Jacqueline Boamah-Bright w2 6210

What immunizations and/ or test might this child receive at this visit?

During a 6-month checkup, according to the Center of Disease Control (2020) there are vaccinations that are recommended for the infant. These include 

DTaP (diphtheria, tetanus, and pertussis)

Hib (Haemophilus influenzae type b), depending on the vaccine given 

IPV (polio)

PCV13 (pneumococcal disease)

HepB (hepatitis B)

Influenza (flu)

RV (rotavirus), depending on the vaccine given (CDC, 2020).

3.What aspects specific to the HEENT exam needs to be performed, and would you anticipate any difficulties?

•Head- Check the shape and size of the head. Inspecting the infant's head includes checking for a head lag when pulling the infant to a sitting position. This position is expected until 3-4 months. All infants during this month should be evaluated for muscle tone. If the infant's head is lagging, the provider should be concerned (Duderstadt, 2019). Head alignment should also be evaluated in the young infant, with the head remaining at the midline of the examination table. Persistent head tilts from the normal position may indicate hypotonia or congenital torticollis. An infant's range of motion and head movement should be emphasized during an examination to determine the tone and flexibility. At this developmental stage, the provider should note that the infant should be able to follow a light or small toy to determine the full range of motion of the head and neck of the musculature (Duderstadt, 2019). Any limited range of motion or jerking and tremors should be further evaluated when noticed. Another point is observing the head size and shape of the infant. A flattened occipital region or a unilateral flattening of the parietal region can occur in young infants because of prolonged positional placement. Palpate any suture lines of the infant. They should not be palpable after 4 to 6 months of age. Check for masses, skin lesions, or edema on the skull (Duderstadt, 2019).

• Eyes: Observe the color of the sclera and conjunctiva. Note for symmetry with upper lids and check for lice around eyelashes. Note for any ptosis and look for drainage around the eye (CDC, 2020). Try to hold an object, preferably a toy, lower than eye level for the child to observe the upper eyelid. Assess for retinal light reflex and six cardinals of gaze for corneal light reflex. Do the uncover/ cover test and evaluate using a toy for focus purposes. Note for symmetry in eyebrows and eyelids. Look at the shape of the periorbital area (Duderstadt, 2019). 

•Ears: First, start by inspecting the ears looking at size, shape, deformity, placement, discharge, and color. Gently pull the pinna straight back to insert the otoscope. Check light reflexes in bilateral auricles. Assess mobility of tympanic membrane. Make a sound and monitor if the child can turn their head without experiencing any difficulties (Duderstadt, 2019). 

•Nose: Assess nose for patency and nares. Also, note any drainage. Observe for possible foreign objects inside nostrils. Note any signs of flaring, which could indicate breathing issues. An otoscope is preferred for viewing the nose (Duderstadt, 2019). 

• Neck: The provider needs to extend the infant's head back for full inspection during this assessment. Inspect the thyroid gland and assess for any swelling, masses, or asymmetry (Duderstadt, 2019). 

 •Throat: Check the infant's gag reflex to note whether it is intact. Uvula should be positioned midline. Watch for any lesions, and assess the hard and soft palate for abnormalities. Mucous membranes should be pink and moist. The tongue should be positioned midline with no protrusion (Leung, & Suskind, 2020). 4 Discuss anticipatory guidance you may discuss with the mother specific to a 6-month-old well visit. The infant may start to turn their head towards familiar faces and look to the parent for consolation when visibly upset (Duderstadt, 2019). Most babies are rolling over and will soon sit up, crawl, and pull up to stand. Lowering the crib mattress is advised as your infant will soon crawl around and pull up to stand. Parents can introduce solid food like iron-fortified cereals this time. Infants may start teething during this time. This process consists of drooling, gnawing at things, and irritability. The symptoms can be relieved by teething rings (Duderstadt, 2019). It is not advisable to put a bottle of breastmilk or formula in the crib with the baby. These contain sugar and cause cavities if they contact the teeth while the baby is sleeping (Duderstadt, 2019). Use gates at stairways and doors, and cover sharp furniture and electrical cords as the baby will be moving around the house (CDC, 2020).

References

Center of Disease Control and Prevention (CDC, 2020). Information for Parents, Infants and Toddlers. https://www.cdc.gov/parents/infants/healthy_children.html

Duderstadt, K. (2019). Pediatric physical examination: An illustrated handbook. (3^rd ed.). Mosby: St. Louis

 Leung, & Suskind, D. L. (2020). What Parents Know Matters: Parental Knowledge at Birth Predicts Caregiving Behaviors at 6 Months. The Journal of Pediatrics, 221, 72–80. https://doi.org/10.1016/j.jpeds.2019.12.021

 My initial pos

Specific Questions

At 6 months old, I would ask the mother for the newborn screening results, whether there is any swelling in the neck area, how the child is managing head control, whether the child has a history of neonatal or maternal infection, quality of strength and muscle tone, and whether the child is achieving her developmental milestones (Duderstadt, 2017: p.287). This would allow me to gather information for the head and neck assessment. I would additionally ask the mother whether the child has a history of respiratory infection or fever or any exposure to them and whether the child has poor growth or is failing to thrive (Duderstadt, 2017: p.309). This additional information would help me gather information for lymphatic system assessment. Moreover, I would ask the mother when the child started to visually follow her, if the child reacts or blinks to bright light, whether there is any rapid involuntary eye movement, if there is a persistent tearing or discharge on either or both eyes, whether the mother has any concern concerning visual development, whether there was significant jaundice during the neonatal period, if there was an occurrence of neonatal meningitis, and whether there is any abusive head trauma history. This would allow me to gather information for eye assessment.

I would also ask the mother if the child reacts to sound with activity change or startle response, whether the infant turns her body or head towards the sound, whether the child makes babbling or cooing noises, if the child is breastfed, if the child experience frequent colds, whether there is a history of a ruptured tympanic membrane or frequent ear infections, if there is an occurrence of ear drainage, if the mother has any concern about the verbalizing and hearing of the infant, whether the child turns her head towards her when her name is called, and whether there is any concern about the motor development of the child (Duderstadt, 2017: p.371). This would help me gather information for ear assessment. Finally, I would ask the mother if there are any nasal discharges, any sucking difficulty, feeding, whether the mother has introduced solid food to the child, whether there are any sores, moth bleeding, or white patches, and if the child has any erupted teeth, whether the mother gives the child some juice in the bottle, whether the child is water fluoridated or is on fluoride supplement, her weaning plans from bottle or breast, if the child has the habit of putting objects in the mouth, if the child sucks her fingers or thumb, or uses a pacifier, and if so, the frequency of the habit (Duderstadt, 2017: pp.413-4). This would help me gather assessing information for the nose, mouth, and throat.  

Immunizations/Tests