Health and Wellness Appraisals- at least 200 words
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You are a teacher in a 4-year-old classroom and begin each day with your daily health and wellness check.  You notice that a child who is dropped off looks very tired and is uncommonly quiet as she walks into the classroom.  She was dropped off by bus so you have no additional information.   

Given the above scenario, the cause for the change in the child is sickness/illness. 

Examples of some of these common situations are described further in Chapter 7.  Use your imagination to develop it further discussing what you may see when you conduct your observation of the child.  Be mindful to detail what you might look for and how you will document your observations.  Based on your fictitious observation, create a plan of action for how to proceed.  This plan should include both immediate and long-term actions that you will take.  

Address the following points in your discussion:

    • Fictitious elaboration of what you observe in the child including the possible cause.  Include enough so that you can make a plan of action
    • Short-term plan of action detailing the procedure of how you will address the issue immediately or by the end of the day
    • Long-term plan of action detailing the procedure of how you will follow-up your short-term plan of action
    • Specific discussion regarding how you will support the child during this time




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7 Assessing Health © Bambu Productions/Getty Images After studying this chapter you will be able to: ▸▸ Describe how to conduct health appraisals, daily health checks, and nutritional health screenings. ▸▸ Explain why it is important to perform health screenings in early childhood settings. ▸▸ Maintain health records in an early childhood setting. ▸▸ Understand the process of typical sensory development. ▸▸ Identify signs of possible disabilities in vision, hearing, speech/language, and oral health. ▸▸ Evaluate a child’s social and emotional well-being. ▸▸ Include families in health appraisals, daily health checks, and screenings. ▸▸ Talk with families about health referrals. ▸▸ Collaborate with other professionals in the health screening and service of young children. Introduction to Assessing Health Chapter 7 7.1 Introduction to Assessing Health Assessing the health of a child is one of the most important functions a caregiver can perform. Accurate and prompt assessments of ill health or a potential medical condition can help a child receive medical attention promptly, prevent complications from developing, and decrease the chances of other children in the center becoming ill. However, care must be taken to make sure that the assessment is done accurately to avoid alarming parents unnecessarily. Further, caregivers must remember that the news of a possible problem may upset parents; therefore caregivers should approach parents in a sensitive manner to increase the likelihood that the child receives timely intervention to ensure the best outcome possible. Health Appraisal Through Observation An observation is a careful, visual inspection of the child. Caregivers should perform a visual inspection of each child every day when the child arrives at the center, such as while the caregiver is greeting the child and the parents at arrival. Visually observing the child provides caregivers with a benchmark for the child’s appearance that day and can help caregivers quickly identify any signs or symptoms of illness that may develop over the course of the day. Additionally, it can help caregivers identify any illness a child has, or preexisting bruises or scrapes that a child may have acquired from playing before the child arrived at the center. Any concerns should be discussed with the parent. However, any signs of possible trauma should be discussed with the center director to determine if the injury rises to the level that requires reporting to child protective services. Daily health checks are a good way for center staff to identify any unusual behavior, should it appear. Daily checks will help caregivers identify a change in a child that may signal the start of an illness, and obtain appropriate treatment for the child. Early identification will generally prevent a more serious situation from developing (e.g., a cough turning into bronchiThe best way to conduct a daily  tis), which will help to lower the rate at which infechealth check is to use four of the tion, viruses, and other ailments are introduced into five senses: sight (looking for sympthe child care center. toms), hearing (listening for unusual sounds), touch (noting any fever), and smell (sniffing for incontinence or other unusual odors). Daily checks are an initial step in a more thorough investigation, and should not be used to alarm the child or the parent. If something unusual is noticed, the other staff at the center should be alerted and asked to keep watch for additional symptoms. When Should Daily Health Checks Be Done? Caregivers should perform daily health checks shortly after the child arrives at the center, ideally, before the parent has left the facility. Caregivers should encourage parent involvement and input. If the child had difficulty sleeping the night before or went to bed late, he or she may appear lethargic. This is important information to have so that staff do not jump to a conclusion that the child is sick because of inactivity. How Should Daily Health Checks Be Done? To begin a quick but thorough daily health check, the examiner should get in a position that allows a clear look at the child at eye level (Healthy Childcare Consultants, Inc., 2012; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety Introduction to Assessing Health Chapter 7 Performance Standards, 1992). Hovering from above may leave the child feeling judged, whereas a position at eye level can help to put the child at ease. In this position, the caregiver should visually examine the child for any obvious physical signs of poor health such as a rash, whether the child is pale or flushed, and whether there is any discharge from the eyes, nose, or mouth (Healthy Childcare Consultants, Inc., 2012; Indiana Institute on Disability and Community, 2011a; National Health and Safety Performance Standards, 1992). Other signs to look for include any visible sores that may be oozing, changes in the child’s skin color (e.g., redness or bruising) or texture (e.g. lumps, inflammation), skin tenderness, itchiness, or any area that the child may seem to be protecting or covering, indicating pain or irritation (Healthy Childcare Consultants, Inc., 2012; Indiana Institute on Disability and Community, 2011a; North Carolina Department of Health and Human Services, 2005; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety Performance Standards, 1992). ▲ Daily health checks identify any changes in the child's typical appearance and help prevent the spread of infection. Next, caregivers should perform an auditory check for any sound that the child may be making that indicates a situation requiring further investigation. Child care center staff should encourage par- © Stockbyte/Thinkstock ents to note any problems the child or someone else in the family is having (e.g., siblings with a cold, earache, sore throat, etc.). Alternatively, the caregiver may hear something from the child to indicate that the child is ill or in pain, such as coughing, wheezing, difficulty breathing, or hoarseness. If a child is whimpering or moaning and unable to be soothed by the caregiver after a reasonable period of time, the child may be injured or coming down with some illness (Healthy Childcare Consultants, Inc., 2012; Indiana Institute on Disability and Community, 2011a; North Carolina Department of Health and Human Services, 2005; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety Performance Standards, 1992). Daily, caregivers should also evaluate a child’s health by smell. Any unusual odors or sudden changes in odors are possible signs that the child may be suffering from an ailment. Examples include if the child’s breath smells like fruit or sugar; if the child’s breath is particularly unpleasant or smells rotten; or if the child produces an unpleasant smell after he or she has urinated or had a bowel movement (Healthy Childcare Consultants, Inc., 2012; North H E A LT H I N A C T I O N : Conducting Daily Health Checks Daily health checks should be conducted calmly while the child is positioned comfortably. They should not be intrusive to the child’s body. The checks should respect the family’s philosophy, values, and beliefs (e.g., if the parent does not want the caregiver to physically touch the child during the check, then any changes of the skin such as rash, sweating, and flushing will have to be assessed by observation only). (North Carolina Child Care Health & Safety Resource Center, 2002) Introduction to Assessing Health Chapter 7 Carolina Department of Health and Human Services, 2005; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety Performance Standards, 1992). Finally, a child should be checked for fever or lack of sufficient fluids (Healthy Childcare Consultants, Inc., 2012; North Carolina Child Care Health & Safety Resource Center, 2002; National Health and Safety Performance Standards, 1992). A caregiver can simply touch the child on the arm to see if the child’s skin feels clammy or if he or she appears to have a temperature, which are common signs of fever. A caregiver can check for dehydration by gently pushing a finger down on the child’s skin. If the skin does not spring back quickly, this may indicate the child is not getting enough fluids. Another indication of dehydration is when a child does not visit the bathroom very often, or if, when they do, the urine is dark yellow. After these physical checks, the caregiver should observe the child for changes in normal activity level, behavior, or emotional state (e.g., a typically easygoing child suddenly showing signs of distress; or a usually energetic child being listless). All of these indicators of illness and/or injury should be evaluated further and brought to the attention of the center director and the child’s parents. In the event that there is a change in the child’s behavior or physical presentation, the caregiver will be able to identify it quickly, recommend that the parent seek medical attention if necessary, and protect the caregiver from allegations that the illness or injury happened at the child care facility. Quick action on the part of caregivers can ensure that the child receives proper attention (either parental or medical), the child achieving the best possible outcome, and that the spread of illness in the facility is minimized. There are many daily health checklists available online. Instructions on how to conduct a daily health check can be obtained at http://www.in.gov/fssa/files/DailyHealthCheck. pdf. The Indiana Institute on Disability and Community has a child care health and safety daily checklist that can be obtained from http://www.iidc.indiana.edu/styles/iidc/defiles/ ECC/CCR-HSDailyChecklist.pdf. This checklist is based on the American Academy of Pediatrics (AAP) Model Child Care Health Policies and consists of two simple questions with a number of sub-questions, including questions to ask parents. The North Carolina Department of Health and Human Services has a daily child care health check form that tracks a child’s behavior and physical condition on a weekly basis so that caregivers can quickly see weekly averages for children. This form can be obtained from http:// ncchildcare.dhhs.state.nc.us/PDF_forms/healthcheck.pdf. Finally, the National Resource Center for Health and Safety in Child Care has a chart with a variety of symptoms with accompanying causes, typical child complaints, and recommendations. This chart can be obtained at http:// nrckids.org/CFOC3/PDFVersion/PDF_Color/CFOC3_A.pdf. It is important to note that hardcopy records should be kept of these daily health checks in order to observe any sort of patterns that could predict future health issues. Caregivers should not rely on memory alone. These records should be kept in a secure location and only viewed by essential staff to ensure that there are no breaches of confidentiality. Screenings Health screenings are routine examinations that can indicate if a child has a condition that requires medical intervention in an area such as vision, hearing, or oral health. Some of these screenings can identify possible developmental delay (e.g., in speech, language) and indicate that a child needs to be referred to a specialist for supplemental assistance or intervention that can improve the developmental outcome (Centers for Disease Control and Prevention Introduction to Assessing Health Chapter 7 [CDC], 2011d). If these health issues are not caught early, they can lead to learning problems when the child enters school. For instance, a child with an undiagnosed hearing problem may not achieve the required developmental milestones for speech. This could be misdiagnosed as a learning problem instead of a hearing problem. Alternately, a child with a vision problem may not be able to distinguish between letters, again possibly being referred for learning problems. Early childhood caregivers are in a prime position to identify these issues and work with parents so that the children in their care receive prompt attention to correct any health issues as soon as possible. The sooner early intervention is received by the child, the better the child’s developmental prognosis. The AAP has published a chart listing the most important screenings, their timing, and characteristics (http://practice.aap.org/content. aspx?aid=1599). Maintaining Health Records A child’s health record is a collection of medical information (physical, dental, cognitive, etc.) about the child such as dates of diseases, illnesses, vaccinations, operations, and medications. A child’s medical record should include the contact information for the child’s primary health care provider, dentist, and mental health care professional (if applicable); a log of the child’s vaccinations, including dates; any known food allergies or dietary limits; a list of the dates of any major illnesses or accidents; and a list of medications the child is currently taking, including over-the-counter drugs, and instructions for dos- ▲ Health records keep track of important informaage (Farrer & Zamani, 2003). Maintaining accurate tion regarding a child's medical history. and complete child health records assists caregivers © iStockphoto/Thinkstock in identifying gaps in a child’s medical care, such as missed vaccinations, thereby better assuring that a child receives the appropriate medical attention. Accurate records also assist caregivers in providing better quality care to all children and aid caregivers in developing individualized programs for children who have prolonged medical conditions or particular medical needs (e.g., asthma). Comprehensive child health records also provide caregivers and center administrative staff necessary information to determine if the child requires care beyond what the child care center is able to provide (e.g., a child who develops a condition with severe dietary restrictions). Child care practitioners who keep precise and comprehensive child health records can also serve as a A hearing or vision issue can be useful support system for parents. For instance, if a ­misdiagnosed as a learning problem family does not have a pediatrician, a center’s request or developmental delay. for the child’s medical information may prompt parents to obtain a pediatrician, and the center can help them locate one. These requirements also encourage communication between parents and caregivers. Caregivers can learn a lot from the information provided by parents, which can make caring for the child easier. For instance, when a parent provides medical information about the child, the parent may note a medical condition (e.g., allergy) in another family member, which could also impact the child. The center’s child health records give child care providers a more complete picture of a child’s health and help them to notice any changes that Early Detection of Atypical Sensory Conditions Chapter 7 H I G H L I G H T: Recommendations Regarding Maintenance of Child Care Medical Records The types of mandatory medical information that should be kept by a child care facility vary from state to state. The following minimum items are recommended by the California Childcare Health Program: • Name, address, and phone number of medical, dental, or mental health care providers • Documentation of current immunizations (“blue card”) or signed waiver by parent releasing child from immunizations • Medical assessment, including dietary allergies and restrictions • Emergency instructions, and signed consent for emergency medical treatment • Record of illness or injury requiring treatment by a health care provider or dentist, and for which the center provided assistance • Record of current medications, including the name of prescribing health care provider and instructions • Signed and dated authorization for activity away from the center (Farrer & Zamani, 2003) may indicate a more serious condition. Additionally, this information equips caregivers so that they can respond appropriately and quickly in the event of an emergency involving the child. For full information on selecting a secure location for medical records, see the National Health and Safety Performance Standards (1992), which endorse the practice of selecting a specific, secure location in which to keep all of the child medical information. Each child care center should institute a policy that allows it to obtain the correct amount of information without becoming intrusive (Farrer & Zamani, 2003; The National Health and Safety Performance Standards, 1992). Caregivers need a certain amount of information to ensure the best possible care is provided to every child in their care; in the pursuit of this goal, caregivers sometimes will become privy to sensitive medical information about the child. Caregivers should treat all medical information as confidential and not discuss it with anyone who is not authorized. It is recommended that caregivers sign confidentiality agreements with their centers to protect themselves, the centers, the families, and most importantly the children in their care (Farrer & Zamani, 2003; The National Health and Safety Performance Standards, 1992). 7.2 Early Detection of Atypical Sensory Conditions Sensory development is defined as a child’s progress in vision, hearing, and speech/­ language. Although there is a wide range in which typically developing children reach certain developmental milestones, unusual progress in any of these areas should trigger further investigation. If a child displays any of the conditions described below, the caregiver should talk to the parents to ensure that the child receives more in-depth evaluations. Early Detection of Atypical Sensory Conditions Chapter 7 H I G H L I G H T: Eye Health Children should have their vision assessed by a qualified health care professional at the following ages: • The first 3 months • Between 6 months and 1 year • Close to their 3rd birthday • Shortly after their 5th birthday (CDC, 2011e) Vision To assess a child’s visual skills, it is important to understand the progress of typical visual development. Vision is the ability to sense or perceive objects with the eyes. Normal Vision Development During the first month of life, a baby’s pupils will widen or narrow when exposed to a light source. Babies will direct their eyes toward an item placed near their face. If given a choice, newborns will choose to look at black-and-white patterns, simple shapes, and people’s faces. From 1 to 3 months of ▲ As their eyes begin to work together, infants age, infants will watch an item that is held to one often enjoy watching themselves in a mirror. side of their body, follow it past the middle of their © iStockphoto/Thinkstock body, and continue watching it all the way to the other side of their body. In infancy, the eyes work together and are able to follow items moved up and down. Infants enjoy watching themselves in a mirror. Also at this age, babies will look around for specific sounds and they enjoy examining their hands (Bedinghaus, 2010; Heiting, 2010; Bailey & Wolery, 1989). Between the ages of 4 months to approximately 1 year, babies are able to focus all their attention on an item (e.g., their favorite toy) that is approximately 3 feet away. They will try to reach for and hold onto different things at 3 feet and mimic different faces that people make. Babies Not all children reach developmental  at this age also are able to detect colors, distinmilestones at the same time, and guish various shapes, and demonstrate that they some never reach them. This can be have object permanency. Object permanency is the cognitive ability to understand that if an ob ...
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