Child Growth and Development

What are the divisons of childhood?

• Neonate: First 28 days of life

• Infant: 1 month–1 year

• Toddler: 1–3 years

• Preschooler: 3–5 years

• School-aged child: 6–12 years

• Adolescent: 13–17 years

• Late adolescent: 18–21 years

What are the theories of development- stages of childhood?

How is famliy centered care done?

• ****Family is whoever the patient feels their family is

• Family dynamics are observed by the behaviors between the child and parent

• Important to establish a good rapport with the parent by asking open questions

• Conduct interview in a comfortable room with available seating for the parent

What are the environmental influence onna child?

• Social Determinants of Health

• Parent–child relationship

• Sibling socialization and relationship

• Physical activity and health

• Nutrition

• Physical growth

• Health maintenance

• Cognitive development

What are the nursing prorities for growth & development?

• Delayed growth and development risk related to lack of age-appropriate activities

• Readiness for enhanced family coping related to caregivers seeking information about a child’s growth and development

• Malnutrition related to parental knowledge deficit

• FTT- Failure to thrive

What is the purpose of health assessment?

• To gather information that will direct physical or laboratory examinations to complete a thorough health evaluation

• To elicit facts such as parental problems in childrearing or detection of future health problems

• To lay the foundation for health education and health promotion

• Provides anticipatory guidance to caregivers

What are the techniques for health interview?

Child Health Interviewing

• Young children: Interview the child’s parents

• Adolescents or preadolescents: Choice of interview with or without parents present

Important Principles of Child Health Interviewing

• Establishing a conducive interview setting

• Formulating the right types of questions

• Organizing information collected

What are the cultural considerations for health assessment?

• Health assessment findings can vary by racial, ethnic, and cultural factors.

• Eye contact expectations differ across cultures; lack of eye contact may be respectful, not evasive.

• Some cultures view touching a child’s head as harmful; ask permission before examining sensitive areas.

• Standard height/weight growth charts may not reflect growth patterns of all children.

• Build rapport by recognizing that families may have different expectations, values, and practices.

• Immunization beliefs and acceptance vary by culture and community.

  • Immunization decisions may also be influenced by cost, convenience, religion, and safety concerns.

• Use assessment findings to tailor health education and surveillance to the child/caregiver’s cultural perspective.

How should the health interview contain?

• Introduction and explanation

• Demographic data

• Chief concern

  • Exactly as stated

• History of chief concern

  • Duration; intensity

  • Frequency; description

  • Associated symptoms; actions taken

• Health and family profile

• Day history

  • Play

  • Sleep

  • Hygiene

  • Nutrition

    • Including signs of adequate nutrition and risk factors

  • Kid need routine so want to poerserve thier usual routine as much as possible

• Past health history

  • Including pregnancy history → do you have any other kids?

• Family health history

• Review of Systems

• Parents are caregivers so its important to incorporate them in care

What are the physical signs of adequete nutrition?

• Overall impression: Alert, with good energy level; positive mood.

• Hair: Shiny, strong.

• Eyes: Good eyesight, particularly at night; conjunctiva moist and not pale.

• Mouth: No cavities in teeth; no swollen or inflamed gingivae; no cracks or fissures at corners of mouth; mucous membrane moist and pink; tongue smooth and nontender.

• Neck: Normal contour of thyroid gland.

• Skin: Smooth; normal color and turgor; no ecchymotic or petechial areas present.

• Extremities: Normal muscle mass and circumference; normal strength and mobility; normal reflexes; legs not bowed; no tender joints or edema present.

• Gastrointestinal: No diarrhea or constipation present.

• Finger and toenails: Smooth, pink; not cracked or broken.

• Height and weight: Within normal limits on growth chart and body mass index.

• Blood pressure: Normal for age.

How is physical exam done?

• Want to do least invasive thing first so they get comfortable?

• Body Measurements

  • Weight

    • Plot infant growth on WHO charts (birth–2 years) when appropriate.

    • BMI is often computed/used in older children.

    • huge indicator of growth in kids

  • Height: if not getting enough nutrition bones won’t grow

  • Head circumference

    • Should correlate with the height or length of the child.

• Assessments

  • Skin

    • Ensure adequate lighting and use resources across skin tones.

    • skin disorders can indicate a immune issue

  • Head

  • Odors

  • Pain → FACES, FLAC, NIPS

• Eyes

  • Conjunctivitis

  • Ptosis

  • Avoid misinterpreting scleral coloration.

    • Normal variation can occur. Assess in good lighting and consider overall findings before concluding jaundice/cyanosis.

• Nose

• Ears

  • Alignment

  • Otoscopic exam:

    • Ear canal

    • Malleus of the inner ear

    • Tympanic membrane

    • Signs of infection

  • Eardrum mobility may be assessed with a pneumatic attachment.

  • Tympanogram may assess fluid.

• Mouth

  • Appearance, including symmetry and color of lips

  • Number and condition of teeth

  • Condition of gums, tongue, uvula, epiglottis, and tonsils

  • Do not depress the tongue if epiglottitis is suspected.

• Neck; Lymph nodes

• Heart

  • PMI

  • Heart sounds

    • Identify extra heart sounds: S3 may be normal in children. S4 is abnormal and requires follow-up. → can be normal when young for heart to skip a beat when breaking

    • Rhythm

      • Sinus arrhythmia: An irregular rhythm that varies with the breathing pattern can be a normal finding in children/adolescents.

• Abdomen

  • Newborn and infant

  • Preschooler and school-aged child

• Genitorectal Area

  • Female genitalia

  • Male genitalia

  • Inguinal hernia

• Age Considerations

  • Adolescent: Ensure modesty and provide privacy, Use drapes., Explain each step. Offer a chaperone.

• Extremities: unkempt nails, bruising (nonaccidental trauma), injured extremities can indicate abuse

• Back

• Neurologic Function

  • Reflexes

  • Motor and sensory

  • Vision, hearing, and speech screening

• Safety Screening

  • Signs of self-harm

What are the immunizations give to kids and general time line?

• Diphtheria, Tetanus, Pertussis (DTaP)

• Polio

• Measles, Mumps, Rubella (MMR)

• Hepatitis B (HBV)

• Hepatitis A

• Rotavirus

• H. influenzae Type B (Hib)

• Varicella

• Pneumococcal Pneumonia

• Human Papillomavirus (HPV)

• Meningococcal Vaccine

• Influenza

• COVID-19