Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

1. As a primary care provider working in an underprivileged free clinic you realize there are some challenges and barriers in your patient population. You are seeing a 12 month old who is showing signs of developmental delays. What information will you highlight in your Review of Systems with the parent? Explain the rationale for requiring this information. Please include your plan of care to address the concern for developmental delay.

Samantha’s Response to the above question:

While developmental milestones are important guidelines to the assessment of the child, it is important to remember that minor delay may not be a serious concern and can be monitored. The pace of growth and development is specific for each child. Developmental changes vary considerably for each child. Some children demonstrate early skill in motor coordination, and others demonstrate early skill in language acquisition (Burnes et al., 2017). These changes are unique to each child. It will be important to complete a thorough assessment to identify the severity of the delay. This will include a thorough health history for the infant including complications or hazards during pregnancy such as drug use, trauma, congenital screenings, complications during delivery, and a thorough assessment of family history including developmental disorders. Certain periods are critical during growth and development. Critical periods are points of time when developmental advances occur and are particularly susceptible to alterations due to internal and external influences (Burnes et al., 2017). For example, fetal exposure to certain viruses during the first trimester of pregnancy increases the risk of congenital abnormalities. Then it is important to assess the infant’s environment, and influences. The child’s internal and external environments affect growth and development. Opportunities for play, societal norms, cultural values, family traditions, and family beliefs all influence child development (Burns et al., 2017). Similarly, children influence their environment to achieve desired experiences and opportunities. Red flags that can be rules out through the health history include prenatal exposure to street drugs or alcohol, prematurity, low birth weight, small for gestational age, intrauterine growth retardation, anoxia or birth trauma, neonatal intensive care and long-term hospitalization, cardiovascular illnesses, endocrine and metabolic problems, genetic syndromes, failure to thrive, cerebral palsy, sensory problems, and parental or environmental deficit in meeting the infant’s needs (Burnes et al., 2017).

12 Month Assessment

Developmental delay in infants involves disorders that manifest as motor, communication problems, and/or cognitive problems. Processing disorders may occur due to peripheral problems, such as deafness and blindness; central processing that results in motor, language, and perceptual dysfunction; and behavioral problems (AAP, 2009). Concerning findings for the 12-month-old include a lack of physical development including gaining less than triple birth weight, losing more than two standard deviations on growth curve for weight, length, or head circumference, poor sleep-wake cycle, and extreme inability to separate from parent (CDC, 2018). Gross motor delay may include not pulling self to stand, and not moving around the environment to explore. Fine motor delay includes persistent mouthing, not attempting to feed self or hold cup, and not able to hold toy in each hand or transfer objects (CDC, 2018). Language and hearing delay include the inability to localize to sound, not imitating speech sounds, not using two or three words, and does not point, or uses only gestures or pointing (AAP, 2009). Poor social and emotional skills include no response to game playing, no response to reading or interactive activities, withdrawn or solemn affect, and poor eye contact. Finally, visual red flags include not visually following activities in the environment.

Action of Provider

The provider must determine when additional intervention and assessment is needed. Early identification and correction of developmental barriers will lead to a higher success rate of healthy child development. When suspicious a specialist referral is warranted and together the specialist and practitioner can follow a “wait and see” approach. If the infant needs referral, primary health care providers work with the parents to connect them to community resources, advocate for necessary services, and continue to provide the infant with long-term primary care (Burnes et al., 2017).

AAP. (2009, May 1). Developmental Milestones: 12 months. Retrieved from http://healthychildren.org/English/ages-stages/baby/Pages/Developmental-Milestones-12-Months.aspx.

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G.,Garzon (2017) Pediatric Primary Care. Retrieved from https://bookshelf.vitalsource.com/#/books/9780323243384/ (Links to an external site.)Links to an external site.

CDC. (2018, September). Important Milestones: Your child by one year. Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html.

2.You have just finished seeing a 2 year old girl for complaints of a cough and fever who was accompanied at the visit by her parents. Parents are very poor historians and are arguing about an unrelated issue in your exam room. How would you approach this scenario and gather the necessary information to inform your clinical decision-making? Please provide the rationale for this approach to care.

Eric’s Response:

Poor parenting is a major problem in our society and as mid-level providers many of us will have to directly deal with these parents or caregivers. So how are we going to deal with them, when they are either failing to assist in the care of their children or are directly interfering with care. In this case one of the first things to approach in correlation to the scenario above would be to ask them if they have a caretaker or relative such as an aunt, grandmother or older sibling that cares for the child, perhaps if you were able to contact them you could obtain a better history of the current illness as well as medical history of the child. Parental behaviors such as the ones mentioned above can be destructive to their childs development and can result in poor outcomes for these children; Increasing interest in supporting effective parenting behaviors as a means to improve pediatric health is being reflected in a growing array of professional and policy initiatives. Professionals in nursing, psychology, education, and social work have developed multiple interventions aimed at improving parenting behaviors and affecting child outcomes (Shah, Kennedy, Clark, Bauer, & Schwartz, 2016). It can be uncomfortable and there can be social barriers but it would be beneficial to speak to the parents about their values that they hold and what they want to accomplish as a caregiver as well as what strategies the parents use to reach these goals; sometimes this form of questioning can open up the doors for awareness and change (Oconnell, Davis, & Bauer, 2015). Practitioners will be able to intervene regarding parenting behaviors if they are aware of parenting resources that exist in the local community. Resources may range from parenting support groups to manualized skills programs;3 Knowing where to refer families will help pediatricians be more comfortable assessing these behaviors, as they will know what to do with a “positive result” (Oconnell, Davis, & Bauer, 2015).

references

Oconnell, L. K., Davis, M. M., & Bauer, N. S. (2015). Assessing Parenting Behaviors to Improve Child Outcomes. Pediatrics,135(2). doi:10.1542/peds.2014-2497

Shah, R., Kennedy, S., Clark, M. D., Bauer, S. C., & Schwartz, A. (2016). Primary Care-Based Interventions to Promote Positive Parenting Behaviors: A Meta-analysis. Pediatrics, 137(5), e20153393. doi:10.1542/peds.2015-3393