NCMA219 RCE

Promoting preschooler safety

— 4 years of age

— Attitude of independence and the ability to take care of their on needs

— Need supervision to be certain they do not injure themselves or other children while roughhousing

— To ensure that they do not stray too far from home

Preschooler

— Since the children this age have sense of initiative or are learning to do things, allow a child to prepare simple foods, such as making sandwich or spreading jelly on a toast

Preschooler — Obesity

— Urge parents to offer snacks such as fruit, cheese, or milk rather than cookies and a soft drink or juice

Preschooler — Vitamins

— Not to give more than the recommended daily amount or poisoning from high doses of fat-soluble vitamins or iron can result

Dressing — Preschooler

— Fold together matching shirts and slacks so a child sees them as a set instead of individual pieces

— If the child insist on wearing mismatched clothes, urge parents to make no apologes for their appearance

Sleep — Preschooler

— When they are tired they often curl up on a couch or soft chair

— On some occasions, even though they may be tired, refused to sleep because of fear of the dark and may wake up terrified by a bad dream

— May need a night-light turned on

Exercise — Preschooler

— Promoting active games and reducing TV watching can be steps toward:

• Helping children develop motor skills

• Preventing childhood obesity

Hygiene — Preschooler

— Preschoolers can wash and dry their hands adequately if the faucet is regulated for them

— Parents should turn down the temperature of the water heater in their home to under 120 degF to help prevent scalds

— They should not be left unsupervised at bath time in case they decide to add more hot water or practice swimming and then be unable to get their head out of the water again.

Teeth-grinding

— Bruxism

— A way of “letting go”, similar to body rocking

— If damage is extensive, the crowns of the teeth can become abraded

Telling tall tales

— Stretching stories to make them seem more interesting

— This is not lying, but merely supplying an expected answer

— Caution the parents not to encourage this kind of storytelling but instead help the child separate fact from fiction

Imaginary friends

— Normal, creative part of the preschool years and should not pose a problem and often leave as quickly as they come

Difficulty sharing

— 3 years of age

— Children begin to understand some things are theirs, some belong to others, and some can belong to both

— Assure parents that sharing is a difficult concept to grasp and preschoolers need practice to learn and understand it

— Defining limits and exposing children to the concepts of mine, yours, ours help them determine which objects belong to which category

Regression

— In relation to stress, revert to behavior they previously outgrew, such as:

• Thumb-sucking

• Negativism

• Loss of bladder control

• Inability to separate from their parents

— Normal in these circumstances

Broken fluency

— The repetition or prolongation of sounds, syllables, and words

— Often referred to as secondary stuttering because the child began to speak without these problems and then, during the preschool years, develops it

— Part of normal development, and if accepted as such, will pass

Fear of the dark

— Heightened by a child’s vivid imagination

— Monitor the stimuli their children are exposed to especially before bedtime, such as TV, adult discussions, and frightening stories

— Leaving on a dim night-light can solve the problem

Fear of mutilation

— Intense reaction to even simple injury

Fear of separation and abandonment

— Sense of time is distorted and sense of distance is limited

Chronic back pain

— Backpack weighs more than 10% of the child’s body weight

— Cause to lean forward chronically to bear he eight

Sexual maltreatment

— Unfortunate and all-to-common hazard for children

Proper etiquette

— Is important.

— Parents can model this behavior for their child and encourage meals to be eaten at the table rather than while watching TV

Boys

— Require more calcium and nutrients than girls at this time

Iron

— Both boys and girls require more

Calcium and fluoride

— Are important to ensure good teeth and bone growth

Dress — School-age

— Teach the importance f caring for their own belongings

— Base their clothing styles on the likes of their friends or their idols rather than their parent’s preference

10 to 12 hours

— Younger children

8 to 10 hours

— Older children

Exercise — School-age

— Increasing time need not involve organize sports

Obesity or osteoporosis

— Can result in life without exercise for a school-age

6 to 7 years old — School age

—Need help in regulating bath water temperature and in cleaning their ears and fingernails

8 years old — School-age

— Generally capable of bathing but may not do it well because they are too busy or may not find bathing important

Dentist visit — School-age

— Twice yearly

— Checkup cleaning

— Possibly fluoride treatment

Dental caries — School age

— Is largely preventable with proper brushing and use of fluoridated water or fluoride application

Every 6 months — School age

— Recommended dental visits

Malocclusion

— Deviation of tooth position from the normal and may be congenital due to conditions

First graders — anxiety beginning school

— Capable of mature action at school but appear less mature when they return home

• May bite their fingernails, suck their thumb, or baby talk

Sex education

— Be educated about pubertal changes and responsible sexual practices

Preteens — Sexual education

— Should have adults they can turn to for answers to question about sex

Nurses —Sexual education

— Can take steps to improve outcomes for LGBT youth by providing care that is affirming and inclusive

Stealing

— Occurs because, although a child is gaining an appreciation is not yet balanced by strong moral principles or an understanding ownership

• Rule: best handled without a great deal of emotion

Bullying

— Frequent reasoning of anxiety

— Feeling so unhappy that they turn guns on classmates or commit suicide is because they were ridiculed or bullied to the point they can no longer take such abuse

Dress and hygiene — Adolescent

— Capable of total self-care and may even be overly conscientious about personal hygiene and appearance

Care of teeth — Adolescent

— Very conscientious about tooth brushing because of fear of developing bad breath

Teens with braces

— must be extremely conscientious about tooth brushing to prevent plaque buildup on hidden tooth surfaces.

Sleep and exercise — adolescent

— May need proportionately more sleep than any other age group

— Because are building new cells during protein synthesis.

16-year-old girls — Hypertension

— blood pressure is above the 95th percentile, or 127/81 mmhg

16-year-old boys — Hypertension

— 131/81 mmhg

Infant — First year

— High protein- high-calorie intake for extremely rapid growth

Infant — Overweight prevention

— Calorie allowances gradually reduces from a level of 120 cal/kg of body weight at birth to approximately 100/kg of body eight at the end of the first year

Infant — Overweight during the first year

— More likely to become an obese adult whos weight is within normal limits as, once formed, fat cells(adipocytes) remain for life

Breastfed infants

— gain less eight than those who are formula fed

— Delaying the introduction of solid food until 4-6 months and avoiding sweet drinks for infants can help avoid obesity in formula fed infants

Infant - Ready for solid food

— Nursing vigorously every 3-4 hours

— Taking more than 32 oz (960 mL) of formula a day and do not seem satisfied

Infant — Approximately 2 to 3 months

— Amylase is present in saliva

— Infants are not ready to digest complex starches

Infant — 3 months

— BITING movement begins

7 to 9 months

— CHEWING movements begin

2 Tablespoons (30 m L)

— Newborn’s stomach can hold

No more than about 1 cup (240 mL)

— A stomach can hold by 1 year of age

Teething

— Gums are sore and tender before a new tooth breaks the surface

— infants can be resistant to chewing for a day or two and be slightly cranky, possibly because they are a little hungry from not eating as much as usual.

High fever, seizures, vomiting or diarrhea, and earache are never normal signs

Sleep problem

— Breastfed babies - Wake more often than those who are formula fed because breastmilk is more easily digested, so infants become hungry sooner

— Late infancy - The problem of waking at night and remaining awake for an hour or more becomes common

Colic

— Paroxysmal abdominal pain that generally occurs in infants under 3 months of age and is marked by loud, intense crying

Infant caries

— Baby-bottle syndrome

— Carbohydrate in solutions such as formula or glucose water ferments to organic acids that demineralize the tooth enamel until it decays

Obesity in infants

— Increase in the number of fat cells because of excessive calorie intake

Lead screening

— 6 months and 6 years

— Live in communities with buildings built before 1950 should be tested periodically for the presence of _______

Toddler nutrition

— Unpredictable appetite and food preferences

— Protein and carbohydrate needs are often those most easily met during the toddler period

Sedentary children ages 1 to 3 years

— Consume 100 kcal daily`

Active children

— 1400 kcal daily

Toilet training

— Is an individualized task for each child

— It should be completed according to a child’s ability to accomplish it, not according to a set schedule

Negativism

— As part of establishing their identities as separate individuals, toddlers typically go through a period of extreme ____

— They do no want to do anything a parent wants them to do

• Their reply to every question is a very definite no

— Normal phenomenon but also a positive stage in development

— They have learned they are separate individuals with separate needs

Discipline

— Setting rules or road signs so children knw what is expected of them

— NOT interchangeable terms with punishment

— Should be instilled early in life because part of it involves setting safety limits and protecting others or property

Punishment

— Consequences that result from a breakdown in discipline, from the child’s disregard of the rules that were learned

Timeout

— Technique to help children learn that actions have consequences

— The child sits there fr a specified period of time

Separation anxiety

— 6 months of age

— Fear of being separated from parents begins at about and persists throughout the preschool period

Temper tantrums

— Occur as a natural consequence of toddlers’ development

— Occur because toddlers are independent enough to know what they want, but they do not have the vocabulary or the wisdom to express their feelings in a more socially acceptable way

— A way toddlers express feelings

INFANT

— Nursing assessment of an infant begins with interview with the primary caregiver

— Assessment must be done quickly but thoroughly

— Using a calm approach helps stay calm

Lateral incisors (UPPER)

— 9-13 months

Lateral incisors (LOWER)

— 10-16 months

Central incisors(UPPER)

— 8-12 months 

Central incisors (LOWER)

— 6-10 months 

Month 1 — infant

— Largely reflex actions

— Keeps hands fisted; able to follow object to midline with eyes

— Enjoys watching face of primary caregiver; Needs play time in prone position 

Month 2 — infant 

— Holds head up when prone 

— Demonstrates social smile

— Makes cooing sounds; differentiates from cry

— Grasp reflex fading

— Enjoys bright-colored mobiles

3 months — Infant 

— Holds head and chest when in prone 

— Follows object past midline with eyes 

— Laughs out loud

— Landau reflex is strong 

— Spends time looking at hands(hand regard)

— Tummy time important during the day 

4 Months — Infant

— Turns back to front

— No longer has head lag

— Bears partial weight on feet

— Stepping, tonic neck, extrusion reflexes are fading

— Needs space to practice turning 

5 Months — Infant 

— Should turn readily front to back and back to front

— Tonic neck reflex fading

— Handles rattles well

6 Months — Infant 

— Begins to show ability to sit

— Uses palmar grasp

— May say vowel sounds

— Moro and tonic neck reflex have faded 

— Enjoys bathtub toys, rubber ring for teething

7 Months — Infant

— Reaches out to be picked up— First tooth( central incisors) erupts

— Transfers objects hand to hand 

— Shows beginning fear of strangers

— Likes objects that are good size for transferring

8 Months — Infant

— Sits securely without support

— Fear of strangers peaks

— Enjoys manipulation, rattles, and toys of different textures

9 Months — infant

— Creeps or crawls(abdomen off floor)

— Says first word

— Needs safe space for creeping

10 Months — Infant

— Pulls self to standing

— Uses pincer grasp(thumb and finger) to pick up small objects 

— Plays games like patty-cake and peek-a-boo

11 Months — Infant

— Cruises (walks with support)

— Cruising can be main activity 

12 Months — Infant

— Stands alone; some infants take first step

— Holds cup and spoon well; helps to dress (pushes arm into the sleeve)

— Says four words

— Landau reflex fades

— Likes toys that fit inside each other(pots and pans), nursery rhymes, will like pull toys as soon as walking

Toddler

— Assessment begins with taking a careful health history

— Asking parents about a toddler’s ability to carry out activities of daily living offers assessment information not only on the child’s developmental progress but also important clues about the child-parent relationship

— A typical sign they are not feeling weel is acting “out of sorts” or “different”

15 Months — Toddler 

— Puts small pellets into small bottles; scribbles voluntarily with a pencil or crayon; holds a spoon well but may still turn it upside down on the way to the mouth

— Walks alone well; can seat self in chair; can creep up stairs

— 4-6 words

— Can stack two blocks; enjoys being read to; drops toys for adult to recover(exploring sense of permanence) 

18 Months — Toddler 

— No longer rotates spoon to bring it to mouth 

— Can run and jump in place; can walk up and down stairs holding too a person’s hand or railing; typically places both feet on one step before advancing 

— 7-20 words; ses jargoning; names one body part

— Imitates household chores such as dusting; begins parallel playing(playing beside, not with another child)

24 Months — Toddler

— Can open doors by turning doorknobs; can unscrew lids

— Walks up stairs alone, still using both feet at the same time

— 50 words; two word

— Parallel play evident

30 Months — Toddler

— Makes simple lines or strokes for crosses with a pencil

— Can jump down from chairs

— Verbal language increasing steadily; knows full name; can name one color; holds up fingers to show age

— Spends time playing house, imitating parents’ actions, play is “roughhousing” or active

Good rule

— is to think of a toddler as a visitor from a foreign land who wants to participate in everything the family is doing but does not know the customs or the language.

3 years — Preschooler

— Undresses self; stacks tower of blocks; draws a cross

— Runs; alternates feet on stairs; rides tricycle; stands on one foot

— Vocabulary of 900 words

— Able to take turns; very imaginative

4 Years — Preschooler

— Can do simple buttons

— Constantly in motion; jumps, skips

— Vocabulary of 1500 words

— Pretending is major activity

5 years — PReschool

—Can draw a six- part figure; can lace shoes

— Throws overhand

— Vocabulary of 2100 words

— Likes games with numbers or letters

Oedipus complex

— Strong emotional attachment a preschool boy demonstrated toward his mother

Preschool

— Assessment includes obtaining a health history and performing both a physical and developmental evaluation.

— speak very little during a health assessment; they may even revert to baby talk or babyish actions such as thumb-sucking if they find a health visit stressful.