CHAPTER
40
Assisting in
Pediatrics
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40-2
Learning Outcomes (cont.)
40.1 Relate growth and development to
pediatric patient care.
40.2 Identify the role of the medical assistant
during pediatric examinations.
40.3 Discuss pediatric immunizations and
the role of the medical assistant.
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40-3
Learning Outcomes (cont.)
40.4 Explain variations of pediatric
screening procedures and diagnostic
tests.
40.5 Describe common pediatric diseases
and disorders and their treatment.
40.6 Recognize special health concerns of
pediatric patients.
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40-4
Introduction
• Pediatrics
• Medical Assistant
– Specialty
– Parent education
– Healthcare of children
– Adhering to
immunization
schedules
• Pediatrician
– Monitors development
– Diagnose and treat
– Recognizing special
health concerns
– Liaison between
parent and physician
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40-5
Developmental Stages and Care
• Developmental milestones for each stage
– Physical development
– Intellectual-cognitive development
– Psycho-emotional development
– Social development
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40-6
Neonate
• Birth to one month
• Physical development
– Umbilical cord
– Head
• ¼ the length
• Fontanels
– Skin
• Loose, wrinkled, red
• Peels during 1st week
– Jaundice
• Yellowish color
• Bilirubin
– Reflexes
– Vision and
hearing
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40-7
Neonate (cont.)
• Intellectual-cognitive development
• Social development
– Responds to stimulation
– Establishes an activity pattern
– Responds to a soft, gentle voice
– Tries to focus on voice and face
– Can show excitement and distress
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40-8
Neonate (cont.)
• Aspects of care
– Hygiene
• Tepid sponge baths
• Avoid oil, lotions,
and powders
– Jaundice treatment
• Hydration
• Ultraviolet light or
bili-blanket
• Blood tests
– Feeding
instructions
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40-9
The Infant: One Month to One Year (cont.)
• Physical development
– Rapid growth
– Develops head to foot
– Larger groups of
muscles develop
before smaller groups
• Intellectual-cognitive
development
– Recognition and
understanding develop
– At 12 months ~ follows
simple directions
– Eye-hand
coordination
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40-10
The Infant: One Month to One Year (cont.)
• Psycho-emotional development
– Address physical needs quickly and calmly
– Physical contact and cuddling important
• Social Development
– Occurs quickly
– Increasing interaction with family
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40-11
The Infant: One Month to One Year (cont.)
• Aspects of care
– Regular checkups and immunization
– Provide physical contact
– Introduce solid foods
– Ensure safety
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40-12
The Toddler: One to Three Years
• Physical development
– Weight gain slows
– Arms and legs lengthen
– Begins walking
– Toilet trained by three
years of age
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40-13
The Toddler: One to Three Years (cont.)
• Intellectual-cognitive development
– Learn through play
– Develop independence
– Speech progresses
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40-14
The Toddler: One to Three Years (cont.)
• Psycho-emotional
development
• Social
development
– Gain control over
expression of
feelings
– Progress to sharing
and playing with
others
– Need consistent
limits
– Adult guidance to
learn appropriate
behavior
– Become sensitive
to feelings of others
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40-15
The Toddler: One to Three Years (cont.)
• Aspects of care
– Promote the development of
• Fine motor skills
• Language skills
– Set limits
– Provide a safe
environment
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40-16
The Preschooler: Three to Five Years
• Growth rates vary
• Respiratory and heart rates slow down
• Require adequate calcium intake
• Achieve of nighttime continence
• Develop fine motor skills
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40-17
The Preschooler: Three to Five Years
• Intellectual-cognitive development
– Vocabulary at three years ~ 900 words
– Vocabulary at five years > 2000 words
• Psycho-Emotional Development
– Progresses from pleasant to negative to selfassured
– Capable of accepting some responsibility by
five years old
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40-18
The Preschooler: Three to Five Years
• Social development – able to take turns
and play with other children
• Aspects of care
– Developmental assessment and physical
– Receive appropriate immunizations
– Maintain nighttime routines
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40-19
The Elementary School Child: Six to Ten
Years
• Physical development
– Girls may be larger than boys
– Muscles continue to develop
– Need regular exercise
• Intellectual-cognitive development
– Attention span increases
– Better able to separate fantasy from reality
– Develop sense of right and wrong
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40-20
The Elementary School Child: Six to Ten
Years (cont.)
• Psycho-emotional
development
– Peer influences
– Gender-related
roles
– Sensitive to
criticism
• Social
development
– Avoid
overwhelming child
– Outdoor activities
– Appropriate social
behaviors learned
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40-21
The Elementary School Child: Six to Ten
Years (cont.)
• Aspects of care
– Structure and schedule
– Monitor physical activities
– Be consistent in activities and discipline
– Regular health and dental checks
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40-22
The Middle School Child: Eleven to
Thirteen Years
• Physical development
– Onset of puberty
• Girls – 12 to 13 years of age
• Boys – around 14 years of age
– Skin problems and acne
• Intellectual-Cognitive Development
– Grades may slip
– Tend to exaggerate
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40-23
The Middle School Child: Eleven to
Thirteen Years (cont.)
• Psycho-Emotional
Development
– Crave
independence
• Social development
– Relationships
– Need a trusted adult
to talk to
– Sexuality
– Temperamental
– Take on behaviors
of peers
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40-24
The Middle School Child: Eleven to
Thirteen Years (cont.)
• Aspects of care
– Provide assurance that the child is valued and
loved
– Discipline consistently
– Do not be hypercritical
– Monitor friendships and associations
– Do not over schedule the child’s time.
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40-25
The Adolescent: Fourteen to Nineteen
Years
• Physical development
– Centered on normal sexual change
– May develop unhealthy habits leading to
health problems as an adult
• Intellectual-Cognitive Development
– Developing own values
– Do not always see the consequences of
behaviors
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40-26
The Adolescent: Fourteen to Nineteen
Years
• Psycho-emotional development
– Pressure of adolescence may lead to angry
outbursts
– Anxiety and depression may be present
• Social development
– Friendships are important
– Problems include eating disorders, substance
abuse, STIs, suicide and violence
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40-27
The Adolescent: Fourteen to Nineteen
Years
• Aspects of care
– Teens should know the risks of engaging in
sexual activity
– Need people to
•
•
•
•
•
Listen and give them the facts
Trust them
Provide discipline and consistency
Educate them to be independent
Set good examples
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40-28
Apply Your Knowledge
What are the four developmental milestones
that are part of each life stage from birth
through the teen years?
ANSWER: The developmental milestones for
each stage are:
• Physical development
• Intellectual-cognitive development
• Psycho-emotional development
• Social development
Very
Good!
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40-29
Pediatric Examinations
• Discussions should be appropriate for the
child's developmental stage
• Relieve fear
– Explain procedures
– Allow child to examine
instruments
• Speak in terms
appropriate to age level
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40-30
Well Child Examination
• Infants need seven well-baby
examinations during their first year
– 2 weeks
– 6 months
– 1 month
– 9 months
– 2 months
– 1 year
– 4 months
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40-31
Well Child Examination (cont.)
• Children in the second and third year
– 15 and 18 months
– 24 and 30 months
• Annually after 3 years old
• Prepare for exam as you would
for an adult
• Follow Standard Precautions
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40-32
Apply Your Knowledge
Kris who is 2 yrs old is due for his well child
exam. When you try to take his temperature he
starts to cry and tries to hide behind his mother.
What can you do to gain his cooperation?
ANSWER: You could let him examine the
thermometer while explaining what you
will be doing. You might also take his
mother’s temp so he can see it doesn’t
hurt.
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40-33
Pediatric Immunizations
• Provide protection from infectious
diseases
• Vaccination
– Weakened strain of a virus
– Killed virus
– Toxoid ~ weaken toxin
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40-34
Pediatric Immunizations (cont.)
• Medical assistant role
– Scheduling appointments based on
immunization schedule
– Educating parents
– Administering the vaccine
– Keeping careful immunization records
– Ensuring proper vaccine storage and handling
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40-35
Pediatric Immunizations (cont.)
• Immunization recommendations
• Informed consent
– Explain benefits and risks
– Review the Vaccine Information Statement
• Administering immunizations
– Injection or oral
– Check for contraindications
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40-36
Pediatric Immunizations (cont.)
• Immunization
records
• Vaccine Storage
and Handling
– Require specific
information
– Correct
temperature
– Instruct parents to
maintain up-to-date
records
– Rotation of stock
– Preparation for
administration
– Infections control
guidelines
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40-37
Apply Your Knowledge
What are the responsibilities of the medical
assistant relating to immunizations?
ANSWER: The medical assistant should be sure that
vaccines are stored properly, administer vaccines
correctly (if within scope of practice), maintain
careful immunization records, educate parents,
follow recommended immunization schedule for
follow-up appointments.
Super!
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40-38
Pediatric Screening and Diagnostic Tests
• Comparison to national averages
• Medical assistant role
– Vital signs and measurements
– Vision and hearing tests
– Collecting specimens
– Administration of medications and
immunization
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40-39
Vital Signs
• Take temperature last – no oral
temperature in children less than five
years old
• Blood pressure
– Cuff size
– Do not use palpatory method
– Document where heartbeat becomes muffled
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40-40
Body Measurements
• Done at each office visit
– Weight
– Length or height
– Head circumference
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40-41
General Eye and Vision Exam
• General eye and
vision exam
– Pediatrician
examines interior of
the eye
– Visual acuity
testing
• General ear exam
– Test a child in the
same way as an
adult
– Infant or toddler ~
check for response
to sounds
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40-42
Diagnostic Testing
• Throat cultures
– Rapid test for streptococcal bacteria
– Confirm with throat culture
• Urine specimens
• Blood specimens
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40-43
Apply Your Knowledge
How often are pediatric measurements
taken?
ANSWER: At each appointment.
CORRECT!
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40-44
Pediatric Diseases and Disorders
• Do not make assumptions regarding
diagnosis or treatment
• Do not recommend aspirin for fever in
children
• If complaint includes a high fever, notify
the physician
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40-45
Common Diseases and Disorders
• Head lice
• Pinworms
• Herpes simplex
virus
• Ringworm
• Impetigo
• Streptococcal sore
throat
• Infectious
conjunctivitis
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40-46
Less Common Diseases and Disorders
Condition Description
AIDS
Juvenile
rheumatoid
arthritis
Most cases are transmitted mother-to-child
during pregnancy, labor, delivery, or
breastfeeding. All babies born to HIV-positive
mothers, test positive for HIV antibodies, but not
all remain permanently infected.
Autoimmune disease of the joints; occurs in
children 16 years or younger. Severity of the
disease ranges from mild to severe and may
affect the eyes and internal organs. The disease
has periods of remission and flare-up.
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40-47
Less Common Diseases and Disorders
Condition Description
ADHD and
Learning
Disabilities
ADHD – all conditions identified as hyperactivity,
hyperkinesis, and attention deficit.
LD – a wide rand of conditions that interfere with
learning
Cerebral
palsy
Birth-related disorder of nerves and muscles;
caused by brain damage occurring before,
during, or after birth or in early childhood
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40-48
Diseases and Disorders (cont.)
Condition Description
Congenital
heart
disease
Down
syndrome
Cardiovascular malformations in the fetus
before birth; causes include genetic
mutations, maternal infections, maternal
alcoholism, or maternal insulin-dependent
diabetes
Genetic disorder due to one extra
chromosome in all cells formed during fetal
development; characteristic facial features
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40-49
Diseases and Disorders (cont.)
Condition Description
Hepatitis B
Infection of liver; virus can be transmitted
from the mother before or during birth;
immunization available
Respiratory Major cause of lower respiratory infections;
Syncytial
highly contagious; difficult to treat; antibiotics
Virus (RSV) only treat any secondary infections
Sudden
Unexplained sudden death of an infant
Infant Death during sleep; usually occurs between 2 and
Syndrome
4months old; “back to sleep”
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40-50
Diseases and Disorders (cont.)
Condition
Description
Spina bifida
Defect of spinal development occurring
during the first trimester of pregnancy; the
spinal cord is not fully protected
Viral
Inflammation of stomach and intestines;
gastroenteritis can cause dehydration and electrolyte
imbalance due to fluid loss
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40-51
Apply Your Knowledge
ANSWER:
Matching:
F virus that causes cold sore blisters
E highly contagious dermatologic
disease
D an autoimmune disease of the
joints
B birth-related disorder of nerves and
muscles
A genetic disorder from one extra
chromosome
C cause of lower respiratory disease
in infants and young children
A. Down
syndrome
B. Cerebral palsy
C. RSV
D. JRA
E. Impetigo
F. Herpes simplex
virus
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40-52
Pediatric Patient Special Concerns
•
Detecting child abuse or neglect
–
Watch for problems in relationship between
child and parent/caregiver
–
Observe for physical injuries and signs of
neglect
–
Document and report to physician
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40-53
Pediatric Patient Special Concerns (cont.)
•
Physician will examine for
–
–
–
•
Some risk factors
–
–
•
Internal injuries
Malnutrition
Lack of cognitive ability
Stress
Financial problems
Abuse or neglect must be reported by law
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40-54
Pediatric Patient Special Concerns (cont.)
• Eating disorders
– Adolescents
– Anorexia nervosa
– Bulimia nervosa
• Depression,
substance abuse,
and addiction
– Difficult to
distinguish
– Family should be
aware if issue
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40-55
Pediatric Patient Special Concerns (cont.)
• Violence
• Suicide
– Be aware of
warning sides
– Always take suicide
threats seriously
• STIs and birth
control information
available from
– Schools
– Local health
departments
– TV and the internet
– CDC
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40-56
Apply Your Knowledge
List the warning signs of potential violence?
ANSWER: They are:
•
•
•
•
•
•
•
•
•
•
Frequent physical fighting
Increased or serious use of drugs or alcohol
Increase in risk-taking behavior
Gang membership or strong desire to be in a gang
Trouble controlling feelings such as anger
Withdrawal from friends and usual activities
Feeling rejected or alone
Having been a victim of bullying
Feeling constantly disrespected
Failing to acknowledge the feelings or rights of others
Superb!
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40-57
In Summary
40.1
Growth and development occur in stages throughout
life, including neonate, infant, toddler, preschooler,
elementary school child, middle school child, and
adolescent.
Each stage of development occurs through physical,
cognitive-intellectual, psycho-emotional, and social
milestones.
40.2
The medical assistant must be able to communicate
with pediatric patients of all stages, gather and
provide educational information to the parent or
caregiver, assist with diagnostic and screening
procedures, and serve as a liaison between the
patient and the physician.
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40-58
In Summary
40.3
Immunizations provide patients with protection from
infectious diseases.
The medical assistant may schedule appointments,
provide education, obtain informed consent,
administer the medication, maintain the
immunization record, and properly handle and store
the immunizations.
40.4
Screening procedures and diagnostic tests for
pediatric patients vary depending upon the age and
size of the child.
When performing procedures and diagnostic tests,
follow the specific guidelines for the procedure and
child.
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
40-59
In Summary
40.5
Some childhood diseases include chickenpox,
influenza, measles, mumps, rubella, scarlet fever,
and tetanus.
Other diseases are outlined in Table 40-2.
40.6
The medical assistant should be alert to signs of
special health concerns of pediatric patients,
including child abuse and neglect, eating disorders,
depression, substance abuse and addiction,
violence, suicide, and sexually transmitted
infections.
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution
in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.
40-60
The End of Chapter 40
There are only two
things a child will
share willingly:
communicable
disease and his
mother’s age.
- Benjamin Spock
© 2014 by McGraw-Hill Education. This is proprietary material solely for authorized instructor use. Not authorized for sale or distribution
in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.