Pediatric Concepts: Growth, Development, and Nursing Care

Pediatric Concepts

Growth, Development, and Nursing Care of the Pediatric Client

  • Instructor: Kristin Thorberg, MSN, RN

Lesson Objectives

  1. Recall essential components of developmental theorists (Erikson and Piaget) as they relate to pediatric growth and development.

  2. Apply developmental theory to assessments of children.

  3. Identify interventions to promote health and safety for each pediatric age group.

  4. Communicate effectively with children.

  5. Predict developmentally appropriate assessment findings for the ill and/or hospitalized child.

  6. Identify developmentally appropriate interventions for the ill and/or hospitalized child and the child’s family.

  7. Describe the assessment of pain for children in various stages of growth and development.

  8. Identify developmentally appropriate interventions for pain management in children.

  9. Identify nursing interventions to support the child with a chronic illness/condition, and their family.

Importance of Developmental Knowledge

  • Guides communication and assessment.

  • Shapes nursing interventions.

  • Promotes safety, trust, and comfort.

Erikson’s Psychosocial Stages

Age Group and Stage

  • Infant: Trust vs Mistrust

  • Toddler: Autonomy vs. Shame and Doubt

  • Preschool: Initiative vs. Guilt

  • School-Age: Industry vs. Inferiority

  • Adolescent: Identity vs. Role Confusion

Piaget’s Cognitive Stages

Age Group and Stage

  • Infant - Toddler: Sensorimotor

  • Preschool: Preoperational

  • School-Age: Concrete Operational

  • Adolescent: Formal Operational

Physical Growth in Infants

  • Growth is cephalocaudal (from head to tail):

    • Infants hold head up first, then roll over, sit, and stand.

  • Weight Changes:

    • Lose 5-10% of birth weight in first days of life but should regain it by week two.

    • Gain 5 to 7 ounces per week for the first 6 months.

  • Reflexes:

    • Startle, sucking, rooting, grasping, yawning, coughing.

  • Body Position:

    • Infants are flexed at rest, and movement involves all four extremities but can be sporadic.

Cognitive Growth in Infants

  • Learn to respond to visual stimuli.

  • Crying as a form of communication:

    • Cry patterns differ based on needs.

Psychosocial Growth in Infants

  • Interactions with caregivers promote nurturing and attachment:

    • Positive interactions foster attachment, while negative experiences hinder it.

  • Most infants can mimic caregiver smiles by 2 weeks old.

  • Bonding is crucial for subsequent development.

Health Promotion for Infants

  • Monitor height and weight.

  • Utilize growth charts and assess developmental milestones.

  • Meet the needs of the child to ensure nurturing.

  • Safety Measures:

    • Car seat safety, hygiene, clothing standards.

    • Encourage back to sleep practices, and use of pacifiers.

    • Sleep on firm mattresses without extra blankets or stuffed toys.

    • Advocate against smoking.

  • Educate about SIDS and reduction of risk.

  • Teach parents about normal growth and development.

  • Discuss immunization schedules and infant care practices.

Growth in Toddlers

Physical Growth

  • Weight Changes:

    • Average gain of 4-6 lbs per year.

  • Height Changes:

    • Average growth of 3 inches per year.

  • Independence becomes pivotal:

    • Learn to dress, feed, and toilet train independently.

    • Walk unassisted by 15 months, run by 18 months, and jump in place with both feet.

    • By 2.5 years, can jump with both feet and stand briefly on one foot.

Cognitive Growth

  • Develop memory of personal events.

  • Object permanence should be fully developed.

  • Begin to imitate others.

  • By age 2, most toddlers understand 300 words and can form 2-3 word sentences.

Psychosocial Growth

  • Engage in parallel play; observe and play alongside other children but not interactively.

  • Crucial for parents to maintain behavior limits to avoid domination by the toddler.

Health Promotion for Toddlers

  • Risks and interventions related to aspiration and home safety.

  • Emphasize dental health and immunization.

  • Address common issues like separation anxiety, regression under stress, sibling rivalry, and sleep disturbances.

  • Allow caregivers to provide support during hospital stays.

Care of the Hospitalized Infant and Toddler

Addressing Separation Anxiety

  • Allow caregivers to stay to alleviate separation fears.

  • Create a comforting environment with familiar objects (blankets, toys).

  • Address fears about dark, being alone.

  • Recognize the three stages of reaction to separation: protest, despair, and detachment.

Communication in Hospitalized Infant and Toddler

  • Avoid discussing sensitive topics in front of the child to decrease parental anxiety.

  • Utilize clear and simple language the child can understand.

  • Tolerate behavioral regression but reinforce appropriate behavior.

Physical Growth in Preschoolers

  • Weight Changes:

    • Gain 4.5-6.5 lbs per year.

  • Height Changes:

    • Grow 2.5-3.5 inches per year.

  • Improvements in fine motor skills observed.

    • Ability to dress and undress, stack blocks, and solve simple puzzles.

Cognitive Growth in Preschoolers

  • Make judgments based on physical appearances.

  • Conceptions include:

    • Artificialism: Belief that everything is created by human beings.

    • Animism: Attribution of life-like qualities to inanimate objects.

    • Imminent justice: Belief that rules will always be followed.

  • Acquire intuitive thought regarding cause and effect relationships.

  • Develop an understanding of time (past, present, future) and expand vocabulary to around 2,100 words.

Psychosocial Growth in Preschoolers

  • Engage in associative play, where children cooperate but organize play loosely.

  • Parents should model standards and allow for some independence.

Health Promotion for Preschoolers

  • Emphasize home safety, motor vehicle safety, and dental health.

  • Establish rules related to playground safety (e.g., helmets) and hygiene practices.

  • Regular vision and hearing screenings are crucial.

  • Prevent illness and injuries through education and immunization.

Care of the Hospitalized Preschooler

Communication Strategies

  • Use simple vocabulary to avoid misunderstandings, and confirm the child’s understanding.

  • Keep explanations brief and honest; utilize drawings to express fears.

  • Prepare children for medical procedures and maintain routines as much as possible.

  • Offer choices in care when feasible.

Physical Growth in School-Age Children

  • Weight Changes:

    • Gain 7 lbs per year.

  • Height Changes:

    • Growth of 2 inches per year.

  • Movements become more coordinated and defined, with the emergence of permanent teeth and the onset of puberty:

    • Female: budding breasts, pubic hair, menarche.

    • Male: pubic hair and testes enlargement.

Cognitive Growth in School-Age Children

  • Function at the concrete operational level.

  • Understand cause and effect, simple analogies, and concepts of time (days, seasons).

  • Develop the ability to define words, link words into phrases, and understand jokes and riddles.

Psychosocial Growth in School-Age Children

  • Engage in cooperative and competitive play through games and organized sports.

  • Parents should navigate rejection and provide support without withdrawing care.

Health Promotion for School-Age Children

  • Encourage responsibility for personal safety, participation in organized group activities.

  • Provide accurate information on sexual issues and address hygiene practices.

  • Limit screen time, addressing issues like obesity, substance abuse, and information reliability.

  • Conduct regular vision and hearing checks, along with dental screenings.

Care of the Hospitalized School-Age Child

Communication Techniques

  • Address children directly; monitor emotional reactions and provide accurate explanations.

  • Support children with disabilities or learning delays through adjusted communication.

  • Maintain a consistent schedule and reassure regarding hospitalization.

Physical Growth in Adolescents

  • Final growth spurt occurs; physical growth tends to stabilize or cease.

  • Maturation of sexual characteristics is significant during this stage.

Cognitive Growth in Adolescents

  • Enter the formal operations stage; they develop complex reasoning abilities.

  • Language usage may vary, utilizing different communication styles with peers and adults.

  • Encourage open-ended questions to facilitate discussions on sensitive topics.

Health Promotion for Adolescents

  • Emphasize motor vehicle safety and provide accurate sexual health information.

  • Address substance use/abuse, emotional disturbances, and maintain regular health checkups.

  • Promote exercise, nutrition, and discuss potential eating disorders.

Care of the Hospitalized Adolescent

Communication Strategies

  • Maintain a calm demeanor, use humor, and offer choices when appropriate.

  • Develop rapport through active listening and non-judgmental approaches.

  • Involve adolescents in decision-making regarding their care.

Family Care and Chronic Illness

Importance of Family Resilience

  • Desired outcome: a resilient family unit.

  • Maintain balance between illness and other family needs.

  • Ensure clear role boundaries are established for well children.

  • Promote competent communication and active coping strategies.

  • Encourage social integration and collaborations with community supports.

  • Focus on attributing positive meaning to challenges while fostering family unity.

Pain Assessment and Management

Pain Assessment Tools

  1. FLACC Scale:

    • Face (0-2)

    • Legs (0-2)

    • Activity (0-2)

    • Crying (0-2)

    • Consolability (0-2)

    • Total score guides assessment; commonly used for infants and young children.

  2. Poker Chip Tool:

    • Uses physical tokens to represent pain intensity for preschool or early school-age children.

  3. Faces Scale:

    • Uses cartoon faces to indicate pain levels.

General Pain Management Strategies

  • Clearly communicate reasons for painful procedures in understandable terms.

  • Utilize non-pain vocabulary (e.g., "feels like heat") to reduce anxiety.

  • Provide distraction techniques, comfort options, and a safe environment.

  • Employ pharmacologic options like Tylenol, NSAIDs, opioids (avoiding aspirin for children under 19), and PCA pumps.

  • Non-pharmacologic methods include play, relaxation techniques (e.g., imagery, hypnosis), and TENS (transcutaneous electrical nerve stimulation).

Pain Management Options

  • Pharmacologic:

    • Tylenol, NSAIDs, opioids (PCA Pumps).

    • NEVER provide aspirin for children under 19 years (risk of Reye's Syndrome).

  • Non-Pharmacologic:

    • Distraction through play, relaxation imagery, hypnosis, and TENS methods.