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Introduction
Early childhood is associated with multiple health concerns and the risks of disorders and infectious diseases. Challenges that can make parents more cautious are young children’s limited ability to realize and explain their issues and the tremendous influence of health information from non-authoritative sources. This paper discusses two case studies in which outside influences on parents’ immunization decisions and complex issues in toddlers are illustrated.
Parental Decision-Making on Childhood Vaccination
Key Health Issues
In this case, two health issues, including the new mother’s vaccine hesitancy and missed four-month vaccinations for the six-month-old infant, are introduced. The woman’s hesitancy about the safety of child immunization as per the approved national schedule stems from the exposure to information about links between vaccination and autism spectrum disorder (ASD). Regarding the next issue, based on Australia’s immunization schedule, the child has already missed immunizations against diphtheria, tetanus, hepatitis B, pertussis, rotavirus, and pneumococcal infections (Australian Government, Department of Health, 2021). This situation creates the need for subsequent health assessments and measures to prevent missed immunizations from increasing the child’s susceptibility to the listed conditions.
Issue Management Strategies
The first issue should be managed by employing parent education. As current research suggests, anti-immunization messages from mass media sources are positively correlated with immunization hesitancy attitudes among families (Bianco et al., 2019). Worse still, this client’s distrust of the national healthcare system is exacerbated by the case of her niece or nephew diagnosed with autism after immunization, which is an example of a post hoc fallacy. Firstly, the client is to receive education on the importance of immunization for protecting the child against poorly treatable and life-threatening conditions concerning statistics regarding disease in immunized and non-immunized children. Secondly, due to the client’s specific concerns about ASD, it is critical to gather information from trustworthy sources of health-related information, including peer-reviewed research and documents from the World Health Organization, to dispel the myths about child vaccination in an educational conversation (Geoghegan et al., 2020). Finally, it will be made explicit to the mother that her child will be denied child care services as per the New South Wales immunization policy (New South Wales Government, 2021). After the education, she will be encouraged to make an informed choice.
The problem related to missed four-month vaccinations will be handled using risk assessment interventions. Since the immunization requirements are slightly different for Indigenous and non-Indigenous Australians and high-risk conditions, the nurse will gather information about the child’s ethnicity and risk conditions for pneumococcal disease and other diseases mentioned above (Australian Government, Department of Health, 2021). Using this information and the details of the child’s medical history, the professional will determine the high-risk conditions stemming from missed immunizations and schedule a comprehensive physical assessment. Apart from deviations from the immunization schedule, risk factors for the diseases for which the immunizations have been missed include skin lesions, eczema, puncture wounds, low weight, and inadequate sanitary conditions at home (Becerra-Culqui et al., 2018). Therefore, physical assessments and interviewing the mother about currently used hygiene and sanitary practices are necessary. Finally, it is pivotal to administer deferred vaccines as soon as possible if the woman does not confirm her status as a conscientious objector after receiving the necessary health education.
Partnerships and Parent Empowerment
The child and family health nurse can collaborate with diverse professionals, including the state’s immunization specialists, to improve the child’s health prospects while also empowering the mother to get updated information from national authorities in the field. Particularly, in case of concerns regarding presenting research-based information to the client, the nurse can seek advice from New South Wales Immunization Specialist Service (NSWISS) which offers information support to both families and healthcare providers (National Centre for Immunization Research and Surveillance, 2021). The nurse will be able to use the service’s immunization advice line to get professional advice regarding recommended vaccine doses in the case of interrupted vaccination (NCIRS, 2021). If the mother insists on having a consultation with dedicated child vaccination experts or health examinations reveal the presence of complex needs or the risks of post-vaccination adverse events, it will be possible to refer the woman to the Specialist Immunization Clinic in New South Wales (NCIRS, 2021). This organization supports parents that have doubts and questions regarding immunization and offers close monitoring and observation services for children at risk of post-immunization adverse reactions, including allergies and abnormal laboratory findings.
Family Guidance and Support
As touched upon in the issue management section, the mother will be introduced to research findings regarding ASD and child vaccination as per the predetermined schedule. In particular, the nurse will discuss the evidence from the summaries of peer-reviewed studies on the subject, including the article by Geoghegan et al. (2020). Using the source, the nurse can explain that the myth regarding links between ASD and measles, mumps, and rubella vaccine emerged in 1998 due to one study with twelve participants that was inaccurate in terms of methodology and inter-group comparisons, and that article caused massive media coverage of the “sensation” (Geoghegan et al., 2020). More recent epidemiological studies with more than five hundred participants did not reveal any causative or at least correlative links between immunization and ASD (Geoghegan et al., 2020). This information will be delivered to the client in plain language.
Next, the support and guidance measures will include the discussion of unvaccinated children’s status and rights. Current health policy will be applied to explain the long-term consequences of vaccination refusal to the mother. The recent amendment to the Public Health Act of 2010 which is effective since January 2018 states that conscientious objectors’ unvaccinated children should be excluded from the childcare system (NSW Government, 2021). After the explanation, the mother will be encouraged to make an informed choice and either fill out the required vaccination objection forms or proceed with the vaccination schedule as soon as possible.
Developmental Issues in a Child
Key Health Issues
The central issue in the case refers to the recent emergence of warning signs that may indicate current or future developmental issues in the two-year-old girl. One component of the issue refers to worrying changes to the child’s usual sleeping patterns, regular instances of night waking two and more times a night, and more frequent tantrums. Another area of concern is the girl’s behavior when it comes to peer communication and cooperation with adults. The mother reports the child’s unwillingness to cooperate when taking a bath and playing with peers during playgroup activities. There are multiple possible reasons for such changes, ranging from stress to developmental disorders, so comprehensive health assessments are required to identify the root cause of all these issues.
Issue Management Strategies
Managing the issues separately is not the best strategy since all concerns emerged almost simultaneously, which may point to their possible links to one central development-related concern. For a preliminary assessment that would consider all worrying symptoms simultaneously, it is possible to apply the developmental checklist for two-year-old children recommended by the New South Wales Ministry of Health (2017). The mother will be encouraged to fill out the checklist, thus singling out the most critical areas of concern, such as communication, socio-emotional behavior, or physical development (NSW Ministry of Health, 2017). The parent will identify whether the child has lost skills that once were optimal for her age. Since changing sleeping patterns, aggression, and reluctance to communicate find manifestation in toddlers with autism, screening for ASD can be necessary (Miller et al., 2021). As a preliminary measure, the mother can be encouraged to complete the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) (Aites & Schonwald, 2019; Dai et al., 2021). It is a two-stage risk assessment tool completed by parents that have shown an adequate predictive value in English-speaking families from any racial background.
Aside from potential developmental disorders, sleep- and bathing-related concerns might be caused by other factors to be investigated and excluded. Night waking can be related to two-year molars’ growth and related discomfort and pain, ear pain/infections, anxiety because of moving to a new house, nightmares, excessive naps, or uncomfortable beds and mattresses. As for reluctance to cooperate at bath time, the child might be afraid of getting soap in the eyes or have a fear of water. Several assessments will be needed to analyze these hypotheses. To evaluate the presence of external reasons for sleep issues and poor cooperation, it will be essential to assess skin color, rashes/signs of irritation, and history of allergic reactions. The HEENT assessment will enable the professional to detect any signs of disease or irritation that might be related to waking up at night and inspect the child’s oral cavity for tooth eruption abnormalities. Based on the results, the child may need to be referred to a pediatrician doctor for additional consultations.
Partnerships and Parent Empowerment
Solving the case may require working with multiple partners, including the mother, local autism assessment resources, and pediatric dentistry services. Collaborating with the mother to gain information that will eventually support her ability to parent the girl confidently is pivotal. To achieve this, the nurse will emphasize interviewing the mother on all aspects of daily life that may be related to the issues. The nurse will gather information on changes to hygiene practices, hygiene product selection, environmental conditions in the child’s bedroom, and the girl’s nutritional regime and then provide the necessary education. As for dentistry services, if there is any evidence that poor sleep is linked with teething pain, the child can be referred to a local dental service for a more comprehensive assessment and consultation on pain relief medications and gels that are approved for use in two-year-olds (Rosu et al., 2017). Next, the nurse can contact a local autism assessment service for further information on the possibility of developmental abnormalities. The patient may need to be referred to this specialized service where pediatric patients are assessed by speech therapists, child psychologists, and other professionals.
Family Guidance and Support
The mother will receive extensive information support regarding the potential causes of her child’s issues and the need for assessments for developmental disorders with subject matter experts. Following the World Health Organization’s (2020) components of nurturing care, the nurse will explain the interconnected factors affecting child development, such as early learning opportunities, the sense of safety, or adequate nutrition, and provide the mother with advice based on findings from assessments and interviews. For instance, using recent evidence on links between toddlers’ sleep quality, family environments, and bedtime routines, the nurse will evaluate interview results and propose bedtime practices and approaches to sleep environment organization that will reduce the child’s anxiety (Hoyniak et al., 2020). All guidance will be individualized to consider the mother’s current opportunities and family situation.
Additionally, in the case of referrals to ASD assessment services, the mother will need information on learning disabilities and early interventions that might be required. As per the guidelines by Early Childhood Intervention Australia (2016), toddlers with ASD and other developmental disorders are eligible for early interventions that observe seven universal principles, including everyday interactions with familiar people, teamwork approach, and care individualization. As per Mary Sheridan’s works on developmental progress, at the age of two, parallel but not cooperative play is normal, and it is common for children to “play near peers but not with them” (Sharma & Cockerill, 2014, p. 41). Considering this, psychological support and reassuring notes should also be provided to prevent the mother from seeing any minor issue as an immediate sign of developmental disorders.
Conclusion
In summary, based on the cases above, child and family health professionals must be able to address parents’ misconceptions and complex concerns. In the instance of objections to immunization, delivering timely and appropriate health literacy interventions for parents is pivotal. For more complex cases where developmental disorders might be involved, thorough investigations and interprofessional collaborations present some of the high-priority areas.
References
Aites, J., & Schonwald, A. (2019).Developmental-behavioral surveillance and screening in primary care.UpToDate. Web.
Australian Government, Department of Health. (2021). National immunization program schedule 1 July 2020.Web.
Becerra-Culqui, T. A., Getahun, D., Chiu, V., Sy, L. S., & Tseng, H. F. (2018). Prenatal tetanus, diphtheria, acellular pertussis vaccination and autism spectrum disorder. Pediatrics, 142(3), 1-9. Web.
Bianco, A., Mascaro, V., Zucco, R., & Pavia, M. (2019). Parent perspectives on childhood vaccination: How to deal with vaccine hesitancy and refusal? Vaccine, 37(7), 984-990. Web.
Dai, Y. G., Porto, K. S., Skapek, M., Barton, M. L., Dumont-Mathieu, T., Fein, D. A., & Robins, D. L. (2021). Comparison of the modified checklist for autism in toddlers, revised with follow-up (M-CHAT-R/F) positive predictive value by race. Journal of Autism and Developmental Disorders, 51(3), 855-867. Web.
Early Childhood Intervention Australia. (2016). National guidelines: Best practice in early intervention. Web.
Geoghegan, S., O’Callaghan, K. P., & Offit, P. A. (2020). Vaccine safety: Myths and misinformation. Frontiers in Microbiology, 11, 1-7. Web.
Hoyniak, C. P., Bates, J. E., McQuillan, M. E., Albert, L. E., Staples, A. D., Molfese, V. J., Rudasill, K. M., & Deater-Deckard, K. (2020). The family context of toddler sleep: Routines, sleep environment, and emotional security induction in the hour before bedtime. Behavioral Sleep Medicine, 1-19. Web.
Miller, L. E., Dai, Y. G., Fein, D. A., & Robins, D. L. (2021). Characteristics of toddlers with early versus later diagnosis of autism spectrum disorder. Autism, 25(2), 416-428. Web.
National Centre for Immunization Research and Surveillance. (2021). New South Wales Immunisation Specialist Service (NSWISS). Web.
New South Wales Government. (2021). Questions and answers about vaccination requirements for child care. Web.
New South Wales Ministry of Health. (2017). I am 2 years old. My development – learn the signs. Act early. Web.
Rosu, S., Montanaro, F., Rosu, A., & Oancea, R. (2017). A randomized, open-label, parallel-group multicentre study on the efficacy and tolerability of a non-medicated, patented gel for the relief of teething symptoms in infants.Italian Journal of Dental Medicine, 2, 45-54. Web.
Sharma, A. & Cockerill, H. (2014). Mary Sheridan’s from birth to five years: Children’s developmental progress (4th ed.). Routledge.
World Health Organization. (2020).Improving early childhood development: WHO guideline. Web.
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