Pediatric – week 3 discussion 2nd reply

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.  

JO 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.

In preparation for this patient’s well-child check, it is imperative to review the patient’s perinatal history (any complications during pregnancy), birth history (term/preterm, vaginal or c-section delivery), medical history, immunizations, hospitalizations, growth chart, vital signs, lab work (if applicable), family history, if any illnesses have occurred since birth.  Important questions pertinent to growth and development include: does the infant’s diet consist of breast milk, formula, or both? If breastfed only, do you supplement with vitamin D?  How many ounces and how often is the baby eating? How many wet diapers and bowel movements has the baby had in the last 24 hours?  How is the baby sleeping? Does the baby respond to your voice? Does the baby coo or smile? Is the baby able to lift and hold head while on her stomach? Is the baby able to move all four extremities? Can she bring her hands to her mouth? I would also like to ask the parent if they have any concerns about the baby’s development.

Describe the developmental tool to be used for Asia, its reliability and validity and how Asia scored developmentally on this tool.

The developmental tool used to monitor children from birth to age 8, is the Parents’ Evaluation of Developmental Status PEDS test.  This test is completed by the parents and is used as a reference for primary care providers to assess for autism and to analyze the patient’s behavior, development, and social-emotional/mental health (Bright Futures, 2021). The PEDS test and retest reliability studies were conducted on 193 pediatric patients over a 0–32-day span, revealed a 94% agreeance in PEDS Paths and parental concerns (PEDS Test, 2018). Asia’s PEDS test score of zero and her overall physical exam, she is developing appropriately.

Is she developmentally appropriate for her age? What immunizations will Asia be given at this visit; what is the patient education and follow-up?

As mentioned previously, given the PEDS results, reviewing trends in growth chart, and per the physical exam, Asia is developmentally appropriate for her age.  According to the CDC immunization schedule, Asia should receive DTap, Hep B (second dose, as she received 1st Hep B after birth), Hib, IPV, PCV13, RotaV (CDC, 2021).  Asia’s mother should obtain a handout about the immunizations Asia will receive at the visit and possible side effects the patient may experience after the immunizations have been given.  Common side effects after vaccine administration include: tenderness and/or redness at injection site, low grade fever, fussiness, decreased appetite, and vomiting (CDC, 2021).  Asia’s mother should be educated on the need to encourage Asia to drink plenty of fluids, and to administer Tylenol and Ibuprofen as needed for discomfort.  The patient may experience redness at the injection site.  Asia’s immunization card/record should be updated, and her mother should receive the 2-month Bright Futures informational handout.  

References

Centers for Disease Control and Prevention. (2021).  Cdc vaccine schedules app for health care providers. Retrieved from https://www.cdc.gov/vaccines/schedules/hcp/schedule-app.html

Centers for Disease Control and Prevention. (2021). Possible side effects from vaccines. Retrieved from https://www.cdc.gov/vaccines/vac-gen/side-effects.htm

PEDS Test. (2018). Peds validation. Retrieved from https://pedstest.com/static/research/peds-standardization.html

Woolfenden S, Eapen V, Jalaludin B on behalf of the ‘Watch Me Grow’ study group, et al. Prevalence and factors associated with parental concerns about development detected by the Parents’ Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort

           BMJ Open 2016;6:e012144. doi: 10.1136/bmjopen-2016-012144

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