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• Health Promotion, Restoration and Maintence of the Family: Pediatric Fundamentals: Growth and Development is a lecture by Professor Meghan McCrillis DNP PHNL CNE from Quinsigamond Community College NUR201

Measuring Health: Mortality

• Mortality involves statistical data about the number of deaths in a specific time
• Infant mortality is an important measure of children's health
• Infant mortality is defined as the number of infant deaths in the first 12 months per 1,000 live births
• Leading causes of infant death include prematurity, low birthweight, congenital anomalies, SIDS, RDS, unintentional injuries, and bacterial sepsis
• Childhood mortality is defined as the number of children deaths between ages 1-14 per 100,000
• The leading cause of death for ages 1-4 is unintentional injuries followed by congenital malformations
• The leading cause of death for ages 5-14 is unintentional injuries followed by cancer

Measuring Health: Morbidity

• Morbidity is a measure of specific illnesses in a population, per 1,000 people
• Morbidity is commonly related to respiratory disorders, GI issues, mental health, chronic conditions, and injuries

Role of the Pediatric Nurse

• Pediatric nurses work in acute and critical care, clinics, surgical centers, psychiatric facilities, schools, homes, daycare centers and summer camps
• Pediatric nurses emphasize family-centered, atraumatic care using evidence-based practices

Family-Centered Care Concept

• Includes empowerment, information sharing, flexibility, support, colaboration, family strengths, respect and choice

Atraumatic Care

• Is based on the concept of "do no harm"
• Principles of atraumatic care include preventing or minimizing physical stressors and child/family separation and promoting a sense of control

Evidence-Based Nursing Practice

• Provides quality nursing care to patients, improves patient outcomes based on high quality statistically significant research findings

Role of the Child Life Specialist

• Child Life Specialists work with children and families in healthcare settings
• CLS roles require a bachelor's degree or higher with training in child development often with certification
• CLS use creative therapeutic play activities to foster growth, decrease fear and educate families about healthcare processes

Measurement of Infant Growth and Development

• Includes the infant and the newborn from birth to 12 months

Growth and Development Patterns

• Cephalocaudal: Head-to-tail development; Infants gain head control before controlling their trunk or extremities
• Proximodistal: Near-to-far development: Infants gain control of their torso before their shoulders or arms

Physical Infant Growth

• Involves plotting weight, height, and head/chest circumference on growth charts
• Growth charts are plotted with every well visit
• Gender and age-specific growth charts include birth to 24 months (WHO chart) and 2 - 19 years (CDC Chart)
• Weight and length are the most commonly used measurements, along with BMI and head circumference

Infant Weight

• Doubles by 4-6 months, triples by 12 months
• Height increases almost 50% by 1 year
• Head circumference is on average 14 inches for a full-term newborn and increases by 4 inches from birth to one year
• Chest circumference equals head circumference by 12 months

Infant Development Milestones

• Primitive Reflex: Root, Normal Duration: Birth to 3 months
• Primitive Reflex: Suck, Normal Duration: Birth to 2-5 months
• Primitive Reflex: Moro/Startle, Normal Duration: Birth to 4 months
• Primitive Reflex: Asymmetric Tonic Neck, Normal Duration: Birth to 4 months
• Primitive Reflex: Palmer Grasp, Normal Duration: Birth to 4-6 months
• Primitive Reflex: Plantar Grasp, Normal Duration: Birth to 9 months
• Primitive Reflex: Babinski, Normal Duration: Birth to 12 months
• Primitive Reflex Step, Normal Duration: Birth to 4-8 weeks

Premature Infants and Adjusted Age

• Adjusting age is vital to consider any assessment of a preemie's G & D
• Chronological age example: 6 months (24 weeks)
• If an infant was born at 28 weeks gestation and 40 weeks is full term, this means the infant was born 12 weeks early
• Adjusted age example: 24 weeks - 12 weeks = an adjusted age of 12 weeks (3 months)

Infant Nurse Screenings

• Hearing must be detected by 6 months to decrease developmental delays
• Vision: fix and follow objects by 2 months
• Weight and Body Mass Index (BMI) should be screened
• Scoliosis screenings begin with the adolescent during growth spurts

Additional Screenings

• MA screens for 53 metabolic conditions
• Iron deficiency anemia: deficiency can cause developmental delays
• Lead: Screen children who live in areas of higher risk. Targeted screening is recommended by the CDC
• Hypertension: begin screenings by age 3 and with all children with risk factors
• Hyperlipidemia: Begin screenings in late adolescence or family history of heart disease

Maturation of Systems: Newborn to 12 Months

• Respiratory rate: 30-60/min to 20-30/min; Irregular/ periodic/diaphragmatic breathing
• Heart Rate: 120-140 to 100/min with sinus arrhythmia; HR increases with inspiration and decreases with expiration
• Blood Pressure: 60/40 to 100/50
• Teething starts around 6-8 months; By 1 year, infants have approximately 4-8 teeth
• Thermoregulation involves response to the cold leading to constriction of capillaries, decreased cap refill (greater than 2 seconds), and bradycardia
• Auditory acuity is established at adult levels
• Visual acuity involves binocularity (2 images fuse into 1 beginning by 6 weeks and well established by 4 months
• Depth perception begins at 7 months and may not mature.
• This makes one year olds at higher risk of falls

Infant Nutrition

• Breast milk is preferred as it meets the infant's nutritional needs for the first 4-6 months
• May need an iron supplement after 4 months
• BM can be stored in the refrigerator for five days or the freezer for six months
• Iron-fortified formula: Fluoride supplements after 6 months with decreased fluoride in water
• The infant will take approximately 32 oz/day
• Cows milk should be avoided until after 1 year because it is difficult to digest and can cause iron deficiency anemia
• Early introduction of Solids introduce increased risk of Food Allergies

Theory of Psychosocial Development

• Erik Erikson's "Trust vs. Mistrust" stage occurs from birth to 1 year
• Comforting a crying infant and responding to them when they are feeding encourages growth
• Positive indicator: learns to trust others
• Negative indicator: mistrust and withdrawal

Theory of Cognitive Development

• Jean Piaget sensorimotor stages
• Object permanence (4-8 months) = infant will search for block hidden under a blanket

Motor Skill Development

• Fine Motor develops in a proximodistal fashion
• The infant will grab an object with the whole hand and then progress to using the thumb and finger
• Gross Motor develops in a cephalocaudal fashion
• the infant will learn to lift its head before rolling over

Socialization, Language & Play

• Includes socialization, language and play
• Separation anxiety begins around the last few months of infancy
• Stranger anxiety may develop around 8 months

Infant Car Seat Safety

• Involves rear-facing car seats in the back, away from airbags until 2 for most children
• Check the owner's manual

Growth and Development of Toddler: 1-3 years

• Height is a slow and steady growth of about 3 inches/year
• Toddler Weight birth weight quadruples by 2 ½ years
• Weight is slow and steady increasing by 3-5 pounds a year
• Wide-based gait includes a protruding abdomen

Toddler: Theory of Psychosocial Development

• Erik Erikson's Autonomy versus Shame and Doubt occurs in early childhood (age 1-3)
• Encourage autonomy as the child learns to be independent
• Positive self-esteem and can express self
• Negative willfulness and defiance

Toddler: Theory of Cognitive Development

• Jean Piaget sensorimotor (12-24 months) involves place items in and out of containers
• Jean Piaget preoperational (2-7 years) involves sorting by shape and color

Toddler: Motor Development

• Gross motor development with the toddler; kicking a ball, throwing a ball overhead plus walking up steps
• Fine motor development scribbles wiggles thumbs, Builds a tower of cubes

Toddler: Language and Play

• Able to acquire 300 words
• Toddlers can understand speech better than the number of words toddler can say
• Work is the play of he child: Parallel play is emphasized

Toddler: Emotional & Social Development

• Separation & Individuation: They start separating fromprimary caregiver and Childs expression of their individual characteristics
• Egocentrism Includes self focused behavior
• They also Need to feel in control
• Power struggles
• Temper tantrums
• Structure and routine can improve security
• Provide Security objects for times of stress

Toddler: Some Parental Concerns

• Include toilet training, sibling rivalry, temper tantrums, regression and negativism

Toddler: Dental Health

• Make it FUN. Begin First exam at age 1
• Brushing and flossing should become routine
• Use toothette for oral care for bottle fed infants and intubated children
• Prevent Tooth decay can occur in children 18 months to 3 years by not giving a bottle or juice at nap time. Lack of fluoride intake and coating pacifiers with honey can also cause botulism.

Toddler: Injury Prevention

• Accidental injuries are the leading cause of death among toddlers
• Motor vehicle injuries
• Car versus pedestrian risks
• Drowning
• Burns
• Poisonings
• Falls and Amputation

Toddler: Car Seat Safety

• Enforce the rear-facing car seat between ages 2-4/until 40lbs
• Check the owners manual

Growth & Development of the Preschooler: Ages 3-6

• Height: 2.5-3 inches a year and Weight increases by 4 - 5 lbs./year
• All 20 baby teeth are present in preschooler

Preschooler: Gross Motor Development

• Involves petals on the tricycle
• Balances on each foot

Preschooler: Fine Motor Development

• includes copying circles plus printing a name

Preschooler: Theory of Psychosocial Development

• Erik Erikson Initiative versus Guilt (Late childhood, preschooler, from ages 3-6 years)
• How to encourage growth: The preschooler are inquisitive learners, therefore provide opportunities to do things themselves
• They will Evaluate self behavior right against wrong
• The negative indicator will show lack of self confidence and fear of doing the wrong activity.

Preschooler: Theory of Cognitive Development

• Jean Piaget's Preoperational Stage ranges from ages 2-7 years
• This stage shows ongoing egocentric thoughts,
• Magical thinking and Imaginary friends

Preschooler: Education and Social skills

• Preschoolers will have increased attention spans
• They Begins to learn simple games
• This includes feeds self completely
• Preschoolers can develop a 900 - word vocabulary by 3 years
• Able to Use complete sentences and they will Ask many questions

Preschooler: Safety Skills

• Focus on education regarding key development stages
• This is where they need Adult supervision,
• There is a Danger of matches along with Car safety and safety on Booster seat ages. Check the age for 4-8 booster seat ranges
• Educate to maintain a Safety Back Seat
• Ensure Water safety education
• Encourage a street sense of safety
• Also Educate to Wear protective equipment
• Parents must demonstrate safe role models to teach healthy parental practices in the home

Growth & Development of the school-age child: 6-12 years

• Height maintains slow steady growth of 2.5 inches/year average
• Weigh should increase with 4 years
• All their Primary teeth are lost at this age

School-Age: Theory of Psychosocial Development

• Erik Erickson Industry, as opposed to any Inferiority, is important during the ages of 6-12 years of schools
• Focus on encouraging encouragement of self initiated learning to create and be productive student.
• Positive indicator includes development of strong sense competence in their skills sets
• A Negative indicator in the child will create a sense that this skill level could not be enough

Toddlers: Theory of Cognitive Development

• Jean Piaget focused an emphasis on age levels and development in the brain
• From roughly Age 7-11, Toddlers can begin to connect thought processes and show reasoning in all the things they do

School-Age: Socialization & Play

• Play with Peer groups is important, and they adhere to Culture of roles and Rituals during play
• Team play is also promoted during this learning
• Quiet games and activities are also enjoyed!

School-Age: Injury Prevention

• Injuries can cause severe harm and lead to death during the young years
• Safety related to cars is extremely important
• Ensure Safety Seat restraint for age 8 and/or under 4'9" tall
• Booster should last until aduld fit properly
• Use with extra caution in the Back seat for best protection
• Always check the bicyclles for breaks that are in prime condition
• Skateboards are dangerous and always supervise youngsters
• Keep the area clear from Ski and motorized vehicles such as ATV's, and dirt bikes

Theory of Psychosocial Development: Adolescents

• Identity is very important in relation to their Role within the confusion of every adolescents face
• Always Offer support, and answer their questions because it is very important
• Help Adolescents know that that the decisions they have made are ok!
• Follows all plans. Encourage a positive route from the adolescent Negative indicator when they show confusion because this can lead to difficulty around making decisions

Adolescents: . Theory of Cognitive Development

• Jean Piaget said it best, he had a long career in psychology helping adolescents!
• As the brain develops with Age, abstract though can present in Adolescents using sientidfic reasoning

Adolescents: Socialization and Play

• Always have a very close set of Peer groups
• They want and desire Best friends
• They will attend school related groups
• It is very critical for television to be used as limited access
• They will Develop interests in art, musics, school etc:
• To ensure quality of life and positive stimulation, please provide good support and open lines of communication on how everything can play a specific role around the individual adolescent

Adolescents: Injury Prevention

• Take the role of an encourager and serve to develop the individual to grow in positive health practices
• Ensure that a Seat belt practice becomes a norm to them.
• Drivers that are safe should also have driver education with a good understanding of their surroundings and other drivers that are on the public road.
• A Helmet when performing quick motor tasks
• Ensure no to driving: when there is drug/alcohol to be consumed that the individual will say no always, otherwise it needs to come with big safety protocols in place and a strong support system
• Please always take safety when performing or working through sports to ensure a minimum number of injuries
• Educate the person on gun safety precautions at all times
• Provide education and demonstration of the Water safety protocols
• Sport education with safety protocols that the individual must accept prior.

*There is an increase of serious injures among all ages now

• As more and more people are not taking good, informed, and safety measures there is greater harm to people taking advantage of these rules
• The Largest number of injuries are those related to cars, sports activities, etc:
• Risk takers and feel that they are indestrucible, This has led to greater injuries and even more often death