Running head: FAMILY ASSESSMENT 1

Family Assessment of a Child with Polymicrogyria

Madison Krekow
California State University Stanislaus












FAMILY ASSESSMENT 2

Family Assessment of a Child with Polymicrogyria
In the field of pediatric nursing, care is not only provided to the child but the family as
well. Family centered care is an essential part of providing competent and outstanding care for
the child. A family and child assessment of pediatric patients provides essential information
about family dynamics and roles, health of the child, and provides a crucial opportunity to teach
the patient and family. On October 4, 2012 the interviewer met with Brittany and her daughter,
Kenzie to perform a family and child assessment. Kenzie, a four year old girl, has
polymicrogyria (PMG), a rare neurological disorder. According to Barkovich (2010), PMG is a
malformation of the cortex that occurs during gestation which results in many abnormally small
gyri. Kenzie presents with the classic symptoms of PMG that include, epilepsy, developmental
delay both physically and cognitively, and hemiparesis (Chang, Walsh, Apse, & Bodell, 2007).
Kenzies family is very involved in each others lives, and her extended family has
played an important role in raising her. Her mother Brittany is 21, and is a nursing student at
CSU Stanislaus. Brittany works at Old Navy and likes the job because it allows her to have a
flexible schedule. Dylan, who is also 21, is Kenzies father and is an EMT. Dylan likes his job
but he works 12 hour day shifts on the weekend so he and Brittany feel like they do not spend
enough time together. Mari Anne, Brittanys mother, is 51, received her bachelors degree in
education and is an elementary school teacher. Mari Anne likes her job, but is now ready to
retire. Jerald, who is Brittanys father, is 51 and works as a firefighter engineer for the country.
Jerald likes his job but is also ready to retire. Dylans mother, Dacia, is 51 and is a teachers aide
at a school for deaf children. Dacia is deaf herself and communicates through sign language (B.
Treat, personal communication, October4, 2012).
FAMILY ASSESSMENT 3

Dylan and Brittany are the primary providers of care for Kenzie, but Kenzies
grandparents provide care on the weekends when they work. Dylan and Brittany are in a
committed relationship but each live in their parents houses. Kenzie shares a room with her
parents at both of her houses. Brittany is the parent that functions as the rule-maker in the
relationship (B. Treat, personal communication, October4, 2012). The interviewer noted that her
parenting style is authoritative. When Kenzie is doing a behavior that is perceived as bad,
Brittany explains why Kenzie is not supposed to do that particular behavior and labels the
behavior as bad rather than the child. Her discipline is firm and consistent while never making
the child feel like love will be revoked (Hockenberry & Wilson, 2009, p. 40). Dylans parenting
style is more permissive than Brittanys. He is reluctant to provide discipline and functions as a
playmate for Kenzie. Kenzie loves to rough house with her rather but has a closer bond with
Brittany and goes to her for comfort when she feels upset.
Brittany and Dylan both love Kenzie very much but when they first learned of Brittanys
pregnancy their feelings were very different. Brittany said that when she became pregnant at 16,
she went through incredible depression and denial. It took Brittany 5 months of pregnancy
before telling her mother and seeking prenatal care (B. Treat, personal communication,
October4, 2012). Upon viewing the interaction between Kenzie and Brittany, the interviewer
noted that Brittany seems overwhelmed at times, and the relationship between mother and
daughter seems strained. Brittany admits that while Kenzie is a blessing, she causes a lot of
stress and pressure in her life. Brittany also feels slightly responsible for Kenzies PMG due to
the prolonged amount of time before she got prenatal care (B. Treat, personal communication,
October4, 2012).
FAMILY ASSESSMENT 4

The function of health care in this family plays a central role. Brittany has type I diabetes
mellitus and Kenzie has PMG, so they both have frequent trips to the pharmacy, the
endocrinologist, and neurologist. The family defines health as having Brittanys blood sugar in
control and Kenzie without seizures. Brittany has negative feelings towards the endocrinologist
and neurologist because she feels that they never have the answers to the questions she asks
about herself and her daughter. Their daily diet consists of a lot of processed food because time
to prepare food for dinner is spare and they prefer to spend it together rather than cooking.
While they dont have time to cook now, Brittany feels that in the future she would like a garden
so that she can make fresh food for herself and her family. The family level of exercise has
decreased in the last two years because Dylan and Brittany are both working, in school, and have
Kenzie. Neither Brittany nor Dylan uses any tobacco products and both only consume alcohol
occasionally on the weekends (B. Treat, personal communication, October4, 2012).
Kenzie is a four year old girl that is approximately three feet tall and around 32 pounds
per Brittanys report. Her clothes and hair are clean except the spots of saliva that are on the
front of her shirt. Her teeth are clean and white with no obvious dental carries visible. Kenzies
language development is behind that of a typical four year old. She is not able to speak orally
due to PMG but rather uses sign language as her primary form of communication. When
comparing the 200 signs she uses to the 1500 word vocabulary of another 4 year old, it
demonstrates how severely her development is delayed linguistically. Kenzies temperament is
very similar to that of a toddler. Like a toddler, Kenzie has frequent temper tantrums due to her
inability to communicate all of her thoughts (Hockenberry & Wilson, 2009). Kenzie shows
aggression towards others and frequently hits others when she feels angry. Kenzie is
appropriately developed for her age within her sexual identity. Before bed, Kenzie watches
FAMILY ASSESSMENT 5

Brittany and Dylan kiss, and proceeds to ask Dylan for a kiss (B. Treat, personal communication,
October4, 2012). This is an example of Sex Typing, according to Hockenberry and Wilson
(2009), children at four years of age will often imitate their parents as a mechanism to develop
their own sexual identity. Kenzies style of play is consistent with 1-3 year olds rather than a
four year old child. She utilizes a parallel style of play, where she plays alongside another child,
but does not play with the child (Hockenberry & Wilson, 2009).
Kenzies development of gross and fine motor skills is variable. Kenzie cannot ride a
tricycle, which most children master at three years of age. While she can run and hop on one
foot like a typical four year old, she cannot catch a ball or throw a ball with her right hand. Part
of her PMG diagnosis means that Kenzie has hemiparesis and has severe developmental delay
with her right hand (Chang, Walsh, Apse, & Bodell, 2007). She has just begun to make a pincer
grasp with her right hand, which is a task that a typical child masters and 10 months of age.
Kenzie also has severe disability with the use of her mouth and cannot say any words orally.
Kenzie can hold a cup, but cannot drink from it and cannot use a straw. She refuses to drink out
of anything but a sippy cup (B. Treat, personal communication, October4, 2012).
Kenzies psychosocial development is appropriate for her age. During the preschool
years, children encounter a phase of initiative vs. guilt where a child feels accomplished when he
or she is curious and learning but feels very guilty if the rules are broken when doing so
(Hockenberry & Wilson, 2009). Kenzie is very active in exploring her world and if she realizes
she has broken a rule, she feels obviously guilty and will put herself in timeout recognizing her
own digression (B. Treat, personal communication, October4, 2012). Kenzies development is
appropriate cognitively, and it closely mirrors that of other four year olds. The main cognitive
development that occurs during this age is the transition from egocentric thought to social
FAMILY ASSESSMENT 6

awareness, and a better understanding of the concept of time (Hockenberry & Wilson, 2009).
Kenzie has begun to understand that when she hits others that it hurts them, rather than just
hitting out of frustration. The awareness that she may hurt others through her actions
demonstrates the development of social awareness. Kenzies perception of time has become more
defined as she has started preschool and follows a schedule. She knows that first comes,
breakfast, then lunch, and finally dinner. At four years old, most childrens conception of time
also follows the idea of meal times (Hockenberry & Wilson, 2009). Kenzies Moral
development is appropriate for her age. In the preschool age group, there is a punishment and
obedience orientation, in which children associate punishment with bad acts and lack of
punishment with good acts (Hockenberry & Wilson, 2009). Kenzie knows that hitting and biting
others is bad, and recognizes it as bad because her parents have labeled that action as such. In the
event that Kenzie hits another person, she is assigned to a time out until she is no longer angry
and ready to apologize to the person that she hurt (B. Treat, personal communication, October4,
2012).
For this family, it is essential to provide teaching to improve Kenzies growth while
taking into consideration her development delay due to PMG. For nutrition, Kenzies parents
should see her neurologist about whether or not starting a Ketone diet would prevent seizures. A
Ketogenic diet is one that is very low in carbohydrates and high in protein and has been used
clinically for years (Maalouf, Rho, & Mattson, 2009). According to Maalouf, Rho, and Mattson
(2009), the ketogenic diet has been clinically proven to reduce the number of seizures
experienced by patients by 50% and has neuroprotective properties that prevent the degradation
of neurons. To improve Kenzies physical well-being, the parents should assess Kenzies
readiness for toilet training. They should be taught the signs of readiness include: dry diapers for
FAMILY ASSESSMENT 7

greater than 2 hours, communicates when wet or has the urge, displays curiosity of others toilet
habits, and shows impatience with soiled diapers (Hockenberry & Wilson, 2009). To ensure that
Kenzies social development continues to progress, her parents should be taught how to handle
her frequent temper tantrums in a safe way. If her behavior is not harmful to herself or another,
the parent should ignore the behavior while remaining within close proximity of the child to
promote safety and instill a sense of security within Kenzie. After the temper tantrum has
subsided, they should provide the child with comfort and love (Hockenberry & Wilson, 2009,
p.421). For parent teaching regarding issues of safety, parents should place Kenzies fruit
flavored seizure medication locked high away out of her reach. When children like the taste of
their medications, they often seek them out and can easily overdose causing immense danger and
potentially death (Hockenberry & Wilson, 2009, p. 432).
The resources that a family possesses often dictate the quality of healthcare and
the quality of their entire lives. The high education, the middle-class financial standing, and the
goals of Kenzies parents for their future careers all lend themselves to a strong source of internal
influences. Kenzie also has a large network of external influences that is provided by Valley
Mountain Regional Therapy. They provide speech, occupational, and physical therapy in home
free of charge. Kenzies speech, gross, and fine motor control have all greatly improved thanks
to the Valley Mountain Regional Therapy (B. Treat, personal communication, October4, 2012).
In pediatric nursing, assessments do not just consist of the patient but the family as well.
They provide essential information about family function, healthcare function, the health of the
child, and resources the family has available to them. These assessments provide opportunities
to teach the patient and family essential information, and without them the nursing profession
would suffer greatly.
FAMILY ASSESSMENT 8

References
Barkovich, J.A. (2010). Current concepts of polymicrogyria. Neuroradiology, 52, 479-487.
Chang, B., Walsh, C. A., Apse, K., & Bodell, A. (2007). Polymicrogyria overview. Retrieved
from National Center for Biotechnology Information website:
http://www.ncbi.nlm.nih.gov/books/NBK1329/
Hockenberry, M. J., & Wilson, D. (2009). Essentials of pediatric nursing. Mosby Elsevier: St.
Louis, MO.
Maalouf, M., Rho, J. M., & Mattson, M. P. (2009). The neuroprotective properties of calorie
restriction, the ketogenic diet, and ketone bodies. Brain Research Reviews, 59, 293-315.