Case Study One

A teen mother brings 6 month old Colby in to the Public Health Unit for immunizations. She has
been bringing him in regularly and his immunizations are on schedule. His measurements today
are: weight 8.6 kg, length 64 cm, head circumference 43.5 cm.

The mother states that Colby has been healthy with the exception of frequent ear infections, for
which he has been treated with antibiotics. The mother is a smoker and lives with her parents,
who are smokers.

At this visit, an Ages and Stages Questionnaire is provided for the mother to fill out. She states
that she is able to fill out the questionnaire without assistance.

Reviewing the Ages and Stages Questionnaire with the mother, you find that Colby is meeting
all developmental milestones in gross motor, fine motor, and social interaction. He does not
babble or form sounds as much as expected for this age; he is at the lowest end of the expected
range.

Mother states that she has begun feeding rice cereal to Colby and he is tolerating it well.

Questions

Please answer these questions as completely as possible, based on the information provided,
knowledge of anatomy, physiology, family theory, growth and development, and your
independent research on the topic. Use of point form is encouraged – along with correct
grammar and spelling so your meaning is clear. Think clear, concise, and correct when
answering questions.

Remember not to “read in” any extra information, nor should you make assumptions about
anything not included in the case. Your answers must be specific to this child and family.

Please cite sources with each answer and provide a reference list (in APA format) at the end of
the assignment.

Part One

1. What conclusions can you come to about this child’s physical growth? 1 mark

2. What developmental milestones do you expect to observe in the areas of language, fine
motor, gross motor, speech, and social interactions? 2 marks

3. What suggestions will you give to the mother for promoting and maintaining the health of
her son, in the areas of language, fine motor, gross motor, speech, and social
interactions? 2 marks
 4. What anticipatory guidance will you provide the mother for advancing solid foods? 2
marks

5. What concerns do you have about this child’s health, growth and development? 2 marks

6. How will you express your concerns to the mother? 3 marks

7. What strengths and stressors are likely to be present in this family? 3 marks

Part Two

You are doing a casual shift at the hospital tonight and Colby, now age 1 year, is brought in for
examination following a rear-ender car crash. On arrival, the EMT reports that Colby was alert
and quiet in his mother’s arms when they arrived on the scene and he did not have any obvious
signs of trauma. He has been brought in for observation to ensure he did not sustain any
injuries.

Colby’s vital signs are: temperature – 37.20 C; respirations – 35; pulse – 110; blood pressure
95/55; oxygen saturation – 95%. He is alert and in no apparent distress. His pupils are equal,
round, and reactive to light. His anterior fontanelle is flat and he has equal movements of all
extremities. His breath sounds are clear and equal bilaterally. His heart sounds have a regular
rate and rhythm without murmur. He voided around 2 hours ago, before the crash.

1. Why is the anterior fontanelle an extremely important body part to examine in Colby? 1
mark

2. What might an abnormal finding on examination indicate in this situation? 1 mark

3. How can you describe the placement of the anterior fontanelle, and when should it close
and become unpalpable? 2 marks

4. Why would the head be more likely to sustain injury in an infant like Colby versus an
adult? 1 mark
5. After reviewing the scenario, what can you tell the parents about Colby’s vital signs and
stability at this time? 2 marks

6. What is the difference between adult vital signs and Colby’s vital signs? 1 mark

7. Given knowledge of car seat restraint, what body parts would you want to examine for
potential injury and why? (see www.tsfbcaa.com/11.aspx for car seat information) 2
marks