Pediatrics Week 1 -- Family Centered Care/Growth + Development/Peds Assessment

Key principles of caring for children

Health promotion, and disease/injury prevention

Family centered care

A philosophy of care that recognizes the family as the constant in the child's life --> emphasizes respect, participation, collaboration, and information sharing between the family and the HCPs

Why is it key to understand the child's household dynamics?

Members of the household will be responsible for the child's care and wellbeing

Ecological theory of development

Bronfenbrenner --> the child is part of a community within a society that impacts development, health and wellbeing (micro, meso, exo, macro-systems)

Child poverty statistics

1/5 children live below the poverty line

50% of children live in low income families

2.5 million children are homeless

How do social/household stressors impact children's health?

Poverty and homelessness reduce health access, treatment, and effectiveness

Family stress theory

The way a family reacts to internal and external stressors --> can have cumulative, chronic impacts on health outcomes

Adverse Childhood Experiences

Stressful or traumatic experiences, including abuse, neglect, household dysfunction --> ex: witnessing domestic violence, growing up with substance abuse, mental disorders, parental discord, or crime in the home

What are the impacts of ACEs on health?

Exposure to ACEs have been shown to increase the risk of substance use, cancer, cardiac disease, mental health diseases

Protective factors against ACEs

Stable relationships, parental resilience and coping systems, access to resources, social support

Effects of hospitalization on children

How to provide atraumatic care to the child

Minimize parental separation, reduce loss of control, emphasize routine, reduce fear of the unknown, minimize bodily injury or pain

Active listening

Empathic listening in which the listener echoes, restates, and clarifies

Manifestations of separation anxiety

Crying, running

Withdrawal, silence

Anger, rejection

Physical growth

A quantitative increase in size or body mass that determines the health and nutrition of the child

Development

A qualitative increase in the child's capacity to function and respond to their environment

Important physical growth measurements

Length/height

Weight

Head circumference

What is normal growth

Continuous, but nonlinear progression of changes in the height, weight and head circumference --> must be consistent with the standards for a given population

Pattern of motor skill development in children

Gross to fine motor skills develop in a cephalocaudal/central to peripheral fashion

Infant growth milestones

Weight triples by 1 year, and height increased of 1 foot

Fontanels close by 1 year

Toddler growth milestones (1-2)

3-5lbs a year, grows about 5 inches

Immature abdominal muscles, slightly bowed legs normal, maturation of digestive system, voluntary control of elimination, bladder capacity increases, develop & coordinated w/ each other, can maintain body temperature

Preschool growth milestones (3-5)

Slender/erect posture, little difference in physicality according to sex, body systems are mature & stable, refinement of eye-hand coordination & muscle coordination

School age growth milestones (6-12)

Differences in gender begin to show, tooth loss, more steady on feet, fat percentage reduces

Adolescence growth milestones

Transition from childhood to adulthood, physical and sexual maturity, puberty, relationships, work

Denver Developmental Screening Test

A test used to assess the development of children between birth and 6 years of age:

1. Gross motor skills

2. Fine motor skills

3. Personal-social skills

4. Language skills

Psycho-social Development Theory

Erik Erikson --> social interactions are crucial in development which happens in stages based on social crises

Psycho-social Development Theory 0-1 yr crisis

Trust vs mistrust --> hope develops

Psycho-social Development Theory 1-3 yr crisis

Autonomy vs shame and doubt --> willpower develops

Psycho-social Development Theory 3-5 yr crisis

Initiative vs guilt --> purpose develops

Psycho-social Development Theory 6-12 yr crisis

Industry vs inferiority --> competence develops

Psycho-social Development Theory adolescence crisis

Identity vs role confusion --> love develops

Cognitive Development (Piaget)

Sensorimotor-explores through the senses, gains object permanence

Preoperational-can't see other people's point of view (egocentrism)

Concrete operational-concept of conservation, logical thinking

Formal operational-adult reasoning develops, abstract thinking, metacognition (thinking about thinking)

Moral Development (Kohlberg)

Preconventional: young children focus on how their actions will effect themselves

Conventional: Base decision on how others will view them, follow standards

Post conventional: Moral reasoning for the good of society, uphold justice