Issue #19 – “How To” Series

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:

1. activity and muscle tone
2. pulse (heart rate)
3. grimace response (medically known as “reflex irritability”)
4. appearance (skin coloration)
5. 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 (pulse)	Normal (above 100 beats per minute)	Below 100 beats per minute	Absent (no pulse)
Breathing (rate and effort)	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 (muscle tone)	Active, spontaneous movement	Arms and legs flexed with little movement	No movement, “floppy” tone
Appearance (skin coloration)	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!

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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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NASET’s “How To” Understand an APGAR Score for a New Infant CLICK HERE

NASET’s “How To” Understand Symptom Patterns and Causes in Children CLICK HERE

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