Pediatric Growth and Development

What is growth?

the physical changes that take place, measured by height and weight (quanitative measurements)

What is development?

the functional and behavioral changes that are observed and measured by skills and abiities

What are the three influences of growth patterns?

Genetic, Environment, Nutrition

What is the single most important influence of growth patterns?

Nutrition- because it can affect into adulthood

What is the cephalocaudal growth pattern?

that growth and development occur from head to toeg

What is an example of a cephalocaudal growth pattern?

child raising their head before sitting

What is the proximodistal growth pattern?

the pattern of growth and development tat occurs from the center of the body out

what is an example of roximodistal growth patterns?

having arm control before fingers

What is a general to specific growth pattern?

where the growth/development goes from broad to targeted

What is an example of a general to specific growth pattern?

baby going from crying to growing and then tugging at their ear

What is a simple to complex growth pattern?

a growth pattern where the skills begin to build

What is an example of a simple to complex growth pattern?

child going from 2 words to full stories

At birth what is the average weight for a newborn?

7.5 lbs (3.4kg) or from around 5-8 lbs

at 3-4 days, what is normal to see in the weight of a newborn?

a 10% decrease due to normal physiological processes such as fluid loss.

at 10-14 days, what is expected to see happen to the weight of the baby?

Regaining weight back to birth weight

at 4-6 months, what is expected to see in the weight?

the baby will double their birth weight

at 12 months, what is expected for the infants weight?

The weight should be tripled the birth weight

at 2 years, what is expected to happen to the birth weight?

the birth weight should quadruple

What should happen to the birth length by 1 year of age

should increase by 50%

what should be expected of the estimate of adult height by age 2?

should be around 50% of adult height

when does the most rapid growth occur?

from birth to 2 years

when puberty occurs what happens in relation to growth?

second growth spurt

when is the most rapid growth period?

birth to 2 years

rapid growth periods slow until when?

puberty

a second rapid growth period takes place when?

during puberty

growth period occurs until around what age?

15

why is it important to watch fontanel closures and fontanels in general?

helps to asses normal brain growth and development

When does the posterior fontanel close?

by the age of 2-3

What is the characteristics of the posterior fontanel?

smaller, with a triangular shape

when does the anterior fontanel close?

by the age of 12-18 months

what are the characteristics of an anterior fontanel?

larger, with a diamond shape

what does a bulging fontanel indicate?

indicates increased ICP

what could be the possible causes of a bulging fontanel?

infection, hydrocephalus, trauma, possible fluid volume overload

what is a classic sign of dehydration?

a sunken fontanel (children/babies dehydrate QUICK)

what should you assess when dealing with a sunken fontanel?

assess fluid status, intake/output, and skin turgor

when should you assess fontanels?

when the infant is calm and upright or sitting

when assessing fontanels, what can happen when the infant is crying?

The fontanels may appear bulging due to increased intracranial pressure from crying.

What is the single most important influence on growth?

Nutrition

What does proper nutrition support?

healthy growth and normal development

overall physical and cognitive development are mainly influenced by what?

nutrition

what is an important part of an infants diet during their rapid growth phase

fats, because they are burning through their calories quicklyand need energy for metabolism.

at what age does a social smile appear?

around 6-8 weeks or 2-3 months

what decreases around 2-3 months

the head lag decreases

at what age do the infants lift their head when prone

around 2-3 months

what age do babies start playing with their hands and fingers?

2-3 months of agearound 3-4 months

what age does the posterior fontanel close?

Around 2-3 months of age.

what age does a infant not have head lag?

none by 4 months

at what can infant turn from the abdomen to the back?

4-5 months

what age can a baby recognize faces, grasp a rattle, and begin to babble?

at 4-5 months

what happens to the birth weight at 6 months?

the birth weight doubles

at what age do infants start to sit up? (tripod position/suppported)

Around 6 months

at 6 months an infant can turn from where to where?

the back to abdomen

at 6 months, what type of anxiety begins for infants?

stranger anxietyt

infants can transfer objects from hand-hand at what age?

can transfer objects hand to hand at around 6 months of age.

when a baby reaches 8-9 months they should be able to sit how?

unsupported and steadily

infants can crawl and pull to stand at what age?

8-9 months

at 8-9 months what type of grasp develops?

a pincer grasp (think like grabbing a cheerio) d

what is object permanence?

The understanding that objects continue to exist even when they cannot be seen or heard

object permanence develops in an infant in what age range?

8-9 months typically between 7-12 months

what type of anxiety peaks at 8-9 months?

stranger anxiety

at 10-12 months the infant should b able to do what alone?

stand

at 10-12 months a baby usually does what for the first time?

walks with assistance, taking steps

by 10-12 months a baby’s speech looks like what?

say 2 or more words

what reflex disappears when an infant turns 10-12 months of age?

The Babinski reflex,

What is the babinski reflex

a reflex in which an infant's toes fan out when the sole of the foot is stroked

What age should an infant begin to feed themselves?

10-12 months

by what age should a baby be walking well?

by 18 months

At what age does the anterior fontanel close?

the anterior fontanel closes around 15-18 months

at 15-18 months, what happens to the vocabulary?

the vocabulary expands

by 15-18 months, what skills really start to improve?

fine motor skills

baby’s begin growing independence around?

15-18 months

by the age of 2-3 months, the baby should be able to do what with their head?

hold their head up

what age does a baby start to roll over?

babies can start to roll over at around 4-6 months

T/F— a baby can “cruise” or move around holding on to something by 10-12 months

true

At what age do infants know 300+ words, and can out 2-3 words together?

by 2 years old

t/f a baby can walk-up/down stairs around the age of 2?

True

if there is no two-word phrases by the age of 2, what could be possible concerns?

hearing deficits, autism

if the babinski reflex is stil present at 12 months, what is a possible concern?

neurological issues

if there is a persistent head lag after 4 months, what could be a potential issue?

musculoskeletal or neurological problems.

why would you be concerned if there is no social smile by 3 months?

developmental delays, or autism

at what age does trust vs. mistrust begin?

birth to 18 months

at what age does autonomy vs. shame begin ?

2-3 years

at what age does initiative vs. guilt develop?

3-5 years

at what do children develop industry vs. inferiority (competent vs.incompetent)

5-11 yearsIndustry vs. inferiority develops

at what age does identity vs role confusion set in

12-18 years

trust vs mistrust deals with what?

meeting needs, consistent care builds trust

what does autonomy vs. shame deal with?

independence and choices

what does initiative vs guilt deal with

imagination and purpose

what does industry vs inferirot deal with

competence and mastery

what does identity vs. role confusion deal with?

self and peer identity

when dealing with trust vs. mistrust what should be met to develop trust in an environment

basic needs such as consistent caregiver, cuddling by caregivers, and minimal stimulation as warranted, non-nutritive sucking

what is the result of need for self-expression and need for independnece when dealing with autonomy vs. shame?

negativism

what do children go through when dealing with autonomy vs. shame?

rapid mood swings, and phases of saying no

What should you keep in mind with dealing with the autonomy vs. shame milestone?

ignore tantrums (as long as safe), praise acceptable behavior, allowing them to give their own oral medication in the cup or syringe, allow them to stay in parent lap and play a game.

what type of behaviors do you see with the initiative vs. guilt milestone

intrusive behavior, enterprising, and imaginative play; focusing on their feelings and familiar objects

understanding time associated with events “after cartoons”

what behaviors do you see with identity vs. role confusion

concerned with appearance, staying in contact with friends, and wanting to be spoken to directly as the pt

What are erikson’s nursing implications for an infant?

consistent caregivers, cuddling, non-nutritive sucking,minimal unnecessary stimulation.

what are erikson’s nursing implications for a toddler?

offer simple choices, ignore tantrums (if safe), allow participation in care, keep routines

what are erikson’s nursing implications for preschool children?

play therapy, reassure illness is not punishment, use sensory explanation, time terms they understand!

What are erikson’s implication’s for school-age children?

engage in productive tasks, allow demonstration on dolls, explain sequentially, support peer contact