Peds Exam 1 - Growth & development and health promotion PDF

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Exam 1 - Normal Growth and DevelopmentStages of Human Development Infant: birth–1 year  Toddler: 1–3 years  Preschooler: 3–6 years  School-age child: 6–12 years  Adolescent: 12–20 yearsKnow the age ranges Ex: if a child is 12 month and 1 day  this child is a toddler (even the child is only 1-d...

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Exam 1 - Normal Growth and Development

Stages of Human Development     

Infant: birth–1 year Toddler: 1–3 years Preschooler: 3–6 years School-age child: 6–12 years Adolescent: 12–20 years

*Know the age ranges* Ex: if a child is 12 month and 1 day  this child is a toddler (even the child is only 1-day past infancy) – this child is not a infant anymore**

General Principles  Development maturation is based on: o Functional behavior (meeting developmental tasks and milestones) o Ability to adapt to environment  Directional pattern for muscular coordination and control: o Head-to-toe (Cephalocaudal) o Trunk-to-periphery (Proximodistal) o Gross-to fine  Chronological age = age in years

G&D: Assessment  Influencing factors o biological o environmental o socioeconomic  ex: affects nutrition  Social characteristics (play) -How does the kid play? o Solitary (Infant): they will be playing by themselves o Parallel (toddler): playing parallel to each other, not with the each other o Associative play (preschool): no specific goals or rules o Cooperative (school aged): specific goals and rules, organized leader team captain  Physical measurements: o height, weight (in kg), head circumference, chest circumference o head circumference very important in a neonatal period for baseline and to check to see what’s going on with the child. Sometime children later in life can have condition which head is enlarge or very small of age  use the length of the child. Once the child go home the pediatrician continuously monitoring the all the physical measurements. o decreased weight may indicate failure to thrive o All measured at birth + continued to be measured throughout infancy  Screening tests: Denver II Development (to identify young children, 0-6 years old, with developmental problems.) o Social skills o Fine motor skills  Later on, the fine motor keeps developing, supposed to lose the gross model skills.  Ex: The child is now 2 years or older, they can button the button, o Language skills o Gross motor skills

Nurses need to understand a lot of these things are done for baseline information and also if the patient think that their child has some problem with growth and development  Psychosocial, Moral and cognitive milestones o Erickson’s  focuses on achievement of autonomy and self-control, learning how to be independent o Freud Kohlberg’s  focuses on the moral development  Ex: Avoiding punishment for disobedience is the first reason a child learns to behave or “be good”. o Piaget’s  focuses on development of the senses  Sensorimotor ex: the toddler accomplishes the satisfaction of using the potty, when preschooler realizes boys and girls have different body parts. Self-identity the child realizes he/she is different from their parent *Erickson’s is the main focus for this class

Infant Growth and Development  Birth to one month  (newborn/neonate)  Head = ¼ of body length  Assess Fontanelles (MUST assess on every child until it’s closed) o Anterior: Closes by 18 months old o Posterior: Closes by 2 months old o We assess each child with fontanelle open o When assessing, do NOT press it down  just lay your finger to feel the fontanelle/soft spot o Check to see whether it’s soft, depressed, or bulging/tense o It should NOT be tense/bulging or depressed; it should be just soft o Depressed fontanelles  child maybe dehydrated o Bulging fontanelles  increased intracranial pressure  Infants are Top heavy, short lower extremities  Wt: 6-8 lbs, gains 5 to 7 oz (142 to 198 g) weekly for 1st 6 months. o Always document the weight in kg o Assess the infant’s weight once a day o If the child is an infant  you do not need an order to assess the weight; you must assess the weight every day. o A healthy infant should be steadily maintaining their weight. o A child should double in birth weight by 6 months and tripled his weight by one year!!!  If the child comes and this child is way less than the birth  problem  If weight less and didn’t double in 6 months  could be a problem  Ex: the child born at 6 kg, after 6 mo  Ht: 20 inches (50 cm), grows 1 inch (2.5 cm) monthly for 1st 6 months. o hold the legs straight to measure the infant height

o The child grows one inch HC: 33 to 35 cm (13 to 14 inches) o HC > CC. o Don’t need to know the specific numbers for HC

Assessing Growth and Development of a Premature Infant  Use the infant’s adjusted age to determine expected outcomes.  Subtract the number of weeks that the infant was premature from the infant’s chronologic age.  Plot growth parameters and assess developmental milestones based on adjusted age  For example: o The nurse assessing developmental milestones for a 7-month-old premature infant born at 28 weeks’ gestation would adjust the age to 4 months.

o Healthy growth would be demonstrated if the infant were the size of a 4-month-old and achieved the developmental milestones of a 4-monthold.

40wks – 28wks = 12wks = 3 months

7months – 3 months = 4 months Sensory Development  Hearing & touch well developed at birth o every child gets a hearing & touch screening before leaving the hospital o if the child fails once, they will do it again; if the child fails again, they

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will just do it again in the pediatrician office before the child being discharged. Then the pediatrician can make a determination. Sight not fully developed until 6 yo, differentiates light & dark at birth, prefers human face, smiles at 2 mos Searches & turns head to locate sounds at 2 mos Has taste preferences by 6 mos Responds to own name by 7 mos o If by 7 months the child is not responds to anything, maybe something is wrong  Maybe, if the child is not stimulated at home then the child may not have any social skills, therefore need to talk to the parent first Able to follow moving objects; visual acuity 20/50 or better. Can vocalize 4 words by 1 yo.

Know these**

- Those things on the crib  are very important because they stimulate the child to focus on visual objects

- Lack of stimulation may cause some types of deficit. - Hospitals have the same thing to stimulate the children as if these children were home

Primitive and Protective Reflexes Primitive reflexes = Primitive reflexes involve a whole-body response  Moro - startle - till 3 - 4 mos o The reflexes should be start disappearing in three to four months o After four months the child should not have this reflex  rooting  Sucking  Tonic neck – fencing – till 3 –4 mos  Babinski (disappears by 12 mos) – last the longest  Palmar grasp - 3 - 4 months lessens  Stepping - till 3 – 4 weeks  **Extensor reflex disappears 4-5 months** Reflexes present at birth and diminishing when they should  indicate a healthy neurological system. If the kid have some type of neurological problems, nurses need to document and have to let the doctor know Extensor reflex/tongue thrust  Infants uses tongue to push away anything in their mouth except for a nipple to suck, this reflex

Protective reflexes = they are gross motor responses related to maintenance of equilibrium; These responses are prerequisites for appropriate motor development and remain throughout life once they are established.  Gag, cough, blink, parachute

Milestones

Head lag = if you pick up a child, the child cannot keep their head up. A 4-month-old should not have a head lag  they can hold the head upright o If you have a five-month-old kid and the head is lagging, growth development that’s a problem When should a child be sitting? o Need to take into consideration that children follow a similar pattern, not the same exact pattern o For example: You expect the child to be sitting at six months, and the child is not sitting at 6 months. Does that indicate something is wrong with the child? o Not really, wouldn’t immediately say something wrong with the child o Some patients never give the child that opportunity to learn to sit

Ex: a 14-month-old child is not walking  check if they are premature baby + ask the parents some questions before you make a determination; If a child is in a crib or seat all the time  they will not be able to start walking on time. Therefore, you should ask the parents if they take the child out of the seat and do the walking activities.

Head Control

Fine Motor  Hand closed at 1 month  Two handed voluntary grasps at 5 mos  Holds bottle, grasps feet at 6 mos o Some parents would always want to feed the child rather than giving a sippy bottle (when they get introduced to solid food). So, the child never gets to practice holding bottle  may result a delay  Transfers from hand to hand at 7 mos  Gross Pincer grasp at 8 mos (raking)  Neat pincer grasp at 10 mos o You give the child a French fry, they take it. That’s fine motor  Tries to draw, feed themself at 12 mos o The kid should be using a sippy cup

Crude Pincer Grasp vs Neat Pincer Grasp

Crude pincer = gross motor Neat pincer = fine motor

Nutrition  Human breast milk is most complete & easily digested. o If you don’t physically put the baby to the breast, you can also pump the breast milk and feed the baby breast milk. o If breastfeeding  feed every 2 hours by waking up the baby throughout the night  Commercially prepared iron fortified formulas for bottle feeding closely resemble the nutritional content of breast milk, recommended for 1st 12 months. o If using commercially prepared  feed every 4 hours o Water is not require and they should never be an option to given to kid, because the formula already has water and water is empty calories  Some Caribbean parents or parents that always introduced some water to the child because they think the child is going to be constipated and dehydration, but you have to take into consideration that it is all about the child gaining weight

o As the child gets older and start to be introducing to solid food, most people give juice but still NO WATER o Any formula that gives a child should be IRON 45  Parent should NOT change to a different formula even the iron causes the child constipation  Nurses need to educate the parent about this  In infancy you concern about hemoglobin and hematocrit, that why all kids have irone 45 formula, and some doctor still order iron supplements o If the kid is constipated, you get a little Q tip and mix with little bit of Vaseline and tick the kid butt  going to pee  Therefore, no need of water o As the child introduce to solid food, they can start to have juice and as they getting older they can have water like after a year  Exception to recommended breast-feeding o Infants with galactosemia o Maternal use of illicit drugs and a few prescription medications o Maternal untreated active tuberculosis o Maternal HIV infection in developed countries

Benefits of Breastfeeding Infant （没说）  Increased bonding with mother  Immunologic protection  Breast milk has anti-infective properties  Decreased incidence and severity of diarrhea  Decreased incidence of asthma, otitis media, bacterial meningitis, botulism, urinary tract infection  Possible enhancement of cognitive development

 Decreased incidence of obesity in later childhood

Maternal （没说）  Increased bonding with infant  Lessens maternal blood loss in the postpartum period  Decreased risk of ovarian and premenopausal breast cancer  Reduced incidence of pregnancy-induced, long-term obesity  Possible delay of return of ovulation in some women  Always ready; no mixing!  Economic advantage

Bottle-Feeding  Proper preparation  Proper storage of formula o Instruct the parents do NOT warm the bottle up in the microwave because it heats up unevenly; a bottle warmer would be preferred to use at home o In the hospital settings, we do NOT warm up the formula = we feed all babies at room temperature. o Do not reheat and reuse partially used bottles. Throw away the unused portion after each feeding.  Care of bottles o All the bottles should be washed and sterilized o Recommend the parents to wash the bottle and the nipples by themselves and use a sterilizer (not in a dish washer)  ONLY formulas that are fortified with iron should be used o Even if the parents complaining of baby being constipated  Nurse can NOT recommend the parents to buy formulas without iron.

Infant Nutritional Requirements  1 month: o 6-7 feedings/day o stomach capacity 50-60 cc/ empties q. 2-3 hrs. o Parents should wake baby up to eat throughout the nights = NEVER leave the young babies sleep throughout the night. o Try not to overfeed a child  6 months: o 5 feedings / day o begin solid food  1 food at a time  food need to be soft o usual order cereal -vegetables-fruits –meats o allergenic foods last. Ex: eggs, orange juice  try to control introduce a bunch of things at the same time, in case the child develops a food allergy which we can know what they are allergic to o solids should be fed with a spoon, with the infant in an upright position.  9 months begins to feed self o Put the baby in a high seat o Some parent don’t want to child to be independent because they make a big mess, therefore some child lack of practice of self-feeding  11-12 months o 4 feedings/day o table foods by one year Baby should NOT be fed with water  water has zero calories Tell the parents that the formula has water in it.

Normal Nutritional Requirements  Expected weight gain o ***Doubled by 6 months tripled by 1 year *** o Ex: Birth weight 7LBS  ?/lbs 6months  ?/lbs 1 year o Answer: 14lbs by 6 months; 21 lbs by 1 year  Breastfeeding preferred over bottle o Iron Fortified Formula Recommended  Elimination o Stools  Yellow/seedy(breastfed) or Brown/pasty(formula) o Urine  6-8x Per Day o You can tell the parents who are breastfeeding  if the child is urinating, that means the child is getting enough.

Thumb Sucking and Use of Pacifier  Importance of sucking in infancy o When a child gets fussy, it does not always mean that they are hungry. If you just feed the child half an hour ago, and the child is crying again, you can try to give a pacifier to sooth the child.  Relationships between pacifier use and frequency and adequacy of feedings  Safety considerations with pacifier use o Some parents put the pacifier in the kid’s mouth and tie it  if the kid vomited that can cause a serious problem

Teething  Teething Syndrome o Painful process o = drooling & saliva, increased temperature. o more acidic BM’s  diaper rash. o If you have a child infancy, your discharge should never develop a fever, so if you have a child that is having a fever when they come to the hospital doctor are very aggressive and treated this child because they’re going to say why is this child have a fever in the first place

o Doctor in the pediatrics checks everything of the child including meningitis, UTI etc.… because when things happen, the kids conditions will go downhill very fast  death (possibly) o For increased temperature  give an antipyretic; but make sure to go to the drug store and buy the ones that is for infant = infant drops. o Do NOT just give the child Tylenol because they can overdose the child  During the first 2 years of life o Age of child in months – 6 = Number of teeth o Ex: at 8 months of age 8 – 6 = 2 (An 8-month-old should have two teeth.)

Psychosocial Development  Trust vs. mistrust - Erikson o Importance of caregiver-child relationship o Importance of consistency of care o When the infant’s needs are consistently met, the infant develops this sense of trust. But if the parent or caregiver is inconsistent in meeting the infant’s needs in a timely manner (such as hungry and need to change the diaper), then the infant develops a sense of mistrust. whoever is providing the best care for that child  the child is going to trust that person.  Oral Stage – Freud o Pleasure focused on oral activities  Feeding  Sucking

Cognitive Development Piaget  Sensorimotor (birth to 2 years) o Infant learns about the world through senses o Sucking brings the pleasure of satiation  Repeats actions to receive wanted results o Later intentionally shakes rattle o Crawls across room to reach a toy o Object permanence at 8 months o Infant begins to associate symbols  Wave bye bye Ex: if you gave a child an IV, which is a traumatic experience for that child  they are going to associate you with the traumatic experience  so as soon as they see you, they will start to cry Therefore, some hospitals have treatment rooms that they do all the traumatic treatments in. So, the child would not associate their patient room with traumatic experience. o Some children back of the head has no hair, because they are constantly laying on his back o Preemie babies turn the baby head side to side o Safest Position: back to sleep o Most population to put baby on the side (you don’t want to do that) o Nurses need to educate the parent it’s not safe to put the baby on the side, because if they vomited  it going to come out of the mouth  Also, if the nose are too close to the mouth, they will inhale and cause aspirate o Now, put the baby back to sleep  baby vomiting they will swallow it back and it’s NOT going to cause any harm

The Concept of object permanence is solidified by 8 months old

If an object is hidden from the infant’s sight, he or she will search for it in the last place it was seen, knowing it still exists. = Infant knows the object still exists when they don’t see it. Viewing own image  By end of first year, the infant knows he or she is separate from the parent or caregiver. Self-image is also promoted through the use of mirrors. By 12 months of age, infants can recognize themselves in the mirror.

Social Development  Separation anxiety  Stranger anxiety o The previously happy and very friendly infant may become clingy and whiny when approached by strangers or people not well known.

 Play as major socializing agent (solitary) o Infant play by themselves  solitary play o Mobiles, Music, Stuffed Animals, Blocks, bath water, rattles, unbreakable mirrors in crib, books o No small toys o Cannot give stuff animals to an infant who has asthma  know the child’s diagnosis

Safety**  Siderails of crib up o For any children who are able to sit up, stand up, the siderails of the crib should be all the way up!  If you see the side rails are halfway up, means the child cannot sit or stand up o NEVER turn your back to an open crib  NEVER leave unattended on table, bed, bathtub o Little water in a bathtub can drown the kid  Check temp of bath water, formula, foods  Avoid bottles at naps or bedtime o Prevent cavities o Prevent ear infections  put the child in a upright position when feeding so the formula does not go into the ear  Injury Prevention (aspiration of small objects – buttons, toys, peanuts, hotdogs) o Prevent anything can choke the kid  Suffocation – plastic bags, strangulation, gloves o No playing with gloves in a hospital setting***  Falls  Poisonings o Coming from under the sink products

 Burns

Infant Car Restraint

 required by every sate  Rear facing car seat until reach maximum weight allowed by manufacturer and 2 yo in middle of back seat of car.  Must be rear facing, cannot be in a front seat; have to be buckled  The nurse cannot send the infant home unless the nurse sees the car seat.  If you see a parent with a car seat on their lap  call 1800 number

Language Development  Crying is first verbal communication o If a child cry or get fussy  requires attention to see what is going on with that child. o They might feel hungry, change diaper, want to be picked up, or not feeling well  Vocalizations  Three to five words with meaning by age 1 year/12 months o Child should not be over 1 and cannot say anything

Common Developmental Concern: Colic  Inconsolable crying lasting 3 hours or more  Resolves by 3 mont...