Objectives
•Definitions
•Benefits and Possible harms of developmental surveillance and screening
•Combining Screening and Surveillance Practice Algorithm
Identifying infants and young children with developmental disorders.pdfDanielPuertas9
This document provides guidance for pediatricians on promoting early identification of developmental disorders in infants and young children. It outlines a universal system of developmental surveillance at every well-child visit and standardized developmental screening at 9, 18, and 30 months. Any concerns identified through surveillance should prompt further screening or direct referral. Special attention to surveillance is recommended at age 4-5 years prior to school entry, with screening if concerns arise. The goal is to identify issues early and connect children to intervention services.
Developmental delay is defined as performance in two or more developmental domains that is 25% below typical expectations. Developmental deviations and dissociations can also occur, where skills develop outside the typical sequence or domains progress at differing rates. Regression, the loss of skills, is more concerning as it can indicate serious neurological issues. Common developmental disorders include speech/language impairment, social-emotional disorders, ADHD, and learning disabilities. Early detection of delays is important for early intervention but most children are not identified until school-age due to limitations of informal assessment in primary care. Standardized screening tools can help but have limitations and should be used as part of ongoing developmental surveillance.
The document discusses psychoeducational assessments. It explains that a psychoeducational assessment is an evaluation conducted by a psychologist to determine if a child has developmental or learning challenges. The assessment explores a child's strengths and weaknesses compared to peers. It allows parents to gauge their child's development. The assessment uses various psychometric tools customized to the child's needs. Parents receive preliminary results on the day of the assessment and a full report two weeks later to discuss the results.
advanced role of nurse practitioner
Define preoperative nursing and operating room nurse.
Describe phases of the preoperative period.
Describe the physical environment of the OR.
Show specific areas within the operating room (OR).
Locate and describe the use of furniture and equipment in the operating room.
Identify the role of each member of the operating room team.
Discuss how environmental layout contributes to aseptic technique.
Perioperative nursing care is crucial in ensuring the well-being and safety of patients throughout the entire surgical process.
It requires a high level of skill, knowledge, and attention to detail.
play a vital role in promoting positive surgical outcomes and providing patients with the support and care they need during this vulnerable time.
The document discusses the nursing process as it relates to family health nursing. It describes the five steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. For each step, it provides details on how the step is carried out for family health nursing, including collecting data, identifying problems and needs, setting goals, monitoring care provision, and evaluating outcomes. The nursing process provides a systematic approach to delivering family-centered nursing care.
Promote children's social emotional and behavioral healthlimiacorlin
State policymakers can promote children's social, emotional, and behavioral health through a continuum of strategies. An effective approach establishes aspirations and uses data to drive decisions, measure progress, and ensure accountability. Key elements include supporting healthy development, families, and treatment for those in need. Data on conditions like autism and ADHD in children informs target-setting to improve outcomes. Recommended strategies begin with promoting early childhood social and emotional development through initiatives to increase public understanding and integrating support into existing programs.
The document discusses incorporating mental health checkups into regular preventative healthcare visits for adolescent patients ages 11-18. It recommends using the Pediatric Symptom Checklist Youth Version (PSC-Y) screening questionnaire to identify issues related to mental illness, suicide risk, and the need for referral to additional services. It provides guidance on administering and scoring the PSC-Y, interpreting the results, conducting follow-up interviews, and making referrals when appropriate. It also discusses relevant reimbursement codes for billing.
A brief research overview connecting parenting education with health related outcomes for children and families. Created by the Parenting Education team at Oregon State University with funding from the Oregon Parenting Education Collaborative.
Identifying infants and young children with developmental disorders.pdfDanielPuertas9
This document provides guidance for pediatricians on promoting early identification of developmental disorders in infants and young children. It outlines a universal system of developmental surveillance at every well-child visit and standardized developmental screening at 9, 18, and 30 months. Any concerns identified through surveillance should prompt further screening or direct referral. Special attention to surveillance is recommended at age 4-5 years prior to school entry, with screening if concerns arise. The goal is to identify issues early and connect children to intervention services.
Developmental delay is defined as performance in two or more developmental domains that is 25% below typical expectations. Developmental deviations and dissociations can also occur, where skills develop outside the typical sequence or domains progress at differing rates. Regression, the loss of skills, is more concerning as it can indicate serious neurological issues. Common developmental disorders include speech/language impairment, social-emotional disorders, ADHD, and learning disabilities. Early detection of delays is important for early intervention but most children are not identified until school-age due to limitations of informal assessment in primary care. Standardized screening tools can help but have limitations and should be used as part of ongoing developmental surveillance.
The document discusses psychoeducational assessments. It explains that a psychoeducational assessment is an evaluation conducted by a psychologist to determine if a child has developmental or learning challenges. The assessment explores a child's strengths and weaknesses compared to peers. It allows parents to gauge their child's development. The assessment uses various psychometric tools customized to the child's needs. Parents receive preliminary results on the day of the assessment and a full report two weeks later to discuss the results.
advanced role of nurse practitioner
Define preoperative nursing and operating room nurse.
Describe phases of the preoperative period.
Describe the physical environment of the OR.
Show specific areas within the operating room (OR).
Locate and describe the use of furniture and equipment in the operating room.
Identify the role of each member of the operating room team.
Discuss how environmental layout contributes to aseptic technique.
Perioperative nursing care is crucial in ensuring the well-being and safety of patients throughout the entire surgical process.
It requires a high level of skill, knowledge, and attention to detail.
play a vital role in promoting positive surgical outcomes and providing patients with the support and care they need during this vulnerable time.
The document discusses the nursing process as it relates to family health nursing. It describes the five steps of the nursing process - assessment, diagnosis, planning, implementation, and evaluation. For each step, it provides details on how the step is carried out for family health nursing, including collecting data, identifying problems and needs, setting goals, monitoring care provision, and evaluating outcomes. The nursing process provides a systematic approach to delivering family-centered nursing care.
Promote children's social emotional and behavioral healthlimiacorlin
State policymakers can promote children's social, emotional, and behavioral health through a continuum of strategies. An effective approach establishes aspirations and uses data to drive decisions, measure progress, and ensure accountability. Key elements include supporting healthy development, families, and treatment for those in need. Data on conditions like autism and ADHD in children informs target-setting to improve outcomes. Recommended strategies begin with promoting early childhood social and emotional development through initiatives to increase public understanding and integrating support into existing programs.
The document discusses incorporating mental health checkups into regular preventative healthcare visits for adolescent patients ages 11-18. It recommends using the Pediatric Symptom Checklist Youth Version (PSC-Y) screening questionnaire to identify issues related to mental illness, suicide risk, and the need for referral to additional services. It provides guidance on administering and scoring the PSC-Y, interpreting the results, conducting follow-up interviews, and making referrals when appropriate. It also discusses relevant reimbursement codes for billing.
A brief research overview connecting parenting education with health related outcomes for children and families. Created by the Parenting Education team at Oregon State University with funding from the Oregon Parenting Education Collaborative.
Presentation on Current principles , practices trends in pediatric nursing..pptxCharutaKunjeer1
This document summarizes a seminar on current principles, practices, and trends in pediatric nursing. It discusses the aims and objectives of the seminar which are to understand the concept of pediatrics and discuss current principles, practices, and trends. Some key points covered include the definition of pediatrics, principles of pediatric nursing focusing on the family and child, current practices involving educational requirements and use of nursing process, and trends such as family-centered care, high-technology care, evidence-based practice, and atraumatic care approaches.
1. Nursing diagnosis is a clinical judgment about a patient's response to actual or potential health problems. It focuses on issues a nurse can treat, unlike a medical diagnosis which identifies disease.
2. The nursing diagnostic process involves collecting data, analyzing it for deviations from norms, clustering related cues, and formulating a diagnosis statement describing the patient's problem, likely cause, and defining characteristics.
3. Nursing diagnoses can be one-part, two-part, or three-part statements specifying the problem, related factors or etiology, and defining signs/symptoms. Variations include unknown or complex etiologies, possible diagnoses, and specifying secondary causes.
Comprehensive family assessments go beyond investigations to identify services needed to address family needs, problems, and ensure child safety. The assessment identifies the nature and duration of abuse/neglect and its impact. It examines parents' and children's views, parents' experiences contributing to needs/problems, parental strengths, previous efforts to meet child needs/resolve problems, and kinship/tribal resources. Various assessment types evaluate education, medical issues, development, functioning, domestic violence, psychology, parenting abilities, sex offending, mental health, and substance abuse. Trauma screening and further assessment are important to understand family trauma impact and guide service referrals and plans.
Here are the key similarities and differences between the two articles on authentic assessment:
Similarities:
- Both discuss authentic assessment as being performance-based and evaluating students in natural environments like home or classroom rather than standardized tests.
- They view authentic assessment as providing a holistic picture of students' strengths and weaknesses by observing real-life application of skills.
Differences:
- Bergen (1993) focuses on authentic assessment for young children through caregiver observation at home, while Dennis et al. (2013) examines its use for school-aged children in the classroom.
- Bergen emphasizes caregivers collaborating with teachers, while Dennis et al. place more responsibility on teachers to design and implement authentic assessments.
-
The document discusses evaluation methods used in pediatric occupational therapy. It describes standardized tests, ecological assessments, skilled observation, interviews, inventories and scales, and arena assessments. Standardized tests provide uniform administration and scoring but may not reflect real-world performance. Ecological assessments consider the child's environment. Skilled observation involves objective recording of behavior. Interviews gather information from the child, parents, and teachers. Inventories and scales evaluate functional capabilities. Arena assessments use a transdisciplinary approach in natural settings.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
The document discusses strategies for conducting well-child visits in a more effective manner. It notes that simply having clinicians check off pre-selected discussion topics may not be the best use of limited visit time and may not meet families' needs. Alternative approaches discussed include using nurses and other providers for routine screening; providing handouts to cover anticipatory guidance; prioritizing interactive discussions of the most evidence-based topics; and using group well-child care models. The document also emphasizes structuring visits with the goal of promoting adult health outcomes by addressing social determinants of health like poverty, education, environment, and adverse childhood experiences.
Pediatric nursing involves the care of children from conception through adolescence to promote health and treat illness. It aims to provide quality care in an environment that supports families and children's psychological and physical well-being. Advances in medicine have made pediatric care more technologically advanced, requiring nurses to have strong technical skills. Primary nursing is commonly used and assigns one main nurse and backup nurses to ensure consistent care for each child. Factors like childhood trauma, disabilities, and family issues must all be considered in pediatric nursing to optimize outcomes and quality of life.
Standards, challenges and scope of psychiatric nursingjasleenbrar03
This document outlines the standards of practice for psychiatric nursing. It describes the nursing process used, which includes assessment, diagnosis, outcome identification, planning, implementation, and evaluation. For each step of the nursing process, nursing conditions and behaviors are defined. The standards represent the profession's commitment to providing quality care and ensuring nurses are practicing safely and effectively.
This document outlines a case study format for assessing family nursing needs. It includes sections on collecting an initial family data base, identifying health problems, prioritizing problems, developing family nursing care plans, and evaluating outcomes. The data base section covers family structure, socioeconomics, home environment, health status, and health practices. The identification of problems section lists potential health conditions, deficits, threats and stresses. Prioritization criteria include the nature, modifiability, preventive potential and urgency of problems. A sample nursing care plan and evaluation plan are provided for the problem of malnutrition in a family's three-year-old child.
This document discusses the importance of developmental monitoring and screening for young children. It defines developmental monitoring as an ongoing process conducted by parents and caregivers to track a child's progress according to milestones. Developmental screening, on the other hand, is a more formal assessment conducted by medical professionals. The document recommends developmental screening for all children at 9, 18, and 24-30 months of age using validated tools. Early identification of delays is critical so that children can receive early intervention services to help them succeed in school and life.
The Annual Health Check-up: what's it for, anyways?Slides4fun
The document discusses the purpose and components of an annual health check-up. An annual check-up aims to assess a patient's health status and risk for disease through early detection. It involves reviewing family history, lifestyle, environment, and conducting physical exams to determine risk factors. The check-up focuses on prevention by identifying modifiable risk factors and providing screening tailored to a patient's age, gender and risk profile. The goal is to review overall health and provide advice to promote wellness and reduce risks.
The document provides an overview of Integrated Management of Childhood Illness (IMCI), which is an integrated approach to child health developed by WHO and UNICEF. IMCI focuses on well-being of children under five years old and includes preventive and curative elements implemented by families, communities, and health facilities. The integrated case management process for sick children ages 1 week to 5 years involves assessing and classifying the child's illnesses, identifying specific treatments, providing treatment instructions, counseling the mother, and follow-up care. The goal is to reduce mortality from major childhood illnesses like pneumonia, diarrhea, and malnutrition through improved skills and systems for managing sick children at primary health facilities.
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
Shannon Stewart, Yasmin Garad, Natalia Lapshini
This document summarizes guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. It recommends that primary care clinicians evaluate any child ages 4-18 presenting with academic or behavioral problems for ADHD. Both behavioral therapy and FDA-approved medications are effective treatments, though the specific treatment recommendation depends on the patient's age. Ongoing monitoring is important, as ADHD is a chronic condition.
approach to child with immunedeficiency Aug 2018.pptxOlaAlkhars
immunodeficiency presents with increased susceptibility to infection but may also manifest with conditions that reflect dysregulation of the immune response, such as allergies, autoimmunity, or lymphoproliferation
Presentation on Current principles , practices trends in pediatric nursing..pptxCharutaKunjeer1
This document summarizes a seminar on current principles, practices, and trends in pediatric nursing. It discusses the aims and objectives of the seminar which are to understand the concept of pediatrics and discuss current principles, practices, and trends. Some key points covered include the definition of pediatrics, principles of pediatric nursing focusing on the family and child, current practices involving educational requirements and use of nursing process, and trends such as family-centered care, high-technology care, evidence-based practice, and atraumatic care approaches.
1. Nursing diagnosis is a clinical judgment about a patient's response to actual or potential health problems. It focuses on issues a nurse can treat, unlike a medical diagnosis which identifies disease.
2. The nursing diagnostic process involves collecting data, analyzing it for deviations from norms, clustering related cues, and formulating a diagnosis statement describing the patient's problem, likely cause, and defining characteristics.
3. Nursing diagnoses can be one-part, two-part, or three-part statements specifying the problem, related factors or etiology, and defining signs/symptoms. Variations include unknown or complex etiologies, possible diagnoses, and specifying secondary causes.
Comprehensive family assessments go beyond investigations to identify services needed to address family needs, problems, and ensure child safety. The assessment identifies the nature and duration of abuse/neglect and its impact. It examines parents' and children's views, parents' experiences contributing to needs/problems, parental strengths, previous efforts to meet child needs/resolve problems, and kinship/tribal resources. Various assessment types evaluate education, medical issues, development, functioning, domestic violence, psychology, parenting abilities, sex offending, mental health, and substance abuse. Trauma screening and further assessment are important to understand family trauma impact and guide service referrals and plans.
Here are the key similarities and differences between the two articles on authentic assessment:
Similarities:
- Both discuss authentic assessment as being performance-based and evaluating students in natural environments like home or classroom rather than standardized tests.
- They view authentic assessment as providing a holistic picture of students' strengths and weaknesses by observing real-life application of skills.
Differences:
- Bergen (1993) focuses on authentic assessment for young children through caregiver observation at home, while Dennis et al. (2013) examines its use for school-aged children in the classroom.
- Bergen emphasizes caregivers collaborating with teachers, while Dennis et al. place more responsibility on teachers to design and implement authentic assessments.
-
The document discusses evaluation methods used in pediatric occupational therapy. It describes standardized tests, ecological assessments, skilled observation, interviews, inventories and scales, and arena assessments. Standardized tests provide uniform administration and scoring but may not reflect real-world performance. Ecological assessments consider the child's environment. Skilled observation involves objective recording of behavior. Interviews gather information from the child, parents, and teachers. Inventories and scales evaluate functional capabilities. Arena assessments use a transdisciplinary approach in natural settings.
Child-health practitioners in Iowa must find better ways to address family, neighborhood and economic factors that shape children' health and well being, according to CFPC executive director Charles Bruner and Debra Waldron, director and chief medical officer of the Child Health Specialty Clinics at the University of Iowa. They presented at the Iowa Governor's Conference on Public Health in Ames on April 5.
The document discusses strategies for conducting well-child visits in a more effective manner. It notes that simply having clinicians check off pre-selected discussion topics may not be the best use of limited visit time and may not meet families' needs. Alternative approaches discussed include using nurses and other providers for routine screening; providing handouts to cover anticipatory guidance; prioritizing interactive discussions of the most evidence-based topics; and using group well-child care models. The document also emphasizes structuring visits with the goal of promoting adult health outcomes by addressing social determinants of health like poverty, education, environment, and adverse childhood experiences.
Pediatric nursing involves the care of children from conception through adolescence to promote health and treat illness. It aims to provide quality care in an environment that supports families and children's psychological and physical well-being. Advances in medicine have made pediatric care more technologically advanced, requiring nurses to have strong technical skills. Primary nursing is commonly used and assigns one main nurse and backup nurses to ensure consistent care for each child. Factors like childhood trauma, disabilities, and family issues must all be considered in pediatric nursing to optimize outcomes and quality of life.
Standards, challenges and scope of psychiatric nursingjasleenbrar03
This document outlines the standards of practice for psychiatric nursing. It describes the nursing process used, which includes assessment, diagnosis, outcome identification, planning, implementation, and evaluation. For each step of the nursing process, nursing conditions and behaviors are defined. The standards represent the profession's commitment to providing quality care and ensuring nurses are practicing safely and effectively.
This document outlines a case study format for assessing family nursing needs. It includes sections on collecting an initial family data base, identifying health problems, prioritizing problems, developing family nursing care plans, and evaluating outcomes. The data base section covers family structure, socioeconomics, home environment, health status, and health practices. The identification of problems section lists potential health conditions, deficits, threats and stresses. Prioritization criteria include the nature, modifiability, preventive potential and urgency of problems. A sample nursing care plan and evaluation plan are provided for the problem of malnutrition in a family's three-year-old child.
This document discusses the importance of developmental monitoring and screening for young children. It defines developmental monitoring as an ongoing process conducted by parents and caregivers to track a child's progress according to milestones. Developmental screening, on the other hand, is a more formal assessment conducted by medical professionals. The document recommends developmental screening for all children at 9, 18, and 24-30 months of age using validated tools. Early identification of delays is critical so that children can receive early intervention services to help them succeed in school and life.
The Annual Health Check-up: what's it for, anyways?Slides4fun
The document discusses the purpose and components of an annual health check-up. An annual check-up aims to assess a patient's health status and risk for disease through early detection. It involves reviewing family history, lifestyle, environment, and conducting physical exams to determine risk factors. The check-up focuses on prevention by identifying modifiable risk factors and providing screening tailored to a patient's age, gender and risk profile. The goal is to review overall health and provide advice to promote wellness and reduce risks.
The document provides an overview of Integrated Management of Childhood Illness (IMCI), which is an integrated approach to child health developed by WHO and UNICEF. IMCI focuses on well-being of children under five years old and includes preventive and curative elements implemented by families, communities, and health facilities. The integrated case management process for sick children ages 1 week to 5 years involves assessing and classifying the child's illnesses, identifying specific treatments, providing treatment instructions, counseling the mother, and follow-up care. The goal is to reduce mortality from major childhood illnesses like pneumonia, diarrhea, and malnutrition through improved skills and systems for managing sick children at primary health facilities.
ISPCAN Jamaica 2018 - The Impact of Domestic Violence on Children's Functioni...Christine Wekerle
The Impact of Domestic Violence on Children's Functioning: Care Planning Approaches to Foster Trauma-Informed Care
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This document summarizes guidelines for diagnosing and treating attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. It recommends that primary care clinicians evaluate any child ages 4-18 presenting with academic or behavioral problems for ADHD. Both behavioral therapy and FDA-approved medications are effective treatments, though the specific treatment recommendation depends on the patient's age. Ongoing monitoring is important, as ADHD is a chronic condition.
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This document discusses the case of a 7-year-old girl presenting with progressive muscle weakness for 3 months. On examination, she has characteristic rashes including a violaceous rash on the eyelids, Gottron papules over the joints, and an erythematous rash on the chest. The most likely diagnosis is juvenile dermatomyositis. Diagnostic criteria include characteristic rashes and muscle inflammation. Treatment involves corticosteroids, methotrexate, and other immunosuppressants to control symptoms and prevent complications like aspiration pneumonia. The natural course varies, but about 1/3 of patients improve spontaneously, 1/3 have a chronic lingering course, and 1/3 may die from the
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2. Objectives
• Definitions
• Benefits and Possible harms of developmental surveillance and
screening
• Combining Screening and Surveillance Practice Algorithm
3. To provide a framework
evidence-based
Practical Algorithm for
Combining Screening
and Surveillance for
early identification and
Intervention for child
with DD
4. Development
Process of functional maturation of individual
Progressive increase in skills & capacity to function
Related to maturation & myelination of the CNS
Includes psychosocial, emotional, social, cognitive changes
5.
6.
7. Questions should be answered for any Child with DD
• Static or progressive developmental disorder?
• What type of developmental issue?
• Global, motor, language, social
• What is the current developmental level of the child ?
• Possible timing? (prenatal/perinatal/postnatal)
• Is there a likely underlying etiology?
• structural, genetic, birth related
• What are the current therapy/rehabilitative needs of the patient ?
8.
9. Diagnostic criteria
Bélanger SA, Caron J. Evaluation of the child with global developmental delay and intellectual disability. Paediatr Child Health. 2018;23(6):403-419. doi:10.1093/pch/pxy093
10. Diagnostic criteria
Bélanger, Stacey A, and Joannie Caron. “Evaluation of the child with global developmental delay and intellectual disability.” Paediatrics & child health vol. 23,6
(2018): 403-419. doi:10.1093/pch/pxy093
11. Definitions
Surveillance
• process of
recognizing
children who may
be at risk
Screening
• use of
standardized
tools to identify
those children at
risk
Evaluation
• complex process
aimed at
identifying
specific
developmental
disorders
12. BENEFITS OF SURVEILLANCE AND SCREENING
Early
Identification
Early Intervention
Earlier Rx of
underlying medical
conditions
Improved
outcomes
13. BENEFITS OF EARLY INTERVENTION
Decreased need for special education services during the school years
Higher graduation rates
Higher employment rates
Decrease in criminal behavior and violence
Benefits sustained for 15 to 49 years after the intervention .
14. BENEFITS FOR CAREGIVERS
Increased numbers of caregivers reporting that their concerns were addressed
and questions answered .
permits them to better match their expectations to their child's abilities
To provide developmentally appropriate activities and stimulation
To feel that they are doing all that they can to assist their child .
Opportunity to avert secondary problems such as self-esteem, self confidence.
15. PERCEIVED HARMS OF SURVEILLANCE AND SCREENING
False positive results
• Unnecessary developmental
evaluation
• Undue anxiety for caregivers
• Stigma for the child
False negative results
• Under-referral or delayed
referral to early intervention
services.
16. PERCEIVED BURDENS OF SURVEILLANCE AND SCREENING
• Additional time
• Additional documentation
17. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
AAP, American Academy of Pediatrics; IDEA, Individuals with Disabilities Education Act; PEDS:DM, Parents’ Evaluations of Developmental Status:
Developmental Milestones.
18. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL SOURCES AND
FOLLOW UP WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
AAP, American Academy of Pediatrics; IDEA, Individuals with Disabilities Education Act; PEDS:DM, Parents’ Evaluations of Developmental Status:
Developmental Milestones.
19. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND
PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-
BEHAVIORAL SCREENING TEST(S) FOCUSED ON
MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR)
ADDITIONAL MENTAL HEALTH SCREENS.
20. • A medical home is an approach
to providing comprehensive
primary care that facilitates
partnerships between patients,
clinicians, medical staff, and
families.
• Extends beyond the four walls
of a clinical practice.
• It includes specialty care,
educational services, family
support and more.
21. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
22. Why are we search for the aetiology ?
• Prognostication
• Prevention (associated conditions)
• Ends the diagnostic journey/limits unnecessary testing
• Recurrence risk
• Closure/family empowerment
24. Developmental Delay/Disability
• There is enormous psychological, emotional, and economic impact on
the affected individuals and society
• Prevalence: It is estimated 1-3%
• It is probably higher in Saudi Arabia
25. Habibullah H, Albradie R, Bashir S. Identifying pattern in global developmental delay children: A retrospective study at King Fahad specialist hospital, Dammam (Saudi
Arabia). Pediatr Rep. 2019 Dec 2;11(4):8251. doi: 10.4081/pr.2019.8251. PMID: 31871607; PMCID: PMC6908955.
26.
27.
28.
29.
30. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
31. PSYCHOSOCIAL RISK FACTORS
- Adverse childhood or family experiences
- Parental/caregiver unemployment or mental health problems
- Parents/caregivers with limited education/literacy
- Teenage parents
32. Protective/Resilience factors
• Strong connections within a loving, supportive family
• Active caregiver-child engagement
• Opportunities to interact with other children
• Opportunities to grow in independence in an environment with
appropriate structure
33. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
34.
35. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
40. • Parent or caregiver-completed screening
tools that encourage parent/caregiver
involvement
• Tools to accurately identify children at
risk for developmental or social-
emotional delay
• Tools to educate adults about child
development and guide developmental
promotion
41.
42. Features : ASQ-3 Intervals
2,4,6,8,9,10,12,14,16,18,20,22,24
27,30,33,36
42,48,54,60,66
Recommendations:
Monitor every 4-6 months up to 2 years
Monitor every 6 months after 2 years
Monitor more frequently if concerned
43. Features : ASQ-3 cover page
• Administration window
indicated on the cover page
• 16 months “window” is for
children ages 15 months 0 days
through 16 months 30 days
50. M-CHAT
An autism-specific screen (e.g., M-CHAT [Modified Checklist for Autism in Toddlers]).
Use of previsit, parent-completed tools is particularly efficient.
51.
52.
53.
54.
55.
56. Combining Screening and Surveillance:
a Practice Algorithm
1. ENSURE A MEDICAL HOME.
2.REVIEW MEDICAL CHART FOR HEALTH RISK FACTORS.
3. IDENTIFY AND MONITOR PSYCHOSOCIAL RISK AND PROTECTIVE FACTORS.
4. ELICIT AND ADDRESS PARENTS’ CONCERNS.
5. ADMINISTER AND SCORE DEVELOPMENTAL-BEHAVIORAL SCREENING TEST(S)
FOCUSED ON MILESTONES.
6. IF INDICATED, ADMINISTER (OR REFER FOR) ADDITIONAL MENTAL HEALTH
SCREENS.
57.
58. Indications for mental health screening
Psychosocial concerns identified by the caregivers
Family disruption
Poor school performance
Behavioral difficulty
Recurrent somatic complaints
Involvement of a social service
59. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL SOURCES AND FOLLOW UP
WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
60. Physical Examination
• Children should kept in close proximity to the parents
• Leave the more intrusive ( hands on ) aspects of the exam until the end
• Social interaction with parents & examiner
61. • Observations : Stand and look don't disturb , just give look for 30 sec.
for
• Dysmorphic pictures , gait and balance , left handed or right handed.
62. General physical examination
• Growth parameters
• Head shape and circumference
• Eye findings (e.g., cataracts in various IEM)
• Birth marks, vascular markings, and Wood lamp examination
• Spine
• Examine closely for findings consistent with abuse/neglect
• Hepatosplenomegaly
63. • Mental status
• Motor function
• Sensory exam.
• Evaluation of the cranial nerves.
64. Developmental Evaluation
• Rapport : Go to the child level and try to play with him.
• Demonstrate for him and ask to do a MOTOR DEVELOPMENTALN TASKS:
• GROSS MOTORM (stand /walk/run/jump/climb stairs/Ball )
• FINE MOTOR AND VISON (Cubes/Crayon and paper/Scissors and paper/Beads and threads/
pictures Book/Board/Pincer grip)
• HEARING / SPEECH ASSESSMENT AND COGNITION:
• Name , age, sex, address and ask him to count from 1-10
• Say and understanding of words/sentences structure
• Identify body parts or colors
• Assess concentration and attention
• Assess picture recognition and selection
• ASSESSMENT OF SOCIAL MILESTONES: (ask parent)
• Feeding
• Play (Solitary/Spectator/Parallel/Associate/Co-operative)
• Caring /Dressing
65. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL SOURCES AND FOLLOW UP
WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
68. EEG and neuroimaging
INDICATIONS:
• clinical suspicion of a seizure disorder
• Hydrocephalus
• Micro- or macrocephaly
• Encephalopathy
• Neurofibromatosis
• Tuberous sclerosis
• Focal Neurological defiecit
• Extreme handedness at an early age
• persistence of fisting after 4 months
• Other neurological problem (not including autism)
69. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL
TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND
FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL
SOURCES AND FOLLOW UP WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
70. • The primary medical provider should present the screening
results to parents in person.
• Results should be explained in a positive manner
• Asking the parents if they know any families with children who
have developmental differences may be helpful in
understanding any strong reaction to the information being
presented.
• Offers to re-explain findings to other family members may be
needed.
71. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL
TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND
FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL
SOURCES AND FOLLOW UP WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
72. • Referral forms or letters, which target the areas of concern
• speech-language therapy,
• Occupational and physical therapy
• Social-emotional assessment
• Intelligence testing, academics
73. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL
TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND
FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL
SOURCES AND FOLLOW UP WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
74. • Some parents wish to try at-home interventions.
• Other parents get “cold feet” and may be deterred by differing opinions from relatives (e.g.,
“His father was just like that” ; “It is a phase. She’ll grow out of it.”).
• A follow-up appointment in 3-4 months is helpful for encouraging families, and, if needed,
at least advising parents to visit the programs recommended.
• Note that ambiguous concerns such as “I think he’s doing better” still convey
substantial risk.
75. Combining Screening and Surveillance:
a Practice Algorithm
7. PROVIDE PHYSICAL EXAMINATION AND CLINICAL OBSERVATION.
8. WHEN INDICATED, PLAN AND REFER FOR ADDITIONAL MEDICAL TESTS.
9. EXPLAIN SCREENING RESULTS TO PARENTS.
10. MAKE REFERRALS FOR NONMEDICAL INTERVENTIONS AND FOLLOWING UP.
11. REVIEW REPORTS AND OTHER FEEDBACK FROM REFERRAL SOURCES AND FOLLOW UP
WITH FAMILIES
12. PROVIDE DEVELOPMENTAL-BEHAVIORAL PROMOTION.
76. • Providing written patient education materials
• When screening and surveillance methods do not identify a need for nonmedical
interventions, the need to address “the normal problems of normal children”
remains.
• All parents need advice about typical problems
• All parents need to be encouraged to promote their child’s language and
preacademic/academic development.
• Follow up with families, in 6-8 weeks to assess the effectivenesss of promotion
activities.
77.
78.
79. • All patients with DD/LD need a comprehensive medical evaluation
by complete medical Hx, P/E
• Development assessment by using standardized development
assessment scales.
• If the clinical diagnosis is obvious or suspected, confirm the
diagnosis with appropriate genetic testing.
80. • If diagnosis is unknown and no clinical diagnosis is strongly suspected, begin in stepwise
evaluation by: chromosomal microarray; Fragile X testing; for females complete MECP2
• Whether diagnosed or not, results and their implications should be carefully explained
to the parents/care givers.
• Appropriate support should be made.