Infant and Childhood Development

Neonatal Period

• Period of life from birth to 27 days

Postnatal Period

• Period of life from 28 days to 1 year

Birth Weight and Mortality

• Lower birth weight correlates with higher infant mortality rates.

Infant Mortality Risk Factors

• Race (Black)
• Gender (Male)
• Premature or Post-mature gestation
• Maternal age (young or old)
• Maternal education level

Causes of Infant Death

• Congenital anomalies
• Sudden Infant Death Syndrome (SIDS)
• Unintentional injuries

Causes of Childhood Death (over 1 year)

• Injuries are the leading cause
• Motor vehicle collisions (MVCs)
• Drowning
• Burns
• Firearm injuries
• Poisoning

Developmental Trends

• Cephalocaudal: Head to tail development
• Proximodistal: Midline to periphery development
• Bilateral and symmetrical: Development is typically balanced
• Simple to complex: Progression from basic to more intricate skills

Sequential Trends

• Development follows a predictable sequence (e.g., crawling before walking)

Sensitive Periods

• Periods of heightened susceptibility to environmental influences affecting growth and development (e.g. prenatal development)

Periods of Growth

• Infancy (most rapid growth)
• Preschool to puberty (slower growth)
• Puberty (significant growth spurt)
• Post-puberty (growth rate decreases)

Factors Influencing Growth

• Heredity
• Nutrition (most influential)
• Gender
• Disease
• Environment

Factors Influencing Development

• Heredity and environment
• Gender differences/cultural expectations
• Disease
• Prenatal influences
• Socioeconomic status
• Relationships
• Stress
• Media (television, etc.)

Major Milestones (Age-Related)

• 2 months: Posterior fontanelle closes
• 3 months: Head and chest lift while prone
• 5 months: Rolling over
• 5-6 months: First teeth erupt
• 6 months: Doubles birth weight, sits upright with support
• 7 months: Sits upright without support
• 8 months: Sits unsupported
• 9 months: Crawls, pulls up to stand
• 11 months: Cruising
• 12 months: Walks, weight triples
• 9-18 months: Anterior fontanelle closes
• 24 months: Climbing, running, kicking a ball, stacking blocks

Developmental Screening

• Denver 2: Widely used, but has limitations
• Ages and Stages Questionnaires: Higher-quality screening tools

Freud's Psychosexual Stages

• Oral (birth-1 year): Focus on the mouth
• Anal (1-3 years): Focus on bowel and bladder control
• Phallic (3-6 years): Focus on genitals
• Latency (6-puberty): Sexual feelings inactive
• Genital (puberty-death): Maturing sexual interests

Erikson's Psychosocial Stages

• Trust vs. Mistrust (birth-1 year): Developing trust
• Autonomy vs. Shame and Doubt (1-3 years): Establishing independence
• Initiative vs. Guilt (3-6 years): Trying new things, developing confidence and initiative
• Industry vs. Inferiority (6-12 years): Exploring interests, developing competence or inferiority
• Identity vs. Role Confusion (12-18 years): Defining identity

Piaget's Cognitive Stages

• Sensorimotor (birth-2 years): Reflexes to trial-and-error problem-solving
• Preoperational (2-7 years): Egocentrism, inability to reason beyond the observable, limited conservation
• Concrete Operational (7-11 years): Logical reasoning, conservation, sorting, ordering
• Formal Operational (11-15 years): Abstract thought, logical conclusions

Kohlberg's Stages of Moral Development

• Preconventional (0-9 years): Obedience, individual exchange
• Conventional (early adolescence-adulthood): Interpersonal relationships, maintaining social order
• Postconventional (some adults): Social contracts, universal principles

Informed Consent

• Legally required before procedures with significant risk
• Consent should be obtained from the individual(s) with legal custody

Restraint Methods

• Assess the need for restraints
• Therapeutic holding
• Mummy/swaddle restraint
• Jacket restraint
• Limb restraint
• Elbow restraint

Specimen Collection (Urine)

• Clean-catch vs. sterile collection (Sterile is better for children)
• 24-hour urine collection

Diaper-Weighing Technique

• 1 gram wet diaper weight = 1 ml urine

Tracheostomy Suctioning

• Limit suction time to 5/10 seconds
• Hyperventilate with 100% oxygen before and after suctioning
• Do not extend suction catheter past the end of the tracheostomy tube

Stressors of Hospitalization (Separation Anxiety)

• Protest: Crying, clinging
• Despair: Crying stops, depressed mood
• Detachment/denial: Resignation, superficial adjustment
• Important to allow family visitation to alleviate the impact on attachment

Loss of Control (Children's Reactions)

• Preschoolers: Egocentric, magical thinking; may view illness as punishment
• School-age: Striving for independence; fears of injury or abandonment; boredom
• Adolescents: Independence, separation from peers; anger and frustration; need for information

Coping Mechanisms

• Approach behaviors: Seeking help, planning for the future, expressing feelings
• Avoidance behaviors: Refusal to comply with treatment, avoiding people, failing to acknowledge diagnosis

Age Ranges

• Infancy: 0-1 year
• Toddlerhood: 2-3 years
• Preschool: 4-6 years
• School-age: 6-11 years
• Adolescence: 12-18 years

Increased Fluid Needs

• Fever
• Vomiting
• Diarrhea
• High-output renal failure
• Shock
• Burns
• Tachypnea
• Postoperative bowel surgery
• Diabetes insipidus

Decreased Fluid Needs

• Heart failure
• Syndrome of inappropriate antidiuretic hormone (SIADH)
• Postoperative periods
• Increased intracranial pressure (ICP)

Dehydration in Children

• Higher percentage of water (especially ECF)
• Small stomach capacity, limiting fluid intake

Dehydration Care Steps

• Assessment
• Dehydration severity assessment
• Dehydration type assessment
• Identify the cause
• Treatment
• Reassessment

Types of Dehydration

• Isotonic: Equal loss of fluids and electrolytes; common in diarrhea, hypovolemic shock
• Hypotonic: Electrolyte loss exceeds water loss; neurological symptoms
• Hypertonic: Water loss exceeds electrolyte loss; most dangerous, potential brain cell dehydration

Urine Specific Gravity Range

• 1.005 to 1.030

Normal pH Range

• 7.35 to 7.45

Normal PaCO2 Range

• 35 to 45

Normal HCO3 Range

• 22 to 26

Oral Rehydration Solutions

• Mild: 50 ml/kg over 4 hours
• Moderate: 100 ml/kg over 4 hours (Administer PO slowly, if vomiting)

Parental Fluid Therapy

• For those unable to tolerate oral fluids
• Initial IV bolus of 20 ml/kg over 5-20 minutes

Mild Dehydration Symptoms

• Increased thirst, slightly dry mouth
• Normal BP, HR, RR

Moderate Dehydration Symptoms

• Loss of skin turgor, dry mouth, sunken eyes, sunken fontanel
• Normal to orthostatic BP, slightly increased HR, slightly increased RR

Severe Dehydration Symptoms

• Signs of moderate dehydration plus: rapid pulse, cyanosis, fast breathing, lethargy, coma
• Low BP, very increased HR, hyperpnea

Acute Infectious Diarrhea Symptoms

• Abdominal cramps, nausea, vomiting, malaise, low-grade fever, watery diarrhea (without blood), 2-3 days duration

Potassium Administration Considerations

• Never add K+ to IV solutions if oliguria/anuria (urine output < 0.5 ml/kg/hr)
• Urine output must be > 1 ml/kg/hr
• Kidneys retain potassium in dehydration
• IV push potassium is unsafe
• Double-check dosages

School-Age Activities (6 years)

• Associative and cooperative play
• Striving for industry (Erikson) ; concrete operations (Piaget); Conventional moral development (Kohlberg); Following rules; well-developed fine motor skills; Computer games, involving others

Types of Play (School Age)

• Cooperative

Hirschsprung Disease

• Congenital megacolon; absence of ganglion cells in the colon; causes obstruction
• Variety of presentations depending on age

Hirschsprung Disease: Newborn Findings

• No meconium in first 24 hours
• Bilious vomiting
• Abdominal distention

Hirschsprung Disease: Infant Findings

• Growth failure
• Constipation
• Abdominal distention
• Episodes of diarrhea and vomiting
• enterocolitis (explosive diarrhea, fever)

Hirschsprung Disease: Childhood Findings

• Chronic constipation
• Ribbon-like, foul-smelling stools
• Visible peristalsis
• Abdominal distension
• Failure to thrive

Hirschsprung Disease Diagnosis

• Rectal biopsy

Hirschsprung Disease Treatment

• Removal of aganglionic portion of colon
• Often a colostomy initially, then pull-through surgery

GER vs. GERD

• GER: Gastric contents entering esophagus
• GERD: Symptoms or tissue damage caused by GER (failure to thrive, respiratory issues, dysphagia)

GERD Diagnostic Tests

• Barium swallow/Upper GI
• Gastric emptying study
• Upper GI endoscopy
• 24-hour pH monitoring

GERD Conservative Interventions (weight gain and no respiratory issues)

• Dietary modifications (avoiding acid reflux triggers)
• Thickened formula/enlarged nipple
• Frequent burping, feeding
• Avoiding strenuous play/feeding before bed
• Elevated head position after feeding

Pharmacological Treatment (for GERD)

• Histamine 2 blockers (e.g., cimetidine, ranitidine)

GERD Surgical Intervention (failure of medical treatment)

• Nissen fundoplication (wrapping of stomach around esophagus)
• G-tube in severe cases

Appendicitis (Assessment finding)

• Patient reports pain that started during travel, better now, perforation concern

Post-Appendectomy Nursing Priorities

• Monitor I&O
• Assess for bowel sounds
• Dressing changes
• Ambulation
• Cough and deep breaths
• Pain management

Pyloric Stenosis

• Muscle hypertrophy/hyperplasia of pylorus, narrowing and obstructing gastric outlet
• Projectile nonbilious vomiting, olive-shaped mass in upper abdomen

Pyloric Stenosis Initial Therapy

• Correct fluid and electrolyte imbalances

Pyloric Stenosis Definitive Treatment

• Surgery

Intussusception

• Prolapse (telescoping) of proximal bowel segment into distal segment; vascular compromise, edema, obstruction
• Classic symptom: "currant jelly" stool

Intussusception Treatment Goal

• Reduce obstruction before bowel necrosis

Contrast Enema (Intussusception)

• Diagnostic and therapeutic in most cases
• Surgical reduction if radiologic fails is possible

Gastroschisis vs. Omphalocele

• Gastroschisis: Abdominal wall defect, no covering; not involving umbilicus
• Omphalocele: Abdominal wall defect, covering sac, involving umbilicus

Tracheal Esophageal Atresia (TEA)

• Congenital anomaly; esophagus ends in a blind pouch instead of connecting to the stomach
• Often with TEF

TEA Clinical Signs (Three Cardinal Signs)

• Coughing
• Choking
• Cyanosis

Tracheoesophageal Fistula (TEF)

• Failure of trachea and esophagus to separate

Ulcerative Colitis

• Involvement: Rectum and variable length of colon; continuous distribution
• Ulcerations: Shallow, mucosa and submucosa
• Fistulas: Rare/absent
• Granulomas: Absent

Crohn's Disease

• Involvement: Any area of GI tract, often terminal ileum/colon; "skip" lesions
• Ulcerations: Transmural (all layers)
• Fistulas: Common
• Granulomas: Present

Overview of the neonatal and postnatal periods, highlighting the correlation between birth weight and mortality. Focus on risk factors, causes of death, and developmental trends from infancy through childhood, including cephalocaudal and proximodistal.