Lecture 6 Flashcards
(14 cards)
9 month WCC
o Milestones
o Developmental Screening
ASQ
o Anticipatory Guidance
o No Vaccines at this visit unless they are behind or on alternative schedule
9 month milestones
o Gross Motor: Pulls to stand, creeping.
o Fine Motor: radial-digital grasp, bangs cubes
o Personal/Social: Uses sound to get attention, follows a point, recognizes familiar voices. May have stranger anxiety.
o Cognitive:
Language: Imitates sounds, babbles, may say words like “mama” but no specific meaning
Problem Solving: rings a bell
gross motor at 9 months
o Crawling: Moving with arms and legs. Belly on the floor. (6-9 months)
o Creeping: Moving on hand and knees belly off the floor. (9-10 months)
o Cruising: Walking while holding on to structure. (9-12 mo)
object permanence
o Object Permanence- The understanding that something exist even though you cannot see it.
o Introduced by psychologist Piaget.
o Infants develop this awareness around 9 months.
o How does this manifest:
They get upset when their parents go away.
Peek-a-boo is a fun game!
They will look for an object that has been hidden. (Ex. Toy under a bowl.)
ASQ
o Administer the 9 month ASQ at this visit as the first comprehensive developmental screen.
o If there is a significant delay (33% or more) in one or more areas then a referral to Regional Center is indicated.
o If there is signs of a deficit that is less severe you can advise on exercises and re-screen at a shorter interval.
o Referrals to other resources such as Help Me Grow can help parents access resources to help with development.
Anticipatory guidance
o Every well child check is an opportunity to offer guidance to parents regarding issues that may arise as their child grows and develops.
o There is an endless list of subjects to discuss. Too much advice may be overwhelming especially for a new parent so it is important to pick and choose points that are appropriate for the child’s age and the family’s needs.
o Examples: Child proofing Fever guidance Diet Adjusting water temperature Sibling interactions Reading
child proofing
o From 6-9 months an infant’s mobility increases significantly as they begin to crawl and cruise (walking while holding onto a support).
o The increased mobility puts infants at risk for accidentally injuring themselves.
o Children should not be left alone unless they are in a secure safe area. (Not even “for a second”)
o Important measures to take to protect the mobile child: Bolting down book cases and TVs Gating stairs Electrical socket guards Safely storing medication Safely storing any weapons Securing drawers and cabinets if possible Corner guards for furniture
12 mo WCC
o Milestones
o Diet – should be transitioning to table foods, whole milk (fat is still important for brain development)
o Dental – recommendation is to see a dentist after eruption of teeth, need to have fluorinated water
o Screening
Anemia – check the transition from formula/breast milk to table food
Lead – less common than in the old days
o Vaccines – MMR, varicella vaccine (live attenuated)
12 mo milestones
o Gross Motor: Stands well, independent steps
o Fine Motor: Scribbles, Two cube tower, Fine Pincer grasp
o Personal/Social: Shows objects to parents to share interest
o Cognitive:
Language: Says first word, points to get objects
Problem Solving: Lifts lid to find a toy
12 mo diet
o Babies develop 1 tooth by 6 months and 4 by 12 months.
o Able to transition to a more solid diet.
o Transition from breast milk or formula to whole cow’s milk through a sippy cup. If there is a high risk for obesity they can drink 2%.
o Milk intake should be limited to 20-24 ox per day. – milk intake is inversely related to iron intake
o Limit juice.
dental
o Children will generally have their first tooth at 6 months. Generally a bottom central incisor.
o By 1 year they may have 4 teeth. Tooth eruption can be delayed. Generally there is nothing that needs to be done about delayed eruption within the first year.
o Tooth brushing should start once teeth have erupted. Use a smear of fluoridated tooth paste.
o Fluoride varnish can be applied every 3-6 months. (Provided at many primary care clinics).
o Bottle usage and bottle propping should be avoided to prevent damage to the teeth.
lead screening
o Infants are at risk for lead poisoning due to their increased body surface area, delicate skin, and propensity for putting things in their mouths.
o Children used to eat lead paint due to the sweet taste. Lead paint is no longer used for housing.
o Current concerns for lead exposure: Old housing Contaminated soil Makeup (Kajal) Foreign Candy/Medicine Recent Immigrant
o Screening for lead poisoning is done at 12 mo with a blood lead level. Can be repeated at 24 mo if risk factors are present.
anemia screening
o First screening for anemia is at 12 mo.
o Infants are at risk because born with iron stores that tend to decrease by 4 mo.
o Dependent on iron rich foods or iron supplementation to replete stores.
o If child is anemic can start ferrous sulfate 4-6 mg/kg/day. Can be taken with orange juice. Dairy products can inhibit absorption.
12 mo vaccines
o MMR
o VZV
o Hep A
