Developmental Assessment Final.docx

UNIVERSITY OF ZAMBIA SCHOOL OF NURSING SCIENCES RIDGEWAY CAMPUS

INDIVIDUAL ASSIGNMENT ==================================================================== NAME:

LUNGU GABRIEL

COMPUTER NO:

2018242806

PROGRA:

MASTER

OF

SCIENCE

IN

MENTAL

HEALTH AND PSYCHIATRIC NURSING

YEAR:

2019

COURS:

HEALTH ASSESSMENT AND DIAGNOSTIC REASONING

COURSE CODE:

NRS 6010

LECTURER:

DR. P.K. MUKWATO

TASK:

DEVELOPMENTAL

ASSESSMENT

IN

CHILDREN

DUE DATE:

25th

MARCH,

2019

Table of Contents Task……………………………………………………………………………………………......ii Abstract ............................................................................................................................................1 Introduction ......................................................................................................................................1 Definitions........................................................................................................................................2 Indications of developmental assessment ........................................................................................2 Goal of developmental assessment ..................................................................................................3 Principles of developmental assessment ..........................................................................................3 Benefits of developmental assessment…………………………………………………………….3 Normal developmental assessment……………………………………………………………..…5 Conducting assessment………………………………………………………………………..…..7 Implications………………………………………………………………..……………………....7 Conclusion………………………………………………………………………………………...8 References…………………………………………………………………………………………9 Annex 1……………………………………………………………………………………….........

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TASK Individual Assignment Having completed you MSc Nursing, you have been appointed as Area Nursing Officer for Children’s Hospital of the University Teaching Hospitals, Lusaka. In your first week of work you realize that most nurses are unable to conduct Developmental Assessment of Children. They totally depend on the Drs to assess and are therefore unable to give appropriate IEC to Parents. You decide to conduct a half day seminar on Developmental Assessment. Outline the information you would include in your seminar which is being attended by nurses of different qualifications from your department. Due date 25th March, 2019

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Abstract Developmental assessments are useful to assess a young child’s current skills relative to where they should be compared to typical child development. Assessment involves procedures to identify children who are at risk for a particular problem and for whom there are available effective interventions. According to as study on Implications of Newborn Screening for Nurses, results showed that, adequate developmental assessment had dramatically decreased the morbidity and mortality associated with a wide range of developmental conditions (Deluca, J., et al., 2013). In this assignment, a close look is taken on developmental assessment and information necessary for nurses and nursing faculty and its impact and benefits. The information aims to equip nurses with skills and knowledge needed when handling children and their parents and also helps nurses to conduct developmental assessment with confidence and purpose.

Introduction Developmental assessment is a public health approach to the identification of rare but treatable conditions in early childhood. Nurses, nurse educators, and nurse researchers are positioned to contribute to the field of newborn screening by assuring programs are implemented safely and effectively, by facilitating education of the nursing work force, and by developing and contributing to research programs in newborn screening. Developmental assessment is the process of observing and recording the work children do and how they do it, as a basis for a variety of decisions about their care, suitable programs and program goals and service needs. It is done on every contact with a child and parents by attentive caregivers. It includes early identification of problems through screening and surveillance, and more definitive assessment including both standardized and non-standardized measures, as well as integration of information from the developmental, social, and family history and the medical history and examination.

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Definitions 1. Developmental assessment is the process of mapping a child’s performance compared with children of similar age (Bellma, M., 2013). 2. Developmental assessment is the process of observing and recording the work children do and how they do it, as a basis for a variety of decisions about their care, suitable programs and program goals, and service needs done every day by attentive caregivers (Bower, R., 2010). 3. Developmental assessment is the detailed analysis of particular areas of development and follows concern after screening that a child’s developmental progress may be abnormal in some way. It is part of the diagnostic process and includes investigation, therapy and advice on how to optimize the child’s progress (Lissauer, T., & Clayden, G., 2012). Developmental assessment is by referral to a specialist service and this may be the developmental pediatrician, therapy disciplines, or the local multidisciplinary child development service, which will include a pediatrician (Lissauer, T., & Clayden, G., 2012). 4. Development is the process by which each child evolves from helpless infancy to independent adulthood (Bellma, M., 2013). 5. Growth and development of the brain and central nervous system is often termed psychomotor development and is usually divided into four main domains namely gross and fine motor skills, speech and language, social and personal and activities of daily living and performance and cognition.

Indications for developmental assessment 1. Screening might be needed for follow up of high risk neonates for early detection of cerebral palsy and or mental retardation and if a child is at high risk for developmental problems due to preterm birth, low birth weight, or other reasons. 2. For identification of children at increased risk of having developmental difficulties that uses relatively brief and simple techniques, according to well recognized criteria. 3. Complete evaluation of children with developmental, chromosomal and neurological disorders.

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4. To differentiate children with retardation in specific fields of development as opposed to those with global retardation. Goal of Developmental Assessment 

The goal of developmental assessment is not only to generate a diagnosis, but equally important to analyze the pattern of strengths and weaknesses in the child, family, and available developmental, educational, and social support systems, in order to direct treatment.

Principles of developmental assessment 

Utilization of play as a fundamental assessment tool.

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Promotion of optimal performance of the child.

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Gearing the assessment towards remediation rather than merely producing a profile.

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Involvement of the parents in the assessment process. Child health surveillance or assessment should not generate significant parental anxiety. There is no "pass" or "fail" in child health surveillance. Therefore, when speaking with parents or discussing Concerns with Parents of a child where there is concern about an aspect of development, it is essential to emphasize the positive features of the child's development.

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Close linking of the assessment with services offering help and support.

Benefits of developmental assessment 

Early diagnosis and intervention: it helps in the coming up of the diagnosis and identify special need(s) that may establish eligibility for funding or services.

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Provides an opportunity to interact with children’s carers. Therefore parents need to be informed about the content, purpose and outcome of developmental assessments of their child and attend to questions and concerns they may have.

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Early diagnosis of conditions with a genetic basis, such as Duchene muscular dystrophy and fragile X syndrome, facilitates genetic counseling for families

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Provides carers with reliable information before a developmental problem becomes obvious and gives them more time to adjust to the child’s difficulty and make appropriate management plans for their family

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Carers are reassured and relieved of anxiety if assessment shows that the child is within the normal range During infancy, assessment serves to reassure parents and to identify sensory, motor, cognitive, and emotional problems early, when they are most amenable to treatment as well as helping in addressing academic and social problems.

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Early assessments can be compared with later ones, allowing the practitioner to follow a child’s individual developmental trajectory.

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Provides an opportunity to encourage good parenting and developmental stimulation

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Milestones are useful indicators of mental and physical development and possible deviations from normal.

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Offers an opportunity for institutions of early intervention which includes prevention and early detection of disabilities, as well as health, educational and community services that assist the child, family and community in adapting to the child’s developmental needs and disability.

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In a case of serious concern, provides a mechanism for rapid referral for further exploration of the issue and dealt with it without incurring a lengthy period of parental anxiety when parents feel powerless and fear of the worst possible outcome.

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Creates provision for advice and guidance to families, parents, schools and other agencies as they may cause concern for parents, difficulties in the pre-school period and constitute a risk factor for subsequent poor school performance and lead to further delays causing a wide range of personal and social difficulties for the individuals concerned (Law, et al., 1998, Hall & Elliman, 2004).

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Provides the parents and family with an understanding of the child’s development and outlines developmental goals and strategies to reduce any handicapping effects of the disability through the input of physiotherapists, speech pathologists, teachers, occupational therapists, psychologists and social workers (Thomson, et al., 2014)

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Normal developmental milestones Skills Age

6 weeks

Gross motor

Head level with body in

Fine motor and

Hearing, speech, and

Social, emotional, and

vision

language

behavioral

Fixes and follows

Becomes still in

Smiles

ventral suspension 3 months

response to sound

Holds head at 90° in ventral

Holds an object

suspension

placed in the hand

Turns to sound

Red flags

Unresponsive to sound or visual stimuli

Hand regard, laughs, and

Lack of social

squeals

response or vocalization

6 months

9 months

No head lag on pull to sit; sits

Palmar grasp of

Vocalizations

May finger feed self

Poor head control,

with support; in prone

objects; transfers

floppiness, not

position lifts up on forearms

objects hand to hand

reaching

Crawls; sits steadily when

Pincer grasp; index

2 syllable babble,

Waves bye bye, plays pat-a-

Can’t sit unsupported;

unsupported and pivots

finger approach;

non-specific consonant

cake; indicates wants; stranger

no babble

around

bangs two cubes

vowel, such as “mama”

anxiety emerging

together 12

Pulls to stand; cruises; may

Puts block in cup;

One or two words;

Imitates activities; object

Not communicating

months

stand alone briefly; may walk

casts about

imitates adults’ sounds

permanence (the understanding

by gestures, such as

that objects still exist when

pointing; not weight

they cannot be seen)

bearing through legs

alone

established; stranger anxiety

5

established; points to indicate wants 18

Walks well; runs

months

Builds tower of 2-4

6-12 words

Uses spoon; symbolic Play

Not walking; no

cubes hand

“talking” on telephone;

symbolic play; no

preference emerges

domestic mimicry “helps” in

words

household chores like sweeping, wiping surfaces 2 years

Kicks ball; climbs stairs two

Builds tower of 6-7

Joins 2-3 words; knows

feet per step

cubes; does circular

some Can remove some

scribbles

clothes body parts;

Can remove some clothes

Not joining two words; cannot run

identifies objects in pictures 3 years

Stands briefly on one foot;

Builds tower of 9

Talks in short sentences

climbs stairs one foot per step

cubes; copies a circle that a stranger can understand

6

Eats with fork and spoon; puts

Not communicating

on clothing; may be toilet

with words; cannot

trained

climb stairs

Conducting an assessment Developmental screening or assessment involves the use of standardized screening tests to identify children who require diagnostic assessment. The American academy of pediatrics recommends the use of validated standardized screening tools at three of the health maintenance visits: 9 months, 18 months and 30 months (Marcdante, K. J., & Kliegman, R. M., 2015). Clinics that serve a higher risk patient population (children living in poverty) often perform a screening test at every health visit. A child who fails to pass a developmental screening test requires more comprehensive evaluation but does not necessarily have a delay; definitive testing must confirm. Prior to assessment, a health care provider should have knowledge on the developmental milestones in order to detect diversion from the normal. A good starting point is to believe parents and carers who are worried about their child. It is important that these are elicited through appropriate history and examination. Observe the child entering and moving around the clinic while playing with a few age appropriate toys, such as blocks, toy cars, pull-along toys, paper, and crayons. A range of tests have been developed to screen or to assess development in a formal reproducible manner. The common used assessment tool is the Denver developmental screening test II, which is completed by an observer and gives “pass or fail”, results in the four major developmental fields, and the schedule of growing skills. It was a classic test used by general pediatricians. The Denver II assesses the development of children from birth to 6 years of age in the following domains Personal-social, fine motor-adaptive, Language and Gross motor (Marcdante, K. J., & Kliegman, R. M., 2015). The advantage of this test teaches developmental milestones when administered (See Annex I).

Implications Nurses are uniquely well suited to address the educational needs and future research in newborn screening because of the role that nurses play in the provision of direct clinical care and in population-based healthcare delivery. Nurses, nurse educators, and nurse researchers are positioned to contribute to the field of newborn screening by assuring programs are implemented safely and effectively, by facilitating education of the nursing work force, and by developing and contributing to research programs in newborn screening (Deluca, et al., 2013).

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CONCLUSION Child development can seem baffling to those not used to thinking about it. However, like most things in medicine it is straightforward if you familiarize yourself with what is normal and develop a system for trying to identify what is abnormal. Health maintenance or supervision of visits should consist of comprehensive assessment of the child’s health and of the parents’/guardian role in providing an environment for optimal growth, development and health. Elements of each visit should include evaluation and management of parental concerns, inquiry about any interval illness, growth development and nutrition, anticipatory guidance, physical examination and screening tests.

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REFERENCES Bellma, M., Byrne, O., Sege, R., (2013). Developmental assessment of children. Departmental of paediatrics. Royal free Hospital, London. Deluca, et al., (2013). Implications of Newborn screening for nurses. Journal of nursing scholarship, Sigma Theta Tau international vol 45:1 Dosman, C. F., Andrews, D., & Goulden, K. J., (2012). Evidence-based milestone ages as a framework for developmental surveillance. Pediatrics & child health, 17(10). Frankenburg, William K., (2002). Developmental Surveillance and Screening of Infants and Young Children, Pediatrics 109 (109). Lissauer, T., & Clayden, G., (2012). Illustrated textbook of pediatrics. 4th edition, Mosby Elsevier, Philadelphia. ISBN: 978-0-7234-3565-5 Marcdante, K. J., & Kliegman, R. M., (2015). Nelson Essentials of Pediatrics, 7th edition, Elsevier Saunders, 1600, John F. Kennedy Ste 1800, Philadelphia. ISBN: 978-14557-5980-4. McEniery, J,. (2012). Assessment of infant / child nutrition, growth and development, within the primary health care setting. Statewide Child and Youth Clinical Network (SCYCN). Standard 12. Queensland government. Thomson K., et, al. (2012). Pediatrics handbook. 8th edition, Blackwell Publishing, A John wiley and Sons Ltd. Melbourne. ISBN: 978-1-405-17400-8.

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