WHAT DO WE KNOW ABOUT JUSTIN'S LIFE? CRISES, SITUATIONAL AND DEVELOPMENTAL

1. WHAT DO WE KNOW ABOUT JUSTIN'S LIFE? CRISES, SITUATIONAL AND DEVELOPMENTAL • Justin's Life- child of separated parents , • Can not verbalize but may think - Did I do something Bad? • primary caregiver -Single parent mother has mood disruption ( alone , depressed) • breast feeding , now being weaned - intestinal upset, cramps, diarrhea, vomiting, • Nutritional /digestive problems , allergy , intolerance • going to daycare • potential sibling rivalry with step sisters • Lisa supportive and nurturing • constantly moving back and forth to father's place • separation anxiety ? • schedule disrupted • may have been a witness to violence, negligence, anger , • sleeps little, • Language 10 words • plays with "large " toys- same ones • demanding yet ignores adults • little or no eye contact • mobile, gets around -walking on tip toes, • ignores adults, • has favourite toys, 

2. Would you consider Justin to be the oldest child in the family ? • What implications will this have for Lisa and Jack as well as the twins? • As an older brother, what will the expectations be for Justin ? ( p. 77-81 ) • Will JUSTIN have a adaptive crisis ? Not sure? Can not speculate. but can gather information and • compare with the likelihood & look for indicators of crises- potential or current. • Linked to the growth and developmental norms of children of the similar age and health status, relationships and family wellness/ adaptation .

3. The Goals of Parenting are: • TO PROMOTE SURVIVAL AND HEALTH OF THE CHILD - • TO ASSURE SURVIVAL. • TO FOSTER SKILLS AND BEHAVIOURAL CAPABILITIES ESSENTIAL FOR SOCIAL INTEGRATION, PERSONAL MAINTENANCE, AND ECONOMIC SELF -SUFFICIENCY . • TO MAXIMIZE CULTURAL VALUES AND BELIEFS AS WELL AS PRACTICES. • Parents may need support and education with parenting responsibilities, roles, tasks, skills. • Some Parents may be warm, or hostile, permissiveor restrictive, authoritarian or permissive, or authoritative. ( p. 83-100 )

4. A CHILD PROTECTION PLAN is Specific for AGE and for 6 months ahead - Anticipatory Guidance • Sometimes there is a court intervention that prescribes a child/ parent contact plan- visits under supervision. • Children's Aid , Community and Social Services • P. 74 PYRAMID OF SERVICES • p. 92-100 special parenting situations- divorce, step-parenting, adoption, fostering • Do we see any actual; sign of the impact of domestic violence on the members of this family ? • p. 75 COMMUNITY FOCUS QUESTIONS . • A CHILD PROTECTION / WELLNESS PROMOTION PLAN • CHILD AGE DEVELOPMENTAL MILESTONES/ CRISES GUIDANCE & INTERVENTION • Aurora 2 mo + 6 months >> 8 mo. old for 8 mo. old • & • Divinity • Justin 18 mo +6 mo >> 24 mo . old for 24 mo. old

5. LOOK AT THE DEVELOPMENTAL TABLES TO SEE WHAT THE CURRENT AND FUTURE MILESTONES ARE AND THE LEARNING NEEDS OF PARENTS . • p. 503 - Table 12.1 , • p. 508 - Table 12.2 , • p. 510-515 - Table 12.3 , • p. 526 ,Table 12.5, • p. 524 , Family Home CARE plan , • p. 519, Figure 12-14 Dental eruption & number • P. 542-543 Table 12-15 Safety + p. 549 and p.550 Family Home Care • Include MD. , NP , PHN , well baby visits , parents groups, fathering and mothering groups, • Telehealth Ontario 1-866-797-0000 • Early Years • Invest in Kids

6. CHILDREN ADAPTING TO PARENTAL DIVORCE OR SEPARATION - ( p. 94-98) • Stressors - lack of parenting, intimacy, contact, touch, consistency, same schedule, home, place, food, • Careprovider may be a stranger, cyclic contact, have many different approaches to discipline, sleeping patterns, emotional patience, playfulness, comforting. • *Adults need to keep promises, not use children as pawns or spys, • *Careproviders must reinforce the value of the child's worth and loveability, • *Assure the child not the fault of the child, not a punishment to the child. • * Others can keep the child linked to their other family members- grandparents = roots . • * Encourage child's growth. development , Do no harm . • * Seek help with eating, sleeping, elimination , & learning if deficits/ changes assessed. • * Provide $ and support services, contact with the child as courts designate. • * Reduce fear and panic about the child's place tolive, food, safety. • * Do not threaten to leave the child {with someone }- if they don't behave. • *Watch for regression and DO NOT belittle , or make fun of the child- seek support from the specialists. • * Separation Anxiety & lack of Trust can be seen in behaviour and personality changes - • seek supportive resources. • * Talk in simple words, , use play, puppets, painting to express and learn about feelings. • * Give only REAL choices.and follow through. • * Do not blame other partner or state that the child is a bad reminder of the absent partner.

7. CRYING - The Language of the Preverbal child! • Different cries for different reasons • Sleepy cry accompanied by yawns or eye rubbing or droopy head • Fear cry - Little inhalation, turn red-flushed, eyes wide, withdraw/ move away- body part or whole body • Frustration - throw things, hands and arms shake, • Loneliness- Prolonged exhalation, different tonation- whail - • Separation Anxiety - Stranger Anxiety - Turn away collapse into the bed or into a ball posture - smile at the familiar person , look for & reach out to known person/parent • Bored - Whine , up and down • Cramps- Draw legs up , kick, tears • Pain, intermittent full gutteral deep breaths after an initial inhalation- sounds throughout the loud sound • At the end of their rope! - Scream , turn deep red colour, take awhile to console when picked up. • Hunger - stop when food presented . Make sure not to aspirate • Cries may reflect the TEMPERAMENT of the child. - p. 507-511 . Some children are "slow to warm " and may cry before anything new is done, tried, or any change is made.

8. Many Settle when picked up, swaddled, rocked, sung to in low sounds, SHHHHH's ,AHHHH, SHHHH, POOR POOR LITTLE ONE , • Adults need to attend to the BABY when they cry. • Myths of spoiled child p. 515-516 . Many overwhelmed adults mistake the interactive behaviours and communication of infants as demands- and are not aware of how much a child needs help. The expectaions of care are underestimated and therefore the child is seen as overdemanding, self-centred and egocentric = spoiled - A spoiled child has no limits set. or may not understand them Adults perceive that the infant/toddler is always just thinking of themselves and become frustrated and angry . Violence and abuse may result. • Attending to the child's cry DOES need toreinforce positive interaction, self validity & Security, & teach a child something- encourage self-sufficiency, " patience"- waiting- consistent limits /outcomes.

9. IMMUNIZATION : - Particular to countries, provinces . • Needed for Ontario School Entrance & Attendance • Must be recorded in an immunization record • Travel may require proof • There are medical precautions- allergies , eggs, horse serum, Neosporin, Thimerasol, • Immunodeficiency , on Steroids, In a pyrexic condition - not related to a cold . • Selected Neurological syndromes. • Refusal - Religious conviction, Immigrant families, Non-believers , fear, myths. • *** CBC Tuesday January 20 , ? time - The Case Against Immunization

10. CARE p. 527-541 • Must be kept in proper refrigeration till used. • Check expiry date -do not give if overdue. • Requirements may change from time to time to meet emerging health crises( flu ) ( varicella) • Know Ontario Schedule. • Start with DPT Dipthereia, Perertussis , and Tetanus 2,4,6 months • Polio added at 6 months • Hib = Haemophilus influenzae type b • Pneumoccal Vaccine may be given as early as 2 months (if at risk) to 23 months • Measles, Mumps and Rubella - MMR- 12 months • Hepatitis B. may be given if mother has the antigen • Hepatitis A and Menigoccal vacines are available for older children • Give the right amount in the right way - Deep IM , SQ., po .

11. ATRAUMATIC CARE-p. 534 • Explain and describe procedures and reasons . Take allergy history . • Sign consent if needed • Set up record, And continue to add with each injection • teach post care symptoms and when to seek assistance • Vastus Lateralis , ventrogluteal NOT DELTOID till 18-24 mo . • use of airbubble to clear needle is practiced but not theoretically proven to be effective • EMLA cream to injection site at least 1 hour before injection- topical anesthetic • or topical coolant spray prior to injection • Have distraction ready - do not let the child see the needle • praise for helpfulness • acetaminophen 1 hr.ac po and as ordered after injection for 24 hours will help  prevent undue pyrexic reactions and discomfort .

12. AUTISM - p. 1008-1010 • has been reported to have links with immunization . There is ongoing research into Thimerasol as a preservative agent that some children can be sensitive to and result in meningitis & subsequent behavioural and learning disabilities/variations. • Hereditary elements are more likely to have a causative influence, but there are many syndromes that can be associated with altered social interaction , language , communnication, play , repetitive patterns , and sensory interpretation, learning , adjustment to changes, and behavioural control. • Some other causes may be related to maternal drugs prenatals, O2 deficit, Toxins, PCB's, Lead, Lack of SECRETIN, chromosomal anomalies, - can also be called Asperger's Syndrome ,

13. CARDINAL SIGNS _ No eye contact, |No babbling and gesturing of needs /language by 16 months, sudden loss of verbal gains and expressive speech, limited interactional functional play, self abusive or self stimulating / repetitive behaviours • CARE - Each child is unique MAny are in the 95th percentile, very strong, may not sleep have gait alterations( tip toes) - • NEED Less stimuli , Quiet room, private apace , supervision by a known person, keep routines the same, offer favourite activity as reward for doing another thing, singing can help child listen and understand, minimal physical contact and eye contact, introduce change slowly, communication at child's level, support family, not a parenting deficit, many feel guilty , help them understand with research data and links with specialists, Join societies and learn what resources are available early to intervene .

14. Early REFERRAL AND Intervention can prevent lost potential and foster maintenance of learning , social contact, behavioural interaction, management of change and care - developmental milestones can be assessed and resources applied to foster enrichment and remediation resources. Costs of care can be extraordinary . " Family stress is huge!" • Local assistance / resources. • Regional Children's Centre, • Psychology department at the University of WIndsor, • THE SUMMIT PROGRAMME helps families with special education focused activities / school. • The Autism Society of Windsor and Essex County . • No Cure - • May move into a group home with other Autistic persons- Need to watch for the safety of others in the household- younger siblings- • May need to move into the group home if families are injured- or if temper outbursts create damage to the environment . Some children "move out " when young and the children grow into their own "family"unit - little change, but each person has their host of care providers to maintain their routine and assure safety, comfort, rewards, achievements, learning, growth and developmental achievement. • If children reside i their biological family, Respite is important for others .

15. NANDANutritional deficit / imbalance - less than body requirements for Iron = anemia Due to : altered eating patterns, less than required intake , Poor quality of nutrients, food intolerances, digestive functional anomalies, hereditary syndromes altering metabolism ( ie: enzyme deficit -Lactose)neglect, Allergy to proteins, casein, gluten .Exhibited by: weight fluctuations, gains, losses over time. Relate to intake, hunger gastric distress, flatulence, cramps, regurgitation, GER, vomiting,stools - consistency, number ,shape, odour, colour, strain , bowel soundsdoes the stool sink or float ? Skin condition in perineum. Anus Sphincter anomalies - GER ( cardiac sphincter too lax ), Pyloric Stenosis (duodenal sphincter too thick, tight , hypertrophy)

16. GER – Spit up , regurgitate when head low, danger of aspiration and reduced intake Need to feed upright 60-90' angle, thicken formula bed position head high on blocks use sling to support right side or sitter chair avoid gas-producing foods - either breast feeding, or formula , feed last , after all care such as bath is done, keep air out of nipple and bottle, avoid sucking air bubble and burp well before and after feeds may need H+ blocker to prevent gastric ulcer, antispasmodics don't overfeed or force to finish formula watch for taught abdomen - prevent crying , anticipate needs skin care at neck and chin , buttocks

17. PYLORIC STENOSIS - Hypertrophy of Duodenal Sphincter - mostly males, Projectile emesis , Olive shaped mass in upper right quadrant can see reverse peristalsis,palpable hardened mass in URQ may try antispasmodics po , altered feeding routines, metabolic imbalances, usually require surgery- Fredt Rhamstedt Procedure also called a Pylorotomy ( incise the internal diameter of sphincter )Post operative recovery moves from NPO to graduated sips, clear to half strength and then full strength formula while patient on IV fluids . As long as fluids tolerated and retained ( x4) , amount is increased to next stageSterile dressing , Daily weight, I & O , watch urine concentration, stooling , Vitals , O2 sats ,tempobservation for pain - analgesic PRN , prevent crying , strain, & gulping air

18. COLIC Sudden , frequent ,spasmodic abdominal cramping related to feeding usually after 2 months of age, first borns, abdominal muscles become taught- tight - cramps, pain, unable to Crying is plaintive, annoying, fatiguing for the adult. Nothing will settle baby. Some change formula or what eating if breast feeding to reduce gas and spasms Baby massage, Yoga exercises, tummy rock, patting back , Play Mozart and heartbeat sounds on tape /CD White noise- dryer or vacuum sounds from motors, car ride, May need to change soother, feed a little sooner to avoid empty stomach, Swaddle, quiet room darkness, rocker, cap and socks. GREAT POTENTIAL FOR FAMILY UPSET- VIOLENCE - Not a bad parent- POST PARTUM DEPRESSION - Need ongoing family support, respite overnight relief Time limited condition - it will end ! May have antispasmodic gtts ac meals. Gripe water not the best as it contains alcohol www.vh.org/Providers/ClinRef/FPHandbook/Chapter10/14-10html