Chapter 7

Life span development

How humans physically, mentally, and emotionally change throughout their lives; EMTs must know these changes because they may affect the approach to patient care

Neonate

Birth to 1 month of age

Infant

1 month to 1 year of age

Toddler

1 to 3 years of age

Preschooler

3 to 6 years of age (some slides list 4 to 6)

School-age child

6 to 12 years of age

Adolescent (teenager)

12 to 18 years of age

Early adult

19 to 40 years of age

Middle adult

41 to 60 years of age

Older adult

61 years and older

Neonate weight at birth

6 to 8 lb (3 to 3.5 kg)

Head size in a neonate

The head accounts for about 25% of body weight

Infant growth rate

About 1 oz per day (about 30 g per day); weight triples by the end of the first year

Neonate cardiovascular transition

At birth, the neonate transitions from fetal circulation to independent circulation

Infants younger than 6 months

Prone to nasal congestion

Infant airway differences

Larger tongue and shorter, narrower airways, so airway obstruction is more common than in older children or adults

Why are infant airways easily obstructed?

Proportionately larger tongue, shorter and narrower airways, large occiput, and flexible trachea; overextension or overflexion can occlude the airway

Most important thing to remember when bag-mask ventilating an infant

The infant's lungs are fragile; ventilations that are too forceful can cause barotrauma (pressure trauma)

Barotrauma

Injury caused by pressure; can occur if ventilations given to an infant are too forceful

Moro reflex

Neonate opens arms wide, spreads fingers, and seems to grab at things (startle reflex)

Palmar grasp reflex

Occurs when an object is placed into the neonate's palm; the hand grasps it

Rooting reflex

Neonate instinctively turns head when something touches its cheek

Sucking reflex

Occurs when a neonate's lips are stroked

Fontanelles

Spaces between the bones of the skull that eventually fuse

Posterior fontanelle

Fuses by 3 months of age

Anterior fontanelle

Fuses between 9 and 18 months of age

2 months of age (infant milestone)

Tracks objects with the eyes and recognizes familiar faces

4 months of age (infant milestone)

Reaches out to people and drools

6 months of age (infant milestone)

Sits upright and babbles

12 months of age (infant milestone)

Walks with minimal assistance

Infant immune system

Maintains some of the mother's immunities; infants can also receive antibodies via breastfeeding

Infant psychosocial development

Begins at birth and evolves as the infant interacts with and reacts to the environment

Main way an infant communicates distress

Crying

Bonding

Based on a secure attachment between the infant and parent or caregiver

Secure attachment

The infant understands that parents or caregivers will be responsive to his or her needs

Anxious-avoidant attachment

Seen in infants who are repeatedly rejected; they show little emotional response to caregivers, treat them like strangers, and develop an isolated lifestyle

Separation anxiety

Common in older infants when separated from parents or caregivers

Trust and mistrust

Infant stage of development involving whether the infant's needs are being met by parents or caregivers

Neonate pulse rate

90 to 180 beats/min

Infant pulse rate

100 to 160 beats/min

Toddler pulse rate

90 to 150 beats/min

Preschooler pulse rate

80 to 140 beats/min

Preschooler respiratory rate

20 to 25 breaths/min

Preschooler systolic blood pressure

80 to 100 mm Hg

Toddler and preschooler cardiovascular system

Not dramatically different from an adult's

Why do toddlers and preschoolers catch colds so easily?

All of the above: loss of passive immunity, poorly developed lung musculature, and lots of time around playmates and classmates

Preschooler lung musculature

Not well developed; prevents sustaining deep or rapid respirations for long periods

Preschooler weight gain

Should level off

Preschooler passive immunity

Passive immunity is lost

Average age of completed toilet training

28 months

Preschooler psychosocial changes

Learn to speak and express themselves, master basic language, play games with other children, begin to understand cause and effect, and recognize gender differences by observing role models

School-age growth per year

About 4 lb and 2.5 inches each year

School-age physical changes

Permanent teeth come in and brain activity increases in both hemispheres

Preconventional reasoning

School-age children act to avoid punishment and to get what they want

Conventional reasoning

School-age children look for approval from peers and society

Postconventional reasoning

Children make decisions guided by their conscience

Self-concept

Our perception of ourselves (how we see ourselves)

Self-esteem

How we feel about ourselves (includes how we fit in with peers)

Adolescent pulse

60 to 100 beats/min

Adolescent respirations

12 to 20 breaths/min

Adolescent systolic blood pressure

90 to 110 mm Hg

Adolescent growth spurt

Lasts 2 to 3 years; girls finish by 16 years and boys by 18 years

Adolescent physical changes

Reproductive system matures, secondary sexual development, voices start to change, menstruation begins, acne can occur

Adolescent psychosocial changes

Family conflict, privacy becomes an issue, self-consciousness increases, struggle to create own identity, code of ethics develops

When do antisocial behavior and peer pressure peak?

Ages 14 to 16 years (smoking, illicit drug use, unprotected sex, eating disorders)

Why be concerned about a depressed 16-year-old?

Adolescents are at higher risk for suicide and depression than other populations

Early adult pulse

60 to 100 beats/min

Early adult respiratory rate

12 to 20 breaths/min

Early adult systolic blood pressure

90 to 120 mm Hg

Early adult optimal body function

From age 19 to 25 years the body should be functioning at its optimal level

Early adult psychosocial changes

Life centers on work, family, and stress; settling down, marriage, and family; lifelong habits are solidified; one of the more stable periods of life

Middle adult pulse

60 to 100 beats/min

Middle adult respiratory rate

12 to 20 breaths/min

Middle adult systolic blood pressure

90 to 140 mm Hg

Middle adult health changes

Vulnerable to vision and hearing loss, cancer incidence increases, menopause in late 40s or early 50s, diabetes, hypertension, and weight problems are common

Menopause

Occurs in the late 40s or early 50s in middle adults

How can middle adults diminish the effects of aging?

Exercise and a healthy diet

Middle adult psychosocial changes

Focus on achieving life goals, readjust lifestyle as children leave home, have reserves to handle life's issues, finances become a concern

Why do finances become a concern in middle adulthood?

They are often supporting both their children (leaving for college) and their aging parents

Life expectancy (older adults)

Constantly changing; now approximately 78 years

Older adult cardiovascular changes

Decline due largely to atherosclerosis; heart rate and cardiac output decrease, vascular system becomes stiff, blood cell replacement and blood volume decline

Older adult respiratory changes (airways and alveoli)

Size of airway increases, surface area of alveoli decreases, natural lung elasticity decreases, breathing becomes more labor intensive

Older adult respiratory changes (chest and reflexes)

Vital capacity decreases, chest becomes more rigid and fragile, cough and gag reflex diminish

Respiratory risks in older adults

Greater risk for aspiration and airway obstruction; more susceptible to lung infections

Why is breathing more labor intensive for the elderly?

All of the above: airway size increases while alveolar surface area decreases, lung elasticity decreases, and intercostal muscle and diaphragm strength decreases

Older adult endocrine changes

Insulin production drops off, metabolism decreases, reproductive system changes to some extent

Older adult digestive changes

Taste sensations and saliva decrease, intestines move food less well, gallstones become more common, anal sphincter changes can cause fecal incontinence

Older adult renal changes

Filtration declines, kidney mass decreases by 20%, diminished blood flow to kidneys, decreased ability to clear wastes and conserve fluids

Older adult nervous system changes

Motor and sensory neural networks slow, neurons are lost but there is no loss of knowledge or skill, sleep patterns change

Brain atrophy in older adults

Age-related shrinkage creates a void (subdural space) between the brain and the dura mater; stretched or torn bridging veins may bleed into this space

Why are older adults prone to falls and trauma?

Diminished peripheral nerve sensation, slower reflexes, increased reaction times, and decreased kinesthetic sense

Older adult sensory changes

Visual distortions are common; may need glasses or hearing aids; hearing loss is four times more common than vision loss

Older adult psychosocial changes (home and brain function)

Most retain high brain function until about 5 years before death; 95% of the elderly live at home

Older adult psychosocial changes (finances)

Financial limits may restrict access to health care or medications; more than 50% of single women in the US age 60 or older live at or below the poverty line

Older adult psychosocial challenges

Facing their own mortality; isolation and depression

Vital signs: which age group has the highest pulse range?

Neonate (90 to 180 beats/min), followed by infant (100 to 160 beats/min)

Blood pressure trend with age

Systolic blood pressure typically increases with age (preschooler 80-100, adolescent 90-110, early adult 90-120, middle adult 90-140)