In This Issue:
How To Understand an APGAR Score for a New Infant
&
How To Understand Symptom Patterns and Causes in Children
The very first test given to a newborn, the Apgar score occurs right after your baby’s birth in the delivery or birthing room. The test was designed to quickly evaluate a newborn’s physical condition after delivery and to determine any immediate need for extra medical or emergency care.
Although the Apgar score was developed in 1952 by an anesthesiologist named Virginia Apgar, you may have also heard it referred to as an acronym for: Activity, Pulse, Grimace, Appearance, and Respiration.
The Apgar test is usually given to your baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Rarely, if there are concerns about the baby’s condition and the first two scores are low, the test may be scored for a third time at 10 minutes after birth.
Five factors are used to evaluate the baby’s condition and each factor is scored on a scale of 0 to 2, with 2 being the best score:
- activity and muscle tone
- pulse (heart rate)
- grimace response (medically known as “reflex irritability”)
- appearance (skin coloration)
- respiration (breathing rate and effort)
Doctors, midwives, or nurses add these five factors together to calculate the Apgar score. Scores obtainable are between 10 and 0, with 10 being the highest possible score.
Apgar Scoring |
|
||
|
Apgar Sign |
2 |
1 |
0 |
|
Heart Rate |
Normal (above 100 beats per minute) |
Below 100 beats per minute |
Absent |
|
Breathing |
Normal rate and effort, good cry |
Slow or irregular breathing, weak cry |
Absent (no breathing) |
|
Grimace (responsiveness or “reflex irritability”) |
Pulls away, sneezes, or coughs with stimulation |
Facial movement only (grimace) with stimulation |
Absent (no response to stimulation) |
|
Activity |
Active, spontaneous movement |
Arms and legs flexed with little movement |
No movement, “floppy” tone |
|
Appearance |
Normal color all over (hands and feet are pink) |
Normal color (but hands and feet are bluish) |
Bluish-gray or pale all over |
A baby who scores a 7 or above on the test at 1 minute after birth is generally considered in good health. However, a lower score doesn’t necessarily mean that your baby is unhealthy or abnormal. But it may mean that your baby simply needs some special immediate care, such as suctioning of the airways or oxygen to help him or her breathe, after which your baby may improve.
At 5 minutes after birth, the Apgar score is recalculated, and if your baby’s score hasn’t improved to 7 or greater, or there are other concerns, the doctors and nurses may continue any necessary medical care and will closely monitor your baby. Some babies are born with heart or lung conditions or other problems that require extra medical care; others just take a little longer than usual to adjust to life outside the womb. Most newborns with initial Apgar scores of less than 7 will eventually do just fine.
It’s important for new parents to keep their baby’s Apgar score in perspective. The test was designed to help health care providers assess a newborn’s overall physical condition so that they could quickly determine whether the baby needed immediate medical care. It was not designed to predict a baby’s long-term health, behavior, intellectual status, or outcome. Few babies score a perfect 10, and perfectly healthy babies sometimes have a lower-than-usual score, especially in the first few minutes after birth.
Keep in mind that a slightly low Apgar score (especially at 1 minute) is normal for some newborns, especially those born after a high-risk pregnancy, cesarean section, or a complicated labor and delivery. Lower Apgar scores are also seen in premature babies, who usually have less muscle tone than full-term newborns and who, in many cases, will require extra monitoring and breathing assistance because of their immature lungs.
If your doctor or midwife is concerned about your baby’s score, he or she will let you know and will explain how your baby is doing, what might be causing problems, if any, and what care is being given. For the most part, though, most babies do very well, so relax and enjoy the moment!
Introduction
When children experience serious social, emotional, physical, academic, psychological, language, perceptual, or environmental problems, the tension from these issues exhibits itself in the form of behavioral symptoms. These would be the first thing teachers notice and should understand that they are behavioral symptoms which indicate a more serious underlying problem. What follows is a series of problem areas that children may encounter and what kind of symptoms may exhibit themselves in the classroom.
SYMPTOM PATTERN POSSIBLE CAUSE
Intellectual Symptom Patterns
low academic achievement low functioning, limited capacity
short attention span low functioning-unable to maintain focus
confusion over directions low functioning resulting in limited memory
difficulty following directions low functioning resulting in difficulty grasping concepts
concrete thinker/trouble with
abstract concepts
asks things to be repeated constantly
Academic ( Achievement) Symptom Patterns
low academic achievement poor skill development
procrastinates low skills result in avoidance
brings home unfinished work low skills reduce productivity
poor computational math poor basic fact skills
poor written spelling
reading on grade level adequate reading skills
uses fingers to count poor math skills/basic facts
Psychological Symptom Patterns
short attention span- affected by possible tension
confusion over directions anxiety reduces memory
reticent behavior fear of reaction
disorganized high anxiety
trouble getting started avoidance behavior
trouble handing in assignments avoidance behavior
makes excuses fear of failure, low energy
procrastinates avoidance behavior
brings home unfinished work high anxiety slows productivity
squinting tic disorder, high levels of tension
stubborn low self esteem, fear of reaction
Social Symptom Patterns
stays alone during recess
argumentative towards peers
intrusive
trouble following rules during games
sarcastic towards peers
fights with others
tries anything to be like
Environmental Symptom Patterns
reticent behavior critical household, symbiotic relationship, older siblings taking control
comes in tired all the time
daydreams early in the day
resistance to leaving school
extreme fear of notes going home
never talks about family
Medical Symptom Patterns
confusion over directions hearing problems
poor handwriting neurological or physical limitations, visual problems
difficulty following directions hearing problems
disorganized neurological impairment
poor written spelling neurological or physical limitations, visual problems
difficulty in art neurological, vision problems
difficulty in physical activities neurological or physical limitations, vision problems, depth perception
squinting vision problems
Language Symptom Patterns
confusion over directions processing problems
trouble labeling things
asks things to be repeated constantly
uses wrong words
confuses words in sentences
hesitates when expressing ideas
Perceptual Symptom Patterns
awkward gait
large and fine motor difficulties
poor auditory memory
confusion over directions auditory memory problems
poor handwriting visual motor difficulties
difficulty following directions auditory reception, auditory association or memory problems
disorganized processing limitations
poor written spelling visual motor problems, auditory memory to motor difficulties
difficulty in art fine motor problems, visual motor problems
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