Pediatric Nursing Fundamentals: Growth and Development - PDF

Health Promotion, Restoration and Maintenance of the Family: Pediatric Fundamentals: Growth and Development Professor Meghan McCrillis DNP PHNL CNE Quinsigamond Community College NUR201 Sharing and Cop...

Health Promotion, Restoration and Maintenance of the Family: Pediatric Fundamentals: Growth and Development Professor Meghan McCrillis DNP PHNL CNE Quinsigamond Community College NUR201 Sharing and Copyright Infringement Any handouts or postings related to course content is the intellectual property of QCC faculty and cannot be shared by any means to other students or outside entities. FOOD FOR THOUGHT http://youtu.be/cDDWvj_q-o8 2 A Method to Measure Health: Mortality  Mortality: Statistical data gathered regarding the number of people who have died over a specific period of time  Infant mortality rate is a significant measure of children’s health.  Infant mortality= the # of infant deaths occurring in the first 12 months of life per 1000 live births.  The major causes of early infant death in the U.S. include prematurity, low birthweight, congenital anomalies, sudden infant death syndrome (SIDS), respiratory distress syndrome (RDS), unintentional injuries and bacterial sepsis.  Childhood mortality= the # of children deaths occurring between 1 to 14 years of age per 100,000.  Age 1-4: leading cause of death being unintentional injuries followed by congenital malformations.  Age 5-14: leading cause of death being unintentional injuries followed by cancer. 3 A Method to Measure Health: Morbidity  Morbidity: the measure of prevalence of a specific illness, in rates per 1,000 population, at a particular time  Commonly related to:  Respiratory disorders (most common), GI disturbances, mental health disorders, chronic health disorders and injuries. 4  Role of the Pediatric Nurse  The pediatric nurse works in various settings.  Acute and critical care, clinics, surgical centers, psychiatric facilities, schools, homes, day care centers summer camps…..  Pediatric nurses provide family-centered, atraumatic care utilizing evidence-based practice. https://www.nytimes.com/2008/01/01/health/ 01visi.html 5  Information Sharing Empowerme Collaborati nt on Family- Centered Family Flexibility CORECare: CONCEPTS Strengths Core Concepts Support Respect Choice Atraumatic Care  Based on the concept of “do no harm”  Major principles  Prevent or minimize physical stressors  Prevent or minimize child & family separation  Promote a sense of control https://www.nytimes.com/2008/01/01/health/ 01visi.html 7 Evidence-Based Nursing Practice  An approach to providing quality nursing care to patients with a goal to improve outcomes based on current high quality statistically significant research findings. 8  The Role of the Child Life Specialist (CLS)  The CLS work with children and families in healthcare settings.  They hold a bachelor's degree or higher with training in child development and are often times certified.  Through creative therapeutic play activities they:  Foster growth & development  Decrease fear & anxiety related to hospitalization and treatment.  Educate the family unit about the healthcare process. 9 Measurement of Growth and Development 10 Growth and Development of the Infant D R. M E G H A N M C C R I L L I S N U R 2 0 1 P E D I AT R I C S 11 Growth and Development of the Infant  Newborn/neonate  birth until 28 days  Infant  birth to 12 months of age 12 Patterns in Growth and Development  Cephalocaudal (head-to-tail):  Infants achieve control of the head before they can control the trunk or extremities.  Proximodistal (near-to-far):  Infants achieve control of their torso before their shoulders or arms. 13  Physical Growth  weight, height, head and chest circumference plotted on a growth chart. 14 Growth Charts  Plotted with every well visit  Gender and age specific  Birth to 24 months (WHO Chart)  2 to 19 years (CDC Chart) https://www.cdc.gov/growthcharts/who_charts.htm  Weight and length  most commonly used  Body mass index  Head circumference  See Appendix A for additional growth charts 15 16  Weight  Doubles birth weight by 4-6 months  Triples birth weight by 12 months  Height  Increased almost 50% by 1 year  Head Circumference  14 inches average circumference for a full-term newborn  Increase is size on average of 4 inches from birth to 1 year  Chest Circumference  Equals head circumference by 12 months 17 Posterior may close shortly after birth &/or by 2 months. Measures between 0.5-1cm (< 1/2 in.) Anterior closes by 9-18 months of age and measures 1-4 cm 18 Developmental Milestones Primitive Reflex Normal Duration Root Birth to 3 months Suck Birth to 2-5 months Moro / Startle Birth to 4 months Asymmetric Tonic Neck Birth to 4 months Palmer Grasp Birth to 4-6 months Plantar Grasp Birth to 9 months Babinski Birth to 12 months Step Birth to 4-8 weeks 19  Premature Infants and Adjusted Age  Adjustedage is vital when assessing G & D of a premature infant  Chronological age is 6 months (24 weeks)  The infant was born at 28 weeks gestation  40 weeks is full term gestation  40 weeks – 28 weeks = born 12 weeks early  24 weeks – 12 weeks = adjusted age of 12 weeks (3 months). 20  Screening Tests and Disease prevention 21 Nurse Screenings  Hearing  Must be detected by 6 months to decrease developmental delay  Vision  Fix and follow an object by 2 months of age.  Weight & Body Mass Index (BMI)  Scoliosis  Screening begins with the adolescent. This is a time during rapid growth. 22  Additional Screenings  Metabolic  State of MA screens for 53 conditions. babysfirsttest.org  Iron-deficiency anemia  Deficiency can cause developmental delays  Lead  All children who live in areas of higher risk should be screened. Targeted screening is recommended by the CDC.  Hypertension  Recommended to begin by age 3 and with all children with risk factors.  Hyperlipidemia  Recommended to begin in late adolescence or with a family history of heart disease. 23  Maturation of Systems: Newborn to 12 months  Respiratory rate  Blood Pressure  30-60/min to 20-30/min  60/40 to 100/50  Irregular / periodic  Diaphragmatic breathing  Teething  Generally begins  Heart Rate around 6-8 months  120-140 to 100 /min  By 1 year: ~ 4-8  Sinus arrhythmia teeth.  HR ↑ with inspiration and ↓ with expiration 24  Maturation of Systems: Newborn to 12 months  Thermoregulation  Visual acuity   Binocularity (2 Response to cold → constriction of images fuse into 1) capillaries → ↓ cap begins by 6 weeks refill (>2 sec.) → & well established bradycardia by 4 months  Auditory  Depth perception acuity   At adult levels Begins at 7 months & may not mature until 3 years of age  ↑ risk of falls 25  Infant Nutrition  Introduce cows milk after 1  Breast milk is preferred year or:  Meets infants nutritional  It is difficult to digest requirements for the 1st 4- 6  Can cause iron deficiency months. anemia  May need iron supplement after 4 months   Food allergies Store in refrigerator x 5 days,  Increased risk if solids are freezer x 6 months introduced to early  Iron-fortified formula  Fluoride supplements after 6 months with ↓ fluoride in water  32 oz./day 26  Theory of Psychosocial Development Erik Erikson  Trust versus Mistrust (birth-1 yr.)  How to encourage growth  comforting a crying infant, feeding when hungry  Positive indicator: learns to trust others  Negative Indicator: mistrust and withdrawal 27  Theory of Cognitive Development  Jean Piaget  sensorimotor stage  Example: object permanence (4-8 months) = infant will search for a block hidden under a blanket 28  Motor Skill Development  Fine Motor  Develops in a proximodistal fashion  Will grab an object with the whole hand and then progress to using the thumb and finger  Review Table 3.4 p. 72  Gross Motor  Develops in a cephalocaudal fashion  Will learn to lift head before rolling over.  Review Table 3.3 p. 68 29 What to Expect…  Socialization, Language & Play  Separation anxiety  May start around the last few months of infancy  Stranger anxiety  May develop around 8 months 30  Infant Safety  Car Seat Safety  Rear-facing car seat in the back  Away from an air bag  Birth through age 2 for most  Leading cause of accidental injuries  falls children  ingestions  Check the owners manual for  burns weight and height limit.  Leading cause of accidental death  suffocation,  motor vehicle-related injury  drowning http://www.cdc.gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html 31  Growth and Development of the Toddler (1-3 years)  Height  Slow steady growth at about 3 inches/yr.  Weight  Birth weight quadruples by 2 ½ yr.  Slow and steady growth, 3-5 pounds/yr.  Posture and Gait  Wide-based gait  Abdomen protrudes, “pot-bellied” 32 Theory of Psychosocial Development  Erik Erikson  Autonomy versus Shame & Doubt (early childhood, age 1-3)  How to encourage growth  Encourage autonomy as child learns to be independent  Positive indicator: has self esteem and can express self  Negative Indicator: willfulness and defiance 33 Theory of Cognitive Development: Jean Piaget  Sensorimotor  (12-24 months)  Places items in and out of containers.  Preoperational  (2-7 years)  Sorts objects by shape and color. 34 Motor Development Gross Motor Kicks ball Throws ball overhead Walks up steps Fine Motor Scribbles Wiggles thumbs Builds tower of cubes 35  Language and Play  Language  About 300 words are acquired  Can understand speech much greater than the number of words the child can say  Play is the work of the child  Parallel play alongside, not with, other children  Imitation 36  Emotional & Social Development  Separation & Individuation  Separation from primary caregiver  Childs expression of their individual characteristics  Egocentrism  Focuses on self  Need to feel in control  Power struggles  Temper tantrums  Structure and routine helps  Security objects for comfort during times of stress  Separation anxiety  May reemerge 37  Sibling Toilet Rivalry Training Some Parental Concerns Negativism Temper Tantrums Regression 38  Dental Health  Make it FUN!  1st exam by age 1  Brushing and flossing should become routine  Toothette for oral care for bottle fed infants and intubated children Dental Caries  Tooth decay in children 18 months to 3 years, some causes…  Bottle or juice given to child at nap time  Lack of fluoride intake  Coating pacifiers with honey  Can also cause botulism 39  Injury Prevention  Accidental injuries are the leading cause of death among toddlers  Motor vehicle injuries  Car versus pedestrian  Drowning  Burns  Poisonings  Falls  Amputation 40  Car Seat Safety  Between ages 2-4/until 40 lbs  Forward-facing child safety seat  Back seat and buckled with seat harness  Check the owners manual for weight limit. http://www.safekids.org/ 41 Growth and Development of the Preschooler 42 Growth & Development of the Preschooler (3 to 6 years) Gross Motor Development  Height: 2.5-3 inches a year. Pedals tricycle  Weight: 4 - 5 lbs./year Balances on each foot  Teeth: all 20 baby teeth (deciduous) are present Fine Motor Development Copies circles Prints name 43 Theory of Psychosocial Development Erik Erikson  Initiative versus Guilt (Late childhood, preschooler, 3-6 years)  How to encourage growth  They are inquisitive learners, give opportunities to do things themselves  Positive indicator: Begins to evaluate one’s own behavior, right vs wrong  Negative indicator: lack of self confidence, fear of doing wrong 44 Theory of Cognitive Development: Jean Piaget  Preoperational Stage  2-7 years  Remains egocentric  Magical thinking  Imaginary friend 45  Socialization  Has increased attention span  Begins to learn simple games  Feeds self completely  Language  900 word vocabulary by 3 years  Uses complete sentences  Asks many questions 46  Safety During Play  Education is the key at this stage of development  Adult supervision needed  Danger of matches  Car safety  Booster seat ages 4-8 or until 4’9” tall  Back seat  Water safety  Street safety  Wear protective equipment  Parents as role models  Parents must practice what they preach 47 Growth and Development of the School Aged Child 48 Growth & Development of the School-Age Child (6-12 years)  Height: slow steady growth 2.5 inches/yr.  Weight: 7 pounds/yr.  Teeth: all of their primary teeth are lost during this age span 49  Theory of Psychosocial Development Erik Erikson  Industry versus Inferiority (school age, 6-12 years)  How to encourage growth  Encourage self-initiation to create and be productive  Positive indicator: Develops a sense of competence  Negative indicator: sense of not being good enough 50 Theory of Cognitive Development  Jean Piaget  Age 7-11  concrete operational thought- can organize facts about the world to use in problem solving  Example: A child’s thought process becomes more logical… “If I water my plant and put it in the sun then it will grow” 51  Socialization & Play  Play  Peer groups  A culture of rules and rituals  Team play  Quiet games and activities 52  Injury Prevention Mostcommon cause of severe injury or death is due to accidents Safety related to: Cars Seat restraint for age 8 and/or 4’9” tall Booster seat until adult seat belts fit properly Back seat for best protection Bicycles FYI: See attached web site for steps to properly fit a bicycle helmet Skateboards Skis ANY motorized vehicles: ATV’s, dirt bikes….. www.nhtsa.gov/staticfiles/nti/bicycles/pdf/8019_Fitting-A-Helmet.pdf 53 Growth and Development of the Adolescent D R. M E G H A N M C C R I L L I S N U R 2 0 1 P E D I AT R I C S 54 Growth & Development of the Adolescent (usually 11-20 years) A period of transition from childhood to adulthood  Early adolescence (10-13 years)  Middle adolescence (14-16 years)  Late adolescence (17-20 years) Some general physical changes throughout the adolescent period:  Female: Development of pubic hair, breast buds and first menses (9-16 years of age, average age 12), and rapid growth of height and weight.  Male: Development of pubic hair, enlargement of testes, scrotal skin darkens, voice changes, and rapid growth of height and weight. 55 Theory of Psychosocial Development Erik Erikson  Identity versus Role Confusion (adolescence, 10-20 years)  How to encourage growth  Offer support, answer questions  Positive indicator: they know who they are as a person and follows through with plans  Negative indicator: Confusion and has difficulty making decisions 56  Theory of Cognitive Development  Jean Piaget  10 – 20 years  formal operational thought- the adolescent can think abstractly  Example: Adolescent using scientific reasoning 57  Socialization and Play  Have peer groups  Best friends  School-related group activities/sports  Television  Technology  Develops interests in art, music etc. 58  Injury Prevention  Encourage and role model:  Seat belt use  Increaserisk for  Driver education death or serious  Discourage distractions injury   Largest number of Helmet use  Say no to drugs/alcohol injuries are related to motor vehicle crashes  Take safety measures with sport activities  Risk takers and feel  Gun safety indestructible = injuries  Water safety and death  Sports safety 59 Dr. Seuss Inspiration of the Day D R. M E G H A N M C C R I L L I S N U R 2 0 1 P E D I AT R I C S 60