Growth and Development of Children PDF

Growth and Development of Children Growth and Development of Children  General Objective: By the end of this lecture, the student will be able to discuss growth and development of children.  Specific Objectives: By the end of this lecture, the student will be able to: Ident...

Growth and Development of Children Growth and Development of Children  General Objective: By the end of this lecture, the student will be able to discuss growth and development of children.  Specific Objectives: By the end of this lecture, the student will be able to: Identify the importance of growth and development. Define growth and development. Mention the principles of growth and development. List factors affecting growth and development. Mention types of growth and development. Identify the stages of development. Growth Growth refers to an increase in physical size of the whole body or any of its parts. It is simply a quantitative change in the child’s body. It can be measured in Kg, pounds, meters, inches, ….. etc Development Development refers to a progressive increase in skill and capacity of function. It is a qualitative change in the child’s functioning. It can be measured through observation. Maturation Increase in child’s competence and adaptability. It is describing the qualitative change in a structure. The level of maturation depends on child’s heredity. *Maturing involves growth in ability perform n skills, to think relate to people, to trust, to have confidence in one self *Development refers to increase in skill or ability to function  Development 1-Motor development: it is either gross or fine motor behaviors a.Gross motor include maturation in posture, head balance, sitting, creeping, standing and walking b.Fine motor include the use of hands and fingers in the grasp of an object 2-Emotional development: e.g. love , fear......etc  Development 3-Psychosocial development: refers to personality development. e.g. self-concept, friendship, development of sense of trust----etc 4-Moral development: refers to knowing right from wrong 5-Cognitive development: refers to the ability to learn and understand from experience, acquire and retain knowledge , respond to new situations and solve problems  Importance of Growth and Development for Nurses: Knowing what to expect of a particular child at any given age. Gaining better understanding of the reasons behind illnesses. Helping in formulating the plan of care. Helping in parents’ education in order to achieve optimal growth & development at each stage. Principles of Growth & Development Continuous process Predictable Sequence Don’t progress at the same rate (↑ periods of GR in early childhood and adolescents & ↓ periods of GR in middle childhood) Not all body parts grow in the same rate at the same time. Each child grows in his/her own unique way. Each stage of G&D is affected by the preceding types of development. Principles of Growth & Development G & D proceed in regular related directions : - Cephalo-caudal(head down to toes) - Proximodistal (center of the body to the peripheral) - General to specific Growth Pattern  Growth Patterns cephalocaudal The child’s pattern of growth is in a head-to-toe direction. proceeding or occurring in the long axis of the body especially in the direction from head to tail proximodistal. Where growth proceeds from the center or midline of the body to the periphery or from inward to outward pattern Factors affecting growth and development: Hereditary Environmental factors Pre-natal environment 1-Factors related to mothers during pregnancy: - Nutritional deficiencies - Diabetic mother - Exposure to radiation - Infection with German measles - Smoking - Use of drugs 2-Factors related to fetus Mal-position in uterus Faulty placental implantation Post-Natal Environment I - External environment: - socio-economic status of the family - child’s nutrition - climate and season - child’s ordinal position in the family - Number of siblings in the family - Family structure (single parent or extended family … ) Internal environment Child’s intelligence Hormonal influences Emotions Types of growth and development Types of growth: - Physical growth (Ht, Wt, head & chest circumference) - Physiological growth (vital signs …) Types of development: - Motor development - Cognitive development - Emotional development - Social development  Stages of Growth and Development Prenatal Middle Childhood - Embryonic (conception- 8 w) - School age - Fetal stage (8-40 or 42 w) - 6 to 12 years Infancy - Neonate - Birth to end of 1 month Late Childhood - Infancy - 1 month to end of 1 year - Adolescent Early Childhood - 13 years to approximately 18 - Toddler years - 1-3 years - Preschool - 3-6 years 1- Newborn stage Newborn stage is the first 4 weeks or first month of life. It is a transitional period from intrauterine life to extra uterine environment.  Normal Newborn Infant Physical growth - Weight = 2.700 – 4 kg - Wt loss 5% -10% by 3-4 days after birth - Wt gain by 10th days of life - Gain ¾ kg by the end of the 1st month Weight: They loose 5 % to 10 % of weight by 3-4 days after birth as result of : ▪ Withdrawal of hormones from mother. ▪ Loss of excessive extra cellular fluid. ▪ Passage of meconium (feces) and urine. ▪ Limited food intake. Height Boys average Ht = 50 cm Girls average Ht = 49 cm Normal range for both (47.5- 53.75 cm) Head circumference 33-35 cm Head is ¼ total body length Skull has 2 fontanels (anterior & posterior) Anterior fontanel Diamond in shape The junction of the sagittal, corneal and frontal sutures forms it Between 2 frontal & 2 parietal bones 3-4 cm in length and 2-3 cm width It closes at 12-18 months of age Posterior fontanel Triangular Located between occipital & 2 parietal bones Closes by the end of the 1st or 2 stmonth of age (6-8 weeks of age ) Chest circumference It is 30.5 to 33cm (usually 2–3cm less than head circumference). Physiological growth Vital signs - Temperature (36.3 to37.2C ). - Pulse ( 120 to 160 b/min ). - Respiration ( 35 to 50C/min). (30 To 60 c/min) It is usually irregular in depth, rate , &rhythm Newborn Senses  Senses - Touch - Vision - Hearing - Taste - Smell Newborn Senses (Touch) It is the most highly developed sense. It is mostly at lips, tongue, ears, and forehead. The newborn is usually comfortable with touch.  Newborn Senses(Vision) Pupils react to light Bright lights appear to be unpleasant to newborn infant. Follow objects in line of vision Newborn Senses (Hearing) The newborn infant usually makes some response to sound from birth. Ordinary sounds are heard well before 10 days of life. The newborn infant responds to sounds with either cry or eye movement, cessation of activity and / or startle reaction. Newborn Senses(Taste ) Well developed as bitter and sour fluids are resisted while sweet fluids are accepted. Newborn Senses(Smell) Only evidence in newborn infant’s search for the nipple, as he smell breast milk. Normal Newborn Infant  Gross Motor Development Motor development: The newborn's movement are random, diffuse and uncoordinated. Reflexes carry out bodily functions and responses to external stimuli.  Fine motor development -Holds hands in fist -When crying, he draws arms and legs to body  Reflexes Moro reflex/Startle reflex Palmar/grasp reflex plantar grasp reflex walking/stepping reflex tonic neck reflex Babinski’s reflex Moro Reflexes: Beings at birth and disappear after 3 to 4 months  Palmar/Planter grasp reflexes Weakens after 3 months, disappears after 1 year  Walking/stepping reflex present at birth, disappears at approx 2-4 months Tonic-Neck reflex : appears at birth and Disappears after 2 months Babinski’s reflex: appears at birth and Disappears 9 months to one years Rooting reflex appears at birth and Disaapears after 3 to 4 months Suking and swallowing reflex appears at birth Disappears after 3 to 4 months  Cognitive development The cognitive development of newborn infant is difficult to understand or observe it.  Emotional development The newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation  Social development Newborns quickly learn to communicate. They seek interaction with the mother and express how they feel with sounds and facial expressions.  Care of newborn -Immediate care of newborn -Essential Newborn care -Health education for needs of newborn  General pathophysiology and Assessment Neonatal resuscitation: Newborn stabilization Airway warming Positioning Breathing Clearing and airway Drying, stimulatine Circulation breathing what do you look for? -Breathing or crying Yes Skin to skin -Good muscle tone Yes contac -Colour Yes -Breathing or crying No Neonatal -Good muscle tone No Resuscitation -Colour pink No Basic needs of a baby at birth  Arrival of the Newborn If delivery in ambulance -Use blankets -Confirm ABCs. -Place on mother’s chest. -Suction mouth,then nose. -Keep newborn at level of mother.  Arrival of the Newborn -Clamp and cut the umbilical cord. -Do an initial rapid assessment. -Newborn is at risk for hyperthermia. Ensure thermoregulation. -Position the newborn, clear secretions, and assess the respiratory effort.  Arrival of the Newborn If the newborn begins to turn pink in the first 5 minutes. Maintain observation. Contine thermoregulation with direct skin-to- skin contact with mother. Care at birth Immediate skin to skin contact&breastfeeding Ensuring warmth at the time of delivery: ‘Warm chain’  ‘Warm chain’: At delivery At delivery: Ensure the delivery room is warm (25’ C ), with no draughts. Dry the baby immediately; remove wet cloth wrap the baby with clean dry cloth keep the baby skin-to skin with mother  Helping the baby breathe Assess baby’s breathing at the time of drying: -If the baby is crying vigorously or breathing adequately,then no intervention is needed -If airway is not clear, suction with the head turned to the side. Flick the soles of the feet and rub the back  Drying and Stimulation -Nasal suctioning stimulates breathing. -Position on the back or side in sniffing position. If the baby is not breathing or gasping, then skilled care in the form of positive pressure ventilation etc..(i.e. RESUSCITATION) would be required  ‘Warm chain’: After delivery 1-Keep the baby clothed and wrapped; cover the head 2-Postpone bathing particularly for small babies 3-Keep baby close to the mother 4-Use kangaroo care for Stable LBW babies 5-Show mother how to void hypothermia and to recognize 6-Initiate breastfeeding  The four modalities by which the infant lost his-her body temperature  The Apgar score Condition Descriotion Score The initial assessment: APGAR scoring system Apperance- Completely pink body 2 skin color pink,extremities blue 1 Purpose: centrally blue,pale 0 is to assess the new born’s Pulse rate >100 2 immediate adjustment to 0 1 extrauterine life Absent 0 Grimace- Cries 2 -If score is less than seven, irritability Grimaces 1 redo every 5 minutes untill 20 No response 0 minutes after birth Activity- Active motion 2 Muscle tone Some flexion of 1 extremities Limp 0 Respiratory- Strong cry 2 effort Slow and irregular 1 Asent 0 -clamp and cut the umbilical cord -Wipe both eyes ( separately ) withe sterile gauze piece to take complete history about the mother and neonate -To be sure that the neonate has identification band. -To perform complete physical assessment (General appearance, V.S, G.M, Gestational age assessment). -Prevention of hemorrhage (administer vit K if not given in the delivery room). -Initate breastfeeding Documentation Apply a sterile tie tightly around cord at 2 Cm and 5 Cm from the abdomen Cut between the ties with a sterile instrument Observe for oozing blood every 15 minutes; blood oozes,place a second tie Do not apply any substance to the stump DO NOT bind or bandage stump Leave stump uncoverd (Properly timed cord clamping ) Wait 3 minutes or until the cord stops pulsating before cutting the cord  Eye care Clean eyes immediately after birth with swab soaked in sterile water Use separate swabs for each eye; clean from medical to lateral side Give prophylactic eye drops within 1 hour of birth (as per hospital policy ) Do not put anything else in baby’s eyes  Initiating breastfeeding -Keep the baby in skin-to skin contact betwwen mother’s breasts immediately after drying -Help the mother in her first few attempts to breastfeed -Make mother and the baby comfortable Explain and show mother about proper positioning and attachment  Management of breast feeding 1) Preparation of prospective mother: a- emotional support. b-education on benefits of B.F. and Technique C-good maternal health and nutrition d-avoidance of drugs that interfere with breast feeding i.e. ergometrine ; sedatives ; analgesics  2)Early initiating breast feeding within first 30-60 minutes after delivery: a-psychological bonding by skin contact is maximal b-Rooting and suckling reflexes are maximal c-Suckling stimulates milk secretion or let down reflex d-Colostrum has nutritious anti-infective characters.  Composition of breast milk Colostrum: Bright lemon yellow; alkaline ; viscous fluid secreted during first 5-7 days : compared to mature milk it is : 1)More rich in protein (2.3gm/dl) but less CHO or fat 2)Very rich in immunoglobulin especially lgA. 3) rich in cholesterol , Na , K , CL , Zinc , Copper , leucocytes ( macrophages , lymphocytes ) & Antibacterial 4) More rich in Vit.A than mature milk. 4) Laxative effect by enhancing GIT motility leading to prevention of meconium blood formation which is the most common cause intestinal destruction. 5) reducing enterohepatic circulation and prevent hyperbilirubinaemia  Prevention of infections : ‘Clean chain’ At delivery: WHO five cleans Clean 1. Hands of attendants (washed with soap ) 2. Surface for delivery 3. Cutting instrument for cord ( i.e. razor. blade ) 4. String to t cord 5. Cloth to wrap baby and mother  Monitoring the baby Do not leave the mother and baby alone in the first hour after birth Monitor three parameters every 15 minutes: Breathing :Gruntung, chest in-drawing,fast breathing (>60/min) Warmth: Check if the baby’s feet are cold ( by using your hands ) Color: Evaluate the color of trunk and extremities Essential Care of newborn  Hepatitis B vaccine Immunization against hepatitis B disease is recommended for all newborn babies, infants, children, and adolescents up to 19 years of age. Descriotion and Brand Names Engerix-B Engerix-B Pediatric Recombivax HB Recombivax HB Pediatric Adolescent Engerix-B (R): Three doses ( 10 mcq each), IM, on a 0, 1, and 6 month schedule Recombivax HB(R): Three doses ( 5 mcg each ), IM, on a 0, 1 ,and 6 month schedule  BCG vaccine -BCG vaccination in neonates ( 0-4 weeks ) -Bacillus calmette-Guerin (BCG) is the only licensed vaccine against tuberculosis. It is a live attenuated strain derived from from mycobacterium bovis, which stimulates the development of antibodies to mycobacterium tuberculosis ( and other Mycobacteria). -Draw up 0.05ml of vaccine -Administer intradermally using a 26G needle. -Introduce the needle just under the skin over the left deltoid area 2-3 weeks after BCG vaccination development pf a papule End of 5-6 weeks-paplule,increases to a size of 4- 8mm: get converted to pustule within few days, pustule bursts open |& again get sealed off The process continue for multiple times; at the end it dries up & a crust is formed. Crust Falls off & a scar is formed by 6: 12 weeks  Heelstick ( Capillary blood sampling new born metabolic screen is ideally performed in the first 48-72 hours of life ( however,can be done after 24 hours). It should be done before a transfusion and antibiotic therapy and ideally after receiving breast milk or formula to ensure accurate testing. Equipment Automated self-shielding lancets are preferred in neonayes, filter paper card for newborn screening ( if appropriate ) , a warm washcloth or heel warming antisepticc solution, gloves and a diaper.  Heelstick Sampling aim to testing for congenital Hypothyroidism,Cystic Fibrosis,and over 20 rare conditions. These tests ensure early detection and treatment of these conditions. congenital Hypothyroidism Usually caused by an absence or improper functioning of the thyroid hormone, thyroxine. Lack of this hormone leads to severe intellectual disability, deafness and growth problems. If detected early and treated with daily thyroxine supplements, the infant can grow and develop normally. Cystic Fibrosis ( CF) An inherited autosomal recessive condition.The mucous in the lungs and digestive system is thick and sticky resulting in respiratory infections and difficulties in digesting food properly. Early detection and treatment improves the health of the infant. phenylketontia An inherited autosomal recessive condition. It is caused by an enzyme deficiency (phenylalanine hydroxylase) which results in the inability to convert phenylalanine to tyrosine. High levels of phenylalanine in the blood and tissues can damage the brain. If not identified and treated soon after birth, severe, progressive intellectual disability results. This condition can be treated with a diet low in phenylalanine which results in normal frowth and development. Heel stick procedure Hold the foot with a firm grip, grasp heel with thumb placed below puncture site and index finger placed over the arch -Puncture site at a 90 degree angle parallel to the heel -use a quick continuous motion Health promotion Health education  Needs of Newborn Love and security Nutrition Warmth Protect from infection Safety measures Immunization Screening  Problems of New Born Birth injury, Prematurity, Postmaturity. Respitatory Distress Syndrome, Meconium Aspiration Syndrome Jaundice in Newborns, Anemia Thyroid Disorders, Sepsis