TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Trends in Nursing Project Plan

Neurological Deficit Awareness
Heather Small, Jana Gerlock, Bradley Schmidt, Seulpyo Caleb Hong, Cortney Prince
Raritan Valley Community College
Nursing of Families with Child Clinical NURS C24-37
Professor Maryann Balut
February 19, 2014

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Course Instructors:
Maryann Balut; Alison Campoli
Name of Students:
Heather Small (group contact person; phone: 908-343-7915, email:heather.small@ymail.com)
Jana Gerlock, Bradley Schmidt, Seulpyo Caleb Hong, Cortney Prince

Problem Statement:
The Center for Great Expectations provides social services to pregnant and postpartum
homeless women who meet the ASAM level III or III.3 criteria for residential treatment. The
profile for women served by this organization includes women that present with homelessness,
trauma, and a lack of family, financial and social support. Many of the women have struggled
with addictions to a variety of chemical substances such as opiates, benzodiazepines, heroin, and
alcohol while they were pregnant.
Because 75 percent of the children born to the women at the center present neurological
deficits related to maternal addictions during pregnancy, the mothers need an education to help
increase compliance receiving care and identiying potential neurological deficits in their children
in order to facilitate the initiation of proper care.

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Background:
The Center for Great Expectations provides social services to pregnant and postpartum homeless
women who meet the ASAM level III or III.3 criteria for residential treatment. The profile for
women served by this organization includes women that present with homelessness, trauma, and
a lack of family, financial and social support. Although these women may have received prior
treatment at an outpatient setting or prior residential treatment program, they are at risk for
relapse. Whether legal or illegal, substance abuse can be harmful and lead to addiction.
Substance abuse, therefore, exposes children and/or expecting or postpartum women to increased
risks to physiological and psychosocial harm.
Specifically, The Center for Great Expectations, through the Trends Program hopes to gain
understanding about how to recognize the potential impact of pre-natal drug use upon the child
post-delivery ay present risks such as developmental delays, behaviors, and cognitive deficits.
Also, in regards to these potential outcomes, what resources are readily available to women
whose children are exposed to such risks or present signs that they may be at risk.

Development Milestone Chart

We will use infant development milestones provided by the CDC and other researchers to create
visual checklists that will allow mothers to easily recognize whether their babies are developing
typically. Because addictive substances differ in their effects on fetal development, we will also
provide a breakdown of "areas to monitor" as they relate to different substances (e.g., alcohol,
tobacco, narcotics).

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Video Record

We will create and/or compile a list of videos demonstrating behaviors that are indicative of
negative effects of substance abuse manifested in infants and toddlers.

What Can Parents Do?

We will create handouts that highlight the ways in which various treatment modalities manage
developmental delays and deficits (e.g., speech and behavior therapy, dedicated schools). These
handouts will list providers in the area as well as information about financial assistance that can
help them manage the costs of therapy, if necessary. Before and After video testimonials should
be included as they will reinforce to parents the benefits of enrollment in such therapies.

Project Objectives:

Public Awareness Modalities provided to the Center for Great Expectations:

Deliver video presentations that create awareness of how addictions affect the pregnant
woman and fetus.

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Deliver guidance checklists and handouts to the Center.

Schedule Education Workshop:

Create and schedule a power point presentation that highlights key topics:
o potential impact of pre-natal drug use upon the child post-delivery
o potential risks (e.g. developmental delays, behaviors, and cognitive deficits)

Provide information and education on care of the pregnant woman, female anatomy.

Provide teaching and information on proper exercise, relaxation and hygiene

techniques.

TRENDS - NEUROLOGICAL DEFICIT AWARENESS

Community Partner Contact information:

Ms. Noreen Whittemore

The center for Great Expectations
19b Dell wood Lane, Somerset, NJ.
Phone: 732-247-7003
Email: nwhittemore@cge-nj.org

TRENDS in Nursing
Service Learning Project
Helping Mothers at Risk
Recognize Developmental Milestones

TRENDS in Nursing
Student Learning for Civic Capacity:
Stimulating Moral, Ethical, and Civic
Engagement for Learning that Lasts

What were the central course concepts

that deepened your understanding of
these issues? 1
The center for Great Expectations
p
is a community-based
y
organization that provides housing, meals and
rehabilitation for pregnant young women who have
become dependent on drugs, alcohol or were
incarcerated.

A large percentage of babies born to these women have

physical and developmental delays due to alcohol and
dr g exposure
drug
e pos re in utero.
tero

Course concepts include

Role of the health care team in the community

setting
Creating
g awareness through
g education;;
Developmental milestones and recognizing
delays

Pediatrician

These physicians are doctors

who provides medical care to
children
Pediatric patient age limits range
from birth to 18

Ne rologist
Neurologist

Neurologists are medical doctors

that specialize in the diagnoses
and treatment of nervous system
disorders and diseases affecting
the brain, spinal cord, and the
rest of the nervous system

This term, which issue did y

you focus on:
diversity, equity, health and/or
y
1
sustainability?
Our project focused on health in two ways:
1 Education - We provided a PowerPoint Presentation
1.
and 2 brochures about CDC Developmental
Milestones
2. Nutrition - We demonstrated how to prepare fresh,
flavorful meats, vegetable bean salad and fruits

In what ways did you continually engage these

issues?
1

Brochures were provided that include information on developmental

delays milestones
delays,
milestones, specialized physicians and resources as future
reference material

Our presentation ended with preparation of a healthy, nutritious

home cooked meal which was enjoyed not only by the mothers but
their children too

What is or will be the effect on the consumer?

2

We hope we provided the mothers with information and ideas that

will not only
y reassure the mothers they
y provide
p
the skills needed to
raise a healthy and well adjusted child, but also to help them to
recognize a possible developmental delay if a problem with child's
development is noticed.
noticed

We hope the message about the importance of addressing a

possible problem and acting early reached the mothers as it will only
benefit the child and give him or her the opportunity to meet their full
potential

In what ways did you continually engage these

issues?
2

We used multiple modes of communication to inform and

demonstrate to the mothers the importance of recognizing
developmental delay, meeting developmental milestones and
importance of a healthy diet

PowerPoint presentation was given as a visual aid that highlighted

important developmental milestones,
milestones safety
safety, and a follow up care
with health care professionals

During the PowerPoint presentation we served healthy snacks

demonstrating to the group that healthy food is tasteful and
nutritious

Focus on
Education

We discussed
developmental milestones
with the mothers at the
Center for Great
Expectations helping them
Expectations,
to identify typical
milestones as well as signs
of delay
delay. Our hope is that
that,
in the event of a delay, the
mothers can recognize it
and
d gett th
their
i children
hild
iinto
t
early intervention programs

Focus on
Nutrition

We researched wellbalanced easy

balanced,
easy-to-prepare
to prepare
recipes, and made the
meals for the mothers
during the presentation
presentation, to
demonstrate their quality
and simplicity. We also
provided copies of the
recipes so that they can
make the meals
th
themselves
l
iin th
the ffuture,
t
and provided information
about the health benefits of
each
h iingredient
di t used
d

How did this ongoing engagement deepen your

understanding of these issues?
4

Common view of the

alcohol/drug addicts:
Selfish, Irresponsible, Lacking
moral judgment

What we saw:
Loving, caring mothers who
were taking control of their
complicated lives by learning
to new ways to cope
Living in a safe
safe, supportive
environment that is conducive
to enhanced quality of life

Maternal alcohol and congenital cardiac defects

4
Women of
childbearing age
53%
53%: currentt alcohol
l h l
users.(at least 1
D/30days)
24%: binge drinkers (5
or more D in 30 days)
5%: heavy drinkers

Pregnant women
11.8% current alcohol
users
2.9%
2 9% binge drinkers
0.7% heavy drinkers

How do you make moral decisions about what

is right and what is wrong in actions you or
others take to build diverse, equitable, healthy
and sustainable communities?
5

Moral decision making processes are specific to each person and

may be shaped by:

Early family and community socialization

Faith based instructions

Cultural differences

Laws and Statutes

Institutional Policies & Code of Ethics

How will this ongoing engagement impact your

personal life,
life work
work, and career
career, and
community?
5

Many of us have or know someone who is raising a child at this very

moment. We are no different. So, reflecting on development
milestones and privately making assessment to the children we
know comes almost automatically.

The greatest impact we experienced was looking into the eyes of the
mothers and children who entrusted us with providing them with
relevant information to promote optimum health and wellness in
their lives
lives.

Healthy Child Development

Learning Goals:

Importance of Brain Development

Helping Your Child Grow
Keeping Your Child Safe
Importance
p
of Social Development
p
What are Development Milestones?
Keeping In Touch with a Healthcare Team

Stages of Development

Developmental Milestones are organized into 6 different

age groups.
Infants (0-1 year of age)
Toddlers (1-2 years of age)
Toddlers (2-3 years of age)
Preschoolers (3-5 years of age)
Middle Childhood ( 6-8 years of age)
Middle Childhood (9-11 years of age)

Infants (0-1 year of age)

Milestones 0-2 months

Milestones 2 months to 1 year old

Social/Emotional

Social/Emotional

Smiles at people

Nervous around strangers

Looks around for parents

Cries when parents leave

Language/Communication

Language/Communication

Coos and gurgles

Tries to say words, dada

Turns head toward sounds

Shaking head no

R
Responds
d tto simple
i l spoken
k requests
t

C
Cognitive
iti (learning,
(l
i
thi
thinking)
ki )

Cognitive (learning, thinking)

Pay attention to faces

Follows things with eyes

Shakes, bangs, throws small objects

Acts bored when activity does not

change

Looks at the right thing when named

Physical/Movement

Can hold up head, brings hand to

mouth
Pushes up when on tummy

Physical/Movement

Sits up

Pulls up to stand

Walks holding on to furniture

Conclusion

How does your project affect nursing?

B
By educating
d
ti th
these mothers
th
about
b td
developmental
l
t l milestones,
il t
this project could end up changing the trajectory of a childs
development and changing the entry point at which the mother
and child encounter nurses in the healthcare sector. By helping
the mothers to be proactive, this project potentially keeps a child
from acute care and/or reduces the number of encounters and
overall encounters with the healthcare system.

2014 RVCC Student Nurses

Hello and Goodbye

New Jersey Early

Intervention System

developmental milestones. Children reach

Phone: (888) 653 - 4463

http://www.njeis.org/

Skills such as taking a first step, smiling for the first

time, and waving "bye bye" are called
milestones in how they play, learn, speak, behave,
and move (crawling, walking, etc.).
From birth to 5 years, your child should reach
milestones in how he plays, learns, speaks and
acts. A delay in any of these areas could be a sign
of a developmental problem, even autism. The

FamilyLink
2333 Morris Avenue
Suite A-204
Union, NJ 07083
Phone: (908) 964 - 5303
Fax: (908) 964 6091
http://www.familylinknj.org/

good news is, the earlier its recognized the more

Helpful Hands

you can do to help your child reach her full

65 Willowbrook Boulevard
nd
2 Floor
Wayne, NJ 07470
Phone: (973) 256 - 8484
Fax: (973) 256 - 1233
http://www.nreic.org/

potential.

You Know Best

As a parent, you know your child best. If your child

is not meeting the milestones for his or her age, or

Mid-Jersey CARES

if you think there could be a problem with the way

2 King Arthur
Court
Suite B
North Brunswick,
NJ 08902
Phone: (732) 937
- 5437
Fax: (732) 937 5540
http://cjfhc.org/

your child plays, learns, speaks, or acts, talk to

your childs doctor and share your concerns.
Dont wait.
Contact the New Jersey Early Intervention System
today - (888) 653-4463.

Act Early

Understanding your childs development

725 Airport Road

Suite 1C
Lakewood, NJ
08701
Phone: (732) 363 5400
Fax: (732) 363 5554
http://cjfhc.org/

Southern New Jersey

Regional Early
Intervention
Collaborative
1044 South Route 73
Suite A
Berlin, NJ 08009
Phone: (856) 768 - 6747
Fax: (856) 768 - 2059
http://www.snjreic.org/

Prepared by the Raritan Valley Community

College Nursing Program.

Act Early by Talking to Your Childs

Doctor if Your Child:
Your Baby at 2 Months

Your Baby at 1 Year

Your Baby at 4 Years

Doesnt respond to loud sounds

Doesnt watch things as they move
Doesnt smile at people
Doesnt bring hands to mouth
Cant hold head up when pushing up when on tummy

Your Baby at 4 Months

Doesnt watch things as they move

Doesnt smile at people
Cant hold head steady
Doesnt coo or make sounds
Doesnt bring things to mouth
Doesnt push down with legs when feet are placed on a
hard surface
Has trouble moving one or both eyes in all directions
Your Baby at 6 Months

Doesnt try to get things that are in reach

Shows no affection for caregivers
Doesnt respond to sounds around him
Has difficulty getting things to mouth
Doesnt make vowel sounds (ah, eh, oh)
Doesnt roll over in either direction
Doesnt laugh or make squealing sounds
Seems very stiff, with tight muscles
Seems very floppy, like a rag doll

Your Baby at 9 Months

Doesnt bear weight on legs with support

Doesnt sit with help
Doesnt babble (mama, baba, dada)
Doesnt play any games involving back-and-forth play
Doesnt respond to own name
Doesnt seem to recognize familiar people
Doesnt look where you point
Doesnt transfer toys from one hand to the other

Doesnt crawl
Cant stand when supported
Doesnt search for things that she sees you hide.
Doesnt say single words like mama or dada
Doesnt learn gestures like waving or shaking head
Doesnt point to things
Loses skills he once had

Your Baby at 18 Months

Doesnt point to show things to others

Cant walk
Doesnt know what familiar things are for
Doesnt copy others
Doesnt gain new words
Doesnt have at least 6 words
Doesnt notice or mind when a caregiver leaves or
returns

Your Baby at 2 Years

Doesnt use 2-word phrases (for example, drink milk)
Doesnt know what to do with common things, like a
brush, phone, fork, spoon
Doesnt copy actions and words
Doesnt follow simple instructions
Doesnt walk steadily
Loses skills she once had
Your Baby at 3 Years
Falls down a lot or has trouble with stairs
Drools or has very unclear speech
Cant work simple toys (such as peg boards, simple
puzzles,
turning handle)
Doesnt speak in sentences
Doesnt understand simple instructions
Doesnt play pretend or make-believe
Doesnt want to play with other children or with toys
Doesnt make eye contact

Cant jump in place

Has trouble scribbling
Shows no interest in interactive games or make-believe
Ignores other children or doesnt respond to people
outside
the family
Resists dressing, sleeping, and using the toilet
Cant retell a favorite story
Doesnt follow 3-part commands
Doesnt understand same and different
Doesnt use me and you correctly
Speaks unclearly
Loses skills he once had

Your Baby at 5 Years

Doesnt show a wide range of emotions

Shows extreme behavior (unusually fearful, aggressive,
shy or sad)
Unusually withdrawn and not active
Is easily distracted, has trouble focusing on one activity
for more than 5 minutes
Doesnt respond to people, or responds only
superficially
Cant tell whats real and whats make-believe
Doesnt play a variety of games and activities
Cant give first and last name
Doesnt use plurals or past tense properly
Doesnt talk about daily activities or experiences
Doesnt draw pictures
Cant brush teeth, wash and dry hands, or get undressed
without help
Loses skills he once had