Infant Growth & Development PDF

Growth & Development Infants Normal VS: HR 80-150 (apical pulse for full minute to listen to murmurs) RR 25-55 (full minute) BP 65-100 / 45-65 T 97.7-99F (36.5-37.3) First 6 months Gain approx. 1.5 lbs and 1 inch in length per month Head circumference (indicator of brain growth) increases b...

Growth & Development Infants Normal VS: HR 80-150 (apical pulse for full minute to listen to murmurs) RR 25-55 (full minute) BP 65-100 / 45-65 T 97.7-99F (36.5-37.3) First 6 months Gain approx. 1.5 lbs and 1 inch in length per month Head circumference (indicator of brain growth) increases by 0.6 inches per month 6-12 mos Double birth weight by 6 mo and triple birth weight by 1yr Growth slows to 0.5 inch per month in height Head circumference growth slows to 0.2 inches per month Anterior fontanel closes between 12 to 18 mos posterior closes 2 months Cognitive development Piaget's sensorimotor stage until 1yr: separation, object permanence, and mental representation Separation- infants learn to separate themselves from other objects in the environment Mental representation- ability to recognize and use symbols Children are learning through their senses 4-5mos: recognize parents and memories lasting 4-5mins 6-7mos: learn object permanence and develop stranger anxiety 10-12mos: will look for hidden toys Progress from reflexive to simple repetitive and imitation activities Language Receptive language development- ability to understand others Expressive language development- ability to communicate with others via speech Milestones - 1-2mos - 3mos - 4-5mos - 6-7mos - 8-9mos - 10-12mos Gross motor development 1-2mos rudimentary reflexes are still present 3mos Lifts head from bed when prone Head lag diminishes 4-5 mos Majority of rudimentary reflexes (reflexes had at birth) have disappeared puts weight on feet when held May turn from stomach to back 6-7 mos Sits in tripod position Head lag disappears May turn from back to stomach 8-9mos Sits well Crawls and pulls self to standing 10-12mos Stands independently and walks holding on with one hand Fine motor development 1-2 mos Follows objects with eyes Drops rattle or object 3mos Grasp reflex diminishes Holds object if placed in hand 4-5mos Begins to reach and grasp voluntarily 6-7 mos Can transfer object from hand to hand Uses palmar grasp (holding with palm instead of fingers) 8-9mos Develops crude pincer grasp (using thumb and index finger to grab things) Purposely drops objects 10-12 mos Feeds self with finger foods Recommended toys 1-2mos Items for visual and auditory stimuli Sing and talk to baby 3-4mos Rattles and floor time 5-6mos Peek a boo and patty cake Mirrors, large balls, soft toys Blocks and shape sorters 9mos Hide and seek with toys Pots and pans 12 mos Push and pull toys Picture books Immunizations Term neonates are protected from infection by passive immunity from their mothers for up to 3mos and breastfed infants receive additional immunoglobulins and receive longer immunity Nutrition AAP recommends exclusively breastfeeding for first 6mos Needs supplementation for vitamin D with breastfeeding Reasons to formula feed Galactosemia Illegal drug use by mother Chemo Untreated active TB HIV When can we begin introducing solids? Infant is able to sit Birth weight has doubled and infant at least 13 lbs Infant able to maintain balance Desire for food indicated by infant opening mouth and leaning forward Extrusion reflex (when object placed in baby's mouth they expel it with tongue) disappears (4-5 mos) Infant moves food to back of mouth and swallows No toothpaste with fluoride Teething discomfort is normal Restraining car seats are only practical means of risk reduction for motor vehicle safety When to see HCP Temp 100 deg or higher Rash Refuses to eat Difficult to arouse from sleep Fewer than recommended wet/soiled diapers Diarrhea or vomiting Yellow tinged skin or sclera (jaundice) Toddlers Toddler is 12-36 mos Gain approx. 5 lbs per year and grow about 3 inches per year Reduced demand for calories Anterior fontanel will close 12-18 mos VS T 98.6 (37) Apical HR 70-110 RR 20-30 BP girls 100/61 boys 100/59 Dentition 2 ½ full set of 20 teeth and begin dental checkups Receive Fluoride supplementation (helps prevent tooth decay and strengthens their enamel) Proper care is crucial for general health and alignment of their permanent teeth Gross motor By 15 months they should walk independently and crawl up the stairs By 18 months they should be able to climb up the stairs while holding hands, jump in place, and throw a ball overhand By 2yrs they should be able to run and kick a ball and climb stairs with two feet on each step Fine motor By 15 months they should be able to drink from a cup using both hands, build tower of 2 blocks, and put a block in a cup By 18 months they should be able to build a tower of 3-4 blocks, turn pages of a book 2 or 3 pages at a time, and use a spoon (not very accurately) Development By 2 yrs toddlers can feed themselves fairly well with a spoon, build a tower of 6 blocks, and turn pages of a book one at a time By 2 ½ -3yrs they can draw circles Language development By 15 months of age toddlers can say two or three words together and understand the meaning of 15 words By 2yrs toddlers can possess a vocabulary of 300 words and use telegraphic speech of short simple sentences ("me do it") Sensory development Thinking is immature and limited in logic Animism- toddlers believe that toys have human qualities and capabilities Behavior is characterized by negativism (ex. saying no to everything), ritualism, and egocentrism Piaget's preoperational thought stage: view and experience the world directly, cannot conceptualize things, think symbolically and engage in make believe play Psychosocial Erikson's autonomy vs. shame and doubt Struggle for autonomy- is developing a sense of self separate from parent, egocentric ("me do it") Spend most of the time at play- parallel or symbolic play Parallel play- toddlers enjoy being with other toddlers but rarely interact while playing Grab toys from one another Push pull toys, blocks, balls for gross motor Large crayons, paints, books, and large puzzles for fine motor Health promotion: Physiological anorexia is common Food fads are common; may eat only cereals one day or only cheese the next Must have whole milk until 2 for brain growth 12-14 hrs of sleep per day with one nap Discipline Discipline must be firm, consistent, immediate, realistic, age appropriate, and related to the incident Tantrums occur because verbal skills are immature and frustration occurs Clearly explain limits and give enough time for toddlers to respond to instructions Separate them from the behavior and praise them for good behavior Readiness for toilet training Physical: Removes own clothes is willing to let go of toy Is able to sit, squat, and walk well has been walking for a yr Psychological readiness: Notices wet diaper ind. need for diaper change Communicates need to go to the bathroom and can get there by self Wants to stay dry Burn safety Set water heaters no higher than 120 F Pre-School 3-5yrs Same growth as toddlers (5lbs per year and about 2-3 inches per year) VS same as toddler Lowest safe BP is 70 plus 2x child's age (ex. 4yr old =70 +8= 78) Dentition Full set of primary teeth by preschool; may start losing by 4 ½ or 5 Regular toothpaste if capacity to swish and spit Physical G&D Coordination and muscle strength increase rapidly Increase in brain size Perfects fine and gross motor skills By ages 4-5 the child is independent and can dress, eat, and go to bathroom Gross motor By 3: ride a tricycle, perform a broad jump, and walk on tiptoes By 4: hop on one foot and balance on one foot for a few seconds By 5: walk heel to toe, skip, and jump rope Fine motor 3-4: begin using a fork 4: can copy a circle 4 ½: can copy a cross or x 5: begin to use a dull knife and can draw a stick figure Language development 3yrs Still telegraphic speech Talk sometimes and may be non stop and to toys Asks many questions 4-5yrs Increasing vocabulary Use all parts of speech May use verbs incorrectly Vivid imagination and makes up stories May use bad words to get response Speech Stuttering is fairly common because their verbal ability is less advanced than their thoughts Usually disappears once language progresses Allow children to complete their thoughts without finishing their sentences and don't call attention to the stuttering Play and toys Associative play with others like play house and dress up Legos, dolls, kitchen sets, dress up clothes, art supplies, ride on toys Supervised water and sand play May have imaginary friends: normal, don't contradict unless child blames bad behavior on imaginary friend All play must be supervised Psychosocial Erikson's stage of initiative versus guilt: developing behaviors that are self directed "Magical" thinking: may think they have caused bad things to happen, they believe whatever they think is real, and cannot distinguish between reality and fantasy Must be careful to discipline for the behavior and not let the child feel they are bad Cognitive Piaget's preoperational stage from preschool to 7 Preschooler's fears may be unrelated to reality (ex. May fear they will go down the drain when the toilet is flushed) Psychosexual Gender identity and body image are developing Sexual curiosity, anatomic exploration, and masturbation are common Encourage parents to answer questions simply and honestly Children should not be shamed or punished for self comforting behaviors Discipline Need consistent discipline Appropriate limits setting teaches self confidence, self control, and normal values Techniques include time out, time in, and restricted choices, and diversion Health promotion Mealtime problems and physiologic anorexia fade Feed them what the entire family is eating Sleep problems are common and caused by an active imagination and immaturity Nightmares are common Make sure to maintain nightly ritual and limit technology Immunizations 5th dose dtap, 4th dose IPV (polio), 2nd dose MMR, 2nd dose Varicella \*Forward facing car seats with guidelines for height and weight School-age Weight gain of 4-6 lbs per year and height increase of about 2 in per year Preadolescence (9-12) Differences between sexes: boys remain taller and heavier Visible sexual maturation is minimal in males during preadolescence Increased muscle mass, maturation of body systems, and increased antibody production Cognitive Piaget's concrete operations Transition from perceptual to conceptual thinking logical thinking ability and ability to solve problems like math and analytical See the perspective of others Psychosocial Erikson's industry vs. inferiority Develops skills and knowledge that contributes to society Sense of accomplishment through cooperation and interactions Need to be challenged by and to complete tasks Important to complete school projects at child's own pace Moral Early school age Later school age -Can't understand reasoning behind rules -able to judge intentions of act rather than -Judgment guided by reward and punishment just consequences -Can believe what others tell them -understand different povs -may interpret accidents as punishment -conceptualize treating others the way they Wish to be treated -children can feel pressure to conform to Norms of the group Self Concept early school age parents influence self ideals and older school age teachers and peers are influential positive self concept is important for feelings of self worth and confidence solidification of body image sex ed should begin regarding normal development more modest than preschoolers/emphasis on privacy social bullying may occur create best friends prefer same gender companions until late school age Age appropriate activities cooperative play 6-9: board games, hop scotch and jump rope, collections, stuffed animals, build simple models, organized sports 9-12: models and crafts, hobbies, puzzles and board games, organized sports Health Promotion immunizations seasonal influenza, 6 yrs DTap, mmr, varicella 11-12 yrs Tdap, HIV, meningococcal screen for scoliosis - don't use food as a reward, can lead to obesity Injury prevention in car, appropriate restraint system until 4'9 keep chemicals locked teach older school age to say no to alcohol, drugs, etc. teach 911 Promoting self esteem provide opportunities to assume responsibility and follow rules allow to make responsible choices and problem solve give praise, encouragement, and positive feedback allow child to make mistakes and take responsibility emphasize strengths and help improve weaknesses do not do their homework for them: assist them, make suggestions, and praise consistent and demonstrative love signs of stress in children unhappy and moody irritability and increased aggressive behavior fatigue inability to concentrate hyperactivity changes in eating or sleeping habits physical complaints like nausea, headache, or stomachache bed wetting substance abuse diminished school performance suicidal behavior normal in hospital setting concerning at home Adolescents Physical development transition from childhood to adult dramatic changes to size and appearance (2nd biggest to infancy) girls grow 2-8 inches and gain 15-55lbs (stop growing 2yrs after they get their period) boys grow 4-12in and gain 15-66 lbs (stop growing at around 18-20yrs) Sexual maturation girls: breasts, pubic hair, axillary hair, menstruation boys: testicular enlargement, pubic hair, penile enlargement, axillary hair, facial hair, voice changes cognitive Piaget's formal operations stage inductive and deductive reasoning inductive: generalizations based on specific observations or examples deductive: way of thinking where you start with a general idea and use it to make a specific conclusion ability to connect separate events Understanding of consequences Understanding of complex concepts using analytical methods Psychosocial and moral -Erikson: identity vs. role confusion Develop a sense of personal identity View themselves as unique individuals Become part of a peer group \- Kohlberg: conventional stage Begin to internalize moral principles and norms and question existing moral values and society Sexual Identity Begins with close same sex friendships during early adolescence Self exploration through masturbation Transition from friendships to intimate relationships as adolescence progresses Sexual identity is typically formed in late adolescence Age appropriate activities Nonviolent video games Group sports Supervised social events Caring for a pet Creative hobbies Reading Playing musical instruments Health promotion Immunizations: yearly influenza, meningococcal vaccine Screen for scoliosis Additional protein, calcium, iron, zinc, and folic acid Yearly assessment of height, weight, and bmi High metabolism requires more sleep \*injuries claim more lives during adolescence than all other causes of death combined Risk taking behavior is a part of normal growth and development for an adolescent Play therapy Purposes of play therapy - Children often struggle to verbalize their feelings so play allows them to express emotions like anger, sadness, and fear - Helps children to cope with med procedures, hospitalization, and chronic illness by providing some normalcy and control - Supports emotional and social development Techniques - Dramatic play uses dolls, action figures, or puppets to act out scenarios that may reflect the child's feelings or experiences - Art activities like drawing or painting to express emotions and thoughts that might be hard to articulate - Board games or role playing games that facilitate interaction and discussion about feelings and situations Play therapy can help reduce anxiety, build trust, and enhance communication Erikson's stages Trust vs. mistrust (0-1yr) The basic needs such as nourishment and affection will be met Autonomy vs. shame and doubt (1-3yrs) Developing a sense of personal control and independence; allow them to make choices Initiative vs. guilt (3-6yrs) Take initiative on some activities, but may develop guilt when unsuccessful or boundaries overstepped Industry vs. inferiority (6-12yrs) Develop self confidence in abilities when competent or a sense of inferiority when not Identity vs. role confusion (adolescence 12-18 yrs) Developing a personal identity and sense of self; respect autonomy, engage in open communication, and support exploration of identity Piaget stages Sensorimotor stage (birth - 2yrs) Learning through sensory experiences and motor activities; development of object permanence Use toys and sensory activities to engage infants; provide consistent routines to help them feel secure Preoperational stage (2-7yrs) Development of language and symbolic thinking; egocentric perspective (thinking only of themselves), magical thinking Concrete operational stage (7-11 yrs) Logical thinking about concrete objects, understanding of cause and effect, beginning of operational thought Use concrete examples to explain health concepts, encourage questions, involve them in hands on activities Formal operational stage (11yrs+) Abstract thinking, ability to reason and think about hypothetical situations Support decision making and respect their growing independence Ritualism Ritualism refers to the importance of routines for children that provide a sense of security and predictability Help children feel safe and reduce anxiety, promote healthy development, and can help with coping Use play to mimic routines and rituals, create predictable schedules, can use as a way to ease transitions