pediatric development and safety sarah lewis mhs pa-c

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