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The Normal Child

The Normal Child. Tintinalli Chapter 114. General Principles. Communicate appropriately with the child Communicate with the family Assess by observation before interacting Obtain meaningful vital signs Interpret in context of activity. General Principles. Vitals SBP =70+(2 x years)

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The Normal Child

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  1. The Normal Child Tintinalli Chapter 114

  2. General Principles • Communicate appropriately with the child • Communicate with the family • Assess by observation before interacting • Obtain meaningful vital signs • Interpret in context of activity

  3. General Principles Vitals • SBP =70+(2 x years) • Weight <12 months: kg = 4 + (months / 2) 1 - 12 years: kg = 10 + (2 x years)

  4. Growth and Developmental Stages • Early infancy (0 – 6 months) • General • Weight loss 5-10% over first 3 days • 20 – 30 gram / day weight gain is sign of health • Anterior fontanelle slightly depressed when upright • Obligate nose breathers • Immature central control of breathing

  5. Growth and Developmental Stages • Early infancy (0 – 6 months) • Neuro • Primative reflexes are symmetrical • Suck, grasp, Moro • 1 month • Lift head, follow object, social smile • 4 months • Steady head control, reach and grasp, cooing, rolling over

  6. Growth and Developmental Stages • Late infancy (6 – 18 months) • General • Triple birth weight by 1 year, then rate slows • Teeth begin at 6 months at rate 1 / month • Anterior fontanelle closed by 18 months

  7. Growth and Developmental Stages • Late infancy (6 – 18 months) • Neuro • 6 months • Transfers objects, babbles • 9 months • Crawling, pulls to stand, nonspecific jargon • Stranger anxiety begins • 12 months • Pincer type grasp, walks, specific words

  8. Growth and Developmental Stages • Toddler (18 – 36 months) • General • Decelerating growth rate, appetite • Primary teeth (20) in place by 36 months • Increased risk of orthopedic injuries • Curious, immature growth plates • Nursemaid’s elbow

  9. Growth and Developmental Stages • Toddler (18 – 36 months) • Neuro • 18 months • Walk, feed themselves, simple commands, stranger anxiety peaks • 24 months • Run, climb stairs, three word phrases, peak risk of falls and ingestions

  10. Growth and Developmental Stages • Preschool (3 – 5 years) • General • Decreased appetite • Injuries increase with activity • Risk for injuries from improperly positioned seatbelt • Ohio has new booster seat law for children until 4’9” or 8 years

  11. Growth and Developmental Stages • Preschool (3 – 5 years) • Neuro • Progressive autonomy • Attraction to books, coloring • Expanded language skills • Strong sense of fear of pain • Limited sense of time and history • Magical thinking

  12. Growth and Developmental Stages • School age (5 – 12 years) • General • Slowest period of growth • Primary teeth loosening, secondary erupt • Increased activity / sports – injuries common • Neuro • Concrete reasoning, understands cause and effect • Aware of self, modesty • Task oriented behavior / sports • Eager to please

  13. Growth and Developmental Stages • Adolescence (12 – 17 years) • General • Second period of rapid growth (10 girls, 12 boys) • Secondary sexual development after growth spurt • Menarche between 10 and 16 years • Drug use

  14. Growth and Developmental Stages • Adolescence (12 – 17 years) • Neuro • Abstract thinking • Self centered world view • Self conscious regarding appearance • Feelings of immortality, risky behavior • Mistrust / rebellion against authority • Psychiatric disease and suicidal behavior recognized

  15. Vaccine Schedule

  16. Medical Consent and Treatment • Consent • Must be obtained unless emergency • Ohio allows for written statement signed by parent and be presented by any appointed adult (friend, relative etc) • Only one parent needs to consent • If divorced not finalized: either parent • If divorce final: custodial parent should consent • Non custodial parent will suffice if unable to reach custodial

  17. Medical Consent and Treatment • Implied consent (Ohio) • Must points must be met: • According to competent medical judgment, the proposed surgical or medical treatment is reasonably necessary • A person authorized to consent in not readily available • Any delay in treatment would jeopardize the minor’s life or health

  18. Medical Consent and Treatment • Consent (Ohio) Minor may consent: • To an examination for the purpose of gathering physical evidence of an alleged sexual offense; treatment related to the assault. Parent must be notified. • Suspected child abuse. • For the diagnosis or treatment of HIV or any venereal disease by a licensed physician; • Pregnancy testing. • Contraception including emergency contraception. • To an abortion after judicial review and notification. • IF 12 YEARS of AGE or OLDER; For the diagnosis or treatment • of any condition that it is reasonable to believe is caused by drug abuse, beer, or intoxicating liquor; • IF 14 YEARS of AGE or OLDER; To up to 1 month of outpatient mental health treatment. • Incarcerated minor prosecuted as an adult.

  19. Medical Consent and Treatment • Parental refusal • If in the setting of life threatening emergency or child abuse is suspected; • ORC 2151.421 Physician has duty to notify children’s services; police • Child under 18 • Mentally retarded under 21 • Court order may be obtained for treatment (24/7)

  20. Medical Consent and Treatment • Emancipation of a minor • Varies by state • In Ohio – determined by circumstances • Successful enlistment in the Armed Forces • Valid marriage • Independent for the care / control of parents • Employed and self sustaining • On 18th birthday • Pregnancy / delivery does not emancipate a minor • Judicial emancipation : NONE • No mechanism to petition court for emancipation

  21. Questions?

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