Developmental Red Flags in Infants
A mother brings in her 16-month-old, Brittany, for treatment of an acute illness. During the history, the mother reports that her mother-in-law is concerned about the toddler’s development. Further questioning reveals the following:
•Brittany was a term infant born vaginally with no intrapartum complications. Birth weight was 8 pounds 1 ounce and current weight is 26 pounds 9 ounces
•She was breastfed until 12 months of age and now drinks 24 ounces of whole milk and eats table foods daily.
•Physical milestones are as follows: Rolled front to back at 6 months, developed pincer grasp at 11 months, crawled at 8 months, and began cruising at 10 months. She does not walk independently.
•Social development includes mimicking adult behavior, four-word vocabulary (mama, dada, baba, and no), follows one-step commands, and quiets easily when comforted.
To prepare:
•Review this week’s media presentations, as well as “Developmental Management of Infants” and “Developmental Management of Toddlers and Preschoolers” in the Burns et al. text.
•Think about how physical, social, and cognitive development vary during infancy, toddlerhood, and the preschool years. Reflect on normal versus abnormal growth and development and consider the decision-making process of identifying and managing red flags of abnormal development.
•Select one of the three case studies provided. Reflect on the patient information included in the case study and consider any developmental red flags.
•Reflect on standardized screening tools, clinical guidelines, and management strategies that would be used to assess and manage the patient in your selected case study.
Post 2 discussion page paper on :An explanation of any developmental red flags that presented in the case study you selected based on the stages of normal physical, social, and cognitive development for infants, toddlers, and preschoolers. Explain how you differentiated between normal and abnormal growth and development for this patient and identify which standardized screening tools, clinical guidelines, and management strategies you might use to assess and manage this patient and why
REFERENCES
Readings
• Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
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◦ Chapter 5, “Developmental Management of Infants” (pp. 59–75).
◦ Chapter 6, “Developmental Management of Toddlers and Preschoolers” (pp. 76–91
◦ Chapter 11, “Breastfeeding” (pp. 186-201)
Chapter 17, “Role Relationships” (pp. 334–344)
Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics
Infancy” (pp. 253–380)
◦“Early Childhood” (pp. 381–461)
Media
•Laureate Education (Producer). (2013c). Strategies for determining red flags. Retrieved from https://class.waldenu.edu
Developmental changes in the second through fifth years of life are subtler than those seen in the first year, yet they are highly significant. Children enter toddlerhood as babies, dependent on parents and caregivers for their survival and leave as accomplished children with elaborate and sophisticated skills. Ready to enter the social world of school and community, 5-year-olds have a sense of self that shapes the quality of their character as older children, adolescents, and adults. Children begin this change process by refining abilities acquired in the first year, learning, for example, to walk smoothly with control and speed, to run and climb, and to combine words into phrases and sentences. They add to their repertoire of skills, growing stronger, bigger, and more socially, emotionally, and intellectually capable. This chapter reviews some of the many changes that occur for toddlers (usually defined as a child 12 to 24 months old) and preschoolers (a child 2 to 5 years old), and describes the primary health care provider’s role when working with these children and their families.
Physical and physiologic changes in toddlers and preschoolers continue at a much slower pace than in the first year of life. Statistically, children gain weight faster and earlier than children in earlier decades (Trifiletti et al, 2006); however, growth charts continue to show the average 2-year-old weighs 26 to 28 pounds (12.5 to 13.5 kg), with boys being slightly heavier than girls, and is 34 to 35 inches (85 to 90 cm) tall. Head circumference in the average 2-year-old is 19 to 19.5 inches (48 to 50 cm). Although most toddlers have no palpable fontanelles by 12 months, the anterior fontanelle should completely close by 18 to 19 months. During the fourth and fifth years, skeletal growth continues as additional ossification centers appear in the wrist and ankle and additional epiphyses develop in some of the long bones. For the 4- to 5-year-old, the legs grow faster than the head, trunk, or upper extremities.
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