NUR 41- PEDS- final blueprint PDF

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Growth and Development: 5 Stages Infant o o o -

developmental stage is divided into 3 periods: Neonatal period: birth to 28 days Young infancy period: 1 month to 6 months Older infancy period: 6 months to 1 year Experience the highest rate of infant mortality The majority of those who die due to: congenital anomalies, complications of birth, complications of prematurity, or a life-threating condition  will die within the first week after birth. ¼ of these deaths occur within the first 24 hours of life.

Developmental Theory  Erik Erikson’s Theory of Psychosocial Development: Trust vs. mistrust During the first year of life If the infant fails to develop a sense of trust in the environment and care providers, the infant will demonstrate signs of mistrust – (frustration and anxiety). Providing for an infant’s basic needs: warmth, feedings, dry diapers, holding/cuddling, sensory exploration, and consistent caregiving  gives the infant the sense of security needed to develop trust. Jean Piaget’s Theory of Cognitive Development:  Infancy till the second birthday  the sensorimotor stage The infant uses their senses to explore the environment and objects The infant develops more coordinated movements that allow for object manipulation and exploration. The recognition of object permanence emerges  the infant searches for items taken out of sight. Differentiation of self from environment is established.  Sigmund Freud’s Theory of Psychosexual Development: The oral phase The primary focus of exploration and sensation is the mouth. Will place all items in their mouth to explore and learn. Sucking and biting are the primary sources of pleasure at this time. Expected Growth and Development INFANCY: marked by rapid growth and development Quickly moves from complete dependency and motor movements based on primitive reflexes to rapidly developing gross and fine motor control. Cephalocaudal: a growth pattern, from the head downward Proximal-distal: a growth pattern, from the center point outward Communication: begins with cooing sounds should be able to babble freely by 7 months of age. If they do not, a hearing impairment should be ruled out. Most infants will say at least one purposive word by one year of age. The first recognizable sound is usually “dada”  can occur as early as 4 months of age Reading, talking, and singing to the infant will help expand the child’s language acquisition and cognitive development. Infants are especially prone to the following health conditions:  Head injuries – (due to falls and motor vehicle accidents)  Anemia – (due to poor nutrition and lack of iron-fortified cereals) Maternal stores of iron are depleted by 6 months of age  Sudden infant death syndrome (SIDS)  (place an infant on the back for sleeping [‘back to sleep’], and do NOT Smoke around the infant or hold infant in clothing with smoke on it)  Shaken baby syndrome (abusive head trauma) due to vigorous shaking of infant  Failure to thrive, (demonstrated by growth plot points below the 5th percentile on multiple occasions  Significant diaper rashes  caused by Candida (yeast with satellite lesions)  Otitis media  Lead poisoning from oral fixation  Aspiration, choking and asphyxiation  Hyperbilirubinemia  Dehydration and acid-base imbalances  Neonatal seizures  related to a metabolic disorder, birth trauma, prenatal infection, or neurologic malformation  Sepsis  due to immune system immaturity and development of an infectious process  Exposure to maternal infections  TORCH: o Toxoplasmosis o Other (syphilis, varicella, HIV, parvovirus B19) o Rubella o Cytomegalovirus infection o Herpes simplex  Exposure to drugs: in utero or fetal alcohol spectrum disorders  Inborn errors of metabolism: o Phenylketonuria [PKU] o Congenital hypothyroidism

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Galactosemia Sickle cell disease Thalassemia Cystic fibrosis and congenital adrenal hyperplasia

Toddler period: age range 1 year – 3rd birthday Child’s physical growth slows down, master locomotion, they feel the need to express themselves as independent and autonomous ‘terrible twos’ Children of this age are inherently unsafe, as they explore their environment using all of their senses and try out new motor skills that make them prone to falls and other potential harm Toddlers are very curious and persistent in their exploration As they grow, they demonstrate more energy, more creativity, and more sophistication in their play activities. Social considerations at this age include the child’s ability to understand object permanence, stranger anxiety, and the beginning of toilet training. If the family has another baby while the previous child is a toddler, the older child may display jealously toward the new sibling or regression to earlier behaviors. Developmental Theory: the toddler period is marked by exploration, cognitive expansion, and increasing motor activities. Erik Erikson’s Theory of Psychosocial Development:   ‘autonomy vs shame and doubt’  A theory of the development of personality over the life span based on social influences and environmental factors  Toddlers struggle with becoming perceptually aware of their separation from the primary caregiver.  Mastery over autonomy ( the ability to act without another person’s control or influence ) must occur, otherwise, subsequent feelings of shame and doubt ( self-questioning about one’s ability to handle problems) will emerge.  May display frustration as they learn that they must wait to have their needs met or gratification secured.  Parents can display autonomy with “can do it” or “me do it” roles  Parents need to be encouraging and supportive, also provide rules, boundaries, and feedback.  Children must learn that their behaviors and responses will have predictable effects on others, and they need positive feedback to develop acceptable behaviors.  Egotistical thought, frequently saying “NO”, loud protests, and tantrums all add to the special patience and guidance required to care for a toddler in a positive and productive way. 

Sigmund Freud’s Theory of Psychosexual Development: focused on the sexual centers of the buttocks and the anus This “anal” stage is marked by the required mastery of retention and voluntary expulsion of fecal elimination Toileting skills become important as toddlers gain ever-increasing control of their neuromuscular functions psychosexual development  focuses on the development of libido fixed on specific areas of the body, which proceeds through five stages (oral, anal, phallic, latent, genital) it suggests that the mastery of toileting and established control of eliminative behaviors gives the toddler a sense of mastery over “letting go or holding on.”

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Kohlberg’s Theory of Moral Development: Obedience, punishment, and rewards shape the toddler period stage of moral development (i.e., development of a sense of right and wrong, and the ability to perform moral reasoning) As the child is egocentric—without the ability to see others’ points of view—negativity develops toward actions that produce punishment Caregivers must apply consistent rules and consequences when dealing with toddlers, who may not understand the connection between their actions and the discipline Time-outs are effective if kept short and accompanied by a quick, developmentally appropriate explanation as to why the time-out is occurring

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Jean Piaget’s Theory of Cognitive Development: cognitive development  (i.e., development of the ability to think and reason) describes the toddler period as being marked by sensorimotor exploration and development Toddlers are actively exploring, using their senses, and creating an understanding of their environment, and they require constant stimulation, movement, and play Both spatial relationships and causal relationships bloom as they experience increasing interest in their environment, experiment with objects, and achieve locomotion.

Expected Growth and Development: Toddler The toddler experiences slower growth through what are known as “spurts and lags.” The toddler gains only 1.8 to 2.72 kg (4‒6 lb) in weight per year, the head circumference expands by just 1.25 to 2.5 cm (0.5–1 in) per year, and height increases by only 7.5 cm (3 in) per year, or less

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Most experts agree that the weight of a toddler who is 21⁄2 years of age should be approximately 4 times (quadruple) the birth weight Toddlers should continue to have their head circumferences measured at each well-child check-up to ensure expected head growth and confirm closure of the anterior fontanel Notably, injuries or conditions of the brain tissue and cerebral spinal fluid can affect this measurement. Communication: Language development occurs rapidly in the toddler period The toddler begins the second year with only 1 to 2 words, but ends the toddler period at the third birthday with between 300 and 500 words Typically, the toddler uses 2- to 3-word sentences, learns to use pronouns, and states his or her first and last names by approximately 2 1⁄2 years of age. Multilingual families typically provide rich cultural experiences, but may create some challenges in language development Residence in a household where two languages are spoken has been known to cause small delays in toddler language development Residence in a home with three or more spoken languages can cause further delays. The toddler may demonstrate an understanding of what is said around him or her, but responses may be delayed The toddler stage is the point at which many developmental delays and neurologic disorders, including autism, first become apparent. Because of the direct link between a toddler’s language development and experiences with positive and supporting parenting, the toddler’s ability to communicate and any barriers to developing language skills should be assessed. Many tools are available for developmental assessment of toddlers and preschool-age children; a comprehensive review of such tools is available through the National Early Childhood Technical Assistance Center Play Needs of the Toddler: Children of this age are moving away from individual play  solitary play, in favor of parallel play. Toddlers will move toward each other and play near each other, but they typically end up back to back, or alongside each other, not sharing toys or craft supplies. Due to their developmental stage, toddlers have difficulty learning to share or being cooperative with toys or play items. For this reason, it is best to offer each toddler a separate activity Sharing is a learned behavior that requires parental role modeling, support, and positive reinforcement. It is typical for a toddler to be interested in a toy for a short period of time and then want to move on to another play item Offering a variety of large, colorful, safe toys creates a successful play opportunity for the young child Appropriate toys that are fun for this age include: blocks for building or stacking, play telephones, play kitchens and workshops, large puzzles, musical instruments made for young children, and pretend medical supplies All play items should be assessed for small parts that can be chewed off or swallowed, or are considered a choking or aspiration risk.

Preschool period: includes the age range of 3 years – 5 years. -

Growth continues to be slow and steady. Growth  an increase in physical size Development  an increase in skill and an increase in complexity of demonstrated tasks. Preschoolers development is characterized by an increasing ability to show more complexity in movement, cognitive processing, language, and fine motor abilities. Magical thinking  the idea that merely thinking about or wishing an interaction, person, or event will cause it to occur. Demonstrate more graceful and coordinated movements. Fine motor development of their fingers continues  allows for greater manipulation and progressive success in the use of writing utensils, art supplies, crafting skills, and toys that require more fine manipulation Emotionally, they have fewer tantrums, and greater ability to express themselves verbally and negotiate.

Developmental Theory:  Erik Erikson’s Theory of Psychosocial Development: Initiative vs. guilt Child attempts new skills, tries out new relationships, and participates in new activities (initiative) If discouraged or unsuccessful in these attempts, the child may develop a sense of self-doubt and guilt. Without mastery of this phase, the preschool-age child will not continue to demonstrate a sense of exploration, initiation, and desire for mastery of new experiences Learning how assertiveness and purposeful actions influence their environment They evaluate their own behavior and notice the behavior of others. Guides the development of conscience. If the child initiates actions that are met with parental disapproval, the child may develop further guilt. 

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Sigmund Freud’s Theory of Psychosexual Development: Phallic-locomotion phase  the child recognizes differences in the genders and shows an interest in discovery and understanding of the genital area. 4 experiences: penis envy, the Oedipus complex, the Electra complex, and castration anxiety (genital

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mutilation anxiety). Electra complex in a female child  feels a psychosexual competition with the child’s mother or significant female figure over her father. The male child experiences the Oedipus complex as a competition with his father figure over his mother.

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Lawrence Kohlberg’s Theory of Moral Development: A person develops in a progressive pattern, including a progressive development of moral reasoning Preconventional  signifying that the child’s moral thinking and behavior are based on concepts related to obedience and punishment. The child learns socially acceptable “normal” behavior by being compelled by the threat of punishment and rewarded by social obedience. A child does not “jump” stages of moral reasoning, but rather progresses stage by stage through various experiences and levels.

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Jean Piaget’s Theory of Cognitive Development: Preconceptual thought  inability to distinguish members of the same class The child continues to use egocentric approaches to address the demands made by both society and the environment. Intuitive thinking  in which the child centers his/her thinking on one characteristic of something and then forms a judgement or makes a decision based on that single characteristic. Egocentric perspective  that the world revolves around “me” but during this phase, their thoughts begin to include others. Young child’s judgement of self or the environment through visual experiences Child enjoy exploring their environments and rapidly develop language that allows them to describe their world and experiences to others Learns to understand cause and effect The egocentric thought process diminishes and children begin to include other’s ideas and preferences into their thinking.

Expected Growth and Development: Preschooler Children experience slow and steady growth “spurts and lulls” in growth are still common, but overall growth in height, weight, and head circumference is slow and steady. Gains only 2.27kg or 5lbs per year and increases in height by 7cm (less than 3 in) per year. Average height is 97.5 to 112.5cm (39-45in) Average weight is 15.9 to 20.5kg (35-45lb) 

Communication and Discipline: Language development flourishes Typical 3-year-old: 300 to 900 words 4-year-old: 1000-1500 words 5-year-old: 1500 -2100 words Children become capable of distinguishing reality from imagination and knowing limitations Discipline for misbehavior needs to take into account what the child is and is not able to comprehend Realistic expectations and positive, behavior-focused practices  (time outs, rewards and approval, and praise, but not lectures or denial of play, food, or affection) Parents should be guided to avoid disciplining preschoolers using physical or corporal punishment  have been associated with negative long-term behavioral patterns

Play Needs of the Preschooler: Associative play  includes loose rules, creativity, and pretend or dramatic play. Typically starts as spontaneous with little preparation, thought, organization, or role delineation. Enjoy imitating adults and will have fun dressing up as adult-type characters such as: nurse, police officer, fire fighter, construction worker, dentist, doctor, business person, ballerina, and characters from movies (e.g., Disney films). Enjoy using “play” or toy replicas of adult items: toy cash registers, toy medical equipment, play computers, and play structures: kitchens, schoolrooms, and toolkits. Some enjoy the development of an imaginary friends and will demonstrate intense conversations and interactions with their “friend” Parents needs anticipatory guidance that this behavior is normal throughout the preschool period and does not represent any pathology or concerns. Participate in symbolic functioning  in which they are able to take an item and turn it into an object of their reality EX: preschoolers imaginations might lead them to make a king’s crown out of a paper plate, use a towel to dress up in a royal cape, use a cardboard box as a race car, or create a classroom by setting up dolls and stuffed animal arranged as an audience. Health Concerns for the Preschooler: Nutrition:  “picky eating” habits or refusal to eat are normal Pediatric nurses should provide anticipatory guidance to parents about what to expect regarding preschooler’s eating behaviors and nutritional needs. Ethnicity and food security have important effects on consumption of fruits and vegetables as well as sedentary 

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behavior, and should be taken into consideration when offering guidance o Consume: grains, lean proteins, dairy products, fruits, and vegetables daily o Daily calcium requirement: 1,000mg o Vitamin D is very important for growing bone structure. Daily requirement is 600 to 1,000 IU between 3 and 4 years of age. 1,000 and 2,000 IU for preschoolers between 4 and 5 years of age. o Protein intake should be approximately 0.95 g/kg of weight per day (approximately 19-21g of protein per day in young children) Dental Care: Children are still dependent on their parents for their oral hygiene. Anticipatory guidance for parents includes: the importance and impact of preventive dental care for primary teeth, the essential role of fluoride, and the effects of feeding practices on dental health Nurses should also inquire whether families have access to dental care and whether a family’s primary drinking water source is fluoridated.

School age developmental period: starts when the child enters kindergarten (usually age 5 ½ or 6) and lasts until age 13. -

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Can be conceptualized as consisting of 2 distinct segments: (1) the early school-age period, in which the child is leaving the preschool developmental stage marked with dependence and magical thinking, and (2) the later school-age period, as the child begins to enter prepubescence children begin to relate to their peers as much as or more than they relate to the family, and they spend more time away from the family as their social life and extracurricular activities expand and grow parenting role changes as the child demonstrates increased independence. this stage as the “easiest” in parenting, as children are mastering independent tasks and becoming accomplished in social expansion, academic work, and self-care losing the “baby face” and growing taller and leaner with increasing coordination and independence in tasks. describe young school-age children (ages 6 to 10) as sweet; cooperative; eager to please parents, teachers, and others in authority such as coaches; and easy to be around many teachers describe children in the school-age stage as being more compliant with academic responsibilities including homework assignments and classroom activities

Developmental Theory  Erik Erikson’s Theory of Psychosocial Development: ‘industry vs. inferiority’ Industry  is a feeling ...