chin up in prone position

• hands fisted

• startles to sound

• discriminates parents voice

• follows face

4 months dev milestones

• sits with support, no head lag

• rolls from FRONT to BACK

• hands mostly open, reahces for objects

• LOL

• stops crying to soothing voice

• social smile

6-7 month dev milestones

• sits propped on hands, bounces when held

• transfers objects from hand to hand

• reaches out with one hand

• feeds self teething cracker

• babbles constant sounds

• enjoys reflection in mirror

9 months

• pulls to stand

• pincer grasp

• bangs two cubes together

• says mama nonsepcifically

• imitates sounds

• enjoys peek a boo

• dev stanger anxiety

12 month dev milestones

• starts takign first steps

• scribbles + hold crayon

• makes tower with 2 cubes

• says one word with meaning

• points to objects, follows one step commands

• show object to parent to share

15 month dev milestones

• stops to pick up toys

• climbs on furniture

• runs stiff elgged

• uses spoon with some spilling

• places 10cubes in cup

• turns page sin book

• uses 3-5 words

• mature jargon

• points to body part

• shows empathy

• gives hug on request

18 month dev milestones

• creeps down stairs; runs well

• makes 4cube tower; imitates vertical stroke

• uses 10-15 words

• points sto 3 body parts

• points to self and familiar ppl

• engages in pretend play

24 month dev milestone

• walks downstairs, holding rail, with both feet on one step

• kicks ball

• imitates horizontal line

• opens door knob; sucls through straw

• uses 2 word sentences

• uses 50+ words

• 50% intelligibility

• refers to self by name

• parallel play

physical dev tasks (middle chilhood- 5-10yo)

• enhanced stength and coordination

• competence in various tasks and activities

• healthcare needs

  • screenign for strengths, assessing problems

  • involving parents

  • support disabilities

  • anticipatory guidance; safety, exercise, nutrition, sleep

cognitive dev tasks (middle chilhood- 5-10yo)

• concrete operationsal: focus on present

• achievement of knowledge and skills; self efficacy

• emphasis on short term consequences

• support: screenign for skills and performance

social dev tasks (middle chilhood- 5-10yo)

• achieving good fit with fmaily, friends, school

• sustained self esteem

• evolving self identitiy

• assessment, support, advice about interactions including peer relationships

• support, emphasis on strengths

• understanding, advice, support

interdisciplinary team approach for developmental delays

• peds subspecialties: neuro, ortho, psych, dev/behavioral, etc

• under age of 3- early intervvention with childrens dev services agency will eval at no cost

referral to dev center for developmental delays

• olson huff center for child dev

• physical therapy

• speech therapy

• feeding and swallowing program

• occupational therapy

individual educational plan (IEP)

• programs administered at school to address dev delays

lead screening

• routine screening at 12 and 24 months

• capillary blood samples

• if elevated→ repeat with venous sample

• risk assessment 6months-6 years

RF lead

• spend time in pre 1960 building with scracked or peelign paint

• sibling, playmate, or community memeber with lead poisoning

• live with adult whose job or hobby involves lead

• live near battery recyclign plant, or similar

• use home remedies or pottery from another country

TB testing

• all children should be assessed fro risk of TB at health maintenance visit at 1 month, 6 months, 12months, and then annual

• PPD

iron def and anemia screening

• CBC + serum ferritin

  • breastfed infant: 9-12months

  • formula fed infants: 15-18months

  • adolescents: at least 1 year postmenarche, no later than age 14

IDA prevention

• iron supp

• delayed cord clamping

  • preterm infants: start iron fotification or supp by 2 weeks of life

IDA dx

• low ferritin- iron def

• low ferritin and low Hbg- IDA

cholesterol risk screeenign recommendaiton

• ages 2,4,6,8,10

universal lipid screening

• ages 9-11 AND
  18-20

fasting lipid panel- total cholesterol

• ≤170 = normal

• 170-199= borderline

• ≥200= elevated

STI screening

• all sexually active female pts <25 should be screened annually fro chlamydia and gonorrhea

• test all pts for HIV at least once btwn 15-21

• no pap until 21 regardless of sexual actiivy

growth measurements

• weight- every visit

• length: <24 months

• height: >24months

• HC: ≤24 months

plotting growth chart

• measures growth in comparison to same age, dame gender

• discusse din terms of percentiles

  • 90th percentile= child is taller than 90% of children same age, same gender

• trends are important as absolute measurements

• always recheck abnormal data

• always use correct age adjusted chart

BMI

• no BMI <2yo

  • instead, weight for length percentile

rules of thumb for growth- weight

• weight loss in first few days: 5-10% of birthweight

• return to birth weight 7-10days of age

• double birth weight 4-5months

• triple birth weight 1 year

use NEWT in clinic - newborn weight loss tool

vital signs to check at eahc visit

• weight

• height (or length)

• head circumference (through age 2)

• temp

• HR
  RR
  BP beginning at age 3

when to begin vision testing

age 3; snellen chart with shapes

when to begin hearing test

age 4

full scale acoustic screenign test usign standardizzed equip

dental varnish

• fluoride dental varnish applied at WCC

  • q3-6 months btwn 9months and 5 years

• begin dental visits after first tooth eruption

oral health recommendations

• dental exam by dentist annually

• cleaning by dentist or hygenist q6months

• brushing.flossing

where to give IM vaccine in children <2yo

• anterolateral thigh

where to give IM vaccine for children ≥3yo

deltoid

Hep B vaccine schedule birth- 6yo

• dose 1 at birth

• dose 2 at 1-2 months

• dose 3 at 6month-18months

rotavirus vaccine schedule birth-6yo

• dose 1 at 2 months

• dose 2 at 4 months

• possible 3rd dose at 6months

DTaP vaccine schedule birth- 6yo

• dose 1 at 2 months

• dose 2 at 4 months

• dose 3 at 6 months

• dose 4 at 15-18months

• dose 5 at 4-6 yrs

Hib vaccine schedule birth- 6yo

• dose 1 at 2 months

• dose 2 at 4 months

• possibel dose 3 at 6 months

• dose 4 at 12-15months

pneumococcal vaccine schedule birth- 6yo

• dose 1 at 2 months

• dose 2 at 4 moths

• dose 3 at 6 months

• dose 4 at 12-15 months

poliovaccine schedule birth- 6yo

• dose 1 at 2 months

• dose 2 at 4 months

• dose 3 at 6-18months

• dose 4 at 4-6yo

covid vaccine schedule birth- 6yo

• at least one dose of current vaccine 6month-4-6yo

flu vaccine schedule birth- 6yo

• every year; one + booster 1 month after (only for first ever dose)

• btwn 6month— 4-6 yo

MMR vaccine schedule birth- 6yo

• dose 1 at 12-15months

• dose 2 at 4-6yo

chickenpox vaccine schedule birth- 6yo

• dose 1 at 12-15months

• dose 2 4-6yo

vari

hepatitis A

2 doses separated by 6 months

• btwn 12months— 20-23months

HPV vaccine recommendation 7-18yo

• 9-10yo

• 11-12yo

Tdap vaccine recommendation 7-18yo

• 11-12yo

meningococcal ACWY vaccine recommendation 7-18yo

• 11-12yo

• 16yo

live attenuated vaccines

• weakened formof infectious agent

• capable of causing attenuated form of dz

  • usually not

• more dangerous/CI in immunocompromised

• more likely to cause fever

examples of live attenuated vaccines

• MMR

• varicella

• RV (liquid)

• Flu (intranasal)

inactivated vaccines

• made with killed infctious agent that is able to induce immune response in host

• not capabel of causing disease

• more likely tp require booster

examples of inactivated

all EXCEPT

• MMR

• varicella

• RV (liquid)

• Flu (intranasal)

when to give tylenol or motrin in relation to vaccines

AFTER

contraindications to vaccines

• serious rxn

  • anaphylaxis to previous vaccine dose

  • anaphylaxis to vaccine component

• immunicompromised

  • NO Live virus vaccine

• moderate to severe acute illness with or without fever

conditions that do NOT contraindicate vaccine admin

• mild illness (no fever or wheezing)

• recent exposure to infectious dz

• current antimicrobial therapy

• breast feeding

• mild to moderate local xn to previous vaccine admin

• fever after prev vaccine admin

• hx monvaccine allergy

• recieving allergen extract immunotherapy

• chronic medical cond

• egg allergy

documentation of vaccine refusal

• document refusal and counseling

  • ensure proper education

• revisit and document at every visit

• use AAP refusal to vaccinate form

anticipatory guidance birth and/or 3-5days injury prevention

• crib safety

• hot water heaters <120^o

• care safety

• smoke detectors

anticipatory guidance birth and/or 3-5days violence prevention

• assess bonding and attachent

• ID family strife, lack of support, pathology

• educate parents on nurturing

anticipatory guidance birth and/or 3-5days sleep position

• back to sleep

• crib safety

anticipatory guidance birth and/or 3-5days nutritional counseling

• exclusive breast feeding encouraged

• formula as second best

anticipatory guidance birth and/or 3-5days fostering optimal dev

• discuss parenting skills

• refer for parenting education

anticipatory guidance 4 months injury prevention

• infant walkers

• choking/suffocation

anticipatory guidance 4 months violence prevention

• reassess

anticipatory guidance 4 months sleep position

• back to sleep

anticipatory guidance 4 months nutritional counseling

• intro to solid foods

anticipatory guidance 4 months fostering optimal dev

• discuss central to peripheral motor dev

• praise good behavior

vaccine schedule - 2months

• DR. HIP

• DTap + rotavirus + Hib + IPV + PCV

vaccine schedule - 4 months

• DR. HIP

• DTap + rotavirus + Hib + IPV + PCV

vaccine schedule- 6 months

• DR. HIP + flu + Hep B

• DTap + rotavirus + Hib + IPV + PCV + influenza (start at 6 months) and final Hep B

vaccine schedule— 12-15months

• MAD HPV

• MMR + Hep A + DTaP + Hib + PCV + varicella

vaccine schedule— 4-6years

• Very DIM

• varicella + DTaP + IPV + MMR

vaccine schedule— 11-12years

• TADA human men

• Tdap + HPV + men ACWY

vaccine scheduke 16-19yo

• men

• menACWy booster