Growth & Development PDF

GROWTH AND DEVELOPMENT Auhreen Oria, RN, MN  GROWTH AND DEVELOPMENT AND THE ROLE OF NURSES  Health Promotion and Illness Prevention - must be able to recognize the predictable stages of growth and development, from newborn to young adult, through which each child passes (Go...

GROWTH AND DEVELOPMENT Auhreen Oria, RN, MN  GROWTH AND DEVELOPMENT AND THE ROLE OF NURSES  Health Promotion and Illness Prevention - must be able to recognize the predictable stages of growth and development, from newborn to young adult, through which each child passes (Goldson & Reynolds, 2008).  Health Restoration and Maintenance - It is equally essential to consider developmental stages when caring for a sick child or one having surgery - Physical growth is another important factor to consider, because disease affects children differently at various stages of growth PRINCIPLES OF GROWTH AND DEVELOPMENT Growth - denote an increase in physical size or a quantitative change. Development - indicate an increase in skill or the ability to function (a qualitative change). Maturation is a synonym for development  Psychosexual development (Sigmund Freud)  Psychosocial development (Erikson’s stages of personality development)  Moral development (Lawrence Kohlberg)  Cognitive development (Jean Piaget) PRINCIPLES  Growth and development are continuous processes from conception until death.  Growth and development proceed in an orderly sequence  Different children pass through the predictable stages at different rates.  All body systems do not develop at the same rate.  Development is cephalocaudal. (Cephalo is a Greek word meaning “head”; caudal means “tail.”)  Development proceeds from proximal to distal body parts  Development proceeds from gross to refined skills.  There is an optimum time for initiation of experiences or learning.  Neonatal reflexes must be lost before development can proceed.  A great deal of skill and behavior is learned by practice FACTORS INFLUENCING GROWTH AND DEVELOPMENT 1. GENETICS a. Gender b. Health c. Intelligence 2. TEMPERAMENT - usual reaction pattern of an individual, or an individual’s characteristic manner of thinking, behaving, or reacting to stimuli in the environment (Chess & Thomas, 1995). An inborn characteristic set at birth. REACTION PATTERN (CHESS & THOMAS, 1995) Nine separate characteristics that define temperament or how children react to situations. 1. Activity Level - The level of activity among children differs widely. 2. Rhythmicity - A child who has rhythmicity manifests a regular rhythm in physiologic functions. 3. Approach - refers to a child’s response on initial contact with a new stimulus. 4. Adaptability - is the ability to change one’s reaction to stimuli over time. 5. Intensity of Reaction - Some children react to situations with their whole being. 6. Distractibility - Children who are easily distracted or who can easily shift their attention to a new situation (distractibility) are easy to care for. 7. Attention Span and Persistence - Attention span is the ability to remain interested in a project or activity. 8. Threshold of Response - is the intensity level of stimulation that is necessary to evoke a reaction. 9. Mood Quality - A child who is always happy and laughing has a positive mood quality. Although individual children show characteristics from all groups, most children can be categorized into one of four groups: 1. Difficult: arrhythmic, withdrawing, low in adaptability, intense, and negative in mood. 2. Slow to warm up: inactive, low in approach and adaptability, and negative in mood. 3. Intermediate: some characteristics of both groups. 4. Easy: rhythmic, approaching, adaptable, mild, and positive in mood 3. ENVIRONMENT a) Socioeconomic Level b) Parent–Child Relationship c) Ordinal Position in the Family d) Health 4. NUTRITION - Nutrition also plays a vital role in the body’s susceptibility to disease because poor nutrition limits the body’s ability to resist infection. Food Guide Pyramid Guidelines for a Healthy Diet a) Eat a Variety of Foods. b) Balance the Food You Eat With Physical Activity - Maintain or Improve Your Weight. c) Choose a Diet With Plenty of Grain Products,Vegetables, and Fruits. d) Choose a Diet Low in Fat, Saturated Fat, and Cholesterol. e) Choose a Diet Moderate in Sugars. f) Choose a Diet Moderate in Salt and Sodium. g) If Drinking Alcoholic Beverages, do so in Moderation. THEORIES OF DEVELOPMENT  A theory is a systematic statement of principles that provides a framework for explaining some phenomenon. Developmental theories provide road maps for explaining human development. Developmental task is a skill or a growth responsibility arising at a particular time in an individual’s life, the achievement of which will provide a foundation for the accomplishment of future tasks.  Sociocultural theories  Learning theory  Epigenetic theories  Still other theories deal mainly with negative aspects of childrearing that can cause mental illness in children, either immediately or later, when a child reaches adulthood (see discussion on Freud that follows).  Erikson discusses positive aspects necessary for normal growth and for development of a mentally healthy and productive adult (Coles, 2001). BASIC DIVISION OF CHILDHOOD Stage Age Period Neonate First 28 days of life Infant 1 mo – 1 yr. Toddler 1 – 3 yrs. Preschooler 3 – 5 yrs. School-Aged Child 6 – 12 yrs. Adolescent 13 – 21 yrs.  FREUD’S PSYCHOANALYTIC THEORY SIGMUND FREUD (1856–1939)  An Austrian neurologist and the founder of psychoanalysis, offered the first real theory of personality development (Edmundson, 2007).  Freud based his theory on his observations of mentally disturbed adults.  He described adult behavior as being the result of instinctual drives that have a primarily sexual nature (libido) that arise from within the person and the conflicts that develop between these instincts (represented in the individual as the id), reality (the ego), and society (the superego). He described child development as being a series of psychosexual stages in which a child’s sexual gratification becomes focused on a particular body part. FREUD’S STAGES OF CHILDHOOD ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT ERIK ERIKSON (1902–1996)  He was trained in psychoanalytic theory but later developed his own theory of psychosocial development, a theory that stresses the importance of culture and society in development of the personality (Erikson, 1993).  a person’s social view of self is more important than instinctual drives in determining behavior, allows for a more optimistic view of the possibilities for human growth.  While Freud looked at ways mental illness develops, Erikson looked at actions that lead to mental health. The Young Adult Achieving a sense of intimacy versus isolation. Intimacy is the ability to relate well with other people, not only with members of them opposite sex but also with one’s own sex to form long-lasting friendships. The Middle-Aged Adult The developmental task of middle age is to establish a sense of generativity versus stagnation. People extend their concern from just themselves and their families to the community and the world. The Older Adult The developmental task of older adults is integrity versus despair. Older adults with integrity feel good about the life choices they have made. PIAGET’S THEORY OF COGNITIVE DEVELOPMENT JEAN PIAGET (1896–1980)  Swiss psychologist,  Introduced concepts of cognitive development or the way children learn and think that have roots similar to those of both Freud and Erikson and yet separate from each (Wadsworth, 2003).  Piaget defined four stages of cognitive development; within each stage are finer units or schemas.  Stage of Development Age Span Nursing Implication I. Sensorimotor a. Neonatal 1 month Stimuli are assimilated into beginning mental images. Behavior entirely reflexive. b. Primary circular 1–4 month Hand–mouth and ear–eye coordination reaction develop. Enjoyable activity for this period: a rattle or tape of parent’s voice. c. Secondary circular 4–8 month Infant learns to initiate, recognize, and repeat reaction pleasurable experiences from environment. Good toy for this period: mirror; good game: peek-a-boo. d. Coordination of 8–12 Infant can plan activities to attain specific secondary reactions month goals. Perceives that others can cause activity and that activities of own body are separate from activity of objects. Good toy for this period: nesting toys (i.e., colored boxes).  Stage of Development Age Span Nursing Implication e. Tertiary circular 12–18 month Child is able to experiment to discover new reaction properties of objects and events. Good game for this period: throw and retrieve. Transitional phase to the preoperational thought f. Invention of new means 18–24 month period. Uses memory and imitation to act. Can solve through mental basic problems, foresee maneuvers that will succeed combinations or fail. Good toys for this period: those with several uses, such as blocks, colored plastic rings. II. Preoperational 2–7 year Thought becomes more symbolic; can arrive at thought answers mentally instead of through physical attempt. Child is egocentric Displays static thinking Concept of time is now, distance is only as far as they can see No awareness of reversibility Unable to state cause–effect Good toy for this period: items that require imagination, such as modeling clay.  Stage of Development Age Span Nursing Implication III. Concrete 7–12 years Concrete operations includes systematic reasoning. operational Uses memory to learn broad concepts (fruit) and thought subgroups of concepts (apples, oranges). Child is aware of reversibility, an opposite operation or continuation of reasoning back to a starting point. Understands conservation, sees constancy despite transformation. Good activity: collecting and classifying natural objects such as native plants, sea shells, etc. IV. Formal operational 12 years Can solve hypothetical problems with scientific Thought reasoning; understands causality and can deal with the past, present, and future. Adult or mature thought. Good activity for this period: “talk time” to sort through attitudes and opinions. KOHLBERG’S THEORY OF MORAL DEVELOPMENT LAWRENCE KOHLBERG (1927–1987)  A psychologist who studied the reasoning ability of boys and,  based on Piaget’s development stages,  developed a theory on the way children gain knowledge of right and wrong or moral reasoning. NURSING CARE OF A FAMILY WITH AN INFANT AUHREEN M. ORIA, RN, MN  INFANT GROWTH Infants grow rapidly both in size and in their ability to perform tasks. Although development follows set of patterns, some of it is dependent on cultural factors. PHYSICAL GROWTH - CHANGES THAT OCCUR IN THE INFANT YEAR REFLECT BOTH THE INCREASING MATURITY AND GROWTH OF BODY ORGANS  Changes IV. Body Proportion - Mandible is more prominent - chest circumference is generally less than that of the head at birth by about 2 cm; even for some at 6 mos, and most by 12 mos. - abdomen protuberant until the child has been walking until toddler - Cervical, thoracic, and lumbar vertebral curves develop as infants hold up their head, sit, and walk.  Changes V. Body Systems CV = 120 – 160 by the end of the year 100 – 120 - The heart continues to occupy a little over half the width of the chest - PR may begin to slow with inhalation (sinus arrhythmia) - BP = 80/40 to 100/60 mm Hg - 5 to 6 months = Hgb is totally converted fetal to adult - 6- 9 months = in serum iron levels : last of iron stores are used - RR : 20 – 30 b/m - GI : ability to digest protein is present and effective: - 1-3 mos: deficient amount of amylase; Lipase entire 1st year of life - Liver: immature - Kidney: immature; more prone to dehydration - Endocrine system: Immature; infant may not be able to respond to stress effectively.  Changes Immune System: 2 months : immune system becomes functional 1 year: produce both IgG and IgM antibodies. Thermoregulation: 6 months: adjusts to cold; an infant can shiver in response to cold (which muscle activity and provides warmth) and additional adipose tissue developed. Body Fluids: extracellular fluid accounts for approximately 35% of an infant’s body weight; intracellular fluid accounting for approximately 40% by the end of the first year ( adult proportions of 20% and 40%) Note: Infant is susceptibility to dehydration from illnesses such as diarrhea: loss of extracellular fluid =loss of over a third of an infant’s body fluid  Changes VI. Teeth The first baby tooth (typically a central incisor) usually erupts at age 6 months, followed by a new one monthly. However, teething patterns can vary greatly among children. Note: Deciduous teeth are essential for protecting the growth of the dental arc  MOTOR DEVELOPMENT An average infant progresses through systematic motor growth during the first year that strongly reflects the principles of cephalocaudal and gross to fine motor development. Control proceeds from head to trunk to lower extremities in a progressive, predictable sequence. Types: Gross motor development (ability to accomplish large body movements) Fine motor development are prehensile ability (ability to coordinate hand movements)  A. GROSS MOTOR DEVELOPMENT TO ASSESS GROSS MOTOR DEVELOPMENT, AN INFANT IS OBSERVED IN FOUR POSITIONS: Positions Age Ventral Suspension Prone Sitting Standing 1 mos. lifts the head momentarily, then lift their heads and has gross head lag stepping reflex can drops it again turn them easily to as in the first days of still be demonstrated the side life. 2 mos. hold their heads in the same raise their heads and can hold their head hold their head up plane as the rest of their body maintain the fairly steady when with the same show position, but they sitting up, although of support as in a cannot raise their it does tend to bob sitting position chests high enough forward. to look around yet. 3 mos. Child lifts and maintains the lifts the head and Has only slight head Begin to try to support head well above the plane of shoulders well off lag when pulled to part of their weight. the rest of the body. the table and a sitting position looks around Landau reflex - an infant’s head, when prone. legs, and spine extends. When Prone to side lying the head is depressed, the hips, knees, and elbows flex ; (-) Cerebral Palsy or other Neurological Problem  Positions Age Ventral Suspension Prone Sitting Standing 4 mos lift their chests off the bed - No head lag when begin to be able and look around actively, pulled to sitting to support their turning their heads from position weight on their side to side legs turn from front to back Stepping reflex Neck-righting Reflex, faded which begins at this age. When an infant turns the head to the side, the shoulders, trunk, and pelvis turn in that direction, too. 5 mos rests weight on their straighten the continues the forearms when prone. back when held ability to sustain a Turns completely over or propped in a portion of weight sitting position Tonic Neck reflex extinguished Moro reflex fading  Positions Age Ventral Suspension Prone Sitting Standing 6 mos Parachute rest their weight on sit momentarily support nearly reaction - infants are their hands with without support their full weight suddenly lowered toward extended arms have only a limited an examining table from raise their chests and ability to sit ventral the upper part of their independently suspension, the arms abdomens off the extend as if to protect table. themselves from falling 7mos - (-) Cerebral palsy child sits alone with child bounces with hands held forward enjoyment for balance. 8 mos Sit securely without any additional support 9 mos can creep from the sit so steadily they can stand holding prone position can lean forward onto a coffee and regain their Table balance. Some can pull up to standing position  Positions Age Ventral Suspension Prone Sitting Standing 10 mos can pull themselves to a standing position by holding, but they cannot let themselves down again 11 mos “cruise” or move about the crib or room by holding onto objects such as the crib rails, chairs, walls, and low tables 1 year children stand alone at least momentarily B. FINE MOTOR DEVELOPMENT Age Fine Motor 1 mos. strong grasp reflex 2 mos. The hands are held open, not closed in fists 3 mos. reach for attractive objects in front of them Assure parents this is part of normal development 4 mos. bring their hands together and pull at their clothes Thumb opposition (ability to bring the thumb and fingers together) is beginning Palmar and plantar grasp reflexes have disappeared. 5 mos. can accept objects that are handed to them by grasping with the whole hand can reach and pick up objects without the object being offered and often play with their toes as objects 6 mos. can hold objects in both hands will drop one toy when a second one is offered for the same hand can hold a spoon and start to feed themselves (with much spilling) Moro, palmar grasp, and the tonic neck reflex have completely faded  Age Fine Motor 7 mos. can transfer toys from one hand to the other 8 mos. random reaching and ineffective grasping have disappeared as a result of advanced eye–hand coordination 9 mos. 10 mos. ability to bring the thumb and first finger together in a PINCER GRASP pick up small objects Use one finger to point to objects offer toys to people but then cannot release them 1 year draw a semi straight line with a crayon enjoy putting objects such as small blocks in containers and taking them out again hold a cup and spoon to feed themselves fairly well (if they have been allowed to practice) can take off socks and push their hands into sleeves can offer toys and release them  DEVELOPMENTAL MILESTONES Language Development Age Development 1 mos. make small, cooing (dovelike) sounds 2 mos. child differentiates a cry; caregivers can distinguish a cry that means “hungry” from one that means “wet” or from one that means “lonely.” Note: IMPORTANT MILESTONE ability to make throaty, gurgling, or cooing sounds also increases 3 mos. will squeal with pleasure 4 mos. very “talkative,” cooing, babbling, and gurgling when spoken to. 5 mos. says some simple vowel sounds (for example, “goo-goo” and “gah-gah”) 6 mos. learn the art of imitating; may imitate parent’s coughing 7 mos. can imitate vowel sounds well (for example, “oh-oh,” “ah-ah,” and “oo-oo”) 9 mos. usually speaks a first word: “da-da” or “ba-ba 10 mos. masters another word such as “bye-bye” or “no.” 12 mos. can generally say two words besides “ma-ma” and “da-da”; they use those two words with meaning.  Play Age Development Toy 1 mos. 1-month-olds can fix their eyes on an object Mobiles (Musical, Black and white or bright colored) children also spend a great deal of time parent's face watching their parent’s face Hearing is a second sense that is a source of Music Box, Musical pleasure rattle mobiles or cradle 2 mos. hold light, small rattles for a short period of gyms strung across time but then drop them their crib 3 mos. handle small blocks or small rattles Blocks and small rattles 4 mos. Four-month-old children need a playpen or Rolling over is so a sheet spread on the floor so they have an intriguing it may serve opportunity to exercise their new skill of as a “toy” rolling over 5 mos. infants are ready for a variety of objects to plastic rings, blocks, handle squeeze toys, clothes pins, rattles, and plastic keys 6 mos. sit steadily enough to be ready for bathtub rubber ducks or toys plastic boats teething teething ring  DEVELOPMENT OF SENSES Vision Age Development 1 mos. regard an object in the midline of their vision (something directly in front of themselves). Around 18 inches. They follow at a short distance. 2 mos. focus well (from about age 6 weeks) and follow objects with the eyes (although still not past the midline); BINOCULAR VISION 3 mos. can follow an object across their midline typically hold their hands in front of their face and study their fingers for long periods of time (hand regard) 4 mos. recognize familiar objects, such as a frequently seen bottle, rattle, or toy animal. Follow their parents’ movements with their eyes. 6 mos. Infants are capable of organized depth perception. This increases the accuracy of their reach for objects as they begin to perceive distances accurately. 7 mos. Pat their image in a mirror. Depth of perception has matured; can perform such tasks as transferring toys from hand to hand 10 mos. Infant looks under a towel or around a corner for a concealed object (BEGINNING OF OBJECT PERMANENCE)  Hearing Age Development 1 mos. quiets momentarily at a distinctive sound such as a bell or a squeaky rubber toy 2 mos. infants will stop an activity at the sound of spoken words. 3 mos. turn their heads to attempt to locate a sound 4 mos. when infants hear a distinctive sound they turn and look in that direction 5 mos. they can localize sounds downward and to the side, by turning their head and looking down 6 mos. locate sounds made above them 10 mos. can recognize their name and listen acutely when spoken to can easily locate sound in any direction and turn toward it. A 12 mos. vocabulary of two words plus “ma-ma” and “da-da” also demonstrates an infant can hear. Touch Needs to be touched to experience skin-to-skin contact Clothes should feel comfortable and soft rather than rough; diapers should be dry rather than wet TASTE Infants demonstrate that they have an acute sense of taste by turning away from or spitting out a taste they do not enjoy. SMELL can smell accurately within 1 or 2 hours after birth respond to an irritating smell by drawing back from it. appear to enjoy pleasant odors and learn early in life to identify the familiar smell of breast milk.  EMOTIONAL DEVELOPMENT Age Development 1 mos. They quiet best and eat best for the person who has been their primary caregiver. 2 mos. SOCIAL SMILE (6 weeks) 3 mos. Increased social awareness by readily smiling at the sight of a parent’s face Laugh out loud at the sight of a funny face. 4 mos. Recognize their primary caregiver and prefer that person’s presence to others 5 mos. Show displeasure when an object is taken away from them 6 mos. May begin to draw back from unfamiliar people. 7 mos. Begin to show obvious fear of strangers. Shrieks. 8 mos. Fear of strangers; Phenomenon is often termed EIGHTH MONTH ANXIETY, OR STRANGER ANXIETY (Goldson & Reynolds, 2008) 9 mos. Very aware of changes in tone of voice. They will cry when scolded. 12 mos. Overcome their fear of strangers and are alert and responsive again when approached.  COGNITIVE DEVELOPMENT A. Primary circular reaction Explores objects by grasping them with the hands or by mouthing them. Appear to be unaware of what actions they can cause or what actions occur independently. B. Secondary Circular Reaction (6 months) Infants can grasp the idea their actions can initiate pleasurable sensations. C. Coordination of Secondary Schema 10 months discover OBJECT PERMANENCE 1 year of age, they are capable of reproducing interesting events and producing new events. HEALTH PROMOTION OF INFANT AND FAMILY PROMOTING ACHIEVEMENT OF DEVELOPMENTAL TASK: TRUST VERSUS MISTRUST A synonym for trust in this connotation is love. Examples: Feeding Diaper changing Being held By this process, infants learn to trust that when they have a need or are in distress, a person will come and meet that need. Note: Infants thrive on routine and consistency. The care be given largely by one person  PROMOTING INFANT SAFETY Aspiration Prevention: Check size of solid food being served Caution parents to be certain nothing comes within an infant’s reach that would not be safe to put into the mouth. Use clothing without decorative buttons Check toys and rattles Should use one-piece construction pacifier with a flange large Allow no plastic bags within infant’s reach. Do not use pillows in a crib. Buy a crib that is approved for safety (spacing of rails is not over 23⁄8in [6 cm] apart). Fall Prevention teach parents to be prepared for their infant to roll over by 2 months of age Never leave an infant on an unprotected surface. Place a gate at the top and bottom of stairways; do not allow an infant to walk with a sharp object in the hands or mouth Raise crib rails and make sure they are locked before walking away from crib. Do not leave a child unattended in a highchair; avoid using an infant walker. Motor vehicle Never transport unless an infant is buckled into an infant car seat in the back seat of the car. Be aware of the proper technique for placing an infant in a car seat. Do not be distracted by an infant while driving. Do not leave an infant unattended in a parked car (can become dehydrated from excess heat, move gear shift, or be abducted). Drowning Do not leave infants alone in a bathtub or unsupervised near water (even buckets of cleaning water). Animal bites Do not allow an infant to approach a strange dog; supervise play with family pets. Poisoning Never present medication as a candy. Buy medications in containers with safety caps; put away immediately after use. Never take medication in front of infants. Place all medication and poisons in locked cabinets or overhead shelves. Never leave medication in a pocket or handbag. Use no lead-based paint in any area of the home. Hang plants or set on high surfaces. Post telephone number of the poison control center / 911by the telephone Burns Test warmth of formula and food before feeding (use extra precaution with microwave warming). Do not smoke or drink hot liquids while holding or caring for infant. Buy flame-retardant clothing for infants. Use a sunscreen on a child over 6 months when out in direct or indirect sunlight; limit the child’s sun exposure to less than 30 min at a time. Turn handles of pans toward back of stove. Use a cool-mist, not a hot-mist, vaporizer; remain in room to monitor so child cannot reach vaporizer. Monitor infants carefully near candles. Do not leave infants unsupervised near hot-water faucets. Do not allow infants to blow out matches (don’t teach children that fire is fun). Keep electric wires and cords out of reach; cover electrical outlets with safety plugs. PROMOTING NUTRITIONAL HEALTH OF AN INFANT Recommended Dietary Reference Intakes for an Infant: high-protein, high-calorie, Vitamins and Minerals Calorie allowances can be gradually reduced during the first year from a level of 120 per kilogram of body weight at birth to approximately 100 per kilogram of body weight at the end of the first year. Breastfed infants gain less weight than those who are formula fed. Introduction of Solid Food (4-6 months) Delaying helps prevent overwhelming an infant’s kidneys with a heavy solute load that can occur when protein is ingested. It also delay the development of food allergies in susceptible infants and be another way to help prevent future obesity (Sass, 2007).  Teach parents: Introduce one food at a time, waiting 5 to 7 days between new items. Introduce the food before formula or breastfeeding when an infant is hungry. Introduce small amounts of a new food (1 or 2 tsp) at a time. Respect infant food preferences; a child cannot be expected to like all new tastes equally well. Use only minimal to no salt and sugar on solid foods to minimize the number of additives. Remember that the extrusion reflex is present for the first 4 to 6 months of life, so any food placed on an infant’s tongue will be pushed forward. To prevent aspiration, do not place food in bottles with formula. Introduce foods with a positive, “You’ll like this” attitude. feed infant in the parent’s arms as if bottle-feeding or breastfeeding. Extrusion Reflex - fades at 3 to 4 months. Types of food and Quantities A newborn’s stomach can hold approximately 2 tablespoons (30 mL). By 1 year, a stomach can hold no more than about 1 cup (240 mL) Age Food Rationale 5–6 Iron-fortified infant Aids in preventing iron- So rich in iron parents should cereal mixed with deficiency anemia; the least continue feeding it at least breast milk, orange allergenic type of food; an through the first year juice, or formula easily digested food 7 Vegetables Good source of vitamin A; adds * Usually offered at lunch new texture and flavors to diet 8 Fruit Best source of vitamin C, good * It can be given in addition source of vitamin A; adds new to cereal for breakfast and texture and flavors to diet dinner. 9 Meat Good source of protein, iron, *Offer beef and pork 1st, then and B vitamins Chicken *Part of the evening meal 10 Egg yolk Good source of iron *May be prepared by hard-boiling *Wheat, tomatoes, oranges, fish, and egg whites should be omitted if there are allergies in the family, because these foods are most likely to cause allergies. Establishment of Healthy Eating Patterns Remind parents that they should individualize their approach according to the cues their child is giving them for readiness. If an infant does refuse to eat, ask the parents what foods they are offering. If intake is inadequate and the child is, indeed, a fussy eater, ask about the parents’ methods of feeding. An infant who is fatigued or overstimulated may not eat well. Encourage parents not to force infants to eat if they do not seem hungry. Weaning Sucking reflex starts to diminish at 6-9 months, infant can dink from cup at 9. This is the best time to wean Things to teach to parents: choose one feeding a day and then begins offering fluid by the new method at that feeding. After 3 days to 1 week, when an infant has become acclimated to the one change, the mother changes a second feeding. No set of number of weeks should be prescribed to complete weaning. Self-Feeding At 6 months of age, infants become interested in handling a spoon and beginning to feed themselves. Parents who insist on continuing to spoon-feed past the time infants want to feed themselves can cause infants to balk at eating. When infants no longer attempt to feed themselves at a meal but merely begin to play with their food it is time to end the meal. This behavior indicates that they have had enough. Adequate Intake With a Vegetarian Diet Should continue to be breastfed or ingest an iron-fortified, balanced, commercial formula for the entire first year. When solid foods are added at 6 months, an assortment of foods should be provided, including : a. vegetables: avocados, potatoes, and broccoli; b. fruits such as apples, prunes (high in iron), and bananas; c. infant cereal; d. tofu; e. wheat germ; f. legumes; g. brewer’s yeast; h. and synthetic vitamin D.  PROMOTING INFANT DEVELOPMENT IN DAILY ACTIVITIES Bathing Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap (Smoker, 2007) Diaper –Area care Change diapers frequently, about every 2 to 4 hours. If an infant develops a rash from sleeping in wet diapers, air drying or sleeping without a diaper may be a solution. Routinely using an ointment such as Desitin or A&D ointment Parents do not need to use baby powder. Care of Teeth At 6 months to12 can receive fluoride. From water or toothpaste Teach parents to begin “brushing” even before teeth erupt by rubbing a soft washcloth over the gum pads. Once teeth erupt, all surfaces should be brushed with a soft brush or washcloth once or twice a day. Initial dental checkup by 1 year of age; checkups should continue at 6-month intervals until adulthood. Dressing Should be easy to launder and simply constructed When they begin to creep, they need long pants to protect their knees. they need only soft-soled shoes or socks or booties to keep their feet warm. when they begin walking, the soles of their shoes need only be firm enough to protect their feet against rough surfaces. Sleep 10 to 12 hours and naps during the day Caution parents not to place pillows in an infant’s bed to avoid suffocation. Always place infants on their back to sleep (to prevent SIDS) Use of a pacifier while an infant sleeps may further reduce this risk (Damato, 2007) Exercise Expose the child to the sun for only very short periods, 3 to 5 minutes the first day, a little more the next day, and so on up to 15 to 20 minutes at a time(No sunscreen until 6 mos) Toward the end of the first year, infants need space to crawl and then to walk. PARENTAL CONCERNS AND PROBLEMS RELATED TO NORMAL INFANT DEVELOPMENT Teething Spitting up Thumb-sucking Diaper dermatitis Use of pacifier Miliaria, or prickly heat Head banging rash Sleep problem Infant Caries (Baby- Constipation Bottle Syndrome) Loose stools Obesity in Infants Colic  REVIEW POINTS The infant period is from 1 month to 12 months. Double their birth weight at 4 to 6 months and triple it at 1 year. Develop first tooth at 6 months; by 12 months, have six to eight teeth. Important gross motor milestones: 2 months - lifting the chest off a bed , 6 to 8 months - sitting at 9 months - creeping, 10 to 11 months - “cruising” 12 months - walking Important fine motor accomplishments 7 months- ability to pass an object from one hand to the other and a 10 months - pincer grasp Important milestones of language development 2 months - differentiating a cry 5 to 6 months - making simple vowel sounds, and 12 months - saying two words besides “ma-ma” and “da-da” The more infants are spoken to, the easier it is for them to acquire language.  Providing infants with proper toys for play helps development. All infant toys need to be checked to be certain they are too large to be aspirated. Important milestones of vision development: 3 months - ability to follow a moving object past the midline and ability to focus securely without eyes crossing According to Erikson, the developmental task : trust versus mistrust. Safety is important. Infants must be protected from falls and aspiration of small objects. Solid food is generally introduced into an infant’s diet: 4 to 6 months. Before infants can eat solid food, they must lose their EXTRUSION REFLEX. Common concerns related to infant development include teething, thumb- sucking, use of pacifiers, sleep problems, constipation, colic, diaper dermatitis, baby-bottle syndrome (decayed teeth from sucking on a bottle of formula while they sleep), and obesity. Nurses play a key role in teaching parents about these problems and measures to deal with them. Remember that parent–infant attachment is critical to mental health. Urge parents to continue to give as much care as possible to sick infants to maintain this important relationship. Nursing Care of a Family with a Toddler Child Auhreen Oria , RN, MN Growth and Development of a Toddler Physical Growth Weight Gains 5 to 6 lb(2.5kg) / year Height 5 in (12 cm) / year Head Circumference increases only about 2 cm A. Body Contour prominent abdomen forward curve of the spine at the sacral area (LORDOSIS) waddle or walk with a wide stance B. Body Systems Body systems continue to mature during this time: Respirations slow slightly but continue to be mainly abdominal. In the respiratory system, the lumens of vessels enlarge progressively = lower respiratory infection becomes less. HR : 90 b/m; BP : 99/64 mmHg. The brain : 90% of its adult size. Stomach secretes more acid; therefore, gastrointestinal infections become less common Stomach capacity increases = a child can eat three meals a day. Control of the urinary and anal sphincters becomes possible with complete myelination of the spinal cord = toilet training IgG and IgM antibody production becomes mature at 2 years of age = passive immunity non operative C. Teeth 2 years = Eight new teeth (the canines and the first molars) 2.5 to 3 years = All 20 deciduous teeth (Gonsalves, 2008).  Developmental Milestones Age(Mos) Fine Motor Gross Motor Language Play Puts small pellets into small bottles. Scribbles voluntarily with a Walks alone 4–6 words Can stack 2 blocks; pencil or crayon. Can seat self in chai Enjoys being read to 15 Holds a spoon well but Creeps upstairs Drop toys for adult may turn it upside down to recover on the way to the mouth Run and Jump in place Can walk up and down 7–20words, uses Imitates household No longer rotates spoon the stairs with something jargoning chores, dusting, etc. 18 to bring to mouth to hold on to. Typically names 1 body BEGINS PARALLEL places both feet on one part PLAY step before advancing. Age(Mos) Fine Motor Gross Motor Language Play Can open doors turning Walks on stairs alone but 50 words, PARALLEL PLAY the nob; still using both feet on 2-word EVIDENT Unscrews lids same step to advance sentences 24 (noun-pronoun and verb) Ex: “Me go” Makes simple lines or Can jump down from Verbal language Spends time playing strokes for crosses with stairs increases house pencil Knows full name Imitating parent's Can name one action 30 color “Rough-housing” or Holds finger to active show age Language Development “No” = autonomy Encourage language development by naming objects as parents p lay with their child (“ball,” “block,” “music box,” “doll”); Childre n should not be made to name an object before they can have it. Always answer a child’s question Note: Because children learn language from imitating what they hear, they will sp eak like those around them. If they are spoken to in baby talk, their enunciation of words can be poor Emotional Development A. Autonomy Sense of Autonomy VS Shame or doubt (Erik Erickson, 1993) Autonomy = Independence Notioned to be negativistic, obstinate (stubborn), and difficult to manage. B. Socialization Once toddlers are walking well, they become resistant to sitting in laps and being cuddled 15 months - enthusiastic about interacting with people 18 months - imitate the things they see a parent doing, such as “study” or “sweep,” so they seek out parents to observe and initiate interactions. 2 or more years - become aware of gender differences and may point to other children and identify them as “boy” or “girl.” Play Behavior Parallel play – side-by-side play (normal developmental sequence) Age appropriate toys: ( toys they can control, giving them a sense of power in manipulation, an expression of autonomy ) Trucks, squeaky frogs, Waddling ducks, Rocking horses, Pegs, Blocks, Toy telephone 15 months - put-in, take-out stage; stacks of boxes or balls that fit inside each other 18-months - pull toys; Toys should be strong enough to take a great deal of abuse 2 years - imitating adult actions; Imitation is the play By the end of the toddler period - rough-housing; spend at least part of every day in this very active, stimulating type of play. Cognitive Development Tertiary Circular Reaction Stage (Between 12 and 18 months) Fifth and sixth stages of Piaget’s sensorimotor thought ; “a little scientist” Health Promotion For A Toddler And Family Promoting Toddler Safety Accidental ingestions (poisoning) are the type of accident that occurs most fr equently in toddlers (Dart & Rumack, 2008). Aspiration or ingestion of small objects Urge parents to childproof their home A safety gate on the door of the room is another way to keep a toddler conta ined and safe. Other accidents that occur frequently in toddlers include motor vehicle accidents, burns, falls, drowning, and playground injuries. Note: These accidents happen because toddlers’ motor ability jumps ahead of their judgment.  Common Safety measures Potential accident Prevention measures Maintain child in car seat; do not be distracted from safe driving by a child in a car. Do not allow child to play outside unsupervised. Supervise toddler who is too young to be left alone on a tricycle. Motor vehicles Teach safety with pedaling toys (look before crossing driveways; do not cross streets) *But do not expect that toddler will obey these rules at all times (in other words, stay close by). Never present medication as candy. Buy medications with childproof caps; put away immediately after use. Never take medication in front of child. Place all medication and poisons in locked cabinets or overhead shelves where child c annot reach them. Never leave medication in parents’ purse or pocket, where child can reach it. Poisoning Always store food or substances in their original containers. Know the names of house plants and find out if they are poisonous. (Call regional poison control center for information.) Hang plants or set them on high surfaces beyond toddler’s grasp. Be certain that small batteries or magnets are out of reach. Post telephone number of nearest poison control center by the telephone. Inspect toys to be certain they are free of lead-based paint. Promoting Nutritional Health of a Toddler Take note during toddler stage: a. Appetite is decreased b. Promotion of independence is important c. They usually do not like food that is “mixed up” d. They often prefer brightly colored foods to bland colors. TODDLERS NUTRITION Sedentary children ages 1 to 3 years = 1000 kcal daily; Active children ages 1 to 3 years = 1400 kcal daily (U.S. Department of Agriculture [USDA], 2005) Protein and carbohydrate calcium and phosphorus 2 years old = do not restrict fats Over 2 years old = fat intake between 30% and 35% of calories; Sources : fish, nuts, and vegetable oils Milk should be whole milk until age 2 years Trans–fatty acids should be kept to a minimum Avoid high sugar foods  Promoting Toddler Development in Daily Activities A. Dressing B. Sleep ▪ Need for sleep declines; 8 – 12 hours with naps in between; they natura lly fall asleep when they are tired. ▪ Other toddlers resist naptime as part of their developing negativism. ▪ They love a bedtime routine: bath, pajamas, a story, brushing teeth, bei ng tucked into bed, having a drink of water, choosing a toy to sleep wit h, and turning out the lights. ▪ Many toddlers are ready to be moved out of a crib into a youth bed or regular bed with protective side rails or a chair strategically placed besi de it by the end of the toddler period. C. Bathing Usually enjoy bath time, and parents should make an effort to make it f un by providing a toy, such as a rubber duck, boat, or plastic fish. NOTE: DON’T LEAVE THE CHILD UNATTENDED WHEN BATHING D. Care of Teeth Toddlers need to have a toothbrush they recognize as their own; At the end of the toddler period, they can begin to do the brushing themselves under supervision First visit to a dentist skilled in pediatric dental care at about 12 months of age for assessment of dentition Promoting Healthy Family Functioning Learning self-reliance is the primary goal of a child du ring the toddler period Help parents to understand their responses towards the attempts of a toddler at being independent which are crucial to the healthy development of their child. If parents punish children excessively at each move toward independence, children will not fight them indefinitely. Instead, they will begin to feel guilty for wanting to do things independently.  Caution some parents not to begin to function at the same level as their toddler. At bedtime, naptime, or anytime they are tired, toddlers may become much more like their old selves, wanting to sit on a parent’s lap and be rocked or picked up and carried, this is natural. Parental Concerns Associated With the Toddler Period A. Toilet Training - one of the biggest tasks a toddler tries to achieve; toilet traini ng is an individualized task for each child. Before children can begin toilet training, they must have reached three important dev elopmental levels, one physiologic and the other two cognitive: They must have control of rectal and urethral sphincters, usually achieved at the ti me they walk well. They must have a cognitive understanding of what it means to hold urine and sto ols until they can release them at a certain place and time. They must have a desire to delay immediate gratification for a more socially accep ted action. NOTE: Some toddlers smear or play with feces, often at about the same time that toilet training is started. Teach parents to accept this behavior for what it is: enjoyment of the body and of the self, and the discovery of a new substance. After a child is fully toilet trained, this activity rarely persists.  How To Toilet Train A Toddler 1. Children are physically ready for toilet training when 7. Do not allow a child to remain on a potty chair for they walk securely. much longer than 10 minutes (less than that if he is resistant). 2. Use pull down pants to avoid accidents. 8. If your child is not ready or does not successfully use 3. Purchase either a potty chair that sits on the floor or the potty on a day-to-day basis, have him return to an infant seat that is placed on the regular toilet diapers for a short period. 4. Place child on the potty chair or toilet at regular 9. When boys have mastered defecation, it is time to interval. include urination. 5. Praise your child if he does urinate or defecate. 10. Some toddlers have difficulty remaining dry at night Remind him to wash his hands. until they are 3 to 4 years old. Do not pressure your child to accomplish nighttime dryness, but assume 6. Be careful not to flush the toilet while the child is that he is doing the best he can do sitting on it. 11. Do not wake your child during the night and carry him to the bathroom to void. B. Ritualistic Behavior Although toddlers spend a great deal of time every day investigating new ways to do things and doing things they have never done before, they also enjoy ritualistic patterns. C. Negativism - As part of establishing their identities as separate in dividuals, toddlers typically go through a period of extreme negativism. A positive stage in development Toddlers have learned they are separate individuals with separate needs A toddler’s “no” can best be eliminated by limiting the number of questions asked of the child. D. Discipline - means setting rules or road signs so children know what is expected of them. Punishment is a consequence that results from a breakdown in discipline, from the child’s disregard of the rules that were learned. Remind parents that “discipline” and “punishment” are not interchan geable terms. It is setting safety limits and protecting others or property Two general rules to follow are (a) parents need to be consistent (b) rules are learned best if correct behavior is praised rather than wrong behavior punished. “Timeout” is a technique to help children learn that actions have co nsequences. E. Separation Anxiety - begins at about 6 months of age and persists throughout the preschool period. Most toddlers react best to separation if a regular babysitter is employed or the day care center is one with consistent caregivers. Parents should say goodbye firmly. Prolonged goodbyes only lead to more crying. Sneaking out prevents crying and may ease the parents’ guilt, but it can strengthen fear of abandonment so should be discouraged. F. Temper Tantrums Temper tantrums occur as a natural consequence of toddlers’ development (Taylor, 2007); they are independent enough to know what they want, but they do not have the vocabulary or the wisdom to express their feelings in a more socially acceptable way. A tantrum may be a response to difficulty making choices or decisions or to pressure from activities such as toilet training. PRESCHOOL AGE Auhreen Oria, RN, MN http://www.free-powerpoint-templates-design.com  Slimmer, taller, and much more childlike proportions. Growth and Ectomorphic (slim) or endomorphic (large)— becomes apparent Handedness Development of a Major step = ability to learn extended language Lymphatic tissue begins to increase in size = tonsils Preschooler Levels of IgG and IgA antibodies increase Physiologic splitting of heart sounds may be present for the Physical Growth first time on auscultation; innocent heart murmurs may also be heard for the first time. PR : 85 beats b/m; BP 100/60 mmHg. Bladder is easily palpable above the symphysis pubis; voiding: frequent (9 or 10 times a day) Muscles are noticeably stronger Many children at the beginning of the period exhibit GENU VALGUS (KNOCK-KNEES) disappears with increased skeletal growth at the end of the preschool period  Language Development Growth and 3-year-old child has a vocabulary of about 900 words Four- and 5-year-old children continue to ask many Development of a questions. Imitate language exactly Preschooler Egocentric, so they define objects in relation to themselves B Developmental Milestone Play Enjoy games that use imitation such as pretending to be teachers, cowboys, firefighters, and police etc. They imitate exactly what they see parents doing Imaginary friends as a normal part of having an active imagination (Goldson & Reynolds, 2008). Four- and 5-year-olds : roughhousing and imitative play. Five-year-olds : group games or songs they have learned in kindergarten or preschool.  Emotional Development Developmental Task: Initiative Versus Guilt Sense if initiative and Sense of Guilt INITIATIVE A child with a well-developed sense of initiative has discovered that learning new things is fun. Need exposure to a wide variety of experiences and play materials so they can learn as much about the world as possible. GUILT If children are criticized or punished for attempts at initiative. Imitation Preschoolers need free rein to imitate the roles of the people around them. Role playing should be fun and does not have to be accurate. Fantasy. Preschoolers begin to make differentiation between fantasy and reality. They may become so engrossed in a fantasy role, however, they become afraid they have lost their own identity or have become “stuck” in their fantasies. Such intense involvement in play is part of “magical thinking,” or believing thoughts and wishes can come true.  Emotional Development Oedipus and Electra Complexes Oedipus the strong emotional attachment a preschool boy demonstrates toward his mother. Electra is the attachment of a preschool girl to her father. Note: Parents can be reassured that this phenomenon of competition and romance in preschoolers is normal.  Emotional Development Gender Roles Preschoolers need exposure to an adult of the opposite gender so they can become familiar with opposite gender roles. Children’s gender-typical actions are strengthened by parents, strangers, preschool teachers, other family members, and other children.  Emotional Development Socialization - Preschool period is a sensitive and critical time for socialization. 3 years old capable of sharing, they play with other children their age much more agreeably than do toddlers Children who are exposed to other playmates have an easier time learning to relate to people than those raised in an environment where they never see other children of the same age. 4 years old they may become involved in arguments more than they did at age 3, especially as they become more certain of their role in the group. 5 years old begin to develop “best” friendships, perhaps on the basis of who they walk to school with or who lives closest to them. “The elementary rule that an odd number of children will have difficulty playing well together pertains to children at this age: two or four will play, but three or five will quarrel.” Cognitive Development Moral and Spiritual Development 3 years = according to Piaget is Determines right from wrong based on their parents’ still PREOPERATIONAL (Piaget, 1969). rules. They have little understanding of the rationale for these rules or even whether the rules are Although children during this period do enter a consistent. second phase called INTUITIONAL THOUGHT, they lack the insight to view themselves as other Preschoolers begin to have an elemental concept of see them or put themselves in another’s place God if they have been provided some form of religious (termed CENTERING). Because preschoolers training. Belief in an outside force aids in the cannot make this kind of mental substitution, they development of conscience; however, preschoolers feel they are always right. tend to do good out of self-interest rather than because of strong spiritual motivation (Kohlberg,1984) Are not yet aware of the property of conservation..  As preschoolers broaden their horizons, safety issues increase. By age 4, children may project an attitude of independence and the ability to take care of their own needs. Health Keeping Children Safe, Strong, and Free Promotion For Educate children about the potential threat of harm from strangers or even how to address bullying behavior from people A Preschooler Warning a child never to talk with or accept a ride from a Stranger And Family Teaching a child how to call for help in an emergency (yelling or running to a designated neighbor’s house if outside, or dialing 911 if near a telephone) A Describing what police officers look like and explaining that police officers can help in an emergency situation Promoting Explaining that if children or adults ask them to keep secrets about anything that has made them uncomfortable, they should tell their parents o Preschooler r another trusted adult, even if they have promised to keep the secret Safety Explaining that bullying behavior from other children is not to be tolerated a nd should be reported so they can receive help managing it  General Know whereabouts of preschooler at all times. Be aware that frequency of accidents is increased when parents are under stress. Special precautions must be taken at these times. Some children are more active, curious, and impulsive and therefore more Health vulnerable to accidents than others. Promotion For A Preschooler And Family A Promoting Motor Vehicle and Bicycle Safety Preschooler Teach safety with tricycle (look before crossing driveways; do not cross streets). Teach child to always hold hands with a grownup before crossing a street. Safety Teach parking lot safety (hold hands with grownup; do not run behind cars that are backing up). Children should wear helmets when riding bicycles. Encourage parents who ride bicycles to demonstrate safe riding habits by wearing helmets as well. Health Poisoning Promotion For Never present medication as a candy. Never take medication in front of a child. A Preschooler Never store food or substances in containers other than their own. Post telephone number of local poison control center by the telephone. And Family Teach child that medication is a serious substance and not for play. A Promoting Preschooler Safety  Falls Supervise preschooler at playgrounds. Remove drawstrings from hooded clothing. Help child to judge safe distances for jumping or safe heights for climbing. Health Promotion For A Preschooler And Family A Drowning Teach beginning swimming Promoting Preschooler Safety  Animal bites Do not allow child to approach strange dogs. Supervise child’s play with family pets. Health Promotion For A Preschooler And Family Burns A Store matches in closed containers. Do not allow preschooler to help light birthday candles, fireplaces, etc. (fire is not fun or a “treat”). Promoting Preschooler Safety  Offer small servings of food Parents need to check that children are not snacking so frequently that they miss out on planned meals to be certain children receive a complete range of nutrients (Gable, Chang, & Krull, 2007) Urge parents to offer foods such as fruit, cheese, or milk rather than cookies and a soft drink (Rolfes, Pinna, & Health Whitney, 2009). Teach parents to make mealtime a happy and enjoyable Promotion For part of the day for everyone by allowing the child to prepare simple food (e.t. sandwich) A Preschooler Recommended Dietary Reference Intakes And Family Foods selected for preschoolers should be based on food pyramid groups, making sure to offer a variety. A Caution parents not to give more vitamins than the recommended daily amount, because poisoning from Promoting high doses of fat-soluble vitamins or iron can result. Nutritional Health of the Preschooler  Dressing Preschoolers prefer bright colors or prints and so may select items that do not match. Children need the experience of choosing their own clothes. One way for parents to solve the problem of mismatching is to fold together matching shirts and pants so a child Health sees them as a set rather than individual pieces. Promotion For Sleep A Preschooler Preschoolers are more aware of their needs; when they are tired , they often curl up on a couch or soft chair and fall asleep. And Family Children in this age group, however, may refuse to go to sleep because of fear of the dark. Night waking from nightmares or B night terrors reaches its peak (Hiscock et al., 2007). Parents should screen out frightening stories or television watching and give night light Promoting Development of the Preschooler in Daily Activities  Exercise Preschool period is an active phase, so children receive a great deal of exercise. Time-honored games such as ring-around-the-rosy, London Bridge, or other more structured games. Rough-housing Health Promoting this type of active game and reducing television / gadgets can help Promotion For children develop motor skills as well as be a step toward preventing childhood obesity (Kline, 2008). A Preschooler And Family Hygiene Preschoolers do not clean their fingernails very well, so these often need “ touching up” by a parent or older sibling. B Caution parents about not using bubble bath with preschoolers as some girls develop vulvar irritation (and perhaps bladder infections) Promoting Assist in cleaning the ears. Development of the Preschooler in Daily Activities  Care of Teeth Independent tooth brushing should be started but checked. Flossing with assistance from parents A child should continue to drink fluoridated water or prescribed oral fluoride Health supplement if fluoride is not provided in the water supply (Armfield & Spencer, 2007). Promotion For Encouraging children to eat apples, carrots, celery, chicken, or cheese for snacks rather than candy or sweets. A Preschooler Visit the dentist. Deciduous teeth must be preserved to protect the dental arch. And Family Night grinding (Bruxism) grinding the teeth at night (usually during sleep), is a habit of many young children (Goddard, 2008). Teeth grinding may be a way of “letting go,” similar to body rocking, that children do for a short time B each night to release tension and allow themselves to fall asleep. Promoting Development of the Preschooler in Daily Activities  A major parental role during this time is to encourage vocabulary development. One way to do this is to read aloud to a child; another is to answer questions so a child sees language as an organized system of communication. Health Promotion For Discipline A Preschooler “Timeout” is a good technique to correct behavior for parents throughout the And Family preschool years. This technique allows parents to discipline without using physical punishment and allows a child to learn a new way of behavior without B C extreme stress. Promoting Healthy Family Functioning Parental Concerns Associated With the Preschool Period Common Health Problems Minor illnesses, such as colds, ear infections, and flu symptoms Children who attend child care or preschool programs also have an increased incidence of gastrointestinal disturbances (such as vomiting and diarrhea) from the exposure to other children (Butterton & Calderwood, 2008).  Parental Concerns Associated With the Preschool Period Common Fears Fear of the Dark. Fear heightened by a child’s vivid imagination. Monitor the stimuli the children are exposed to, especially around bedtime. It may be a reaction to undue stress. In these instances, the source of the stress needs to be investigated. Fear of Mutilation. falling and scraping a knee or having an injection. Because they do not know which body parts are essential and which ones can be easily replaced. Boys develop a fear of castration Fear of Separation or Abandonment. It intensifies because their keen imagination allows them to believe they have been deserted when they are safe.  Parental Concerns Associated With the Preschool Period Behavior Variations Telling Tall Tales Imaginary Friends. Many preschoolers have an imaginary friend who plays with them (Goldson & Reynolds, 2008). Difficulty Sharing. Sharing is a concept first understood at 3 years of age. Children begin to understand that some things are theirs, some belong to others, and some can belong to both. Teach about = mine, yours, ours Regression. = stress, exhibits thumb sucking, negativism, loss of bladder control, and inability to separate from their parents. Help parents understand that regression in these circumstances is normal. Removing the stress is the best way to help a child discontinue this behavior. Sibling Rivalry. To help them feel secure and promote self-esteem, supplying them with a private drawer or box for their things. Parental Concerns Associated With the Preschool Period Preparing for a New Sibling There is no rule as to when this preparation should begin, but it should be before the time the child begins to feel the difference the new baby will make. Help parents not to underestimate the significance of a bed to a preschool child. Bed = security, consistency and “Home”. Transfer child at least 3 mos. prior to birth. The fact that he is growing up is a better reason for such a move than because a new brother or sister wants the old bed. Start Preschool or child care prior to birth or two to thee months after birth. During birth of the new baby, when the mother is hospitalized, they should make sue the preschool is prepared. Encourage women to maintain contact with their preschooler during the short time th ey are hospitalized for the new birth.  Parental Concerns Associated With the Preschool Period Sex Education It is important for parents not to convey that these body parts are never to be talked about to leave an open line of communication for sexual questions. Masturbation common while watching television or being read to or before they fall asleep at night. The frequency of this may increase under stress, as does thumb-sucking. Teach them to avoid sexual abuse, such as not allowing anyone to touch their body unless they agree it is all right. Always ask permission before giving nursing care to them that involves touching. “Where do babies come from?” factual answer to this type of question is best: “Babies grow in a special place in a mother’s body called a uterus.” Many new books for children explain where babies come from, including descriptions of sexual relations and orgasm.  Parental Concerns Associated With the Preschool Period Preparing a Child for School Essential to this preparation is the parents’ attitude. If a child was not attending preschool, some parents may have to change their child’s daily routine a few months in advance If a child is to ride a bus to school, a parent might take a child on a municipal bus as an introduction to this form of transportation. If a child is to walk, a trial walk is in order. If a child will be required to take a lunch to school, a parent can introduce this new experience by preparing a bagged lunch at home some noon. For children to do well in a formal school setting, they must be able to follow instructions and sit at a table and chair for a short work period. Going to school is a form of separation so parents must make preparations for this.  Parental Concerns Associated With the Preschool Period Broken Fluency Repetition and prolongation of sounds, syllables, and words. Often referred to as Secondary Stuttering It is a part of normal development and, if accepted as such, will pass. It is associated with rapid speech patterns that may also be present in the parent (Savelkoul et al., 2007). Do not discuss in a child’s presence the difficulty they are having with speech. Do not label them a “stutterer.” Listen with patience to what a child is saying. Do not interrupt or fill in a word for her. Talk to her in a calm, simple way. Protect space for her to talk if there are other children in the family. Do not force a child to speak if she does not want to. Do not reward her for fluent speech or punish her for nonfluent speech. Broken fluency is a developmental stage in language formation, not an indication of regression or a chronic speech pattern. Nursing Care Of A Family With A School Aged Child Auhreen Oria, RN, MN ALLPPT.com _ Free PowerPoint Templates, Diagrams and Charts  Physical Growth Weight gain: 3 to 5 lb (1.3 to 2.2 kg) annually Height: 2 in (2.5 to 5 cm) annually Lordosis and knock-knees should lose it by now Posture is more erect (Goldson & Reynolds, 2008). 10 yo: brain growth is complete; fine motor coordination becomes refined The eye globe reaches its final shape, an adult vision level is achieved. Malocclusion (a deviation from the normal) with teeth misalignment may be present. The immunoglobulin : IgG and IgA reach adult levels  9 yo: lymphatic tissue continues to grow up until this age Frontal sinuses develop at about 6 years, so sinus headache becomes a possibility The left ventricle of the heart enlarges to be strong enough to pump blood to the growing body; Innocent heart murmurs may become apparent PR: 70 to 80 beats per minute BP: 112/60 mm Hg Respiratory system: O2 & CO2 exchange: exertion ability and stamina Scoliosis may become apparent for the first time in late childhood. Teeth: Permanent teeth erupts; 28 teeth between 6 and 12 years of age: the central and lateral incisors; first, second, and third cuspids; and first and second molars Sexual Maturation Onset of puberty varies widely, between 10 and 14 years of age. Girls: 12 and 18 years; Boys: 14 and 20 years Sex education to be effective, parents must introduce this material when their children are in grade school, not in middle school or high school. Sexual and Physical Concerns Girls Boys Change in her pelvic contour Boys are aware of increasing genital size; testicular Prepubertal girls are usually taller, by about 2 in (5 cm) or development precedes penis growth more, than preadolescent boys Hypertrophy of breast tissue (gynecomastia) can occur in Conscious of breast development. prepuberty (most often in stocky or obese boys); will fade Supernumerary (additional) nipples as soon as the male hormones become more mature Early preparation for menstruation. Explanation of the and active. reason for menstrual flow, good hygiene and reassurance Pubic hair normally appears first and that chest and facial they can bathe, shower, and swim during their periods; hair use sanitary napkins Nocturnal emissions: ejaculation during sleep Age o Menarche: 12. 4 years; there may be irregularity in 1st yr or 2 Vaginal secretions will begin to be present  Developmental Milestones Age Gross Motor Fine Motor Play 6 Enough coordination to walk a Can easily tie their shoelaces Rough straight line Can cut and paste well and draw a Spend hours playing increasingly Can ride a bicycle person with good detail challenging video games They can skip rope with practice Can print, although they may routinely reverse letters. 7 Appears quiet Concentrate on fine motor skills Require more props for play: Gender differences usually begin to “eraser year” decline in imaginative play manifest in play. They set too high a standard for Develop an interest in collecting themselves items: quantity important 8 More graceful Can read regular-size type Develop skills for sorting and May stumble on furniture or spill milk Reading is a great pleasure and cataloging. and food school is more enjoyable Ride a bicycle well and enjoy sports Learns to write script rather than such as gymnastics, soccer, and print hockey, basketball etc Enjoy showing off this new skill in cards, letters, or projects. Age Developmental Milestones Gross Motor Fine Motor Play 9 are on the go constantly writing begins to look mature and less Competitive behaviors can have enough eye–hand coordination awkward. develop 10 more interested in perfecting their very interested in rules and athletic skills fairness in competitive play situations 11 feel awkward because of their growth spurt They may channel their energy into Music and artistic expression also constant motion instead: Drumming, child is “turned on” to reading. become important during this time tapping pencils or feet plunge into activities with intensity and 12 concentration. may be refreshingly cooperative around the house  Emotional Development Developmental Task: Industry Versus Inferiority A sense of industry is learning how to do things well. Children concentrate their questions on the “how” of tasks Need reassurance they are doing things correctly and this reassurance is best if it comes frequently rather than infrequently after long waits. The best type of book has many short chapters: develop sense of accomplishment Small chores Hobbies and projects are enjoyed best if they are small and can be finished within a short time. A. Home as a Setting to Learn Industry B. School as a Setting to Learn Industry C. Structured Activities D. Problem Solving E. Learning to Live With Others Socialization Age Activity 6 Play in groups, but when they are tired or under added stress, they prefer one-to-one contact 7 Increasingly aware of family roles and responsibility; Promises; Tattle 8 Actively seek the company of other children; close friends; whispers and shares secrets 9 Take the values of their peer group very seriously; Gang age with secret password and secret meeting place, generally all girls or all boys; Are ready for activities away from home 10 Enjoy groups, they also enjoy privacy; Own bedroom or at least their own dresser; One of the best gifts for a 10-year-old is a box that locks. 11 Interest in the opposite gender; Favorite activities are mixed-sex rather than single-sex ones; Particularly insecure 12 Feel more comfortable in social situations; Boys experience erections on small provocation and might feel awkward in boy-girl situation.  Cognitive Development Children can use concrete operational thought because they learn several new concepts, such as: a. Decentering - the ability to project oneself into other people’s situations and see the world from their viewpoint rather than focusing only on their own view. Compassion for others. b. Accommodation - the ability to adapt thought processes to fit what is perceived such as understanding that there can be more than one reason for other people’s actions. c. Conservation - the ability to appreciate that a change in shape does not necessarily mean a change in size. Child is not easily fooled by perception. d. Class inclusion - the ability to understand that objects can belong to more than one classification. Necessary for learning mathematics and reading, systems that categorize numbers and words.  Moral and Spiritual Development Begin to mature in terms of moral development as they enter a stage of preconventional reasoning. Begin to learn about the rituals and meaning behind their religious practices. Parent role modeling is also important. Are rule-oriented; when they pray, they may expect their God to follow rules also (if you are good and pray for something, you should receive it).  Health Promotion for a School Aged Child  Promoting School-Age Safety Many children as young as 8 or 9 stay by themselves after school, are generally ready for this type of experience if they can reliably follow instructions. Be certain they know how to use seatbelts in cars and bicycle safety around cars. Accident Preventive measure Motor vehicle accident Insist children use seat belts in a car; role model their use. Teach street-crossing safety Teach bicycle safety, including advice not to take “passengers” on a bicycle and to use a helmet. Teach parking lot and school bus safety Community Avoid unsafe areas Do not go with strangers Children should say “no” to anyone who touches them if they do not wish it, including family members For late school-age, teach rules of safer sex Falls Teach that rough-housing on fences, climbing on roofs, etc., is hazardous Teach skateboard, scooter, and skating safety.  Accident Preventive measure Burns Teach safety with candles, matches, campfires—fire is not fun. Teach safety with beginning cooking skills Teach safety with sun exposure—use sun block. Do not climb electric poles. Sports injuries Teach that wearing appropriate equipment for sports (ex. helmet for bicycle riding, skateboarding, or in-line skating; batting helmets for baseball) is not babyish but smart. Stress not to play to a point of exhaustion or in a sport beyond physical capability Use trampolines only with adult supervision to avoid serious neck injury Drowning Teach how to swim; dares and rough-housing when diving or swimming are not appropriate. Do not swim beyond limits of capabilities. Drugs Help your child avoid all recreational drugs and take prescription medicine only as directed. Avoid tobacco and alcohol. Firearms Teach safe firearm use. Keep firearms in locked cabinets with bullets separate from gun. General School-age children should keep adults informed regarding where they are and what they are doing. Be aware that the frequency of accidents increases when parents are under stress and therefore less attentive. Special precautions. Some children are more active, curious, and impulsive and therefore more vulnerable to accidents than others.  Teaching Points to Help Children Avoid Sexual Abuse A NUMBER OF COMMON RULES ARE: 1.Your body is your property and you can decide who looks at it or touches it. 2.Secrets are fun things to keep. If a person asks you not to tell about something that was done to you that you did not like, it is not a secret. It is all right to tell about it. 3.Do not go anywhere with a stranger (a stranger is someone you do not know, not someone “strange”). Do not be fooled by people asking you to give them directions or to go with them because your mother is sick or hurt or they have lost a pet. 4.Being touched by someone you like is a good feeling. You do not have to allow anyone to touch you in a way you do not like. Do not allow yourself to be left alone with a person you are uncomfortable with because that person touches you in a way you do not like. 5.A “private part” is the part of you a bathing suit touches. If anyone asks you to show them a private part or touches a private part, tell them to stop, and tell someone else. 6.If the person you tell does not believe you, keep telling people until someone does believe you.  Promoting Nutritional Health of a School-Age Child Establishing Healthy Eating Patterns School-age children need breakfast For packed lunches to school, urge parents to allow them some say in the meal Health care personnel should play an active role in nutrition education at health maintenance visits. Most children are hungry after school and enjoy a snack when they arrive home such as fruit, cheese, or milk, rather than cookies and a soft drink. Limit salty foods and saturated fat Teach parents to make every attempt to make mealtime a happy and enjoyable part of the day for everyone.  Promoting Nutritional Health of a School-Age Child Fostering Industry School-age children usually enjoy helping to plan meals. They may eat meals they have planned or prepared more willingly than ones that are just set in front of them. Most parents would like children to develop better table manners. It is often comforting for parents to know that children typically display better table manners in other people’s homes than in their own. Recommended Dietary Reference Intakes it is important that the increasing energy requirements that come with this age(often in spurts) are met daily with foods of high nutritional value. Late School years: boys require more calories and other nutrients Both need High fiber and Iron foods Adequate calcium and fluoride intake remains important  Promoting Development of a School-Age Child in Daily Activities Activity Dress The right age, however (if not started already), to teach children the importance of caring for their own belongings. Have definite opinions about clothing styles, often based on the likes of their friends or a popular sports or rock star Sleep Sleep needs vary among individual children. Younger school-age children typically require 10 to 12 hours of sleep; older ones require about 8 to 10 hours. Nighttime terrors may continue during the early school years; may actually during the first-grade year as a child reacts to the stress of beginning school. about age 9, children generally are ready to give up pre-bedtime talks with parents in preference to calling or chatting / text messaging a friend. Activity Hygiene 6 or 7 years of age still need help in regulating bath water temperature and in cleaning their ears and fingernails. Age 8, children are generally capable of bathing themselves but may not do it well Both boys and girls become interested in showering as they approach their teens. Girls = menstrual hygiene Boy= uncircumcised: practice good hygiene Care of teeth Should visit a dentist at least twice yearly for a checkup, cleaning, and possibly a fluoride treatment to strengthen and harden the tooth enamel (marinho et al., 2009) Fear of dentists = early visit and check up prevent this fear. Have to be reminded to brush their teeth daily. Exercise need daily exercise. It can come from neighborhood games, walking with parents or a dog, or bicycle riding. Those with poor coordination may become reluctant to exercise; Urge to participate in some daily exercise, or else obesity, or osteoporosis later in life, can result.