Ped wk 1 discussion replies (2)
Peer 1: Week 1 Discussion Part I
Table 1
Developmental Milestones
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Complete the table |
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Physical |
Gross Motor |
Fine Motor |
Language |
Socialization |
Sleep |
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Two months |
The posterior fontanel closes; the crawling reflex disappears |
Decreasing head lag when pulled to sit; lifts head and chest while prone; holds head upright but forward when sitting; symmetric tonic neck position |
Hands frequently open; fading grasp reflex |
Vocalizes more than crying; coos vocalizes to a familiar voice |
Has a social smile; is more awake during the day |
Sleeps more at night (8.5-10 h) and 6-7 h during the day; takes 3-4 naps |
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Four months |
Begins drooling; Moro and tonic neck reflexes disappeared |
Minimal to no head lag when pulled to sit; balances head well in a sitting position; sits upright if propped; raises head and chest 90 degrees off surface when prone; begins to roll prone to supine |
Plays with own hands; pulls on clothing, blankets, hair, earrings, and eyeglasses; reaches for items; grasps with both hands; grasps rattle when placed in hand, but can’t pick it up; mouths most objects |
Vocalizations show mood; laughs out aloud; makes b, g, k, n, and p sounds |
Enjoys interacting with others; fusses to demand attention; anticipates feedings when sees bottle or mother if breastfeeding (shows the beginning of memory); prefers certain toys |
Develops regular sleep and wake pattern; self-soothes briefly; usually settles back to sleep; may sleep through the night without feeding; sleeps 12-15 hours a day |
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Six months |
Growth rate declines, gains 90-150 g (3-5 ounces)/week Height increases by 1.25 cm (0.5 inches)/month, chewing and biting begins |
Rolls from supine to prone, lifts chest and upper abdomen and bears weight on hands when prone, sits in a high chair with back straight; bears weight on legs when supported |
Grasps manipulates, and bangs small objects; releases one object when offered another; grasps feet and pulls to mouth; holds bottle if bottle feeding |
Begins to imitate sounds, has one-syllable utterances, vocalizes to toys and mirror images; face brightens to own sounds |
Adjusts posture to see an object; localizes sound made above ear |
Recognizes parents; fears strangers; extends arms to be picked up; imitates sticking out tongue or coughing, definite likes, and dislikes; searches briefly for dropped objects |
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Eight months |
Starts regular bladder and bowel patterns; parachute reflex emerges |
Sits steadily unsupported for short periods; bears weight on legs when standing; may stand holding onto furniture; readily adjusts position to reach an object |
Develops pincer grasp, releases objects at will (“the dropping game”); shakes rattle or bell; holds two cubes while eyeing a third; reaches for out-of-reach objects |
Listens selectively to familiar words; consonant sounds include t and w; begins to have vocalizations with emphasis and emotion |
Increased anxiety when a parent is unseen; increased stranger anxiety; understands the word “no”; dislikes dressing or diaper changes. |
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12 months |
Triple’s birth weight; increased birth length by 50%; has an equal head and chest circumference; anterior fontanel starts closing; Landau reflex fading; lordosis when walking. |
Walks holding one hand; attempts to stand without holding on to furniture; may take first steps; sits from standing position. |
Easily releases cubes into a cup; builds two-cube towers; tries to release pellet into the narrow-necked bottle; begins using spoon and cup; quickly turns book pages. |
Says “mama” and “dada” and 3-5 other words; receptive language > expressive language; knows object names (e.g., ball, blanket); imitates animal noises; understands one-step commands |
Enjoys familiar settings of home and daycare; begins to explore away from a parent; shows joy and delight; gives affection by hugging or kissing when asked; gets angry when jealous; may cling to parent when unsure; may have a favorite object, such as a security blanket; searches for unseen objects (object permanence) |
Sleeps 8-11 h at night with 1-2 naps |
Table 2
HEEADSSS Assessment:
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What is the HEEADSSS Assessment? |
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Include common questions asked below. |
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H |
Home: Who lives with you? How are your relationships with the other people with whom you live? Have there been any changes at home? Do you feel safe at home? |
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E |
Education/employment: What do you like/dislike about school? How is school going? How are your grades? Have you ever had trouble at school? Do you work? How many hours do you work? Where do you work? Do you have friends at school? At work? |
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E |
Eating: Are you comfortable with your body? Are you interested in gaining/losing weight? How do you manage your weight? Tell me about how often you exercise. Tell me about what you normally eat every day. |
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A |
Activities: What do you do for fun? What types of things do you like to do with your friends? What types of things do you like to do with your family? Do you play sports? Are you in clubs or other organizations? How much time do you watch TV? Use the computer? Text? Listen to music? What types of activities do you like to do online? On your phone? |
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D |
Drugs: Do you, anyone in your family, or your friends use drugs/tobacco/drink alcohol? Have you ever used performance-enhancing drugs? |
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S |
Sexuality: Do you date? Have you ever had a romantic relationship? What do you consider to be sex? Have you ever had sex? How many partners have you had? Are you interested in males/females or both? Have you ever had someone hurt or threaten you sexually? Do you use birth control/condoms? How often? |
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S |
Suicide/depression: Do you ever feel like you are all alone or no one cares? Do you feel sad most of the time? Have you ever thought of actually hurting yourself? Do you ever need to use drugs (alcohol, tobacco, street drugs) to make you feel better? Have you lost interest in being with friends or doing things you previously liked to do? |
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S |
Safety: Have you ever been hurt by or threatened by someone (who)? Have you ever been seriously injured? Do you use sports safety equipment? Do you use seat belts? Do you text/talk when you drive? Do you ever feel unsafe (where)? Have you ever been bullied? Have you ever met (or do you plan on meeting) someone you first met online? |
Table 3
Tools for Screening Toddlers and Preschoolers
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Screening Tools for Toddlers and Preschoolers |
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Name |
Use |
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Ages and Stages Questionnaires |
Screening and surveillance of five key developmental areas: communication, gross motor, fine motor, problem-solving, and personal-social For use with 1-month-olds to 5½-year-olds Parents report on 30 items plus overall concerns. They are written at the fourth- to sixth-grade level. The manual includes activity handouts for parents. Available in English, Spanish, and French Screening and surveillance of social-emotional development: self-regulation, compliance, social communication, adaptive functioning, autonomy, affect, and interaction with people Parents report on 32 items. For use with 1- to 72-month-olds It takes 10-15 min or less to administer. Available in English and Spanish |
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Battelle Developmental Inventory |
Screening for early childhood developmental milestones Measures personal-social, adaptive, motor, communication, and cognitive abilities Parents report on 100 items. For use from birth to 8 years old Takes 10-30 min; complete test 1-2 h |
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Child Development Inventory |
Screening for motor, social skills, expressive language, language comprehension, self-help, letters, and numbers Parents report on 300 items. For use with 15-month-olds to 6-year-olds The test takes 30-40 min to administer development milestones. Measures fine motor and gross skills |
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Pediatric Symptom Checklist |
Psychosocial screen designed to recognize cognitive, emotional, and behavioral problems Parents complete 35 items. For use with 4 to 11 years old The test takes 5-10 min to complete Available in English and dozens of other languages |
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Modified Checklist for Autism in Toddlers, Revised with Follow-up |
Screening for autism risk Parents complete 20 items. For use from 16 to 30 months It takes 5 min to complete Available in multiple languages |
Table 4
Development Milestones – Screening Toddlers and Preschoolers
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Age |
Fine Motor Skills (list 3-5) |
Gross Motor Skills (list 3-5) |
Language |
Common Behaviors |
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12 months |
Uses pincer grasp Points at objects Stacks two blocks Clasps hands together |
Pulls self to stand Stands alone for 3-5 s Walks holding onto furniture Lowers self from standing to sitting without falling Rolls a ball |
Follows one-step commands Each week, understand new words. Increased interest in naming pictures Differentiates environmental sounds Points to familiar objects and body parts when named Understands simple questions Begins to distinguish “you” from “me.” |
Uses all vowels, many consonants Increased use of real words Jargon is sentence-like Likes to use negatives (i.e., says “no” often) Name a few pictures By 18 months old, articulates 15-20 words and understands 50 Imitates non-speech sounds (e.g., cough, tongue click) Identifies body parts |
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15 months |
Puts blocks in a cup Drinks from a cup Holds utensils; some attempt to use Stacks two blocks |
Stands alone well Walks forward and backward Stoops and recovers Climbs up stairs without alternating feet Pulls a pull toy |
Follows one-step commands Each week, understand new words. Increased interest in naming pictures Differentiates environmental sounds Points to familiar objects and body parts when named Understands simple questions Begins to distinguish “you” from “me.” |
Uses all vowels, many consonants Increased use of real words Jargon is sentence-like Likes to use negatives (i.e., says “no” often) Name a few pictures By 18 months old, articulates 15-20 words and understands 50 Imitates non-speech sounds (e.g., cough, tongue click) Identifies body parts |
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18 months |
Builds a tower of four cubes Scribbles spontaneously Puts blocks in large holes Drinks from cup with little spilling Removes socks Stacks 4-6 blocks |
Throws while aiming Walks well independently Pushes and pulls toys Pulls toy while walking backward |
Follows one-step commands Each week, understand new words. Increased interest in naming pictures Differentiates environmental sounds Points to familiar objects and body parts when named Understands simple questions Begins to distinguish “you” from “me.” Follows two-step commands without visual cues Vocabulary increases rapidly Enjoys simple stories and songs Recognizes pronouns |
Uses all vowels, many consonants Increased use of real words Jargon is sentence-like Likes to use negatives (i.e., says “no” often) Name a few pictures By 18 months old, articulates 15-20 words and understands 50 Imitates non-speech sounds (e.g., cough, tongue click) Identifies body parts Imitates two-word combinations Dramatic increase in vocabulary, 200+ words Speech combines jargon and words. Names self Answers some questions Begins to combine words He begins to use pronouns, such as my, me, and mine. |
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24 months |
Builds tower of seven cubes Circular scribbling Imitates folding paper once Turns doorknob Turns pages one at a time Unbuttons or unzips clothing Washes hands with assistance Uses a spoon |
Throws overhand Runs well Climbs up on furniture Kicks ball Walks up and down stairs, may not alternate feet Walks with control Runs Jumps up Assists with dressing Able to pull pants down with assist |
Follows two-step commands without visual cues Vocabulary increases rapidly Enjoys simple stories and songs Recognizes pronouns Understands prepositions in and on He seems to understand most of what is said. Understands more reasoning (“when you are finished, then …”) Identifies object when given function (wear on feet, cook on) |
Imitates two-word combinations Dramatic increase in vocabulary, 200+ words Speech combines jargon and words. Names self Answers some questions Begins to combine words He begins to use pronouns, such as my, me, and mine. Babbles less Two- to three-word sentences Repeats two numbers Increased use of pronouns Asks simple questions Joins in songs and nursery rhymes Can repeat simple phrases and sentences |
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30 months |
Builds tower of nine cubes Draws vertical and horizontal lines Imitates circle Buttons large buttons He holds a fork in a fist and attempts to use Dresses self with assistance |
Jumps with both feet Climbs stairs alternating feet Stands on one foot for 1 s Walks on tiptoes |
Understands prepositions in and on He seems to understand most of what is said. Understands more reasoning (“when you are finished, then …”) Identifies object when given function (wear on feet, cook on) Listens to adult conversations Understands preposition under Can categorize items by function Begins to recognize colors Begins to take turns Understands descriptive concepts, such as “big” and “little,” “boy” and “girl.” |
Babbles less Two- to three-word sentences Repeats two numbers Increased use of pronouns Asks simple questions Joins in songs and nursery rhymes Can repeat simple phrases and sentences Three- to four-word sentences Answers questions (“wear on feet,” “to bed”) Repeats three numbers Use of plurals Can help tell a simple story |
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36 months |
Builds tower of 9-10 cubes Imitates three-cube bridge Copies circle Uses scissors Brushes teeth but not well Puts on shoes Feeds self with utensils Plays with 1- to 3-piece puzzle Puts on shoes and socks Brushes hair It imitates drawing a cross. Twists jar lids |
Jumps with both feet Climbs ladders May pedal tricycle Balances on one foot 2-3 s Kicks ball with direction Catches a ball |
Listens to adult conversations Understands preposition under Can categorize items by function Begins to recognize colors Begins to take turns Understands descriptive concepts, such as “big” and “little,” “boy” and “girl.” Understands fast Understands prepositions behind and in front Responds to simple three-part commands Increasing understanding of adjectives and plurals Understands “just one.” |
Three- to four-word sentences Answers questions (“wear on feet,” “to bed”) Repeats three numbers Use of plurals Can help tell a simple story Understands and answers (“cold,” “tired,” “hungry”) Mainly three- to four-word sentences Appropriate use of pronouns Gives full name when asked Begins rote counting Begins to relate events Lots of questions, some beginning prepositions (on, in) |
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48 months |
Copies bridge from model It cuts curved lines with scissors. Dresses self independently Strings small beads Demonstrates hand preference Imitates a square Undresses self Buttons Strings beads Pours from a small pitcher |
Tries to skip using alternate feet Catches a bouncing ball Runs around corners lightly on toes and stops voluntarily Stands on one foot for 5 s Walks down stairs alternating feet Throws ball underhand |
Recognizes coins Begins to understand future and past tenses Understands number concepts—more than one Responds to three-step commands |
Uses prepositions Tells stories Can give the function of objects Repeats longer than six-word sentences Repeats four numbers Gives age Good intelligibility Can explain what, who, where, and why Asks “how” questions Answers verbally to questions, such as “How are you?” Uses past and future tenses Can use conjunctions to combine words and phrasesWeek 1 Discussion Part I Table 1 Developmental Milestones
Table 2 HEEADSSS Assessment:
Table 3 Tools for Screening Toddlers and Preschoolers
Table 4 Development Milestones – Screening Toddlers and Preschoolers
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Peer 2: Case Scenario 2 – Allen
Week 1 Discussion Part I
Table 1: Developmental Milestones. (Maaks et al., 2020).
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Complete the table |
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Physical |
Gross Motor |
Fine Motor |
Language |
Socialization |
Sleep |
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2 months |
– Posterior fontanel closes – Crawling reflex disappears |
– Decreased head lag when sitting – Lifts head and chest when in prone position – Head upright but forward when sitting – Symmetrical tonic neck position |
– Hands open – Decreasing grasp reflex |
– Vocalizes, coos, vocalizes to familiar voices |
– More aware during daytime – Social smile |
– Sleeps 8.5-10 hours at night and 6-7 hours in the daytime. – Takes 3-4 naps |
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4 months |
– Drooling – Moro and tonic reflexes disappears |
– Minimal to no head lag when sitting – Balances head well – Sits upright – Head and chest off surface when prone – From prone to supine |
– Plays with own hands – Pulls on blankets, hair, earrings, eyeglasses – Reaches for items – Grasps with both hands – Mouths items |
– Laughs out loud – Sounds: B, G, K, N, and P sounds – Vocalizations express mood |
– Enjoys interactions with others – Fusses for attention – Anticipates feedings when they see bottle or mother – Prefers particular toys |
– Regular sleep-wake pattern – Self-soothes briefly – Settles back to sleep – Sleeps 12-15 hours/day – Can sleep throughout the night without feeding |
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6 months |
– Growth rates decline – 90-150 grams gained per week – Height increases by 1.25 cm per month – Chewing and biting |
– Supine to prone – Able to loft chest and upper abdomen – Bears weight on hands – Can sit in high chair with back straight – Bears weight on legs when supported |
– Grasps, bangs, and manipulates small objects – Releases an item in exchange for another – Grasps feet and pulls to mouth – Holds bottle |
– Imitates sounds – One syllable – Vocalizes to toys and mirror image – Face brightens to own sounds |
– Recognizes parents – Fears strangers – Extends arms to be carried – Imitates sticking out tongue or coughing – Has definite likes and dislikes – Searches for dropped items |
– Sleeps 13-14 hours/day – Uninterrupted night sleep with 2-3 naps |
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8 months |
– Regular bladder and bowel patterns – Parachute reflex |
– Sits unsupported for a short time – Bears weight on legs when standing – Stands holding on to furniture – Adjusts position to reach object |
– Pincer grasp – Releases items at will – Holds two cubes while eyeing third – Reaches for out of reach items |
– Understands “no” |
– Increased anxiety when parent is unseen – Increased stranger anxiety – Dislikes dressing or diaper changes |
– Can sleep through the night without feeding – Sleeps 11-12 hours/night – 2-3 naps daily |
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12 months |
– Birth weight has tripled – Length increased by 50% – Equal head and chest circumference – Anterior fontanel closing – Landau reflex decreasing – Lordosis |
– Pulls self to stand – Stands alone for 3-5 seconds – Walks holding on to furniture – Standing to sitting position without falling – Rolls a ball |
– Easily releases cubes into cup – Two-cube towers – Starts using spoon and cup – Easily turns pages of books |
– “Mama” and “dada” – 3-5 other words – Receptive > expressive language – Knows object names – Copies animal noises – Understands one-step commands |
– Likes familiar places, such as home and day care – Starts to explore away from parent – Expresses joy and delight – Affection: hugging or kissing – Gets angry or jealous – Clingy to parent when unsure – Has favorite item – Object permanence |
– 8-11 hours of sleep per night – 1-2 naps |
Table 2: HEEADSSS Assessment. (Maaks et al., 2020).
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What is the HEEADSSS Assessment? Method of assessing risky behavior, such as tobacco use, substance use, and poor academic performance. |
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Include common questions asked below |
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H: Home |
Who lives with you? How are your relationships with people you live with? Is there any changes at home? Do you feel safe at home? |
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E: Education Employment |
What do you like or don’t like about school? How is school going? How are your grades? Have you even been in trouble at school? Do you work? How many hours do you work? Where do you work? Do you have friends at school or work? |
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E: Eating |
Are you comfortable with your body? Do you want to gain or lose weight? How do you manage your weight? How often do you exercise? What do you normally eat every day? |
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A: Activities |
What do you for fun? What activities do you like to do with your friends? What activities do you like to do with your family? Do you play sports? Do you participate in clubs or organizations? How much time do you spend watching TV, using the computer, texting, or listening to music? What activities do you like to do online or on your phone? |
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D: Drugs |
Do you, or anyone in your family or friends use drugs, tobacco, or drink alcohol? Have you ever used performance-enhancing drugs? |
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S: Sexuality |
Do you date? Have you ever had a romantic relationship? Have you ever had sex? How many partners have you had? Are you interested in males, females, or both? Has someone ever hurt or threaten you sexually? Do you use contraception and how often? |
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S: Suicide/depression |
Do you ever feel all alone or that no one cares? Do you feel sad most of the time? Do you have thoughts of hurting yourself? Do you need drugs, alcohol, or tobacco to make yourself feel better? Have you lost interest in being with friends or doing things you normally liked to do? |
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S: Safety |
Have you ever been hurt or threatened by someone, and who? Have you ever been seriously injured? Do you use sports safety equipment? Do you use seatbelts? Do you text or talk when driving? Do you ever feel unsafe? Have you ever been bullied? Have you ever met someone you first met online? |
Table 3: Tools for Screening Toddlers and Preschoolers. (Maaks et al., 2020).
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Screening Tools for Toddlers and Preschoolers |
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Name |
Use |
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Ages and Stages Questionnaires |
Developmental milestones. Measures communication, gross motor, fine motor, problem-solving, social, and overall development. |
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Battelle Developmental Inventory |
Early developmental milestones. Measures personal-social, motor, adaptive, cognitive ability, and communication. |
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Child Development Inventory |
For gross motor, fine motor, language, social, and comprehension skills. |
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Pediatric Symptom Checklist |
Identify cognitive, emotional, and behavioral issues. |
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Modified Checklist for Autism in Toddlers, Revised with Follow up |
Screening for autism risk |
Table 4: Development Milestones – Screening Toddlers and Preschoolers. (Maaks et al., 2020).
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Age |
Fine Motor Skills (list 3-5) |
Gross Motor Skills (list 3-5) |
Language |
Common Behaviors |
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12 months |
– Pincer grasp – Points at objects – Stacks 2 blocks Clasps hands |
– Pulls self to stand – Stands alone for 3-5 seconds – Walks holding on to furniture – Standing to sitting position without falling – Rolls a ball |
– Follows one-step commands – Understands new words per week – Increased interest in naming pictures – Understands simple questions – Points to familiar items and body parts when named – Differentiates environmental sounds – Distinguishes “you” from “me” – Uses all vowels and consonants – Increased use of real words |
– Imitates sounds – Pulls up to stands – Claps hands – Responds to name – Puts objects into the container |
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15 months |
– Blocks in a cup – Drinks from a cup – Holds utensils – Stacks 2 blocls |
– Stands alone – Walks forward and backward – Stoops and recovers – Climbs up stairs without alternating feet – Pull toy |
– Follows one-step commands – Understands new words per week – Increased interest in naming pictures – Understands simple questions – Points to familiar items and body parts when named – Differentiates environmental sounds – Distinguishes “you” from “me” – Uses all vowels and consonants – Increased use of real words |
– Stack blocks – Climbing attempts – Points to body part – Taking few steps |
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18 months |
– Tower of 4 cubes – Scribbles – Drinks from cup with minimal spills – Removes socks – Stacks 4-6 blocks |
– Throws with aim – Walks well independently – Pushes and pulls toys – Pulls toy while walking backward |
– Follows two-step commands without visual cues – Increased vocabulary – Enjoys simple stories and songs – Recognizes pronouns – Imitates two-word combinations – 200+ words in vocabulary – Names self – Answers some questions – Uses pronouns: my, me, mine |
– Walk – Drink from cup – Points to indicate wants/needs – Names pictures in book |
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24 months |
– Tower of 7 cubes – Circular scribbles – Turns doorknob – Unbuttons or unzips clothes – Uses a spoon |
– Overhand throws – Runs well – Kicks ball – Walks with control – Jumps up |
– Understands “in” and “on” – Understands most of what is said – Understands reasoning – Identifies object with function – Less babbling – 2-3 word sentences – Repeats two numbers – Asks simple questions – Joins in songs and nursery rhymes – Repeats simple phrases and sentences |
– Kick ball – Jumps – Recognize familiar people – Throws and retrieve items |
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30 months |
– Tower of 9 cubes – Draws vertical and horizontal lines – Imitates circle – Holds fork in fist and tries to use it – Dresses with self assistance |
– Jumps with both feet – Able to stand on 1 foot for 1 second – Tiptoes – Climbs stairs with alternating feet |
– Listens to adult conversations – Understands “under” – Classifies items by function – Recognizes colors – Takes turns – Understands descriptive concepts – 3-4 word sentences – Answers questions – Repeats 3 number – Use of plurals – Can help tell simple story |
– Plays next to other children – Follows simple commands – Playing pretend – Tantrums |
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36 months |
– Tower of 9-10 cubes – Copies circle – Brushes teeth but not well – Puts on shoes – Uses utensils and feeds self |
– Jumps with both feet – Climbs ladders – Able to pedal tricycle – Balances on 1 foot for 2-3 seconds – Can catch a ball |
– Understands “fast,” “behind,” “in front,” and “just one” – Responds to simple 3-part commands – Increased understanding of adjectives and plurals – Understands and answers – Mostly 3-4 word sentences – Appropriate pronoun use – Full name when asked – Relate events and rote counting – Lots of questions |
– Play with other children – Get out of bed – Tantrums – Can stand and hop on one foot – Climbs up and down the slide independently |
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48 months |
– Cuts curved lines with scissors – Able to dress self independently – Hand preference – Undresses self – Can imitate square |
– Attempts to skip with alternate feet – Catches a bouncing ball – Stands on 1 foot for 5 secons – Underhand ball throwing – Walks down stairs with alternating feet |
– Responds to 3-step commands – Answers “how” – Responds to questions verbally – Uses past and future tenses – Can use conjunctions |
– Eager to try new things – Able to express emotions – Walking down steps – Throwing and catching |
Case Scenario 2:
Allen is a 14-year-old male who has come into the clinic for a complete physical exam. Two years ago, he was placed in foster care, but he has recently moved into his paternal grandfather’s home. His grandfather is with him today. During the visit, you will perform an adolescent health history focusing on his current development and anticipatory guidance needed.
1) Allen is in what phase of adolescence?
- Early adolescence (11-14 years old): A lot of changes occur in this phase and is considered the most challenging adjustment period for young people (Maaks et al., 2020).
2) Summarize the physical, cognitive, and social/emotional challenges and anticipatory guidance to prepare Allen and his grandfather for this phase of adolescence.
- Physical: Physical changes differ widely in early adolescence. For males, an increased testicular size is the first sign of puberty due to the development of the seminiferous tubules (Breehl & Caban, 2023). Hair growth in the pubis, axillae, and face begin to grow. The penis grows in length and width, while the glans penis and corpus cavernosum becomes bigger (Breehl & Caban, 2023). In addition, the larynx and vocal cords increase in size; the pitch deepens and their voice may crack. Increased oils in the hair and skin may occur, as well as more acne (Breehl & Caban, 2023).
- Cognitive: Frequent daydreaming, which is cognitive work for adolescents(Maaks et al., 2020). They should be given the chance to foster and utilize their growing reasoning skills in order to solve problems, practice their values, and evaluate their principles as basis for decision-making (Maaks et al., 2020).
- Social/Emotional: Early adolescents start to develop deeper connections with their peers; they lack social skills and experience, resulting in not belonging in an adolescent subculture(Maaks et al., 2020). In addition, early adolescents prefer to spend more time with friends than with their family, and are embarrassed of their parents(Maaks et al., 2020). Early adolescents become more independent, and one way of exhibiting independence is testing their parents’ authority – they engage in arguments, become disobedient, reject doing chores, and challenge the rules(Maaks et al., 2020). Early adolescents also experience wide mood fluctuations that range from elation to sadness, they become body conscious especially due to the changes their body is going through, and wants more privacy. Forming friendships are significant in the early adolescent phase, and can explore sexual interest (Maaks et al., 2020).
- Anticipatory guidance: (Maaks et al., 2020).
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- It is essential to educate the adolescent on bodily function and regarding the timing of the primary and secondary sexual characteristics in males and females.
- Discuss sexual orientation, sexual feelings, and masturbation with the adolescent.
- Counsel adolescent about safety, injuries or accidents, substance abuse, and the use of helmets, seatbelts, and appropriate sports gear.
- Stress the importance of school completion, academic performance, reality checks, and encourage adolescent to participate in conversation.
- Have a discussion with the adolescent regarding their beliefs and what they consider valuable. Aid them in conflict resolution and prevention.
- Clarify with the parents regarding the adolescent’s need for privacy and sense of self-identity.
- Engage in discussion with the adolescent regarding peer activities, avoiding gang participation, bullying, avoiding drug, tobacco, and alcohol use, as well as dating, relationships, and the use of social media in a safe manner.
3) What strategies should the APRN utilize to develop trust and establish confidentiality during Allen’s history and physical exam?
In order to develop trust and establish confidentiality during Allen’s history and physical examination, it is essential to be exhibit honesty, respect, and empathy; establishing a connection with adolescent can also encourage open communication (Hardin et al., 2021). Trust is established over time, and is strengthened when health care providers, such as APRNs, delivered care with patience, support, and without judgment. Keeping matters private between the adolescent and the health care providers is essential in building trust and rapport (Hardin et al., 2021). Furthermore, being honest and transparent, as well as not withholding information from the adolescent exhibits honesty. In addition, APRNs should make a sincere effort to listen and exhibit concern (Hardin et al., 2021).Case Scenario 2 – Allen
Week 1 Discussion Part I
Table 1: Developmental Milestones. (Maaks et al., 2020).
|
Complete the table |
||||||
|
Physical |
Gross Motor |
Fine Motor |
Language |
Socialization |
Sleep |
|
|
2 months |
– Posterior fontanel closes – Crawling reflex disappears |
– Decreased head lag when sitting – Lifts head and chest when in prone position – Head upright but forward when sitting – Symmetrical tonic neck position |
– Hands open – Decreasing grasp reflex |
– Vocalizes, coos, vocalizes to familiar voices |
– More aware during daytime – Social smile |
– Sleeps 8.5-10 hours at night and 6-7 hours in the daytime. – Takes 3-4 naps |
|
4 months |
– Drooling – Moro and tonic reflexes disappears |
– Minimal to no head lag when sitting – Balances head well – Sits upright – Head and chest off surface when prone – From prone to supine |
– Plays with own hands – Pulls on blankets, hair, earrings, eyeglasses – Reaches for items – Grasps with both hands – Mouths items |
– Laughs out loud – Sounds: B, G, K, N, and P sounds – Vocalizations express mood |
– Enjoys interactions with others – Fusses for attention – Anticipates feedings when they see bottle or mother – Prefers particular toys |
– Regular sleep-wake pattern – Self-soothes briefly – Settles back to sleep – Sleeps 12-15 hours/day – Can sleep throughout the night without feeding |
|
6 months |
– Growth rates decline – 90-150 grams gained per week – Height increases by 1.25 cm per month – Chewing and biting |
– Supine to prone – Able to loft chest and upper abdomen – Bears weight on hands – Can sit in high chair with back straight – Bears weight on legs when supported |
– Grasps, bangs, and manipulates small objects – Releases an item in exchange for another – Grasps feet and pulls to mouth – Holds bottle |
– Imitates sounds – One syllable – Vocalizes to toys and mirror image – Face brightens to own sounds |
– Recognizes parents – Fears strangers – Extends arms to be carried – Imitates sticking out tongue or coughing – Has definite likes and dislikes – Searches for dropped items |
– Sleeps 13-14 hours/day – Uninterrupted night sleep with 2-3 naps |
|
8 months |
– Regular bladder and bowel patterns – Parachute reflex |
– Sits unsupported for a short time – Bears weight on legs when standing – Stands holding on to furniture – Adjusts position to reach object |
– Pincer grasp – Releases items at will – Holds two cubes while eyeing third – Reaches for out of reach items |
– Understands “no” |
– Increased anxiety when parent is unseen – Increased stranger anxiety – Dislikes dressing or diaper changes |
– Can sleep through the night without feeding – Sleeps 11-12 hours/night – 2-3 naps daily |
|
12 months |
– Birth weight has tripled – Length increased by 50% – Equal head and chest circumference – Anterior fontanel closing – Landau reflex decreasing – Lordosis |
– Pulls self to stand – Stands alone for 3-5 seconds – Walks holding on to furniture – Standing to sitting position without falling – Rolls a ball |
– Easily releases cubes into cup – Two-cube towers – Starts using spoon and cup – Easily turns pages of books |
– “Mama” and “dada” – 3-5 other words – Receptive > expressive language – Knows object names – Copies animal noises – Understands one-step commands |
– Likes familiar places, such as home and day care – Starts to explore away from parent – Expresses joy and delight – Affection: hugging or kissing – Gets angry or jealous – Clingy to parent when unsure – Has favorite item – Object permanence |
– 8-11 hours of sleep per night – 1-2 naps |
Table 2: HEEADSSS Assessment. (Maaks et al., 2020).
|
What is the HEEADSSS Assessment? Method of assessing risky behavior, such as tobacco use, substance use, and poor academic performance. |
|
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Include common questions ask |
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