Pediatric Nursing: Growth and Development Principles

• NUR 230/NUR 231/NUR 254.
• Unit 6 of the course is Introduction to Pediatrics.

Principles of Pediatric Nursing

• Pediatric nursing includes family-centered care and atraumatic care.
• Families are given the opportunity to display their caring abilities and gain new ones.
• Empowerment means families can acquire a sense of control and make positive changes.
• Principles of atraumatic care include preventing separation, promoting a sense of control, and minimizing bodily injury.
• The role of a pediatric nurse encompasses therapeutic relationships, family advocacy, health promotion and teaching, injury prevention, and family support.

Influences on Child Health

• Social roles are primary vs secondary groups.
• Culture impacts self-esteem.
• Some cultures promote individual pride and independence more than others.
• The more external and internal assets, the less risky behavior.
• Peer groups relate to risk-taking behaviors.
• Some cultural or religious health practices may be considered abusive in the dominant culture.
• Abusive practices are reportable, while others may be tolerated.

Growth and Development

• Growth is an increase in the number and size of cells as they divide and create new proteins.
• It includes physiological size (height, weight, bone length, etc.).
• Development advances from a lower to a more complex stage.
• This increased capacity comes through growth, maturation, and learning.
• Development involves acquiring skills and functioning.
• Sequential trends occur when children normally pass through each stage of growth and development in a predictable sequence.
• This is universal and basic to all humans.
• Each person accomplishes this individually.

Directional Growth

• Cephalocaudal progresses from head to toe.
• Proximodistal progresses from near to far.
• Midline to peripheral concept.

Biologic Growth and Physical Development

• Growth occurs both internally and externally.
• There is dramatic growth from birth to 4 years, then again at age 12 during puberty.
• Neurologic maturation mostly occurs before birth.
• There are periods of rapid neurological growth between 15-29 weeks gestation.
• Rapid growth happens from birth to 1 year and continues through early childhood.
• There is a more gradual rate through childhood into adolescence.
• Severe illness or malnutrition affects the rate of both growth and development.

Erikson's Stages of Psychosocial Development

• Trust vs. mistrust (birth to 1 year) involves basic needs being met by a loving person, leading to faith and optimism.
• Autonomy vs. shame and doubt (1 to 3 years) is centered on a toddler's ability to control their body, themselves, and their environment.
• A favorable outcome is self-control and willpower.
• Initiative vs. guilt (3 to 6 years) is characterized by vigorous, intrusive behavior, enterprise, and strong imagination.
• Outcomes include direction and purpose.
• Industry vs. inferiority (6 to 12 years) happens when children are ready to be workers and producers.
• They learn to compete and cooperate.

Piaget's Stages of Cognitive Development

• Sensorimotor stage (birth to 2 years) involves simple learning, behavior imitation, and sensory activities using toys and lights.
• Preoperational stage (2 to 7 years) involves egocentric thinking and the ability to make simple associations.
• Thought is tangible.
• Concrete operations stage (7 to 11 years) involves thoughts becoming logical and coherent, with problem solving that is concrete and systematic.
• There is less self-centered.
• Formal operations stage (11 to 15 years) involves adaptability and abstract thinking.

Role of Play in Development

• Functions of play include sensorimotor development, intellectual development, creativity, self-awareness, therapeutic value, and moral value.

Common Types of Play

• Unoccupied play is when the infant child is not mobile and has random movements with no purpose.
• Solitary play has the infant/toddler playing alone with their interest focused on their own activity.
• Onlooker play has the infant/toddler watching other children but not attempting to join the play activity.
• Parallel play has children playing independently but with other children.

Communication with Children

• Infants respond to non-verbal cues and cannot understand verbal ones yet.
• Cooing and crying are their main forms of communication.
• Early childhood is egocentric.
• The response is best when discussing how THEY will be affected.
• The experience of others has no interest to them.
• School-age children want explanations and know why.
• Confidentiality is important with Adolescence:
• Nurses have to be more creative when communicating with kids.

Physical Assessment

• The sequence is head-to-toe.

• Growth Charts-pattern over time is most important.

• World Health Organization (WHO) charts are used for ages 0-2.

• CDC charts are used for 2 years and older.

• Components of assessment include obtaining length until 24-36 months, then obtaining patient height.

• Weight is preferred when the patient in naked if using an infant scale

• Other components of assessment include head circumference and temperature.

• Pulse trends down with age.

• Respirations trend down with age.

• B/P trends up with age.

• Other components of physical assessment include overall general appearance, skin variations in racial groups, accessory structures.

• Other components include Lymph Nodes, Head and Neck shape, Ears.

• For infants, pull the ear pinna down & back. Over age 3, pull pinna up and back.

• Assess: Nose, Mouth & Throat and Chest

• Additional components include lungs, heart, abdomen, genitalia, anus, back, extremities, joints, muscles, and neurologic-cerebellum function.

Pain Assessment & Management

• You need to be creative when treating a patient's pain.
• NIPS (Neonatal Infant Pain Scale) - used for Facial expression, cry, breathing pattern, arms, legs, state of arousal - neonates under 2 months old.
• FLACC (Face, legs, activity, cry, consolability) used for infants older than 2 months.
• Wong-Baker Faces for children aged 3-4 years old and up.
• Numeric Scale (0-10) - for 8 years and older.
• It may be used as early as 5 if able to count and understand values of the numbers.

Non-Pharm Management

• Containment uses blanket rolls to provide a "nest”.
• Positioning with white noise music can help.
• Sucking an provide comfort with a pacifier.
• Kangaroo care using skin to skin contact with a parent.
• Music/pet/art therapy, Distraction and Relaxation can help.

Pharm Management

• For mild to moderate pain, acetaminophen or NSAIDS (such as ibuprofen) can be used.
• Aspirin is only ok for heart conditions.
• Aspirin not given to kids due to the develop. of Reye’s Syndrome. For moderate to severe pain, opioids (morphine, hydromorphone, fentanyl) can be used.
• Adjunct meds: Antianxiety: Diazepam (valium) & midazolam (versed), Tricyclic antidepressants, Antiepileptics (gabapentin, clonazepam).
• Others include: Stool softeners/Laxatives, Antiemetics, Diphenhydramine, and Steroids.

Infant Developmental Milestones (1 month)

• Weight gain of 5-7 oz weekly for the 1st 6 months.
• Monthly height gain is 1 inch for the 1st 6 months.
• Primitive reflexes are present.
• Obligatory nose breather.
• Flexed position.
• Can turn head to the side when prone.
• There is Marked head lag when pulled from lying down.
• Grasps strong.
• Visual acuity is 20/100.
• Quiets when hears a voice and makes comfort sounds during feeding.
• Cries to express displeasure.

Infant Developmental Milestones (2 months)

• Posterior fontanel is closed.
• Less head lag.
• Can lift head 45 degrees off table and hold it up but bending in sitting position.
• Hands are open; grasp reflex fading.
• Visually searches to locate sounds.
• Vocalizes distinctly from crying.
• Has a social smile.
• Coos.

Infant Developmental Milestones (3 months)

• Primitive reflexes are fading.
• Able to hold head but with bobbing.
• Slight head lag
• Grasps are absent.
• Holds objects but cannot reach for them.
• Follows objects into periphery and turns head to follow sounds.
• Coos and squeals to show pleasure.

Infant Developmental Milestones (4 months)

• Moro, tonic neck, and rooting reflexes disappear.
• Almost no head lag and is able to sit propped.
• Rolls from back to side and puts objects in mouth.
• Plays with hands.
• Begins hand-eye coordination and laughs aloud.
• Fusses when bored and shows excitement.

Infant Developmental Milestones (5 months)

• Birth weight doubles.
• Possible tooth eruption.
• No head lag.
• Rolls from abdomen to back.
• Voluntarily grasps objects.
• Visually pursues dropped objects and squeals and coos.
• Discovers body parts. Rapid mood swings.

Infant Developmental Milestones (6 months)

• Central incisors erupt.
• Growth begins to decline.
• Sits in high chair with back straight
• Rolls from back to abdomen.
• Holds bottle.
• Undergoes beginning stranger danger and imitates sounds/actions.
• Babbles one syllable and briefly searches for a dropped object.

Infant Developmental Milestones (7 months)

• Upper central incisors erupt.
• Sits, leaning forward on hands if teething.
• Bounces when held in the standing position.
• Transfers objects from one hand to the other.
• Bangs cube on table.
• Responds to own name and has taste preferences.
• Experiences increasing stranger danger.
• Plays peekaboo and has oral aggressiveness (biting).

Infant Developmental Milestones (8 months)

• Regular bowel/bladder patterns.
• Sits steadily unsupported. Tries to lift a Heavy object.
• Bears weight on legs when supported.
• Pincer grasp beginning and reaches for toys.
• Makes consonant sounds and combines syllables.
• Responds to "no" and dislikes dressing/diapering.

Infant Developmental Milestones (9 months)

• Upper lateral incisors erupt.
• Creeps on hands and knees and tries to walk.
• Pulls self to the standing position while creeping along furniture.
• Responds to simple verbal commands and shows fears of going to bed and being left alone.

Infant Developmental Milestones (10 months)

• Can change from lying down to sitting and Creeps along furniture.
• Says mama, dada with meaning and comprehends bye-bye.
• Waves and develops object permanence.
• Cries when scolded.

Infant Developmental Milestones (11 months)

• Lower lateral incisor erupts.
• Cruises or walks with both hands held.
• Imitates definite speech sounds.
• Shows joy with task completion.
• Rolls ball on request. Shakes head no.

Infant Developmental Milestones (12 months)

• Birth weight is tripled.
• Birth length has increased by 50%.
• The anterior fontanel is nearly closed.
• Walks holding onto one hand.
• Attempts to build 2-block tower.
• Says 3-5 words besides mama/dada and has a favorite toy or blanket.

Toddler Developmental Milestones (15 months)

• Has steady growth.
• Creeps up the stairs V steps.
• Says 4-6 words and tolerates separation from parents.
• Exhibits temper tantrums.

Toddler Developmental Milestones (18 months)

• Anterior fontanel is closed with no soft spots.
• Physiologically able to control sphincters.
• Runs clumsily and throws the ball overhand without falling.
• Manages spoon.
• Can say 10 or more words.
• Has awareness of ownership (my toys).

Toddler Developmental Milestones (24 months/2 years old)

• Weight gain of 4-6 pounds per year, with a height increase of 4-5 inches
• Runs fairly well.
• Talks incessantly - 300 words.
• Can play Parallel to others at this time.

Toddler Developmental Milestones (30 months)

• Birth weight is now quadrupled.
• Runs with a wider stance
• Has a vocab ranging between 400-500 words
• Toddlers can say their First and Last Names
• Kids at this age may be Potty Trained, look for signs of readiness!

Preschooler Developmental Milestone (3 years)

• The child may have achieved nighttime bowel/bladder control.
• Rides a tricycle and walks up stairs with alternating feet.
• Can copy some shapes.
• Dresses self and has a vocabulary of 900 words.
• Can speak 3-4 word sentences and play parallel and associative.
• Egocentric in thought and attempts to please parents.

Preschool Developmental Milestone (4 years)

• Growth rate is similar to the previous year.
• Birth length has doubled.
• Hops on one foot and uses scissors.
• Speaks vocab of 1500 words in 4-5 word sentences and can be very independent
• Rebellious if parental expectations are high.

Preschool Developmental Milestone (5 years)

• Handedness is established.
• Eruption of permanent teeth may begin.
• Throws and catches a ball, walks backward, and balances on alternate feet.
• Speaks vocab of 2100 words in 6-8 word sentences and plays associative, though they may cheat.
• Gets along with parents and can tolerate other points of view.

School-Age Developmental Milestones

• School age ranges from 6-12 years.
• Growth continues at a slower, steady rate.
• Height increases approximately 2 inches per year.
• Weight increases approximately 2-6 lbs per year.
• Self-concept and body image begin to develop.
• Active and plays with friends.
• Lots of maturity occurs at 8-9 years of age. Puberty may begin at 10-12 years.

Adolescent Developmental Milestones (Early, 11-14 years)

• Rapid growth with body image issues.
• Secondary sex characteristics appear.
• Conforms to group norms, which can lead to a decline in self-esteem.
• The person has an increased focus on 'best friend' relationships.
• Wide mood swings, moodiness, and temper outbursts occur.

Adolescent Developmental Milestones (Middle, 15-17 years)

• Growth decelerating in females.
• Develops abstract thinking and modifies body image.
• Is self-centered and can understand the future implications of current behavior.
• Major conflicts stem from issues over independence/control.
• Behavioral standards are set by the person's peer group.
• Withdraws when upset/feelings are hurt.

Adolescent Developmental Milestones (Late, 18-20 years)

• The person is now physically mature with established abstract thought.
• Able to view problems comprehensively.
• Experiences an increase in self-esteem as well as complete emotional/physical separation from parents.
• Peer group recedes in favor of individual relationships.
• Anger is more apt to be concealed.

Reactions to Hospitalization

• Reactions involve loss of control
• Infants feel lost if separated from their baby, they feel scared.
• Toddlers cant explore the hospital due to having cannots.
• They can turn backwards in their development skills. For Example
• They are potty trained they turn into bed wetting, or Drinking from a Sippie cup they return to drinking from a Bottle.
• Preschoolers can ex: think they did something bad and feel like they’re being punished.
• 5yr old ex think and has punished for PSS, this can cause them ex:- Die Dada. ex :- and a couple of days later with an accident something happens and next day dad an accident something happens= the kid feels like that is their bad.
• School Age feel like they could be fearing for Independence and fear the abandonment, injury or death
• Adolescents feel encourage w/ friends to visit.

Nutrition

• Obesity occurs from an increase in body weight, resulting from excessive accumulation of body fat relative to lean body mass.
• Give healthy food options
• Consequences/Complications: elevated blood cholesterol, high blood pressure, respiratory/pulmonary disorders, orthopedic disorders. Include cholelithiasis, fatty later liver disease, cancer, Type II diabetes, poor body image/low self-esteem, social isolation, depression, rejection.

Obesity Influencing factors:

• Environmental Factors: abundance of food, limited access to low-fat foods, reduced or minimal activity.
• Family/Cultural views, snacking cultural view, socioeconomic
• Community Factors: neighborhoods are unsafe & high rates of crime and violence.
• Fast food Availability increase, overzealous advertisement.
• Institutional Factors: lunches at school,vending Machines, vending that allows students to leave for school to get access to these foods/ drinks.Video games, TV and other technology
• Activity are very limited (because they are always on screen).
• Psychologist factors: Reinforcements, comfort, and encouragement w/themselves

Failure to Thrive

• Weight (and sometimes height) is below the 5th percentile for age.
• Organic: Preemie, IUGR, CHD
• Nonorganic: Poverty, neglect, knowledge deficit

Clinical manifestations

• Growth/developmental delays
• Withdrawn, apathetic
• Minimal smiling, avoidance of eye contact
• Treatment: reverse the cause

Immunizations

• Up-to-date vaccine schedules can be found on the CDC website -https://www.cdc.gov/vaccines/schedules/index.html
• Review types of immunity: - https://www.cdc.gov/vaccines/vac-gen/immunity-types.htm
• Start at birth, continue through adolescence and beyond
  • Preterm infants- at chronological age to get them on the schedule
  • If the child is missed to get a vaccine,- you re-do the vaccination.
• Contraindications for vaccines - If a child has severe febrile illness - Hold a vaccine appointment and reschedule. - If a child Known allergy to vaccinations- DON'T do it! - If you administer to them they can be life threatening
• *If a child has minor illness such as a cold is NOT a contraindication **
• Severely immunocompromised children **Should NOT do this, give them live viruses.
• Children receiving immunoglobulin therapy should not get MMR and varicella vaccines for minimum of 3 months - Give 3 months = MMR SCHEDULE
• Administration
  • Must have parents sign and agree to the vaccines or vaccinations
    • VIS is provided a parent can request these Immunization reactions
• Immunizations are among the safest available medication with the most reliable drugs
• serious reactions are rare: mild side effects more common -side effects occur a few hours -Local Tenderness,erythema,- redness, swelling at injection
  • -Low grade fever -drowsiness and the baby has prolonged crying etc

There is Tx Side effects -give them cold compress to area/comfort measures- altered level of consciousness and adverse resp (issue)

Explore the fundamental principles of growth and development in pediatric nursing. This includes atraumatic care, key roles of pediatric nurses, and patterns of growth. Also learn about the stages of psychosocial development according to Erikson.