NEED HELP! I am looking to interview a Pediatric nurse.

Pediatric Critical Care Columnist · Mar 9, 2017

Critically ill children, like those admitted to pediatric intensive care units (PICU), are not usually assessed for developmental milestones. They're simply too sick for that to be a concern. When they're no longer critically ill we may ask parents or caregivers if they're behaving at their baseline if there's a concern regarding their neurological status. This might arise in the setting of prolonged hypotension or hypoxia, traumatic brain injury or severe sepsis. But we're definitely not performing Denvers or any other formal assessments. For the longer-term technologically dependent patients, our occupational therapy and physical therapy teams do the assessing and treatment planning.

Annaiya, NP · Mar 12, 2017

Although we aren't doing formal developmental assessments, they should be getting some assessment on admission. Every admission isn't intubated and sedated. You should know a baseline GCS and if they are on track with their milestones or delayed. It has a huge impact on your ability to assess if the patient is ok or not. Particularly in patients where you are concern about neurologic decompensation. So to answer the questions from the OP:

Â· What is your role?

PICU NP

Â· What assessment do you use to evaluate childrens development between 0 to 3 and why?

Physical exam. No formal assessment tool.

Â· What are the strengths of this assessment tool?

N/A

Â· What are the weaknesses of this assessment tool?

N/A

Â· How do you use the results of the assessment?

To evaluate for potential problems and develop a diagnosis.

Â· What is the biggest challenge of assessing an infant or toddler?

There is a lot of normal variation between children at this age, so parents are key to knowing what their baseline is.

Â· How are family members involved in the assessment?

Parents are asked if the child is on track developmentally or if there are concerns and also if the parents feel that their current behavior is normal or not.

Â· How are other professionals involved in the assessment?

flyingpenguin92 · Mar 23, 2017

I'm a RN at a pediatric hospital that deals with a lot of longer term patients that are a bit more stable than most hospital settings. Our kids definitely get assessed for developmental milestones, but most of that assessment is completed by child life specialists, not nursing. Nurses may help in answering questions about if we have seen the kids perform certain tasks that they may not have observed while doing their assessment (rolling over, sitting unassisted, cooing, etc). We also help with making sure that adjustments are accurate since many of our kids are extremely premature and so their age gets corrected. We don't generally use the results of the assessment for any of the nursing tasks, but PT and OT probably do in focusing on what tasks they should be working on. Parents are pretty seldom involved in assessments, because they are not usually at the hospital throughout our kids stay. When parents do have the opportunity to visit, training them in caring for the medical needs of their kid, and letting them enjoy time with their kid definitely take priority over developmental assessments. Developmental assessments are also not completed nearly as often as other assessments, and most of our kids are working towards multiple goals, and making a ton of progress in one area (ie eating, walking, fine motor, etc) may not translate to a higher developmental score so often its easier to track progress in terms of each goal than using multiple factors. Many of our kids also have pretty complex medical conditions, so it's not always safe to hit all of the traditional developmental milestones even if they are making great progress.

Sorry that was long and kinda didn't answer all your questions. At least where I work developmental assessments are commonly done, nursing is just not really involved with them.