Child Development & Impact of Hospitization

Eriksons stages of psychosocial development

• Trust vs. mistrust (birth to 1 year)

• Autonomy vs. shame and doubt (1-3 years)

• Initative vs. guilt (3-6 years)

• Industry vs. inferiority (6-12 years)

• Identity vs. role confusion (12-18 years)

Physical development for Infancy (birth - 1 year)

• Wide variation

• Height (increases by 50% in first 6 months, then ½ inch monthly)

• Weight (doubles by 5 months, triples by 1 year)

• First tooth by 8 months

Infancy psychological development

• Language development and socialization begin

  • Baby cooing

• Play is integral in socialization

  • colorful things

  • mobile above bed

  • socialization

Eriksons stage for infancy

Trust vs mistrust (birth to 1 year)

Trust vs mistrust

• Achieving this task is based on the quality of the caregiver-infant
  relationship and the care received by the infant.

• Trust is developed by meeting comfort, feeding, stimulation, and
  caring needs.

• Mistrust develops if needs are inadequately or inconsistently met, or
  if needs are continuously met before being vocalized by the infant.

Infancy nutrition

• Human milk for first 6 months

• introduce new foods at 6 months

Infancy dental hygiene

• first visit to a dentist 6 months after eruption of the first tooth or by 1 year of age.

• Regular cleaning appointments start after a couple years

• should clean gums with cloth not tooth brush

Infancy sleep and rest

• babies tend to refuse to sleep

• broken up type of sleep

  • e.g., sleep for an hour, awake for a one then sleeping again

Infancy immunization/SIDS

• Nurse should provide education on why you should immunize but ultimately parents decide

• SIDS prevention

  • back sleep

  • no toys in bed

  • breast feeding is best

  • no co-sleeping

  • no alcohol, drugs

  • pacifier

Infancy injury prevention

• Falls most common injury

• Ingestion 2nd most common

• Burns 3rd most common

Physical development of toddlerhood (1-3 years)

• Growth rate slows in 2nd year

• Steady growth pattern

• Food intake decreases

• All teeth present by 33 months

Eriksons stage for toddlers

Autonomy vs. shame and doubt

Toddlers and independence

• Independence is paramount for toddlers, who are attempting to do everything for themselves.

• Toddlers often use negativism, or negative responses, as they begin to express their independence.

Toddlers and routine

Maintaining routines and reliability, provides a sense of comfort for toddlers as they begin to explore the environment beyond those most familiar to them.

Toddler nutrition

• Well balanced meal needed

• They’re picky

• 75% of food they like and 25% of new food to try on plate

Toddler sleep and activity

• Refuses to go to bed

• Kid scared of monsters, the dark etc

• Should sleep 11-12 hours, have naps

Toddlers dental health

• Dentist 12 months

• brush teeth

Toddler injury prevention

• #1 Motor vehicle accidents

  • seat installed wrong or kid in wrong

• #2 Drowning

  • can drown in inches of waters

• #3 Burns

  • kids will try to climb onto counter/stove

Preschool physical development

• Height increases by 2.5-3 inches/year

• Weight increases by 3-5 lbs per year (average 32 lbs at 3 years, 41 lbs at 5 years)

Preschool psychological development

• More social development

  • Preschool

• Language

• Play

Preschool (3-5 years) eriksons stage

Initiative vs guilt

Preschoolers and learning

Preschoolers become energetic learners, despite not having all of the physical
abilities necessary to be successful at everything

Preschoolers and guilt

• Guilt can occur when preschoolers believe they have misbehaved or when they are unable to accomplish a task.

• Guiding preschoolers to attempt activities within their capabilities while setting limits is appropriate.

Preschoolers and nutrition

Outside influences

• They are seeing what their friends eat, might want to eat same foods as friends

Preschooler and sleep and activity

• Don’t take that much naps

• Social butterfly

Preschooler and dental health

• Primary teeth

• Go to dentist

• Check if their teeth are clean

• Parent floss kids teeth as the kids don’t have motor dextarity

Preschooler injury prevention

• Motor vehicle accidents

  • Ball rolls across the street they’ll go chase it without looking. Important to exaugurate actions to demonstrate to kid about looking both ways

• ATVs

• Bicycle injury

  • Wear a helmet that properly fits to head

School age physical development

• pubertal changes

  • all over the map

• maturation of systems

School age physical development

• Efficient vocabulary

  • will repeat words they hear like curse words

• Play is structured (best friends)

  • want to fit in with peer groups

School age (6-12 years) eriksons stage

industry vs inferiority

school age and sense of industry

A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society

school age and nutrition

• Have a good diet

• Incorporate the food groups

• You don’t know what theyre eating at school could be lunch swapping

School age and sleep and activity

• Sports

• Probably sleeping alot

preschool and exercise

• usually not an issue

• in lots of sports

preschool and dental health

• dental visits every 6 months

Preschool and injury prevention

• Motor veichle accidents

  • need correct car seats and seat belts on correctly

• drowning

  • dont leave unattended around a body of water

Adolescence physical devlopment

• period of rapid change and growth spurts

• development of secondary sex characteristics

Adolescence (12-19 years) eriksons stage

identity vs role confusion

adolescents and identity

Adolescents often try different roles and experiences to develop a sense of personal identity and come to view themselves as unique individuals.

• Group identity: Adolescents become part of a peer
  group that greatly influences behavior.

adolescents and parenting/family adjustment

If parents are fighting a lot at home kid may take on violent behaviorus

adolescents and psychosocial adjustment

• lots of pressures

• coping

adolescents and intentional/unintentional injury

• Car accidents

• Suicidal

adolescents and sexual behaviour

• be open and honest in conversations

• explain risks of STIs and pregnancy

adolescents and substance abuse

• Vapes

• Drugs

• have open dialogue with them about these substances

adolescents and depression, suicide

Screen for it

adolescents and physical, sexual, emotional abuse

• screen for it

• more likely to take on damaging behaviours

adolescents nutrition

• greatest need

• increase calcium for bone growth

• increase calories

adolescents sleep and rest

• most sleep deprived because of online communication

• most need 9 hours

• gaming systems

adolescents exercise

some get enough some dont

adolescents dental hygine

dentist every 6 months

adolescents and injury prevention

• motor vehicle accidents but now they drive

• monitor for depression, suicide, ED

the hospitalized child may be faced wirh

• Unfamiliar surroundings

• Unfamiliar routine

• Unfamiliar caregivers

• Feelings of fear

  • stranger danger

  • afraid of pain

  • watching peoples emotions of their illness

• Perception of disease/illness

• Pain ******

childrens reactions to hospitlization are influence by

• Age

• Developmental level

• Previous experience

• Innate coping skills

• Diagnosis

• Support systems

  • Is mom and dad there all day or no visitors all day?

Four common stressors of hospitilization

• Separation

• Loss of control

• Bodily injury

• Pain****

  Each of these stressors are experienced differently, depending on the
  developmental level of the child

Separation anxiety

Common in 6–30-month-olds and involves known phases:

• Protest

  • going to scream, cry, holding on

  • will push away nurse trying to take them

  • going to hide and try to escape

• Despair

  • parents gone for a little, waiting for them to come back

  • can regress e.g., potty trained kid pees themselves

  • might not eat or drink

• Detachment

  • accepts parents are not coming back and moves on

Nursing interventions for seperation anxiety

• Minimize separation

• Primary nursing

• Rooming-in

• Support parents

• Establish daily routine

• Provide continuity from home

Loss of control

• Increases the perception of threat

• Influenced by physical restriction, altered routines, and dependency

Loss of control and infants

going to cry and act out

loss of control and toddler

regresses, has accidents, refuses to sleep or eat

loss of control and preschool

• need simple explanations or will imagine much worse

• questions everything

loss of control and school age

• they want control

• get them to help is, give them jobs to do

loss of control and adolescence

• they want information

• seeing if the information matches the non verbal

Bodily injury and pain: infants

• facical expression

• distractions dont work

• if younger than 6 months, doesnt remember pain

Bodily injury and pain: toddler

• grimace, rocking, agresssion

• nasty “I hate you”

• will hit and bite you

Bodily injury and pain: preschoolers

• threat of bodily injury

• be careful of words

• they think the worse e.g., see a needle and think it leaves a big hole

• they try to negotiate

Bodily injury and pain: school-age

• need factual information

• they ask questions

• they try to be brave

Bodily injury and pain: adolescents

• threat to body image

• stand out from peer group

• privacy

• give them information

• they may think since you’re a nurse so you know their pain without them sharing

Parental reactions to hospitilzation

• Parents are influenced by....

  • Seriousness of the illness/injury/disease

  • Previous experiences

  • Support systems

  • Previous coping abilities

  • Additional stressors

  • Cultural/religious beliefs

  • Familial relationships/roles

Parental reactions

Wide ranges of reactions..

• Disbelief

• Anger

• Guilt

  • “Its all my fault for working so much”

• Fear

• Frustration

  • because theyre stuck in hospital and cant leave

• Depression

  • physically and mentally exhausted

Sibling reactions

• Loneliness

• Fear

• Worry

• Anger *****

• Resentment *****

• Jealously *****

  • The sick kid gets more attention

• Guilt *****

  • “I didnt give them the ball now theyre sick”

Normalizing the hospital enviroment

• Promote freedom of achievement

• Maintain child’s routine, if possible

• Time structuring

• Self-care (age appropriate)

• Schoolwork

• Friends and visitors

Beneficial effects of hospitalization

o Recovery from illness
o Increase coping skills
o Master stress and feel competent in coping
o New socialization experiences