Chapter 8 Lifespan Development

Chapter 8 Lifespan Development
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Objectives Image source: clipart.com

Lifespan Lifespan The period during which something is functional
In humans, lifespan is the period from birth to death. Lifespan refers to the period during which something is functional. For example, the lifespan of a battery means the amount of time the battery will last. In humans, lifespan is the period from birth to death.

Human Development Human development is the process of growing to maturity Infancy – birth to 12 months Toddler – 12 to 36 months Preschooler – 4 to 5 years School-age – 6 to 12 years Adolescence – 13 to 18 years Early adulthood – 20 to 40 years Middle adulthood – 41 to 60 years Late adulthood – 61 years and older Human development is the process of growing to maturity.

Milestones Physiologic Cognitive Psychosocial
Each stage of human development is accompanied by physiologic, cognitive, and psychosocial milestones. Physiologic milestones pertain to growth, body system changes, and changes in vital signs. Vital signs are measurements of breathing, pulse, skin temperature, pupils, and blood pressure. Cognitive changes pertain to mental processes such as reasoning, imagining, and problem-solving. Psychosocial milestones pertain to personality, emotions, social interactions and expectations.

Infants Each stage of human development is accompanied by physiologic, cognitive, and psychosocial milestones.

Physiologic Changes Birth – usually weighs about 7 pounds
Doubles birth weight by 3 to 4 months Triples birth weight by end of first year Length Usually about 19 to 20 inches long at birth Reaches about 29 to 30 inches at 12 months A North American infant usually weighs about 7 pounds (3.2 kilograms) at birth, doubles his birth weight by 3 to 4 months of age, and triples it by the end of the first year. An infant is usually about 19 to 20 inches long (48 to 51 centimeters) at birth, reaching about 29 to 30 inches (74 to 76 centimeters) at 12 months. Infants will usually sleep 16 to 18 hours per day with sleep and wakefulness evenly distributed over a 24-hour period. Sleep requirements gradually decrease to 14 to 16 hours per day, with 9 to 10 hours of sleep-time occurring at night. Most infants sleep through the night at 2 to 4 months. An infant is usually easily arousable from sleep.

Physiologic Changes Top-heavy appearance
Chest circumference less than head circumference About 9 to 10 months, circumference of head and chest are about the same After 1 year of age, chest larger Image source: Microsoft clipart The head and trunk of an infant and young child is large in proportion to the rest of the body, giving the child a “top heavy” appearance. The chest circumference of an infant’s head is usually less than the head circumference. By about 9 or 10 months, the circumference of the head and chest are about the same. After 1 year of age, the chest circumference is larger. Growth of the hips, legs, and feet catches up in later childhood.

Physiologic Changes Head may be misshapen during vaginal delivery
Fontanels (soft spots) present on top and back of the head “Gaps” in the bones of the head Allow flexibility during delivery and growth of the brain At birth, the heads of many newborns are misshapen because of the molding of the head that occurs during vaginal deliveries. Molding is possible because of small diamond-shaped openings called fontanels (soft spots) that are present on both the top and back of the head. Fontanels are “gaps” in the bones of the head of an infant, which allow flexibility during delivery and growth of the brain. These areas will not completely close until about 6 months of age for the rear fontanel and 18 months for the top one.

Physiologic Changes Reflexes Feeding reflexes Moro reflex
Rooting Sucking Moro reflex Palmar grasp reflex Image source: Microsoft clipart Newborns possess a number of reflexes, which are involuntary responses to a stimulus. Touching a baby’s cheek stimulates a feeding reflex called the rooting reflex and causes the baby to turn its mouth toward the side that was touched and start to suck. This reflex usually disappears after 4 months. The sucking reflex, another feeding reflex, causes a newborn to suck (such as a nipple, fingers, or toes) when its lips are touched. This reflex is present throughout infancy. If the newborn’s hearing is intact, he will react with a startle to a loud noise (the Moro reflex). In contrast, the rhythmic, soothing sound of a lullaby or heartbeat will put an infant to sleep. The palmar grasp reflex, which disappears after 3 months, occurs when a small object is placed against the palm of the hand, causing the fingers to curl around it.

Physiologic Changes Senses
At birth, the most developed of the senses is hearing. Sight is the least developed sense. Image source: Microsoft clipart At birth, the most developed of the senses is hearing and the least developed is sight. Within days, an infant will recognize the sound of his mother’s voice and turn toward it. Newborns are able to smell and some quickly recognize the smell and handling of their caregiver. They are also sensitive to pain and extremes of temperature. Most newborns respond positively when touched, held, and cuddled. An infant’s response to pain is similar to that of an older child.

Physiologic Changes Heart rate
Between 100 and 160 beats per minute during first 30 minutes of life Slows to about 120 beats per minute Heart rate is usually between 80 and 140 beats per minute during first year. The heart rate of the newly born is usually between 100 and 160 beats per minute during first 30 minutes of life, and slowing to about 120 beats per minute. In the first year of life, an infant’s heart rate is usually between 80 and 140 beats per minute.

Physiologic Changes Respiratory rate
Usually between 40 and 60 breaths per minute Drops to about 30 to 40 breaths per minute after first few minutes of life, and slowing to 20 to 30 breaths per minute by one year. The respiratory rate of the newly born is usually between 40 and 60 breaths per minute, dropping to about 30 to 40 breaths per minute after first few minutes of life, and slowing to 20 to 30 breaths per minute by one year.

Physiologic Changes Respiratory anatomy
In general, all structures are smaller. More easily blocked than in adults Nasal passages Soft and narrow Have little supporting cartilage Image source: Microsoft clipart The respiratory anatomy of infants and young children differs from that of older children and adults. In general, all structures are smaller. Because they are smaller, they are more easily blocked than in adults. The nasal passages are soft and narrow and have little supporting cartilage.

Physiologic Changes Tongue takes up proportionally more space in the mouth of a child than in an adult Tracheal rings are softer and more flexible Chest wall is softer and more elastic Fewer and smaller alveoli Depend more heavily on the diaphragm for breathing The tongue takes up proportionally more space in the mouth of a child than in an adult. The tracheal rings are softer and more flexible in infants and children. This puts the airway at risk of compression if the neck is not positioned properly. The chest wall of an infant and young child is softer and more elastic than that of an older child and adult. This is because it is made of more cartilage than bone. Children also have fewer and smaller alveoli. Thus, the potential area for exchanging oxygen and carbon dioxide is less. Infants and young children depend more heavily on the diaphragm for breathing than adults. Air can build up in the stomach during rescue breathing or improperly performed CPR. As a result, the stomach swells with air, movement of the diaphragm is limited, and effective breathing is reduced.

Physiologic Changes Nervous system
Significant growth during first year Neurons (nerve cells) grow and form increasingly dense connections Enables faster and more efficient message transmission An infant’s nervous system undergoes significant growth during the first year of life. Neurons (nerve cells) grow and form increasingly dense connections, enabling faster and more efficient message transmission. As the nervous system develops, motor skills progress from simple reflexes to increasingly complex activities such as grasping, reaching, crawling, standing, and walking.

Physiologic Changes Skin Susceptible to changes in temperature
Large body surface area Skin is thin with few fat deposits Poorly developed temperature-regulating mechanisms Infants and young children are susceptible to changes in temperature. A child has a large body surface area (BSA) compared with his weight. The larger the BSA that is exposed, the greater the area of heat loss. An infant’s skin is thin with few fat deposits under it. This condition contributes to an infant’s sensitivity to extremes of heat and cold. Infants have poorly developed temperature-regulating mechanisms. For example, newborns are unable to shiver in cold temperatures. In addition, their sweating mechanism is immature in warm temperatures. Because infants and children are at risk of hypothermia, it is very important to keep them warm.

Cognitive Changes 2 to 6 months Increasingly aware of surroundings
Begins to explore own body Should make eye contact by 6 months Between 6 and 12 months Begins looking for things not in sight By 12 months Speaks first understandable words Infants 2 to 6 months of age are increasingly aware of their surroundings and begin to explore their bodies. By 6 months, an infant should make eye contact. Lack of eye contact in a sick infant could be a sign of significant illness or depressed mental status. Between 6 and 12 months of age, an infant begins looking for things not in sight, such as a toy hidden under a pillow. Infants begin babbling at about 6 months of age. By 12 months many infants speak their first understandable words.

Psychosocial Changes Crying Pre-cry signals Basic cry Angry cry
Pain cry Image source: Microsoft clipart Crying is an infant’s method of communication. In fact, newborns spend about 1 to 4 hours each day crying. Babies cry for many reasons such as having a wet or soiled diaper, being hungry, tired, bored, lonely, hot or cold, or in pain. Crying may be preceded by signals such as anxious facial expressions, arms flailing, and excited breathing. Parents and researchers have identified three unique types of cries: the basic cry, the angry cry, and the pain cry. The basic cry begins softly and gradually increases in intensity, usually signaling that the infant is hungry or tired. The angry cry is more intense than the basic cry. The pain cry begins suddenly with a long burst of crying, followed by a long pause and gasping. When obvious reasons for crying have been addressed, persistent crying can be a sign of illness.

Implications for Healthcare Professionals
Young infants are unafraid of strangers and have no modesty. Older infants have separation anxiety. If possible, assess the baby on the caregiver’s lap. Handle the infant gently but firmly Support the head and neck if the baby is not on a solid surface Keep the infant warm Infants are completely dependent on others for their needs. Young infants (birth to 6 months of age) are unafraid of strangers and have no modesty. Older infants (6 months to 1 year of age) do not like to be separated from their caregiver (separation anxiety). They may be threatened by direct eye contact with strangers. They show little modesty. When providing care for an infant, watch the baby from a distance before making contact. If possible, assess the baby on the caregiver’s lap. Avoid loud noises; bright lights; and quick, jerky movements. Smile and use a calm, soothing voice. Allow the baby to suck on a pacifier for comfort, if appropriate. Be sure to handle an infant gently but firmly, always supporting the head and neck if the baby is not on a solid surface. An infant must be kept warm and covered as much as possible, particularly the head. The head is the largest BSA in infants and young children. Heat loss from this area significantly cools the rest of the body. Make sure your hands and stethoscope are warmed before touching the infant.

Toddlers (1-3 Years of Age)

Physiologic Changes Looks chubby Heart rate Respiratory rate
Relatively short legs Large head Heart rate Between 80 and 130 beats per minute Respiratory rate About 20 to 30 breaths per minute Image source: Laura S. Horowitz A typical toddler looks chubby with relatively short legs and a large head. A typical 2-year-old measures between 32 and 36 inches (81 to 91 centimeters), which is about half of his adult height. A toddler’s heart rate is usually between 80 and 130 beats per minute and his respiratory rate is about 20 to 30 breaths per minute.

Physiologic Changes Body systems continue to grow Respiratory system
Terminal airways continue to branch Alveoli increase in number Musculoskeletal system Muscle mass increases Bone thickness increases Nervous system Effortless walking Fine motor skills are developing A toddler’s body systems continue to grow and are relatively mature by the end of the toddler years. The terminal airways of the respiratory system continue to branch and the alveoli increase in number. In the musculoskeletal system, muscle mass increases and the bone thickness increases. Continued development of the nervous system allows effortless walking and other basic motor skills. Fine motor skills are developing, such as throwing a ball and scribbling. The brain has achieved 80% to 90% of its ultimate weight at 3 years of age.

Physiologic Changes Always on the move Prone to injury
Image source: EMSC Slide Set (CD-ROM) Courtesy of the Emergency Medical Services for Children Program, administered by the U.S. Department of Health and Human Service's Health Resources and Services Administration, Maternal and Child Health Bureau. A toddler is always on the move. As a result, toddlers are prone to injury. Remember that infants and toddlers are “top heavy,” the head is larger and heavier relative to the rest of the body. The skull of an infant and child is thin and flexible. When an infant or child suffers trauma to the head, force is more likely to be transferred to the brain instead of fracturing the skull. In infants and young children, the ligaments of the neck are underdeveloped and the muscles of the neck are relatively weak. In addition, young children have less muscle mass and more fat and cartilage than older children. Injuries to the spinal cord and spinal column are uncommon in infants and young children. When they do occur, children younger than eight years of age tend to sustain injury to the uppermost area of the cervical spine.

Physiologic Changes Immune system
More susceptible to minor respiratory and gastrointestinal infections A toddler is more susceptible to minor respiratory and gastrointestinal infections because the immunity that he had from his mother is lost. At this stage, immunity to common pathogens develops as exposure occurs. Many toddlers (and preschoolers) develop colds and minor infections because of their exposure to pathogens in group settings, such as daycare.

Physiologic Changes Digestive and urinary systems
Stomach capacity increases Voluntary control of elimination Toilet training Average age for completion is about 28 months Image source: Microsoft clipart The digestive system continues to develop and the stomach’s capacity increases, allowing for the typical schedule of three meals per day. An important development in the digestive and urinary systems is the voluntary control of elimination. A child is physiologically capable of toilet training by 12 to 15 months and psychologically ready between 18 and 30 months. The average age for completion is about 28 months.

Cognitive Changes 12 to 18 months Imitates older children and parents
Knows major body parts Knows 4 to 6 words 18 to 24 months Begins to understand cause and effect Can identify objects Talks in short sentences 24 months Knows about 100 words At 12 to 18 months, a toddler imitates older children and parents, knows major body parts, and knows 4 to 6 words. By 18 to 24 months, the child begins to understand cause and effect, can identify objects, and talk in short sentences. By 24 months, he knows about 100 words.

Psychosocial Changes Strong separation anxiety Temper tantrums
Can answer simple questions and follow simple directions However, you cannot reason with a toddler. Image source: Microsoft clipart A toddler responds appropriately to an angry or friendly voice. When separated from their primary caregiver, most toddlers experience strong separation anxiety. A toddler is easily frustrated and may have temper tantrums in an attempt to control others. A toddler can answer simple questions and follow simple directions. However, you cannot reason with a toddler.

Psychosocial Changes Comfort object Blanket Stuffed animal Toy
Afraid of: Being left alone Monsters Interruptions in their usual routine Getting hurt (such as a fall or cut) Image source: Laura S. Horowitz A toddler responds appropriately to an angry or friendly voice. When separated from their primary caregiver, most toddlers experience strong separation anxiety. A toddler is easily frustrated and may have temper tantrums in an attempt to control others. A toddler can answer simple questions and follow simple directions. However, you cannot reason with a toddler. A toddler is likely to be more cooperative if he is given a comfort object like a blanket, stuffed animal, or toy. They are afraid of being left alone, of monsters, of interruptions in their usual routine, and of getting hurt (such as a fall or cut).

Favorite words: no and mine Distrustful of strangers May scream, cry, or kick when touched Do not like having clothing removed Do not like anything on their faces Image source: Microsoft clipart Toddlers understand “soon,” “bye-bye, “all gone,” and “uh oh.” A toddler’s favorite words are no and mine, so avoid asking questions that can be answered with a yes or no. If you ask questions that begin with “May I,” or “Can I,” or “Would you like to,” a toddler will probably say no. If you then do whatever you asked them anyway, you will immediately lose the toddler’s trust and cooperation. Toddlers are distrustful of strangers. They are likely to resist examination and treatment. When touched, they may scream, cry, or kick. Toddlers do not like having their clothing removed and do not like anything on their faces.

Approach the child slowly Address him by name Talk to him at eye level Use simple words and short phrases Use a calm, reassuring tone of voice Assess the child’s head last Respect the child’s modesty Praise for the child for cooperative behavior Image source: Microsoft clipart Encourage the child’s trust by gaining the cooperation of his caregiver. When he sees you talking with the caregiver first and understands that the adult is not threatened, the child may be more at ease. When possible, allow the child to remain on the caregiver’s lap. If this is not possible, try to keep the caregiver within the child’s line of vision. Approach the child slowly and address him by name. Talk to him at eye level and use simple words and short phrases. Speak to him in a calm, reassuring tone of voice. Although the child may not understand your words, he will respond to your tone. Assess the child’s head last. Start with either his trunk or his feet and move upward. Respect the child’s modesty by keeping him covered. When it is time to remove an item of clothing, ask the child’s caregiver to do so, if possible. Replace clothing promptly after assessing each body area. Be sure to praise the child for cooperative behavior.

Image source: Microsoft clipart
(4-5 Years of Age)

Physiologic Changes Taller and thinner than a toddler Heart rate
Between 80 and 120 beats per minute Respiratory rate About 20 to 30 breaths per minute Hops, swings, climbs… Dresses self Brushes own teeth Image source: Microsoft clipart A preschooler appears taller and thinner than a toddler, which may be mistaken for weight loss by the child’s caregiver. The heart rate of a preschooler is usually between 80 and 120 beats per minute and his respiratory rate about 20 to 30 breaths per minute. A preschooler can stand on one foot for ten seconds or longer, hop, swing, climb, and may be able to skip. He begins to skate and swim by age 5. Most preschoolers can dress themselves and brush their own teeth.

Cognitive Changes Has a better understanding of time
Can count ten or more objects Increased attention span Vocabulary of about 1500 words Sentences now consist of 6 to 8 words Can correctly name at least four colors Can say his name and address Understands a 3-part request Children this age have a better understanding of the concept of time and can count ten or more objects. Their attention span increases and they have a vocabulary of about 1500 words. Sentences now consist of 6 to 8 words. A preschooler can correctly name at least four colors and can say his name and address. He understands a 3-part request such as, “find your teddy bear,” “pick it up,” and “bring it to me.” His speech is clearly understood by strangers.

Psychosocial Changes Likes to sing, dance, and act
Wants to be like his friends Certain that he knows everything May be rude when you ask him to do something he does not want to do Able to play more independently May be able to spend more time apart from caregiver Explores his body Finds playing “doctor” an interesting activity A child of this age likes to sing, dance, act, and wants to be like his friends. A preschooler is certain that he knows everything and may be rude when you ask him to do something he does not want to do. He is able to play more independently and may be able to spend more time apart from his caregiver without becoming too upset. Preschoolers explore their bodies and find playing “doctor” an interesting activity.

Afraid of adults who look or act mean Approach slowly Talk to the child at eye level Image source: EMSC Slide Set (CD-ROM) Courtesy of the Emergency Medical Services for Children Program, administered by the U.S. Department of Health and Human Service's Health Resources and Services Administration, Maternal and Child Health Bureau. Preschoolers are afraid of the unknown, the dark, being left alone, and adults who look or act mean. They may think their illness or injury is punishment for bad behavior or thoughts. Approach the child slowly and talk to him or her at eye level. Use simple words and phrases and a reassuring tone of voice. Assure the child that he or she was not bad and is not being punished. A preschooler may feel vulnerable and out of control when lying down. Assess and treat the child in an upright position when possible. Preschoolers are modest. They do not like being touched or having their clothing removed. When assessing a child, keep in mind that he has probably been told not to let a stranger touch him. Remove clothing, assess the child, and then quickly replace clothing. Allow the caregiver to remain with the child whenever possible.

Preschoolers are curious and like to "help.” Encourage the child to participate Preschoolers are highly imaginative Choose your words carefully Avoid baby talk Avoid frightening or misleading terms Dress and bandage wounds promptly Preschoolers are curious and like to "help.” Encourage the child’s participation. Tell the child how things will feel and what is to be done just before doing it. For example, a preschooler may fear being suffocated by an oxygen mask. It may be helpful to use a doll or a stuffed animal to explain the procedure. The child may want to hold or look at the equipment first. Avoid procedures on the child’s dominant hand or arm. Preschoolers are highly imaginative. When talking with a preschooler, choose your words carefully. Avoid baby talk and frightening or misleading terms. For example, avoid words such as take, cut, shot, deaden, or germs. Instead of saying, “I’m going to take your pulse,” you might say, “I’m going to see how fast your heart is beating.” Instead of saying, “I’m going to take your blood pressure,” you might say, “I’m going to hug your arm” or “I’m seeing how strong your muscles are.” Because they are afraid of blood, dress and bandage wounds promptly.

Ask about the child’s favorite: Ask the child to:
Distractions Ask about the child’s favorite: Foods Games Cartoon characters Movies Computer game Ask the child to: Visually locate an item in the area Sing a song Tell you about school Depending on the child’s age, you may find that distracting them is helpful. Remember that children are self-centered—they imagine that the world revolves around them. Paying attention to their world and needs will improve your ability to assess and care for your pediatric patients. Examples of distractions: Ask a child about his or her favorite foods, games, cartoon characters, movies, or computer game. Ask the child to visually locate an item in the area. Ask the child to sing a song or tell you about school. Use a stuffed animal as a distraction or comfort item.

School-Age Children (6-12 Years of Age)

Physiologic Changes Heart rate usually 70 to 110 beats per minute
Respiratory rate 20 to 30 breaths per minute Systolic blood pressure 80 to 120 mmHg Growth in height and weight continues Growth spurts begins before onset of puberty Fine motor skills continue to develop Baby teeth are lost and permanent teeth come in The heart rate of a school-age child is usually 70 to 110 beats per minute, respiratory rate is 20 to 30 breaths per minute, and the systolic blood pressure is 80 to 120 mmHg. Growth in height and weight continues to occur in the school-age child, but at a slower pace as compared with earlier years. Growth spurts, occurring in girls at age 10 and age 12 in boys, begins before the onset of puberty. The school-age child can run, ride a bicycle, climb, jump, hop, and skip. Fine motor skills continue to develop such as writing, drawing, working on puzzles, typing, playing the piano, and building model cars. During the school-age years, the baby teeth are lost and permanent teeth come in, giving an appearance of teeth that are too large for the child’s face.

Cognitive Changes Thinks logically
Able to see things from another’s point of view Ability to read is acquired The school-age child thinks logically and is able to see things from another’s point of view. An important skill, the ability to read, is acquired.

Psychosocial Changes Important to a school-age child: School
School-related activities Popularity Peer groups More interaction with adults and children Begins comparing himself with others Develops self-esteem Takes pride in learning new skills School, school-related activities, popularity, and peer groups are important to children of this age. Friendships are most common between children of the same age, gender, interests, and from the same race or ethnic group. The school-age child has more interaction with adults and children, begins comparing himself with others, develops self-esteem, and takes pride in learning new skills. At age 6 and 7, the child prefers playing with others of the same gender. By age 8 and 9, the child is interested in relationships with the opposite gender but will not admit it. Around age 10 to 12, the child begins developing interest in the opposite gender.

Psychosocial Changes Body image is important
Children with a chronic illness or disability are very self-conscious. Physical differences often result in taunts from other children Can have lasting effects Body image is also important to the school-age child. Children with a chronic illness or disability are very self-conscious. Physical differences, such as a bumpy nose, need for glasses, being overweight, or the wearing of a hearing aid often result in taunts from other children, and can have lasting effects.

Psychosocial Changes Begins to understand that death is permanent
May feel responsible and guilty for a loved one’s death Grief reaction varies The school-age child begins to understand that death is permanent and that it eventually happens to everyone. However, the child may feel responsible and guilty for a loved one’s death. Help the child understand that he or she did not cause the death. Phrases such as, “Grandma is only sleeping,” should be avoided because they may be taken literally, causing confusion. A child’s grief reaction to death varies and may include denial, anger, hoping that the deceased will return, physical ailments, and problems at school.

Usually cooperative Very modest May view illness or injury as punishment Talk directly to the child about what happened Explain procedures Be honest Image source: EMSC Slide Set (CD-ROM) Courtesy of the Emergency Medical Services for Children Program, administered by the U.S. Department of Health and Human Service's Health Resources and Services Administration, Maternal and Child Health Bureau. School-age children are less dependent on their caregivers than are younger children. They are usually cooperative. They fear pain, permanent injury, and disfigurement. They are also afraid of blood and prolonged separation from their caregiver. A school-age child is very modest and does not like his body exposed to strangers. A child of this age may still view his illness or injury as punishment. Reassure the child that how he feels or what is happening to him is not related to being punished. When caring for a school-age child, approach him in a friendly manner and introduce yourself. Talk directly to the child about what happened, even if you also obtain a history from the caregiver. Explain procedures before carrying them out. Because school-age children often view things in concrete terms, choose your words carefully. For example, the phrase “I am going to take your pulse” will concern a school-age child. He will wonder why you are taking it away and when he will get it back. Allow the child to see and touch equipment that may be used in his care. Honesty is very important when interacting with school-age children. If you are going to do something to the child that may cause pain, warn the child just before you do it. Give a simple explanation of what will take place and do it just before the procedure so that he does not have long to think about it. For example, if a child has a possible broken leg and you must move the leg to apply a splint, warn the child just before you move the leg. Do not threaten the child if he or she is uncooperative.

Adolescents (13-18 Years of Age)

Physiologic Changes Size and strength of the heart increases
Blood volume increases Systolic blood pressure increases Heart rate decreases Heart rate is usually 55 to 105 beats per minute Respiratory rate is 12 to 20 breaths per minute Systolic blood pressure is100 to 120 mmHg During adolescence, the size and strength of the heart increases, blood volume increases, systolic blood pressure increases, and heart rate decreases. An adolescent’s heart rate is usually 55 to 105 beats per minute, respiratory rate is 12 to 20 breaths per minute, and systolic blood pressure is100 to 120 mmHg.

Physiologic Changes Muscle size and strength increase
Bone growth is nearly complete Rapid 2 to 3 year growth spurt Physical maturity Girls Begins at age 10 and ends about age 16 Boys Begins at age 12 and ends about age 18 Muscle size and strength increase and bone growth is nearly complete. Most adolescents experience a rapid 2 to 3 year growth spurt that begins distally with enlargement of the feet and hands, followed by enlargement of the arms and legs. Enlargement of the chest and trunk occurs in the final stage. Physical maturity occurs at different times beginning at age 10 and ending about age 16 in girls and beginning at age 12 and ending about age 18 in boys.

Physiologic Changes Primary sexual development
Ovaries, uterus, breasts, and penis Secondary sexual development Voice changes Development of facial and genital hair Primary and secondary sexual development occurs during adolescence. Primary sexual development refers to the internal and external organs responsible for reproduction, such as the ovaries, uterus, breasts, and penis. Secondary sexual development refers to body changes that are the result of hormonal change, such as voice changes and the development of facial and genital hair.

Physiologic Changes Menarche Onset of menstruation during puberty
Average age of menarche is 12.5 years Menstruation Periodic discharge of blood and tissue from the uterus Occurs about every 28 days Increased risk of teen pregnancy and sexually transmitted infection In the U.S., the average age of menarche is 12.5 years. Menarche is the onset of menstruation during puberty. Menstruation, which is the periodic discharge of blood and tissue from the uterus, occurs about every 28 days. Menstruation is also called a period. The onset of menarche and subsequent sexual activity increase the risk of teen pregnancy and sexually transmitted infection (STI).

Cognitive Changes Ability to reason Think beyond the present
Concerned about the opinions of others Develop morals Question adults who say one thing but do another Adolescents have the ability to reason and think beyond the present. They are concerned about the opinions of others. Adolescents develop morals, questioning adults who say one thing but do another.

Psychosocial Changes Wants to be treated like an adult
Conflicts between an adolescent and parents are common An adolescent wants to be treated like an adult, yet conflicts between an adolescent and his or her parents are common. While the adolescent is developing his or her own identity, the parent wants to protect the teen from harm or something the teen may later regret.

Psychosocial Changes Self-consciousness increases
Peer pressure increases Interest in the opposite sex increases Anti-social behavior peaks around eighth or ninth grade. Hormone surges cause wide mood swings. During adolescence, self-consciousness increases, peer pressure increases, and interest in the opposite sex increases. Anti-social behavior peaks around eighth or ninth grade. Hormone surges cause wide mood swings.

Psychosocial Changes Peer groups are important
School is typically the focus of social life Body image is of great concern Compare themselves with their peers and determine if they are “normal” based on what they observe Image source: Microsoft clipart Peer groups are important to an adolescent and school is typically the focus of his or her social life. Body image is of great concern at this age. Adolescents continuously compare themselves with their peers and determine if they are “normal” based on what they observe.

Psychosocial Changes Eating disorders common
Experimentation with tobacco, alcohol, and illicit drugs Depression and suicide are more common in adolescents than any other age group. Some adolescents do not adjust well to the demands and responsibilities of adolescence. For example, although many adolescent girls accept menstruation and changes in their body as a matter of course, others are distressed and frightened. Teens often experience an increase in weight and fat distribution during their growth spurt. Eating disorders are common because the adolescent desires the “perfect” body, or at least a slimmer one. Some teens respond to the stressors of adolescent life in unhealthy ways, such as experimentation with tobacco, alcohol, and illicit drugs. Depression and suicide are more common in adolescents than any other age group.

Psychosocial Changes Between 15 and 17 years of age:
Cautiously establishes relationships Usually knows if he or she is homosexual or heterosexual Around the age of 18: Begin to understand who they are Develop an attachment to another person Stable relationships form Between 15 and 17 years of age, the teen cautiously establishes relationships. An adolescent usually knows by this time if he or she is homosexual or heterosexual. Around the age of 18, adolescents begin to understand who they are and start to feel comfortable with that. An attachment to another person develops and stable relationships form.

Inconsistent, unpredictable Expect to be treated as adults Obtain the history from the patient instead of a caregiver Expect many questions Do not bargain in order to do what you need to do Image source: Microsoft clipart Adolescents often show inconsistent and unpredictable behavior, although they expect to be treated as adults. Talk to an adolescent in a respectful, friendly manner, as if speaking to an adult. If possible, obtain a history from the patient instead of a caregiver. Expect an adolescent to have many questions and want detailed explanations about what you are planning to do or what is happening to him. Explain things clearly and honestly. Be honest about procedures that will cause discomfort. Allow time for questions. Give the patient choices when appropriate, but do not bargain with an adolescent in order to do what you need to do. Recognize the tendency for adolescents to overreact. Do not become angry with an emotional or hysterical adolescent.

Try to have an adult of the same gender as the child present during the exam Do not tease or embarrass an adolescent patient, particularly in front of peers Image source: Microsoft clipart Adolescents fear pain and permanent damage to their body resulting in a change in appearance, scarring, or death. They may go back and forth between modesty and open displays of their body. Try to have an adult of the same gender as the child present during the exam. Allow the caregiver to be present during your assessment if the patient wishes. However, some adolescents may prefer to be assessed privately, away from their caregiver. Peers are a major influence in the life of an adolescent. When providing care, an adolescent may prefer to have a peer close by for reassurance. When caring for an adolescent, do not tease or embarrass him, particularly in front of his peers.

Early Adulthood (20 to 40 Years of Age)

Physiologic Changes Peak physical condition
Heart rate averages 70 beats per minute Respiratory rate averages 16 to 20 breaths per minute Systolic blood pressure averages 120/80 mmHg Accidents are a leading cause of death in this age group Peak physical conditioning occurs between 19 and 26 years of age and adults develop lifelong habits and routines during this time. All body systems function at optimal performance. The heart rate of an early adult averages 70 beats per minute, respiratory rate averages 16 to 20 breaths per minute, and the systolic blood pressure averages 120/80 mmHg. Doctor visits during early adulthood are usually related to pregnancy or injuries. Accidents are a leading cause of death in this age group.

Cognitive Changes Young adults recognize that, in some situations, there is no single correct solution. In fact, the solution may vary from situation to situation. Image source: Microsoft clipart The thought process of an adolescent is closely related to logic. As a result, they often feel that the only solution (or solutions) to a problem is a logical one. Young adults recognize that, in some situations, there is no single correct solution. In fact, the solution may vary from situation to situation. This type of thought process is practical, flexible, and involves emotion and logic.

Psychosocial Changes Becomes independent of parents
Completes education Establishes a career High levels of job stress Establishes an intimate relationship Decides whether to have children Friendships are important During early adulthood, an individual typically becomes independent of his or her parents, completes his or her education, and establishes a career. High levels of job stress are experienced during this time. The young adult usually establishes an intimate relationship with a significant other and decides whether to have children. Childbirth occurs more often in this age group than in any other. A new family provides the young adult with new challenges and stress. Friendships are important, particularly if a young adult is single. Friendships between men typically involve outdoor activities and talk about work, sports, politics, and cars. In contrast, friendships between women usually involve conversations about their personal weaknesses, secrets about their past, personal health issues, or problems with their significant other or family.

Psychosocial Changes Demonstrate reckless behavior less often than adolescent More likely to use abuse alcohol and illicit drugs and have serious emotional difficulties than older adults Eating disorders are more common in this age group than at other ages. Young adults demonstrate reckless behavior (such as driving at a high rate of speed) less often than adolescents do. Young adults are more likely to use abuse alcohol and illicit drugs and have serious emotional difficulties (such as major depression and rage) than older adults. Eating disorders are more common in this age group than at other ages.

Approach in a respectful, friendly manner. Obtain a history from the patient. Explain what you are planning to do and why it needs to be done. Allow time for questions. Provide clear and honest explanations. Talk to a young adult in a respectful, friendly manner. Obtain a history from the patient. Explain what you are planning to do and why it needs to be done. Allow time for questions. Provide clear and honest explanations.

Middle Adulthood (41 to 60 Years of Age)

Physiologic Changes Heart rate averages 70 beats per minute
Respiratory rate averages 16 to 20 breaths per minute Systolic blood pressure averages 120/80 mmHg In the early 40s, the body is still functioning as effectively as it did in 20s The heart rate of a middle adult averages 70 beats per minute, respiratory rate averages 16 to 20 breaths per minute, and the systolic blood pressure averages 120/80 mmHg. In an adults early 40s, his or her body is still functioning as effectively as it did in his or her 20s.

Physiologic Changes Near vision declines by the late forties
Taste sensations diminish Ability to hear high frequency sounds decreases, particularly in men Metabolism slows, making weight control more difficult However, as the years go by, many physical changes take place. Near vision declines by the late forties. Taste sensations diminish and the ability to hear high frequency sounds decreases, particularly in men. Metabolism slows, making weight control more difficult.

Physiologic Changes Cardiovascular health becomes a concern
Blood vessels lose elasticity and become thicker. Cholesterol levels increase Cardiac output decreases Cardiovascular health becomes a concern as blood vessels lose elasticity and become thicker. Cholesterol levels increase and cardiac output decreases throughout this period.

Physiologic Changes Hormonal changes occur in both women and men.
In women, menopause occurs in the late 40s or early 50s. In men, testosterone levels gradually decline and sperm production decreases. Hair begins to thin and turn gray Skin’s elasticity and moisture decrease Wrinkling occurs Cancer often strikes in this age group. Hormonal changes occur in both women and men. In women, menopause (cessation of menstruation) occurs in the late 40s or early 50s. In men, testosterone levels gradually decline and sperm production decreases. The hair begins to thin and turn gray. The skin’s elasticity and moisture decrease and wrinkling occurs. Cancer often strikes in this age group.

Cognitive Changes Memory, perception, learning, problem solving, and creativity change very little. Reaction time may diminish toward the later part of middle adulthood. Experience and expertise allows them to surpass younger workers in problem solving ability. Image source: Microsoft clipart The middle adult’s memory, perception, learning, problem solving, and creativity change very little. Reaction time may diminish toward the later part of middle adulthood. In the workplace, the middle adult’s experience and expertise allows them to surpass younger workers in their problem solving abilities.

Psychosocial Changes Approach problems more as challenges than threats
Typically the center of the family, between aging parents, adult children, and grandchildren Some may be burdened by financial commitments for them. Middle adults approach problems more as challenges than threats. They are typically in the center of the family, between aging parents, adult children, and grandchildren. Some may be burdened by financial commitments for them.

Psychosocial Changes Empty nest syndrome
A feeling of sadness and loneliness when one or more of the children leaves home Middle adults may experience empty nest syndrome, which is a feeling of sadness and loneliness when one or more of their children leaves home. However, after the children have left home, most middle adults find that their relationship strengthens as they have more time for each other and pursuing mutual interests and activities.

Talk to the patient in a respectful, friendly manner. Obtain a history from the patient. Listen carefully to the patient’s answers. Explain what you are planning to do and why it needs to be done. Allow time for the patient to ask questions. Provide clear and honest explanations. Talk to the patient in a respectful, friendly manner. Obtain a history from the patient, listening carefully to the patient’s answers to your questions. Explain what you are planning to do and why it needs to be done. Allow time for the patient to ask questions of you. Provide clear and honest explanations.

(61 Years of Age and Older)
Late Adulthood (61 Years of Age and Older)

Physiologic Changes Maximum life expectancy
Oldest age to which any person lives Average life expectancy The age at which half of the people born in a particular year will have died Maximum life expectancy is the oldest age to which any person lives. At present, maximum life expectancy for humans is about 120 years. Average life expectancy is the age at which half of the people born in a particular year will have died. In 2004, a baby born in the United States had an average life expectancy of 77.9 years.

Physiologic Changes Cardiovascular system changes
Thickening of the blood vessels Decreased vessel elasticity Increased peripheral vascular resistance Marked increase in systolic blood pressure Heart’s valves become hard and thick Heart is less responsive to exercise Rapid heart rates are not well tolerated Image source: Microsoft clipart An older adult’s heart rate, respiratory rate, and blood pressure depend on his or her physical health. Cardiovascular system changes associated with aging include thickening of the blood vessels, decreased vessel elasticity, and increased peripheral vascular resistance, which contribute to reduced blood flow to organs. There is often a marked increase in the systolic blood pressure and a slight increase in the diastolic blood pressure because of increased peripheral vascular resistance. The heart’s valves become hard and thick, which affects the heart’s ability to adequately fill and empty. Normally, heart rate (and cardiac output) increases with exercise. In older adults, the heart is less responsive to exercise. When a rapid heart rate occurs, it is not well tolerated and is slow to return to normal.

Physiologic Changes Respiratory system changes
Diminished elasticity of the diaphragm Weakening of the chest wall muscles Coughing is often ineffective Decreased number of alveoli that participate in gas exchange Activity of cilia in the lungs is decreased Changes in the respiratory system include diminished elasticity of the diaphragm and weakening of the chest wall muscles. Coughing is often ineffective because of weakened expiratory muscles. Damage or loss of the elastic fibers in the small airways and thickening of the alveoli results in a decreased number of alveoli that participate in gas exchange. The activity of the cilia in the lungs is decreased, which results in an increased collection of mucous in the respiratory tract and an increased susceptibility to infection.

Physiologic Changes Sensory changes Loss of taste buds Hearing loss
Diminished sense of smell Diminished vision Diminished perception of pain Diminished reaction time. Image source: Microsoft clipart Sensory changes that occur in older adults include a loss of taste buds, hearing loss, and a diminished sense of smell, vision, perception of pain, and reaction time.

Physiologic Changes Older adults have Less subcutaneous tissue
Inefficient blood vessel constriction Diminished shivering and sweating Diminished perception of temperature Diminished thirst perception Increase the likelihood of a heat- or cold-related emergency Older adults have less subcutaneous tissue, inefficient blood vessel constriction, diminished shivering and sweating, diminished perception of temperature, and diminished thirst perception. These factors increase an older adult’s likelihood of experiencing a heat- or cold-related emergency.

Physiologic Changes Musculoskeletal system changes
Loss of muscle strength Decrease in the number of muscle cells Loss of bone mass Falls are common in older adults Image source: Microsoft clipart Older adults experience a loss of muscle strength and a decrease in the number of muscle cells. Regular exercise can help slow this process. Older adults also experience a loss of bone mass. Bone loss is greater in women, particularly after the onset of menopause. Falls are common in older adults. They occur because of vision and/or balance problems, physical weakness, environmental hazards (such as poor lighting and throw rugs), urinary problems, and the effects of taking multiple medications.

Physiologic Changes Urinary system changes
Reduced blood flow to the kidneys Thickening of the blood vessels Narrowing of the renal arteries Bladder holds less urine Increased urinary frequency In the urinary system of some older adults, blood flow to the kidneys is reduced because of thickening of the blood vessels and subsequent narrowing of the renal arteries. The amount of urine the bladder holds decreases with age and the need to urinate becomes more frequent. As a result, older adults often arise during the night to urinate.

Physiologic Changes Gastrointestinal (GI) system changes
Some older adults have no teeth and depend on dentures. Saliva declines with age. Delayed gastric emptying. GI secretions are decreased. Less efficient break down of protein. Less efficient break down of fats. Vitamin and mineral deficiencies. Many changes occur in the older adult’s gastrointestinal (GI) system. Some older adults have no teeth and depend on dentures. Many have dentures but do not wear them. Others cannot afford to purchase them. The amount of saliva normally present in the mouth declines with age. Loss of smooth muscle in the stomach causes a delayed emptying time. GI secretions are decreased. Liver blood flow is decreased, resulting in less efficient break down of protein. A decrease in pancreatic secretions results in less efficient break down of fats. Impaired absorption of B vitamins, calcium, and iron can cause vitamin and mineral deficiencies.

Physiologic Changes Nervous system changes Loss of nerve cells
Can learn new material, but may have difficulty retrieving information Balance and coordination are decreased Sleep disorders common Image source: Microsoft clipart In the nervous system, there is a loss of nerve cells, which can result in memory impairment. Older adults are able to learn new material, but may have difficulty retrieving information. Balance and coordination are decreased. Sleep disorders are common in older adults. Most older adults feel drowsy more often in the daytime, take more naps, take longer to fall asleep, spend less time in deep sleep, and wake up more often.

Cognitive Changes Short-term memory is relatively unaffected
Age-related changes in memory most often occur in recent memory Long-term memory is essentially unaffected by the aging process Image source: Microsoft clipart Some cognitive abilities decline with aging, while others remain stable or improve. Short-term memory, which is what a person has in mind at a given moment (such as remembering a phone number long enough to dial it), is relatively unaffected in older adults. Age-related changes in memory most often occur in recent memory. Recent memory is that which is used every day, such as information pertaining to current events or a recently read article. Long-term memory, such as memories of childhood friends and events, is essentially unaffected by the aging process.

Psychosocial Changes Making personal choices to find the meaning of life Evaluating one’s self-worth Adjusting to retirement Adjusting to reduced income Establishing satisfactory living arrangements Adjusting to the death of a spouse or companion Maintaining contact with friends and family Meeting social and civic obligations In addition to adjusting to decreasing physical strength and health, older adults face many psychosocial changes including the following: Making personal choices to find the meaning of life Evaluating one’s self-worth Adjusting to retirement Adjusting to reduced income Establishing satisfactory living arrangements Adjusting to the death of a spouse or companion Maintaining contact with friends and family Meeting social and civic obligations, such as through volunteering and political activities

Elderspeak should be avoided: Speaking louder and more slowly Using a patronizing tone High pitch Increased volume Increased repetition Simpler vocabulary and grammar than normal adult speech Making statements that sound like questions Exaggerating words When communicating with an older adult, obtain a history from the patient, speaking to him or her in a respectful, friendly manner. Elderspeak should be avoided. Elderspeak, often unknowingly used by young adults when speaking to an older adult, is a style of speech that resembles baby talk and contains the following features: Speaking louder and more slowly Using a patronizing tone High pitch Increased volume Increased repetition Simpler vocabulary and grammar than normal adult speech Making statements that sound like questions Exaggerating words

Elderspeak does not communicate appropriate respect. Implies that the patient is dependent and incompetent An older adult will better understand you if you repeat and reword what you are saying. Elderspeak does not communicate appropriate respect. Its use implies that the older adult is dependent and incompetent, lacking the ability to understand and respond. The use of elderspeak when talking with an older adult can cause confusion and decrease comprehension. For example, speaking too slowly can affect an older adult’s ability to focus on the main point you are trying to make. It is also hard to understand a statement that sounds like a question. Exaggerating words can cause confusion. Slow speech, shortened sentences, and using simple vocabulary sounds like baby talk and is perceived by most older adults as demeaning. An older adult will better understand you if you repeat and reword what you are saying.

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Chapter 8 Lifespan Development

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