PowerPoint Template

Health Promotion of the School Aged ChildPresented by: Jaime Callaghan (Family Nurse Practitioner student), Samantha Moyer (Physical Therapist student), and Sandra Bragg (Counselor student) OverviewThe goals of health maintenance in school-aged children are to promote health, detect any presence of disease, and to prevent adverse health problems or injuries in the future.The Nurse Practitioner Role Performs periodically scheduled well visit checks to assess mental and physical development.

Ensures immunizations are up to date.

Provides counseling and guidance to parents and children in areas of physical, behavioral, and emotional development.

Ensures the safety of the school-aged child and contacts proper authorities in cases of abuse or violence.

Reviews the daily habits of this age group such as: nutritional intake, quality of physical activity, time spent watching TV, sleeping habits, and difficulties at school.

Parts of a school aged well visit

Screening and secondary prevention tests Hearing testVision testLead poisoning blood level for recent immigrants, foreign adoptees, and refugee children between 6 months and 16 years old. Dental routinely done every six months Tuberculosis screening for high risk childrenLipid assessment routinely at 2,4,6,8, and 10 years of age or if risk factors indicate additional testing X-rays for suspicion of injury or voiced concern by parent

CDC Recommended Vaccine Schedule

How is the media effecting children?If screen time is controlled by responsible parents or caregivers then children can be enhanced cognitively and socially. If watching or engaging in screen time together the experience can even bond interpersonal relationships.

Negative physical effects: promotes sedentary lifestyle, decreases imaginative play, encourages the use of unhealthy products such as beer from stimulating commercials, arouses aggressive impulsesNegative cognitive effects: interferes with ability to creatively think, promotes short attention spans, teaches stereotypes of men and women, stimulates consumerismNegative behavioral effects: keeps child occupied if parents or babysitter is avoiding responsibility, promotes social isolation, competes with forming interpersonal relationships with othersNegative emotional effects: reduces interest in school or home activities, can increase fear or anxiety, promotes passive aggressive acceptance of violent behaviorNegative moral effects: confuses values and value system, fosters attitude of dominance of others, emphasizes sexuality and instant gratification.

Incidence of Childhood ObesityAbout 12.5 million children and adolescents aged 2-19 are obese1 in 3 children are overweight or obesePrevalence of childhood obesity has tripled since 1980Obese children have 70% chance of remaining obese in adult years

Overweight is defined as having a body mass index at or above the 85th percentile but lower than the 95th percentile for children of the same age and sexObesity is defined as a having a BMI at or above the 95th percentile for children of the same age and sexConsequences of Childhood ObesityHealth Risks NowHigh blood pressure and high cholesterol Impaired glucose tolerance, insulin resistance, type 2 diabetesBreathing problemsJoint and musculoskeletal problemsFatty liver disease, gallstones and GERDSocial and psychological issuesFuture Health RisksAdulthood obesity associated with heart disease, diabetes, and some cancers

HTN and hyperlipidemia are risk factors for CVDBreathing problems include sleep apnea and asthmaChildhood bullying and self-esteem issues

Role of the Physical TherapistAble to relief pain and help children resume daily activitiesCan teach children exercises designed to help them regain strength and range of motion. Can be beneficial to helping improve daily activity in the following children: those with sports injuries, developmental delays, head injuries, muscle disease, cardiac disease, those suffering from acute trauma, and many more.

Physical Activity GuidelinesChildren should engage in at least 60 minutes of physical activity daily Aerobic activity - majority of timeEither moderate or vigorous intensityMuscle strengthening - at least 3 days/week Gymnastics, tree climbingBone strengthening - at least 3 days/weekRunning, Jump rope

Benefits of Physical ActivityWeight controlReduces the risk of cardiovascular disease, type 2 Diabetes, some cancersStrengthens bones and musclesImproves mental health and moodCan increase life expectancy

Increasing Activity LevelsEncourage an active lifestyle through leading by exampleMake physical activity part of the family's daily routineFamily walks or playing games togetherGive children equipment that encourages physical activity.Take children to public parks, community fields or courtsPositive attitudes Make physical activity fun Team sports, running, skating, bicycling, swimming, playground activities or free-time playLimit television time. Encourage children to find fun activities to do by themselves, with friends or familyBike riding, sports

Healthy Children Initiatives

Ethnic Considerations For some cultures respect for your elders is ingrained into the adolescent thought processSome cultures have strong influences over the direction a school aged child takes their life. Be careful in addressing the child specifically without taking culture into consideration..this might be seen as a sign of disrespect if the head of the household is not the one properly addressed.

Does this child need a referral?Dental- Any dental abnormality such as caries, gingivitis, or need for orthodontic care. Parents should be encouraged to take their child to the dentist every six months Physical therapy- Any injury whether it be sports related or not. Chronic illnesses such as cystic fibrosis or cerebral palsy may benefit from a physical therapy referral.Counseling- Economic issues at home, students at risk for dropping out of school, disruptive interpersonal relationships at home or in the community.Psychiatric- suicidal or homicidal tendencies expressed by patient, mental disturbances outside the scope of therapeutic counseling with trained professionals. Nutritionist- If body mass index falls outside of normal limitations for age, lack of dietary knowledge, abnormal lipid panel.

Role of the Counselor Gains insight and knowledge to make valuable contributions to the school aged childs treatment. Provides support and positive role modeling.Supervises and structures interpersonal relationships Actively participates in group and individual meetings.

Mental Health Issues Involving the SchoolchildThere are many mental health issues that affect hundreds of thousands of school-age children every yearAccording to the DSM-IV-TR some common disorders onset during childhood are often not diagnosed until adulthoodCommon mental illnesses seen in childhoodAnxiety disordersADD/ADHDAutism spectrum disordersBipolar disorderDepression Eating disordersSchizophrenia

Startling Statistics: Children and Adolescents5% to 9 % of children in the US have a serious emotional disturbanceOnly 21 % of children in the US who need mental health services actually receive servicesApproximately 13% of children ages 9-17 have an anxiety disorder About 4% of school-aged children have Attention Deficit Hyperactivity Disorder Almost 4% of boys and 6% of girls have symptoms of Post-Traumatic Stress Disorder caused violence they have witnessed or endured

2 out of 3 boys and 3 out of 4 girls in juvenile detention centers have a psychiatric disorder Students who have been bullied are 50% more likely to bring weapons to school campuses A young person commits suicide about every 2 hours3 million teens have considered or attempted suicide in the past yearSuicide is the 3rd leading cause of death of the under 24 population only after accidents and homicides

Screening and Assessment ToolsThere are many screening and assessment tools used by mental health professionals Child and Adolescent Functional Assessment Scale (CAFAS) ages 5-19Childrens Depression Inventory-2 (CDI-2) ages 7-17 Reynolds Child Depression Scale 2 (RCDS-2) ages 7-13Millon Clinical Multiaxial Inventory, 3rd Edition (MCMI-III) Minnesota Multiphasic Personality Inventory, 2nd Edition (MMPI-A: ages 14-18MACI (ages 13-19)The Achenbach Child Behavior Checklist (CBCL)One test: ages 2-3One test: ages 4-18

Childrens Depression Inventory 2nd editionhttp://downloads.mhs.com/masc/MASC2_US_InfoSheet.pdf

When to assess for mental, emotional or behavioral issues Problem behaviors in a variety of settings Home, School, Peers, DaycareChanges in appetite and/or sleep patternsSocial withdrawal, or new fearful behaviors Returning to previous younger child behaviors for an extended period of time:bedwetting, thumb sucking Sadness and/or tearfulnessSelf-destructive behaviorsHead banging, getting hurt oftenIncreased or repeated thoughts of death

Standard Diagnosing and ReferralsPrimary Care Physician

Carefully observes signs and symptomsTake history of the problem History of childs developmentPhysical/Emotional traumaNatural disastersIncreased stress BirthsDeathsReports from family, caretakers, teachers

Specialists

Mental Health ProfessionalsPsychiatristsPsychologistsSocial workersMental health workersHMOsCommunity Mental Health Hospital psychiatric and outpatient centers University/school mental health programsState hospitals/outpatient clinicsFamily services, social agencies, clergyPeer supportsPrivate clinics and facilitiesLocal medical/psychiatric facilities

Screening History QuestionsPhysical Therapy Aspect

How is their dietary intake?Are they physically active?60 minutes of moderate to vigorous activity dailyWhat is their living situation?Two parents, single parent, divorced..How much time do they spend in front of the TV?Limit to 1-2 hours dailyHow much sleep do they get each night?Ideal is 11 hours a nightWhat is their dental hygiene like?Should brush 2 times a day with a pea-sized amount of toothpasteHave they had any unintentional injuries?Are they protecting their skin?

Nursing Aspect

Do you see a primary care provider for well visits annually?Are all of your immunizations currently up to date?How often do you brush your teeth and go to see the dentist?How many hours of sleep do you get on average? (Should receive 8-12 hours a night)Have you had any recent injuries? Are these injuries sports related?Do you wear a seatbelt every time you are in the car?Do you know what to do in case of an emergency?Do you have a medical condition that warrants a medical ID bracelet?

Screening Tool (cont.)Nursing Aspect cont.

Do you have any concerns, needs or priorities at home or school that are not being met?For special needs children- are you able to perform self-care as you would like?How do you feel about yourself and the way that you look?How do you feel about school and your performance? Do you ever feel like you are depressed or want to hurt yourself or others?

Counseling Aspect

Do you feel safe at home?Is there anything that makes you afraid? Do you ever have nightmares?Who do you usually talk to whenever you are upset?What are some hobbies that you like to do?Who are your close friends? Have you ever tried smoking, drinking or using drugs? Do your friends ask you to try these things?How much time do you spend watching TV or other electronic devices?Do you like school? What are your favorite classes, teachers, etc.Have you ever felt like you were being bullied at school? How do you feel about the way you look? Do you ever feel like hurting yourself or others?

Screening Tool (cont.)Physical Assessment

Height, weight, basic vital signs, body mass, blood pressure, vision acuity, hearing acuity, heart rate and rhythm, Tanner stage assessment of physical development, mental status and overall general description of the body. Review body systems of the skin, head, eyes, nose, throat, respiratory system, cardiovascular system, gastrointestinal system, genitourinary system, any skeletal abnormalities, neurological system, and lymphatic system.

Tests Hearing testVision testLead poisoning blood level for recent immigrants, foreign adoptees, and refugee children between 6 months and 16 years old. Dental routinely done every six months Tuberculosis screening for high risk childrenLipid assessment routinely at 2,4,6,8, and 10 years of age or if risk factors indicate additional testing X-rays for suspicion of injury or voiced concern by parent

Referral Process (Refer to individual slides on this process)

References Anderson, D., Keith, J, Novak, P. & Elliot, M. (2002). Mosbys Medical, Nursing

& Allied Health Dictionary (6th ed.). St. Louis, Missouri: Mosby.

Center for Disease Control and prevention (2013).

Recommended Immunizations for Preteens and Teens (7-18 years).

Retrieved from www.cdc.gov/vaccines/schedules

Collins-bride, G. & Saxe, J. (2013). Clinical guidelines for

advanced practice nursing (2nd ed.). Burlington, MA:

Jones & Bartlett Learning.

Murray, R., Zentner, J., & Yakimo, R. (2009). Health Promotion Strategies Through the Life Span (8th ed.).

Upper Saddle River, NJ: Pearson Education, Inc.

References (cont.)Moses, Scott. Pediatric Health Maintenance. Family Practice Notebook. http://www.fpnotebook.com/Prevent/HME/PdtrcHthMntnc.htm. Published February 8, 2013. Accessed February 11, 2013Basics About Childhood Obesity. Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/childhood/basics.html. April 27, 2010. Accessed February 7, 2013.Data and Statistics. Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/data/childhood.html. January 11, 2013. Accessed February 7, 2013. How much physical activity do children need? Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html. November 9, 2011. Accessed February 7, 2013. Physical Activity and Health. Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/health/index.html. February 16, 2011. Accessed February 7, 2013. Making Physical Activity a Part of a Child's Life. Centers for Disease Control and Prevention. http://www.cdc.gov/physicalactivity/everyone/getactive/children.html. November 9, 2011. Accessed February 7, 2013.Overweight Children in America Childhood Obesity Statistics. Your Health Community. http://obesity.ygoy.com/overweight-chidren-in-america-childhood-obesity-statistics/. Accessed February 11, 2013.References (cont.)American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, Washington, DC, American Psychiatric Association, 2000.

National Institute for Mental Health, retrieved from the world wide web, February 10, 2013: http://www.nimh.nih.gov/health/publications/treatment-of-children-with-mental-illness-fact-sheet/index.shtml