1. Chapter 9
Life Span Development 1

2. National EMS Education Standard Competencies
Life Span Development Integrates comprehensive knowledge of life span development. 2

3. Introduction Humans evolve over their life span.
Paramedics must be aware of the changes that occur at each stage of life.
Paramedics may need to adjust care based on patient’s life stage. 3

4. © Johanna Goodyear/ShutterStock, Inc.
Infants
Age 1 month to 1 year
Younger than 1 month:
Newborns
Neonates
© Johanna Goodyear/ShutterStock, Inc. 4

5. Infants 5

6. Infants Weight Cardiovascular system Generally 6–8 pounds at birth
Lose 5–10% of body weight in week 1
Begin weight gain during week 2
Cardiovascular system
Switch to own vasculature system 6

7. Infants Pulmonary system First breath inflates lungs for first time
Under 1 month, nose breathers
Under 6 months, prone to nasal congestion 7

8. Courtesy of Marianne Gausche-Hill, MC, FACEP, FAAP
Infants
Pulmonary system (cont’d)
When compared to adults:
Softer rib cages
Horizontally oriented ribs
Immature accessory muscles
Larger tongue
Shorter, narrower airway
Fewer alveoli
Fragile lungs
Courtesy of Marianne Gausche-Hill, MC, FACEP, FAAP 8

9. Infants Renal system Immune system Nervous system Consider:
Dehydration
Electrolyte imbalances
Immune system
Passive immunity helps protect up to 1 year
Nervous system
Continues to evolve following birth
Born with:
Moro reflex
Palmar grasp
Rooting reflex
Sucking reflex 9

10. Infants Nervous system (cont’d)
Fontanelles allow the head to be molded.
Sleep patterns vary. 10

11. Infants Musculoskeletal system Dental system
Growth and epiphyseal plates help bones grow.
Muscles account for 25% of weight.
Growth charts track growth.
Dental system
Teething begins at 4–7 months.
Baby teeth are in by age 3 years.
Permanent teeth come in around age 6. 11

12. Infants Psychosocial development begins at birth.
Evolves as infant interacts with and reacts to the environment 12

13. Infants Infants typically have their own timetable for development.
Bonding based on a secure attachment
Anxious avoidant attachment based on rejection
Most infants use crying as the primary method of communicating distress. 13

14. Infants
For infants, a reaction to a situational crisis follows three phases:
Protest phase
Despair phase
Withdrawal
Infants go through trust and mistrust phase. 14

15. Courtesy of Howard E. Huth, III, BA, EMT-P.
Infants
Children may be:
Easy
Difficult
Slow to warm up
Let caregiver hold infants whenever possible!
Courtesy of Howard E. Huth, III, BA, EMT-P. 15

16. Toddlers and Preschoolers
Toddlers are ages 1–3 years.
Preschoolers are ages 4–5 years.
Vital signs
Slower pulse and respiratory rates than infants
Higher systolic blood pressure
© Kevin Levit/ShutterStock, Inc.
© Maxim Bolotnikov/ShutterStock, Inc. 16

17. Toddlers and Preschoolers
Cardiovascular system
Similar to adult’s, but lacks well-developed lung musculature
Immune system
Passive immunity loss leads to acquired immunity.

18. Toddlers and Preschoolers
Neuromuscular system
Development of gross and fine motor skills
Brain weighs 90% of final adult weight
© EML/ShutterStock, Inc.

19. Toddlers and Preschoolers
Renal system
Begin bladder control
Teething process may be painful and include fever.
Sensory development makes tickling fun.

20. Toddlers and Preschoolers
Psychosocial changes
Separation anxiety peaks.
Language development occurs.
Peer interactions result in:
Learning control, following rules, competitiveness
Modeling behavior
Recognizing sexual differences

21. Toddlers and Preschoolers
Tips for paramedic:
Always include caregiver!
Position yourself at eye level.
Explain what you are going to do.
Save the worst for last.

22. Toddlers and Preschoolers
Development is a reflection of parents
Styles:
Authoritarian: expects complete obedience
Authoritative: balances authority with freedom
Permissive: no imposition of rules
Divorce may affect self-esteem and well-being.

23. © Trout55/ShutterStock, Inc.
School-Age Children
Ages 6–12 years old
Vital signs, physical body approaching those of an adult
Grow approximately 4 lbs, 2½″ per year
Puberty may start as early as 10 years
© Trout55/ShutterStock, Inc.

24. School-Age Children Psychosocial changes Three stages of reasoning
Preconventional: avoid punishment
Conventional: obtain approval
Postconventional: conscience
Self-concept develops
Self-esteem develops

25. School-Age Children Tips for paramedics:
Use same techniques as for preschoolers.
Gaining (and losing) trust is a huge issue.
Be direct, assertive, and open!

26. Adolescents (Teenagers)
Ages 13–17 years
Vital signs level off to adult ranges.
Growth spurt
Reproductive changes
Secondary sex characteristics
Hormone secretion
© Jamie Wilson/ShutterStock, Inc.

27. Adolescents (Teenagers)
Psychosocial changes
Family conflict related to:
Privacy
Self-consciousness
Rebelliousness
Peer pressure
Self-destructive behavior
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28. Adolescents (Teenagers)
Tips for paramedics:
Provide discretion and respect to patients.
Speak with patient separately from caregivers, whenever possible.
© Jones & Bartlett Learning. Courtesy of MIEMSS.

29. © Rubberball Productions
Early Adults
Ages 18–40 years
Vital signs remain constant.
Body functions at optimal level between ages 19–25.
Accidents are common cause of death.
© Rubberball Productions

30. Early Adults Psychosocial changes
Work, family, and stress are main focus
Want to “settle down”
Seek and find love
One of the most stable life periods, with less psychological problems than other stages

31. Middle Adults Ages 41–60 years. Physical changes: Vision/hearing loss
Cardiovascular disease
Lower metabolism
Cancer rates increase
Menopause/bone density loss, fractures
© Photodisc

32. Middle Adults Psychosocial changes Focus on meeting life goals
“Empty nest” syndrome
Financial worries related to retirement
May see crisis as a challenge, not a threat

33. Late Adults Ages 61+ Vital signs depend on:
Life expectancy approximately 78 years
Vital signs depend on:
Overall health status
Medical conditions
Medications
© Photodisc

34. Late Adults Cardiovascular system
Atherosclerosis leads to blood vessel blockage.
May lead to aneurysms
Hearts are less able to deal with exercise or disease due to:
Decreased pulse rate
Declining cardiac output
Inability to elevate cardiac output

35. Late Adults Cardiovascular system (cont’d)
Vascular system becomes stiff due to:
Increased diastolic blood pressure
Decreased cardiac output
Impeded blood flow
Reduced elasticity of peripheral vessels
Reduced ability to compensate for changes

36. Late Adults Respiratory system Changes make breathing more difficult:
Larger airway; smaller alveoli
Reduced lung elasticity; increased use of intercostal muscles
Rigid chest as ribs calcify to sternum
Decrease in intercostal muscle strength

37. Late Adults Respiratory system (cont’d)
Changes in mouth and nose leave airway less protected.
Difficult to clear secretions
Cough and gag reflexes decline
Less responsive to smoke and dust due to decline in cilia

38. Late Adults Respiratory system (cont’d)
Weakening of smooth muscles may lead to:
Collapse
Inspiratory wheezing
Low flow rates

39. Late Adults Respiratory system (cont’d)
Vital capacity only 50% of younger adult’s
Loss of respiratory muscle mass
Increased stiffness of thoracic cage
Decreased surface area for air exchange
Residual volume increases causing air to hamper gas exchange in alveoli.

40. Late Adults Endocrine system Diabetes related to weight gain
Males lose penis rigidity; females experience atrophy of uterus and vagina

41. Late Adults Renal system Functional changes of the kidneys:
Declining filtration function
Decreasing kidney mass
Declining number of nephrons
Decreased response to hemodynamic stress

42. Late Adults Gastrointestinal system
Decreased sense of taste, weaker teeth
Decreased saliva production
Slower gastric motility
Diminishing acid secretion
Decreased ability to extract nutrients
Fecal incontinence

43. Late Adults Nervous system Central nervous system changes:
Brain weight loss of 10%–20%
Loss of 5%–50% neurons
Loss of 20% frontal lobe synapses
Slower motor and sensory neural networks
Change to biphasic sleep patterns

44. Late Adults Nervous system (cont’d)
Brains have increased risk for injury.
Smaller brain may lead to movement.
Bridging veins may tear.

45. Late Adults Nervous system (cont’d) Peripheral nervous system changes:
Diminished sensation
Diminished proprioception
Deteriorated nerve endings

46. Late Adults Sensory changes: Vision changes
Pupils less responsive to light
Diminished visual acuity
Restricted ocular movement
Increased distortions
Decreased ability to focus at close range
Decreased peripheral vision

47. Late Adults Sensory changes (cont’d): Hearing changes
Loss of high-frequency hearing
Deafness
Loss of taste bud sensation and olfactory perception

48. Late Adults Psychosocial changes
Up until five years preceding death, most late adults retain high-level brain function
Terminal drop hypothesis

49. © Jones & Bartlett Learning. Courtesy of MIEMSS.
Late Adults
Psychosocial changes (cont’d)
95% live at home.
May live in assisted living facility
Financial concerns related to health care
Patients face own mortality
© Jones & Bartlett Learning. Courtesy of MIEMSS.

50. Summary
Developmental stages of life include infant, toddler, preschool age, school age, adolescence, early adulthood, middle adulthood, and late adulthood.
Each developmental stage is marked by different physical and psychological changes and characteristics.
The vital signs of toddlers and preschoolers differ somewhat from those of an infant.

51. Summary
From ages 6 to 12 years, the school-age child’s vital signs and body gradually approach those observed in adulthood.
The vital signs of adolescents begin to level off within the adult ranges.
Vital signs do not vary greatly through adulthood; however, the vital signs of late adults do vary depending on each person’s health.

52. Summary Infants develop at a startling rate.
Two important points regarding an infant’s airway are that an infant’s tongue can more easily occlude the airway, and the lungs are fragile.
Infants are classified as an easy child, difficult child, or slow to warm up. Their primary means of communication is crying.

53. Summary
Toddlers and preschoolers learn to speak and express themselves. Toilet training is usually accomplished around age 28 months.
A child’s development is affected by the parenting style employed by his or her parents. Parenting styles include authoritarian, authoritative, and permissive.

54. Summary
School-age children develop self-esteem and reasoning abilities and receive their permanent teeth.
Adolescents undergo significant reproductive development, focus on creating their self-image, are self-conscious, and may engage in self-destructive behavior.

55. Summary
Early adults focus on work and family. The body should function at an optimal level.
Middle adults focus on achieving life goals. Medical problems become more common.
Late adults undergo significant physical changes. They also focus on their mortality.

56. Credits Chapter opener: © digitalskillet/ShutterStock, Inc.
Backgrounds: Blue—Courtesy of Rhonda Beck; Gold—Jones & Bartlett Learning. Courtesy of MIEMSS; Red—© Margo Harrison/ShutterStock, Inc; Purple—Courtesy of Rhonda Beck.
Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.