CHILD GROWTH AND DEVELOPMENT

NURSING CARE OF A FAMILY WITH an infant

physical growth

• weight

• height

• head circumference

• body proportion

• body systems

• teeth

anthropometric measurements

• weight is doubled by 4-6 months and tripled by the first year

• length increases by 50% during the first year

• by 1 year, brain is 2/3 the adult size

weight is doubled by ___ months and ___ tripled by the first year

4-6, tripled

length increases by ___ during the first year

50%

by 1 year, brain is ___ the adult size

2/3

measuring an infant head to heel, from the top of the head to the base of the heels

body systems

• HR 100-120 bpm to 120-160 bpm

• BP 80/40 to 100/60 mmHg

• physiologic anemia at 2-3 months of age

• RR 20-30 bmp to 30-60 bpm

• GIT, liver, renal remains immature

• immune system functional by 2 months

• thermoregulation matures by 6 months

HR ______ bpm to ______ bpm

100-120, 120-160

BP ____ to ____ mmHg

80/40, 100/60

Physiologic anemia at ___ months of age

2-3

RR ____ bmp to ____ bpm

20-30, 30-60

GIT, liver, renal remains ___

immature

Immune system functional by ____

2 months

Thermoregulation matures by ____

6 months

teeth

natal/neonatal teeth

born with teeth (natal teeth)

teeth erupt in the first 4 weeks of life (neonatal teeth)

motor development

gross motor development

ventral position

prone position

sitting position

standing position

ventral position

• 1 month: lift their head momentarily and then drop it again.

• 2 months: hold their head in the same plane as the rest of their body, a major advance in muscle control.

• 3 months: infants lift and maintain their head well above the plane of the rest of the body in ventral suspension.

lift their head momentarily and then drop it again

1 month

hold their head in the same plane as the rest of their body

2 month

infants lift and maintain their head well above the plane of the rest of the body in ventral suspension

3 months

landau reflex

• stimulation: newborn were made to lie in a prone position with the nurse’s hand supporting the trunk

• normal response: the head will extend and the back and hips will extend in sequence (superman)

• age of disappearance: appears in 3 months, disappears at 12-24 months

• function: absence of reflex occurs in hypotonia, hypertonia or mental abnormality

landau reflex stimulation

• newborn were made to lie in a prone position with the nurse’s hand supporting the trunk

landau reflex normal response

• the head will extend and the back and hips will extend in sequence (superman)

landau reflex age of disappearance

appears 3 months, disappears at 12-24 months

landau reflex function

absence of reflex occurs in hypotonia, hypertonia, mental abnormality

parachute reflex

• appears about 6-9 months and persists thereafter

• elicited by holding the child in ventral suspension and suddenly lowering him to the couch

• arms extend as a defensive reaction

clinical significance

• absent or abnormal in children with cerebral palsy

• would be asymmetrical in spastic hemiplagia

reflex appears at about ___ months and persists there after

6-9

elicited by holding the child in _____ and suddenly lowering him to the couch

ventral suspension

arms extend as a ____ reaction

defensive

parachute reflex clinical significance

• absent or abnormal in children with cerebral palsy

• would be asymmetrical in spastic hemiplagia

prone position

• 1 month: lift head and turn it easily to side

• 2 month: can raise head and maintain position but cannot raise chest high enough to look around yet

• 3 months: lifts head and shoulders well off the table and looks around when prone

• 4 month: lift their chest off the bed and looks around actively, turning their head from side to side. they can turn from front to back

• 5 month: able to rest weight on their forearms when prone; can turn completely over, front to back and back to front

• 6 months: can raise their chest and the upper part of their abdomens off the table

• 9 months: can creep from the prone position

lift head and turn it easily to side

1 month: prone position

can raise their head and maintain the position but they cannot raise their chest high enough to look around yet

2 month: prone position

lifts the head and shoulders well off the table and looks around when prone

3 month: prone position

lift their chests off the bed and look around actively, turning their head from side to side. They can turn from front to back.

4 month: prone position

able to rest weight on their forearms when prone; can turn completely over, front to back and back to front

5 month: prone position

can raise their chests and the upper part of their abdomens off the table

6 month: prone position

can creep from the prone position

9 month: prone position

sitting position

1 month: extreme head lag

2 month: can hold head fairly when sitting up

4 month: no more head lag

6 month: can sit momentarily without support

7 month: may sit alone with hands held forward for balance

8 month: can sit securely without support (major milestone)

9 month: sit so steadily that they can lean forward and regain their balance

extreme head lag

1 month sitting position

can hold head fairly when sitting up

2 month sitting position

no more head lag

4 month sitting position

can sit momentarily without support

6 month sitting position

may sit alone with hands held forward for balance

7 month sitting position

can sit securely without support (major milestone)

8 month sitting position

sit so steadily that they can lean forward and regain balance

9 month sitting position

standing position

1 month: stepping reflex

3 month: try to support part of their weight on their feet

4 month: able to support their weight on their legs

6 month: nearly support their full weight when in a standing position

7 month: bounces with enjoyment in a standing position

9 month: can stand holding onto a coffee table if they are placed in that position

10 month: can pull themselves to a standing position by holding onto the side of a playpen or low table, but cant let themselves down again yet

11 month: learns to “cruise” or move about the crib or room by holding onto objects such as crib rails, chairs, walls, and low tables,

12 months: can stand alone at least momentarily

stepping reflex

1 month standing position

try to support part of their weight on their feet

3 month standing position

able to support their weight on their legs

4 month standing position

nearly support their full weight when in a standing position

6 month standing position

bounces with enjoyment in a standing position

7 month standing position

can stand holding onto a coffee table if they are placed in that position

9 month standing position

can pull themselves to a standing position by holding onto the side of a playpen or a low table, but they cannot let themselves down again yet

10 month standing position

learns to “cruise” or move about the crib or room by holding onto objects such as the crib rails, chairs, walls, and low tables

11 month standing position

can stand alone at least momentarily

12 month standing position

fine motor development

• grasp reflex (1 month)

• holds object (2 month)

• reach for objects (3 month)

• thumb opposition(4 month)

• grasping objects with both hands (5 month)

• holds objects with both hands (6 month)

• transfer toys from one hand to the other (7 month)

• pincer grasp (10 month)

• hold crayon and draw semi-straight line (10 month)

development milestones 1

month 0-1: coos at the end of first month

• play: enjoys watching face of primary caregiver; needs play time in prone position

month 2: makes cooing sounds; differentiates cry

• time reflexes fade: grasp reflex fading

• play: enjoys bright- colored mobiles

month 3: smiling face, nodding and squeal with pleasure or laugh out loud

• time reflex fade: landau reflex is strong

• play: spends time looking at hands; “tummy time” important during the day

month 4: very talkative, cooing, babbling, and gurgling when spoken to

• time reflex fade: stepping, tonic neck, extrusion reflexes are fading

• play: needs space to practice turning

development milestone 2

month 5: say some simple words (e.g., “googoo,” “gah-gah”)

• times reflexes fade: tonic neck reflex

month 6: may say vowel sounds (oh- oh); imitates sound

• moro and tonic neck reflex have faded

month 7: imitates sounds; shows beginning fear of strangers

• play: likes objects that are good size for transferring

month 8: fear of stranger peaks

• play: enjoys manipulation, rattles, and toys of different texture

development milestones 3

month 9: Says first word (da-da or ba-ba)

• play: needs safe space for creeping

month 10: masters the word “bye-bye” or “no”

• play: Plays games like pattycake and peek-a-boo

month 11:

• play: Cruising can be with main activity

month 12: says two words plus ma-ma and da-da

• time reflexes fade: landau reflex fade

• play: Likes toys that fit inside each other (pots and pans); nursery rhymes; will like pull toys as soon as walking

development of vision

• Babies start to focus at 6-8 weeks “Binocular Vision”

• Hand regard at 3 months

• Recognize familiar objects at 4 months

• Depth perception at 6 months.

• Pat their own image in a mirror at 7 months

• Object permanence begins to surface at 10 months.

Babies start to focus at 6-8 weeks ______

“Binocular Vision”

______ at 3 months

Hand regard

development of hearing

• hearing awareness at 2 months

• turns head to locate sound at 3 months

• turns and looks in the direction of a distinctive sound at 4 months

• localizes sound at 5-6 months

• recognizes name and listen when spoken to at 10 months

development of touch, taste, smell

• infant need to be touched so that they can experience skin to skin contact

• infants have acute sense of taste. solids are to be introduced at 6 months

• infants-paced complementary feeding

• infants can accurately smell within 1-2 hours after birth

emotional development

• social smile at 6-8 weeks

• fear of strangers start at 6 months but peaks at 8 months

• very aware of changes in tone of voice at 9 months

• overcome the fear of strangers at 12 months

cognitive development

• primary circular reaction at 3 months: explores objects by grasping them with the hands or by mouthing

• secondary circular reaction at 6 months: reach for a mobile above the crib, hit it, and watch it move, they realize it was their hand that initiated the motion, and so they hit it again

• discover object permanance at 10 months: ready for peek-a-boo

• 1 year of age: they are capable of reproducing new events (they deliberately hit a mobile once, it moves, and they hit it again)

primary circular reaction at 3 months:

explores objects by grasping them with the hands or by mouthing

secondary circular reaction at 6 months:

reach for a mobile above the crib, hit it, and watch it move, they realize it was their hand that initiated the motion, and so they hit it again

discover object permanence at 10 months:

ready for peek-a-boo

1 year of age:

they are capable of reproducing new events (they deliberately hit a mobile once, it moves, and they hit it again)

nursing diagnoses

• ineffective breastfeeding r/t maternal fatigue

• disturbed sleep pattern (maternal) r/t babies need to nurse every 2 hours

• imbalanced nutrition, less than body requirements r/t infants difficulty sucking

• health seeking behaviors r/t adjusting to parenthood

• social isolation r/t lack of adequate social support

• ineffective role performance r/t new responsibilities within the family

promoting infant safety

• aspiration prevention

• fall prevention

• car safety

• safety with siblings

• bathing and swimming safety

• childproofing

promoting nutritional health of an infant

• only breastmilk for the first 6 months

• breastfeeding up to 2 years and beyond

• complementary feeding at 6 months

promoting infant development in daily activities

• bathing

• diaper-area care

• dental care

• dressing

• sleep

• exercise

parental concerns and problems r/t normal infant development

ü Breastfeeding

ü Teething

ü Thumb-sucking

ü Use of Pacifiers

ü Head banging

ü Sleep Concerns

ü Constipation

ü Loose Stools

ü Colic

ü Spitting up

ü Diaper Dermatitis

ü Miliara

ü Baby-Bottle Tooth Decay

ü Obesity in Infants

extensive decay in the upper teeth

baby-bottle syndrome

NURSING CARE OF A FAMILY WITH A TODDLER

TODDLER PHYSICAL GROWTH

• gains 5-6 Ibs and 5 inches a year

• head circumference increases by 2 cm at a second year 20 decidous teeth at 2.5 year

• pouchy abs

• chest circumference bigger than head at 2 years

• noticeable lordosis

• baby fat begin to disappear

• wide-base gait

• HR 90-110 bpm

• RR slow slightly

• BP 99/64 mmHg

• brain develops 90% of adults size

• GIT become less common

• bowel and urinary control

toddler development milestones

toddler safety

• accidents are the major cause of death

• lead screening

nutritional health

• a toddler’s appetite is usually less than a infant’s

• allow self-feeding

• toddlers usually prefer to eat the same type of food over and over

• daily food consumption may vary greatly, energy needs are generally met when sufficient food is supplied in a positive environment

toddler activities of daily-living

• dressing

• sleep

• bathing

• dental care

parental concerns in toddlerhood

• toilet training

• ritualistic behavior

• negativism

• discipline

• separation anxiety

• temper tantrums

nursing diagnoses toddlerhood

• health seeking behavior r/t normal toddler development

• deficient knowledge r/t best method of toilet training

• risk for injury r/t impulsiveness of toddler

• interrupted family process r/t need for close supervision of a toddler

• readiness for enhance family coping r/t parents ability to adjust to need of child

• risk for imbalanced nutrition

• disturbed sleep pattern

nursing care of a family with a preschool child

nursing diagnoses preschooler

• health seeking behaviors r/t developmental expectations

• risk for injury r/t increased independence outside the home

• delayed growth and development r/t frequent illness

• risk for poisoning

• parental anxiety r/t lack of understanidng of childhood development

growth and development preschooler

• vocabulary increases markedly

• tonsils appear enlarged

• growth is only 2-3.5 inches per year

• no new teeth develops

• pulse rate decreases to about 85/min

• body contour changes to be more childlike

• genu valgus may be evident

• increased coordination

summary of preschool growth and development

emotional development

• play

• initiative

• imitation

• fantasy

• oedipus and electra complex

• gender roles

• socialization

preschool cognitive, moral, and spiritual development

• children learn by asking

• intuitional thought

• magical thinking to rational beliefs

• right or wrong based on parent rules

• do good out of self interest

preschooler safety

• keeping children safe, strong, and free

• motor vehicle and bicycle safety

• falls

• drowning

• animal bites

• poisoning

• burns

• community safety

preschooler activity of daily living

• dressing

• sleep

• exercise

• hygiene

• dental care

• discipline

parental concerns with the preschool period

• common health concerns

• common fears of the preschooler

• behavioral variations

• sex education

• choosing a preschool or child care center

• preparing child for school

• broken fluency

• bathroom language

developmental skills for 3-4 years