You are a nurse at the Community Health Center. Based on the first letter of your first name, you are assigned the following age groups:
G-L: 4-6 months
A parent/caregiver has brought their infant to your Community Health Center. Based on your assigned age group, what will you assess to determine health and development status of the infant? Describe the normal findings you would anticipate for each area assessed. Select one area that could be a “red flag” finding. Discuss the recommendations that you would give the parent/caregiver supported by evidence-based practice to address this “red flag” finding.
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “RN-BSN DQ Rubric” and “RN-BSN Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.
Example 1 (Eileen)
Normal Findings and Red Flag Assessment at 10-12 Months
At 10-12 months, infants achieve critical developmental milestones encompassing motor, cognitive, language, and social-emotional domains. Recognizing typical developmental expectations and identifying potential red flags is essential for caregivers to foster healthy growth and intervene promptly if necessary.
Motor Skills: Normal Findings: Infants aged 10-12 months typically demonstrate independent sitting, crawling or beginning to crawl, pulling themselves up to stand, and possibly taking assisted steps. They exhibit refined fine motor skills such as pincer grasp and enjoy exploring objects through manipulation.
Red Flag Finding: Delayed motor milestones, such as failure to sit independently or attempt crawling by 12 months, may indicate developmental delays requiring further evaluation.
Recommendations: Encourage regular tummy time starting early to strengthen motor muscles. Provide a safe environment that encourages exploration and practice. Consult with a pediatrician or early intervention specialist if concerns about motor delays arise to initiate appropriate assessments and interventions (American Academy of Pediatrics, 2020).
Cognitive Skills: Normal Findings: Infants at this stage display heightened curiosity and grasp the concept of object permanence (understanding objects exist even when unseen). They engage in simple games like peek-a-boo and begin mimicking actions and gestures.
Red Flag Finding: Lack of interest in object permanence games or unresponsiveness to familiar faces and voices may suggest cognitive delays.
Recommendations: Foster cognitive development through interactive play and daily routines. Utilize toys that promote problem-solving and exploration. Maintain consistent, nurturing environments that support learning and development (Zero to Three, n.d.).
In conclusion, monitoring developmental milestones at 10-12 months is crucial for early detection of potential issues. Early intervention significantly impacts outcomes, underscoring the importance of collaboration between caregivers and healthcare professionals for timely assessments and evidence-based interventions.
References:
American Academy of Pediatrics. (2020). Developmental milestones: 10 months. HealthyChildren.org. Retrieved from https://www.healthychildren.org/English/ages-stages/baby/Pages/Developmental-Milestones-10-Months.aspx
Zero to Three. (n.d.). 10-12 months: Cognitive development. Retrieved from https://www.zerotothree.org/resources/107-10-12-months-cognitive-development
Example 2 (Wendy)
Based on my 10-12 month old age group I will assess a variety of factors to determine the health and developmental status of the infant. I would start by using the World Health Organization’s (WHO) growth standards chart to assess the child’s physical health and developmental progression. I would ensure head circumference, weight-for-length, length-for-age, and weight-for-age are all appropriate for the infant’s age and gender. Next I would assess their gross and fine motor skills. At this stage in development children should be able to drink from cups with assistance, poke at objects with finger, scribble with crayons or markers, take objects out of a container, get into a sitting position without assistance, stand alone, walk while holding onto furniture, and in some cases may be able to take a few steps without holding onto anything for support.
I would also assess the infant’s cognitive abilities and development by observing their responses to the environment. Infants at this age should respond to simple verbal cues or requests. Their babbling should evolve to monosyllabic words such as “dada” or “mama”. Object permanence will likely improve and infants should easily find hidden objects.
One “red flag” finding would be if the infant consistently drags one side of the body while crawling, cannot stand without help, and cannot get into a sitting position without assistance. These may all be symptoms of hypotonia, or poor muscle tone, and may be indicative of a more serious underlying problem. If the findings were coupled with cognitive delays such as trouble speaking or feeding self I would recommend magnetic resonance imaging (MRI) and computerized tomography (CT) scans to assess muscle mass and rule out abnormalities of the spinal cord and nerves.
Source:
Grand Canyon University (2022). Health Assessment Foundations for Effective Practice (GCU, Ed.; Second) [Review of Health Assessment Foundations for Effective Practice]. https://bibliu.com/app/#/view/books/1000000000584/epub/Chapter1.html#page_10
Muscle weakness (hypotonia). Muscle Weakness (Hypotonia) | Boston Children’s Hospital. (n.d.). https://www.childrenshospital.org/conditions/muscle-weakness-hypotonia#:~:text=What%20is%20hypotonia%3F,is%20usually%20detected%20during%20infancy
Example 3 (Joel)
INFANT ASSESSMENT-A 4-6 MONTHS OLD INFANT ASSESSMENT.
My first name is Joel and therefore will conduct assessment for an infant that is aged between 4-6 months that is brought to the community health center. In evaluating their health aspects and development, I will assess, physical growth. In analyzing an infant of this age, I expect the following normal findings, the infant is supposed to have doubled the birth weight and are expected to exhibit excellent muscle tone, have move legs and arms symmetrically. They are also required to as well have a head circumference which is proportionate to their size of the body. The red flag finding in such a case would relate to significant discrepancies in weight gain and failure to appropriately gain weight. This could be a signal towards an underlying health concern or condition. I would then assess the infant on nutrition and feeding. In assessing this, the normal findings that I would expect relates to ability to swallow, coordinate sucking and as well, breathing while feeding. The child at this level may show great interest in solid foods and make moves towards reaching for objects. The red flag finding in such a case would be difficulties in swallowing, refusal to feed and as well inadequate weight gain in spite of adequate feeding issues. This could imply developmental issues or as well feeding difficulties for the infant.
It is also important to assess for developmental milestones where the normal findings is that infants may roll from the back of their stomachs, ability to use hands to grasp objects and have enhanced head control. The red flag for this would be regression or delays in the motor skills like failure on the infant to reach objects and insufficient head control. This may indicate neurological issues and developmental delays for the infant. In making recommendations for the red flags, there is need to ensure a comprehensive and thorough analysis. In the case that the infant records inadequate weight while he or she has been feeding well, it would be important to address the feeding issue in most effective ways. Evidence-based practice calls for one to consult a pediatrician to have a comprehensive and thorough medical evaluation of the infant to check on allergies, reflux among other issues (Jerome et al., 2023). There is also need for an assessment on his feeding and in this, one should consult a feeding specialist or lactation expert to provide solutions by assessing the situation. The other approach relates to nutritional counselling where guidance and education on feeding schedules and techniques is necessary (Fenton et al., 2022). The other aspect relates to follow-ups and monitoring by scheduling visits to help monitor the feeding progress and monitor weight gain. This will ensure that necessary interventions are made and hence ensure optimal outcomes for the 4-6 months year old infant.
References.
Fenton, T. R., Dai, S., Lalari, V., & Alshaikh, B. (2022). Neonatal and Preterm Infant Growth Assessment. Clinics in perinatology, 49(2), 295–311. https://doi.org/10.1016/j.clp.2022.02.001
Jerome, M. L., Valcarce, V., Lach, L., Itriago, E., & Salas, A. A. (2023). Infant body composition: A comprehensive overview of assessment techniques, nutrition factors, and health outcomes. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 38 Suppl 2(Suppl 2), S7–S27. https://doi.org/10.1002/ncp.11059