PEDS EXAM 1: Growth/Development, Intro to Peds, and Lab content

Erickson’s Psychosocial Development

-”Personality continues to evolve throughout the life span.”

-Must move through and master all 8 stages in life, failure to master a stage leads to maladjustment.

-Can regress to earlier stages during stress or face tasks from later in life early d/t life events.

Stages:

• Infant (0-1yrs)

  • Trust vs. Mistrust

  • Dependant on others (caregivers) to have needs met and develop trust

  • Needs met → trust

  • Needs not met → mistrust

  • Important event: feeding

• Toddler (1-3yrs)

  • Autonomy vs. Shame/Doubt

  • Personal control over physical skills and learning independence

  • Important event: toilet training

• Preschool (3-6yrs)

  • Initiative vs. Guilt

  • Learning to cope with new social/academic demands

  • Strict parents→ leads to guilt

  • inquisitive parents→ leads to initiative

  • Important event: school

• School Age (6-12yrs)

  • Industry vs. Inferiority

  • need to learn to cope with social/academic demands

  • want acceptance, learn comparison

  • important even: School

• Adolescence (12-18yrs)

  • Identity vs. Role confusion

  • need to develop sense of self and personality demands

  • discover sexual and social identity

  • Important events: school relationships

Piaget’s Cognitive Developmental

-Ability to think, reason, and use language

-4 stages total from birth to adolescence→ must complete each stage before moving onto the next

-3 competencies:

• Adaptation (adapt)

• Assimilation (use existing thought process to interpret new situation)

• Accommodation (change thought process/create new on to fit new info)

Stages:

• Sensori-Motor (0-2yrs)

  • Uses senses and motor skills to learn about worlds

    • Reflexive → simple repetitive → imitative activities

      • differentiates self from objects

      • acts intentionally

      • learn cause/effect

      • shakes rattle to hear noise

      • 3 tasks accomplished:

        • Separation

        • Object permanence (at 9-10 months)

        • mental representation (at 18-24 months)

• Pre-operational (2-7yrs)

  • Uses symbols and language

    • uses language and represents objects with words/images

    • egocentric thinking

    • classifies objects by single feature (ex. red blocks)

• Concrete operational (7-11yrs)

  • What child perceives is considered actual

    • think logically

    • can classify objects by several features

    • can name order series

• Formal operational (11yrs and older)

  • Able to think abstractly

  • can think logically about abstracts propositions and test hypotheses systematically

  • can think/ be concerned over hypothetical things and futures

Infant (Birth to 1 yr) Milestones ONLY

-Rapid growth over first 12 months

-Lose 5-10% of body weight over 1st week of life then return to birth weight by week 2 of life.

-If you notice a discrepancy in the infant’s development, notify pcp so they can further investigate possible causes of the delay

2 months:

• Gross motor skills develop in a cephalacaudal fashion (head to toe)

• Fine motor skills develop in a proximo-distal fashion (from center to periphery)

• Should be able to:

  • hold head up when prone

  • control extremity movements

  • grasp reflex fading (so they can control opening hand briefly)

  • gaze at an object for several seconds (their sight is still developing)

  • startled from loud noises

  • cry and make other sounds

  • calms when picked up

  • makes facial contact (2mo.) and smiles when spoken to (3mo.)

• Parent education:

  • talk, read, sing, cuddle, and hold infant to promote bonding

  • position infant on belly when awake periodically (and safely) to help develop head control.

4 month:

• Should be able to:

  • push up onto elbow when prone

  • hold head unsupported

  • holds objects that are places in their hand

  • bring hand to mouth

  • uses palmar/plantar grasp primitively

  • open mouth when breast/bottle seen or is hungry

  • interest in hands

  • cooing, constant sounds

  • makes sounds when spoken to

  • turns head towards familiar voice or sounds

  • smiles, chuckling noises, moves, and makes sounds to get attention

  • shows interest in environment

• Parent education:

  • should have a routine established for feeding and sleeping

  • encourage sounds by showing interest in their noises

  • allow infant to show interest in objects

  • read, sing, and talk to them

6 months:

• Should be able to:

  • roll over from prone to supine

  • push up with straight arm when prone

  • tripod (sit leaning forward on hands)

  • hold bottle

  • move object from hand to hand (7mo)

  • begin using pincer grasp (8mo)

  • grab toys

  • put objects in mouth

  • high pitched squeels

  • stick out tongue and blow raspberries

  • mimmick talk with another person

  • laugh

  • enjoy self in mirror

  • recognize familiar people

• Parent education:

  • allow reciprocal play (ex. peek-a-boo)

  • introduce solid and complimentary foods

  • continue to read, talk, and sing to them

9 months:

• Should be able to:

  • get into sitting position independently

  • sit unsupported

  • rake food

  • move objects from one hand to another

  • crude pincer grasp (use pad of finger to grasp object at 9 months)

  • change from prone to sitting position independently and grasp rattle in hand (10 months)

  • neat pincer grasp (use fingertip to grasp at 11 months)

  • bang two objects together

  • looks for food/objects when dropped or hidden

  • make sounds with longer syllables

  • lift arms to be picked up

  • understand simple commands and gestures

  • stranger danger/reacts when familiar face leaves room

  • make various facial expressions

  • respond to name

  • smiles/laughs when playing games

• Parent education:

  • encourage parent to repeat sounds infant makes

  • use simple words

  • show how to wave bye-bye and shake head “no”

  • play by putting blocks into containers

  • encourage a variety of foods

  • schedule “Child developemental screening” with pcp

Infant (Birth-1yr)

-Sensory Developement:

• Sight:

  • Birth→ nearsighted, prefer human faces and high-contract objects (black/white)

  • 1 month→ recognize people

  • 7 months→ full color and distance vision, can track objects

• Hearing: intact, like an adult

• Smell: develops rapidly, prefer moms smell, and can distinguish mom’s breastmilk from others/strangers

• Taste: prefer sweet taste

• Touch: most important sense for newborn communication. want to be held, hugged, cuddled.

• RED FLAG if:

  • does not respond to loud noises

  • does not focus on near object

  • does not start to make sounds by 4 months old

  • does not turn to locate sounds at 4 months old

  • crosses eyes most of the time at 6 months old

-Communicate with child by:

• respond quick to cries

• give time to warm up to you

• use soothing/calm tone

• talk directly to infant

• use play with older infant

• notice signs of overstimulation (avert eyes, yawn, cry, etc)

-SocialEmotional:

• Bonding occurs first few hours after birth. if mom not available, use dad to bond

• kangaroo care helps stabilize infant’s breathing, temperature, and vital signs

• temperament is inborn and traits are consistent thru life (easy baby, difficult baby, slow to warm baby)

• EDUCATE PARENT

  • How to handle difficult baby

  • Reinforce that it isn’t due to poor parenting

-Feeding:

• 0-6mo→ breast milk or formula ONLY

• 6 mo→ intro to solid foods (spoon fed) and sippy cup

• 8 mo→ table foods, textured/soft/mashed foods, and finger foods

• Avoid choking hazards

• no fruit juice

• eat orange and green veggies before fruits

-Sleep:

• Establish bedtime routines early on

• Teach safe sleep '“Back to sleep” :

  • firm mattress, fitted sheet, swaddlers

  • no pillows, blankets, toys, crib bumper, positioners

  • bed away from vents, open windows, heaters

  • sleep alone

• Sleep habits:

  • 3 months→ 3 daytime naps and 7-8 hrs of nighttime sleep

  • 4 months→ no longer need mid-night feeding

  • 12 months→ 2 daytime naps and 8-12 hrs of nightime sleep

-Play:

• learn motor skills thru play

• prefer to interact with parent

• prefer solitary play and don’t share/play with other infants

• watch and mimic expressions

• encourage parent to sing, talk, and read to child daily

• Use age appropriate toys (and commons sense when selecting them)

-Safety:

• Safe sleep

• choking/aspiration/poison/ingestion

• water safety (can drown in 1 inch of water)

• falls

• suffocation/strangulation

• motor vehicles→ read facing carseat and in the back seat

• animal bites→ don’t leave them alone with pets

• burns

• no smoking in the house

• AVOID:

  • buttons on stuffed animals and loose parts

  • coins

  • clips

  • popcorn, nuts

  • carrot slices, grapes

  • hot dogs

-PCP/Shots and Well baby visits done at:

• 3-5 days old (Hep B, Vit K)

• 1 month

• 2 months (HEP B, Rota, Dtap, HIB, IPV, Pneumococcal)

• 4 months (Rota, Dtap, HIB, IPV, Pneumococcal)

• 6 months (Hep B, Rota, Dtap, HIB, IPV, Pneumococcal, and can start FLU)

• 9 months (only if needed)

• 1 year checkup

-Nursing Care when dealing with infants:

• Can have regression

• Child-parent separation anxiety in the beginning (so avoid separation)

• daily weight (same time, same scale)

• monitor I/O

• keep crib rails up

• remove any choking hazards

• try to maintain same schedule as at home (feeds, naps/sleeps, activities)

• Console infant directly

• educate family

-Pain:

• Neonates feel pain with higher intensity than older children

• Changes:

  • Behavioral→ facial expressions, chin quivering, body movements, crying, irritability, restless sleep, poor feeding

  • Physiological→ increased (hr, rr, bp, icp) , decreased (O2), palmar sweating

• Pain Scales:

  • NPASS→ neonatal pain, aggitation, and sedation scale (used in NICU on neonates)

  • NIPS→ neonatal infant pain scale (used on infants)

  • CRIES→ scale for neonatal postoperative pain assessment (post op)

  • FLACC→ behavioral scale (Most often used)

Medications (Non-opiod):

• Acetaminophen

  • DO NOT GIVE IF UNDER 2 MONTHS OLD

  • high risk for overdosing

  • provide parent education on correct dosing

• Ibuprofen

  • DO NOT GIVE IF UNDER 6 MONTHS OLD

• Aspirin (ASA)

  • DO NOT GIVE TO CHILDREN AT ALL!!!

  • High risk for Reye Syndrome:

    • brain swelling

    • liver failure

    • death

Common issues in infants:

• Colic→ inconsolable crying with no cause that is prevalent in evening (usually resolves by 3 months of age

• Spitting up (as their esophageal sphincter and stomach matures)

• Thumb sucking, pacifiers, security items (can form attachments and have bad habits)

• Teething (irritability, fevers, pain in gums, excessive drooling/bitting

Toddler (1-3years). MILESTONES ONLY

12 Months:

• Should be able to:

  • pull up to stand

  • drink from cup w/o lid

  • use pointer finger and thumb to pick up things

  • walks with cruiser

  • try to stack 2 blocks

  • place blocks in container

  • look for hidden object/toy

  • wave bye

  • say MAMA/DADA, etc

  • understands the word no

  • play games with other kids

• Parent Education:

  • Safety

  • Limit screen time

  • teach to make noises

  • encourage positive behaviors

15month / 1yr and 3 months

• Should be able to:

  • takes a few steps independently

  • stacks 2 blocks

  • uses fingers to self-feed

  • attempts to use things in correct way (phone, book, cup)

  • speak a few words other than mama/dada

  • follow simple directions

  • point to things they want

  • mimic other children when playing

  • show affection

• Parent education:

  • assist w/ learning to speak

  • repeat what they say/add to it

  • allow child to assist with daily activities

  • encourage to stack blocks and then knock them over

18 month / 1.5 years old:

• Should be able to:

  • Walk independently

  • climb onto things

  • scribble

  • drink from lidless up

  • feed themselves w/ fingers

  • attempt to use spoon

  • mimic caretaker doing chores

  • play with toys (stack blocks, scoot a car)

  • say 3 or more words

  • follows one step directions

  • points

  • assists with dressing by lifting hands, put leg thru pants

• Parent education:

  • schedule Developmental screening 1

Toddler (1-3yrs olds)

-Slower growth than infant (gain 3-5lbs/year and 3in/year in height)

Vital Sign trends from infant to adolescent

Respiratory rate: high → low

Heart rate: high → low

Blood pressure (systolic): low → high

Newborn Primitive Reflexes disapearance ages

Step → at 4-8wks of birth

Root (stroke cheek=root/search for boob) → at 3 months old

Suck (auto suck) → at 2-5 months old

Moro (startle reflex/extenion and c-shaped arms) → at 4 months old

Asymmetric Tonic Neck (fencing position) → at 4 months old

Palmar Grasp → at 4-6 months old

Plantar Grasp → at 9 months old

Babinski (fan out toes when you stroke the side of their foot → at 12 months old