Intro to Peds Nursing: Growth & Development

Leading causes of morbidity and mortality in infants

1. birth defects

2. preterm birth and LBW

3. pregnancy complications

4. SUIDS/SIDS

5. injuries

Leading causes of morbidity and mortality in children ages 1-4

1. accidents

2. congenital or chromosomal abnormalities

3. assault (homicide)

Leading causes of morbidity and mortality in children ages 5-14

1. accidents

2. cancer

3. self-harm (suicide)

Growth

increase in size

Development

increased capabilities and ability to adapt

Cephalocaudal

head to tail direction

Proximodistal

near to far; midline to periphery

Groos motor

walking, running, riding a bike, etc.

Fine motor

coloring, buttoning a shirt, etc.

Touchpoints

dynamic variation of the family system from birth to 3 years

Infant stage

birth to 1 year old

Toddler stage

1 to 3 years old

Preschool stage

3 to 5-6 years old

School-age stage

6 to 12 years old

Adolescent stage

12 to 18 years old

Erikson’s theory of psychological development

core research focused on 8 stages of healthy development and maturation over one’s lifespan (5 out of 8 focus on peds client); framework goes beyond the immediate family and explores how social interactions shape an individual’s ability to deal with the developmental “crisis” of each level

Trust vs. mistrust age

birth to 1 year

Trust vs. mistrust

basic needs must be met, and trust must be learned

Trust vs. mistrust example

“hold me, feed me, take care of me”

Autonomy vs. shame & doubt age

1 to 3 years

Autonomy vs. shame & doubt

controlling body excretion, “no,” balance independence and self-sufficiency

Autonomy vs. shame and doubt example

“watch me do this myself”

Initiative vs. gulit age

3 to 6 years

Initiative vs. guilt

exploring world, creating, resourcefulness to achieve and learn new things

Initiative vs. guilt example

“I want to help you; I can do it too”

Industry vs. inferiority age

6 to 12 years

Industry vs. inferiority

new activities, sports, school, sense of confidence

Industry vs. inferiority example

“I want to fit in,” “What are the rules?”

Identity vs. role confusion age

12 to 18 years

Identity vs. role confusion

new sense of identity, clear sense of self

Identitiy vs. role confusion example

“I just want my friends,” “Who cares, so what”

Piaget’s theory

core research focused on cognitive/intellectual maturation at each 4 stages and the influences impacting individual’s world view; specific to the process of assimilation and accommodation

Sensorimotor age

infant to 2 years

Sensorimotor stage

learns from sensory input, language skills

Sensorimotor example

looking, hearing, touching, mouthing, grasping

Preoperational age

2 to 6 years

Preoperational stage

increasing verbal limitations in thought, development of motor skills

Preoperational example

using words and images to represent things, gradually evolves into pretend play

Concrete operational age

7 to 11 years

Concrete operational stage

organize thought in logical order, manipulates object

Concrete operational example

grasping concrete analogies, performing mathematical operations

Formal operational age

12 to adulthood

Formal operational stage

mature, abstract thought and reasoning to handle difficult concepts

Formal operational example

looking at moral reasoning

Physical importance of play

reflexes and neurological development, motor skills

Cognitive importance of play

communication and language development

Psychosocial importance of play

personality and temperament, moral development

General physical changes in infants

• body organs are not fully mature at 1 year, includes nervous system and ability to control their bodies

• infant growth is measured month to month

Newborn (birth to 1 month)

• no head control, flexed position, hands closed but has strong grasp

• communicates by cooing, babbling, and crying

3 to 6 months old

• BIRTH WEIGHT DOUBLES AT 6 MONTHS

• holds head more erect

• sits supported at 6 months

• rolls over

• can move objects from hand to hand (7 months)

• discovers self - plays with hands, feet, mouth (~4 months)

• begins to support self in tripod position

• communicates by cooing, babbling, and crying

9 to 12 months

• BIRHT WEIGHT IS TRIPLED BY 12 MONTHS

• head and chest circumference are the same by 12 months

• creeps, pulls self up on objects, teetering (begins to take steps with assistance)

• uses pincer grasp

• begins to hold and release objects (throw)

• waves bye-bye

• can understand “no,” say “mama” “dada”

• stranger anxiety

Infant cognitive, sensory, and psychosocial development

• discriminates visual images, sounds, tastes

• solitary play, reflexive manner-grasps objects

Multisensory stimulation

• music, noise-making objects

• rocking, cuddling

• visual patterns, mirrors, mobiles

• black and white patterns

• hearing spoken language

Fine/gross motor activities

• soft toys, rattles-objects to grasp

• teething toys

• large blocks (9-12 months)

• peek-a-boo

• pincer grasp - “cheerios”

Toddler general physical changes

• gains about 1.4-2.3 kg per year

• height increases about 3 inches per year

• walks, climbs, runs, jumps

• holds objects such as utensils, draws, begins to undress self

Toddler cognitive and sensory function

• temper tantrums, “NO”

• enjoys pictures, reading aloud, and naming objects

• age 1 - uses 1 word commands, can follow 1 step direction

• age 2 - uses 2 words and follows 2 word commands

• age 3 - uses 3 words and follows 3 word commands

Toddler psychosocial development

• parallel play

• imitative behaviors

• occasionally trade toys and words

Parallel play

not talking to each other, but playing/doing the same thing

Toddlers - what can I play with?

fine/gross motor play:

• building blocks

• scribbling with crayons

• push and pull toys

• up and down stairs

Preschooler general physical changes

• gains about 1.5-2.5 kg per year

• height increases about 4-6 cm (1.5-2.5 inches) per year

• walks, climbs, runs, jumps easier

• tie shoes, fasten buttons

• draws stick figures

• can use scissors

Preschooler cognitive and sensory function

• visual acuity sharpens - can focus on letters and numbers

• concrete thinking

• “why,” enjoys rhymes, vocabulary 1,500-2,000 words

Preschoolers psychosocial development

• learns rules

• begins to pick up on gender differences

• associative play

Preschoolers - what can I play?

fine/gross motor play:

• dramatic play, puppets

• very effective in hospital for teaching

• reading together (learning letters)

• crafts, can use scissors

• large motor activities

• bicycle, climbing, swinging

School age general physical changes

• gains about 4-6 lbs per year

• height increases about 2 inches per year

• walks, climbs, runs, jumps with precise coordination, additional activities such as swimming, dancing

• fine dexterity improves - writing, playing instruments, crafting

School age cognitive and sensory function

• thinking becomes more logical, solve problems

• “why” goes to “how”

• visual acuity reaches 20/20

• vocabulary 8,000 to 15,000 words

School age psychosocial development

• increased peer influence

• gender identity - same sex friends

• cooperative play (bargaining, negotiating)

School age what can I play with?

sports:

• can concentrate longer

• able to jump rope, ride two-wheeler

• decrease in active physical play d/t technology

puzzles, reading, games

cooperative play:

• goal oriented play (winning/losing)

• if hospitalized - separated from playmates, playroom/integrative play into care

Adolescent general physical changes

• weight: girls about 15-55 lbs, boys 15-66 lbs

• height: girls increase ~2-8 inches, boys ~4-12 inches

• secondary sex characteristics develop

• endurance and coordination start to peak

• fine dexterity sharpens allowing for effortless manipulation of objects

Adolescent cognitive and sensory function

• can think in abstract terms, hypothesize

• can use future time perspective

• vocabulary of 50,000 words

Adolescent psychosocial development

• mainly guided by peer influence - teach them not to give into peer pressure

• push-pull dynamic with parental/caregiver units

• continues with cooperative play (bargaining, negotiating)

Adolescents what can I play with?

fine/gross motor play:

• sports, school activities, peer group is focus, may arrange for visits if hospitalized

• games, reading, music

• movies, video games

• dance

Pediatric general health history

• nutrition

• PMH including birth Hx

• play/activity/sleeping patterns

• family Hx

• social/psychosocial Hx

• immunizations, UTD?

• developmental milestones

Pediatric physical exam

• assessment - always begin with least invasive to most distressful, steps may not always be in order

• vital signs

• measurements

Infant physical assessment approach

• start with non-invasive procedures

• save ears, throat, etc. for last

• separation anxiety - always keep parent close

• examine in parent’s lap for as much of exam as possible

• neurologic portion of exam will include several more reflex assessments

Toddler physical assessment approach

• allow child to remain in parent’s lap

• let child get comfortable/used to being in room before starting

• don’t ask for permission to perform exam

• give choice when possible

• use distractions when needed

Preschooler physical assessment approach

• more cooperative

• sense of body image

• fear of mutilation

• use simple explanations

• have child participate

• use games

School-age physical assessment approach

• child should sit up on the table

• explain what you are doing

• take the opportunity to teach about the body

Adolescent physical assessment approach

• do physical examination alone

• teen may request parent’s presence

• talk with teen throughout the exam

• good opportunity to provide teaching about maturing body, physical changes

• be non-judgmental

• confidentiality

• cover sensitive topics when parents are out of room

Length

• measure supine until ~2 years old; hips and knees extended flat

• use paper on table if no board

• stadiometer

• shoes off

• shoulder and heels touch wall

Weight & BMI

• infant scale until ~2 years old; remove all clothes/diaper

• older children = standing scale

• BMI - compares to same age and gender

• height is ALWAYS documented in cm, weight is ALWAYS documented in kg

Growth charts

• plot on growth chart until 18

• separate charts

• boys and girls

• by ages

Head circumference

• plot for first 2 YEARS

• supine or sitting positing

• place tape over the occipital, parietal, and frontal prominences

• deviations can signify problems

• ALWAYS documented in cm