Bright Futures: Guidelines Pocket Guide: Guidelines for Health Supervision of Infants, Children, and Adolescents
123
Bright Futures: Guidelines Pocket Guide: Guidelines for Health Supervision of Infants, Children, and Adolescents
123(Spiral Bound - New Edition)
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Product Details
| ISBN-13: | 9781610020824 |
|---|---|
| Publisher: | American Academy of Pediatrics |
| Publication date: | 03/01/2017 |
| Edition description: | New Edition |
| Pages: | 123 |
| Sales rank: | 227,746 |
| Product dimensions: | 3.90(w) x 7.00(h) x 0.30(d) |
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Read an Excerpt
Bright Futures fourth Edition Pocket Guide
Guidelines for Health Supervision of Infants, Children, and Adolescents
By Joseph F. Hagan Jr, Judith S. Shaw, Paula M. Duncan
American Academy of Pediatrics
Copyright © 2017 American Academy of PediatricsAll rights reserved.
ISBN: 978-1-61002-082-4
CHAPTER 1
Supporting Families Successfully
Understanding and building on the strengths of families requires health care professionals to combine well-honed clinical interview skills with a willingness to learn from families. Families demonstrate a wide range of beliefs and priorities in how they structure daily routines and rituals for their children and how they use health care resources. This edition of Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents places special emphasis on 3 areas of vital importance to caring for children and families.
Social Determinants of Health
From the moment of conception, individuals grow in physical and relational environments that evolve and influence each other over time and that shape their biological and behavioral systems for life. Dramatic advances in a wide range of biological, behavioral, and social sciences have shown that each child's future depends on genetic predispositions (the biology) and early environmental influences (the ecology), which affect later abilities to play, learn, work, and be physically, mentally, and emotionally healthy.
Social determinants of health are social factors that affect children and families. Bright Futures' emphasis on social determinants of health reflects the importance of a broad view of health promotion. Contemporary health supervision looks beyond the office encounter to assess and address the family's risks and strengths and protective factors, which emerge from the family's and community's circumstances and which affect health in both positive and negative ways. Although social factors are not new issues for health care professionals who care for children, adolescents, and families, new science underpins their importance and provides evidence for effective interventions. Social determinants of health are one of the 5 Anticipatory Guidance priorities in every Infancy Visit and in most visits thereafter.
Children and Youth With Special Health Care Needs
Birth defects, inherited syndromes, developmental disabilities, and disorders acquired later in life, such as asthma, are relatively common — nearly 20% of the childhood population, or 14.6 million children, have special health care needs. In addition, a growing number of children are receiving diagnoses of developmental disabilities and conduct disorders, which may indicate special health care needs. Family-centered care that promotes strong partnerships and honest communication is especially important when caring for children and youth with special health care needs.
At the same time, the effect of specialness or extensive health care needs should not overshadow the child. The child or youth with special health care needs shares most health supervision requirements with her peers. Bright Futures uses screening, ongoing assessment, health supervision, and anticipatory guidance as essential interventions to promote wellness and identify differences in development, physical health, and mental health for all children.
Cultural Competence
Cultures form around language, gender, disability, sexual orientation, religion, or socioeconomic status. Even people who have been fully acculturated within mainstream American society can maintain values, traditions, communication patterns, and child-rearing practices of their original culture. Immigrant families, in particular, face many cultural stressors.
It is important for health care professionals who serve children and families from backgrounds other than their own to listen and observe carefully, learn from the family, and work to build trust and respect. If possible, the presence of a staff member who is familiar with a family's community and fluent in the family's language is helpful during discussions with families.
CHAPTER 2Bright Futures Health Promotion Themes
A number of themes are of key importance to families and health care professionals in their common mission to promote the health and well-being of children, from birth through adolescence. These themes are
* Promoting Lifelong Health for Families and Communities
* Promoting Family Support
* Promoting Health for Children and Youth With Special Health Care Needs
* Promoting Healthy Development
* Promoting Mental Health
* Promoting Healthy Weight
* Promoting Healthy Nutrition
* Promoting Physical Activity
* Promoting Oral Health
* Promoting Healthy Sexual Development and Sexuality
* Promoting the Healthy and Safe Use of Social Media
* Promoting Safety and Injury Prevention
The Bright Futures Guidelines provide an in-depth, state-of-the-art discussion of these themes, with evidence regarding effectiveness of health promotion interventions at specific developmental stages from birth to early adulthood. Health care professionals can use these comprehensive discussions to help families understand the context of their child's health and support their child's and family's development.
CHAPTER 3Introduction to the Bright Futures Health Supervision Visits
Unlike sick care visits, which aim to remedy a particular malady, the health supervision visit seeks many unique outcomes, often related only because these outcomes have a shared goal of the child's health. Multiple desired outcomes inevitably drive many separate interventions within the one encounter of the visit. The best way to conceptualize a single health supervision visit is not as one visit but as a visit of multiple encounters encompassing 4 objectives: disease detection, disease prevention, health promotion, and anticipatory guidance.
objectives of the Bright Futures Visit
Disease Detection: surveillance and screening
Surveillance is a continuous process in which knowledgeable professionals skillfully observe children as they provide health care. It includes eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.
Screening is a formal process that employs a standardized tool to detect a particular disease state. Universal screening is performed on all patients at certain ages. Selective screening is performed on patients for whom a risk assessment suggests concern.
Disease Detection: The Physical Examination
Bright Futures recommends that each visit includes a complete physical examination, with particular focus on certain aspects at each visit. We believe that the complete physical examination comprises "best care" for children and adolescents.
Disease Prevention
Disease prevention includes primary prevention activities applied to a whole population and secondary prevention activities aimed at patients with specific risk factors. Where evidence exists, it has been incorporated into the guidance for that encounter.
Health Promotion
Health promotion activities focus the health supervision visit on wellness. Health promotion activities shift the focus from disease to assets and strengths, on what the family does well and how health care professionals can help them do even better.
Anticipatory Guidance
Anticipatory guidance is a process in which child health care professionals anticipate emerging issues that a child and family may face and provide guidance. For anticipatory guidance to be effective, it must be timely (ie, delivered at the fef right age), appropriate to the child and family in their community, and relevant, so key recommendations are adopted by the family. This is an opportunity to broach important safety topics, help the family address relationship issues, access community services, and engage with the extended family, school, neighborhood, and faith communities.
Timing of the Bright Futures Visit
Health supervision visits usually are scheduled as a longer encounter than a sick visit. We chose 15 to 18 minutes as the target time for the face-to-face encounter of the health care professional and the patient. The overall visit will last longer for the patient because it also will include physical and developmental screenings and professional nursing time with the patient.
Employing Evidence
Satisfactory studies on preventive health issues in children are uncommon. Absent evidence does not demonstrate a lack of usefulness, however. The lack of evidence of effectiveness most often simply reflects the lack of study. This edition of the Guidelines relies on a range of sources to ensure that relevant evidence and expert opinion are incorporated into every Bright Futures Visit.
Components of the Bright Futures Visit
Context
Each visit begins with a description of children at the age of the visit, their developmental milieu, their family development, and their environment. It is intended to help the health care professional focus on the unique qualities of a child this age.
Priorities for the Visit
For the visit to be successful, the needs and agenda of the family must be addressed. Thus, the first priority is to address the concerns of the child and parents. Each visit also has 5 additional priorities. The priorities help the health care professional focus the visit on the most important topics for a child this age.
Health supervision
History
A history is taken to assess strengths, accomplish surveillance, and enhance the health care professional's understanding of the child and family and to guide their work together.
Surveillance of Development
Developmental surveillance occurs with each clinical encounter with the infant, child, and adolescent, and these observations are central to health supervision for children. Each Bright Futures Visit includes a rich discussion of developmental nuance for that age.
Review of Systems
A standard, brief review of systems is an effective method of ensuring that significant problems are addressed.
Observation of Parent-Child/Youth Interaction
Health supervision activities always involve observation of the parent-child/youth interaction. This assessment is context for the work of the visit.
Physical Examination
The physical examination must be comprehensive yet also focus on specific assessments that are appropriate to the child's or adolescent's age, developmental attainment, and needs, which are discerned from the patient history.
The health supervision examination should be unhurried, with adequate uninterrupted time set aside for questions and discussion by parents and the child. Beginning in middle childhood and by adolescence, policies related to privacy and confidentiality must be established and reviewed for the child and family. By the 7 or 8 Year Visit, it is appropriate to offer the option of part of the visit without the parent present. Most health care professionals will always excuse the parent from part of the visit by the 12 Year Visit.
Screening
Recommended screening occurs at each Bright Futures Visit. Screening tasks were chosen on the basis of available evidence or of expert opinion statements.
Immunizations
Assessing the completeness of a child's or an adolescent's immunizations is a key element of preventive health services. The value of immunizations in avoiding preventable diseases and disease complications is an important discussion for providers to have with parents. Often, parental anxiety and misinformation must be addressed. Bright Futures uses the Centers for Disease Control and Prevention National Immunization Program and the American Academy of Pediatrics Red Book for up-to-date immunization schedules.
Anticipatory Guidance
For each visit, anticipatory guidance is organized by the visit's 5 priorities and their component elements. Within each priority, the anticipatory guidance begins with a brief contextual description for the health care professional. The sample questions and anticipatory guidance points provide a possible script for discussion and help frame a relevant conversation with the family and child. Health care professionals are encouraged to adjust and enhance the questions and guidance as appropriate for their patients and community.
Prenatal Visit
Health supervision
observation of Family Dynamic
Do verbal and nonverbal behaviors and communication among family members indicate support and understanding, or differences and conflicts?
screening
Discuss purpose and importance of routine newborn screening tests performed before the baby is discharged. Inquire about any maternal prenatal testing, any abnormal findings seen on ultrasound, and/or any maternal conditions that may affect the developing fetus or newborn.
immunizations
Discuss importance of initiating routine immunizations.
Anticipatory Guidance
The first priority is to attend to the concerns of the parents. In addition, the Bright Futures Infancy Expert Panel has given priority to the following topics for discussion in this visit:
social determinants of health: Risks (living situation and food security, environmental risks, pregnancy adjustment, intimate partner violence, maternal drug and alcohol use, maternal tobacco use), strengths and protective factors (becoming well informed, family constellation and cultural traditions)
* Community agencies can help you with concerns about your living situation. Tell me about your living situation. What are your resources for caring for the baby?
* Check home for mold, lead.
* Programs like WIC and SNAP are available to help you if you have concerns about your food situation.
Within the past 12 months, were you ever worried whether your food would run out before you got money to buy more? Within the past 12 months, did the food you bought not last and you did not have money to get more?
* Eating nonfood substances can harm you and your baby.
* Take advantage of support from family and friends and community groups.
How have you been feeling physically and emotionally? How does your partner feel about your pregnancy?
* Ask for help if you are concerned about or have experienced violence from your partner or another significant person in your life.
Do you always feel safe in your home? Has your partner ever hit, kicked, shoved, or physically hurt you? Would you like information on where to go or who to contact if you ever need help?
* You can also call the National Domestic Violence Hotline toll-free at 800-799-SAFE (7233).
* Don't use alcohol/drugs/tobacco/e-cigarettes. Call 800-QUIT-NOW (800-784-8669) for help to quit smoking.
Parent and family health and well-being: Mental health (perinatal or chronic depression), diet and physical activity, prenatal care, complementary and alternative medicine
* Become well-informed, using trusted sources.
* Support your other children to help them get used to baby.
* Maintain your health (medical appointments, sleep, physical activity, healthy diet with appropriate weight gain).
* It is common for women during and after pregnancy to feel down, depressed. It is important to address these feelings to ensure your health and your baby's. I can help with treatment options. Over the past 2 weeks, have you ever felt down, depressed, or hopeless? Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Newborn care: Introduction to the practice as a medical home, circumcision, newborn health risks (handwashing, outings)
* Let me tell you about our practice.
* Circumcision has potential benefits and risks. Let's discuss what's best for baby.
* Wash hands frequently (diaper changes, feeding).
* Limit baby's exposure to others.
Nutrition and feeding: Breastfeeding guidance, prescription or nonprescription medications or drugs, family support of breastfeeding, formula-feeding guidance, financial resources for infant feeding
* Choose breastfeeding if possible; use iron-fortified formula if formula feeding. What are your plans for feeding your baby?
* Contact WIC/community resources if needed. Are you concerned about having enough money to buy food or infant formula? Would you be interested in resources that can help you care for you and your baby?
* Tell me about supplement/over-the-counter medication use.
Safety: Car safety seats, heatstroke prevention, safe sleep, pets, firearm safety, safe home environment
* Use seat belt.
* Correctly install rear-facing car safety seat in backseat.
* Prevent heatstroke; never leave your baby alone in a car.
* Put baby to sleep on back; choose crib with slats less than 2%" apart; have baby sleep in your room in own crib.
* Learn about pet risks.
Do you have pets at home? If you have cats, have you been tested for toxoplasmosis antibodies?
* Remove firearms from home; if firearm necessary, store unloaded and locked, with ammunition separate; if firearms in other homes where child plays, ensure same safety precautions are used before letting child play there.
Do you keep firearms at home? Are there firearms in homes you visit (grandparents, relatives, friends)?
* Set home water temperature less than 120°F; install smoke detectors, carbon monoxide detector/alarm.
Newborn Visit
Health supervision
* surveillance of Development
- social Language and self-help
- Has periods of wakefulness; looks at and studies parent when awake; looks in parent's eyes when being held
- Calms when picked up; responds differently to soothing touch and alerting touch
* Verbal language (Expressive and Receptive)
- Communicates discomfort through crying and behaviors such as facial expressions, body movements, movement of arms and legs
- Moves or calms to parent's voice
* Gross Motor
- Moves in response to visual or auditory stimuli
- Reflexively moves arms and legs, observed in the Moro and tonic neck reflexes
* Fine Motor
- Keeps hands in fist; automatically grasps others' fingers or objects
Observation of Parent-Newborn Interaction
Who asks/who responds to questions? Do the verbal/nonverb al b ehaviors/communication between family members indicate support, understanding, differences of opinion/conflicts? Do parents recognize and respond to baby's needs? Are they comfortable when feeding/holding/ caring for baby? Do they have visitors, other signs of support network?
(Continues...)
Excerpted from Bright Futures fourth Edition Pocket Guide by Joseph F. Hagan Jr, Judith S. Shaw, Paula M. Duncan. Copyright © 2017 American Academy of Pediatrics. Excerpted by permission of American Academy of Pediatrics.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Contents Bright Futures at the American Academy of Pediatrics How to Use This Guide Supporting Families Successfully Bright Futures Health Promotion Themes Bright Futures Health Supervision Visits Introduction to the Bright Futures Health Supervision Visits Prenatal Visit Newborn Visit First Week Visit (3 to 5 Days) 1 Month Visit 2 Month Visit 4 Month Visit 6 Month Visit 9 Month Visit 12 Month Visit 15 Month Visit 18 Month Visit 2 Year Visit 2 1/2 Year Visit 3 Year Visit 4 Year Visit 5 and 6 Year Visits 7 and 8 Year Visits 9 and 10 Year Visits Early Adolescence Visits (11 Through 14 Year Visits) Middle Adolescence Visits (15 Through 17 Year Visits) Late Adolescence Visits (18 Through 21 Year Visits) Appendixes List of Abbreviations Developmental Milestones for Developmental Surveillance at Preventive Care Visits Social and Emotional Development in Middle Childhood Domains of Adolescent Development Tooth Eruption Chart Sexual Maturity RatingsRelated Subjects
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