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GROWTH AND DEVELOPMENT Pat Volker, RN October 2008.

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Presentation on theme: "GROWTH AND DEVELOPMENT Pat Volker, RN October 2008."— Presentation transcript:

1 GROWTH AND DEVELOPMENT Pat Volker, RN October 2008

2 Growth and Development –Children are not small adults!!! –Vary in size, thought processes, physical and emotional maturity and in their ability to interact socially. –Psychological response to illness and/or injury affected by developmental level, culture, past experiences, support systems, etc. –Understanding of illness and/or injury, treatments, hospitalization and death affected by psychosocial and cognitive maturity.

3 Growth and Development Principles of growth and development: –Growth increase in size (i.e. height and weight) –Development acquisition of skills and abilities through growth, maturation and learning

4 Growth and Development Principles of growth and development: –Maturation an increase in competence and adaptability that allows for functioning at a higher level –Differentiation alteration of cells and structures to achieve specific and characteristic physical and chemical properties

5 Growth and Development Patterns of growth and development: –Cephalocaudal Head to toe in an orderly fashion (control of head before trunk, eyes before hands, hands before feet). –Proximodistal Trunk to tips of extremities (shoulders before hands, hands before fingers).

6 Growth and Development Influences on growth and development: –Intrinsic »Physical – large babies don’t roll early »State of wellness – poor nutrition reduces fetal brain cell development and limits brain size »Temperament and inborn personality »Genetics

7 Growth and Development Influences on growth and development: –Extrinsic »Cultural background »Economics »Siblings »Home environment

8 Growth and Development Age guidelines: NeonateBirth until leaves hospital InfantNewborn discharge – 1 year Toddler1 year – 3 years Preschooler4 years – 6 years School – Aged6 years – 12 years Adolescent12 years – 18 years

9 Growth and Development Respiratory System: –Nose breathers for first 4 weeks of life –Apnea spells of less than 10 seconds common up to 6 weeks- if longer or if include color change further investigation needed! –Tongue is large and can cause obstruction –Larynx is soft and easily compressible – hyperextension or hyperflexion can compress airway –Cartilage of ribs and sternum soft Review of Systems: Pediatric Differences

10 Growth and Development Respiratory System: –Airways are small and easily obstructed by secretions –Poorly developed intercostal muscles – retractions common –Small chest/tidal volume –Trachea is high and close to esophagus – increases risk for aspiration –Abdominal breathers until age 7 Review of Systems: Pediatric Differences

11 Growth and Development –Respiratory System: LATECYANOSIS IS A LATE SIGN OF DISTRESS! Review of Systems: Pediatric Differences

12 Growth and Development Cardiovascular System: –Increased blood volume –Neonate – 90ml/kg –Child – 75 ml/kg –Adult – 70ml/kg –May develop physiologic anemia due to decreased hemoglobin and shortened RBC’s survival –Heart rate higher –BP may remain normal well into shock states – children maintain adequate cardiac output due to strong compensatory mechanisms Review of Systems: Pediatric Differences

13 Growth and Development Central Nervous System: Neurologic system immature Reflexes may be jerky Tremors may occur Myelination of nerve fibers incomplete but is complete peripherally by the time the child walks – DO NOT GIVE IM INJECTIONS IN BUTTOCKS UNTIL CHILD IS WALKING! Review of Systems: Pediatric Differences

14 Growth and Development Gastrointestinal System: Liver palpable 1 – 2 cms below right costal margin until 1 year of age Cardiac sphincter loose Peristalsis faster – can lead to malabsorption Immature until age 2 Diameter of abdomen is larger than chest in children (pot belly) High nutritional and fluid requirements Babies tend to swallow air and need burping every 2 – 3 ozs Review of Systems: Pediatric Differences

15 Growth and Development Kidneys more vulnerable to trauma due to position and size Urinary output: –Neonate – 2mg/kg/hr –Child – 0.5 – 2 mg/kg/hr Review of Systems: Pediatric Differences Genitourinary System: Kidneys immature – do not fully concentrate urine until 2 yrs of age – can lead to drug toxicity

16 Growth and Development Fluid and Electrolyte Balance: Rate of fluid exchange 7x greater than adult Rate of metabolism 2x greater than adult 2x as much acid is formed leading to more rapid development of acidosis Review of Systems: Pediatric Differences

17 Growth and Development Thermoregulation: Infants and children have large surface area Infants and young children do not have the ability to shiver. This leads to non-shivering thermogenesis which ↑ O 2 and glucose consumption causing hypoglycemia Infants and young children have a thin layer of subcutaneous fat ↑ metabolic rate leads to higher insensible loss from ↑ heat production per body weight 25% of children under the age of 5 experience febrile seizures due to rapid temperature fluctuation Sepsis may be present in neonates and infants without an ↑ temperature ! Review of Systems: Pediatric Differences

18 Growth and Development Review of Erickson’s Theory of Development AgeStageDevelopmental TaskOutcomes Infancy (Birth to 1 year) Trust vs. mistrustLearning to trust or mistrust that basic needs such as nourishment, sucking, warmth, cleanliness and physical contact will be met Faith and optimism Toddler 1 year – 3 years) Autonomy vs. shame and doubt Learning to be self-sufficient in many areas, such as toileting, feeding, walking, talking OR to doubt their own abilities Self-control and willpower Preschool (3 years – 6 years) Initiative vs. guiltLearning about the world through play and develops a conscience Direction and purpose School-age (6 years – 12 years) Industry vs. inferiority Learning to be competent and productive OR feel inferior and unable to do anything well Competence Adolescent (12 years – 19 years) Identity vs. role confusion Ask, “Who am I?” Figure out sexual, ethnic and career identities OR are confused about future roles Devotion and fidelity Young AdulthoodIntimacy vs. isolation Seek companionship and love with another person OR become isolated Comfortable relationships Sense of commitment, safety, and care within a relationship AdulthoodGenerativity vs. stagnation Productive, meaningful work and family life OR become stagnant and inactive Feeling that you are contributing to the world by being active in home and community MaturityIntegrity vs. despair Make sense out of their life either seeing it as meaningful OR as regretting goals never met Integrity and feelings of satisfaction

19 Growth and Development - Neonate

20 –Characteristics 10% loss of birth weight in first 3 – 4 days of life 73% of body weight is fluid Head circumference is 70% of adult size Needs to consume 120 cal/kg/day in feedings every 2 -3 hours

21 Growth and Development - Neonate –Characteristics Grows about 1 inch/month and gains 5 – 7 oz/week Mottling is common Physiologic jaundice can be seen after 24 hours and for up to 2 weeks Obligatory nose breathers

22 Growth and Development - Neonate –Characteristics Should pass meconium within 24 hrs Delayed gastric emptying causes regurgitation CNS immature – jerky tremors common

23 Growth and Development - Neonate –Reflexes »Moro »Asymmetric tonic neck

24 Growth and Development - Neonate –Reflexes »Babinski’s »Rooting

25 Growth and Development - Neonate –Reflexes »Involuntary grasp – touching palms of hands or soles of feet near base of digits causes flexion of hands and toes. Palmar lessens by 3 months. Plantar lessens by 8 months. »Trunk curving – stroking infant’s back alongside spine causes hips to move forward toward stimulated side. Disappears by 4 weeks.

26 Growth and Development - Neonate –Fontanels Anterior Posterior

27 Growth and Development - Neonate –Sensory »Hearing – well established at birth. Can distinguish mother’s voice from other female voices within the first week of life. »Vision – eye structure incomplete. Can momentarily fixate on bright or moving object that is midline and within 8 inches. Visual acuity – 20/100 – 20/400. Show some visual preferences – medium colors over dim or bright; black-and-white contrasting patterns; reflecting objects

28 Growth and Development - Neonate –Sensory »Smell – well developed. Turn away from aversive odors. Can differentiate mother’s breast milk from breast milk of other women »Taste – prefer sweet tastes.

29 Growth and Development - Neonate –Health promotion Poor feeding patterns –May need more time due to inability to suck and swallow –Report frequent regurgitation, cyanosis and poor intake Altered elimination patterns –Report decrease in number of wet diapers, constipation, diarrhea, water loss in stools Poor growth –Monitor weight gain and head growth along growth curve

30 Growth and Development - Neonate –Health promotion Altered CNS - Monitor for: Altered sleep/awake cycles (sleeping less than 3 hours between feeds, abrupt changes between states) Hyperextension of head Lethargy Unresponsiveness to stimuli Asymmetrical movement of extremities Bicycling motion of lower extremities

31 Growth and Development - Neonate –Health promotion Cardiorespiratory – Monitor for: Respiratory distress (tachypnea, periodic breathing, apnea, retractions, nasal flaring, grunting, pallor, cyanosis, head bobbing) Poor peripheral pulses ↓ capillary refill Bradycardia Tachycardia

32 Growth and Development - Neonate –Health promotion Metabolic instability –Hypoglycemia – lethargy, hypotonia, poor suck, jitteriness, high pitched cry, seizures

33 Growth and Development - Neonate –Safety Considerations Positioning – “back to sleep”, elevate HOB after feeds Never prop bottle Must wear cover gown when holding

34 Growth and Development - Neonate –Safety Considerations Keep nares clear of secretions to avoid respiratory distress Keep side rails up O 2 safety Use appropriate transportation methods

35 Growth and Development - Neonate –Red flags Birth weight should be regained by 2 weeks of age Large or small head Spontaneous postures (frog legs/scissoring) Jaundice that appears during first 24 hours

36 Growth and Development - Infant

37 –Psychosocial Stage Trust vs. Mistrust –Cognitive Development Learn to separate from other objects in the environment Object permanence – objects that leave sight still exist Mental representation – use of symbols to think of an object or situation

38 Growth and Development - Infant AgeGross Motor DevelopmentFine Motor DevelopmentLanguageSocial 2 – 3 monthsHolds head midline Lifts chest off table Brings hands together for midline play Holds object placed in hands No longer clenches fists tightly Receptive – social smile by 8 weeks Expressive – coos and makes musical sounds Recognizes parents/caregiver 4 – 5 monthsSits well with support Supports chest with forearms in prone position Rolls from back to stomach Uses hands to bring objects to midline Gross palmar grasping- bends fingers against hands to squeeze/hold objects Receptive – orients to voice and moves toward sound Expressive – laughs Enjoys looking around environment 6 – 8 monthsSits well unsupported Pulls feet to mouth in supine position Rolls from back to stomach and vice versa Able to get into sitting position from supine Begins to creep or crawl Transfers objects from one hand to the other Operates hands independently (reaches with either hand) Receptive – responds to name Expressive – babbles Likes mirror image Searches for dropped objects Recognizes strangers 9 – 12 monthsCreeps or crawls/cruises Pulls self to standing position Stands assisted Fine pincher grasp – can pick up finger foods, hold bottle Receptive – follows verbal routines (bye-bye), understands the meaning of “no” Expressive – First meaningful words (Dada or Mama) Separation anxiety Rapidly expanding sense of self Likes “peek-a-boo”

39 Growth and Development - Infant –Height and Weight Birth weight doubles by 6 months –Antigen-antibody response Mother’s antigen-antibody response drops off around 3 months. Generation of own antibodies begins between 3 & 4 months

40 Growth and Development - Infant –Tooth eruption Begins between 7 and 9 months –Sleep Begin to sleep 8 hrs with nap –Eye color Permanent by 8 months

41 Growth and Development - Infant –Vision 20/120 at 12 months –Fontanels Posterior closes between 2 & 5 months of age Anterior closes around 18 months of age

42 Growth and Development - Infant Red Flags –Doubled birth weight by 5 months –No pincher grasp by 12 months –Persistent fisting beyond 3 months –Using mouthing as the primary mode of exploration after 12 – 18 months

43 Growth and Development - Infant Health Promotion –Teaching regarding »Safety of home environment »Car seat safety »Choking »Falls »Importance of smoke-free environment

44 Growth and Development - Infant Approaches to Care –Approach slowly, gently and calmly –If possible, assess while in caregiver’s lap –Provide comfort –Monitor nonverbal cues

45 Growth and Development - Infant Approaches to Care –Calm child so parent can focus –Complete touching components last –Avoid using dominant hand for IV access

46 Growth and Development - Infant Reactions to Hospitalization –Crying –After 7 months – stranger anxiety Nursing Interventions –Provide comfort measures such as swaddling –Satisfy needs promptly –Provide consistency in caregivers

47 Growth and Development - Infant Toys/Activities –Mobile –Mirror –Rattles –Nesting cups –Push/pull toys

48 Growth and Development - Toddler

49 –Psychosocial Stage Autonomy vs. Shame and doubt –Cognitive Development Increased interest in texture & color Improved awareness of objects and their purpose “Symbolic thinking”

50 Growth and Development - Toddler –Physical Development Triples birth weight Half adult height Head circumference equal to chest circumference –Physical Development Teeth 18 months 24 months Anterior fontanel closes Require 90 – 100 cal/kg/day Require hours sleep

51 Growth and Development - Toddler AgeGross Motor DevelopmentFine Motor DevelopmentLanguageSocial 1 – 3 years Stands alone momentarily (12 months) Stands alone well (18 months) Runs ( 18 – 24 months) Throws toy from a standing position without falling Walks up and down stairs Jumps in place (3 years) Pedals trike (3 years) Fine pincher grasp (12 months) Scribbles (15 months) Copies circle (36 m) Builds 6 block tower (24m) Feeds with spoon Turns pages on book Receptive – “naming period” – realizes people and objects have labels ( m) Follows simple commands Able to pick between two objects Advancement of language skills highly related to environmental stimulation/deprivation Expressive – “telegraph” speech Knows 20 – 30 words, 8 body parts, name, follows two step command (18-24m) 50% of speech may be unintelligible to strangers Curious – want to be autonomous Parallel play until 2, better in groups by 3 Pretend play Imitate housework Increasing independence – dress and undress, drink from cup, indicates wants and needs Toilet training can be initiated between age 2 and 3

52 Growth and Development - Toddler Red Flags –Hand dominance which occurs before 18 months –Persistent toe walking –Lack of intelligible language by 3 years –No or delay in expressive language by 15 – 18 months. Could be related to impaired hearing, environmental deprivation, autism, emotional maladjustment

53 Growth and Development - Toddler Health promotion –Car seat safety –Poisonings –Falls –Bike helmets –Burns

54 Growth and Development - Toddler Approaches to Care –Incorporate play –Introduce equipment gradually –Provide limited choices –Use simple and concrete terms –Demonstrate use of equipment on parent

55 Growth and Development - Toddler Reactions to Hospitalization –Separation anxiety –Perceive illness as a punishment Nursing Interventions –Do not give choices if none exist –Encourage parents to stay –Bring comfort objects from home –Utilize medical play prior to procedures

56 Growth and Development - Toddler Nursing Interventions –Toys/Activities: »Pounding boards »Wooden puzzles »Markers/paper »Books

57 Growth and Development - Preschooler

58 –Psychosocial Stage Initiative vs. Guilt –Cognitive Development Magical thinkers Developing concept of time Interpret words literally

59 Growth and Development - Preschooler –Physical Development Require 1400 – 1800 cal/kg/day Require 12 hours sleep Rapid skeletal development

60 Growth and Development - Preschooler AgeGross Motor Development Fine Motor DevelopmentLanguageSocial 4 – 5 yearsHops and skipsUnbuttons clothing Catches a ball Prints name (5 yrs) Copies : cross (4 yrs) square (41/2 yrs) triangle (5 yrs) Receptive – knows colors, songs and asks what words mean Expressive – uses 4 – 5 word sentences Speech is intelligible all the time Increased peer interaction, cooperation and cooperative play (abides by rules) Likes to help Likes group games Fears pain and darkness

61 Growth and Development - Preschooler –Red flags Continued substitution of very easy sounds for harder ones after age 5. Inability to copy vertical lines by 3 – 4 years. Height doubles by 3 – 4 years.

62 Growth and Development - Preschooler –Health promotion Discuss use of bike helmet Discuss pedestrian and playground safety Ensure adequate sleep and physical activity Teach about personal hygiene

63 Growth and Development - Preschooler –Approaches to care Allow to handle equipment Use simple, concrete terms that are appropriate for developmental level Respect modesty Set limits on behavior Assess level of understanding Enlist their help

64 Growth and Development - Preschooler Reactions to Hospitalization –May displace feelings on others –May regress Nursing Interventions –Prepare for procedures –Be truthful –Utilize medical play –Use band-aids after procedures

65 Growth and Development – School-Aged Child

66 –Psychosocial Stage Industry vs. Inferiority –Cognitive Development Logic similar to adult Unable to reason about the hypothetical or abstract Understand the concept of time

67 Growth and Development – School-Aged Child –Physical Development Height increases 5 cm (2 inches)/year on average Weight increases 2.5 kg (6 lbs)/year on average Brain at approximately 90% adult size by age 7 Puberty Permanent teeth

68 Growth and Development – School-Aged Child AgeGross Motor DevelopmentFine Motor DevelopmentLanguageSocial 6 – 12 yearsWell developed Adult proficiency by 7 – 8 years Hide feelings Exhibit risk-taking behaviors Want help

69 Growth and Development – School-Aged Child –Red flags Persistent articulation delay after 7 years Reading disability cannot be detected until 6 – 7 years of age

70 Growth and Development – School-Aged Child –Health promotion Discuss water, bike and sports safety

71 Growth and Development – School-Aged Child –Approaches to care Provide choices Explain procedures simply Be honest Provide privacy

72 Growth and Development – School-Aged Child Reactions to Hospitalization –Use passive coping – withdrawal, excessive TV watching –Develop strategies to deal with pain – lies rigidly still, clenches teeth and fists –Displaced anger –Seeks information –Does not want others to see loss of control

73 Growth and Development – School-Aged Child Nursing Interventions –Provide preparational education through pictures, simple diagrams, books and tours –Encourage communication with siblings and friends –Promote choice, if possible

74 Growth and Development – School-Aged Child Nursing Interventions –Toys/Activities: »Collections »Music »Crafts »Tutor for schoolwork »Board games »Video games

75 Growth and Development – Adolescent

76 –Psychosocial Stage Identity vs. Role Confusion

77 Growth and Development – Adolescent –Puberty Early (12-14 years) – rapid body changes. Secondary sex characteristics begin to appear. Growth accelerates. Crushes common. Mid (15-17 years) – Secondary sexual characteristics fully developed. Growth decelerates. Sex and Sexuality important. Late (18 – 21 years) – Full attainment of maturity

78 Growth and Development – Adolescent

79 –Cognitive Development Early adolescent – difficulty with concrete thought patterns ; difficulty projecting themselves into the future Mid adolescent – have a sense of immortality which may lead to problem behavior. Bound tightly to peer group. Last adolescent – fully aware of their limitations and how will affect their future

80 Growth and Development – Adolescent –Health Promotion Recreational safety Enforce seat belt use Safe sex practices Counseling regarding avoidance of drugs, alcohol and tobacco Healthy eating, sleeping and exercise habits

81 Growth and Development – Adolescent –Approaches to care Avoid interruptions Be honest and nonjudgmental Encourage questions Respect privacy

82 Growth and Development – Adolescent –Approaches to care Health risk screening Encourage adolescent to involve parent Maintain confidentiality Parents should encourage communication and the move toward self-care

83 Growth and Development – Adolescent Reactions to Hospitalization –Fear of altered body image –Fear of separation from peers –Fear of disability and/or death –May display withdrawal, anger, depression, boredom

84 Growth and Development – Adolescent Nursing Interventions –Be honest –Encourage decision making –Direct questions and explanations to teen, then parent –Maintain privacy

85 References Whaley, L., & Wong, D. (2003). Nursing Care of Infants and Children, 7 th Edition. St. Louis: C.V. Mosby Company


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