Health Assessment Tools

1. Health Assessment Tools

2. Health Assessment Tools • Purpose of Health Assessment Tools is to protect and improve children’s health. • The data collected through the use of health assessment tools provides: • 1) the best information for promotion of health • 2) early detection • 3) the opportunity to adjust programs to meet individual needs

3. Health Records • A permanent Health Record should contain: • A child /family health history • Physical and dental exams • Immunization records • Emergency Contact information • Attendance Records • Accident or injury reports • Parent conference notes on health issues • Test results from hearing, speech or vision screenings • Developmental records • Medication administered

4. Health Records • Why do we keep this information on Children? • To determine health • To Identify Problems • To develop intervention strategies • To Evaluate the success of treatments • To coordinate services • To make referrals • To follow a child’s progress

5. Confidentiality • Health records are confidential. • This means that we never release any health information or records without parental permission in writing. • Not to a school • Not to a doctor • Not to another agency • When parents give permission in writing, to release certain information, the center needs to keep a copy.

6. Health Histories • Health histories are usually include: • Information on the birth • Family circumstances • Major developmental milestones • Previous injuries or illnesses • Personal habits – sleeping, eating and toileting • Parent concerns – behaviors, language, social skills etc. • Special health conditions – allergies, asthma, epilepsy, diabetes etc.

7. Medical Exams • Children less than 1 yr of age should have a check up every 2-3 months • Children 2-3 years of age should have an exam every 6 months • Children 4 yrs. of age and older should have annual check-ups • Development and growth assessed at these visits, immunizations are updated, head size is measured in the early years and all body parts and systems are checked.

8. Screening Procedures • Height and weight screenings are important to assess whether or not growth is proceeding normally. • Height measurements are especially important because they provide a reliable means of evaluating a child’s long-term health and nutritional status. • Teachers can do take measurements and chart it without any special training if they can understand and use a graphing chart. • Examples of growth charts are in the appendix of the text. Try charting a child!

9. Height and Weight Screenings • Caregivers can also do simple charts tracking the growth of children in the class. • This can be done as a group math and science activity to teach body and health awareness as well as teaching the concepts of measurement and bigger and smaller and more or less. • Height and weight measurements should be done every 6 months.

10. Sensory Development • Senses affect the total development of the child. • Vision, hearing , smell, touch and taste. • These senses are needed to interact with the world or the environment and to learn. • Piaget calls the first stage of cognitive development the sensorimotor stage because children learn through their senses and through use of their muscles and movement.

11. Vision Screenings • 20% of children entering kindergarten have undetected vision problems that may interfere with learning • Vision Screenings should be done at 3, 6 and 12 months and yearly thereafter. • Children should also be seen by an ophthalmologist or an optometrist before starting school.

12. Vision Screenings • Parents are often the first to suspect problems. • Often when children enter school and there are greater demands to do things accurately, we see the first problems appear. • Many visually impaired children are labeled slow learners or developmentally delayed. • Children who have never seen well won’t know to tell you that they cannot see properly.

13. Signs of Visual Problems • Some of the signs to look for that children might be having vision problems include: • Rubbing eyes • Attempts to brush away blurs • Irritable or inattentive with close work • Strains to see distant objects • Inattentive to distant tasks • Squints • Blinks often when reading • Quits quickly • Closes or covers an eye to see more clearly • Tilts head to one side • Appears cross-eyed at times

14. Signs of Visual Problems cont. • Reverses letters or words • Stumbles over objects • Runs into things • Complains of headaches or double vision • In infants look for: • Roving, jerky or fluttering eye movements • Eyes wandering in different directions of are crossed after 3rd month • Inability to focus on a moving object • Absense of blink reflex • Drooping of one or both lids • Chronic tearing • Cloudiness of the eyeball • Pupil of one eye larger than the other

15. Vision Screenings • Children 3 yrs, of age and up can usually complete standardized vision testing • The Snellen or Illiterate E test and the HOTV (uses symbols) tests are the most popular for use with young children. • They do not require knowledge of the alphabet . • Teachers and parent volunteers can be trained to perform many of the standardized visual acuity tests to preschool children. • Children failing one screening should be re-screened later. • Children who fail 2 screenings should see a specialist.

16. Vision Screenings • Vision screenings are looking for and trying to detect the following: • Amblyopia: lazy-eye due to an imbalance of eye muscles. • Children usually experience double vision. • It can result in vision loss because the brain ignores information from the weak eye. • If caught before age 6 it is usually correctable with the use of a patch over the good eye thus forcing the weak eye to focus and strengthen.

17. Vision Screenings • Strabismus – cross-eyed is also detected in screenings and is also caused by an imbalance in eye muscles. • This condition causes the child to experience double vision • This is usually detectable with the naked eye by observing the uncoordinated eye movements as the child tries to focus. • One eye usually turns inward or outward. • By 4 months a child’s two eyes should be moving together as a unit. • Treatment includes a patch for the strong eye, eye exercises and sometimes surgery.

18. Vision Screenings • Myopia – nearsightedness is also being looked for when eye screenings are done. • This is characterized by poor distant vision and good vision up close. • These children appear clumsy and stumble and fall and run into things • They squint • Hyperopia – farsightedness. Which is normal in very young children but children gradually grow out of it. By age 5 they should have 20/20 vision. • These children see things at a distance better and have trouble with close up. • Children with hyperopia complain of headaches and are irritable with close work

19. Vision Screenings • Color Blindness – generally limited to boys. Females can be carriers of this genetic trait but are rarely affected themselves • Usually this involves the inability to distinguish between red and green • No treatment is available • Learning is not seriously affected

20. Hearing Screenings • Proper Language development depends on proper hearing. • Poor hearing will also effect social and emotional development • Sometimes children who are not hearing properly are labeled “delayed” or “behavior problems”

21. Methods of Assessment • Observant teachers may notice behaviors that could indicate a hearing loss such as: • Inappropriate responses or behaviors • Frequent mouth breathing • Does not turn toward the direction of a sound • Slowness in acquiring language • Difficulty in understanding and following directions • Asks you to repeat • Rubs or pulls at ears • Mumbles, shouts or talks loudly

22. Methods of Assessment cont. • More signs of possible hearing difficulties include: • Appears quiet or withdrawn • Rarely interacts with others • Uses gestures rather than words • Does well in activities that don’t require hearing • Mispronounces many word sounds • Unusual voice quality – high, low, hoarse, monotone. • Failure to respond to normal sounds and voices • Imitates others at play

23. Who Administers Hearing Screenings? • Audiologists – persons specially trained to use non-medical techniques to diagnose hearing impairments do hearing screenings. • Hearing tests can also be conducted by trained paraprofessionals or nurses. • Hearing screenings test for the normal range of tones used in conversation. • Children should be tested at least once during the preschool years. • Screenings are free from early intervention programs for children 0-3 and in local schools for children 3-12 yrs. of age.

24. Who Administers Hearing Screenings? • Teachers in baby rooms can do informal tests by checking for responses such as eye blinking and turning of the head or interrupting sucking in an attempt to locate a sound. • You can watch older infants and toddler to see if they turn toward sounds.

25. Hearing Screenings • Health Departments often do screenings • Doctors offices do them as well • Speech and hearing clinics (speech pathologists) can also do hearing screenings • Head starts and public schools often bring in people to do screenings as well. • Child care teachers can often arrange with health departments etc. to come to the center to do a screening.

26. Hearing Screenings • As with vision screenings, sometimes the results of hearing screenings can be false because they involve new situations, new people, new tasks and new equipment. • Outcomes are also influenced when children don’t understand what is expected or are uncooperative. • Sometimes teachers can help professionals get better results by preparing children by letting them use headphones, and practicing raising hands, pushing buttons or pointing to pictures. • Maybe a field trip before the testing is possible.

27. Common Hearing Problems • Children born with physical disabilities are at a greater risk of having hearing problems. • Temporary or permanent hearing loss are more commonly associated with: • Hearing loss at birth due to infectious illness during pregnancy • Premature birth • Hearing loss can run in a family • Bacterial meningitis, measles or mumps • Allergies • Frequent colds and repeated ear infections • Birth defects • Head injuries or trauma

28. Common forms of Hearing Loss • Conductive Loss- affects volume e.g. a child hears loud but not soft sounds • Receptive loss- affects the range of tones heard e.g. a child may hear high but not low tones • Sensorineural loss- results when sound impulses cannot reach the brain because of damage to the auditory nerve or brain damage. They hear sounds but don’t understand what they hear.

29. Treatment • Treatments for children with hearing problems vary depending on the cause of the hearing difficulty. • Treatments include: • Antibiotic drug therapy • Surgery • Hearing Aids • Sign language • Cochlear Implants

30. Management • Teachers can take appropriate steps to help children learn who have hearing impairments in some of the following ways: • Individualize instruction • Speak slowly and clearly • Use gestures • Demonstrate what is expected • Get down on the child’s level • Face the child

31. Speech and Language Evaluations • During the early years, learning language is one of the major tasks of early childhood. • Their receptive vocabulary (what they understand) and their expressive vocabulary (what they can say) expand rapidly. • They go rapidly through stages of cooing, gurgling, babbling and jabbering and move on to saying one word for a whole phrase of meaning (holophrastic speech) to putting two words together and then making small sentences etc.

32. Speech and Language Evaluations • Along the way they learn rules for plurals, negatives, tenses, and possessives. • They learn idioms and how to imitate the speech patterns and sounds of their native language. • Some even learn two languages and can figure out which vocabulary goes with which language and who to speak which language to. For example: I speak Spanish to my mother and English to my friends. • In short, they put together a whole language system.

33. Speech Assessments • Speech assessments are usually done by speech pathologists for free in early intervention programs for children 0-3 yr. olds or in schools for children 3-12. • Speech pathologists can help parents and teachers tell the difference between problems that are part of normal speech development and problems that may need special attention. • Example: many preschoolers have developmentally appropriate “misarticu-lations” that disappear as they mature. A three yr. old may pronounce an “r” as a “w” or “wabbit” instead of “rabbit” or an “s” as a “th” as in “thong” instead of “song.”

34. Common Speech Problems • No speech by age 2 • Stuttering or fluency problems (not uncommon in young children who still have limited vocabularies and need to search for some way of expressing themselves.) • Developmentally inappropriate substitution of word sounds • Speaks too fast or too slow • Monotone voice • No improvement in speech development • Unitelligible speech. • Children’s speech should be understandable to anybody about 95% of the time at age 4.

35. Common Speech Problems • Last letters a child pronounces correctly are usually “l” and “r” and “s” • Distortions are also common for the “s,” “z” and “ch” sounds. • After 4 years of age if children are still having real problems in these areas or if their speech is not intelligible, one should seek the help of a speech and language professional.

36. Managing Speech Problems • Be a good role model • Use correct speech and grammar • Avoid correcting children constantly and harping on pronunciations. • This tends to add stress to the situation and hinders improvement • Just say the word correctly and move on. • Children who hear words said correctly usually adjust their speech patterns to imitate those sounds.

37. Nutritional Assessments • The quality of children’s diets has a direct effect on their behavior and their health. • Factors affecting nutrition today include: • Food costs • Food convenience • T.V. Advertising

38. Nutritional Assessments cont. • Well nourished children usually exhibit: • Age appropriate height • Height appropriate weight • Bright clear eyes • Clear skin • Good color • Good gums • Good teeth • Soft moist lips • Nice pink tongue with no cracking

39. Nutritional Assessments cont. • There are four types of Nutritional assessments. Which one is used depends on the child’s age, the resources available, the reason for the evaluation and the type of information desired They include: • 1) Dietary Assessment- actual food intake is monitored to determine adequacy of nutrient intake. • 2) Anthropometric Assessment – measurements of height, weight and head circumference are taken and compared to norms. • 3) Clinical Assessment- Observing the child for signs of nutritional deficiency. Not reliable and not often used because physical symptoms often don’t appear until the deficiency is severe. • 4) Biochemical Assessment – lab tests of various body tissues and fluids are analyzed.

40. Common Disorders • Malnourishment comes in two forms: • 1) Undernourishment – inadequate intake of the proper nutrients – either they do not take in the proper nutrients or they just do not get enough to eat • 2) Obesity – Approximately 20-25% of all children in the United States are considered overweight. These children often take in the wrong kinds of nutrients eating too many sugars and starches. Obese children often do not get the exercise they need. This condition is sometimes tied to stress, heredity, and metabolic disorders as well as to poor eating habits. • Being overweight can lead to social and emotional problems and later in life to serious health problems.

41. Managing Nutrition Problems • Be good role models in terms of nutrition • Start young with good meals and snacks and healthy eating habits will form • Include children and parents as well as teachers and dieticians in helping to plan menus. Children enjoy preparing foods too! • Do parent education activities on meal planning, nutritious eating habits and methods for increasing the daily activity level for children. Children need to do more than watch T.V. • Parents and teachers can help children develop new interests – join a soccer or softball team or go jogging etc.

42. Making Referrals for Nutritional Assessments • To have success when you try to refer a parent for a nutritional assessment: • Gain parent’s trust • Get as much information on community and family as possible • Be aware of customs, beliefs, habits, past experiences with doctors, poverty, job conflicts, religious beliefs, transportation problems and parent’s educational level. These will all impact on parental response. • Contact the parent personally • Follow up to be sure the parent is following through and to encourage and praise and show care and concern.