Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
MB Discussion:
Discuss the history that you would take on this child in preparation for the well-child visit. Include questions regarding her growth and development that are appropriate for her age.
A well-child visit entails monitoring the growth and development of the child. These visits are intended to assess and discuss every significant domain development of the child (Moreno, 2018). On the first well-child visit, the history that the pediatrician would take on the child in preparation for the assessment would include comprehensive birth history. Additional history that the pediatrician would take on the child in preparation for the subsequent well-child visit would include reviewing the development of the child since the last visit and reviewing notes from the previous visit. It would also be discussing the growth of the child with the parents. This may include social, emotional, cognitive, and physical development. It may further include any concern or illness exhibited by the child before the visit, child medical history as well as family history, and dietary, vaccination, and social history (Turner, 2018).
Age-appropriate growth and development questions for the two months old would include:
- Is she able to lift her head and shoulder while lying on her stomach?
- Does she follow a moving object to the midline or past the midline?
- How well she reacts to the sound?
- Does she pay attention to faces and identified people at distance?
- Does she respond to smile?
- Does she try to interact by making cooing and gurgling sounds?
- Can she bring her hand to her mouth and sucks on her hand?
Age-appropriate growth and development questions for the six months old would include:
- Does she recognize familiar faces and notice a new face?
- Does she make sounds in response to sounds she hears?
- Can she pass things from one hand to another?
- Has she started to sit without support?
Age-appropriate growth and development questions for the nine months old would include:
- Does she exhibit fear upon seeing strangers?
- Does she make different sounds?
- Does she put things in her mouth?
- Does she crawl and pulls herself to stand?
Describe the developmental tool to be used for Asia, its reliability and validity and how Asia scored developmentally on this tool. Is she developmentally appropriate for her age?
The American Academy of Pediatrics (AAP) recommends the use of a development tool for developmental screening starting from the well-child visit at nine months interval (Moreno, 2018). The Parents’ Evaluation of Developmental Status (PEDS) is one of the many validated developmental screening tools used for the child. It is an evidence-based approach for identifying and addressing growth and behavior-related concerns in children. It is a simple 10-item questionnaire, which is completed by the parent (Vitrikas et al., 2017). Once the parent has answered the questionnaire, the pediatrician work along with parents to score the questionnaire and interprets the concerns of parents. Expert use of PEDS facilitates the timely recognition of growth and behavior-related concerns in babies (Sun et al., 2017).
Validity and reliability are measures, which reflect the possible efficacy and accuracy of a specific tool. An acceptable sensitivity for a developmental screening is determined to be between 70% and 80%. The acceptable standard for the specificity of a tool is identified to be approximately 80% (Vitrikas et al., 2017). One of the most widely assessed tools that are completed by parents is identified to be PEDS. It entails eight questions requiring answers in yes or no and two open-ended questions written at the fourth to fifth-grade reading level. It takes two minutes for the parent to complete the questionnaire (Sun et al., 2017). It is identified to have a specificity of 74% and sensitivity of 75% on an average for all age groups (Vitrikas et al., 2017). It is known to have maintained psychometric properties across parental education level, socioeconomic status, and child-rearing experience. Physicians at urban pediatric clinics reported the identification of growth-related issues with high accuracy and timely during well-child visits after integrating the use of the PEDS tool into their practice. They further reported that the utilization of PEDS improved the efficiency of well-child visits and ensure the provision of appropriate follow-up care (Vitrikas et al., 2017).
Upon reviewing PEDS developmental screening form completed by the Mother, it is observed that the mother reported no growth or behavioral-related concerns. This indicates that the child has scored well developmentally on PEDS and is placed in the low-risk category. She is identified to be developmentally appropriate for her age as she can sit without support and waves bye-bye. This is considered indicative of regular gross motor and cognitive and communication progress for a nine-month-old child.
What immunizations will Asia be given at this visit; what is the patient education and follow-up?
The immunizations for the child at the nine-month visit included the third dose of inactivated poliovirus that was held at six months well-child visit and annual influenza. The immunizations to be administered at the 12-month well-child visit would include fourth doses of Haemophilus influenzae type b and pneumococcal conjugate. Additional immunization at 12 months well visit would include first doses of measles, mumps, rubella, and varicella. It is also recommended to initiate the two-dose series of Hepatitis A (HepA) at the 12-month well-child visit (Centers for Disease Control and Prevention [CDC], 2021). Every well-child visit must entail anticipatory guidance for parents. This helps them anticipate the growth and nutritional requirements of their child. Parents must also be educated regarding the safety of the child (Turner, 2018). The parent is guided to visit for follow-up at 15 months for the administration of the immunizations recommended at this interval. These would include the fourth dose of Diphtheria, tetanus, and acellular pertussis and the second dose of the two-dose series of (HepA) (CDC, 2021).
References
Aquifer.org. (n.d.). Pediatrics 02: Infant female well-child visits (2, 6, and 9 months). https://southu-nur.meduapp.com/document_set_document_relations/30217
Centers for Disease Control and Prevention. (2021, February 12). Table 1. Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
Moreno, M. A. (2018). The well-child visit. Journal of the American Medical Association Pediatrics, 172(1), 104-111. https://doi.org/10.1001/jamapediatrics.2018.4041.
Sun, J., Patel, F., Jacobs, R. R., Frank, D. A., Black, M. M., & Chilton, M. (2017). Mothers’ adverse childhood experiences and their young children’s development. American Journal of Preventive Medicine, 53(6), 882-891. https://doi.org/10.1016/j.amepre.2017.07.015.
Turner, K. (2018). Well-child visits for infants and young children. American Family Physician, 98(6), 347-353. https://www.aafp.org/afp/2018/0915/afp20180915p347.pdf.
Vitrikas, K., Savard, D., & Bucaj, M. (2017). Developmental delay: When and how to screen. American Family Physician, 96(1), 36-43. https://www.aafp.org/afp/2017/0701/afp20170701p36.pdf.
