Growth and Development Notes PDF

Preview

Summary

peds. Germain... exam 1 notes...

Description

GROWTH & DEVELOPMENT

What is growth?

What is development? What are milestones? Cephalocaudal development

Proximodistal development

What is the Denver II?

Anticipatory Guidance

Growth Charts

Nurses in G&D

Erikson (Psychosocial)

An increase in physical size. It represents quantitative changes such as height, weight, blood pressure, and number of words in the child’s vocabulary. A qualitative increase in capability or function. Refers to how your brain is functioning. Milestone are stages a child goes through. It is used to compare to other children. Proceeds from the head downward through the body toward the feet. Head to toe. For example, infants learn to hold up their heads before sitting, and to sit before standing. Proceeds from the center of the body outward towards the extremities (periphery). For example, infants are first able to control the trunk then the arms. Later, fine movements of the fingers are achieved. The Denver II is a tool to assess development. It is a screening procedure which looks at everything then decides if the child is progressing (meeting milestones). The purpose is to identify delays in children unable to perform at age-appropriate level. Used from birth to 6 years. Assesses development in 4 areas: personal-social, gross motor, fine motor, and language. ~ Personal-social – the ability to get along with people such as playing peek-a-boo and patty-cake. ~ Gross motor – large muscle development such as standing alone and walking well. ~ Fine motor – the ability to see and use hands such as grasping a rattle. ~ Language – the child’s ability to speak such as saying words other than “mama” or “dada”. Nurses use anticipatory guidance to predict upcoming developmental tasks or needs of a child and to perform appropriate teaching related to them. Children follow a consistent pattern of growth. Below 90th percentile and above 10th percentile are ideal. If a child falls near 5th percentile, this causes the nurse to intervene. Nurse’s knowledge in growth and development allows: 1. To give anticipatory guidance to parents 2. Provide age-appropriate care 3. Intervene to promote wellness Refers to how the personality develops in 8 stages. 5 of them apply to children. For each stage, Erikson identified a crisis. If needs are not met, an unhealthy outcome occurs. If needs are met, the consequence is healthy and the child moves on to future stages with strengths. Stages (1) TRUST vs. MISTRUST (birth – 1 year)

GROWTH & DEVELOPMENT

The task of the first year of life is to establish basic trust. Trust is fostered by consistent, loving care by a mothering person and by provision of food, clean clothing, touch, and comfort. If needs are not met, the infant will eventually learn to mistrust others. (2) AUTONOMY vs. SHAME & DOUBT (1 – 3 years) The toddler shows independence by controlling excretions (potty-training), saying no when asked to do something, and directing motor activity and play. Children who are criticized will develop a sense of shame and doubt in their abilities. (3) INITIATIVE vs. GUILT (3 – 6 years) The preschooler initiates new activities and new ideas. Constant criticism leads to feelings of guilt and a lack of purpose. (4) INDUSTRY vs. INFERIORITY (6 – 12 years) School-age childhood is characterized by development of new interests and by involvement in activities. The child takes pride in accomplishments in sports, school, home, and community. If the child cannot accomplish what is expected, a sense of inferiority will occur.

Freud (Psychosexual)

(5) IDENTITY vs. ROLE CONFUSION (12 – 18 years) In adolescence, a new sense of identity or self, is established. The adolescent who is unable to establish a meaningful definition of self will experience confusion. Believes that early childhood experiences form the unconscious motivation for actions later in life. He believed that sexual energy is centered in specific parts of the body at certain ages. Id – basic sexual energy that is present at birth (unconscious mind) and drives the individual to seek pleasure. Ego – realistic part of the person, serves the reality principle (conscious mind). Develops during infancy as they search for acceptable methods of meeting impulses. Superego – moral/ethical system which develops in childhood and contains a set of values and a conscience. Stages (1) Oral (birth – 1 year) The infant derives pleasure largely from the mouth with

GROWTH & DEVELOPMENT

sucking and eating as primary desires. (2) Anal (1 – 3 years) The toddler’s pleasure is centered in the anal area being able to withhold and expel fecal material. (3) Phallic (3 – 6 years) In the preschool child, the genitalia becomes an interesting and sensitive area/ Recognizes sex differences. (4) Latency (6 – 12 years) Sexual energy is at rest. The school-age child elaborates on previously acquired traits and skills.

Piaget (Cognitive)

(5) Genital (12 – adult years) Maturation of the reproductive system is achieved in adolescence (puberty). Production of sex hormones and relationships with others occur. He believed that the child’s view of the world is influenced largely by age and maturational ability. Given nurturing experiences, the child’s ability to think matures naturally. • Assimilation – child incorporates new experiences. For example, the infant uses reflexes to suck on objects that touch the lips. • Accommodation – changes to deal with these experiences. With more experience, the infant accommodates to learn that not all objects are pleasant to suck on. Stages I.

SENSORIMOTOR (birth – 2 years) – infants learn through senses and motor activity Use of Reflexes (birth – 1 month) i. Infants begin life with a set of reflexes. By using these reflexes, the infant receives stimulation via touch, sound, smell, and vision. Primary Circular Reactions (1 – 4 ii. months) Repetition of behavior such as repeating the grasp reflex on a toy because it makes noise and is interesting to look at. iii. Secondary Circular Reactions (4 – 8 months) Awareness of the environment grows as the infant begins to connect cause and effect.

GROWTH & DEVELOPMENT

iv.

v.

vi.

For instance, sounds of bottle preparation will lead to excited behavior. Coordination of Secondary Schemes (8 – 12 months) Object permanence begins to develop. Infant does not know parent will return. Stranger anxiety develops. Tertiary Circular Reactions (12 – 18 months) Curiosity, experimentation, and exploration dominate. Mental Combinations (18 – 24 months) Language develops. Object permanence is now fully developed. Begins to understand the missing parent will return.

II.

PREOPERATIONAL (2 – 7 years) – thinks by using words as symbols, but logic is not well developed. a. Preconceptual (2 – 4 years) Vocabulary and comprehend increase greatly but the child is egocentric (unable to see things from another perspective). b. Intuitive (4 – 7 years) Transductive reasoning – drawing conclusions from one general fact to another. For instance, if the child disobeys the parents and falls and breaks an arm, they relate the broken arm to bad behavior. If the child has shots in the doctor’s office, they relate the doctor’s office to something painful.

III.

CONCRETE OPERATIONS (7 – 11 years) – Transductive reasoning has given way to a more accurate understanding of cause and effect. The concept of conservation is learned, which is that matter (volume, weight, numbers) do not change when its form is altered. For instance, a child knows that putting water in a short, wide glass then putting the same amount of water in a tall, narrow glass equals to the same amount of water. It does not change just because the glasses are different.

IV.

FORMAL OPERATIONS (11 – Adult years) – fully mature intellectual thought has now been

GROWTH & DEVELOPMENT

achieved. The adolescent can think abstractly about objects/concepts and considers different alternatives/outcomes. Kohlberg (Moral)

Stages PRECONVENTIONAL (4 – 7 years) – decisions are based on the desire to please others and to avoid punishment. CONVENTIONAL (7 – 12 years) – A conscience (internal set of standards) becomes important. Rules are important and must be followed to please other people and “be good.” POSTCONVENTIONAL (12+ years) – has internalized ethical standards on which to base decisions.

Maslow’s Hierarchy of Needs

Infants birth – 1 month Erikson (Psychosocial)

Freud ( Psychosexual) Kohlberg (Moral) Piaget (Cognitive)

Type of Play Locomotion

Developing trust by the primary care taker. If failure or inconsistency occurs such as taking too long to respond to a crying infant, mistrust will eventually develop. Oral stage – pleasure is largely from the mouth. Sucking and eating are their primary desires. Right vs Wrong: actions considered good or bad. Sensorimotor phase (birth – 2 years). - Reflexes - Repetitive behaviors - Begins to connect cause and effect - Object permanence Onlooker & Solitary • Cephalocaudal direction of development • Crawls at ____ • Creeps at 9 months • Walks with assistance (holding onto furniture) at 11 months • Walks alone at 12 months

GROWTH & DEVELOPMENT

Development of Body Image

Emotional Development

Social Development

Language Development

Sleep and Activity Fontanelles

Dental Health

Nutrition

• Concept of object permanence at 8 months. • By end of first year, recognizes that they are distinct from parents. Consistency must be established to develop trust, which is vital to the development of a healthy personality. Provide encourage and positive feedback. • Stranger anxiety 12-14 months. Do not expect this at 2 years. • Plays peek-a-boo ____ • Recognizes family’s faces at 3 months. Type of Play: Onlooker and Solitary play • Crying is the first verbal communication • Vocalizations by 6 weeks • Coo, gurgles, laughs • Comprehends “no” at 8-10 months • Nocturnal pattern of 9-11 hours by 3-4 months Total daily sleep  15 hours - Posterior fontanelle closes at 6-8 weeks. Triangle shape. - Anterior fontanelle closes 12-18 months. Diamond shape.  Teeth eruptions at 6 months  Estimate teeth: AGE in months – 6 = # of teeth  First set (primary baby) teeth by 6 months.  First set of permanent teeth by 6 years. How to avoid caries – Don’t sleep with bottle in mouth. Fluoride supplements (not before 6 months). Stop at 36 months. Clean with water initially Breast feeding • 20 mins/per feeding • Contraindications  HIV, chemo, TB, maternal CMV… • If breast feeding, introduce solid foods at 6 months. • If formula fed, introduce solid foods at 4 months. • Choice of formula: 20 kcal/oz

• No whole cow’s milk before 12 months • Eggs until age 2 years • Peanuts, nuts, fish, shellfish (seafood) = 12-18 months

GROWTH & DEVELOPMENT

-

B&B 7th ed. Pg. 285 – 3 years of age

• No honey during the first year of life. Infants cannot detoxify Clostridium botulinum. • When is the infant ready to start solids? When they have achieved good head control. The AAP recommends introducing solid foods at about age 6 months. When introducing solid foods, introduce finger foods (second half of the first year as the palmar and pincer grasp develop, and as teeth begin to erupt – has to be done by 9 months) and water from a sippy cup. Introduce at a rate of one new food every several days. • At about age 8 to 9 months, a cup should be offered to the infant with assistance. • 1 year – able to drink most liquids from a cup with a lid Start in this order  1. Iron-fortified rice/other single-grain cereal (simple grains) 2. Vegetables (6-8 months) 3. Fruits (6-8 months) 4. Meats (8-10 months)

Safety

• When to wean breast milk? Start weaning at 12 months. Stop daytime first. Then stop that first morning. Lastly, stop nighttime feeding. • Crib rails up, canopy down • Place in back to sleep • Support back and head • Mummy wrap not after 2 days • Appropriate use of car seats. Keep the infant in a rear-facing car seat until 2 years of age. Generally, by 4 years the child has outgrown the rear-facing seat, and should be in a forwardfacing car seat. This type of seat is recommended by 4-7 years of age. By 8 years, the child usually outgrows the largest height and weight recommended by the manufacturer of the forward-facing seat. A booster seat is used in the back. Keep all children in the back by 13 years old.

Toddlers 1 – 3 years Erikson (Psychosocial)

Autonomy vs. Shame & Doubt – toddler exerts his/her will,

GROWTH & DEVELOPMENT

Freud (Psychosexual) Piaget (Cognitive) Characteristics of a toddler

What is the goal for toddlers?

Fears

Type of play Nutrition

strives for independence, wants to do things for him/herself. Anal stage – major developmental task is toilet training. Sensorimotor 1. Negativism 2. Ritualism – if you want them to do something, you might have to do it the same way each time. For example, drinking out of a Minnie Mouse sippy cup 3. Temper tantrums 4. Magical thinking – believing something happened because they wished it. For instance, wishing someone was dead. If it happens, they believe they killed the person. 5. Egocentric – unable to see things from another perspective. Do not see another’s point of view. 6. Transductive reasoning The goal is to teach, not punish! - Limit setting - Time-out – one minute for every age. 6 minutes for 6 years old. - Set realistic goals – don’t take your child out during the time they’re supposed to be napping. - Be consistent - Child complies to seek approval - Dark - Pain - Noises - Intrusive procedures – prepare child on what you’re about to do. Parallel Physiologic anorexia – occurs when the extremely high metabolic demands of infancy slow down to keep pace with the more moderate growth rate of toddlerhood Parents of toddlers frequently become concerned about the small amount of food their children eat. Toddlers seem to survive and even thrive with minimal food intake. Although it can appear that the toddler eats nothing at times, intake over days or a week is generally sufficient and balanced enough to meet the body’s demands for nutrients and energy, Finicky eaters – offer them variety and let them make choices. Only wants to eat certain things. They can go up 72 hours with no food, so if they don’t want their food now, tell them it’s there when they feel hungry. Don’t give in to what they want to eat. Ritualistic

GROWTH & DEVELOPMENT

Imitative – wants to be like parents

Preschool 3 – 6 years Erikson (Psychosocial) Freud (Psychosexual) Piaget (Cognitive) Kohlberg (Moral) Major task? Type of play

3 year old 4 year old

5 year old

Personal-Social

Language Development

Sexual curiosity

Nutrition

Initiative vs. Guilt Phallic – Learning sex differences and sexually appropriate behaviors Preconceptual (2-4 yrs) and Intuitive (4-7 yrs) of Sensorimotor phase Preconventional stage Preparations to enter school Associative – group play without rigid rules Imaginative, Dramatic play – imaginary playmates, fear of dark, ghosts, and animals Helpful Can help dress themselves More aggressive Eager to let others know they are superior Be cautious what you say. More talkative (less filter) Begin to wonder about death More responsible Talks constantly Less fearful More jealous More willing to please than toddler Sibling rivalry – new sibling regarded as replacement Hospitalization – fear of bodily harm, mutilation, causes trauma, will regress Thoughts are magical (imaginary friends) Articulations disorders Expressive language delay Global language delay Language disorder Language loss Will ask about sex differences Use correct terminology Masturbation starts • Similar to that of toddlers, but more of a social event. They learn food habits by eating with others. • Engaging them in food preparation enhances knowledge of food and promotes intake at meals.

School-age 6 – 12 years

GROWTH & DEVELOPMENT

Erikson (Psychosocial) Freud (Psychosexual) Piaget (Cognitive) Personal-Social Type of play What are latchkey kids? 6 year old 7 year old 8 year old 9 year old 10 year old 11/12 year old

Industry vs. Inferiority Latency – focus more on friends Concrete operations School and family; respect others; bullying starts Cooperative – organization, group leaders, rules, goal and purpose Kids at home without supervision. Mostly found in single parenting. Energetic Sense of humor; modest Wants to do everything. Can play alone. Creative, group act. Behaves. Hero worship evident Dependable; completes tasks; accepts constructive criticism. Worries Girls more physically mature (breast budding) Self-direction (straight A’s); own goals Intense, observant, energetic Argumentative; needs freedom Preadolescence

Adolescent 12 – 18 years Erikson (Psychosocial) Freud (Psychosexual) Piaget (Cognitive) Kohlberg (Moral)

Major task Personal-Social

Identity vs. Role Confusion Genital stage – pleasing their sex drive. Begins with puberty and lasts until old age Formal operations – the ability to critically think; abstract thinking; able to sympathize and empathize Postconventional – adolescents, to gain autonomy, must substitute their own set of morals and values when making decisions. They must have an internalized set of moral principles Establishing an identity and separating from families Labile emotions. One time they’re happy, the next they’re sad...