Postpartum Care PDF

NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM POSTPARTUM PUERPERIUM ⮚ FOURTH TRIMESTER OF PREGNANCY ⮚ The 6-week interval:...

NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM POSTPARTUM PUERPERIUM ⮚ FOURTH TRIMESTER OF PREGNANCY ⮚ The 6-week interval: between the birth of the newborn and the return of the reproductive organs to normal non pregnant state wherein family members adjust to the presence of a new member of the family where a woman adjusts to her new role of being a mother to a young infant for the first time or again. MATERNAL ADAPTATIONS AFTER DELIVERY I. SYSTEMIC AND PHYSIOLOGIC CHANGES Reproductive system and associated structures ❖ INVOLUTION: Process whereby the reproductive organs return to their nonpregnant state. ✓ UTERUS o UTERINE INVOLUTION o Rapid reduction in size of the uterus and its return to nonpregnant state o Uterus descends 1-2 cm (1 fingerbreadth) every 24 hours o PROCESS INVOLVED 1. ISCHEMIA: Occurs as a result of collapsed blood vessels 2. AUTOLYSIS: Breakdown of the intracellular protein by proteolytic and hydrolytic enzymes 3. PHAGOCYTOSIS: Disposes of elastic/fibrous tissue o SUBINVOLUTION: Failure of the uterus to return to its prepregnant state Causes: retained placental fragment and infection o UTERINE ATONY ▪ Soft and weak uterus after childbirth ▪ Happens when your uterine muscles don’t contract enough to clamp the placental blood vessels shut after childbirth. ▪ Nursing Intervention: a. Fundal massage c. Promote breastfeeding b. Ice pack d. Oxytoxic medication ⚬ Levels and weight of the uterus ▪ End of 3rd stage of labor: 2 cm below umbilicus, wt.: 1,000 g ▪ 2-3 hrs to the next 24 hrs: raises to the level of umbilicus ▪ 6th PP day: halfway between symphysis pubis and umbilicus ▪ 7th PP Day: uterus lies in the true pelvis, 500 g wt. ▪ 9th PP day: not palpable abdominally ▪ 14th PP day: 350 g wt. ▪ 42nd PP day: 50-60 g wt. ⚬ CONTRACTIONS ▪ Increases after birth ▪ Strengthened by oxytocin hormone ▪ Breastfeeding stimulates oxytocin release ⚬ AFTERPAIN ▪ Cramping pain after childbirth caused by alternate and intermittent contraction and relaxation of uterine muscles NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM ▪ Aggravating factors: ▪ Nursing interventions:  Blood clot or placental fragment  Prone position with a small pillow retention under the abdomen  Breastfeeding  Analgesics  Reassure that it is self-limiting and decreases after 48 hours ✓ PLACENTAL SITE Reduced to an irregular nodular and elevated area d/t vascular constriction and thromboses Exfoliation Endometrial regeneration is completed by the end of the 2nd-3rd postpartum week Placental site regeneration is completed 6-7 weeks after birth ✔ Lochia Components: ⚬ Rubra (1-3 days): blood, deciduas debris, trophoblastic debris, mucus ⚬ Serosa (4-7 days): old blood (erythrocyte), leukocytes, tissue debris, mucus ⚬ Alba (7 days to 2 weeks): leukocytes, deciduas, epithelial cells, mucus, bacteria Amount ⚬ Scant - less than 1 inch stain ⚬ Ligh - 1 to 4 inch stain ⚬ Moderate - 4 to 6 inch stain ⚬ Large - saturated pad in 1 hour ⚬ Excessive - saturated pad in 15 minutes ✓ CERVIX Often soft and edematous immediately after birth 2 fingers can be introduced for the first 4-6 days 7th PP Day: external os has the width of a pencil Nulliparous: round opening Parous: slightly open and with slit-like appearance (fish mouth) ✓ VAGINA Edematous immediately after birth Hymen is permanently torn 3 weeks Post partum: vaginal mucosa heals and rugae are regained Needs 6 weeks for the vagina to return to its nonpregnant state The vagina does not entirely regain its nulliparous size Dyspaurenia ▪ 4-6 months ▪ due to decreased vaginal secretion secondary to delayed estrogen production because of lactation Sexuality Issues ▪ Postpone sexual intercourse until perineum is healed ▪ Explain that sexual arousal maybe ▪ Routine Kegel exercise daily slower ▪ Suggest use of water-soluble lubricant ▪ Suggest that intercourse be resumed ▪ Position: woman superior or side-by- in the morning or afternoon side ▪ Encourage verbalization of feeling to their partners NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM ✓ PERINEUM ▪ Maybe edematous and bruised ▪ Classification of perineal lacerations: ▪ Hemorrhoids are common and decreases a. First-degree within 6 weeks b. Second-degree c. Third-degree d. Fourth-degree ▪ Nursing interventions: Assess site: Icepacks for the first 24 hours to R - edness numb the area and decrease edema E - dema Hot sitz bath 2-3 times a day after 24 E - cchymosis hours D - ischarge Dry heat (peri-light)—20-min thrice a A - pproximation day; 40 watts bulb; 50 cm from the perineum ▪ Health teaching ⚬ Side-lying or sitting in a pillow ⚬ Squeeze buttocks together before sitting; Kegel exercises ▪ Medications as ordered ⚬ Change pad at least 4 times a day ⚬ Anesthetic spray ⚬ Perineal care ⚬ NSAIDS Breast ⚬ Nursing Interventions ▪ Engorgement: ▪ Wash nipples with water (no soap)  Breast binder or tight bra (if non- ▪ Dry nipples between feeding lactating) ▪ Wear comfortable bra  Ice packs  Mild analgesics Endocrine System 1. Placental and Pituitary Hormones ▪ Estrogen, progesterone, hPL and hCG level drops and reaches their lowest level after 1 week ▪ Decreased estrogen causes  Breast engorgement  Diuresis 2. Resumption of ovulation and menstruation a. Non-lactating women i. 7-9 weeks: return of menses among non-nursing mothers & those who don’t breastfeed < 28 days ii. Ovulation resumes after 3 months b. Lactating women i. Ovulation and menstruation occur as early as 3 months and as late as 18 months ii. First cycles are often anovulatory 3. Lactation o Hormones involved: ▪ Prolactin: milk production; prolactin suppresses FSH stimulation ▪ Oxytocin: milk ejection ▪ (“let down” reflex) o Occurs 2-3 days after childbirth due to prolactin hormone  NURSING INTERVENTION o Proper position NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM o Proper Latching ▪ Chin is touching the breast and can breathe through the nose ▪ Mouth is open wide and he has a mouthful of your areola ▪ Latch doesn’t hurt ▪ Starts with short sucks before sucking more slowly and deeply  Advantages of breastfeeding ⚬ Lowers your baby’s risk of certain ⚬ Increasing physical and emotional diseases and helps build a strong bonding immune system ⚬ Establishing trust ⚬ Quicker recovery from childbirth ⚬ Convenience ⚬ Low cost 4. Weight loss ⚬ 4.5-5.5 kg (10-12 lbs): approx wt. loss during childbirth ⚬ 2.3-3.6 kg (5-8 lbs): additional wt. loss due to diuresis in the early PP days ⚬ 6 months: average length of time to regain prepregnant weight Urinary 1. Physical changes Edematous and traumatized immediately after birth 12 to 24hrs: increased urine OU due to puerperial diuresis 2. Physiologic Change Risk for overdistention and retention a. UTI b. Postpartum hemorrhage 3. Signs of bladder distention Fundus is displaced from midline Excessive lochia Bladder discomfort Bulge of bladder above symphysis pubis Frequent voiding of less than 150 mL of urine Assess bladder for distention Stimulate voiding ⚬ Pour water over vulva or place water on hands ⚬ Encourage urinating during shower or hot sitz bath ⚬ Provide hot tea or fluid of choice ⚬ Let her hear running water or flushing of the bowl Bladder distention ⚬ Alternating warm and cold compress ⚬ Straight versus indwelling catheter ⚬ Frequent change in position Gastrointestinal ⚬ Hunger ⚬ Constipation Due to the after effects of decreased bowel tone, fluid and food restriction during labor, iron supplement, and fluid loss NURSING INTERVENTION: ⚬ Progressive exercise ⚬ Adequate fluid ⚬ Hot sitz bath ⚬ High fiber diet such as fruits and ⚬ Laxatives as ordered: docusate calcium vegetables (Surfak), docusate sodium (Colace), milk ⚬ Regular schedule of bowel elimination of magnesia, and bisacodyl (Dulcolax) NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM VITAL SIGNS: Temperature: BP: PR: Cardiovascular System 1. Cardiac Output ⚬ Transient increase in CO that persists for at least 48 hours due to ⚬ Increased flow of blood to the heart from the uteroplacental circulation ⚬ Mobilization of excess extracellular fluid to the intravascular compartment ⚬ CO return to normal 12 weeks after birth ⚬ Bradycardia is common 2. Elimination of Excess Plasma Volume ⚬ “Reversal of the water metabolism of pregnancy” ⚬ ways: ✓ Diuresis ▪ Due to decreased aldosterone and increased oxytocin production ▪ 1000 ml per day for the first few days is normal ✓ Diaphoresis (nocturnal, 2-3 days after birth) 3. Coagulation Increased fibrinogen and normal plasminogen Risk for thrombus formation Nursing interventions: ⚬ Early ambulation ⚬ Anti-embolic stockings 4. Blood values ⚬ Leukocytosis (increased WBC) of 30,000/mm3 (NV: 450-10,000/mm3) Neutrophils account for the major increase in WBC ⚬ Hematocrit returns to normal level after 3-7 days Neurologic ⚬ Headache may indicate worsening of PIH ⚬ After effects of anesthesia Musculoskeletal 1. Muscle and Joints Fatigue and aches Hip and joint pain due to decreasing relaxin hormone Edema will subside for the first and second days Homan’s sign—pain in the calf upon dorsiflexion of the foot; sign of DVT Nursing interventions: ⚬ Health teaching: it is temporary ⚬ Good body mechanics and correct posture 2. Abdominal Wall ⚬ Weak, soft and flabby ⚬ Nursing intervention: Postpartum Exercises Gradual and routine exercise Reach for the knees, Single knee roll, Abdominal breathing Double knee roll Combined abdominal breathing and Leg roll pelvic rock Arm raise Buttocks lift  NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM Integumentary ⚬ Skin discolorations and vascularities gradually fade to the pre-pregnancy state ⚬ Stretch marks gradually fade but do not dis ⚬ Increased hair loss for 3-4 months; regrowth generally occurs by 9 months after birth DANGER SIGNS AND SYMPTOMS THAT SHOULD BE REPORTED Fever Frequency, urgency or burning sensation on urination Localized area of redness, swelling, or pain in either Abnormal change in character of lochia breast that is not relieved by support or analgesics Localized tenderness, redness, swelling or warmth of Persistent abdominal tenderness the legs Feelings of pelvic fullness or pressure Swelling, redness, drainage from or separation of an Persistent perineal pain abdominal incision II. PSYCHOLOGIC CHANGES OF THE MOTHER PHASES OF PUERPERIUM 1. TAKING IN PHASE : Time of reflection Time 1-2 days Behavior Dependent Focus Self and meeting basic needs Maternal Task ✓ Reliance on others to meets needs for comfort, rest, closeness and nourishment ✓ Needs “mothering” ✓ Excited and talkative (needs an “audience”) ✓ Desire to review birth experience Nurse’s Task ✓ Remind to rest or ambulate ✓ Assist with breastfeeding ✓ Comfort measures 2. TAKING HOLD PHASE : Initiate action and mother make her own decisions Time 3-10 days or to several weeks Behavior Dependent-independent Focus Care of baby and competent mothering Maternal Task ⮚ Still need for nurturing and acceptance by others ⮚ Desire to “take charge” ⮚ Eagerness to learn and practice ⮚ Handling of physical discomforts and emotional changes ⮚ Possible experience with “blues” Nurse’s Task ✓ Comfort measures ✓ Health teaching on newborn care ✓ Approval of learning ✓ Assisting in coping Letting-go phase : Mother finally redefines her new role Time Behavior Interdependent Focus Forward movement of family as a unit with interacting members Maternal Task ⮚ Reassertion of relationship with partner ⮚ Resumption of sexual intimacy ⮚ Resolution of individual roles Nurse’s Task ⮚ For primi, assist in acknowledging their loss of carefree lifestyle ⮚ Assist in the acceptance of the real newborn (relinquish their fantasies) NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM PSYCHOLOGIC CHANGES 1. PARENTING Components: ⚬ Knowledge of and skill in child care activities ⚬ Valuing and comfort (attitude of tenderness, awareness and concern for the newborn’s needs and desires) ⚬ DEVELOPMENT OF PARENT AND INFANT ATTACHEMENT Level of Trust Level of Self-esteem Capacity for enjoying self Interest in and adequacy of knowledge about child bearing and child rearing Her prevailing mood and usual feeling tone Reactions to present pregnancy 2. BONDING Development of strong emotional tie of a parent to a newborn Sensitive period ⚬ First 30-60 minute period after birth; newborn is in a quite, alert state and seems to gaze directly at the parents 3. ATTACHMENT o DEVELOPMENT OF STRONG AFFECTIONAL TIES AS A RESULT OF INTERACTION BETWEEN NEWBORN AND A SIGNIFICANT OTHER o EN FACE POSITION: parent’s and infant’s face is approximately 20 cm o Reciprocal attachment behavior: Repertoire of newborn behaviors that promote attachment between parent and newborn ACQUAINTANCE PHASE ⚬ Mother tasks herself of getting to know her baby ⚬ Baby’s behavioral cues and responses will make the mother feel effective and competent MUTUAL REGULATION PHASE ⚬ Mother and infant seek to deal with the degree of control to be exerted by each in their relationship. ⚬ Balance between maternal need and infant’s need Reciprocal Attachment Behaviors o Prolonged mutual eye contact o Attempt to “trace” back parent’s face o Grasp and hold unto parent’s finger o Rooting, latching, and suckling o Be comforted by parent’s voice or touch 4. TOUCH o FINGERTIPPING o BRINGING NEWBORN CLOSER TO BODY (EX. CUDDLING) o CLAIMING OR BINDING IN COMMUNICATION BETWEEN PARENT AND NEWBORN 1. Touch: cuddling, patting, stroking 2. Eye contact: en face 3. Voice ⚬ Newborn can distinguish mother’s voice upon birth ⚬ Newborn cry 4. Odor ⚬ Mothers can distinguish the odor of their baby ⚬ Newborns can distinguish the odor of their mother’s breastmilk NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM 5. Movement of the newborn in a way that is coordinated with the rhythm of the mother’s voice 6. Biorhythmicity: Establishment of newborn’s personal rhythm 7. Reciprocity: Type of body movement or behavior that provides the observer with cue 8. Synchrony: “Fit” between the newborn’s cues and the parent’s response MATERNAL CONCERNS IN THE POSTPARTAL PERIOD 1. Abandonment A mother experiences a sensation very close to jealousy & how she can be a good mother be jealous to her own baby. 2. Disappointment As a result of congenital conditions. 3. Postpartal Blues Feelings of overwhelming sadness DISCHARGE INSTRUCTIONS Work: no lifting or straining for eat least 3 weeks Coitus Rest Contraception Exercise/activity: Home medications Hygiene; daily bath/shower; antibiotic ointment to Follow-up the perineal area after perineal care; METHODS OF FAMILY PLANNING ✔ Contraception ✔ Informed consent responsibilities: B-enefits: advantages and success rates R-isks: disadvantages and failure rates A-lternatives: other available methods I-nquiries: opportunity to ask questions D-ecisions: opportunity to decide and change mind E-xplanations: information about method, how it is used D-documentation NATURAL METHODS a. Abstinence b. Lactation amenorrhea method ⚬ Use other contraception method after 4-6 months c. Coitus interruptus (withdrawal) ⚬ not used anymore d. Fertility awareness method ❖ Calendar method Determine the longest and shortest length of menstrual cycle over a period of six months Subtract 18-21 days from the shortest cycle and 9-11 days from the longest cycle Abstain or use other methods during the identified period Contraindicated to women with anovulatory periods, adolescents, women approaching menopause, women who have recently given birth ❖ Two-day method ❖ Cycle bead method o Standard Days Method o Effective only to women with a cycle of not less than 26 and not more than 32 days ❖ Basal body temperature o based on the principle of identifying the thermal shift in the body temperature that occurs normally around the time of ovulation o BBT—lowest normal temperature of a healthy person, taken immediately after waking and before getting out of bed NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM ❖ Cervical mucus method ⚬ Billing’s or Creighton ovulation method ⚬ Thick and does not stretch easily before ovulation ⚬ Spinnbarkeit ❖ Symptothermal method ⚬ combination of BBT and Billing’s method ❖ Ovulation predictor test ⚬ detects midcycle surge of luteinizing hormone that can be detected in the urine 12-24 hours before ovulation ARTIFICIAL METHODS ❖ Hormonal methods Combination oral contraceptives (“the pill”) o Estrogen + progestin o Available in 21- or 28-day pack ▪ 21-day pack ▪ 28-day pack Contraindications Thrombophlebitis and thromboembolic Diabetes with pathologic complications disorders or DM for 20 years History of heart disease or CVA Undiagnosed vaginal bleeding Impaired liver function Suspicion of or confirmed pregnancy Breast cancer Smoking pattern of more than 15 Breastfeeding and less than 6 weeks cigarettes/day in women >35 years postpartum Warning signs of oral contraceptive complication A-bdominal pain—benign liver tumor, gall bladder disease C-hest pain, dyspnea, hemoptysis—pulmonary embolism, MI H-eadache severe, weakness or numbness of extremities stroke E-ye problems (blurring, double, loss of vision)—stroke S-evere leg pain or swelling—deep vein thrombosis ❖ Progestin-only pills (“minipill”) Contain only progestin ❖ Hormonal injections ❖ Depot Medroxyprogesterone Acetate (Depo-Provera) First shot given at first 5 days of menstrual cycle then every 11-13 weeks for the succeeding injections Do not massage the injection site. It could hasten the absorption causing a shorter period of effective contraception Side effects: amenorrhea, weight gain, headache ✔ Combined monthly hormonal injection (Lunelle) Combination of progestin and estrogen which works by causing the cervical mucus to thicken and the endometrial lining to thin ❖ Hormonal implants: ✔ Single rod hormonal implant (Implanon) ⚬ Duration: 3 years ✔ Six rod hormonal implant (Norplant) ⚬ Duration: 5 years ❖ Transdermal patch (Ortho Evra) ✔ Progestin and estrogen ✔ Duration of effect: 3 weeks; ✔ Areas of application: NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM ❖ Vaginal Nuval Ring ✔ A soft flexible ring that contains estrogen and progestin ✔ Placed once month and removed after 21 days to allow menstruation ❖ Intra-uterine device ✔ A small T-shaped device inserted into the uterine cavity ✔ Types: ⚬ Copper: effective for 4-10 years ⚬ Progestin-releasing: effective for 5-7 years ✔ Signs of potential complication: ⚬ P-eriod late, abnormal spotting or bleeding ⚬ A-bdominal pain, pain with intercourse ⚬ I-nfection exposure, abnormal vaginal discharge ⚬ N-ot feeling well, fever, chills ⚬ S-tring missing, shorter or longer string ✔ Side effects: cramping and bleeding upon insertion, PID, uterine perforation BARRIER METHODS 1. Spermicides (nanoxynol-9) Provides physical and chemical barrier to the sperm Aerosol foams, foaming tablets, suppositories, creams, gels Inserted in the vagina a few hours before intercourse May create irritation and mucosa breakdown increasing the risk for infection 2. Male condom Thin, stretchable sheath that covers the erect penis during sexual intercourse Features: absence or presence of sperm reservoir tip, lubricant, spermicide, contoured/rippled/roughened outer surface Disadvantages: 3. Female condom Thin tube made of polyurethane with flexible rings at both ends Common disadvantage: 4. Diaphragm A shallow dome-shaped latex rubber devise with a flexible, circular wire rim that fits over the cervix 5. v. Cervical cap Smaller than diaphragm Should remain 6-8 hours but not more than 48 hours after intercourse PERMANENT METHODS (STERILIZATION) a. Tubal ligation Cutting the fallopian tube b. Vasectomy Cutting of the vas deferens Use other birth control methods for the first month or during the first 10-20 ejaculation after the operation NCM 107: CARE OF MOTHER, CHILD, ADOLESCENT (Well Clients) TOPIC 4: POSTPARTUM FAMILY ADAPTATION 1. Rooming in: Space to keep the infant with the parents 2. Paternal adjustment: Intense fascination and close face-to-face observation between father and newborn 3. Siblings and others STAGES OF FATHERHOOD 1. EXPECTATIONS: Father has preconceptions about what life will be like after baby comes home 2. REALITY: Father realizes that expectations are not always based on fact Common feelings experienced: sadness, ambivalence, jealousy, frustration, overwhelming desire to be involved Some fathers are pleasantly surprised at ease and fun of parenting 3. TRANSITION MASTERY: Father makes conscious decision to take control and become more actively involved with infant APPROPRIATE NURSING DIAGNOSES FOR THE POSTPARTAL PERIOD 1. Risk for infection 9. Ineffective breastfeeding 2. Constipation 10. Risk for fluid volume deficit 3. Urinary retention 11. Fatigue 4. Sleep pattern disturbance 12. Anxiety 5. Health-seeking behavior 13. Altered family processes 6. Pain 14. Altered parenting 7. fear 15. Risk for situational low self esteem 8. Risk for injury 16. Body image disturbance TRANSCULTURAL N URSING : HEALTH BELIEFS & PRACTICES OF DIFFERENT CULTURES IN PREGNANCY , LABOR DELIVERY , PUERPERIUM A. Communication Interpreter may be needed Latinas, middle eastern, and asians— Muslim—cover hair, bodies, arms to wrists, and legs to ankles Latinas and native americans—direct communication can be distressing; polite and gracious comments as a starter B. Dietary practices Mexican, southeast asians, chinese, korean—eat “hot” foods such as eggs, chicken and rice Chinese—combined yin and yang foods Indian—dried ginger to control postpartum bleeding and cleanse the uterus Muslim— C. Contraception Chinese—iud at birth, no hormonal method of contraception Saudi arabian, hispanic—rhythm method Indian men—vasectomy Hmong—no birth control practices D. Health beliefs Muslim—parents say a prayer from the koran to the ear of the baby at the time of birth; Middle east needs compliments to allah and will be converted to blessing so that mistrust and jealousy and does not occur Southeast asians—spirits reside in the head; colostrum is “unclean” Haiti, filipinos— Latinas—mother should be kept warm Guatemalan—colostrum is bad for baby  Maternal and Child: Nursing Care of a Family with a Toddler Submitted by: C21 Abellera, Shaolimae Ynsha Al-haddad, Abdulrahman Bañiaga, Christine A. Berzabal, Kimberly Shane Comesario, Trisha Mae Cube, Elizabeth Khy D. Fanig, Jenie Rose Gaayon, Marianne Destiny Laita, Kurlin Faye O. Punay, Kristina Cassandra Tojeno, Bianca Diane  DEVELOPMENT MILESTONE OF TODDLERHOOD KEY TERMS: Autonomy- independence Deferred Imitation- toddlers are able to remember an action and imitate it later Lordosis- forward curve of the spine at the sacral area Parallel Play- side by side play, toddlers play beside other children, not with them Preoperative thoughts- toddlers enter a second major period of cognitive development Punishment- consequence that results from breakdown of discipline or the child’s disregard of the rules that were ruled Discipline- setting rules or road signs so children know what is expected of them Assimilation- because children are not able to change their thoughts to fit a situation, they learn to change the situation (or how they perceive it)  ACCORDING TO DEVELOPMENTAL THEORIES PSYCHOSEXUAL DEVELOPMENT ❖ Libido is focused on the anus, and the child derives great pleasure from defecating. ❖ AUTONOMY Develop sense of independence ❖ SHAME AND DOUBT Commonly told not to Made to feel it wrong to be independent COGNITIVE DEVELOPMENT ❖ 12-18 months ○ Substage 5: tertiary circular reactions ○ trial-and-error manner, using both motor skills and planning abilities ❖ 18-24 months ○ Appearance of symbolic or representational thought. ○ Solve problems using mental strategies ❖ 2-3 years old ○ PREOPERATIONAL THOUGHT (2-7 YEARS OLD) ○ Begin to think symbolically and learn to use words and pictures to represent objects ○ Tend to be egocentric and struggle to see things from the perspective of others PHYSICAL GROWTH OF NORMAL INFANT ❖ Average weight gain 1.8 to 2.7 kg/year ❖ Formula to calculate the normal weight of children over 1 year AGE IN YEARS X 2+8 = __ kg E.g. The weight of a child aged 4 years = 4 y/o x 2 + 8 = 16 kg ❖ 1-2 years HT increases by 1 cm/month. Increases 10-12.5 cm/year ❖ Formula Age in years x 5 + 80 = __ cm E.g. The length of 2 years old child = 2 y/o x 5 +80 = 90 cm ❖ The head increases 10 cm only from the age of 1 year to adult age.  ❖ During toddler years, chest circumference continues to increase in size and exceeds head circumferences ❖ By 2 years of age, the toddler has 16 temporary teeth. ❖ By the age of 30 months (2.5 years), the toddler has 20 teeth. ❖ PR: 80-130 bpm (average 110 bpm) ❖ RR: 20-30 cpm ❖ Bowel and bladder control Daytime control of bladder and bowel control by 24-30 months BODY SYSTEM ❖ Respirations slows slightly but continue to be abdominal. ❖ Lumens of vessels enlarge progressively so the threat of lower respiratory infection becomes less. ❖ The brain develops to about 90% of its adult size. CHARACTERISTICS OF A TODDLER 1. NEGATIVISM Favourite word “NO” Way to search for independence Eliminated by limiting questions Modify questions to a statement 2. RITUALISTIC, RIGID, AND STEREOTYPE Ritualism - mastering 3. TEMPER TANTRUMS Head banging, screaming, stamping of foot, holding breath Ignore behaviour 4. PHYSIOLOGIC ANEMIA 5. TOILET TRAINING - unreadiness GROSS MOTOR DEVELOPMENT ❖ 15 months ○ Walk alone ○ Creep upstairs ○ Assume a standing position without falling ○ Hold a cup with all fingers ○ Grasped around it ❖ 18 months ○ Run and jump in place ○ Walk up and down the stairs holding onto a person’s hand or railings ○ Both feet on one step before advancing ❖ 24 months ○ Walks upstairs alone still using both feet on one step at the same time ❖ 30 months ○ Jump with both feet ○ Jump from a chair or step ○ Walk up and down stairs one foot on a step ○ Drink without assistance FINE MOTOR DEVELOPMENT ❖ 15 months ○ Puts small pellets into small bottles ○ Scribbles voluntarily with pencil or crayon ○ Holds spoon well ❖ 18 months  ○ No longer rotates a spoon to bring it to mouth ❖ 24 months ○ Can open doors by turning door knobs, unscrew lids ❖ 30 months ○ Make simple lines or strokes for crosses with a pencil ❖ 36 months ○ Unbutton buttons ○ Draw a cross ○ Ride a tricycle ❖ 1 year old ○ Transfer objects from hand to hand ❖ 2 years old ○ Can hold a crayon and colour vertical strokes ○ Turn the page of a book ○ Build a tower of six blocks ❖ 3 years old ○ Copy a circle ○ Cross – build using small blocks LANGUAGE ❖ 15 months ○ 4 to 6 words ❖ 18 months ○ 7-20 words ○ Uses jargoning ○ Names 1 body part ❖ 24 months ○ 50 words ○ 2 word sentences ○ "Daddy go", "Me come" ❖ 30 months ○ Verbal language increasing steadily ○ Knows full name, can name 1 color ○ Holds finger to show age ❖ 36 months ○ Knows full name and gender ○ Speaks fluently ○ 300-900 words PLAY ❖ 15 months ○ Can stack 2 blocks ○ Enjoys being read to ○ Drops toys for adult to recover (exploring sense of permanence) ❖ 18 months ○ Imitates household chores, ○ Begins parallel play (playing beside another children) ❖ 24 months ○ Evident Parallel play ❖ 30 months ○ Spends time playing house, ○ imitating parents' actions  ○ "rough-housing" ○ Active play Parallel play 30 months ○ Playing alongside not with another ○ Provide similar toys ○ Toys: push-pull toys (best), squeaky frog, waddling duck to pull, building blocks, pounding peg ○ Toys to ride on - tricycle FEAR ❖ Separation Anxiety ○ Begin at 9 months ○ Peak at 18 months ❖ 3 Phases of Separation Anxiety: ○ P – protest ○ D – despair ○ D – denial ❖ Management: ○ Don’t prolong goodbyes ○ Say goodbye firmly, say when you’ll come back EMOTIONAL DEVELOPMENT ❖ 12-18 months ⚬ “Terrible twos” may begin; ⚬ Willful, stubborn, tantrums ❖ 18-36 months ⚬ Feel pride when they are “good” and embarrassment when they are “bad” ⚬ Recognizes distress in others – beginning of empathy ⚬ Emotionally attached to toys or objects for security ❖ 18 months ⚬ Height of possessiveness ⚬ Favourite word – “mine” ❖ 1-3 years old ⚬ Mastery of body and rudimentary ⚬ mastery of environment (can get others to take care of him) COGNITIVE DEVELOPMENT ❖ 15 months ⚬ Learns through imitating complex behaviours ⚬ Knows objects are used for specific purposes ❖ 2 years old ⚬ 2 word phrases ⚬ Uses more complex toys and understands sequence of putting toys, puzzles together ❖ Up to 2 years old ⚬ Toddler uses his senses and motor development to different self from objects. ❖ 2 to 3 years old ⚬ Pre-conceptual phase of cognitive development (2-4 years) SOCIAL DEVELOPMENT The development of autonomy during this period is centered around toddlers' increasing abilities to control their bodies, themselves and their environment. "I can do it myself" Notice sex differences and know own sex ❖ 2 years old ⚬ Terrible 2 ❖ 3 years old ⚬ Terrible 3 ⚬ Learns how to share NUTRITION Sedentary Toddlers: Approximately 1,000 kcal daily. Active Toddlers: May require up to 1,400 kcal daily. 3 meals/day Encourage foods rich in Protein and Carbohydrates Less sugar Foods rich in fats are not restricted until age 2 >2 y/o: Total fat intake of 30% to 35% SLEEP 8-12 hours/night 1-2 naps per day Ready to sleep alone; ensure safety TOILET TRAINING ❖ Preparation for toilet training ○ Able to control rectal and urethral sphincters, usually achieved at the time they walk well. ○ Cognitive understanding of what it means to hold urine and stools until they can release them at a certain place and time. ○ Desire to delay immediate gratification for a more socially accepted action. ❖ 18 months ○ Bowel control is achieved ❖ 24 months ○ Daytime bladder control achieved ❖ 36 months ○ Nighttime bladder control achieved DEVELOPMENTAL MILESTONE ❖ 13 months ○ Casting objects ○ Walks without support ○ Single words ❖ 15 months ○ Feeds self from cup  ○ Domestic mimicry ❖ 18 months ○ Casting stops ○ Tower of 3 ○ Walking well ○ Scribble ❖ 2 years ○ Joins 2/3 words ○ 50 words ○ Runs well,climbs, stairs ○ Cubes tower 6 or 7 ❖ 3 years ○ Mainly dry by day +/- night ○ Dresses & undresses fully ○ Climb stairs- alternate feet TEETHING Temporary teeth - 20 complete; posterior molar last to erupt Toothbrushing - 2-2 ½ years Bring to dentist (2-3 years) or when temporary teeth are complete Tooth brushing with little assistance -3 years Tooth brushing alone -6 years HEALTH CONCERNS AND RISKS OF A TODDLER Need for close supervision Curiosity Poisonings Auto safety ISSUES IN PARENTING -TODDLER (EMOTIONAL DEVELOPMENT) Stranger anxiety - should dissipate by age 2 h to 3 years Temper tantrums: occur weekly in 50 to 80% of children - peak incidence 18 months -most disappear by age 3 Sibling rivalry: aggressive behaviour towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training - END -  1 Growth and Development of Preschoolers (3-5 years old) Submitted by C22 ALEGOYOJO, Princess Joy BOGUEN, Tyra Adrianne CASTANEDA, Sean Matthew DAYWAN, Carina GARCIA, Venus Jasmin M. JACO, Jheraldyn LINGUTAN, Justin Alyandra PACIO, Gwyneth RIVERA, Raenalyn TULINGAN, Jherine Kaye VILLAFUERTE, Jacob Dylan October 22, 2024  2 Growth and Development of Preschoolers (3-5 years old) A. Developmental Milestone Developmental milestones serve as indicators of a child's growth from early childhood (Misirliyan et al., 2023). Most delays resolve on their own (Cleveland Clinic, 2023). Developmental delays may have a chance to progress into more serious issues. It is essential to seek help immediately if you have concerns about your child's development (Cleveland Clinic, 2023). 2. PSYCHOSOCIAL DEVELOPMENT: INITIATIVE VS. GUILT ❖ INITIATIVE - Asserting control and power over the environment. - Allow social role identification; B. Developmental Theories Secure and confident. A theory is a systematic statement of principles ❖ GUILT that provides a framework for explaining some - Disapproval, resulting in a sense phenomenon. Developmental theories provide of guilt. road maps for explaining human development. VIRTUE: Purpose 1. PSYCHOSEXUAL DEVELOPMENT: 3. COGNITIVE DEVELOPMENT ❖ Libido is focused on genitals as the primary source of pleasure. PREOPERATIONAL STAGE (2-7 years) ❖ Gender roles and moral development are ❖ Begin to think symbolically and learn to central. use words and pictures to represent ❖ Understanding of anatomical sex objects. differences begins to form, sparking a ❖ Tend to be egocentric and struggle to see complex mixture of emotions. things from the perspective of others. ❖ Resolved through identification. ❖ Getting better with language and ❖ OEDIPUS COMPLEX thinking, but still tend to think in very conflict arises because the boy concrete terms. develops sexual (pleasurable) desires for his mother. SUBSTAGES ❖ CASTRATION ANXIETY ❖ The Symbolic Function Substage (2-4 yrs) Resolved by identification. - Able to mentally represent an ❖ ELECTRA COMPLEX object that is not present and Girl unconsciously cultivates a sexual dependence on perception in attraction towards her father, viewing her problem solving. mother as a competitor. ❖ The Intuitive Thought Substage (4-7 yrs) Penis envy.  3 - Greater dependence on Intuitive ❖ The bladder is easily palpable above the thinking rather than just symphysis pubis. perception. ❖ Voiding is frequent enough (9 or 10 times a day) ❖ Muscles are noticeably stronger and make 4. MORAL DEVELOPMENT: (LAWRENCE activities. KOHLBERG) PRE-CONVENTIONAL LEVEL ❖ Many children at the beginning of the Stage 2 (Individualism and period exhibit genu valgus (knock-knees); Exchange) this disappears with increased skeletal 4-7 years old growth at the end of the preschool Account for individual points of period. view and judge actions based on how they serve individual needs. TEETHING Reciprocity is possible only if it serves one's own interests. Children generally have all 20 of their deciduous teeth by 3 years C. Physical Growth Development and Body of age. System Preserving these teeth is Physical Growth important as they hold the position for the permanent teeth ❖ Definite change in body contour occurs as the child’s jaw grows larger wide-legged gait, prominent (Mueller, 2008). lordosis, and protuberant abdomen of the toddler change D. Gross Motor Development to slimmer, taller, and much 3 YEARS OLD more childlike proportions. Contour changes are so definite ❖ Runs that future body type: ❖ Alternates feet on stairs Ectomorphic (slim) ❖ Rides tricycle Endomorphic (large) ❖ Stands on one foot ❖ Weight gain is slight during the preschool 4 YEARS OLD years: the average child gains only about 4.5 lbs (2 kg) a year. ❖ FURIOUS 4 ❖ Height gain is also minimal during this ❖ Noisy, stormy, aggressive period: only 2 to 3.5 in (6 to 8 cm) a year ❖ Constantly in motion on average. ❖ Jumps ❖ Not routinely measured at physical ❖ Skips assessments on children over 2 years. 5 YEARS OLD Body System ❖ FRUSTRATING 5 ❖ Throws overhand ❖ Lymphatic tissue begins to increase in ❖ Jumps over low obstacles. size, particularly the tonsils, and levels of E. Fine Motor Development IgG and IgA antibodies increase. ❖ Physiologic splitting of heart sounds may 3 YEARS OLD be present for the first time on ❖ Undress self auscultation; innocent heart murmurs ❖ Stacks tower of blocks may also be heard for the first time. ❖ Draws cross ❖ Pulse rate decreases to about 85 beats per minute. 4 YEARS OLD ❖ Blood pressure holds at about 100/60 mm ❖ Can do simple buttons Hg. ❖ Copy a square  4 Intensified fear due to keen imagination ○ Fear of animals 5 YEARS OLD ○ Fear of thunderstorms ❖ Draws 6-part man ○ Fear of medical Procedures ❖ Can lace shoes I. Emotional Development ❖ Copy triangle Learning new things is fun for a child with F. Language a well-developed sense of initiative During the preschool years, children expand their Criticism or punishment leads to a sense vocabulary and start using longer, more complex of guilt for wanting to try new activities, sentences. They become better at problem-solving affecting future decision-making. Expose a child to a wide variety of and can discuss topics beyond the immediate experiences and play materials. moment, including events from the past and future possibilities. Imitation - Free rein to imitate the roles of people around them. 3 years old Fantasy vs. Reality - Begins to differentiate ○ Vocabulary of 900 words between fantasy and reality. "Magical Thinking" is 4 years old believing thoughts and wishes can come ○ Vocabulary of 1500 words ○ Knows four basic color Gender Roles -Familiarize with opposite gender role ○ Sing songs or poem from memory J. Cognitive Development 5 years old INTUITIONAL THOUGHT ○ Vocabulary of 2100 words Broken Fluency Lack insight to view themselves as others ○ Repetition and prolongation of see them. sounds, syllables and words Centering: put themselves in another's ○ “I-I-I want a n-n-new place. spoon-spoon-spoon.” CONSERVATION - Unaware of the property of ○ SECONDARY STUTTERING conversation G. Normal Play Ego-centric, illogical, magical thinking 3 years old Explosion of vocabulary; learning syntax, ○ Able to take turns grammar; understood by 75% of people ○ Very imaginative by age 3 4 years old Poor understanding of time, value, ○ Major activity is PRETENDING sequence of events 5 years old Vivid imaginations; some ○ Likes game with numbers or Difficulty separating fantasy from reality letters Accurate memory, but more suggestible than older children H. Fear Primitive drawing, can't represent Fear of the dark themselves in drawing till age 4 Don't realize others have different Heightened by vivid's imagination perspective Fear of mutilation Leave out important facts May misinterpret visual cues of emotions Intense reaction to even a simple injury Receptive language better than expressive Doesn't know which body parts are till age 4 essential and which ones can be easily replaced. Fear of abandonment  5 K. Social Development L. Nutrition Not likely to have ravenous appetite Play: Cooperative, imaginative, may Offer small servings of food involve fantasy and imaginary friends, Decrease snacking takes turns in games Less Sugar Develops gross and fine motor skills; Offer variety of foods Social skills; experiment with social roles; reduces fears Wants to please adults DAILY ACTIVITIES Development of conscience: DRESSING Incorporates parental prohibitions; feels Prefer bright colors or prints guilty when disobedient SLEEP Simplistic idea of "good and bad" More aware of their need behavior EXERCISE Curious about his and other's bodies, may Active phase masturbate Rough housing No sense of privacy Time-honored games Primitive, stereotypic understanding of gender role HYGIENE Promote hand hygiene, cleaning of L. Moral and Spiritual Development fingernails Determine right from wrong based on Needs assistance in cleaning ears their parents' rules. Little understanding CARE OF TEETH of the rationale for these rules BRUXISM (Night Grinding): Begin to have an elemental concept of During sleep God if provided with some form of Way of "letting go" religious training. DISCIPLINE Belief in an outside force aids in the Time ou development of conscience Preschoolers tend to do good out of Common Health Problems self-interest rather than because of strong Major cause of death: automobile spiritual motivation accidents, poisoning and falls Increase incidences of colds, ear infections and flu POSSIBLE ACCIDENTS GI disturbances Motor vehicles, Falls, Drowning, Animal bites M. Sleeping pattern Poisoning, Burns ❖ Sleep Requirement Community safety 10 to 13 hours of sleep in a 24-hour period, some might also General have a day nap of about an hour.  6 the number of day-time naps will supportive discipline. gradually reduce and stop by the Consistency in setting limits time they start school. helps children understand expectations. ❖ Common Sleep Challenges: ❖ Independence vs. Supervision Nightmares and Night Terrors can Preschoolers want to do tasks by disrupt sleep and cause night themselves but still need close awakenings supervision, creating a balance Children may seek comfort and challenge for parents. call for parents or climb into bed, ❖ Emotional Regulation depending on family dynamics Preschoolers are learning to (Better Health Channel, 2023). manage emotions, leading to tantrums and emotional Creating a Positive Sleep Environment for outbursts. Parents need to model Preschoolers calm behavior and guide children Importance of Security and Love in expressing emotions healthily. Understanding and Communication ❖ Fostering Social Skills Sleep Tracking Helping preschoolers develop Night-Time Bedwetting in Preschoolers sharing, taking turns, and cooperative play is key. Parents should encourage playdates and group activities. ❖ Screen Time Overuse of screens can impact sleep and behavior. Parents should limit screen time to appropriate educational content and ensure it doesn’t interfere Night-time bedwetting is prevalent as with sleep or physical play. preschoolers transition away from overnight nappies. O. Behavior Variation It can lead to increased waking during the TELLING ALL TALES night. Bedwetting is a normal part of physical Stretching stories to make it more and emotional development. interesting Most children will outgrow bedwetting as Caution not to encouragem they mature. IMAGINARY FRIENDS Even if preschoolers use the toilet or potty during the day, they might still wet Normal creative part of age group the bed at night. DIFFICULTY SHARING REGRESSION Causes of Bedwetting Deep Sleep Some preschoolers, generally in relation Increased Urine Production to stress, revert to behavior they Small Bladders previously outgrew, such as Family History thumbsucking, negativism, bedwetting, ADHD and inability to separate from their parents, fetal position, baby talk. N. Issues in Parenting SIBLING RIVALRY ❖ Discipline and Limit Setting Preschoolers test boundaries as Prepare for new sibling part of their developmental SEX EDUCATION growth, requiring firm yet  7 https://www.mayoclinic.org/healthy-li BATHROOM LANGUAGE festyle/childrens-health/in-depth/child MASTURBATION -development/art-2 Sign of boredom Misirliyan, S. S., Boehning, A. P., & Shah, M. Divert attention - offer a toy (2023, March 16). Development Curious, creative, imaginative, imitative Milestones. PubMed; StatPearls Favorite words - why and how Publishing. Complexes - identification to parent of https://www.ncbi.nlm.nih.gov/books/ same sex and attachment to parent of NBK557518/ opposite sex Pillitteri, A. (2010). Maternal and child health nursing: Care of childbearing and REFERENCES childrearing families (6th ed.). Wolters Kluwer. Better Health Victoria. (2023) Typical sleep behavior (3-5 years). Retrieved from Professional, C. C. M. (2024, May 1). Gross https://www.betterhealth.vic.gov.au/h motor skills. Cleveland Clinic. ealth/HealthyLiving/typical-sleep-beha https://my.clevelandclinic.org/health/ viour-preschoolers-3-5-years articles/gross-motor-skills Cleveland Clinic. (2023, March 27). Raising Children Network. (2023). Preschooler Developmental delays. Cleveland sleep: What to expect. Retrieved from Clinic. https://raisingchildren.net.au/prescho https://my.clevelandclinic.org/health/ olers/sleep/understanding-sleep/presc diseases/14814-developmental-delay-i hooler-sleep n-children Raising Children Network. (2024). Preschooler Foley, M., & Pillitteri, A. (2010). Study guide to behavior: What to expect. Retrieved accompany maternal & child health from nursing: care of the childbearing & https://raisingchildren.net.au/prescho childrearing family. Wolters olers/behaviour/understanding-behavi Kluwer/Lippincott Williams & Wilkins. our/preschooler-behaviour Language development: 3-4 years. (2023, American Academy of Pediatrics. (2019). Caring December 19). Raising Children for Your Baby and Young Child: Birth to Network. Age 5. Bantam. https://raisingchildren.net.au/prescho Berk, L. E. (2013). Child development (9th ed.). olers/development/language-develop Pearson Education. ment/language-3-4-years Hendrick, J. (2016). Total learning: Language development: 4-5 years. (2023, Developmental curriculum for young December 19). Raising Children children. Pearson Education. Network. Hill, H. (2010). Child development: A topical https://raisingchildren.net.au/prescho approach. Sage Publications. olers/development/language-develop ment/language-4-5-years Lerner, R. M., & Ciervo, L. N. (2014). Concepts and theories of human development Language development in preschoolers. (n.d.). (4th ed.). Routledge. https://naitreetgrandir.com/en/step/3 -5-years/reading-language/language-d evelopment-in-preschoolers/ Mayo Clinic. (n.d.). Child development and parenting guidance for preschoolers. Retrieved from  DEVELOPMENTAL MILESTONE - FINAL TERM: SCHOOL AGE ACCORDING TO DEVELOPMENTAL THEORIES IMMUNE SYSTEM PSYCHOSEXUAL DEVELOPMENT Immunoglobulins IgG and IgA reach adult levels, boosting immune function. Dormant stage; sexual impulses are repressed. Lymphatic Tissue: Continues growing up to about age Focus shifts to education, social relationships, and 9, supporting immune system maturation. other skills necessary for adult life. Fixation may lead to insecurity and social isolation. RESPIRATORY SYSTEM PSYCHOSOCIAL DEVELOPMENT Frontal Sinuses: Begin developing around age 6, becoming part of the maturing sinus structure. INDUSTRY VS. INFERIORITY (6-11 years) ○ Industry: Develops a sense of pride in CARDIOVASCULAR SYSTEM accomplishments and abilities. ○ Inferiority: Failure results in feelings of Left Ventricle: Enlarges to efficiently pump blood to inferiority. the growing body. ○ Virtue: Competence; belief in their abilities to handle tasks. SEXUAL MATURATION COGNITIVE DEVELOPMENT Hormonal Activity: Hypothalamus and anterior pituitary gland (APG) begin producing gonadotropic CONCRETE OPERATIONAL STAGE (7-11 years) hormones. ○ Begin thinking logically about concrete Onset: Typically occurs between 10 and 14 years. events. Maturity: ○ Start understanding the concept of ○ Females: 12 to 18 years conservation. ○ Males: 14 to 20 years ○ Thinking becomes more logical and organized, but remains concrete. SPECIFIC CONCERNS FOR GIRLS ○ Begin using inductive logic, reasoning from specific information to a general principle. Growth Patterns: Prepubertal girls are usually taller than boys by around 2 inches (5 cm). PHYSICAL GROWTH Pelvic Development: Pelvis broadens, which may appear as weight gain. Growth is slow and steady. Breast Development: Can vary, with some girls Physical activities aid in developing gross and fine experiencing under- or over-development. motor skills. Menarche: Generally occurs around 12 years. Motor and perceptual motor skills become more integrated. Signs of Sexual Maturation in Girls Eye-hand coordination improves, allowing more accurate reading, drawing, and writing. I - Increase in breast size and genitalia (telarche). Enjoyment of games/activities that require skillful W - Widening of hips. running and jumping. A - Appearance of axillary and pubic hair Weight: Increases by 3 to 5 lbs (1.3 to 2.2 kg) per year. (adrenarche). Height: Grows by 1 to 2 inches (2.5 to 5 cm) per year. M - Menarche, the last sign of sexual maturity. ○ Knock-knees and lordosis are typically outgrown in this age group. ○ Posture becomes more erect. SPECIFIC CONCERNS FOR BOYS VITAL SIGNS Genital Growth: Increase in genital size. Gynecomastia: Temporary breast enlargement may Pulse Rate: 70 to 80 beats per minute. occur. Blood Pressure: Around 112/60 mm Hg. Body Hair: Growth of body hair, including facial hair. Nocturnal Emissions: Begin during this stage as a sign BODY SYSTEM DEVELOPMENT IN SCHOOL-AGE of maturity. CHILDREN Signs of Sexual Maturation in Boys GENERAL DEVELOPMENT (Age 10) A - Appearance of axillary and pubic hair (first sign). Brain: Growth is complete by age 10. D - Deepening of the voice. Vision: Achieves adult vision capabilities. D - Development of muscles. Malocclusion: Misalignment of teeth occurs as I - Increase in size of testes and penis. permanent teeth erupt while jaw growth may not yet P - Production of viable sperm (last sign). align with final head size. TEETHING  Permanent Teeth: Eruption of permanent teeth begins, AGE 7 with an average child gaining 28 teeth between ages 6 and 12. “Eraser Year”: never content. Tooth Eruption Sequence: Includes central and lateral High standards. incisors, cuspids, and first and second molars. AGE 8 Can read regular-size type. Enjoys school. Learn to write a script. AGE 9 Mature handwriting. OLDER SCHOOL AGE Evaluate the teacher’s ability. Perform at varying levels. GROSS MOTOR DEVELOPMENT IN SCHOOL-AGE Enjoys reading. CHILDREN LANGUAGE DEVELOPMENT IN SCHOOL-AGE AGE 6 CHILDREN Jump, tumble, skip, hop. AGE 6 Walks a straight line. Ride a bicycle. Full sentences, using language with meaning. Define objects by use. AGE 7 AGE 9 Gender differences appear in play. Appears quiet. Discover “dirty jokes.” Swears, bathroom language. AGE 8 AGE 12 Graceful. Ride a bicycle well. Sense of humor, engages in adult conversation. Enjoy sports. PLAY DEVELOPMENT IN SCHOOL-AGE CHILDREN AGE 9 AGE 6 Constantly on the go. Eye-hand coordination to enjoy sports. Engages in rough play; spends quiet time with books. AGE 10 AGE 7 Interested in perfecting their athletic skills. Requires more props for play. Decline in imaginative play. AGE 11 Begins to collect items. Drumming fingers and tapping feet or pencils. AGE 8 AGE 12 Develops skills for sorting and cataloging. Plunge into activities with intensity and concentration. AGE 10 Cooperative around the house. Engages in competitive play. FINE MOTOR DEVELOPMENT IN SCHOOL-AGE Interested in internet and mobile games. CHILDREN Explores music and artistic expression. AGE 6 EMOTIONAL DEVELOPMENT IN SCHOOL-AGE CHILDREN Easily tie shoelaces. Cut and paste well. Children can accomplish small tasks independently Draw in good detail. due to a sense of autonomy. Can print. They learn to share and find learning to be fun and adventurous.  Structured activities foster problem-solving skills ○ Show increased interest in the opposite sex (understanding the "how" of things). and engage in mixed-sex activities. They learn to live harmoniously with others. 12 Years of Age ○ Feel more comfortable in social interactions. IMITATION Friendships become situation-specific and depend on shared activities and interests. Children have the freedom to imitate the roles of Develop an understanding of concepts of right and people around them. wrong. Rules are relied upon to guide behavior and play, providing structure and security. FANTASY AGE-SPECIFIC UNDERSTANDING OF RULES Begins to differentiate between fantasy and reality. 5-6 Years: Children believe rules can be changed. Exhibits "magical thinking," believing thoughts and 7-8 Years: Exhibit strict adherence to rules. wishes can come true. 9-10 Years: Start to negotiate rules. Begin understanding social roles, regarding them as GENDER ROLES inflexible, while adapting behavior to fit different situations and practicing various social roles. Familiarization with opposite gender roles develops. Take on more responsibilities at home, contributing to Self-esteem becomes based on the ability to perform family dynamics. and produce. Children explore alternative strategies for dealing COGNITIVE DEVELOPMENT IN SCHOOL-AGE with frustration and expressing emotions. CHILDREN They become sensitive to others' opinions about themselves. DECENTERING ○ The ability to project oneself into other AGE-SPECIFIC DEVELOPMENTAL CONCERNS people’s situations. ○ Enables children to see the world from 6-9 years: Children may have questions about others' viewpoints rather than focusing solely pregnancy, intercourse, sexual swearing, and may on their own. look for nude pictures in books and magazines. ACCOMMODATION 10-12 years: Interest in games involving peeing and ○ The ability to adapt thought processes to fit sexual activity (e.g., strip poker, truth or dare), as well perceptions. as relationships, flirting, kissing, stroking/rubbing, ○ Understanding that there can be multiple and reenacting intercourse with clothes on. reasons for others' actions. CONSERVATION GENERAL DEVELOPMENTAL TRENDS (6-12 years) ○ The ability to appreciate that a change in shape does not necessarily mean a change in Cognitive changes lead to concrete operations. size. Mature language development occurs. CLASS INCLUSION ○ The ability to understand that objects can HEALTH RISKS belong to more than one classification. Language Use Risks include accidents, falls, cancer, abduction, and ○ Language becomes an important infections. communication tool. SOCIAL DEVELOPMENT IN SCHOOL-AGE PERSPECTIVE TAKING CHILDREN 5-8 Years: 6 Years of Age ○ Can recognize others’ perspectives but ○ Engage in play within groups and have one- cannot fully assume the role of the other. to-one contact. 8-10 Years: 7 Years of Age ○ Begin to recognize the difference between ○ Begin to understand family roles and behavior and intent. responsibilities. 10-11 Years: ○ Develop a strong sense of justice. ○ Can accurately recognize and consider 8 Years of Age others’ viewpoints. ○ Actively seek the company of other children. 9 Years of Age CONCRETE OPERATIONS ○ Form peer groups and participate in activities away from home. Characterized by: 10 Years of Age ○ Accurate perception of events. ○ Enjoy being part of groups while also valuing ○ Rational, logical thought processes. privacy. ○ Concrete thinking with self-reflection. 11 Years of Age ○ Understanding concepts of space, time, and dimension.  ○ Ability to remember events from months or 11-12 YEARS years earlier. ○ Development of more effective coping skills. Full energy and constantly active. ○ Awareness of how their behavior affects Sense of humor present. others. Insecure with members of opposite sex. Green jokes. Social and cooperative. MORAL AND SPIRITUAL DEVELOPMENT SAFETY CONCERNS Motor vehicle accidents PRECONVENTIONAL REASONING (Kohlberg) Community ○ Begins to accept social rules regarding what Burns is good and moral. Falls ○ Learns rituals and religious practices. Sport injuries ○ Parent role model. Drowning ○ Rule oriented. Drugs Firearms 6 YEARS General Temporary teeth begin to fall. NUTRITION Permanent teeth appear – 6 years; molar. Establish healthy eating patterns Toothbrushing alone. Limit salt intake and saturated fat Year of constant motion: clumsy movement. Allow in making planned meals Recognize all shapes. Foods with high nutritional value (increased energy Teacher becomes authority figure. requirements) Nail biting. Deficiency in fiber Begin interest in God. Increase iron, calcium, and fluoride 7 YEARS DAILY ACTIVITIES DRESSING Assimilation age. ⚬ Teach the importance of caring for own belongings Central incisors erupt. A quiet year. SLEEP Striving for perfection. ⚬ Younger school: 10-12 hours/night Conservation. ⚬ Older: 8-10 hours/night Can tell time. Enjoys teasing and playing alone. EXERCISE ⚬ Neighborhood games, walking, riding bicycle 8 YEARS HYGIENE Expansive age. Coordination definitely improved. ⚬ Encourage showering (increased perspiration and sebaceous “Best friends” develop. gland activity) Whispering and giggling begin. Can write as well as print. CARE OF TEETH Understands concepts of past, present, and future. ⚬ 2x/year dental check-up Loves to collect objects. ⚬ Effective brushing Count backwards. DISCIPLINE 9 YEARS ⚬ Time out All activities done with gang. COMMON HEALTH PROBLEMS Hero worship. Dental caries Stealing and lying are common. ⚬ Progressive, destructive lesions or decalcification of the tooth Takes care of the body 's needs completely. enamel and dentin Teacher finds this group difficult to handle. Malocclusion 10 YEARS ⚬ Crossbite (sideways) Coordination improves. ⚬ Anterior or posterior Age of special talent. Writes legibly. CONCERNS AND PROBLEMS Ready for competitive games. Attention-deficit/hyperactivity disorder (ADHD) More considerate and cooperative. ⚬ Interferes so dramatically with school progress Joins organizations/clubs. Well-mannered with adults. ARTICULATION ⚬ The child has difficulty pronouncing s, z, th, l, r, and w or substitutes w for r (“westroom” instead of “restroom”) or r for l (“radies’ room” instead of “ladies’ room”) ⚬ Common during 1st and 2nd grade ⚬ Disappears during 3rd year COMMON FEARS AND ANXIETIES Anxiety Related to Beginning School ⚬ Big task for 6 years old ⚬ Elective feeling is gone ⚬ Pseudosophistication ⚬ SCHOOL PHOBIA ￭ Separation from parents ￭ Orient to new environment Displacement from school Loss of privacy – wants bra Death – permanent loss of life; irreversible Home Schooling LATCHKEY CHILDREN ⚬ Absence of adult supervision for part of each weekday SEX EDUCATION ⚬ Education on pubertal changes ⚬ Responsible sexual practices STEALING ⚬ Common at 7 years of age (9 y/o: counseling) ⚬ Shoplifting VIOLENCE OR TERRORISM ⚬ Absence of adult supervision for part of each weekday BULLYING ⚬ Encourage reporting RECREATIONAL DRUG USE ⚬ Cigarette smoking CHILDREN OF ALCOHOLIC PARENTS ⚬ At risk for emotional problems OBESITY ⚬ 1200 calories (30% fat) ⚬ Active exercise program BEHAVIOR VARIATIONS Industrious Modest Can’t bear to lose Love collecting  DEVELOPMENTAL MILESTONE: ADOLESCENCE FINAL TERM Submitted by: C24 Bless S. Bacate Princess M. Castada Louie Nard R. Gumisad Gervie C. Guzman Marinel P. Mamaril Meldrin C. Medina Neil Bryan O. Morden Realyn G. Pan-ag Danielle C. Patindol Jahlia Marie N. Sison Janela Margaret R. Suyat NCM 107 | Care of Mother, Child, and Adolescent Arlene C. Ordoño  DEVELOPMENTAL MILESTONE: ADOLESCENCE ❖ Transition between childhood and young adulthood. ❖ Teen years; Ages 13-20 years Early period: 13 to 14 years Middle period: 15 to 16 years Late period: 17 to 20 years ❖ Increased growth rate, sexual changes, changes in muscle and fat distribution ❖ Growth spurt Girls: 11-14 yrs Boys: 13-17 yrs ❖ Puberty Girls: 11-14 yrs Boys: 12-15 yrs SECONDARY SEX CHARACTERISTICS Age (Years) Males Females 13-15 Growth spurt continuing; pubic hair abundant Pubic hair is thick and curly, triangular in and curly; testes, scrotum, and penis enlarging distribution, breast areola and papilla form a further; axillary hair present; facial hair fine secondary mound; menstruation is ovulatory, and downy; voice changes happening with making pregnancy possible. annoying frequency. 15-16 Genitalia adult; pubic hair abundant and curly; Pubic hair curly and abundant (adult); may scrotum dark and heavily rugated; facial and extend onto the medial aspect of thighs; body hair present; sperm production matures. breast tissue adult and nipples protrude; areolas no longer project as separate ridges from breasts; may have some degree of facial acne. 16-17 Pubic hair curly and abundant (adult), may End of skeletal growth; extend along medial scrotum, and penis adult in size; may have aspect of thighs; testes. some degree of facial acne; gynecomastia (enlarged breast tissue), if present, fades. 17-18 End of skeletal growth. Source: Tanner, J. M. (1962). Growth at adolescence (2nd ed.). Oxford: Blackwell. ❖ Youth acclimate to changes in body 1. Experiences conflict between his needs for sexual satisfaction and society’s expectation 2. Change of body image and acceptance of opposite sex 3. Nocturnal emission - wet dreams 4. Distinctive odor - apocrine glands 5. Sperm viable - 17 years 6. Testes and scrotum increase until age 17 7. Breast and female genitalia increase until age 18 ACCORDING TO DEVELOPMENTAL THEORIES ❖ PSYCHOSEXUAL DEVELOPMENT GENITAL STAGE (12 years to Adulthood) Libido re-emerges and is directed towards peers of the other sex, marking the onset of mature adult sexuality. Heterosexual pleasure Fixation: sexual dysfunction, difficulties forming healthy relationships, or other emotional problems  ❖ PSYCHOSOCIAL DEVELOPMENT IDENTITY VS. ROLE CONFUSION (12-18 years) IDENTITY Sense of self and personal identity Exploration with feelings of independence and control. ROLE CONFUSION Insecure and confuse VIRTUE: FIDELITY ❖ COGNITIVE DEVELOPMENT FORMAL OPERATIONAL STAGE (12 years and up) Begins to think abstractly and reason about hypothetical problems Begins to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning Begins to use deductive logic, or reasoning from a general principle to specific information ❖ MORAL DEVELOPMENT LEVEL 2: CONVENTIONAL MORALITY (EARLY ADOLESCENT -ADULTHOOD) Acceptance of social rules regarding what is good and moral. Focuses on the acceptance of authority and conforming to the norms of the group. PHYSICAL GROWTH ❖ 9 to 12 years of age Onset of puberty ❖ 16-20 years of age Cessation of body growth ❖ Increase in body size does not occur in all organs at the same rate WEIGHT HEIGHT VITAL SIGNS ❖ Boys ❖ Boys ❖ Pulse rate gains 15 to 65 lb (7 4 to 12 in (10 to 30 cm) 70 per minute to 30 kg) ❖ Girls ❖ Respiration rate 2 to 8 in (5 to 20cm) 20 per minute ❖ Girls ❖ Girls are 1 to 2 in (2.4 to 5 cm) taller than gains 15 to 55 lb (7 boys but generally stop growing within 3 ❖ Blood pressure to 25 kg)