Pediatric Nursing: Growth and Development (0-18 Years)
Introduction
Focus on chapters 1, 2, 4, 5, 6, 13, 14, and 16.
Written Assignment
Review the written assignment requirements and rubric.
LOTSOF Teaching
Common Issues
Death, illness, and disease are significant concerns.
Chronic conditions are also a key focus.
Injury by Age
Unintentional injury is the leading cause of death for children aged 1-19 years.
Specific causes vary by age:
<1 year: Suffocation, homicide
1-4 years: Drowning, motor vehicle collisions (MVC)
5-9 years: MVC, drowning
10-14 years: MVC, suicide
15-19 years: MVC, homicide (firearms), suicide
Comfort
Considerations for pediatric patients: pain, position, and potty needs.
Legal/Ethical Considerations
Parents generally provide consent for their child's treatment.
Emancipated minors (self-supporting children <18 years) who are married, pregnant, have fathered a child, or are incarcerated may give informed consent for themselves and their child.
Mature minors (non-self-supporting children 14-18 years) may consent for limited conditions such as testing/treatment for STIs, contraception, substance abuse treatment, and mental health treatment.
Assent: Voluntary agreement to participate in research or treatment.
Privacy
Adolescents may avoid seeking medical care/treatment due to fears of disclosure of confidential information.
It's important to inform adolescents when confidentiality cannot be maintained.
Disclosure is required for reportable diseases: HIV, TB, other STIs.
Parental access to electronic health records and insurance billing statements may need to be considered.
Non-disclosure is overridden when it puts the adolescent's life at risk or interferes with necessary medical treatment.
Family Centered Care
The family is a constant in the child's life and a partner in healthcare.
Providers seek input from families regarding mutual decision-making (negotiation).
Trust is a fundamental element of the relationship between provider and family.
The child is supported to learn about and participate in healthcare decision-making.
Cultural values are integrated into planning and providing healthcare.
Promotion of Normal Development
Child Life specialists focus on the psychosocial needs of hospitalized children.
Therapeutic Play: Presents a direct opportunity to deal with fears or concerns.
Dramatic Play: Medical situations are reenacted by the child.
Pain Rating Scale
Mosby pain rating scale is used to assess pain levels, ranging from 0 (no hurt) to 10 (worst hurt).
Pain Management
Distractions and Heating pads.
Look for respiratory depression and constipation.
Re-assess pain within an hour of intervention.
Medication Administration
Consider when patients are able to tolerate oral medications.
The deltoid muscle has not fully developed in young children.
Stages of Development
Infancy: Birth to 12 months
Toddlerhood: 1-3 years
Preschool: 3-6 years
School Age: 6-12 years
Adolescence: 12-18 years
Growth Patterns
Development progresses from head to toe.
Gross motor skills develop before fine motor skills.
Expectations
Goodness of Fit: Counsel parents on the wide diversity possible in children's behavior.
Parental expectations should be realistic.
Anticipatory guidance: Teach age-appropriate norms and what to expect.
Health Supervision is essential.
Health Promotion and Maintenance
Pediatric Health Care includes well-child visits (routine physicals).
Health Supervision schedule: 2 weeks, 2 months, 4 months, 6 months, 9 months, 12 months, 15 months, 18 months, 2 years, then yearly.
To calculate BMI (Body Mass Index): \text{Weight (kg)} / \text{Stature (m)}^2
Or, using US units: \text{Weight (lb)} / \text{Stature (in)}^2 * 703
Introduction to Infants
Special considerations for infants with a fever less than 2 months old.
Infant Needs
Infants need to meet certain milestones to advance properly.
Use of pacifiers, breastfeeding, and bottle-feeding are important considerations.
Social and Emotional Development
Social bonds and food/nutrition are crucial for development.
Infants repeat reflexes; once something is removed, they understand it's gone.
Nursing Care
Cluster care: Grouping care activities to minimize disturbance to the infant.
Assessment
At 2 months, nurses can show hydration status by checking for bulging or sunken fontanelles to indicate dehydration levels.
Infant Communication
Using a "baby voice" can aid in communication with infants.
Play in Infancy
3-6 months:
Enjoys soft toys with contrasting colors
Prefers noise-making objects (rattles)
Prefers easily grasped objects
6-9 months:
Safety is key to prevent choking
Prefers soft toys that can be manipulated or mouthed
Beginning to enjoy social interaction
Teething toys are important
9-12 months:
Plays interactive games like peek-a-boo
Uses push and pull toys
Enjoys surprise toys like jack-in-the-box
Nesting cups (stackable)
Toys that pop apart and go back together
Dehydration
Infants are more prone to dehydration.
Nutrition
Introduction of Solid Foods at 4-6 months of age
Cereal at 4-6 months
Fruits and vegetables at 6-8 months
Meats at 8-10 months
Introduce one new food at a time every 3-4 days to monitor for Allergies
Avoid honey until 1 year of age
No fruit juice until 1 year of age
Teething
Teethers and Tylenol can help alleviate discomfort.
Physical Activity
Provide opportunities for activity
"Tummy time"
Allow for freedom to move arms and legs
Toys and other stimulating objects
Safety
Prevent injury as they are trying to walk.
Turn handles inward on pots on the stove to avoid burns.
Use caution around pools and bathtubs; never leave unattended.
Administer medications appropriately.
Ensure appropriately sized food to prevent choking.
Back sleeping is recommended; no blankets or co-sleeping.
In cases of abuse: If crying can’t be soothed, put the baby in a safe space and take a minute to walk away.
Red Flags
Less than 6-8 wet diapers a day
Use electrolyte solutions.
Diagnostics
X-rays are NOT common in children.
Consider Shaken Baby Syndrome.
Question 1: Gross Motor Ability
What is the normal gross motor ability of a 9-month-old infant?
Correct Answer: C. Crawls or pulls body along the floor.
Question 2: Vital Signs
A 2-week-old is brought to the clinic for a first well-child visit. Which vital sign would require immediate attention?
Correct Answer: C. Temperature 96.8
Toddlers (1-3 years)
Growth and Development
Growth slows considerably.
Quadruple birth weight by age 2.
By age 2, they have reached ½ of adult height.
Chest circumference begins to exceed head circumference.
Pot-bellied appearance with wide stance.
Teeth eruption complete by 33 months.
Brain growth is 75% complete by 2 years.
Vital Signs
Temperature: 98-100°F
Fever: 101-104°F
Seek immediate medical attention if >104.2°F with rash, inconsolable, lethargic, difficulty breathing, or otherwise symptomatic
Heart Rate: 80-120
Respiratory Rate: 20-30
Blood Pressure: Systolic >88
Freud's Theory of Psychosexual Development: Toddler - Anal Stage
Body control is the prime force in behavior.
Characterized by increased motor ability and independent behavior.
Nursing Implications:
Continue home rituals/elimination patterns and words for elimination
Regression is normal during illness or hospitalization.
Potty chairs in the hospital.
Erikson's Theory of Psychosocial Development: Toddlers - Autonomy Versus Shame and Doubt
Increasing independence
Nursing Implications:
Allow self-feeding opportunities
Encourage child to dress themselves
Encourage child to assist with hygiene
Piaget's Theory of Cognitive Development: Toddlers - Sensorimotor Stage (end)
Increasing curiosity and exploration
Improvement in language skills
Nursing Implications:
Safe surroundings
Allow opportunities to manipulate objects
Name objects
Give simple explanations
Gross Motor Skills
12-13 months - walk alone using wide stance for balance
18 months – try to run but fall easily
2 years – walk up and down stairs
2½ years - jump using both feet, stand on one foot briefly, few steps on tiptoe, kicks ball
3 years – stand on one foot, walk on tiptoes, climb stairs with alternate footing, throws ball overhand
Parallel Play
Toddlers engage in parallel play, not directly interacting with each other.
Temper Tantrums
Temper tantrums are usually normal.
Physical Activity
Important time to develop habits that carry into childhood
"Free play"
Minimum of 60 minutes of unstructured activity daily
Health Promotion & Injury Prevention
Injuries cause more deaths in children age 1-4 than in any other childhood age-group except adolescence
Traumatic injury is leading cause
Unrestricted freedom achieved through locomotion combined with an unawareness of danger in the environment
Motor Vehicle Collisions
Backseat is safest
Should remain in a rear-facing car seat
Approved safety seats only
Falls
Gross motor skills improve – Able to climb
Preventive Measures:
Supervise closely
Provide safe climbing toys
Teach acceptable places to climb
Drowning
Toddler may walk on pool decks, stand on boats
May fall into tubs, toilets, buckets and not be able to get the top of their body out
Preventive Measures:
Supervise when near ANY water
Use approved life jackets
Child-resistant pool covers
Empty buckets when not in use
Poisoning
Climb onto chairs and cabinets
Medicines, cosmetics are easily reached
Preventative measures:
Lock up medications/cleaning products/cosmetics
Child-resistant containers and cupboard locks
Know poison control number
Question 1: Motor Ability
When assessing the motor ability of a 2-year-old toddler, which skills should the nurse expect the child to be able to do?
C. Walk up and down stairs.
Question 2: Milk Consumption
According to the American Academy of Pediatrics, which of the following recommendations for milk consumption is accurate?
None of the options are 100% correct in all situations. Check current guidelines. AAP generally recommends whole milk until age 2, then lower fat options.
Preschoolers (3-6 years)
Growth and Development
Physical growth slows and stabilizes
Long bones of arms and legs with most growth
Short, chubby to slender, long-legged
Physical proportions are now sturdy, graceful, agile, and posturally erect.
Vital signs
Temperature: 98-100°F
Fever: 101-104°F
If > 104.2 with rash, inconsolable, lethargic, difficulty breathing or otherwise symptomatic seek immediate medical attention
Heart Rate: 70-120
Respiratory Rate: 20-30
Blood Pressure: Systolic >90
Freud's Theory of Psychosexual Development: Preschooler - Phallic Stage
Identifies with parent of opposite sex but by end, identifies more with same-sex parent
Nursing Implications:
Pay attention to comfort level of child with male or female nurses and attempt to accommodate.
Encourage parental involvement
Plan for playtime
Offer a variety of materials/toys to choose from
Erikson's Theory of Psychosocial Development: Preschooler - Initiative versus Guilt
The child likes to initiate play
Nursing Implications
Planned playtimes with various toys
Offer medical equipment for play to lessen anxiety
Piaget's Theory of Cognitive Development: Preschoolers
Nursing Implications
Assess concerns (expressed through drawings)
Accept child's choices and expression of feeling
Offer explanations for treatments
CLEARLY explain that a child is not responsible for illness
Fine Motor Ability
Uses scissors
Draws circle, square, cross, and at least a 6-part person
Learns to tie shoes and button clothing
Brushes own teeth
Uses spoon, fork, and knife
Sensory and Gross Motor development
Visual acuity improves, enabling focus and learning letters and numbers.