Purpose
For This Activity You Will Need
Points to Consider
Handout Program Planning Stories
Handout Anemia Screening
Handout Immunizations
Handout Developmental Screening
Handout Nutrition Assessment

Purpose: This activity illustrates how information from screenings, exams, and assessments can affect plans for classroom interventions and parent education.

For this activity you will need:

• Handout: Program Planning Stories #1-#4. Separate the stories and attach to each story the corresponding fact sheets.
• [Handout: Anemia Screening
• Handout: Immunizations
• Handout: Developmental Screening
• Handout: Nutrition Assessment]

Step 1: Explain that participants will be part of an interdisciplinary team conference to review screening and assessment results and develop program plans.

Step 2: Divide participants into four groups: #1, #2, #3, and #4. Instruct each group to begin by...

• having each participant identify his role and function within the interdisciplinary team conference.
  • Each group should have a representative of health, disabilities, social service, education, and family involvement functions.
  • Participants may or may not choose to play their actual roles.
• assigning a "recorder" who will report back to the large group.

Step 3: Distribute to Group #1 the Program Planning Story #1 with its attached fact sheet (Anemia) that corresponds to that story. Distribute the handouts in the same manner to Groups #2, #3, and #4.

Step 4: Allow the groups 15 minutes to review their stories and the fact sheets and then develop a program plan to meet the needs of the situation. Address the following questions:

• What else might you need to know?
• What are some sources of information among the families, community, and health professionals?
• What is the role of the parents? What parent education would you provide?
• What is the role of Head Start staff? What classroom interventions might you make?
• How would you document and follow up your program plan?

Step 5: Bring the groups back together. Have each recorder read the story aloud and summarize that group's plan.

Encourage other participants to add their comments.

Step 6: Ask participants to describe some health problems that many children in your program have experienced.

• Have you done interdisciplinary team conferences to discuss the problems?
• What kinds of classroom-wide, multifamily, and/or community interventions have you tried to address these common health problems?
• Who has been helpful within the program and outside the program?
• Has this activity given you any ideas about new strategies that you might like to try to address common health problems?

Points to Consider:

• When several children and families in the program have the same health problem, programs should consider what classroom, multifamily, and community interventions could help. These might include education and advocacy.
• To address health problems, programs should obtain all of the necessary information about the causes and possible interventions for the problem.
• Sources of information on health issues include program staff, parents, local health care providers, departments of public health, health consultants, and regional/national health agencies.
• It is important that the parents and key staff understand:
  • the results of the screenings and exams, the diagnoses, and the recommended treatment and follow-up;
  • the measures to take at home and school to treat and prevent the problem; and
  • the importance of comprehensive well-child health care, beyond addressing the identified health problem.
• Discussions with families should be sensitive to their knowledge, beliefs, practices, living situation, and resources.
• Careful documentation is crucial to facilitate comprehensive review and appropriate assessment, treatment, and follow-up to meet each child's health needs.

Story #1:	Six children in your Early Head Start program were diagnosed with anemia, some of which are fairly severe cases. All six were found to have iron- deficiency anemia, and four were found to have lead poisoning.
Story #2:	Seven children on your Family Service Worker's caseload are not up-to- date on their immunizations. Many of the families have immigrated from other countries.
Story #3:	Four children in your preschool classroom have difficulty engaging in activities and relationships. During circle time, they tend to stare off into the air and not participate in the songs or discussions. They frequently wander from one activity to another without getting involved. They also haven't seemed to form friendships with other children or teachers.
Story #4:	Six three- to five-year-olds in your center were found to be significantly overweight on their physical exam. The parents tell you that most of what they eat is "fast food," chips, cookies, and soda.

Well-Child Health Care Fact Sheet

Anemia Screening (Hemoglobin/Hematocrit)

What is anemia?

Our bodies need oxygen for energy and growth. Red blood cells, hemoglobin, and iron carry oxygen through the blood to the body. Anemia is when the body does not have enough red blood cells, iron, or hemoglobin. It can slow a child's energy, growth, and development.

How do you screen for anemia?

Anemia screening is a blood test, usually a finger-prick, to check the amount of hemoglobin (or hemat- ocrit) in the blood. It is done by a trained health professional at a clinic, doctor's office, health depart- department, lab, or Head Start.

What might I observe?

Many children with anemia have no symptoms at all.

You might notice:

• Pale skin
• Tiredness
• Lack of appetite
• Frequent illness
• Slow growth and development

Follow-up to anemia screening

If screening shows a hemoglobin level less than 11 or a hematocrit less than 34, the child needs follow- up evaluation and treatment by a health care provider.

Causes of anemia might include:

• Not eating enough iron-rich foods
• Drinking too much milk in place of iron-rich foods
• Sickle cell disease
• Intestinal parasites
• Lead poisoning
• Severe illness
• Loss of blood

Treatment might include:

• Nutrition counseling and diet changes
• Iron supplements or iron-enriched vitamins
• Treatment of other conditions causing anemia

Anemia can delay a child's growth and development. Early diagnosis and treatment of anemia can help improve the child's health and development.

Well-Child Health Care Fact Sheet

Immunizations

What are immunizations?

Immunizations are vaccines or "shots" that protect children from serious illnesses. The illnesses can cause pneumonia, liver cancer, brain damage, and death. A child should receive immunizations for ten diseases:

Immunization	Disease
DTP	Diphtheria, tetanus, pertussis (whooping cough)
OPV or IPV	Polio
MMR	Measles, mumps, rubella (German measles)
HIB	Hemophilus influenza B
HBV	Hepatitis B
VZV	Varicella (chicken pox)

How are immunizations given?

Immunizations are injections or shots, except the polio vaccine which is usually a syrup given by mouth. They are given by a health professional at a doctor's office, clinic, or Head Start site. They require one or more doses.

They should be given at the following ages:

• Birth
• 2, 4, 6, 12, and 15 to 18 months of age
• Before kindergarten (4 to 6 years of age)

Are immunizations safe?

Health experts agree that immunizations are far safer than the diseases they cause. A child may have soreness, low-grade fever, or fussiness for one or two days. Complications like high fever and seizures are very rare. Parents should call their health care provider for any serious reaction.

Are all the immunizations necessary?

Children entering Head Start must be up-to-date with the immunizations required by Head Start and local/state child care regulations. As new vaccines are developed, requirements may change.

If a child is behind on immunizations, he should be referred to a health care provider to catch up. Rarely, exemptions may be given for medical reasons or the family's personal beliefs.

Immunizations protect children from severe diseases. We still have deadly epidemics because many children are not immunized on time.

Well-Child Health Care Fact Sheet

Developmental Screening

What is developmental screening?

Developmental screening helps identify a child's strengths and needs in development and mental health.

It assesses a child's temperament, behavior and skills such as:

• Understanding and thinking
• Emotional, social, and communication skills
• Physical coordination and self-help skills

How is developmental screening done?

Developmental screening may be done by a mental health professional, health care provider, or trained Head Start staff. Standardized developmental checklists and tests may be used

Information is gathered by:

• Talking with parents and teachers
• Observing the child
• Having the child answer questions and complete tasks

What might I observe?

• Difficulty understanding, communicating, or doing things expected at that age
• Extreme moods: anger, sadness, lethargy, restlessness, anxiety
• Difficulty with social behavior: fighting, biting, not interacting with other children or adults

Follow-up to developmental screening

If screening results are outside "normal range" for her age, the child needs follow-up evaluation by her health care provider. Evaluation may involve a mental health consultant, developmental center, or local education agency (LEA).

Intervention might include:

• Special education or early intervention services
• Speech therapy
• Physical and occupational therapy
• Mental health counseling/consultation for the child, family, and staff

Early intervention for developmental and mental health concerns can help improve a child's skills and well-being.

Well-Child Health Care Fact Sheet

Nutrition Assessment

What is nutrition assessment?

The nutrition assessment reviews the child's eating and growth patterns. A child's diet can affect how she grows, develops, looks, and feels.

How is nutrition assessment done?

Nutrition assessment is usually done by trained Head Start staff with consultation from a nutritionist.

It includes:

• Discussion with the family about the child's eating habits, food allergies, feeding problems, and special dietary needs
• Review of the child's growth-height, weight, and head circumference (for infants)
• Review of other screening results-medical/physical exam, hemoglobin/hematocrit, lead, sickle cell, intestinal parasites

What might I observe?

You might notice a child who:

• Looks very short, thin, large, or overweight
• Looks pale or tired
• Eats very little, too much, or prefers non-nutritious foods like sweets, candy, and junk food
• Has chronic illnesses such as allergies, diabetes, HIV/AIDS, or intestinal parasites

Follow-up to nutrition assessment

If nutrition assessment finds inadequate diet (e.g., too little, too much, or unhealthy foods), growth problems (e.g., failure to thrive or overweight), or anemia, the child should be referred to a health care provider for evaluation and treatment.

Treatment may include:

• Referral to a nutritionist
• Counseling for parents and Head Start staff on the types and amounts of food the child should eat and recommended amount of physical activity
• Iron supplements or iron-enriched vitamins
• Treatment of medical conditions causing nutritional and growth problems

How a child eats can affect how she grows, develops, looks, and feels. Nutrition assessment and counseling can promote healthy growth and development.