Toddler Development: Ages 1 to 3

Late Childhood (9-12 Years) (Preadolescence)

• Pre-adolescents are expected to show more refinement and maturity in achieving certain tasks
• These tasks include: becoming independent of adults and learning to depend on oneself
• Also included are developing and keeping friendships with peers and understanding the physical, psychological, and social roles of one's identified gender
• Tasks also involve developing moral and ethical behaviour; developing greater muscular strength, coordination, and balance; and learning how to study

Late Childhood

• Growth changes occur in both boys and girls during this stage
• Both genders exhibit more graceful and coordinated body movements
• Muscle strength and physical skills increase
• Math and language skills improve
• Arguments between boys and girls are common, and they often tease each other
• Disagreement between children and parents increases, sometimes manifesting as rebellion
• The onset of puberty nears in this stage
• Puberty is the period when reproductive organs begin to function, and secondary sex characteristics appear
• Factual sex education is important at this stage, emphasizing honesty and complete answers

Adolescence (12 to 18 years)

• Adolescence is the time between puberty and adulthood
• It involves rapid growth alongside physical, sexual, emotional, and social changes
• Individuals may begin to explore or question their sexual orientation
• Puberty begins during this stage
• Girls typically reach puberty between the ages of 10 and 14
• Boys typically reach puberty between the ages of 12 and 16

Developmental tasks of adolescence

• Accepting changes in the body and appearance is a key task
• Developing appropriate relationships with others of the same age
• Exploring gender identity and accepting the role considered normative for one's age and identified gender are aspects of devleopment
• Development includes becoming independent from parents and adults
• Developing morals, attitudes, and values needed to function in society
• Increased use of social media and electronic communication devices for communicating with peers

Adolescence

• In girls, menarche marks the onset of puberty which is the first menstruation and the start of menstrual cycles
• Pregnancy can occur once girls hit puberty
• Secondary sex characteristics appear, including increased breast size, appearance of pubic and axillary hair, widening and rounding of the hips, and slight deepening of the voice
• In boys, ejaculation (the release of semen) signals the onset of puberty
• Nocturnal emissions (“wet dreams”) occur
• Can contribute to pregnancy
• Other secondary sex characteristics include the appearance of facial, pubic and axillary hair; hair on arms, legs and chest; deepening in voice; increase in shoulder size

Adolescence (Cont'd)

• Growth spurts occur
• Adolescents may find changes in physical appearance hard to accept, considering it an “awkward stage”
• Concern with weight may lead to dieting
• Intense emotions, both highs and lows, are experienced
• Dating begins
• Teenagers may prefer being with peers more than with family
• Appearance becomes important
• Adolescents begin to think about careers and future plans after high school
• Developing independence is crucial
• Adolescents must learn to function, make decisions, and act responsibly without constant adult supervision
• Morals, values, and attitudes for living in society
• Influencing factors includes parents, peers, culture, religion, the media, and school
• Adolescents may disagree with parents and seek advice from peers or other adults instead

Health Promotion for School-Age Children

• Nutrition is important for promoting a healthy lifestyle, including limiting fat intake to 30% of calories and saturated fat to 10% of calories, as well as avoid overeating
• Oral hygiene: Be aware of the importance of low-cariogenic snacks and review proper dental hygiene practices like brushing and flossing alongside the importance of biannual dental checkups
• Infections: Stress the importance of immunization, teach infection prevention practices such as hand hygiene and care of minor skin injuries, and promote regular bathing
• Tobacco, Alcohol, and Drug use: Remind adolescents about available programs for preventing tobacco use and stress information regarding the hazards of these substances

Vaccinations

• Canadian infants and children require various vaccinations
• Visit Health Canada for updated immunization schedules
• Effects of not vaccinating can be pneumonia, deafness, brain damage, heart problems, blindness and paralysis
• Risk of not being vaccinated is much greater than risk of vaccination itself
• In Canada, only Ontario, Manitoba, and New Brunswick require that children be vaccinated in order to attend school
• For a child to attend school without immunizations in those provinces, a notarized statement of the reasons for opting out of vaccinations must be provided to the school by the child's physician or nurse practitioner
• In the case of an outbreak, children who are not vaccinated can be excluded from childcare facilities or schools at the discretion of the Medical Office of Health

Health Risks in Adolescents

• Injuries, including self-inflicted injuries and those from motor vehicle accidents and poisoning, are leading causes of death
• Suicide is an increasing cause of death in adolescents between 15-19 years old
• Depression and social isolation often precede suicide attempts, but suicidal thoughts can stem from various factors

Factors Associated with Suicide

• History: previous suicide attempts, family history of suicide attempts, child maltreatment, past psychiatric hospitalizations
• Individual Factors: Hopelessness, marked depression, alcohol or drug abuse, impulsiveness, difficulty tolerating frustration, self-hatred, excessive guilt or humiliation, physical/behavioral problems, ADHD, concerns about gender identity and orientation
• Seeing oneself as helpless or a victim of fate

Factors Associated With Suicide

• Family Factors - difficult home situation such as bitter parent-child conflict, hostile parents, overt rejection of parents, divorce, recent move, family breakup, unrealistic expectations from parents and parental indifference
• Social and environmental factors - Lack of social support, isolation, suicide of someone known and few educational opportunities

Substance Abuse in Adolescents

• Adolescents may believe that mood-altering substances create a sense of well-being or improved level of performance
• All adolescents are at risk for experimental or recreational substance use. Those with family risk factors are more at risk for chronic and physical use
• Some adolescents believe substance use makes them more mature
• Alcohol is the most common substance
• Cannabis is the second most common substance
• Rates of opioid abuse and overdose are increasing in Canada.

Eating Disorders in Adolescents

• Weight extremes resulting from excessive or inadequate caloric intake are common
• Girls are at high risk for anorexia nervosa and bulimia nervosa.
• Common Obesity with Physical Inactivity
• Contributing factor: increased computer and television/device use, poor nutritional choices

Sexual Experimentation

• Sexual experimentation is common in adolescents
• Contributes to heterosexual and same-sex relations
• Infections can be sexually transmitted
• Interventions should be made after
• Interventions include providing resources, accurate information and encouraging safer sex practices

Indigenous Adolescents

• In Canada, indigenous youth have a 7x higher rate of suicide when compared to non-indigenous youth
• Indigenous adolescents are more likely to live in crowded conditions
• High rates of alcoholism and substance abuse
• The incidence of unemployment is higher in these communities.

Young Adulthood (18 to 40 years)

• Psychological and social development continues
• Little physical growth occurs
• Developmental tasks include choosing education/career, selecting a partner, learning to live with a partner, becoming a parent, and developing a satisfactory sex life
• Relationship choices for adults involve marriage, staying single, or a common-law relationship
• Partners learn to live together
• Adults need to develop a satisfactory sex life

Young Adulthood Developmental Tasks

• Young to middle adulthood is a period involving challenges, rewards, and crises
• Challenges include demands of working and raising families
• Rewards include career, family, and personal successes
• Crises include job loss and caring for children, adolescents, and/or aging parents

Career in Young Adulthood

• People hope to have fulfilling careers and may formulate short and long-term career goals
• Successful employment ensures economic security, and promotes friendships, social activities, support, and self-respect

Sexuality in Young Adulthood

• Young adults typically have the emotional maturity to establish intimacy and develop fulfilling sexual relationships
• For most, the emotional aspect of sexual activity is as important as its type or frequency
• Sexual health and sexual concerns should be addressed and resolved

Singlehood in Young Adulthood

• Social pressure to marry is declining
• From 2011-2016, Canadian families and living arrangements continued to diversify
• Married families account for over half of all families while common-law couples and lone-parent families continue to increase
• Young adults who choose to remain single and maintain independence may consider siblings and parents as their family

Marriage in Young Adulthood

• Each married couple's relationship is unique, regardless of sex or identified gender
• Guidelines are useful for a happy marriage, but there are no rules to guarantee success
• Before marriage, couples should ensure the relationship is based on love, explore their motivations, and develop clear communication
• Couples also ideally accept that behaviors and habits will not change, and that beliefs/values are compatible
• Marriage requires learning sexual expression, roles, effective conflict resolution, and decision-making skills
• Each partner may experience a sense of loss of individuality in transitioning from singlehood

Parenthood in Young Adulthood

• Contraception allows couples to decide when and whether to start a family
• Factors in the decision involve reasons for wanting a child, social pressures, and costs
• General health status and age also affect the decision
• Couples can plan when/if and how many children to have, including the option of adoption, fertility treatment, or surrogacy
• Parents must agree on child-rearing practices and discipline methods, and adjust to the child's needs for parental time, energy, and attention

Health Risks for Young Adults

• Health risk factors originate in lifestyle patterns, family history, as well as the environment and occupation
• Lifestyle habits such as poor food choices, smoking, stress, high-risk sexual behavior, substance abuse, and inactivity increase the risk of illness
• Family history of disease may put a young adult at risk for developing that disease later in life

Accidental Death, Injury, and Substance Abuse

• Accidents are the leading cause of injury and death
• Death and injury can result from motor vehicle accidents, physical assaults, and suicide attempts
• In 2014, 29% of driver fatalities were among drivers aged 20-34
• Substance abuse directly or indirectly contributes to mortality and morbidity
• Regular heavy drinking (five or more drinks on one occasion) is most common among Canadians aged 20-34 (occurs more often in men)

Middle Adulthood (40 to 65 years)

• This stage tends to be more stable and comfortable.
• Developmental tasks relate to adjusting to physical changes, having grown-up children, developing leisure-time activities, and possibly caring for aging parents.
• Several physical changes typically occur, including the slowing down of energy and endurance
• Metabolism and physical activity slows, facial wrinkles and gray hair appear, and the need for eyeglasses rises
• Hearing loss may begin, women go through menopause between 42-55, and diseases/illnesses can develop

Middle Adulthood (Cont'd)

• Children leave home; parents shift to letting children lead their own lives.
• Hobbies and pastimes bring pleasure.
• Responsibility for aging parents may begin, and many adults deal with the death of parents

Psychosocial Changes in Middle Adulthood

• Midlife changes may involve expected events, like children leaving home, or unexpected events, like marital separation or the death of a loved one.
• Many adults find themselves in the "sandwich generation," responsible for both raising their own children and caring for aging parents.
• Individuals often examine their life goals and relationships, a "midlife crisis” can occur where they feel turmoil or anxiety about life and desired change.
• Such feelings can result in changes to relationships, lifestyle, or occupation

Career Transitions in Middle Adulthood

• Career changes can occur for various reasons, like changes in the workplace/society, decreasing job availability, desire for a more challenging occupation, or technological advances.
• Some may continue to work as long as they are able to, but unanticipated changes can cause health issues and stress

Relationship Changes in Middle Adulthood

• Relationship changes during this stage can include the death of a spouse/partner, separation or divorce, and deciding whether to remarry or remain single
• Care of Aging Parents involves expectations, conflicts, responsibilities, financial status, and cultural views

Late Adulthood (65 years and older)

• Developmental tasks involve adjusting to decreased strength and health, retirement and reduced income, coping with a partner's death, developing new friends/relationships, and preparing for one's own death

Caring for Older Adults

• People live longer than ever before, and active aging is becoming the norm
• Older workers are increasingly important to the economy
• Older adults are likely to have higher education, better health, and longer life expectancy, as well as being ethnoculturally diverse
• Families are likely to be smaller and more diverse, and those who are married may be in a second/subsequent marriage
• Older adults can remain active during retirement by contributing to society

Geriatrics and Aging

• Gerontology studies the aging process; Geriatrics is medicine for older adults
• Aging is normal with changes in body structure/function, and emotional/social changes
• Those who are older may live in their own homes, with family members, or in assisted living facilities

Emotional and Social Changes in Older Adults

• Physical reminders of aging may threaten self-esteem and independence
• Social roles change as social relationships evolve
• Some older adults may not have contact with children who also grow older, or they deal with the death of lifetime friends
• Some may experience lack of companionship, or children may become caregivers
• Death of a partner is common (women on average live longer than men) that leads to grieving, depression, and inability to cope with emptiness

Retirement in Older Adults

• Retirement is a reward for a lifetime of work, and although most enjoy it, some retire due to persistent illness or disability
• Work has social and emotional effects, and helps one feel the feeling of self worth
• Retirement usually means a reduced income; CPP may be the only income though it has not kept up with costs of living
• Though some could qualify for Older age security many are in poverty

Health Factors in Older Adults/Late Adulthood

• Depression is not inevitable but is experienced because of life changes.
• While depression can occur in the younger years, it may go unrecognized because signs/symptoms could be mistaken for normal stages of aging
• Once recognized, treatment can begin; common signs and symptoms include sadness, loss of energy, feeling tired, memory problems, irritability, neglecting personal care, loss of interest in hobbies, and suicidal thoughts

Physical Changes in Older Adults

• Physical changes happen to everyone, and the rate/degree of change varies with the person
• Influencing factors include diet/general health, exercise, stress, environment and heredity
• Normal aging does not mean loss of health; quality of life does not decline
• The integumentary system experiences changes such as skin losing elasticity, secretions from oil and sweat glands decrease, and blood vessels decreasing
• Brown spots and loss of skin's fatty tissue layer increases sensitivity to cold. The skin also causes itching and becomes more easily damaged with nails and feet circulation weakening

Nervous/Circulatory System Changes in Older Adults

• Nerve cells are lost and conduction/reflexes often slow
• Blood flow to the brain can be reduced and changes occur in brain cells that adjust sleep patterns
• Touch and sensitivity to pain and pressure is reduced/sensed heat and cold are not as easily felt
• Senses such as taste and smell become dull

Digestive/Urinary System Changes in Older Adults

• Salivary glands produce less saliva making swallowing difficult as peristalsis decreases over time
• Kidney function decreases with atrophies as blood slows
• The ureters/bladder/urethra lose elasticity so muscles weaken and bladder size decreases
• Men can encounter prostate enlargement while anyone can risk having urinary tract infections and/or nighttime urination

Reproductive System Changes in Older Adults

• Testes become smaller in men as testosterone decreases (which affects strength, sperm production, and reproductive tissues)
• Erection takes longer and lost faster as an orgasm can occur at a less intense and forceful state
• Menopause occurs when menstruation stops with hormones such as estrogen and progesterone decreasing
• the uterus in women/vagina/genitalia atrophy which makes vaginal walls thin during the arousal phase and breasts become less firm

Muscoloskeletal System Changes in Older Adults

• Muscle cells decrease in number and atrophy/weaken more and more over time as bones lose mineral like calcium
• Bones become brittle and easily break as vertebrae shorten and joints becomes stiff
• Mobility decreases with bone loss or muscle strength although activity can help maintain it

Older Adult Sexuality

• Love, affection, and intimacy do not disappear, older adults can still form sexual relationships
• Meeting client's sexual needs must also be respected in long term care and privacy/consent should be granted/obtained
• Knock before entering a room, politely excuse self where necessary and do not be demeaning, rather report abuse if relevant.

Rehabilitation

• Rehabilitation may be necessary after an acute injury or illness, or as part of the treatment for a chronic illness or disability.
• Rehabilitation can also maintain or slow the decline of functioning.
• Specific goals of rehabilitation include restoring function to former levels, improving functional abilities, learning new skills, and preventing further disability and illness.

Rehabilitation settings include:

• Hospitals, such as those with cardiac and respiratory rehabilitation programs or programs for complex medical and surgical conditions
• Specialized facilities which focus on specific problems, such as mental health disorders, substance abuse, or addiction
• Long-term care facilities that provide services similar to a hospital setting
• Community care, which includes home care services and adult day programs

Common Health Problems Requiring Rehabilitation

• Acquired brain injury
• Alcoholism or Alcohol Use Disorder
• Amputation
• Brain Tumor
• Burns
• Cerebral Palsy
• Chronic Obstructive Pulmonary Disease
• Mental illness
• Myocardial Infarction (heart attack)
• Parkinson's disease
• Spinal cord injuries or tumours
• Stroke
• Substance abuse

Rehabilitation Team

• The client is the key team member.
• The family, doctor/physician, the nursing team, and other health team members help the client set goals and plan care.
• All team members help the client regain function and independence
• Families provide support and encouragement of the client
• Families can provide care when the client returns home
• Every part of a support worker's job focuses on promoting the client’s independence
• Preventing decline in function is also a goal

Role of Family

• Families play a very important role in rehabilitation
• Families need to learn about the client's illness or disability and how to care for them
• Family members may need to learn new skills to care for the client
• Counselling is provided to help families cope with many changes

Therapy and Training

• A rehabilitation team chooses the therapy and training that is needed to meet the client's goals
• Equipment may be ordered to meet client's needs, and this includes:
• A prosthesis, which is an artificial body replacement
• An orthotic, which is an apparatus worn to support, align, prevent, or correct problems
• Eating or drinking devices
• Self-care devices
• Devices to aid mobility
• Other equipment, like mechanical ventilation

Restorative Care

• Restorative care helps a client regain health, strength, and independence and is similar to rehabilitation
• Restorative care aims to help clients maintain the highest level of function and prevent unnecessary decline in function.
• For clients who are too weak to perform ADLs, restorative care may involve measures in order to promote:
• Self-care
• Elimination
• Positioning
• Mobility
• Communication
• Cognitive function
• Preventing unnecessary decline in function

Whole Person

• Rehabilitation emphasizes the whole person and all dimensions of health, not only the physical.
• A rehabilitation team treats all dimensions of a client, including physical, emotional, social, intellectual and spiritual health.

Assisting with Rehabilitation

• Support workers are vital for giving assistance
• Progress may be slow and frustrating
• It is important to be patient, supportive and empathetic
• Listen to your client, as they may pass along vital information to the therapist

References

• Potter, P. A., Perry, A.G., Stockert, P.A., & Hall, A.M. (Eds.). (2019). Canadian fundamentals of nursing (6th Cdn. ed.) (J. C. Ross-Kerr, M. J. Wood, B. J. Astle& W. Duggleby, Cdn. Adapt.). Toronto, ON: Elsevier Canada.
• Sorrentino, S.A., Remmert, L. N. & Wilk, M.J. (2022). Mosby’s Canadian textbook for the support worker (5th Canadian ed.). Toronto, ON: Elsevier Inc.