Pediatric Primary Care (29 page)

c.  Can define at least 7 words.

d.  Can identify some opposites.

4.  Gross motor.

a.  Can balance on each foot for 6 seconds.

b.  Can heel-toe walk forward and backward.

c.  Rides tricycle without problems.

VI.  SOCIAL DEVELOPMENT

A.  The child is beginning to move from family relationships as primary focus to peer relationships as primary focus.

B.  Continues to use play to develop skills, competencies, and learn about his world.

C.  Social cooperation, morality, critical thinking, and self-concept are developing.

D.  Demonstrates cooperative play.

E.  Team/group activities encouraged (arts programs, organized clubs/sports, etc.); regular exercise encouraged.

F.  Making friends is primary social goal; developing “best friends.”

G.  Developing conflict resolution skills.

VII.  IMMUNIZATIONS (SEE
APPENDIX A
)

A.  Recommended:

1.  DTaP #5 if not done previously.

2.  IPV #4 if not done previously.

3.  MMR #2 if not done previously.

4.  PPD #1 if not done previously.

5.  Varicella.

6.  Influenza annually.

B.  Catch-up.

1.  Hepatitis B series.

2.  Varicella.

3.  Pneumococcal vaccine.

4.  MMR.

5.  DTaP.

C.  High-risk children.

1.  Influenza (yearly).

2.  Hepatitis A series.

3.  Pneumococcal pneumonia vaccine.

4.  PPD (yearly).

5.  Meningococcal.

VIII.  SAFETY

A.  Motor vehicle.

1.  Consistent use of appropriate safety restraints in motor vehicles.

2.  Knows appropriate pedestrian safety rules.

3.  Riding a motorcycle is discouraged. However, consistent helmet use when passenger on motorcycle.

B.  Sports/recreation.

1.  Consistent use of appropriate protective equipment for all activities (biking, rollerblading, sports, boating, etc.).

2.  Ensure appropriate safety instruction provided for all activities.

3.  Obtain swim lessons.

4.  Ensure safety of sports/play areas and proper supervision provided.

5.  Use sunscreen of SPF 15 or higher.

6.  Discourage use of mini-bikes and ATVs.

C.  Household.

1.  Never leave child without appropriate supervision.

2.  Teach appliance safety and monitor use.

3.  Teach hazardous materials/medication safety. Keep out of reach and monitor use.

4.  Teach fire safety. Develop family plan.

5.  Teach gun safety. Keep guns out of reach, locked, unloaded. Store ammunition and guns separately.

D.  Social.

1.  Teach phone number, address.

2.  Teach use of 911.

3.  Teach stranger safety.

4.  Teach about “good touch/bad touch.”

IX.  ANTICIPATORY GUIDANCE

A.  Preventive care.

1.  Annual physical.

2.  Semiannual dental visits.

3.  Immunizations on schedule.

B.  Home.

1.  Establish family rules and remain consistent in enforcement.

2.  Avoid corporal punishment for breaking rules.

3.  Limit TV viewing to 1 hour/day.

4.  Enforce good personal hygiene.

5.  Avoid punishment for urinary or bowel incontinence.

6.  Encourage family meals.

7.  Encourage continued reading to and with child.

8.  If parents work, ensure appropriate, safe supervision is provided before and after school.

9.  Encourage responsibility for age-appropriate chores.

10.  Develop fire safety plan for home.

C.  Family/community.

1.  Encourage and praise school activity, accomplishments.

2.  Encourage socialization with peer groups in organized and unorganized activities.

3.  Encourage consistent exercise; ensure proper supervision for all activities.

4.  Discourage “hurried child syndrome”; no more than 1-2 activities/week.

5.  Reinforce school/bus rules; encourage parents to become actively involved in school/community parent groups.

6.  Encourage parents to teach/model moral behavior, good citizenship (“Do unto others as you would have them do unto you.”).

D.  Safety.

1.  Ensure proper motor vehicle restraints consistently used.

2.  Encourage swim lessons.

3.  Reinforce proper bicycle use, rules, and use of helmet.

4.  Reinforce use of proper safety equipment for all activities including sunscreen SPF 15 or higher applied 30 minutes before going outdoors.

5.  Reinforce proper pedestrian rules.

6.  Reinforce proper gun safety and storing of ammunition separately.

7.  Reinforce “good touch/bad touch” concepts.

8.  Teach “just say no” concepts.

9.  Reinforce how to use telephone to call 911 in an emergency.

10.  Ensure child knows address and phone number.

11.  Reinforce age-appropriate child-proofing in residence and use of smoke detectors.

12 Reinforce fire safety; ensure family has plan for evacuation.

13.  Don't leave child without proper supervision.

14.  Discourage mini-bike and ATV use.

X.  SCHOOL READINESS

A.  Physical readiness.

1.  Has met developmental milestones in cognitive, gross and fine motor areas.

2.  Cognitive, visual, hearing deficits addressed.

B.  Emotional readiness.

1.  Able to separate easily from parent.

2.  Dresses without supervision.

3.  Toilet trained.

4.  Follows instructions.

C. Screening and assessment tools.

1.  Physical exam including full neurologic evaluation.

2.  Vision and hearing screening.

3.  Developmental testing (draw a man and Denver II recommended for ease of administration).

D.  Anticipatory guidance.

1.  Encourage and reinforce positive parental attitudes regarding school.

2.  Prepare parent and child for separation, change in routine.

3.  Have parent obtain list of school/classroom rules and review.

4.  Have parent tour school and meet teacher prior to first day of school.

5.  Prepare parent for child's potential fear/anxiety.

6.  Prepare family to advocate for child in positive, supportive manner.

E.  Potential concerns.

1.  School phobia.

2.  Lack of expected intellectual ability/progress.

3.  ADD/ADHD.

4.  Emotional immaturity.

5.  Behavioral problems related to classroom.

BIBLIOGRAPHY

Burns CE, et al.
Pediatric Primary Care: A Handbook for Nurse Practitioners.
4th ed. Philadelphia, PA: W.B. Saunders; 2009.