growth and development - pediatric assessment

why do you monitor children so closely?

anticipatory guidance, early identifications, earlier followup and interventions

physical growth

quantitative measurement of change in size, length and mass. it is continuous, but a largely uneven process. indicator of general health and nutrition

development

qualitative increase in the capacity to function. new skill development can cause the child to increasingly respond to the environment.

as children age, prepare the family

for what is to come in the future in alignment with their development

growth measurement

length in infants and height in older children; weight in kg and lbs, head circumference in cm or inches

how much does an infant's length grow in the first year of life

9 - 11 inches; one inch per month for first 6 months, 0.5 inches after

infant birth length changes

doubles around 4 years and triples by 13 years

weight changes in infancy

re-attain birthweight by 2 weeks and gains 2lbs per month for 6 months, then 1lb for 6-12 months

most infants double their birth weight by ____ and triple by _____

4 months, 1 year

normal growth patterns

abnormal growth patterns

what does head circumference reflect?

growth and differentiation of the nervous system. head circumference increases significantly until 3 months of age, then weans until one year of age

posterior fontanel closing

2 months

anterior fontanel

not palpable after 18 months

physical differences in children

smaller body size, sutures of skull not fused until past 1 year of age, no voluntary control of movement, short and straight eustachian tubes, slow growing heart, soft larynx and trachea, short urethra/kidney's can't concentrate urine (UTI risk), thin skin, different blood values, immature digestive tract, mental and emotional differences

physical development skills in infant

fine and gross motor skills are obtained in an orderly fashion - from head to toe, center to periphery. fine movement comes with time

physical development in infant (birth-1)

fontanel changes, anterior closes around age 1 and posterior closes 6-8weeks after birth

physical development in toddler (1-3)

growth slows, big belly, bowed legs (slight), voluntary control of elimination before two years of age, bladder capacity increase after one year, coordinated senses, skin is mature and can maintain body temperature

physical development in preschool children (3-6)

slender and sturdy, graceful and good postures. not many sexual physical differences, body systems mature and stable, refinement of eye-hand coordination

physical changes in school-aged children (6-12)

school has a significant impact on child's development and their relationships. gender differences recognized towards end of school age and can cause stressful situations. way steadier on their feet and are efficient movers. fat diminishes and muscle tissue increases, but overuse can damage tissue.

physical changes in adolescence

transition from childhood to adulthood, physical and sexual maturity.

early adolescence (11-14)- changes with puberty

middle adolescence (15-17)- dominant peer orientation, late adolescence (18-20) - adult work and relationships transition

developmental assessment

progressive increase in skills throughout life span like fine motor, gross motor, language, social and cognitive

examples: newborn scrunch and can't support self, supporting arms, sitting with assistance, sitting on own, pulling up on things, walking and running

denver developmental screening test revised (DDST-R)

watching gross motor, fine motor (adaptive), personal-social, and language development from birth to 6 years

erikson psycho-social development

trust vs. mistrust, autonomy vs doubt,

initiative vs. guilt,

industry vs. inferiority,

identify vs. role confusion,

intimacy vs. isolation,

generativity vs. self-absorption, integrity vs. despair

personality development that includes core problems an individual must master

infant trust vs. mistrust

crucial elements are the quality of the parent and child relationships. issues may be consistency of care, the hold of babies during feeding, and the timely manner of responding to distress

toddler autonomy vs. shame and doubt

have an internal conflict of exerting autonomy and relinquishing dependence on others.

- give them simple choices to make

- limit settings and consistent discipline

- accept swings between independence and dependence

autonomy vs. shame and doubt characteristics that child gets as they strive towards autonomy

negativism, ritualism (naptime, bedtime routine, simple choices), egocentric behavior

why do toddlers get so upset easily?

they may not always have the words to explain what they are thinking and think that you don't understand them - they have limits

preschooler initiative vs. guilt

they play and live life to the fullest. activities promote accomplishment and satisfaction. if child oversteps their limits they have a sense of guilt for not acting appropriately. they view life based on what has happened in their life and are very literal.

school-age industry vs. inferiority

achieve work ethic for technical and social competency, have peer approval and are motivated, join clubs and groups. when they explore their environment, they gain satisfaction and independence.

this age is crucial because because regression of these behaviors can happen when in the hospital

adolescence identity vs. identity diffusion

identification means an integration of all previous self-images, including negativity

- seek a place in society

- try out roles

- frequently idealistic

- fomo

piaget cognitive development

1. sensorimotor

2. pre-operational

3. concrete operational

4. formal operational

how children think and how things change in mental activities

sensorimotor phase (birth-24 mo)

progress from reflex behavior to simple repetitive acts to imitative activity

stranger anxiety

object permanence achieved around 9-10 months

preoperational phase (2-7yrs)

thinking is concrete and tangible; egocentric. reasoning and intuitive and transductive

magical thinking, problem solving based on direct observation, egocentricle

when can a preschooler hop on one foot

around 4 years - gross motor skills

fine motor skills

refinement in hand-eye coordination like drawing, dressing, artwork and skillful manipulation. most preschoolers can dress themselves but need help with difficult clothing

concrete operation (7-11yrs)

increasing logistical thought, organization and laws of conservation, inductive reasoning

formal operation (11-15yrs)

abstract thinking; adaptability and flexibility

what is the chief psychosocial task of the preschool period?

developing a sense of initiative

- feelings of guilt, anxiety, fear

- superego

- learning right from wrong and morality

why do most kids enter school around 5-6 years of age?

cognitive development shows a readiness for school and learning

preconceptual phase of cognitive development

2-4 years

intuitive thought phase of cognitive development

4-7 years

cognitive development shifts

from egocentric thought to social awareness and considering other viewpoints, however egocentricity is still evident

magical thinking is still objective but there is a concept of causality. time is incompletely understood.

centration in cognitive development

4-7 years - increased social awareness and decreased egocentric thought but can't think of multiple ideas as a whole; takes one at a time

faith in religion in childhood 4-7yrs

learned from significant others and religious practices, development of conscience linked to spiritual development and may interpret illness as punishment from God

morality in 4-7 yrs

basic level of moral judgement, punishment and obedience, naive instrumental orientation - taking actions to satisfy one's own needs and less concern about others. concrete sense of justice and fairness

the power of play

learning is key towards scientific concepts, mathematical concepts, literacy skills. mental stimulation and cooperation can gain confidence, self-approval and growth, is positive reinforcement

playing with kids builds self-esteem and self-confidence in them and helps them build loving and supportive relationships throughout life

parallel play

activity in which children play side by side without interacting... eventually changes to playing with each other

development of body image in younger children

have an increased sense of what is desireable, aware of racial identity and biases. poorly defined body boundaries and think that insides can leak out if the skin is broken, frightened by invasive experiences

development of sexuality in young children

strong attachment to opposite sex parent but can identify with same sex parent. concerned about modesty. sexual exploration.

social development in younger children

individuation. overcomes stranger anxiety but needs parental security and guidance. security from familiar objects. play therapy is beneficial through different fears, anxieties, and fantasies

concrete operational 7-11 years

begin logical thought and have a conservation of numbers (5-6 years), conservation of substances (6-12 years develops from liquid and mass and length, weight, and volume displacement)

development of school aged children (communication and language)

improved receptive and expressive skills and are intelligible by age 6. stuttering resolves. 8-9 can understand jokes. 10-12 can understand metaphors

some of the most common developmental delays are speech/language disorders

formal operations 11-15yrs

abstract thinking, hypothetical reasoning, idealism

kohlberg moral development

preconventional, conventional, postconventional - how acts are viewed as right or wrong

kohlberg preconventional level

preoperational and intuitive thought, good versus bad are pleasure or punishment. obey to avoid punishment. no concept of basic moral order

kohlberg conventional level

parallels concrete operational thought, concerned with loyalty and conformity - behaviors meet own needs or helps others are "right". important things are duty, honor, respect, and being nice

kohlberg postconventional, autonomous or principled level

parallels formal operational. right behavior is based on rules and laws but societal needs and rational considerations can cause rules and laws to change or a want for change

examination of an infant

do it when baby is sleeping or quiet and perform traumatic procedures last. take axillary temperatures and examine in parents lap. take nude weights and recumbent length

examination of the toddler

most comfortable and cooperative with parent - can sit on parent's lap. interview first. use play to demonstrate and comfort the child. exploration of equipment. traumatic procedures last. conserve privacy. praise cooperative behavior

examination of a preschooler

expect cooperation from the child and state requests. parent will likely be close by. allow child to examine equipment and give them examples. give LIMITED choices. use a story when talking about procedures.

examination of a school-age child

respect privacy and don't look at something if you don't have to. explain the purpose of equipment and use parts of exam to teach the child

examination of adolescent

same as school age. explain your findings and be matter of fact with sexual development. emphasize the normalcy of development. use chaperones for more private assessments

things that cause variations in growth and development

preterm birth, congenital heart defects, failure to thrive, maternal depression, pyloric stenosis, colic, autism, cleft lip or palate, seizure disorders, cerebral palsy, acute trauma, asthma, diabetes, visual/hearing impairments