pediatric development and safety sarah lewis mhs pa-c
TRANSCRIPT
Pediatric Development
and Safety
Sarah Lewis MHS PA-C
Development http://www.aap.org/topics.html Development
Link to lecture from peds http://gradprograms.lhup.edu/pa/DesktopDefault.aspx?tabid=27&pid=25&cMod=22&lecID=5810
Development Areas Motor
Gross
Fine
Communication and Language
Cognition
Social
Peds Development Note HPI: This 27 month old male ………
Per parent, he is able to
Social: wash his hands and dress himself,
Fine motor: stack >8 cubes, draw a circle,
Language: speech is understandable, names >4 colors, and
Gross motor: balance on each foot >2 seconds……
PE: can document all of the above in the office, of each developmental area
A: Development advanced for age
P: encouraged reading with child, coloring, singing; playing with balls; inclusion with mealtime conversation
Safety
http://www.cdc.gov/injury/index.html
Accidents in Kids by Craig at http://gradprograms.lhup.edu/pa/DesktopDefault.aspx?tabid=27&pid=25&cMod=22&lecID=5787
Stats of Death and Injury in Peds
Causes of Death: http://www.cdc.gov/injury/wisqars/pdf/Death_by_Age_2007-a.pdf
Non fatal Injuries seen in ERs: http://www.cdc.gov/injury/wisqars/pdf/Nonfatal_2008-a.pdf
Top Ten Home Child Accidental Fatalities
falls drowning head injuries fire burns: pots, grease irons poisoning electrocution shooting broken bones suffocation
What can we do? ASK!
Open ended safety question
What’s dangerous in your house? Around your home? Where else is the child?
What sorts of safety modifications have you made?
Educate
Reassure
25% of children seen each year for injuries
Age\Concern Car Seats Drowning Falls Suffocation Burns Poison Sleep General1 month Rear facing,
neck support; not in front with airbags; Police/Fire can check
towel/ mesh beneath reduces slips
Changing table; don’t leave, use strap
Baby powders respiratory distress; plastic bags; cords, necklaces, also from blinds
Smoke and carbon monoxide detectors; flame resistant clothing; Reduce house water temp to <120 degrees;
Get rid of non-essentials from active areas of home; poison control number is?
Back to sleep; nothing around child; bumper or not; clothes instead of blankets
Home prep- lead, radon, slip hazards
1-3 months Bed or couch, Chair/ seats should not be off the floor; high chair strap
Small items are gone; crib mobiles
Don’t hold child while smoking, drinking hot liquid or cooking by stove; no microwaving bottles!
4-7 monthsSitting, crawling
Check seat limits for height and weight; 5 point is best
at risk of tipping in tub; falls into toilet
Stairs! Pulling stuff down on self
Teething on everything
Outlet and plug covers; GFCIs (ground fault circuit interruptor)
Bumper out Pool, ponds, etc?; yard safety
8-12 monthsCrawlingrunning!
Rear facing at least till >1 year AND >20 lbs
Gates, esp stairs; coffee tables; windows open from top; furniture straps
Teething, mouthing objects
Heaters? ChemicalsMedications: bath, kitchen, garage, laundry
Lowest crib level; away from drapes and outlets; mobile gone
Gun safety; door locks/knob covers
1-2 years Do not leave alone in a car without you
never alone; early Swim lessons
Still no plug in toys
Crib fall risk? Stackable items?
2-3 years Booster seats; 5 point harness best
Never alone! Bike helmets; stairs/windows; playgrounds
Candles, matches, etc
Out of crib to floor
Lock dangerous areas (hide keys); driveway
Putting Development together with Safety
Example: 20 month old being seen, who climbs up the exam room walls
Consider safety of windows, tub, crib, gates, door knobs
Safety - Room by Room
Convenience in Practice Refer to or give book
Pamphlets or packets of age specific info
Skipping Safety is not an option
Perfection in Your Documentation
Pair up with someone who has had a peds or family practice rotation, and has a peds note
Improve upon the 4 point development history, PE, assessment and a plan that includes predicted milestones, and safety guidance
Email to the student’s advisor to show your increased competency, and upload to portal
When you have kids, it’ll make
more sense