Normal Growth and Development

Why do Nurses need to Understand Child Development?

Freud- Psychosexual Development 1. Oral stage 2. Anal stage 3. Phallic stage 4. Latency stage

Theories of Child Development Erikson - The Four Ages of Childhood 1. Infancytrust vs mistrust 2. Toddlerhoodautonomy vs shame and doubt 3. Preschoolerinitiative vs guilt 4. School-ageindustry vs inferiority

Autonomy VS. Doubt & Shame???

Theories of Child Development Piaget- Theory of Intellectual Development Sensoriomotor Thought0-2 yrs Sensoriomotor Thought0-2 yrs Preoperational Thought2-7 yrs Preoperational Thought2-7 yrs (Egocentrism, Transductive reasoning, Centration, Animism, Magical Thinking) Concrete Operations7-11 yrs Concrete Operations7-11 yrs Formal Operations>11 yrs Formal Operations>11 yrs

Basic Principles of Child Development #1 Children are competent #2 Children resemble one another #3 Each child is unique

#4 Development is Directional Cephalocaudal Proxiimodistal Body midline Which body systems grow most rapidly during early childhood?

#5 Development is Timely There are recognized critical (sensitive) periods of development

Factors Influencing G&D ENVIRONMENT Socioeconomic level Socioeconomic level Parent-child relationship Parent-child relationship Family position Family position Health/Genetics Health/Genetics Nutrition Nutrition Genetics Genetics Temperament Temperament

INFANT 1 –12 months T rust vs Mistrust Double birth weight at 6 months Double birth weight at 6 months Triple at 12 months Triple at 12 months Rolls over 4 months Rolls over 4 months Holds head steady at 6 months Holds head steady at 6 months Sitting 6-8 months Sitting 6-8 months Walking 12 months Walking 12 months Pincer grasp 10 months Pincer grasp 10 months 2 words by 12 months 2 words by 12 months Solid 6 months Solid 6 months Object permanence Object permanence Separation anxiety Separation anxiety Risk for aspiration Risk for aspiration 6 Months 8 Months

Eruption of Teeth-lower incisor are 1 st 6-10 months

Separation Anxiety ~ 8 months

First Steps ~ 12 Months

Nursing Management-Infancy 1. Discuss age-appropriate recommendations 2. Teach nutrition 3. Sleep patterns 4. Foster attachment 5. Explore family support systems 6. Safety

Nutrition in Infancy Breast milk a/o formula 1 st year Breast milk a/o formula 1 st year 4-6 months- iron fortified rice cereal 1 st 4-6 months- iron fortified rice cereal 1 st Next veggies, fruit, then meat 8-10months Next veggies, fruit, then meat 8-10months

Toddler 1 – 3 years 2 word sentences by age 2 2 word sentences by age 2 Screening for lead poisoning Screening for lead poisoning Decreased appetite Decreased appetite (physiologic anorexia) Temper tantrums Temper tantrums Toilet training Toilet training Negativism Negativism NO !

Toddler Years include….. Sibling Rivalry (expect regressive behavior with arrival of new baby) Sibling Rivalry (expect regressive behavior with arrival of new baby) Parallel play (won’t share!) Parallel play (won’t share!)

Toddler years include….. Transitional objects Transitional objects Temper Tantrums Temper Tantrums

Toddler Years include…. Parallel Play

Nursing Management-Toddler 1. Discuss age-appropriate recommendations 2. Growth & Development 3. Toilet Training 4. Negativism 5. Encourage gross motor skills 6. Sibling Rivalry 7. Regression 8. Sleep patterns 9. Safety

Nutrition – Toddler years Physiologic anorexia Physiologic anorexia Food jags Food jags Serving amounts? Serving amounts? If on a food jag may only eat yogurt for days! If on a food jag may only eat yogurt for days! Provide for self feeding: finger foods/spoon Provide for self feeding: finger foods/spoon

Toddlers are at high risk for injuries r/t their increasing cognitive and motor skills curiosity. What measures could prevent injury from the following hazards? Toddlers are at high risk for injuries r/t their increasing cognitive and motor skills curiosity. What measures could prevent injury from the following hazards? Falls Falls Poisoning Poisoning Burns Burns Motor Vehicle Crashes Motor Vehicle Crashes Drowning Drowning

Preschooler 3-5 years Body contour changes Body contour changes Social/language skills ^ Social/language skills ^ Appetite is diminished Appetite is diminished Fear of dark, mutilation, and abandonment Fear of dark, mutilation, and abandonment Self-centered Self-centered Magical Thinking “If I am mad at Mommy & she gets sick, I caused it!” Magical Thinking “If I am mad at Mommy & she gets sick, I caused it!” Bedtime issues Bedtime issues

Preschool years include….Associative Play Associative Play with strong imaginative & dramatic themes …like to assume adult roles in play Associative Play with strong imaginative & dramatic themes …like to assume adult roles in play

Nursing Management-Pre School Discuss age-appropriate recommendations Discuss age-appropriate recommendations Teach nutrition Teach nutrition Sleep patterns Sleep patterns Discuss G&D Discuss G&D Family Family Fears Fears Safety Safety

School-age 6-12 years Slimmer, stronger, ^ fine motor skills Slimmer, stronger, ^ fine motor skills Growth spurt/prepubescent period Growth spurt/prepubescent period girls ~10yrs, boys ~13 yrs girls ~10yrs, boys ~13 yrs Permanent teeth erupt Permanent teeth erupt Latch-key children Latch-key children Concrete thought Concrete thought Cooperative Play/Rules/Routine Cooperative Play/Rules/Routine Obesity risk begins Obesity risk begins Peer group bigger influence Peer group bigger influence Sexuality/Inappropriate touch Sexuality/Inappropriate touch

Nursing Management-School Age Discuss age-appropriate recommendations Discuss age-appropriate recommendations Teach nutrition Teach nutrition Sleep patterns Sleep patterns Discuss G&D Discuss G&D Family Family Promote skill development in school, sports and play Promote skill development in school, sports and play Safety Safety Kids want to know: Why do I wake up at night with leg cramps?

Nursing Interventions: Health Care Setting 1. Infant: consistent contact/feeding, crib all times 2. Toddler: allow transitional objects, prepare for “NO!”; remember can’t “conserve” when giving liquid meds, FULL CRIB RAILS 3. Preschooler: “dramatic play” to explain care-”you listen to Daddy’s heart 1 st, apply concept of animism! 4. School Age: can give more detailed explanations, same age roommate **Involve parents (rooming in) for all age groups **Select age appropriate play activities

Safety in Childhood Prevent aspiration -especially 1 st year Prevent falls -from birth Prevent Poisonings -especially after walking & during toddlers years Prevent Burns -especially after walking and thru school age Prevent injury from firearms especially school- age Prevent drowning- especially after walking Implement Car Safety -from birth

Safety: 1 st year of life

Promoting Safety Throughout Childhood