Growth and development study guide 2.docx

The biopsychosocial model includes biological factors such as genetic and health-related factors; psychological factors such as cognitive, emotional, and personality factors; sociocultural factors such as interpersonal, societal, cultural, and ethnic factors; and life-cycle forces that reflect diffe...

The biopsychosocial model includes biological factors such as genetic and health-related factors; psychological factors such as cognitive, emotional, and personality factors; sociocultural factors such as interpersonal, societal, cultural, and ethnic factors; and life-cycle forces that reflect differences in how the same event affects individuals of different ages. Bronfenbrenner’s ecological systems theory explains how individuals and their environments interact to influence human growth and development. Building on Bronfenbrenner’s theories, Lehman et al. proposed a dynamic biopsychosocial model to study lifespan health by expanding on social dynamics and elaborating on the interdependence and contextual aspects of Bronfenbrenner’s model. Human development involves a complex, somewhat predictable pattern of gradual changes across multiple domains that begins at conception and continues throughout the lifespan. A person is considered to have normal development if they demonstrate expected developmental and physical maturation and physiological function and accomplish expected tasks within or across the developmental domains that are associated with the individual’s chronological age. Sigmund Freud’s (1856–1939) theory on psychosexual development was among the first attempts to bring psychology under the same scientific structure and methodology as medicine and biology. Freud described five stages of psychosexual development that occur in a predetermined sequence and are focused on the development of the child’s libido. Each stage is characterized by sexual pleasure in erogenous zones of the body, including the mouth, anus, and genitals. Freud believed that the adult personality is the result of moving successfully from one psychosexual stage to the next, and that failure to resolve conflicts or being fixed in any of the psychosexual stages results in personality problems. The five psychosexual stages described by Freud are oral, anal, phallic, latent, and genital. Each stage is associated with an age range, an erogenous body part, and a developmental achievement level. The oral stage spans from birth until 18 months of age. The infant’s mouth is the focus of gratification and pleasure, as infants breastfeed or suck from a bottle and explore environment by placing objects in their mouth. Weaning from the bottle is the key achievement in the infant’s oral stage of psychosexual development; it helps the infant learn delayed gratification and lays the foundation for independence and building trust. Too much or too little gratification, which can lead to immature personality development and preoccupation with oral activities such as drinking alcohol, smoking, or overeating. The second stage is the anal stage, occurs from age 18 months to 3 years. The erogenous zone moves from the mouth to the anus. The main source of gratification at this stage is bowel and bladder control. Toilet training is a task that usually occurs around 2 years of age; however, toilet training should be delayed until the child is ready. Markers for toilet training readiness include walking, putting on and removing clothing, following instructions, expressing a desire to toilet, and staying dry through a nap or through the night. Through toilet training, children learn to eliminate body wastes, manage related toileting activities, and respond to parental instructions. The style of parenting influences successful resolution of the anal stage, as the child faces potential reprimands and feelings of inadequacy. The phallic stage occurs between ages 3 to 6 years and is perhaps the most controversial stage. During this stage, children begin to experience pleasure associated with their genitalia as they become aware of their bodies, the bodies of others, and the physical differences between males and females. Masturbation, undressing, and walking around naked are typical behaviors for this age. According to Freudian theory, during the phallic stage, boys develop an unconscious sexual attraction to their mother and perceive their father as a potential rival for their mother’s affection and attention (Oedipus complex), while girls develop an unconscious sexual attraction toward their father and wish to be rid of their mother, who is seen as a competitor for their father’s affection (Electra complex). Children resolve the Oedipus and Electra complexes by taking on roles and characteristics of the same-sex parent, which forms the foundation for sex-role identification. Parental disapproval of the child’s preoccupation with the genitalia during the phallic stage can result in feelings of shame or a confused sexual identity. The latency stage occurs from 6 to 12 years of age; it is a period of development when children suppress or channel their sexual desires toward more socially acceptable activities. During this time, the libido is relatively repressed or sublimated. Freud did not identify any erogenous zone for this stage, as the child begins to focus on activities such as school, sports, and building friendships. Failure to successfully resolve the latency stage can result in an inability to form healthy relationships as an adult. The fifth stage is known as the genital stage, begins with the onset of puberty and lasts throughout adult life. Like the phallic stage, the erogenous zone of the genital stage is centered on the genitalia; however, because the individual’s ego is fully developed, sexuality is consensual and adult, rather than solitary and infantile. At this stage, the individual seeks psychological detachment and independence from the parents and creates meaningful and lasting relationships. Failure to resolve the genital stage may result in an inability to develop meaningful, healthy relationships. Freud’s theory is considered controversial. This theory is difficult to evaluate scientifically because the concepts of libido are impossible to measure and cannot be tested. Freud’s theory is based on case studies and the recollections of adults rather than on study of children. Lastly, this theory focuses primarily on heterosexual development, and ignores homosexual development. Despite this, Freud made important contributions to the understanding of human development, including the idea that unconscious influences impact human behavior and that events of early life play a critical role in the developmental process and can have lasting effects. Eric Erickson (1902–1994), a noted psychologist and follower of Sigmund Freud, developed a theory of psychosocial development in which the stages of development emphasize social and environmental factors, rather than sexual urges and biological forces, as was the case in Freud’s theory. Both theorists believed that personality develops in a series of predetermined stages. Erikson’s theory describes the impact of social experience across the lifespan. Erikson’s theory of psychosocial development includes eight stages of psychosocial development that occur in a series between birth and death. Each stage includes a unique crisis that builds on the tasks of the previous stage. Successful resolution of the crisis at a particular stage leads to psychosocial growth and development. Erikson’s eight stages are trust vs. mistrust, autonomy vs. shame and doubt, initiative vs. guilt, industry vs. inferiority, identity vs. role confusion, intimacy vs. isolation, generativity vs. stagnation, and integrity vs. despair. The first stage of Erikson’s theory is trust vs. mistrust. Erikson believed that a sense of trust in self and others is the foundation of human development and is essential for the formation of a healthy identity. This stage centers on the infant’s basic needs for caring and comfort being met through the interaction between the infant and the caregivers. If caregivers expose the child to security, and regard, the infant’s view of the world will be based on trust. When caregivers are consistent sources of food, comfort, and affection, the infant learns trust. When infants’ needs go unmet, or they are neglected and mistreated, they learn that the world is unpredictable and a potentially dangerous place. Thus, when caregivers do not provide a secure environment and fail to meet the infant’s basic needs, a sense of mistrust and caution may result. Development of mistrust can lead to feelings of suspicion, withdrawal, and a lack of confidence. As children gain control over their bodies, they develop a sense of independence and autonomy. Autonomy in toddlerhood is the result of imitation and maturation, evidenced by the acquisition of skills involving feeding, mobility, dressing, and elimination. For children to gain independence, parents and other caregivers need to provide encouragement, patience, and a secure environment from which the child can venture out and explore. Children at this age are intrigued by the world around them and begin to develop an interest in music, animals, plants, and the outdoors. When caregivers encourage independence and self-sufficiency, toddlers begin to develop a healthy self-concept. If caregivers are highly restrictive or punitive, expect too much, or disallow toddlers from making some of their own healthy choices, children may experience a sense of shame and doubt regarding their ability to function in the world. Initiative vs. guilt: preschoolers explore their environment and try out different roles. Their understanding of how the world works increases as they begin to behave and act with purpose. Imagination, exploration, and curiosity allow children to expand their potential; however, risk-taking behaviors also increase, such as crossing the street or climbing a tree alone. This sense of initiative is moderated by guilt when they realize that their initiative may place them in conflict with others and they cannot pursue their desires without consequence. Toddlers may become frustrated or angry if a goal is not achieved or their ambitions are thwarted. Purpose is achieved with a balance between individual initiative and a willingness to cooperate with others. When parents encourage and support children’s quest for independence while simultaneously helping them make prudent and acceptable choices, children develop a sense of direction and purpose. Without this freedom and guidance, children may develop feelings of guilt and inadequacy. Industry vs Inferiority: Children at this stage are becoming more aware of themselves as individuals and learning complex skills such as reading, writing, problem solving, and telling time. They can manage most of their personal needs with minimal assistance. During this stage, children acquire many new social and physical skills, including pursuing interests in sports, music, art, and education. Erikson believed that the elementary school years were critical for the development of self-confidence, productivity, and a sense of accomplishment. He further believed that attitudes about work learned during childhood formed the foundation for attitudes about work later in adulthood. When children are encouraged to achieve while at the same time praised for their accomplishments, they learn industriousness, perseverance, and putting work before pleasure. When they are ridiculed or punished for their efforts, or fail to complete their work, they may develop a sense of inferiority and incompetence. Similarly, if children are discouraged from pursuing their interests and talents, they may develop a sense of inferiority. Identity vs Role confusion: transitional stage between childhood and adulthood characterized by rapid and dramatic physiological, emotional, and social changes. Adolescents are concerned about their appearance, body image, how they appear to others, achieving a sense of identity, dealing with their emerging sexuality, and finding their place in society. It is common for adolescents to experience role confusion; as a result, they often experiment with a variety of behaviors, activities, beliefs, and friendships. Erikson described adolescence as a time for exploration and identity formation. adolescence forms a bridge between earlier stages of development and anticipation of later stages to come. The dramatic biopsychosocial forces occurring in adolescence may lead to conflict with adults as life decisions about career, education, relationships, politics, religion, and family are being made. Erikson believed that identity formation is often extended for longer periods of time in modern American society, as adolescents gain and master the complex skills necessary to succeed in a fast-paced technologically advanced society. Without support, limits, and guidance, adolescents can experience role confusion and an unachieved identity. Erikson’s model suggests that successful mastery of this stage results in devotion and fidelity to others and a commitment to one’s personal ideals. Intimacy vs. isolation: adulthood, as individuals begin to form intimate, committed relationships with other people. Building on the previous stage of identity formation, young adults develop close, personal relationships with others and make the concessions and compromises that loving, reciprocal relationships require. Successful resolution of this stage results in the ability to love and form lasting, meaningful relationships. If individuals struggle to form an achieved identity, they may develop superficial and unfulfilled relationships, which in turn may lead to a sense of isolation and loneliness. Stagnation Vs Generativity: Erikson defined generativity as the process by which individuals in middle adulthood reflect on their accomplishments and engage in meaningful ways to support future generations. adults undertake activities and causes that benefit others, such as raising a family, mentoring, coaching, and becoming more involved with community and societal efforts. Adults who resolve this stage care for others, take pride in their accomplishments, enjoy watching their children grow into responsible adults, adjust to the physical changes associated with aging, and enjoy mature love and unity with their partner. Those who fail to successfully resolve this stage experience stagnation—a state of being unconcerned about the welfare of others and feeling unproductive, uninvolved in the world, and dissatisfied with one’s life. Integrity Vs. Despair: the final stage of psychosocial development, individuals in late adulthood contemplate and reflect upon their life by retrospectively looking back and taking stock in their accomplishments and failures. Those who have few regrets and an overall sense of satisfaction and accomplishment experience a sense of fulfillment, peace, and integrity. Integrity is achieved if individuals accept their life choices and have little desire to relive or redo their life. This stage can occur during earlier life stages if the person feels they are near the end of life, such as when receiving a terminal illness diagnosis. Individuals who feel regret and dissatisfaction with life may experience feelings of despair and hopelessness and feel as though their life has been wasted and unproductive.  Erikson and his wife, Joan Erikson, also proposed a ninth stage, characterized by the unique challenges and daily difficulties of old age created by living into one’s eighties, nineties, and beyond Erikson’s theory of psychosocial development primarily focuses on development in males and views of adolescence during the process of identity formation. Erikson believed that adolescents who successfully resolve the developmental task of identity achievement vs. role confusion are more likely to be successful at resolving the developmental tasks associated with later life stages. Erikson’s theory has been challenged as to whether individuals really search for identity only during adolescence—other researchers suggest that identity formation and development continue well into adulthood. Nevertheless, Erikson’s theory provides a lifespan approach to understand human development and emphasizes the social nature of human beings and the importance of social relationships for human development. Jean Piaget (1896–1980) was one of the most influential developmental psychologists of the 20th century. His theory on cognitive development describes how an individual acquires knowledge, intellect, and cognition over time. Piaget believed that intelligence is an inborn, natural ability that develops as children grow and adapt to their environment. Thus, his theory focuses on how children construct knowledge and how these constructions change over time. Piaget believed that children naturally attempt to make sense of their world throughout infancy, childhood, and adolescence as they begin to understand the workings of both the physical and social world. In turn, he suggested that children begin to construct knowledge in new ways at critical points during development. Piaget claimed that children go through four distinct stages of cognitive development: sensorimotor, preoperational, concrete operational, and formal operational thought. Each stage represents a fundamental change in how children understand and organize their environment and how they acquire more sophisticated types of reasoning. Piaget acknowledged that children may pass through these stages at different ages, but contended that cognitive development follows a consistent sequence of stages that may not be skipped, where each stage is manifested by new intellectual and cognitive abilities and a more intricate comprehension of the world.  Piaget believed that the first two years of life form a distinct phase of human and cognitive development. Infants learn about the world through basic functions such as sucking, grasping, looking, and listening. By age 8 months, infants begin to demonstrate deliberate, intentional behavior. For example, a parent may hide an infant’s toy behind their hand, and the infant will move the parent’s hand to find the toy. Moving the hand is a means to achieve a goal—to find the toy. Using one action to achieve another is the first indication of purposeful, goal-directed behavior during infancy. By age 12 months, infants become more active by shaking, throwing, or putting objects in their mouths. Through trial and error, they use their sensory and motor skills to learn about themselves and their environment. They learn that objects continue to exist even though they cannot always be seen—an important milestone in cognitive development called object permanence. Children begin attaching names and words to objects as they learn that objects are separate and distinctive and exist on their own. Cognitive development increases as infants become physically mobile as they begin to crawl and walk, allowing them greater opportunity to explore their environment and make new discoveries. Children at this stage begin to learn that they are separate from their environment—that is, from other individuals and objects around them. Near the end of the sensorimotor stage, infants can remember and repeat words as they develop early language skills. During this stage, young children can think symbolically and use their imagination and memory to engage in play, fantasy, and make-believe. This stage is characterized by egocentrism—children see themselves as the center of the universe and are unable to accept or understand other points of view. Children at this stage learn through play, and their thinking is largely based on intuition and not completely logical. They may attribute feelings and motives to objects, a condition known as animism. For example, a child may say, “Bad toy,” believing that a toy can behave badly. Children in the preoperational stage do not yet comprehend complex concepts such as cause and effect, time, and comparison. They may become frustrated or stubborn since they do not comprehend that other people have ideas and emotions different from their own. At this stage, children struggle with the concept of conservation—the understanding that a quantity stays the same even if the size or shape of the container in which it is placed changes. While the foundation for language is developed during the sensorimotor stage, the emergence and mastery of language is one of the major hallmarks of the preoperational stage of cognitive development. The language and thinking skills of children at this stage are improving, but they still tend to think in concrete terms. During the concrete operational stage, thinking is still literal and sometimes rigid. Children at this point have not developed abstract and hypothetical thinking, though they are becoming more adept at using logic. Egocentrism gradually wanes as children have more experiences with friends and family who assert their own perspectives; the children, in turn, begin to realize that theirs is not the only point of view. In essence, children begin to understand that events can be interpreted in different ways and that their opinion may not be the only one, and they realize that their thoughts are unique to them and that others may not share their perspective. As cognitive development increases and children’s ability to think evolves, they can converse on diverse topics and perform many mental operations. Concepts of reversibility, spatiality, and conservation are developed at this stage. Reversibility occurs when children learn that some things that have been changed can be returned to their original condition. Spatiality skills such as locating objects and determining shapes are necessary for locomotion and mobility as children process information about location and space. Conservation is the ability to see objects or quantities as remaining the same despite a change in their physical appearance. Children at this stage can classify and organize objects into categories such as length and weight. Concrete operational thinking is limited to the here and now, however, as thinking abstractly and hypothetically is beyond the ability of these children. The formal operative stage of cognitive development extends from adolescence into adulthood, and is marked by children’s and adolescents’ expansion of their abilities beyond concrete and literal thinking to abstract and hypothetical reasoning. Adolescents can draw logical conclusions from a set of facts, organize their thoughts, problem solve, and perform deductive reasoning. David Elkind (born 1931) posited a theory of adolescent egocentrism and described specific characteristics of adolescent thinking, including the imaginary audience—characterized by a heightened level of self-consciousness and a belief that the individual’s appearance and behaviors are constantly being scrutinized. The personal fable, which also emerges during this period, is the belief that the adolescent’s thoughts and feelings are unique, which often leads to risk-taking behaviors and feelings of invulnerability. The personal fable of feeling special combined with the imaginary audience (i.e., the belief that everyone is watching them) leads some adolescents to believe that other people may grow old and die, but not them; bad things may happen to other people, but not to the adolescent. Although Piaget’s theory represents one of the most comprehensive theories on cognitive development, it has several shortcomings. Specifically, it overestimates cognitive competence in adolescence, does not account for variability in children’s performance, and undervalues the influence of culture and the environment on cognitive functioning and development. Other researchers have criticized Piaget’s research methodology, noting that he rarely detailed how his participants were selected; the research samples were small and often included observations of his own three children; and other participants were children of well-educated professionals of high socioeconomic status, making it difficult to generalize his findings to a larger population. Lawrence Kohlberg (1927–1987) constructed his theory of moral development by expanding on Piaget’s stages of cognitive development. Moral development refers to the changes in a person’s thoughts, emotions, and behaviors that influence their beliefs about right and wrong. Kohlberg believed that children progressively develop moral reasoning as they gain the ability to think logically, and he contended that moral development continued throughout the lifespan based primarily on the principle of justice. In addition, he suggested that stages cannot be skipped and that it is extremely rare to regress in stages or lose higher-stage abilities. Kohlberg developed his theory of moral development by posing stories that contained ethical dilemmas to his study participants. There were no correct answers in these scenarios, as Kohlberg was more interested in the reasoning used to justify the decision. Kohlberg’s best-known moral dilemma is the story of Heinz, whose wife is dying. Kohlberg posed various dilemmas to children, adolescents, and adults and analyzed their responses to develop his theory of moral development. Kohlberg identified three levels of moral development, which are further subdivided into six stages of moral reasoning. In Europe, a woman was near death from cancer. One drug might save her, a form of radium that a [pharmacist] in the same town had recently discovered. The pharmacist was charging $2,000, 10 times what the drug cost him to make. The sick woman’s husband, Heinz, went to everyone he knew to borrow the money, but he could get together only about half of what it cost. He told the pharmacist that his wife was dying and asked him to sell it cheaper or let him pay later. But the pharmacist said, “No.” The husband got desperate and broke into the man’s store to steal the drug for his wife. Should Heinz steal the drug? Why or why not? Suppose the person dying is a stranger. Should Heinz steal the drug for a stranger? Why or why not? Should an individual do everything they can to save another’s life? Why or why not? Do you think it is illegal for Heinz to steal the drug? Why or why not? Do you think it is unethical for Heinz to steal the drug? Why or why not? If this dilemma involved your loved one, and you were in Heinz’s position, what would you do? The preconventional level of moral development is based on external forces and controlled almost exclusively by rewards and punishments. Thinking is largely egocentric and guided by systems of punishment and reward. Individuals at stage 1 of preconventional moral reasoning assume a punishment and obedience orientation and follow the rules in an effort to avoid punishment. At stage 2, which is characterized by an instrumental orientation of preconventional moral reasoning, children recognize that there is more than one point of view and perceive punishment not as proof of being wrong, but rather as something to be avoided. In this stage, individuals act on their own needs and may obey rules for personal gain, such as being considerate to others because they expect a favor in return. Children at this stage are beginning to learn that there are benefits to pleasing others. The conventional level of moral development is associated with conformity and law and order. At this stage, individuals follow the rules and listen to authority figures as they begin to understand that there are certain expected behaviors. At the conventional level, there is little discernment of moral and legal principles; instead, children believe that authorities determine what is right, and disobeying rules is considered wrong. At stage 3 (good boy—nice girl), the individual wishes to win the approval of others and learns that being good and showing concern for others earns acceptance and acknowledgment. During stage 4 (law and order), moral decisions begin to consider societal perspectives such a displaying a sense of duty, showing respect for authority, and maintaining social order. Individuals at this stage believe that roles, expectations, and laws exist to maintain social order and promote the common good. Kohlberg suggested that some individuals may stay at the conventional level of moral reasoning for the rest of their lives, relying on the moral principles from social or religious authority figures rather than establishing moral reasoning for themselves. The postconventional level of moral reasoning is based on a personal moral code. Individuals who operate at this level of thinking usually act according to their own principles and beliefs, rather than relying on external forces to shape their actions. The emphasis is no longer on external forces such as punishment, reward, and social rules. Instead, individuals are guided by a set of principles such as social justice, liberty, and human dignity and perceive rules as malleable and subject to change. At stage 5 (social contract), individuals recognize the possibility of changing the law to improve society and promote the common good. In stage 6, universal ethical principles dominate moral reasoning; that is, universal principles such as justice, compassion, and equality form the basis of a personal code that may conflict with society’s expectations and laws. Kohlberg believed that some individuals never attain this higher level of moral reasoning. Carol Gilligan (born 1936) criticized Kohlberg’s theory because it failed to explore female experiences in relation to moral development. According to Kohlberg, males function at a higher level of moral reasoning compared to females. Gilligan suggested that moral development in females is different than moral development in males because females develop morality based on principles of caring rather than the principle of justice. Both Kohlberg and Gilligan have made significant contributions to the study of moral development; however, recent scholars have been critical of their work, concluding that both men and women exhibit some degree of justice and caring, and not simply one or the other. Kohlberg’s theory also seems to suggest that certain levels and stages of moral reasoning are better than others, and fails to describe how various moral values and principles might be viewed differently by individuals from diverse cultures and societies. From caring for pregnant women and the prenatal development of their babies to providing end-of-life care, nurses practice in a variety of settings and fulfill many roles and responsibilities as they collaborate with other members of the health care team to provide client-centered, evidence-based, holistic, and culturally sensitive care. Nursing interventions to reduce risks before, during, and after birth can lead to optimal outcomes for both the pregnant woman and her newborn. Nursing care is aimed at health promotion to assist the pregnant woman and ensure her developing fetus attains optimal growth and development. Nurses provide ongoing education about good health practices, proper nutrition, and regular visits with health care providers during prenatal development and following the birth of the newborn. While early assessment of the pregnant mother and developing fetus can lead to early diagnosis and treatment of abnormalities, alterations in health may still occur—and nurses play an essential role in addressing these concerns. Down syndrome, also called trisomy 21, occurs in infants who are born with an extra copy of chromosome 21. This extra chromosome copy changes how the infant’s body and brain develop, which can cause physical, mental, and emotional challenges. Down syndrome is the most prevalent genetic disorder in the world and the most common genetic cause of intellectual disabilities, affecting 1 in 400 to 1,500 newborns. Infants diagnosed with Down syndrome experience varying degrees of intellectual disabilities as well as other health concerns including congenital heart defects, gastrointestinal anomalies, weak neuromuscular tone, audio and visual impairment, characteristic facial and physical features, and early-onset Alzheimer’s disease. The severity of these conditions and life expectancy vary considerably among individuals with Down syndrome. The incidence of Down syndrome increases with maternal age. Screening to detect this condition is an important part of routine prenatal care and may be performed during pregnancy. Screening tests typically include a combination of a blood test and ultrasound procedure; the presence of certain components in the blood (e.g., MS-AFP, Triple Screen, Quad-screen) and extra fluid accumulation behind the fetus’s neck region could indicate a genetic problem. If a child receives a positive screening test, diagnostic testing using chorionic villus sampling (CVS), amniocentesis, or percutaneous umbilical blood sampling (PUBS) is conducted to confirm the diagnosis. Down syndrome is a lifelong condition that affects nearly aspect of an individual’s life. Early interventions to improve physical and intellectual abilities and to help children reach their full potential include speech, occupational, and physical therapy. At birth, nurses assist with a head-to-toe assessment of the newborn and provide support and education to the parents by encouraging good nutrition and a well-balanced diet, exercise and activity, hearing and vision screenings, and regular appointments with their health care provider. Families of children with Down syndrome may need emotional support and ongoing education on ways to care for their child. Spina bifida is part of a larger group of neural tube defects that generally occurs in the lumbosacral region of the spinal column. Neural tube defects are the second most common type of birth defect (after congenital heart defects), occurring in around 0.5 per 1,000 births worldwide​​​​​​​. In spina bifida, the neural tube does not close properly, leaving an opening through which the spinal meninges and spinal cord may protrude. The result is damage to the spinal cord and nervous system. The etiology of spinal bifida involves genetic, environmental, and nutritional factors. Low folic acid (folate) intake is a chief contributor to spina bifida, and pregnant mothers need to be educated on the importance of consuming folic acid (folate) during their pregnancy to prevent neural tube defects. Certain medications, particularly those used to treat epilepsy and bipolar disorder, have been associated with a higher risk of giving birth to babies with congenital defects, including spina bifida. Screening tests to detect spina bifida may be conducted during pregnancy using blood tests, ultrasound procedures, and amniocentesis. In some cases, spina bifida may be corrected with fetal surgery during the last months of pregnancy, and in other cases, spina bifida might not be diagnosed until after the infant is born. Evidence of spina bifida includes a hairy patch of skin or a dimple on the infant’s back; the infant is then further examined using imaging such as magnetic resonance imaging (MRI) or computed tomography (CT) scans to confirm the diagnosis.  The effects of spina bifida can range from mild to severe. Some individuals may experience little or no disability, whereas others may be severely limited and require the use of crutches, braces, and wheelchairs. With support and ongoing care, most people affected by spina bifida can lead full, productive lives. Nurses need to encourage pregnant mothers to consume 400 micrograms (mcg) of folic acid every day, in addition to consuming a variety of foods that contain folate, such as legumes, green leafy vegetables, and eggs. When parents receive a diagnosis of spina bifida, they often express a range of feelings, worries, and fears. Nurses can provide support and education to help these families understand their infant’s condition. Early nursing interventions include preventing infection, performing sterile dressing changes at the neural opening, monitoring vital signs, conducting neurologic assessments, performing range-of-motion exercises, administering prescribed medications, and maintaining the infant in a prone position to prevent pressure on the neural sac. In addition, nurses can provide ongoing support by encouraging families to express their feelings and emotions and helping them hold and cuddle the infant using proper safety techniques.  Depending on the type and severity of the neural tube defect, spina bifida can have pervasive impacts on the physical, neurocognitive, psychological and social functioning of affected individuals. Nurses are instrumental in providing care and support for individuals and families throughout the lifespan to help them better understand and live with spina bifida. Women who consume alcoholic beverages during pregnancy may give birth to infants with fetal alcohol spectrum disorders (FASDs), which are triggered when alcohol in the mother’s blood passes to the fetus through the umbilical cord. The most extreme form of FASD, known as fetal alcohol syndrome (FAS), most likely occurs in pregnant women who drink heavily over the course of their pregnancy. FAS is the leading cause of developmental disabilities in the United States. Children with FAS usually grow and develop more slowly than other children and often experience serious attention, cognitive, and behavioral problems. Scientists have not yet determined if there is a safe amount of alcohol to drink during pregnancy; therefore, pregnant mothers are advised to completely abstain from drinking alcohol during pregnancy. FASDs are preventable if a woman does not drink alcohol during pregnancy. If women drink alcohol during pregnancy before they know they are pregnant, it is essential to stop drinking immediately to protect the fetus from acquiring FASD. Infants and children with FASDs often have a low birth weight, misshaped face, small head, thin upper lip, short nose, and widely spaced eyes. As they grow, these children may display hyperactive behavior, attention and memory problems, learning disabilities, speech and language delays, poor judgment skills, and a variety of health problems. Diagnosing FASDs may be challenging because there are no specific medical tests for these conditions, mothers may not be forthcoming about their alcohol consumption, and FASDs can mimic other conditions such as attention-deficit/hyperactivity disorder. FASDs last a lifetime. While there is no cure, early treatment and intervention can improve affected children’s development and help them reach their full potential. Nurses can provide support and ongoing education to help parents better understand FASDs by discussing the importance of behavioral management, fostering social skills, providing a nurturing and stable home environment, utilizing community resources, and seeking assistance with special educational needs if indicated. During the period from infancy through toddlerhood, children grow at a rapid and steady pace and achieve many developmental milestones. As they grow, toddlers begin to experience a sense of self-reliance and independence that increases their desire to do things for themselves, such as dressing, feeding, and toileting. These accomplishments pave the way for the preschool and childhood years. Nurses can help parents keep infants and toddlers safe and feeling secure as they explore their surroundings and establish a sense of healthy independence. Nurses also assess young children for health care needs as well as gauge their progress related to psychomotor, cognitive, language, communication, and social skill development. In addition, nurses assess and modify plans of care related to family dynamics, behavior, sleep, nutrition, toilet training, socialization, school readiness, and health promotion. Failure to thrive (FTT) refers to children whose current weight or rate of weight gain is much lower than that of other children of similar age and gender. Children with FTT have height and weight measures that typically fall below the third (or fifth) percentile and slower rates of growth and development related to undernourishment or malnutrition. FTT may occur in infants who are underfed by caregivers as well as in infants with developmental delays, swallowing difficulties, unwillingness to eat enough food, or repeated vomiting from severe gastroesophageal reflux, all of which may result in insufficient calories to support growth. This problem may also occur in conjunction with health conditions such as cystic fibrosis, celiac disease, severe allergies, and absorption problems, or in children with chronic medical conditions or genetic disorders. Neglect or abuse may be associated with FTT if food is purposely withheld from an infant or child. While symptoms vary, children with FTT generally do not gain weight at the expected rate; they may be irritable, easily fatigued, lack age-appropriate social responses, and exhibit delayed physical skills and motor development. Such children may experience learning and behavior difficulties later in childhood. FTT is usually discovered during a physical health assessment of the child. It is important to determine whether it is related to a medical condition or environmental factors such as maltreatment or neglect. In some cases, the exact cause cannot be determined. The plan of care is based on the etiology, age of the child, health history, family support, and symptomology.  Nurses are vital members of the health care team, whose interventions are based on specific client needs. They may conduct a comprehensive assessment of the child with FTT to measure height and weight and to assess skin turgor, vital signs, manifestations of malnutrition, and level of responsiveness. When interviewing parents or caregivers, nurses observe and assess their interactions with the child and acknowledge positive parenting behaviors displayed by the caregiver. Nurses can also educate parents on ways to properly feed the child and how to provide a well-balanced diet, and discuss access to adequate food sources and the availability of community and family support systems. Autism spectrum disorder is a developmental condition that affects communication, socialization, and behavior. It is known as a spectrum disorder because of the wide variation in the type and severity of symptoms that individuals with ASD experience. Symptoms generally appear in the first two years of life. This condition occurs in all ethnic, racial, and economic groups, and manifestations include difficulty communicating and interacting with other people and exhibiting behaviors that impede an individual’s ability to function appropriately in school, work, and other areas of life. The current definition of ASD includes conditions that were previously considered distinct entities, including autism, Asperger’s syndrome, childhood disintegrative disorder, and an unspecified form of pervasive developmental disorder. Symptoms of ASD commonly occur within the first year of life, and each child with ASD has a unique pattern of behavior and level of severity. Some individuals display signs of ASD in early infancy, while others may develop normally for the first few months or years of life, then abruptly become withdrawn or aggressive or lose language skills they have already acquired. Children with ASD vary in level of intelligence. Some children with ASD have difficulty learning, and some have signs of lower intelligence. Other children with ASD have normal to high intelligence and learn quickly yet have trouble communicating and adjusting to social situations. Common manifestations of ASD include difficulty with communication and social interaction, lack of eye contact and facial expression, aversion to being touched, difficulty recognizing nonverbal cues, performing repetitive movements, developing rituals and routines and subsequently becoming upset if those patterns are altered, and fixating with intensity on various objects. As children mature, those with the least severe ASD may become more socially engaged, show fewer behavioral issues, and eventually lead near-normal lives. In contrast, children with more severe ASD often continue to have difficulty with language and social skills, and the adolescent years can bring serious behavioral and emotional problems. Screening for ASD occurs during visits with the child’s health care provider. Additional screening might be needed if a child is at high risk for ASD. Risk factors include having a family member with ASD, older parents, genetic conditions, and a very low birth weight. Children who show developmental problems during the screening process will likely be referred for a second stage of evaluation. The outcome of this evaluation will result in a formal diagnosis and recommendations for treatment.  ASD has no single known cause, but both genetics and environment are believed to play a role in triggering its development. In addition to genetic disorders, scientists are exploring whether factors such as viral infections, medications used during pregnancy, complications during pregnancy, or air pollutants might be factors in causing ASD. No reliable study has shown a link between ASD and administration of any vaccines. ASD is a lifelong condition. While it cannot be prevented, early diagnosis and intervention can improve affected children’s behavior, skills, and language development. Treatment for ASD should begin as soon as possible after diagnosis. Early treatment can reduce difficulties while helping individuals learn new skills and emphasize their strengths.  Nursing care of children with ASD should be provided slowly and carefully to avoid causing fear and anxiety. A thorough nursing assessment includes an interview with caregivers to obtain information regarding the child’s health history, eating and sleeping patterns, and triggers that might cause fear or anxiety during the assessment. As part of the integrated care process, nurses partner with caregivers and other members of the health care team to address the child’s special needs. It is important to find out as much information as possible from caregivers and teachers of children with ASD to provide client-centered, holistic, optimal care. In addition, nurses provide ongoing education and resource information for children and caregivers on how to manage ASD symptoms or behaviors and methods for effective coping. As defined by WHO, child maltreatment is the abuse or neglect of children younger than 18 years of age, including both physical and emotional ill-treatment, sexual abuse, neglect, and negligence. Maltreatment in early childhood is known to have cascading effects on the child’s physiological, neurologic, social, emotional, and cognitive development. Childhood maltreatment represents a failure of the child’s family and society to provide for the child’s basic needs for safety, security, and support. International studies reveal that nearly three in four children aged 2 to 4 years regularly experience physical punishment or psychological violence at the hands of parents and caregivers. Childhood maltreatment is a global problem with serious lifelong consequences, including physical, emotional, behavioral, and social impairment. Childhood maltreatment can result in serious physical danger, including death.  Physical abuse is any nonaccidental physical injury that a child sustains while being cared for by a parent or caregiver. Psychological abuse refers to attitudes and behaviors exhibited by the parent or caregiver that interfere with the child’s mental and social well-being. Neglect is failure of the parent or caregiver to provide for the basic physiological needs of the child, including food, shelter, clothing, care, and guidance, which causes harm to the child’s safety, health, and well-being. Child sexual abuse includes any sexual activity involving a minor. Children cannot consent to any form of sexual activity, so sexual abuse of any kind is a criminal offense. The behavioral and mental health consequences of childhood maltreatment may contribute to health conditions such as heart disease, suicide, and sexually transmitted infections as well as inequalities in education. They need to be alert for signs of maltreatment of any kind, and if indicated, report their findings to the proper authorities since they are mandatory reporters. Nurses are essential members of the health care team in preventing childhood abuse and neglect, reducing the incidence of maltreatment, and minimizing its consequences. As part of their role, they may provide educational programs for parental and caregiver support, skill-building sessions to teach and support positive parenting and caretaking, and skill-building classes for children and adolescents to help them learn to avoid abuse and exploitation. Nurses may also perform home visits in a community setting to provide ongoing education and support to children and families, implement nursing interventions to minimize risk factors and promote healthy family functioning, and disseminate evidence-based information to prevent and address issues associated with childhood maltreatment. Childhood is a period of slow and steady growth spanning the ages of 6 to 12 years, a time when children begin their formal education but before they reach puberty. During this stage of development, children’s psychomotor, cognitive, communication, and social skills are improving rapidly. Children at this stage need guidance regarding good oral and personal hygiene, healthy eating patterns and good nutrition, and adequate exercise to promote strength, endurance, and optimal health throughout the lifespan. Nurses can help children address their health care needs by encouraging safe and healthy behaviors to prevent chronic diseases, rather than waiting and attempting to change unhealthy behaviors later in adulthood. In particular, nurses encourage regular visits for vision and hearing testing, immunizations, and dental care. They also provide education and support to help children avoid accidents and injuries, eat a healthy diet and exercise to prevent childhood obesity, and avoid smoking, vaping, and use of alcohol and other substances. Accidents (unintentional injuries) such as injuries caused by burns, drowning, falls, poisonings, and bike and motor vehicle accidents are the leading causes of death among children in the United States. During the childhood years, cognitive and motor skills improve. As children become more independent and exposed to environments outside the home, they may be more likely to experience accidents and other unintentional injuries. Some children are risk takers and attempt activities beyond their physical capabilities, which can place them at further risk for injury.  In the United States, injuries due to motor vehicle accidents are the leading cause of death for children in all age groups. During the childhood years, most injury deaths involve the child being an occupant in a motor vehicle traffic accident. Injuries due to falls are the leading cause of nonfatal injury in this age group. Other common causes of childhood injury include being struck by an object, animal bites, insect stings, burns, and poisoning. The nurse’s role includes educating children and parents about safety measures to prevent and avoid injuries and accidents, such as wearing bicycle helmets, seatbelts, and life jackets for water activities. Other injury prevention topics include burns, drowning, poisoning, and fall prevention; sports, bicycle, and playground safety; and road traffic and pedestrian safety. Education related to dealing with bullying behaviors both in-person and online, prevention of school violence, dealing with stress and implementing healthy coping strategies, preventing sexually transmitted infections, and preventing substance misuse and abuse become especially important for school-age children as they approach adolescence. Accidents and unintentional injuries are also the leading cause of death for adolescents. Adolescence is often a time of heightened risk taking, such as texting while driving, failing to use seatbelts or helmets, and responding to peer pressure by engaging in activities that may put youths in peril. Stressing the importance of not drinking and driving, exercising caution during athletic events and activities, wearing protective sports gear, and firearm safety can increase the likelihood of children exercising good safety practices into the adolescent years. Attention-deficit/hyperactivity disorder (ADHD) is characterized by an ongoing pattern of inattention and/or hyperactivity–impulsivity that interferes with functioning or development. Children who experience inattention may be disorganized, lack persistence, and have difficulty focusing and staying on task. Hyperactivity is characterized by restlessness, constant movements, and fidgeting. Impulsivity is marked by a child making hasty or imprudent decisions that occur in the moment without much thought; these impulsive actions have the potential to result in harm or be perceived by the child as having an immediate reward. Children with impulsivity issues may be socially intrusive or make decisions without considering the long-term consequences. Many children have issues paying attention, staying focused, and acting impulsively; however, in children with ADHD, these behaviors occur more often, are more serious, and interfere with or reduce their ability to function socially and academically. For a child to receive a diagnosis of ADHD, the health care provider first ensures that any ADHD symptoms are not related to another medical or health condition. ADHD is diagnosed when manifestations of inattention and/or hyperactivity–impulsivity are chronic or long-lasting, impair the child’s ability to function, and cause the child to fall behind in expected developmental progress for age. Although symptoms can occur as early as 3 to 6 years old, most children with ADHD receive a diagnosis during the elementary school years. Hyperactivity–impulsivity is the predominant symptom of ADHD in early childhood. Symptoms of inattention become more noticeable as the child reaches elementary school and can cause the child to struggle academically. During adolescence, hyperactivity seems to lessen as teenagers display less restlessness or fidgeting, though inattention may persist. Many adolescents with ADHD have difficulty sustaining relationships, and they may struggle with learning disabilities, conduct disorders, anxiety and depression, and substance use. There is no cure for ADHD, but several treatment options are available to reduce symptoms and improve functioning, including psychotherapy, education, medications, or a combination of treatments. When assessing a child with ADHD, nurses will consider the child’s chronological age, level of comprehension, and ability to communicate. Nurses can offer education and support to children and families on ways to help children focus and organize tasks and schoolwork, monitor their behavior, and improve social skills. Other education topics include teaching parents and caregivers how to use a system of rewards and consequences to change a child’s behavior and how to structure situations in ways that support desired behavior and promote success. Nurses can encourage parents to collaborate with their child’s teacher to appropriately structure classroom activities and homework to help the child succeed. Stress management techniques and support groups can help parents deal effectively with their child’s behavior and help them succeed. Physical activity allows children to exert energy and feel less restless, and can help them attain adequate rest and sleep. Finally, nurses may administer prescribed medications that can help reduce hyperactivity–impulsivity to improve the child’s ability to focus, play, and learn. Whatever the treatment plan, families of children with ADHD need guidance and support to help their child reach their full potential. Asthma is the most prevalent chronic respiratory disease worldwide, affecting more than 300 million people of all ethnic and age groups, and the most common chronic disease in children. Asthma affects approximately 6 million children in the United States. If poorly managed or undiagnosed, it can result in trips to the emergency room, hospital stays, missed school days for children, and missed workdays for parents and caregivers. Asthma tends to run in families, and most children with this respiratory disease display symptoms before age 5. The bronchial tubes in infants and young children are small and narrow, and various conditions and environmental contaminants can inflame the airways, causing them to constrict. In children with asthma, the airways become irritated and swollen, with excessive secretion of mucus, resulting in a narrowing of the airways and spasms in the bronchi. The signs of childhood asthma can range from a cough that lingers for days or weeks to sudden and frightening medical emergencies. Common manifestations include coughing, wheezing on inspiration and expiration, expectorating thick mucus, and difficulty breathing. Asthma may be triggered by a wide variety of pollutants, including dust mites, pollen, mold, secondhand smoke, pet dander, and chemicals in the environment. Diagnosing asthma in children is challenging and remains a clinical diagnosis, as no single diagnostic test exists. Thus, multiple tests, including bronchodilator response and bronchial provocation challenge, may be used to diagnose asthma in children. Diagnosis is made through a medical exam that measures airflow in and out of the lungs; however, this test may be difficult for young children to tolerate. Allergy tests may also be conducted to identify which allergens trigger symptoms of asthma. When a child receives a diagnosis of asthma, the plan of care depends on the severity and frequency of asthma symptoms. If not properly managed, asthma can be life-threatening; therefore, proper management of the condition is essential. The overall objective in the plan of care is to decrease the number and frequency of asthma attacks and thereby improve quality of life. Nurses can provide education and support to help children, parents, and caregivers adhere to the plan of care, by helping them learn how to self-monitor and assess symptoms, understand triggers that might cause an asthma attack, use a nebulizer and inhaler as prescribed, and make changes to the environment to reduce or eliminate contaminants. Other recommendations include increasing fluid intake to help liquefy secretions and using peak flow meters to determine airway resistance—a factor that can alert the child and caregiver to an imminent asthma attack. Medications may be prescribed to dilate the bronchi and improve air exchange, reduce buildup of secretions, and decrease swelling in the airway. Nurses also encourage parents and caregivers to collaborate with teachers, coaches, school nurses, and other relevant caregivers to implement the plan of care at school. Finally, the plan of care includes measures to prevent and address a flare-up or a severe attack of asthma and ways to reduce or eliminate environmental allergens or contaminants to promote the child’s well-being and optimal care. Obesity is a serious and rapidly growing problem that often begins in early childhood. The prevalence of childhood obesity in the United States is estimated at 18.5%, and this condition affects approximately 13.7 million children and adolescents. Once considered an adult problem, obesity in childhood is now a major health concern: Many obese children grow to become obese adults, especially if one or both parents are obese. Childhood obesity increases the risk for diabetes, hypertension, cardiac conditions, pulmonary complications such as sleep apnea, muscular skeletal problems, and psychological disorders. Overweight and obese children are also teased and bullied more often than their peers of healthy weight, resulting in lower self-esteem and an increased risk for depression. During the school years, children are developing eating patterns independent of their parents. In too many cases, ready access to vending machines and fast-food restaurants makes it increasingly difficult for children to make healthy food choices. Contributors to childhood obesity include eating high-calorie foods and fast foods on a regular basis, drinking sugary juices and sodas, and eating high-calorie baked goods and snacks from vending machines. Lack of exercise and physical activity combined with consuming too many calories are the main contributors to childhood obesity; however, genetic and hormonal factors may also exacerbate the problem. Heightened levels of stress can increase children’s risk for obesity if they overeat to cope with problems or to deal with emotions. In addition, socioeconomic factors may contribute to childhood obesity: Families with limited income and access to supermarkets may rely on prepackaged, calorie-dense foods to save money. Nurses can promote healthy lifestyle habits by helping children and families make healthy food choices, plan meals ahead of time, engage in regular exercise, and pursue an active lifestyle. Ideally, school-age children will help parents and caregivers plan, select, and prepare healthy meals and snacks—lifestyle changes are more successful when they involve the whole family. Replacing sugar-sweetened beverages and high-calorie foods with healthy choices such as fruits, vegetables, yogurt, nuts, whole grains, and hummus promotes a healthy weight and lifestyle. Eating as a family, eating in restaurants on a limited basis, adjusting portions, and limiting screen time are other effective ways to prevent overweight and obesity in children. Parents and caregivers of children who lack school-based activities and physical education classes can participate with their children in daily exercise. Adolescence is a time of rapid growth and development, as the adolescent experiences dramatic physiological and hormonal changes associated with puberty, remarkable changes in appearance, and increases in cognitive development (e.g., the ability to hypothesize and think abstractly). During this stage, individuals experience many new life events and encounters as they establish a sense of identity. As a population, adolescents are physically healthy, and most possess a well-functioning immune system. Proper nutrition, making sound decisions, and practicing healthy lifestyle habits can all make positive contributions to their overall health. Yearly checkups should include vision and hearing screenings, measurements related to growth and development, dental exams, healthy eating and physical activity assessments, and vital sign recordings to ensure optimal health. Nurses can help adolescents and families understand the physical, emotional, sexual, cognitive, and social development of adolescents to help them anticipate and manage the unique experiences and stressors of adolescence. They may provide education and support on a variety of topics, such as hygiene issues, the physical changes experienced during adolescence, prevention of substance use, healthy eating, and healthy lifestyles. According to the National Institute on Drug Abuse, individuals are most likely to begin abusing tobacco, alcohol, and illegal and prescription drugs during adolescence and young adulthood. Adolescents use mind-altering substances for many reasons, including a desire for new experiences, the belief that substances will help them deal with problems or perform better in school or athletics, and because their friends are using substances and they want to belong and fit in. Among the many factors that influence whether an adolescent tries drugs and alcohol are the availability of these substances within the neighborhood, community, and school and whether friends and family members are using them. Some adolescents use drugs and alcohol to cope with family problems, physical or emotional abuse, or mental illness. An inherited genetic vulnerability, personality traits, mental health conditions, and beliefs that drugs are harmless also make it more likely that an adolescent will use drugs. Substance use during the adolescent years is particularly damaging because the brain is still developing and various areas of the brain, including the prefrontal cortex, are not yet mature. The prefrontal cortex is responsible for problem solving, making sound decisions, and controlling emotions and impulses. Brain development is not fully mature until an individual reaches their mid-twenties, so judgment and the ability to make sound decisions are still limited in adolescents. While most youths do not escalate from trying drugs to developing an addiction or an abuse disorder, simply experimenting with drugs can lead to risky behaviors, such as driving while intoxicated or engaging in unsafe sexual activity. If an adolescent develops a pattern of repeated use, it can lead to serious consequences, including academic failure, relationship problems, impaired memory, and the risk of overdose. Some adolescents use chewing tobacco or snuff, and may consider these forms of tobacco to be safer than smoking because they are smokeless. In reality, the chemicals in chewing tobacco and snuff can cause oral bleeding, ulcers, erosion of tooth enamel, and increased risk of oral cancer. Electronic cigarettes (also known as e-cigarettes or vaping) were originally developed to wean individuals off smoking cigarettes. However, most of these products contain nicotine, a highly addictive substance, along with other harmful substances that can impair brain development. Although some users believe vaping to be less harmful than smoking, scientists are still learning about the long-term health effects of e-cigarettes, which many include pulmonary disorders, symptoms of dependence, and increased blood pressure. According to the Substance Abuse and Mental Health Services Administration, adolescents use alcohol more than any other drug, including tobacco and marijuana. In the SAMHSA survey, nearly one in five individuals aged 12 to 20 years reported drinking alcohol in the past month, and they are more likely to drink as they get older. Consuming alcohol lowers inhibitions, impairs judgment, and exposes adolescents to serious harm, including risky sexual behavior and physical and sexual assault. Unfortunately, some adolescents move beyond moderate drinking to binge drinking—defined as five or more drinks in a row for males and four or more drinks in a row for females within a 2-hour time span. Binge drinking causes a rapid increase in blood alcohol levels and may be life-threatening. Severe alcohol use disorder, previously known as alcohol dependence or alcoholism, is a chronic disease evidenced by an inability to limit drinking, continuing to drink despite personal or professional problems, needing to drink more to get the same effect, and wanting a drink so badly you can’t think of anything else. Adolescents who start drinking early are at risk of suffering from alcohol addiction; those who start drinking before the age of 15 are four times more likely to meet the criteria for alcohol dependence. Long-term alcohol-related health consequences include liver disease, high blood pressure, psychological disorders, and various cancers. It is illegal for individuals younger than age 21 to purchase or publicly consume alcohol in the United States, and youths who violate the law risk serious legal consequences.  Primary prevention is a priority for nurses, who seek to help adolescents avoid the risks associated with substance use, abuse, and addiction. Early education and positive role modeling by parents and other significant adults in the adolescent’s life may be helpful deterrents to using substances. Emphasizing the risks of drug and alcohol abuse can provide an understanding of the problem and address any reluctance the adolescent may have about using substances and giving in to peer pressure to use drugs and alcohol. Prevention programs provide adolescents with practical skills to avoid high-risk behaviors, an understanding of the risks and consequences of substance use, and strategies to prevent and decrease drug use. Nurses may also provide resources for counseling and support groups, and if indicated, provide resources for outpatient or inpatient treatment. Adolescents need to be included in the plan of care and instructed about the adverse effects of substance use.  Eating disorders, including anorexia nervosa and bulimia nervosa, are psychological disorders that involve extreme disturbances in eating behavior. Anorexia nervosa is diagnosed in individuals who are at least 15% below their ideal body weight and have an intense fear of gaining weight. Physical signs and symptoms of anorexia include extreme weight loss, not making expected developmental weight gains, very thin appearance, amenorrhea, dizziness or fainting, hair that thins or falls out, intolerance of cold, dehydration, and low blood pressure. Bulimia nervosa often starts in adolescence as individuals go through cycles of eating enormous amounts of food followed by vomiting, using laxatives and diuretics, and engaging in hours of aerobic exercise to lose weight. Warning signs of bulimia include extreme preoccupation with being overweight, strict dieting followed by high-calorie eating binges, feeling out of control, disappearing after a meal, frequent use of laxatives or diuretics, excessive exercising, and irregular menstrual cycles. The causes of eating disorders are not known, though experts suggest a combination of factors—including impaired family relationships, psychological problems, and genetics—may contribute to their emergence. Risk factors include childhood obesity, low self-esteem, pressure from parents and peers to lose weight, and participation in sports and activities that emphasize being lean. Other factors include being obsessed with perfectionism, being worried about making mistakes, and attempting to live up to high personal and parental standards and expectations. Symptoms of eating disorders include distorted body image, skipping meals, frequent weighing, unusual eating habits, erosion of tooth enamel, and intense interest in exercise. Adolescents with eating disorders often deny that anything is wrong and may display feelings of anxiety and depression. They may withdraw from friends and become overly sensitive to criticism. Although eating disorders are far more common in females, males account for 10% of diagnosed cases of eating disorders. Treatment for eating disorders depends on the specific disorder and typically encompasses a combination of interventions, including psychotherapy, nutrition education, medical monitoring, and sometimes medications. Having an organized approach to eating disorder treatment can help adolescents manage symptoms, return to a healthy weight, and maintain their physical and mental health. Nutrition education helps individuals understand the eating disorder and develop a plan to achieve and maintain healthy eating habits. Moreover, the benefits of a healthy diet need to be discussed with all adolescents.  Routine nutritional screening should be part of the health care program provided to all adolescents. Areas to include in the nursing assessment are past and present diet history, food records, eating habits, attitudes, health beliefs, and socioeconomic and psychosocial factors. Because adolescents rarely volunteer information about their eating behaviors, it is important to take a thorough dietary history. If left undetected and untreated, eating disorders can lead to significant health problems in later life. The most effective programs help change attitudes about weight and provide ways to resist social pressure to be thin. The challenges of adolescence can lead some youths to become depressed. Depression is associated with biochemical changes in the brain, as well as high levels of stress and anxiety. Depression affects an adolescent’s personal, academic, social, and family life; if left untreated, it can end in thoughts or acts of suicide. Adolescents suffering from this mental illness may have a pervasive feeling of sadness, irritability, and low self-esteem. They often sleep poorly, have difficulty concentrating, believe family members and friends don’t care about them, and are dissatisfied with life. Among the many causes of depression are abnormal brain chemistry, changes in hormones, inherited traits, early childhood trauma, and learned patterns of negative thinking. Several factors increase the risk of adolescent depression, including low self-esteem, being a victim of physical or sexual abuse, having a learning disability, having a physical or mental health condition, and having a family history of depression. Untreated depression can lead to problems such as alcohol and drug abuse, academic and relationship problems, and attempted or completed suicide. Suicide is the third most frequent cause of death for adolescents, after accidents and homicide. Roughly 10% of adolescents report having attempted suicide at least once. Suicide is rare before age 15, and is more common in males than females. Depression is a precursor to suicide, and common signs include threats of suicide, preoccupation with death, change in eating or sleeping habits, loss of interest in activities that were once important, persistent feelings of gloom and helplessness, and giving away valued possessions. Although depression is a serious health condition that can affect every aspect of an individual’s life, certain strategies may help alleviate the problem. Implementing techniques to mitigate stress and to build resilience and self-esteem, and engaging in psychotherapy to improve school performance and social relationships may lead to improved mental health. Nurses need to be alert for signs of depression and the potential for self-harm. Using a calm, supportive manner, nurses can ask if troubled adolescents have plans to hurt themselves or have made preparations to complete a suicide, and determine whether they are able to cope and manage feelings in an effective manner. Any adolescent who expresses thoughts of suicide must not be left alone; such a youth must be assisted in obtaining professional help. Therapy is essential to treat feelings of depression and hopelessness that may lead to thoughts of suicide. Medications may be prescribed to alleviate symptoms of depression. Once an individual reaches adulthood, physical growth and development are complete. Most physiological changes during adulthood appear gradually and at different times for each individual. During this stage of development, adults face certain age-related health realities. Both muscular strength and coordination slowly decrease as individuals age. There is a gradual decline in cardiac output, skin and muscle tone and elasticity diminish, and hair begins to thin and turn gray. Adults need good nutrition, adequate rest, and physical fitness. Weight management is important because obesity can lead to many detrimental health conditions, such as diabetes and heart disease. The best approach to weight control is to engage in nutritious eating and lifelong healthy diet and exercise patterns. If such healthy lifestyle habits were established in childhood and adolescence, individuals are more likely to continue to practice these habits throughout adulthood. Nevertheless, dealing with life stressors and complexities can lead to stress-related illnesses such as heart attacks, hypertension, migraine headaches, obesity, and various cancers. Implementing self-care and healthy coping techniques can help individuals manage these kinds of stresses more effectively. Goals of middle adulthood include establishing and fulfilling family roles and responsibilities, securing economic stability for the present and the future, maintaining good health, and establishing a career. Chronic illnesses such as diabetes, heart disease, and cancer may impact achievement of these goals and potentially lead to impaired family relationships, altered self-image and self-esteem, financial stress, social isolation, and medical concerns. Thus, primary prevention of these disorders is an essential factor in the individual’s plan of care. Lifestyle habits that support good health include daily exercise and physical activity, making healthy food choices, avoiding excessive consumption of alcohol, not smoking, and engaging in self-care activities to reduce stress. Adults must pay close attention to diet and exercise because heart disease and cancer remain the leading causes of death for this age group. Routine physical exams and health screenings are recommended to detect and treat any health conditions.  For their adult clients, nurses can provide education and support to improve and reinforce healthy lifestyle habits, explain physiological and psychological principles of good health, and offer evidence-based information regarding the causes, symptoms, transmission, and treatment of various health conditions. As part of their role, nurses assess the knowledge base of each client and family, their ability to manage health conditions, the effectiveness and availability of healthy coping strategies, and the need for referrals to community and social services. According to the American Heart Association, heart disease is the number one cause of death for adults in the United States. Heart disease is an umbrella term that covers a range of conditions, including coronary artery disease, arrhythmias, congenital heart defects, and hypertension. Nearly half (48%) of all U.S. adults have some type of heart disease. Symptoms depend on the type of heart disease an individual is experiencing. For example, symptoms of cardiovascular disease may include chest pain, shortness of breath, weakness or numbness in the arms and legs, and pain in the neck, jaw, upper abdomen, or back region. Symptoms may be different for males and females: Men are more likely to experience chest pain, while women are more likely to have shortness of breath, nausea, and extreme fatigue along with chest discomfort. Symptoms of a heart arrythmia include fluttering in the chest, racing or slow heart rate, chest pain or discomfort, shortness of breath, and vertigo. Other forms of heart disease include congenital heart defects, valvular disorders, and disease from infection. The causes of heart disease vary by type. Atherosclerosis—the most common cause of cardiovascular disease—occurs when fatty plaques build up in the arteries; these deposits thicken and stiffen the artery walls and subsequently inhibit blood flow throughout the body. Atherosclerosis can be caused by an unhealthy diet, lack of exercise, being overweight, and smoking. In general, risk factors for developing heart disease include age, family history of heart disease, smoking, poor diet, hypertension, diabetes, obesity, lack of exercise, stress, and poor dental health. The AHA recommends focusing on seven goals to prevent heart disease: eating a healthy diet, exercising regularly, avoiding excess weight, not smoking, and keeping blood pressure, cholesterol, and blood sugar within a healthy range. Nurses play a key role in primary prevention measures to promote health and prevent heart disease. Prevention measures include adhering to a healthy lifestyle that includes the AHA’s seven recommendations. Nurses may also recommend routine screenings including monitoring blood pressure, lipid screening, and noting progress toward optimal health. Because hypertension is a major risk factor for heart failure, achieving and maintaining a healthy blood pressure level can markedly lower the risk of heart disease. Hypertension can be treated with lifestyle changes and, if indicated, blood pressure–lowering medications. According to the American Cancer Society, cancer is the second most common cause of death in the United States (after heart disease). Cancer comprises a group of diseases characterized by the uncontrolled growth and spread of abnormal cells; if this spread is not limited, it can result in death. Approximately 80% of all cancers in the United States are diagnosed in people 55 years of age or older, and an estimated 40 of 100 men and 39 of 100 women will develop cancer during their lifetime. Although the causes of cancer are not completely understood, various factors are known to increase the disease’s occurrence—namely, smoking, excess body weight, and inherited genetic mutations. Some cancers can be prevented, especially those caused by tobacco use and other unhealthy behaviors. In a recent study conducted by the ACS, at least 42% of newly diagnosed cancers in the United States were potentially avoidable, including those caused by smoking, excess body weight, alcohol consumption, poor nutrition, and physical inactivity. Screenings for skin, breast, prostate, lung, colorectal, and cervical cancers are known to reduce mortality for many cancers. Nearly one in five cancers is caused by excess body fat, alcohol consumption, poor nutrition, and a sedentary lifestyle—risk factors that are considered both preventable and modifiable. Nurses play a crucial role in providing education and support to their adult clients with cancer. Nursing assessment for cancer involves collecting data through a comprehensive health history, physical assessment, and diagnostic studies. Primary prevention is the most effective way to reduce the burden of cancer. Many cancers can be prevented by practicing healthy lifestyle habits such as engaging in daily physical activity, eating a nutritious diet, avoiding excessive sun exposure, not smoking, avoiding excessive consumption of alcohol, and having routine checkups and health screenings.  Nurses will collaborate with clients diagnosed with cancer to address treatment goals that might include surgery, radiation therapy, chemotherapy, and other targeted therapies. In some cases, clients may decide to live out their lives without pursuing treatment. Receiving a cancer diagnosis and undergoing cancer treatment present numerous challenges for clients and their families, which can affect their physical functioning, mental health, and quality of life. The client plan of care includes educating clients and their families about cancer and its treatment, ways to manage symptoms of the disease and side effects of cancer treatments, and pain management; assessing the client’s emotional state; and providing ongoing education and emotional support. Diabetes mellitus (DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, which may be due to impaired insulin secretion, insulin resistance, or both. Type 2 diabetes mellitus, the most common type of diabetes, accounts for approximately 90% of all cases. Although it is most commonly seen in persons older than 45 years, the incidence of this disease is currently increasing in children, adolescents, and younger adults due to rising levels of obesity, physical inactivity, and energy-dense diets. Individuals most likely to develop type 2 diabetes are age 45 or older, have a family history of diabetes, and are overweight or obese. Physical inactivity and hypertension also increase the chances of developing type 2 diabetes. High glucose levels in clients with this form of diabetes, if not treated, can cause other serious health problems, such as heart disease, vision loss, and kidney disease. Symptoms of type 2 diabetes often develop over several years and can persist for a long time without being noticed. Among these symptoms are polyuria, polydipsia, blurred vision, fatigue, sores or wounds that are slow to heal, and dry skin. Individuals experiencing such symptoms or those at risk for the disorder need to have their blood glucose levels measured to receive an accurate diagnosis. Early detection and treatment of type 2 diabetes can decrease the risk that clients will develop complications such as heart and kidney disease, neuropathy, impaired hearing and vision, circulation problems, poor oral health, and mental health issues. Many of these complications can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food, being physically active, and glucose testing. In some cases, individuals with type 2 diabetes take prescribed medications to help manage their condition. Self-management is a critical element in type 2 diabetes care. Clients will collaborate with nurses and other members of the health care team to establish and implement a comprehensive plan of care. This plan of care includes weight management, exercise, glucose testing and monitoring, foot and dental care, adequate rest and sleep, stress-reduction activities, and medication management. Nurses should encourage clients to keep their regular appointments and provide education, support, and guidance to implement and modify the plan of care as indicated. Individuals in late adulthood are the fastest-growing segment of the U.S. population. According to the Population Reference Bureau, the number of Americans older than the age of 65 is projected to double from 46 million today to more than 98 million by 2060, when this cohort will account for approximately 24% of the population. During late adulthood, many physiological changes occur as part of the normal aging process—for example, decreased cardiac output, loss of elasticity in the respiratory system, reduced physical strength and motor function, decreased glucose tolerance, and discolored, wrinkled, and fragile skin. The leading causes of death in elderly people are heart disease, cancer, lung disease, stroke, and Alzheimer’s disease. Accidents and falls are also more likely in this group due to alterations in sensory perception and gait, as well as the onset of neurologic and cognitive disorders. The prevalence of certain lifestyle issues such as loneliness and social isolation may be higher among the elderly, too. Some older adults face other challenges including increasing obesity rates, economic disparities, rising divorce rates, and living alone or in assisted living centers. Health promotion strategies for individuals in late adulthood focus on maintaining and increasing functional capacity, improving self-care, and increasing the individual’s social network to promote longer independence and overall quality of life. Continuing professional work, attending social and cultural events, and participating in community activities are important ways to ensure healthy aging. Both health promotion and health maintenance in late adulthood emphasize exercise, healthy eating, and maintaining a healthy lifestyle. Older adults need adequate rest and sleep as well as physical activity to restore energy and help prevent acute and chronic illnesses. Nurses can provide education and support to older adults by advocating for living conditions and environments that support well-being and healthy lifestyles, adequate housing, emotional and social support, access to affordable health care, and community resources. Skeletal maturity, defined as the point at which bone density is greatest and the skeleton is at peak development, occurs at approximately age 18 years for women and 20 years for men. Bone density then stays relatively stable until women experience menopause and men reach late adulthood. In the years following menopause, women often experience a rapid loss of bone density that causes the bones to become weaker and more brittle, so that they are easier to break and take longer to heal if injured. Severe loss of bone density can result in osteoporosis, a disease in which bones become porous and more susceptible to fractures. In severe cases, osteoporosis can cause spinal vertebrae to collapse. As individuals age, the spinal column loses mineral content and bone density, causing the spine to become curved and compressed. Foot arches may also be less pronounced, causing a loss in height. Movements may become slow and limited, gait can be unsteady, and individuals are more easily fatigued. Approximately half of all women older than age 50 will experience a fracture of the hip, wrist, or vertebra during their lifetime; spinal fractures are the most common type. In general, white, older women are the most likely to experience a loss of bone density. Risk factors include having insufficient amounts or poor absorption of calcium and vitamin D, decreased estrogen levels in women following menopause, decreased testosterone levels in men as they age, being confined to bed due to prolonged illness, certain medications (e.g., seizure medications and hormone treatments), and history of eating disorders. Other risk factors are a family history of osteoporosis, drinking excessive amounts of alcohol, and smoking.  Osteoporosis is the most common type of bone disease, though it has few noticeable symptoms in the early stages. In some cases, people will experience a compression fracture before they realize they have osteoporosis. Other symptoms include loss of height, stooped posture, or a dowager’s hump. Dual-energy X-ray absorptiometry (DEXA) scan is a low-radiation x-ray that may be performed to measure bone density levels, bone loss, and risk for fracture. DEXA scans are used to diagnose osteoporosis, then are usually repeated every two years to assess the progression of the disorder and to determine how well treatment is working. Vertebral fracture assessment (VFA) may be done in combination with DEXA scan to better identify fractures. Treatment for osteoporosis includes dietary changes and daily exercise, calcium and vitamin D supplements, and medications used to strengthen bones. Exercise is essential in preserving bone density, and weight-bearing exercises are especially helpful in this regard. Examples include walking, jogging, or playing tennis; using free weights, weight machines, and stretch bands; balance and core exercises such as yoga and Pilates; and using rowing machines. Eating a diet rich in calcium and vitamin D and/or using supplements to make up for the shortage if diet lacks the recommended amounts is also beneficial. Other interventions include not smoking, limiting alcohol consumption, and removing environmental hazards, such as throw rugs, to reduce the risk of falls. Because osteoporosis is associated with a heightened risk for falls, other safety measures include installing grab bars and anti-slip flooring, and wearing shoes with low heels that fit well. Nurses can help promote bone health by improving awareness, identifying clients at risk for osteoporosis, and encouraging healthy lifestyles. They may also help clients diagnosed with osteoporosis by providing education to help them understand the condition, reduce anxieties, and prevent falls; collaborating with clients in treatment planning; and promoting adherence to the plan of care . The National Institute on Aging (NIA) defines Alzheimer’s disease as a progressive, irreversible brain disorder that slowly destroys memory and thinking skills and in time, inhibits the ability to carry out basic tasks and activities of daily living. In the past, Alzheimer’s disease has been ranked as the sixth leading cause of death for older adults in the United States; however, recent data suggest that it may now rank third behind heart disease and cancer as a cause of death. While Alzheimer’s disease is the most common cause of dementia among older adults, it is not an expected or inevitable part of aging. The loss of cognitive functioning experienced with dementia affects thinking, memory, and reasoning, which then interferes with an individual’s daily life and activities. Depending on the types of brain changes occurring, the causes of dementia can vary and symptoms can range from mild to severe. Scientists continue to study the complexities of brain changes involved in the onset and progression of Alzheimer’s disease. Changes in the brains of individuals with this disease may actually begin years before memory and other cognitive problems appear. Even while significant brain changes are taking place, individuals may seem to be symptom-free. Over time, abnormal deposits of proteins form plaques throughout the brain, resulting in a loss of healthy neuron function and connection with other neurons, which then causes the neurons to die and parts of the brain to shrink. In the final stage of Alzheimer’s disease, brain damage is extensive and brain tissue has diminished significantly. Memory problems are often one of the first signs of cognitive impairment. At first, memory problems may be mild and do not significantly impact daily life. The individual experiences gradual declines in memory, learning, attention, and judgment; confusion as to time and place; difficulties in communicating and finding the right words; and inappropriate social behaviors and changes in personality. As the disease progresses, these symptoms become more pronounced and displayed more regularly. Delusions, hallucinations, and other related behaviors develop and worsen over time, and spouses and family members become strangers. In its advanced stages, Alzheimer’s disease often causes incontinence and a loss of mobility. Clients often become completely dependent on other people for their care and may eventually need to live in assisted care facilities. The rate of deterioration in Alzheimer’s disease varies widely from one individual to another, making it difficult to predict how long a client will survive. Diagnosis of Alzheimer’s disease is made by obtaining a comprehensive health history, performing a physical assessment, and conducting tests to assess memory, problem-solving ability, attention, counting, and language. Other tests include brain scans to confirm the diagnosis; these scans may be repeated over time to measure the progression of cognitive changes. A definite diagnosis of Alzheimer’s disease can be established only after death, with an examination of brain tissue in an autopsy. Although Alzheimer’s disease cannot be stopped or reversed, early treatment helps to preserve daily functioning and gives families time to plan by attending to financial and legal matters, instituting safety issues, learning about living arrangements, and building support networks. Early diagnosis also provides more opportunities for clients to participate in studies to test new treatments for Alzheimer’s disease. Treatment may include medications to help reduce symptoms and help manage behavioral problems. Nursing assessment of older adults should include assessment of cognitive functioning to test memory, judgment, abstract thinking, retention, and calculation abilities. Living with Alzheimer’s disease can have significant physical, emotional, and financial costs. Over time, clients may become bedridden and unable to recognize family and friends. Nurses offer ongoing education and support to clients and families, including evidence-based information about the stages and progression of the disease, ways to manage challenging behaviors, resources for living arrangements and community support, respite care for caregivers, and support groups.