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Health Assessment Tools

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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

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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

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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

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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.

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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.

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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.

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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!

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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.

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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.

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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.

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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.

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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

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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

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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.

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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.

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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.

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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

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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

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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”

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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

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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

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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.

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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.

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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.

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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.

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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

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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.

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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

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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

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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.

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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.

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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.”

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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.

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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.

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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.

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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

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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

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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.

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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.

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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.

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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.