Pregnancy: Environmental & Nutritional Concerns

Environmental Concerns for Mother/Fetus

• Infants exposed to alcohol, smoking, or drugs face risks of developmental deficits and birth complications.
• Smoking can cause low birth weight, preterm birth, birth defects, or infant death.
• Fetal alcohol syndrome leads to neurodevelopmental disorders, including learning and growth disorders, and distinct facial features.

Nutritional Concerns During Pregnancy

• Inadequate nutrition results in low gestational weight, abnormal brain development, learning disabilities, and chronic illness.
• Folic acid deficiency leads to neural tube defects.
• Low vitamin D and calcium weaken bones.
• Iodine deficiency can cause hypothyroidism.

Patient Education and Safety During Pregnancy

• Educating patients about healthy diets, exercise, and the dangers of smoking, drugs, and alcohol is crucial.
• Ensuring a safe living environment is essential.

Development Assessment Questions During Pregnancy

• Assessing support systems and resource availability is important.
• Resources include food banks, dieticians, counseling, parenting/birthing classes, and smoking cessation programs.

Infancy (Birth to 18 months)

• Virtue: Hope
• Psychosocial crisis: Trust vs. mistrust
• Significant relationship: Mother as the primary caregiver.
• Milestones: Development of reflex movements like sucking, head support, sitting up, crawling, walking, smiling, and first words.
• Immunizations: Includes HepB, RV1, DTaP, Hib, PCV15, PCV20, IPV, Influenza, MMR, VAP, HepA.
• Nutritional concerns: Overfeeding, formula preparation, proper feeding techniques, and introduction to solid foods, consulting a doctor for timing and introduction of new foods.
• Parent/health education & safety risks: Risks include propping bottles, leaving the baby unattended near water, crib rails, co-sleeping, and the importance of car seat restraints, infant CPR, avoiding loose bedding, toys, small objects, and baby-proofing.
• Development Assessment Questions: Focus on signs of attachment to caregivers and meeting basic needs.

Early Childhood (2-3 years)

• Virtue: Will
• Psychosocial crisis: Autonomy vs. Shame & Doubt
• Significant relationship: Parents
• Milestones: Development of simple words, potty training, and expressing desire to dress independently.
• Immunizations: Includes Influenza, Hepatitis A, DTaP (booster), MMR (booster), Varicella (booster).
• Nutritional concerns: Addressing food allergies and choking hazards; promoting a balanced diet for growth.
• Parent/health education & safety risks: Secure medications, use stair gates, teach danger words, supervise outdoor play, limit screen time, and encourage interactive play.
• Development Assessment Questions: Focus on the child's ability to use simple phrases, dress independently, potty training status, separation responses, and signs of food allergies.

Preschool Age (3-6 years)

• Virtue: Purpose
• Psychosocial crisis: Initiative vs. Guilt
• Significant relationship: Entire family
• Milestones: Cognitive, language, and psychosocial development increases, learning to count, increased vocabulary, toilet needs and shoe-tying skills by age 5. Develop peer interactions, sports engagement and imagination.
• Immunizations: Includes Dtap, IVP, MMR, Varicella, and flu shot.
• Nutritional concerns: Overfeeding can lead to obesity and potential deficiencies in nutrients, excessive sugar, picky eating habits.
• Parent/health education & safety risks: Focus in safety measures, avoid unsupervised water and fires.
• Development Assessment Questions: Assess the child's assertiveness, and success in asserting control without disapproval.

School Age (6-12 years)

• Virtue: Competency
• Psychosocial crisis: Industry vs. Inferiority
• Significant relationship: Neighbors and schools
• Milestones: Development of reading, writing, basic math skills, task orientation, and peer groups.
• Immunizations: Human papillomavirus (HPV) vaccine in a two-dose series.
• Nutritional concerns: Addressing obesity and ensuring adequate intake of vitamin D and calcium.
• Parent/health education & safety risks: Accidents are the leading cause of death. Focus on street safety, seat belts, bicycle helmets, and dangerous substance awareness.
• Development Assessment Questions: Focus on strengths and weaknesses in academics and social skills.

Adolescents (12-18 years)

• Virtue: Fidelity
• Psychosocial crisis: Identity vs. Role Confusion
• Significant relationship: Peers and role models become significant.
• Milestones: Develop abstract thinking, problem solve, compassion, moral reasoning, increase level of math and create hypothesis' and social relationships
• Immunizations: HPV, Meningococcal, TDAP, and Influenza.
• Nutritional concerns: Focus on eating disorders, such as bulimia and anorexia.
• Parent/health education & safety risks: Address mental health, social media, peer pressure, depression and risky behavior with substance abuse, safe sex practices, and reckless driving.
• Development Assessment Questions: Assess career/educational goals and struggles with self-identity.

Early Adulthood (19-29 years)

• Virtue: Love
• Psychosocial crisis: Intimacy vs. Isolation
• Significant relationship: Friends and partners become significant.
• Milestones: Focus on establishing intimacy and building relationships.
• Immunizations: Includes flu vaccine, Tdap, HPV vaccine, and MMR.
• Nutritional concerns: Over consumption of saturated fats, sweets, sodium, alcohol, drugs, and tobacco. Poor weight management is also a consideration.
• Parent/health education & safety risks: Review parent’s health history and get routine assessments for further potential issues.
• Development Assessment Questions: Focus on forming intimate relationships building towards goals.

Middle Adulthood (40-65 years)

• Virtue: Caring
• Psychosocial crisis: Generativity vs. Stagnation
• Significant relationship: Spouse is most significant.
• Milestones: Increased motivation to learn, awareness of mortality motivating a need to reevaluate goals, career changes and sandwich generation.
• Immunizations: Continue Tdap every 10 years and annual influenza, also ZVL vaccine (2 doses) and RZV (2 doses).
• Nutritional concerns: Decreased calcium, high fat, sodium and carbs, low vegetable, fruit and protein intake.
• Parent/health education & safety risks: Emphasizing annual physical exams and cancer, vision and bone density screenings.
• Development Assessment Questions: Enquire about patients diet, exercise, smoking and alcohol consumption and last physical exams

Later Adulthood (65+ years)

• Virtue: Wisdom
• Psychosocial Crisis: Ego Integrity vs. Despair
  • Integrity: Satisfaction with one's life and accomplishments.
  • Despair: Regret, bitterness, and fear of death.
• Significant Relationship: Family, spouse/partner, close friends, caregivers, healthcare providers
• Milestones: Reflection on life achievements and coping with loss of spouse, friends, independence, and health decline.
• Immunizations: Annual influenza, Tdap/Td, Shingles vaccine, Pneumonia vaccine.
• Nutritional Concerns: Decreased appetite and taste changes
• Parent/Health Education and Safety Risks: Removing trip hazards and assistive devices.
• Development Assessment Questions: Focus on social connection, falls, balanced meals.

Piaget's Stages of Development: Sensorimotor Stage (Birth to 2-3 Years)

• Infants and toddlers develop the five senses (sight, hearing, touch, taste, and smell).
• Children develop imaginary friends for play as well as a bigger vocabulary.

Piaget's Stages of Development: Preoperational Stage (2-7 Years)

• Consists of the preconceptual stage (2-4 years) and the intuitive stage (4-7 years).
• Children use symbols to represent ideas but struggle mentally reversing a situation.
  • Preconceptual stage: Symbolism and pretend play
  • Intuitive stage: Centration, egocentrism, animism, irreversibility.

Piaget's Stages of Development: Concrete Operational Phase (6-12 Years)

• Children learn using concrete objects to sort items by more than two features.
• Loss of egocentricity-ability to see others' perspectives.

Piaget's Stages of Development: Formal Operational Stage (12+ Years)

• People can think abstractly and logically using concepts such as justice or equity.
• People use symbols to understand abstract concepts.

Healthy People 2020-2030

• Sets 10-year targets to improve the nation's health.
• 358 measurable objectives.
• Focuses on social health determinants and includes evidence based research.