Pediatric Transitions

Posted by Nurse Linda in Life After Paralysis on April 24, 2020 # Health

There are many changes that occur in people’s lives. Adults have transitions in life. Children have many transitions. Each is a unique opportunity to advance and mature. Ensuring transitions are as successful as possible is key to a healthy life.

Growth is a transition that happens rapidly in infancy and childhood. Infants have their head circumference measured to assess the growth of the brain. This is not an assessment of brain function, just growth of the head. Too little growth of the head can indicate poor brain development, nutritional or hormonal issues. Too fast can indicate medical issues such as hydrocephalus (too much fluid in the skull) and other medical issues.

Head growth typically remains in the same percentile as the child matures but can be temporarily distorted by growth spurts. A sudden and large drop or increase might warrant further assessment. Measurement of the head is very specific in where the measuring tape should be placed. Mismeasurement is a common error when not conducted by a healthcare professional. Change in head growth is not a diagnostic test, just a pointer in assessment.

Growth can also be assessed as measurement of height and weight in infants and children. This is assessed by the pediatrician to ensure your child is growing at a proper pace within their age range. Most children will stay within national averages as they grow. Sometimes, a child will change their percentage group due to growth spurts or before a growth spurt, but they will basically stay close to their typical percentage group. The groups allow for children that are generally larger and those that are generally smaller. A change in percentage groupings is not a reason for alarm unless the change is extreme and goes along with other healthcare concerns.Doctor and child

Children with spinal cord injury should be carefully checked for growth. Spinal cord injury can lead to issues of rapid growth or slower growth. Some children who have a spinal cord injury may not eat well due to slow gastric motility (movement of food through the gut.) They just don’t feel like eating because they always feel full. Growth measurements might be an indication that they are not taking in enough calories. A diet change, supplemental feedings or even a tube feeding might be indicated after further testing and investigation is conducted. Other children might require extra nutrition due to increased caloric use from spasticity. On the other hand, some children need less calories due to immobility. Children who rely on tube feedings for nutrition may need an adjustment in their calories due to the ease of digestion from the tube feeding solution.

A nutritional consult with a dietitian is essential in providing the correct number of calories and right diet for your child. Dietary adjustments are something that you should rely on an expert in assessment and planning. There are many factors that go into the dietary assessment such as energy expenditure, calorie consumption, medical history and general health status to ensure your child is provided with the nutrition they need for growth, development and brain function. They will also take into consideration your child’s likes and dislikes of foods and textures to ensure they have a healthy diet for their age and abilities.

Growth charts are typically kept in your child’s medical record. If you would like to keep track at home, you can. Growth charts are provided online by the CDC (Centers for Disease Control). These charts can be printed and recorded on paper or you can fill them in online. https://www.pdffiller.com/jsfiller-desk16/?projectId=437499449#096bebc8ba932b5f7673f67454342396

Another set of transitions for children is development. Milestones are assessed at different ages. These are also based on national averages. Since these are averages, a milestone might be met earlier than the specified date or a little later. Milestones are accomplishments by your child such as holding up their head, sitting, walking, talking and learning. Categories for milestones are social, language, cognitive (thinking) and movement. All children have different rates of development. Do not get locked into the averages. Your child will develop at their own rate. Healthcare providers can suggest programs if your child needs assistance in some areas.

The CDC has information about children’s milestones by age with videos for assessments. You can track your child’s milestones online or print the milestones to track on paper. The CDC milestones web page has suggestions for how to help your child and how to discuss your concerns with their healthcare provider. https://www.cdc.gov/ncbddd/actearly/milestones/index.html

There are some milestones that should be adapted for a child with spinal cord injury. These will mostly be in the movement section. An example might be a child with a high-level injury holding up their head by age 2 months. This milestone might be adapted to holding up their head using adaptive equipment for support. Another might be taking steps, altered to independent with use of assistive device such as wheelchair. Milestones should be altered by your child’s abilities and age. Your health care professional should be able to assist you with understanding the adaptions needed for proper assessment of your child.

Parents protect their children. Some parents want to keep their child within their own surroundings and family. If your child has adaptive needs, it is important to ensure their development. Even at early ages, children should be exposed to other children regardless of physical abilities. Children relate well to people their own age. They see what they are doing and connect visually and verbally. Very small children don’t really interact but play side by side.

Older children will begin to interact. All children enjoy talking with each other and playing. Learning to interact with others is easier when a child is younger. If you child becomes injured from an illness or accident, talk with the parents of their friends to ensure a smooth transition in their friendships. Older children, especially in the teen years can be very judgmental. Talk directly with the older child to ensure continuity in friendships or have your child connect directly with their friends. They may be resistant but in the long run, the friendships remain once everyone understands the new situation. Fear of the unknown is typically the issue with the older child.

In school, children change grades but generally know others in their own class. A new school year is a challenge for every student until new friendships are formed. The school counsellor can be a great source for school integration. As schools change from elementary to middle to high school new friendships are formed typically by who is in the same classes.

Children with adaptive needs might be given the opportunity to have an I.E.P. (Individual Education Plan) in school. These are helpful in that the child’s needs should be adapted into the school day. This could include extra time for moving location, use of adaptive equipment and classroom functions. This planning was created through the Individuals with Disabilities Education Act for special education but the IEP is now used throughout the school system. You, as the parent, are a part of the IEP planning process so be sure you have a voice in what you think your child requires. The IEP process does have budgetary restrictions depending on your school system so participate with an open mind.

Transitioning to college or other learning program can be a challenge as this is a time that individuals are maturing into adulthood. Review colleges with your child to ensure their needs can be met if they choose to live away from home. Many colleges, but not all, have programs where another student will be assigned to your student to assist with note taking and traveling from place to place.

A huge transition is from the pediatric world of healthcare to adult healthcare. Talk with your pediatrician to find a healthcare provider that fits with your child’s needs and personality. This should be done for all children making the switch to adult healthcare regardless of abilities. In adult healthcare, the individual is much more responsible for their own care. Prepare your child as they go through their pediatric years, so they are completely involved in every aspect of their own care. This will make transition much less of a shock. Remember and remind them that the first try with an adult practitioner might not be the match they need. It is perfectly fine, to select someone else if they are not connecting with their provider.

As with all children, the more they are involved with their personal care and health care, the more they will be knowledgeable and capable of caring for themselves. This is the goal of parenting, to release your child successfully into the world. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in ourHeath & Wellness discussion.