Pediatric Nursing Reviewer (Final Exam) PDF

NCM 107: PEDIATRIC NURSING FINAL EXAMINATION REVIEWER NURSING CARE OF A FAMILY WITH A TODDLER Age span:1-3 Years. Transition from immobile, preverbal infants to mobil, verbal children with growing independence. Described as “Little Scientist” DEVELOPMENTAL MILES...

NCM 107: PEDIATRIC NURSING FINAL EXAMINATION REVIEWER NURSING CARE OF A FAMILY WITH A TODDLER Age span:1-3 Years. Transition from immobile, preverbal infants to mobil, verbal children with growing independence. Described as “Little Scientist” DEVELOPMENTAL MILESTONES CHARACTER TRAITS: Rigid, ritualistic, and stereotypic Negativistic, their favorite word is “NO” as their way to search for independence PHYSICAL GROWTH KEY DEVELOPMENTAL CHANGES IN TODDLERS ✓ While toddlers are making great strides ▪ Independence developmentally, their physical growth - Children develop autonomy begins to slow. ( independence) - Shift from caregiver dependent to a. Weight exploring the world with less - Gains from 4-6 lbs (1.8-2.7 kg) per assistance. year Birth weight quadruples by 2.5 ▪ Motor and Verbal Skills years - Toddlers begin walking, talking, and b. Height interacting more with their - Grows about 5 inches per year surroundings. - Height at 2 years is about half of the ▪ Exploratory Behavior expected adult height - Children starts with experimenting c. Head Circumference toys, aiding cognitive and physical - Increases only about 2cm during the development. second year compared to about 12 cm during the first year CAREGIVER ROLE DURING TODDLER d. Chest Circumference PERIOD - By 2 years, chest circumference has ▪ Support Growing Independence grown greater than the head - Encourage children to explore circumference safely. (create a “yes” environment e. Body Contour in a play area at home). - Toddlers tend to have a prominent abdomen because, although they NURSING ASSESSMENT OF A are walking well, their abdominal TODDLER’S GROWTH AND muscles are not yet strong enough DEVELOPMENT to support abdominal contents. They also have a forward curve of the spine at the sacral area (lordosis). f. Dental Development - Eight New teeth (Canines and First Molars) emerge in the second year, Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  with all 20 primary teeth typically Play: Stacks 2 blocks; enjoys present by 2.5 to 3 years. being read to; drops toys for retrieval (exploring permanence). PHYSIOLOGIC STATUS Socialization & Language: Uses 4–6 words. Body System Maturation: 18 Gross Motor: Runs, jumps in 1. Respiratory- Breathing Months place; walks upstairs with help remains abdominal. (both feet on one step). 2. Cardiovascular- Heart rate Fine Motor: No longer rotates slows, and blood pressure spoon when eating. gradually rises. Play: Parallel play begins; 3. Digestive- Stomach acid imitates chores (e.g., dusting); increases, and stomach enjoys pull toys. capacity supports three Socialization & meals a day. Language: Uses 7–20 words; 4. Urinary and Anal Control- names 1 body part; achieves Full myelination of the spinal bowel control. cord enables toilet training 24 Gross Motor: Walks upstairs readiness Months alone (both feet on one step). 5. Immunity- IgG and IgM Fine Motor: Opens doors; antibodies mature by age 2, unscrews lids. ending passive immunity Play: Parallel play continues; from birth. imitates tasks like wrapping a doll or "driving a car." DEVELOPMENTAL MILESTONES Socialization & Less numerous but no less dramatic Language: Has a vocabulary than those of the infant year of ~50 words; forms two-word because this is a period of slow and sentences (e.g., "Daddy go"). steady, not sudden, growth. 30 Gross Motor: Jumps down Toddler development is influenced to Months from chairs. some extent by the amount of social Fine Motor: Draws simple contact and the number of strokes and copies circles. opportunities children have to Play: Plays house; engages in explore and experience new rough housing. degrees of independence. Socialization & It is strongly influenced by individual Language: Verbal skills readiness for a new skill. steadily increase; knows full name, one color, and age. 36 Gross Motor: Rides a tricycle; Age Developmental Milestones Months brushes teeth with little help. 15 Gross Motor: Walks alone Fine Motor: Unbuttons Months well; sits in a chair; creeps buttons; draws a cross. upstairs. Play: Begins to share. Fine Motor: Scribbles with a Socialization & pencil/crayon; puts small Language: Speaks fluently pellets into bottles; holds a (300–900 words); knows full spoon (may turn it upside name and sex; achieves down). nighttime bladder control. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Nursing Significance: - Street Safety: Teach toddlers to cross the street safely by holding a Instruct parents not to offer snacks parent’s hand. within an hour of meals. - Supervision: Encourage parents to Avoid small food items such as supervise tricycle riding and outdoor peanuts, carrots, celery, and play. hotdogs. Remind parents not to use food as a PARENTAL CONCERNS ASSOCIATED reward or punishment. WITH THE TODDLER PERIOD Parents should encourage the use of utensils. a. Toilet Training PROMOTING TODDLER SAFETY One of the biggest tasks during the toddler period. Aspiration and Poisoning Toilet training should begin and end - Toxic Substances: Urge parents to according to the child's ability to lock away all toxic substances and accomplish it. secure safety caps on medications. Bowel training is usually completed - Small Objects: Remove small, easily before bladder training. aspirated objects from the child’s Complete nighttime bladder control environment. typically does not occur until age 4 or 5. Falls The child must have control of rectal - Crib Safety: Instruct parents to keep and urethral sphincters, which is crib rails up and place gates across usually achieved by the time they stairways. walk well. - Window Safety: Secure screens on The child must understand what it all open windows. means to hold urine and stools until - Supervision: Supervise the toddler at they can release them at an play. appropriate time and place. A child must have the desire to Burns delay immediate gratification for - Tablecloths: Advise parents to avoid more socially accepted behavior. using tablecloths. - Hot Surfaces: Teach the toddler Signs of Readiness for Toilet Training: what “hot” means. - Storage Safety: Store matches and ✔ Stays dry for 2 hours, with regular lighters in locked cabinets out of bowel movements. reach. ✔ Can sit, walk, and squat. - Electrical Safety: Secure safety ✔ Can verbalize the desire to void or plugs in all unused electrical outlets. defecate. ✔ Exhibits a willingness to please Motor Vehicle and Other Accidents parents. - Car Seat Safety: Instruct parents to ✔ Wants to have soiled diapers continue using an appropriate-sized changed immediately. car seat. - Hazardous Items: Lock cabinets and b. Ritualistic Behavior drawers containing hazardous items (e.g., knives, firearms). Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Toddlers may insist on using only Fear of separation starts around 6 their spoon at mealtime or only months of age and may persist their blanket at bedtime. through the preschool years. They may refuse to go outside Peak: Most intense around 18 unless their favorite cap is found. months. c. Negativism Three Phases of Separation Anxiety: Definition: Common during toddler 1. Protest: Characterized by anger, years as part of establishing their screaming, and calling for the own identities. parent. Behavior: Toddlers often refuse to 2. Despair: Child may withdraw and comply with requests from parents, not want to talk. replying "no" to nearly everything. 3. Denial: Child may ignore the parent upon return. How to Manage Negativism: How to Prevent Separation Anxiety: ✔ Decrease the number of questions. ✔ Make statements rather than asking ✔ Keep goodbyes brief and say questions. goodbye firmly. ✔ Offer choices to the child to give ✔ Transitional objects (e.g., a favorite them some control. toy or blanket) can be helpful during separation periods. d. Discipline f. Temper Tantrums Definition: Discipline involves setting clear rules or guidelines so A normal response to frustration; children understand what is often lack verbal skills to express expected of them. emotions. Punishment: Is a consequence of misbehavior or disregard for the Management: rules learned. ✔ Stay calm and avoid giving in Effective Discipline Measures: demands to prevent reinforcing the behavior. ✔ Consistency: Enforce rules ✔ Offer comfort and alternative outlets consistently. for emotions (like drawing or a quiet ✔ Timing: Discipline should be place) initiated after misbehavior. ✔ Planning: Plan discipline methods NUTRITIONAL REQUIREMENTS in advance. ✔ Focus on Behavior, Not the Growth and Development: As the Child: Address actions, not the growth rate slows, there is a child's character. decrease in the child’s need for ✔ Private & Non-Shaming: Discipline calories, protein, and fluids. should occur in private and should Calorie Requirement: 102 kcal/kg avoid causing shame. per day. Protein Requirement: 1.2 g/kg per e. Separation Anxiety day. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Milk Intake: Milk should be limited to needs as more no more than 1 quart (1 liter) per important or central day. than those of others. Electra Refers to the FOOD PREFERENCES Complex attachment of a female child to a male 12 Months: Most toddlers begin parent. eating the same foods as the rest of Endomorphic A body type the family. Body Build characterized by a 18 Months: Physiologic anorexia larger body build or (picky eating) may occur; they may rounder physique. experience food jags (preference for Genu Valgus A condition where the certain foods over others). knees angle inward Self-Feeding: Toddlers prefer to feed and touch when themselves and tend to favor small standing, also known portions of appealing foods. as "knock knees." Food Choices: They often prefer Intuitional Thinking based on single foods rather than mixtures Thought intuitive feelings (e.g., eating foods like plain pasta rather than logical instead of pasta with sauce). reasoning, often seen in early childhood. Nursing Care of a Family With a Oedipus Refers to a Preschool Child Complex attachment of a male child to a female Term Definition parent. Secondary A type of stuttering Broken Repitition and Stuttering that develops after Fluency prolongation of sound speech has initially syllables, and words. been fluent, often due Bruxism The involuntary to psychological or grinding or clenching environmental factors. of teeth, usually Connected to broken during sleep, which fluency. can lead to dental issues. Conservation A cognitive ability to understand that certain properties of Preschool Period (Ages 3, 4, 5): objects (like volume or mass) remain the Physical growth slows, but same despite personality and cognitive growth changes in form or continue rapidly. arrangement. Preschoolers seek independence: Ectomorphic A body type They want to dress themselves, Body Build characterized by a choose clothing, feed themselves, slim body build or and wash their hair. lean physique. Caregivers may notice the child Egocentrism The tendency to wearing mismatched socks or trying perceive one’s own to eat soup with a fork, which is thoughts, beliefs, or typical behavior for learning new skills. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  It is essential for caregivers to know easily due to improved cognitive how to differentiate tasks that a abilities. preschooler can manage Immune System Changes: independently from those requiring o Lymphatic tissue increases in adult supervision. Setting size, particularly the tonsils. appropriate limits ensures the child's o IgG and IgA antibodies rise, safety while fostering exploration. making illnesses more localized (e.g., upper NURSING ASSESSMENT OF A respiratory infections). PRESCHOOLER'S GROWTH AND Heart and Circulatory Changes: DEVELOPMENT o Physiologic splitting of heart sounds may be noted. o Innocent heart murmurs may develop due to the changing size of the heart in relation to the chest. o Pulse rate decreases to about 85 beats per minute, and blood pressure remains around 100/60 mm Hg. Bladder: Easily palpable above the symphysis pubis, with frequent voiding (9-10 times per day). Skeletal Changes: The longitudinal arch in the foot becomes well-formed, and muscle strength improves, allowing for activities like gymnastics. Genu valgus (knock-knees) typically resolves by the end of the preschool period. WEIGHT, HEIGHT, AND DEVELOPMENT: PHYSICAL GROWTH Weight Gain: Approximately 4.5 lb (2 kg) per year. Body Contour Changes: The Height Gain: 2 to 3.5 inches (6 to 8 transition from a toddler’s cm) per year. wide-legged gait, prominent lordosis, Head Circumference: No longer and protuberant abdomen to a routinely measured after age 2 as it slimmer, taller, more childlike body changes little after this point. occurs. Body Type: Ectomorphic (slim) or Teeth: Endomorphic (larger) body types become evident. Preschoolers typically have all 20 Handedness: Becomes more deciduous teeth by age 3, with apparent during this period. permanent teeth erupting at school Cognitive age. Development: Preschoolers Preserving deciduous teeth is exposed to more than one language essential as they hold the space for may develop bilingualism more permanent teeth. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 DEVELOPMENTAL MILESTONES 3-5-Year-Olds: o Preschoolers enjoy games 3 Fine Motor: Undresses self, stacks that use imagination and tower of blocks, draws a cross imitation, such as pretending Gross Motor: Runs, alternates feet to be a teacher, firefighter, or on stairs, rides tricycle, stands on one store clerk. foot o Many have imaginary friends, Language: Vocabulary of 900 words which often persist until they Play: Able to take turns, very begin school. imaginative o Four- and five-year-olds 4 Fine Motor: Can do simple buttons alternate between active play Gross Motor: Constantly in motion, and imitative play. jumps, skips o Five-year-olds become Language: Vocabulary of 1,500 interested in group games words and reciting songs learned in Play: Pretending is major activity preschool or kindergarten. 5 Fine Motor: Can draw a six-part figure, can lace shoes EMOTIONAL DEVELOPMENT IN Gross Motor: Throws overhand PRESCHOOL CHILDREN Language: Vocabulary of 2,100 words Initiative vs. Guilt (Erikson's Play: Likes games with numbers or Developmental Task) letters Preschoolers develop a sense of initiative when they are encouraged Language Development in Preschoolers to explore and learn new things. If criticized or punished, they may 3-Year-Olds: develop guilt about trying new o Vocabulary of about 900 activities, affecting their confidence words, asking up to 400 later in life. questions a day (e.g., "Why Exposure to diverse experiences is snow cold?"). and creative play materials is key to o Egocentrism: Perceive their fostering initiative. thoughts and needs as more Activities like visiting a zoo or using important than others' and modeling clay help develop initiative. define objects in relation to themselves (e.g., a spoon is Imitation and Fantasy "what I eat with"). 4-5-Year-Olds: Preschoolers often imitate adults o Enjoy participating in and role-play, such as pretending to mealtime conversations and be a firefighter or teacher. can describe incidents in Play is more about engaging in roles detail. than exact accuracy. o Imitate language they hear, Fantasy play is common, but including inappropriate preschoolers may fear they are language, often to gain "stuck" in the fantasy, showing attention. "magical thinking." Parents should support imaginative Play in Preschoolers play while reassuring children of their identity. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Oedipus and Electra Complexes They may struggle to apply learned rules to new situations, like a Preschoolers may show strong hospital visit. emotional attachments to parents of the opposite sex, known as the Spirituality Oedipus (A boy's attachment to his mother and rivalry with his father) Preschoolers develop a basic and Electra complexes(A girl’s understanding of spirituality through attachment to her father and rivalry religious training and rituals. with her mother.) They may engage in spiritual This attachment is normal but may practices like prayer before meals cause jealousy or feelings of for reassurance and security. competition between parents. HEALTH PROMOTION FOR A Socialization PRESCHOOLER AND FAMILY: SAFETY Preschoolers begin to interact more Promoting Preschooler Safety with peers, sharing and playing together. Independence vs. Supervision: At Four-year-olds may have age 4, preschoolers may project disagreements as they test their role independence but still need in the group. supervision to prevent injury during At five, children begin forming close active play and ensure they do not friendships, often based on shared wander too far from home. experiences. Medicine Imitation: Preschoolers may imitate taking medicine if they COGNITIVE DEVELOPMENT see family members doing so. Gun Safety: Ensure any guns in the Piaget's Preoperational Stage home are unloaded and locked to prevent accidental injury. Preschoolers are in the Automobile Safety: Preschoolers preoperational stage, with intuitive should be reminded to always thought emerging as they ask buckle their booster seat and not "How?" and "Why?" walk in front or behind automobiles. Cognitive skills develop, but they still They may act impulsively, running rely on magical thinking and into the street before remembering centration, focusing on one safety rules. characteristic of an object. Preschoolers do not yet understand Keeping Children Safe, Strong, and Free conservation (e.g., that quantity remains the same despite changes Stranger Danger: in shape or appearance). o Teach children not to talk to or accept rides from adults MORAL AND SPIRITUAL DEVELOPMENT without their parent’s permission. Understanding Right and Wrong o Show children how to call for help in an emergency (e.g., Preschoolers understand right from yell, run to a neighbor's wrong based on parental rules rather house, or dial 911). than reasoning. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  o Explain what police officers original containers. look like and how they can - Contact poison help in emergencies. control. o Teach that secrets about Burns - Don’t allow lighting uncomfortable situations candles or fireplaces. should be shared with Community - Don’t go with others parents or trusted adults. Safety without permission. Bullying Prevention: Explain that - Teach "no" to bullying is unacceptable and should inappropriate be reported. touching. Inappropriate Touch: Educate on General - Monitor child’s the difference between appropriate location. and inappropriate touch or behavior. - Extra caution needed during Motor Vehicle and Bicycle Safety stressful times. Car Safety: Preschoolers should be PROMOTING THE NUTRITIONAL in car seats or booster seats in the HEALTH OF A PRESCHOOLER back seat until they are around 40 lbs. Ensure the seatbelt fits properly Appetite and Meal Prep: (shoulder harness should not cross Preschoolers have smaller appetites the child’s face or neck). due to slower growth. Encourage Bicycle Safety: Promote the use of simple food preparation tasks like safety helmets to prevent head making a sandwich to build initiative. injuries, especially as bicycle Snacks: Limit snacks to 1-2 small, accidents are a major cause of healthy options per day. severe head injuries in preschoolers. Nutritional Requirements: Foods Caregivers should model safe should include variety and color, behavior by wearing helmets based on MyPlate themselves. recommendations. Meat Preferences: Preschoolers COMMON UNINTENTIONAL INJURIES TO may not prefer meat as it’s hard to PRESCHOOLERS chew. Vitamins: Generally unnecessary if a Unintentional Prevention Measure balanced diet from all food groups is Injury consumed. Vitamins should be Motor Vehicles - Teach tricycle and stored out of reach and not exceed and Bicycles street safety. recommended doses. - Always use helmets Vegetarian Diets: Colorful and for biking. appealing but may lack calcium, Falls - Supervise at vitamin B12, and vitamin D. playgrounds. Consider supplements if needed. - Remove drawstrings from clothing. PROMOTING THE DEVELOPMENT OF Drowning - Teach swimming. THE PRESCHOOLER IN DAILY Animal Bites - Avoid stray animals. ACTIVITIES - Supervise with pets. Poisoning - Keep meds out of Dressing: Preschoolers can dress reach. themselves (3-4 years) with - Store substances in Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  supervision. Allow them to choose o Exposure to smoke and clothes, even if mismatched. daycare increases infections. Sleep: Some may resist naps, and o Overprotection from illness nightmares or fear of the dark may can hinder independence. arise. Use a night-light and avoid scary stories. Common Fears: Exercise: Encourage active play and structured games. Limit screen o Fear of the Dark: time to promote motor skills and Reassurance, night-lights, prevent obesity. and monitoring bedtime Hygiene: Supervise handwashing stimuli help. and bathing. Ensure water o Fear of Mutilation: Explain temperature is safe. Help with procedures and provide cleaning fingernails and ears. distraction. Care of Teeth: Encourage tooth o Fear of Separation: Prepare brushing and flossing. Use children with clear, fluoridated water or supplements. comforting timelines. Avoid sweets and encourage tooth-friendly snacks. Behavior Variations: Teeth Grinding: May occur due to anxiety or spasticity in children with cerebral palsy. Refer to a pediatric o Telling Tall Tales: Distinguish dentist if severe. fact from fiction without discouraging imagination. o Imaginary Friends: Normal, PROMOTING HEALTHY FAMILY FUNCTIONING helps with language and expression. o Difficulty Sharing: Requires Encouraging Creativity: Read aloud and answer questions to foster practice and guidance in language development. understanding ownership. Handling Questions: It’s okay to o Regression: Temporary say "I don't know" to deep or return to old behaviors due to philosophical questions. stress (e.g., thumb-sucking). Discipline: Preschoolers have o Sibling Rivalry: Promote strong opinions, leading to conflict. self-esteem by emphasizing Guide them through these struggles a child’s unique privileges. while respecting their opinions. Use o Preparing for a New "time-out" as a non-physical Sibling: discipline technique. Time-out duration should match the child’s a. Start preparation when pregnancy is age (3-5 minutes for preschoolers). visible, before changes to the child’s environment. PARENTAL CONCERNS IN PRESCHOOL b. Move the child to a new bed 3 YEARS months before birth. c. Preschool or childcare should be Common Health Problems: before or 2-3 months after the sibling’s birth. d. Plan for separation during childbirth o Preschoolers have minor and allow visits to ease anxiety. illnesses (e.g., colds, ear o Sex Education for infections). Preschoolers Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  a. Answer questions about anatomy In a class of 11 year old sixth simply and factually using correct graders, it is not unusual to discover terms. more than half of the girls are b. Teach privacy and appropriate already menstruating. Materials touch. c. Masturbation is normal, but should must be introduced to the school be framed as a private activity. age for sex education to be effective. o Choosing a Preschool or Precocious puberty - abnormal Childcare Center onset of puberty. a. Preschool helps with social development; assess local programs Sexual and Physical Concerns carefully. School age is the time to reinforce b. Childcare centers can increase exposure to infections; promote previous teaching that their body is hygiene practices. their own, to be used only in the o Preparing a Child for way they choose. School Puberty brings changes to a. Adjust routines for early bedtimes sebaceous glands. and ensure immunizations are Under the influence of androgen, up-to-date. glands become more active, setting b. Present school positively and prepare for new experiences like bus the stage for acne. rides or lunch routines. Vasomotor instability - leads to o Broken Fluency blushing and ↑ perspiration. a. Broken fluency (speech repetition) is normal in preschoolers. Concerns of girls b. Don’t interrupt or make the child They're much taller by about 2 in. or conscious of their speech patterns. 5 cm because their growth spurt CONCERNS FOR PRESCHOOLERS WITH begins early. UNIQUE NEEDS Changes in pelvic contour (might misinterpret as weight gain and Children with disabilities benefit from attempt crash diet). preschool for socialization. Breast development (they tend to Provide alternative activities if the slouch and wear loose clothing to child has physical limitations. hide the size of their breast). BD is Encourage participation in family meals, even if the child has dietary not always assymetrical. restrictions. ○ Supernumerary (additional) nipples may darken or activates changes to the testes increase in size at puberty. It and ovaries to cause puberty. is affected by hormones. Menstruation is an important Timing of onset puberty varies preparation for future childbearing widely between 8 and 14 years of and for a girl's concept of herself as age. a woman. Sexual maturation: ○ Explanation of menstrual ○ Girls - between 12 and 18 flow, good hygiene and ○ Boys - between 14 and 20 reassurance that they can Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  bathe, shower, and swim is Scrotum becomes textured; growth needed. of penis and testes begins. Vaginal secretions (may fear they Sebaceous gland secretion have contracted an infection). increases. Vaginal secretions will begin to be Perspiration increases. present. Secretions that cause vulvar irritations may indicate that it 12-13 is an infection. Pubic hair present across pubis. Menstrual irregularity. This occurs Penis lengthens. primarily because a girl's cycle is at Dramatic linear growth spurt. first anovulatory. With added Breast enlargement may occur. maturity and the onset of ovulation, cycles become more regular. GIRLS ○ Malnourishment, obesity, 9-11 emotions influence menstrual Breasts: Elevation of papilla with regularities. breast bud formation; areolar diameter enlarges. Concern of boys Increasing genital size 11-12 Breast development - hypertrophy Straight hair along the labia. Vaginal of the breasts (gynecomastia) esp. epithelium becomes cornified. those who are stocky or obese. It is pH of vaginal secretions becomes a transitory phenomenon and will acidic; slight mucous vaginal fade as soon as hormones mature. discharge is present. Body hair growth - pubic hair Sebaceous gland secretion appears first and chest and facial increases. hair may not grow until several years Perspiration increases. later. Dramatic growth spurt. Increased seminal fluids begins to be produced. Boys begin to notice ejaculation during sleep (nocturnal 12-13 emissions). Pubic hair grows darker; spreads over entire pubis. Chronologic Development of Secondary Breasts enlarge, still no protrusion of Sex Characteristics nipples. Axillary hair present. BOYS Menarche occurs. 9-11 Prepubertal weight gain occurs. TEETH Deciduous teeth are lost and 11-12 permanent teeth erupts. Sparse growth of straight, downy, Average child gains 28 teeth slightly pigmented hair at base of between 6 and 12 years of age. penis. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  ○ Central and lateral incisors; Children developed an interest of first, second, and third collecting items (e.g, cards, dolls, cuspids; and first and second rocks or marbles. molars. The type of item is not as important as the quantity. GROSS AND FINE MOTOR 8 years DEVELOPMENT The collections have structured; time is spent sorting and cataloging. Enjoys helping in the kitchen with jobs. More involved in simple science projects and expirements. Likes table games but hates to lose, so they tend to avoid competitive play. They may change the rules in the middle of the game to keep from losing. 9 years They play hard. Play is rough and they are not as interested in perfecting their skills. Talent for music and arts become evident. The time they discover the are other children in the internet who are waiting to talk to them in chat rooms or other social media. Not yet wise enough to recognize PLAY the danger of talking to strangers so 6 years supervision is advised. Continues to be rough and tumble 10 years Begins to spend quite time with Spend most of their time playing books as they discover reading as handheld or consoles games. an enjoyable activity that opens Boys and girls play separately doors to other worlds. although interest in the opposite sex Spend hours increasingly is apparent. challenging video games. Boys show off as girls pass by their 7 years group. Requires more props for play. Girls talk loudly or giggle at the site Start of decline of imaginative play of familiar boy and become more Girls begin to prefer teenage dolls interest in the way they look and and coordination is good enough dress. that they can button the miniature Very interested in rules and fairness dresses and pull on tiny boots. They strictly enforce rules. Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 11 and 12 years stories are limited because of Enjoy dancing to popular music and a lack of experience. playing table games. Accomodating enough to play with EMOTIONAL DEVELOPMENT younger siblings who need the rules They have the ability to trust others modified to their advantage. and with a sense of respect for their Time with friends is spent just own worth. talking. Can accomplish simple tasks bcoz More interested in seeing their room they have a sense of autonomy. tidy. Doing things is more important and Twelve year olds like to do jobs like more rewarding than watching things raking leaves or babysitting for being done (sense of initiative). money. Development Task: Industry Vs. LANGUAGE Inferiority Six year olds Erik Erikson ○ talk in full sentences, using Children attempt to master their new language easily and with developmental step: learning a meaning. sense of industry or ○ No longer sound as though accomplishment. talking is an experiment but Learning how to do things well. appear to have incorporated language permanently. Home as a setting for to learn ○ Define objects by their use. industry 7 year olds School as a setting to learn industry. ○ Can tell time in hours. Structured activities ○ Have trouble with concepts Problem solving. such as “half past” and Learning to live with others. “quarter to”. ○ Knows the months of the SOCIALIZATION year, and the months in 6 years old which holiday fall into. ○ Plays in group but when tired ○ Can add and subtract and or stressed they prefer one make simple change. on one contact. 9 year olds 7 years old ○ Discover “dirty jokes” ○ Aware of family roles and ○ Swear words to express responsibility. anger. ○ Promises must be kept since ○ May have a short period of they view them as definite, intense fascination with firm commitments “bathroom language” ○ They tattle because they 12 year olds have a strong sense of ○ Can carry on an adult justice. conversation, although 8 years old Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  ○ Actively seek company of does not necessarily mean a change other children. in size. ○ Girls have a close girlfriend Accommodation - the ability to and vice versa. adapt thought processes to fit what ○ Whispers to share their is perceived such as understanding secret. that there can be more than one 9 years old reason for other people's actions. ○ Take the values of their peer Conservation - the ability to group seriously. appreciate that a change in shape ○ Much more interested on does not necessarily mean a change how others dress. in size. ○ Friend or club age “spite Class inclusion - the ability to clubs”. understand that objects can belong ○ Ready for activities away to more than one classification. from homem 10 years old MORAL AND SPIRITUAL DEVELOPMENT ○ Enjoys privacy KOHLBERG ○ Best gift for them is a box that locks. Preconventional reasoning 11 years old begin to mature in terms of moral ○ Girls increasingly interested development. in boys and vice versa. Thet concentrate on “niceness” and ○ Favorite activities are “fairness”. mixed-sex Rule oriented. ○ Children are secure. 12 years old HEALTH PROMOTION FOR A SCHOOL ○ Comfortable in social AGE CHILD situations. ○ Boys have erections. Promoting Safety ○ Some are still children and Source of unintentional injury. others are almost in Motor Vehicle adolescent making social Bicycle interactions sometimes Community difficult. Burns Falls COGNITIVE DEVELOPMENT Sports injuries PIAGET Drowning Concrete Operational Thought - the ability Drugs to reason through any problem they can Firearms General visualize. Promoting Nutritional Health of a School New concepts during school age: Age Decentering -the ability to appreciate that a change in shape Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻  Most children are hungry after school and enjoy a snack like fruit, Lowest rate of death and serious illness. cheese and milk to be healthy. Enjoys helping to plan meal like Small health concerns jell-o, salad, scrambled eggs, and Head lice sandwiches. Ringworm Children require more iron during their prepuberty. Two causes of death Adequate calcium and fluoride for Unintentional injury teeth and bone growth. Cancer Promoting Development of a School Age Minor illnesses in Daily Activities Dental caries GI disturbances Dress Upper respi infections Able to dress themselves but are not skilled in taking care of their clothes.. ADHD and ASDs are marked in school age. Right time to teach children the importance of taking care of their Caries - (cavities) are progressive, belongings. destructive lesions or decalcification of the tooth enamel and dentin. Sleep When the pH of the tooth surface Younger school.age typically drops to 5.6 or below (which requires 10-12 hours of sleep. happens after children eat readily Older ones require 8-10 hours of fermented carbohydrates, such as sleep each night. table sugar), acid microorganisms In 6 years olds, a quiet time after (acidogenic lactobacilli and aciduric school is needed. Night terrors are streptococci) found in dental plaque still evident. attack the cementing medium of 9 year olds prefer phoning or text teeth and destroy it. messaging friends than talking to parents. Malocclusion - (a deviation of tooth position from the normal) may be congenital Exercise due to conditions such as cleft palate, a Hygiene small lower jaw, or familial traits tending toward malocclusion. The condition can result later on from constant mouth Care of teeth breathing or abnormal tongue position Visit a dentist twice yearly (tongue thrusting & thumb sucking. Pedodontist - specialized in caring Can be a crossbite for children's teeth. (sideways) or anterior of posterior. Common Health Problems of the School Age Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻 Concerns and Problems of the School learn how to make change and also Age discover the importance of money. Stealing occurs because, although a Problems associated with Language child is gaining an appreciation for Common problems is articulation. money, this appreciation is not yet The child has difficulty pronoun in z, balanced by strong moral principles s, th, l, r, and w. They substitute w or an understanding of ownership. for r or r for l. Violence and Terrorism Common fears Children view their world as safe so Anxiety related to beginning school it is a great shock when violence School refusal or phobia enters their lives. Sex Education Bullying Topics Recreational Drug Use Reproductive organ function and physiology of reproduction, so Concerns of School Age Child and children understand what Family with Unique Needs menstruation is and why it occurs The child of alcoholic parents. Secondary sexual characteristics, The child with long-term illness or so children will under- stand what is cognitive challenges. happening in their bodies Nutrition and the school age child Male sexual functioning, including with a challenge. why the production of increased The overweight or obese child. amounts of seminal fluid leads to nocturnal emissions The physiology of pregnancy and the possibility for unin- tended pregnancies, which will come with sexual maturity Responsibilities of sexual maturity. Reproductive life planning measures and the principles of safer sex if appropriate to the cultural setting. Can be taught through films and discussions. Stealing They steal loose change from their mother's purse or father's dresser. This usually happens at around 7 years of age, when children first Marquez | Añonuevo | Garcia | Pediatric Nursing Reviewer 🍼👶🏻