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Health Promotion in Pediatrics
Physical Development
- Infant (birth to 1 year old)o Posterior fontanel closes by 6 to 8 weeks of aeo !nterior fontanel closes by 1" to 18 months of aeo Dentition- si# to eiht teeth sho$ld er$pt by the end of the %rst year&
'irst teeth er$pt between the aes of 6 to 1 months eethin pain can be eased
1& *old teethin rins
"& +* teethin els,& !cetaminophen Ib$profeno .+ /+0 H!. , D!23o Ib$profen only in infants over the ae of 6 months
*lean the teeth $sin cool wash cloth Do not ive bottles to infants when they are fallin asleep
o 4ottle mo$th syndrome5 Dental *aries&
Infant Gross Motor Skills Fine Motor Skills1 month Head a 7rasp 0ee#2 months ifts head o9 mattress Holds hands in an open position3 months 0aises head and sho$lders o9 mattress .o loner has a rasp ree#&
:eeps hands loosely open4 months 0olls from back to side Places ob;ects in mo$th
5 months 0olls from front to back
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- 3chool !e *hildren (6 to 1" years)o Permanent teeth er$ptiono Bis$al ac$ity ""o !$ditory ac$ity and sense of to$ch f$lly developo 0apid rowtho 'emales
4$ddin of breasts
!ppearance of p$bic hair +nset of menarche
o /ales nlarement of testicles
!ppearance of p$bic hair
3chool ae child 7ross /otor 3kills 'ine /otor 3kills*ontin$e to improve *ontin$e to improve
- !dolescent (1" to " years old)o !cne may appearo Increase in metabolism and rapid rowth alter sleepin habits5 sleep late and moreo 'emales
4$ddin of breast 7rowth of p$bic hair
+nsent of menstr$ationo /ales
Increase in siCe of testes and scrot$m
!ppearance of p$bic hair 7rowth of a#illary hair
*hane in voice
!dolescent 7ross /otor 3kills 'ine /otor 3kills*ontin$e to improve *ontin$e to improve
Physical development (weiht and heiht)
!7 =I7H HI7HI.'!.3 (birth to 1) - 1A to "1 per week the
%rst 6 months- Do$ble by 6 months- ripled by 1" months
- "&A cm per month the %rst 6
months- Increases by A by the ae
of 1" months +DD0 (1 to ,) - 3ho$ld weiht fo$r times their
birth weiht
- E&A cm per year
P03*H++ (, to 6) - 7ain " to , k per year - 6&A to F cm per year3*H++ !7 (6 to 1") - " to , k per year - A cm per year
!D+3*.* (1" to " years) - 4oys5 E to , k- 7irls5 E to "A k
- 7irls5 A to " cm- 4oys5 1 to , cm
*onitive Development
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!7 PI!7 !.7
- *an think loically abo$t abstract propositions and test
hypotheses systematically- 4ecomes concerned with the hypothetical> the f$t$re>
and ideoloical problems&1& !ble to think thro$h more than two cateories of variables
conc$rrently"& *apable of eval$atin the K$ality of their own thinkin,& !ble to maintain attention for loner periods of time@& Hihly imainative and idealisticA& Increasinly capable of $sin formal loic to make
- Develops ;aron with their
peer ro$ps
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decisions6& hink beyond c$rrent circ$mstancesE& !ble to $nderstand how the actions of an individ$al
in$ence others
're$d
3!7 !7 *+7.+
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activities&
7enital
stae
P$berty to
death
/at$rin
se#$al
interest
1& he enital stae is a time of
se#$al reawakenin"& he so$rce of pleas$re now
becomes someone o$tside the
family,& 're$d believed that $nresolved
conicts with parents re-
emere d$rin adolescence&
=hen these conicts have been
resolved the individ$al is
capable of developin a mat$re
love relationship and f$nction
independently as an ad$lt@& It is the p$berty period when
se#$al $res reawaken that
may lead to children e#plorin
their se#$alityPsychosocial Development
rikson
!es rikson .$rsin actionInfants ( birth to
1)
"r#st $s Mistr#st % &irth to 1'
1& !chievin this task is based on the K$ality fo
the careiver G infant relationship and the
care received"& he infant beins to learn delayed
rati%cation,& r$st is developed by meetin the needs5
comfort> feedin> stim$lation and
carin&needs@& /istr$st develops if needs are inadeK$ately
or inconsistently met> or if needs are over
met
oddler (1 to ,) A#tonom $s Shame ( )o#*t % 1 to 3'
*hildren learn to either be self-s$Jcient in
many activities> incl$din toiletin> feedin&
=alkin> and talkin +,-. to do$bt theirown abilities&
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Preschooler ( , to
6)
Initiati$e $s G#ilt %3 to 5'
1! Preschoolers become eneretic learners>
despite not havin all of the physical abilities
necessary to be s$ccessf$l at everythin2! 7$ilt may occ$r when preschoolers believe
they have misbehaved or when they are
$nable to accomplish a task3! 7$idin preschoolers to attempt activies
within their capabilities while settin limits is
appropriate3chool !e ( 6 to
1")
In/#str S inferiorit %5 to 12'
1& ! sense of ind$stry is achieved thro$h the
development of skills and knowlede that
allows the child to provide meaninf$l
contrib$tions to society"& ! sense of accomplishment is ained
thro$h the ability to cooperate and
compete with others,& *hildren sho$ld be challened with tasks
that need to be accomplished> and allowed
to work thro$h individ$al di9erences in
order to complete the task@& *reatin systems that reward s$ccessf$l
mastery of skills an tasks can create a sense
of inferiority in children $nable to completethe task or acK$ire the skills
A& *hildren sho$ld be ta$ht that not everyone
will master every skill!dolescence ( 1"
to ")
I/entit S role onf#sion % 12 to 18'
1& !dolescents develop a sense of personal
identity> and come to view themselves as
$niK$e individ$als"& 7ro$p identity- adolescents become part of a
peer ro$p that reatly in$ences behaviors
Psychosocial development (*ontin$ed)
!7 3+*I! 3' *+.*P /+0! 4+D2 I/!7 !*IBI3
I.'!.
(birth to
1)
1& !ttachment-
bein to bond
with parents&
3een within the
%rst month"& 3eparation-
infants %rst
distin$ish
themselves and
their primary
careiver as
separate
individ$als,& 3eparation
an#iety G @ to 8
months& Infants
will protest when
separated from
3eparation-
infants %rst
distin$ish
themselves
and their
primary
careiver as
separate
individ$als
1& /o$ths are
pleas$re
prod$cers (oral
phase"& Hands and feet
are ob;ects of
play,& 3milin ca$ses
others to react
1& 3hort attention"& solitary play,& rattles@& teethin toysA& playin pat a
cake6& playin with
ballsE& readin books8& mirrorsF& brihtly colored
toys1& playin with
blocks
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parents@& 3traner fear- 6
to 8 months& ess
likely to accept
straners +DD0
( 1 to ,)
1& separation
an#iety
1 separation
complete
"& 4eins
e#ploration
on own
1& *losely associated
with conitive
development"& ocentric G
$nable to see
thins from the
perspectives of
others,& P$nishment and
obedience beins
with a sense that
ood behavior is
rewarded and bad
behavior is
p$nished
1& !ppreciate
$sef$lness of
vario$s body
parts"& 7ender
identity by ,
years of ae
1& Parallel play-
toddlers observ
other children
then may
enae in
activities nearb"& 'illin emptyin
containers,& Playin with
blocks@& ookin at bookA& P$sh p$ll toys6& ossin ballsE& 'iner paints8& are piece
p$CClesF& hick crayons1& emper
tantr$ms5
fr$strated withrestrictions on
independence&11& oilet trainin
can bein when
toddlers have
the sensation o
needin to
$rinate or
defecate1"& Discipline sho$
be consistent
with well-de%ne
bo$ndaries thatare established
to develop
appropriate
social behavior&P03*H+
+0 ( ,
to 6)
1& Do not e#hibit
straner an#iety
and have less
separation
an#iety"& Proloned
separation>
d$rin
hospitaliCation>can provoke
an#iety- 'avorite toys
and
appropriate
play sho$ld
be $sed to
help ease
preschoolersM
fears,& Pretend play is
healthy and
allows
1 masterin
skills make
them feel ood
" reression
may occ$r
d$rin stress
1 arly
preschoolers
contin$e in the
ood-bad
orientation of the
toddler years&
!ctions are taken
based on whether
or not it willres$lt in a reward
p$nishment" +lder
preschoolers
primarily take
actions based on
satisfyin
personal needs>
yet are beinnin
to $nderstand the
concepts of
;$stice and
- 4ein to
reconiCe
di9erences in
appearances>
and identify
what is
considered
acceptable and
$nacceptable- 4y the ae of A
years>
preschoolers
bein
comparin
themselves
with peers- Poor
$nderstandin
of anatomy
makes intr$sive
e#periences>
s$ch as
- 3hifts to associative
play- Play is not hihly
oraniCed b$t
cooperation does
e#ist between
children- Playin ball- P$ttin p$CCles
toether- 0idin tricycles- Playin pretend and
dress $p activities- 0ole playin- Painin- 3imple sewin- 0eadin books- =adin pools- 3katin- *omp$ter prorams- lectronic ames
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preschoolers to
determine the
di9erence
between reality
and fantasy
fairness in;ections or
c$ts>
frihtenin to
preschoolers1&"&,&@&A&
3*H++-
!7 (6 to
1"
- Peer ro$ps play an
important part in
social development- Peer press$re bein
to take e9ect- *l$bs and best
friends are pop$lar- 4$llyin- Prefer the company
of same ender
companions> b$t
bein developin
an interest in the
opposite se#
toward the end of
school ae years- /ost relationships
come from school
associations- *onformity becomes
evident
- Develop an
awareness
ofthemselves
in relation to
others&-
abilities> and
physical
characteristi
cs- *on%dence is
ained
thro$hestablishin
a positive
self-concept- Parents
contin$e to
in$ence
the school
ae childMs
self-ideals>
b$t by
middle
childhood
the opinionsof peers and
teachers
become
more
val$able
arly school ae
- Do not $nderstand the
reasonin behindr$les and
e#pectations for
behavior- 4elieve what they
think si worn and
what others tell
them is riht- ?$dement is $ided
by rewards and
p$nishment
ate 3chool ae years
- !ble to ;$de theintentions of an act
rather than ;$st its
conseK$ences-
stamps>
cards> coins
or st$9edanimals
- 0ide bicycle- 4$ilde
simple
models- ?oin
oraniCed
sports
F- 1" years of ae
- /ake crafts- 4$ild mode- *ollect
thins
enae in
hobbies- 3olve ;isaw
p$CCles- Play board
and card
ames- ?oin
oraniCed
competitive
sports!D+*
. (1"
to ")
- Peer relationships
develop& hese
relationships act as
s$pport system for
adolescents- 4est friend
relationships are
more stable and
loner lastin than
they were in
prevo$s years- Parent child
relationships
chane to allow
reater sense of
- Biew
themselves
in relation to
similarities
with peers
d$rin
yo$ner
adolescence- Biew
themselves
accordin to
their $niK$e
characteristi
cs as the
adolescent
- 3olve moral dilemma
$sin internaliCed
moral principles- N$estion relevance of
e#istin moral
val$es to society
and individ$als
- 4ase their own
normality on
comparison with
peers- he imae
established
d$rin
adolescence is
retained
thro$ho$t life
- .on-violent
ames- .on- violent
m$sic- 3ports- *arin for a pet- *areer trainin
prorams- 0eadin- 3ocial events
( oin to
movies> school
dances)
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independence years
proress
Health promotion
!e Imm$niCation .$trition In;$ry preventionInfant
(birth to
year )
- 4irth G hepatitis 4
" months5 DtaP> rotavir$s
vaccine (0B)> inactivated
poliovir$s (IPB)> haemophil$
in$enCa type 4 (HI4)>
pne$mococcal vaccine(P*B)> Hep 4@ mos G DtaP> 0B> IPB> Hib>
P*B- 6 months 5 G DtaP> IPB (6 to
18 mos)> P*B> Hep 4 (6
to 1" mos)> rotaeK
(alternative form$lation
for 0B> reK$ires , doses
that m$st be completed
by ," weeks of ae)- 6 to 1" mos G seasonal
in$enCa vaccinationyearlyO can ive
trivalent inactivated
in$enCa vaccine (IB)
as I/
- 4reastfeedin provides
complete diet for infants d$rin
the %rst 6 months- Iron fortifed form$la is
acceptable alternative to breast
milk- *owMs milk is not recommended- 4ein vitamin D s$pplements
within the %rst few days of life- !lternative so$rce of $ids are
not needed d$rin the %rst @
months of life- !fter 6 months> 1 fr$it ;$ice
sho$ld be limited to @ to 6 oC
per day- 3olid foods are introd$ced
aro$nd @ to 6 months- 0eadiness incl$de interest in
solid foods> vol$ntary control of
the head and tr$nk- Iron forti%ed cereal is
introd$ced- .ew foods sho$ld be introd$ced
one at a time> over a @ to E day
period> to observe for sins of
allery or intolerance> which
may incl$de f$ssiness> rash>
vomitin> diarrhea> and
constipation- Beetables fr$its started
between 6 to 8 months of ae&
!fter both have been
introd$ced> meats may beadded
- *itr$s fr$its> meat> and es are
not started $ntil 6 months of
ae- 4reast milk form$la sho$ld be
decreased as intake of solid
foods increase> b$t breast milk
sho$ld remain the primary
so$rce of n$trition thro$h the
%rst year- 'oods that are cooked>
chopped> and $nseasoned are
appropriate by F months of ae
!spiration of forein ob;ects
- !void rapes> coin> candy- *lothin sho$ld be checked
for haCards (loose b$tton)
4odily harm
- 3harp ob;ects sho$ld be
kept o$t of reach- 3ho$ld not be left
$nattended with any
animals present
4$rns
- emperat$re of bath sho$ld
be checked- How water sho$ld be set
below @F *- Handle pots and pans
sho$ld be kept t$rned to
the back of stoves- lectrical o$tlets sho$ld be
covered
Drownin
- 3ho$ld not be left
$nattended in bath t$bs
'alls
- :ept at the lowest position
with the fails all the way $p- 0estrains sho$ld be $sed in
infants seats- Place safety ates on the
top and bottom of stairs
Poisonin
- #pos$re to lead paint
sho$ld be avoided- o#in sho$ld be kept o$t of
reach- n$mber of poison control
center sho$ld be kept near
the phone
/otor vehicle in;$ry
- infant only and convertible
infant toddler car seats- rear facin car seat $ntil the
ae of " years or the
recommended heiht- safest area for infants and
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- 'iner foods incl$de5 ripe
banana> toast strips> raham
crackers> cheese c$bes>
noodles> peeled checks of
apples> pears> peaches- =eanin can be accomplished
when the infants are able to
drink for a c$p&- +ne meal may be replaced with
breast milk or form$la in a c$p
with handles- 4ed time feedins are the last
to be stopped
child is the back seat of a
car
s$9ocation
- plastic ba sho$ld be
avoided- balloons sho$ld be kept
away from infants- crib mattress sho$ld %t- pillows sho$ld be kept o$t
of reach- placed on their backs for
sleep
oddler (1
to ,
years)
1" to 1A mos G IPBO HibO
P*BO //0O varicella
1" to ", mos G Hep !> in "
doses> 6 mos apart
- ife time eatin habits- 4ein developin taste preference- 3ho$ld cons$me "@ to , oC of milk
per day& /ay switch from drinkin
whole milk to drinkin low fat milk
after " years of ae- ?$ice sho$ld be limited to @ to 6 oC
per day- rans fatty acid sho$ld be avoided- Diet sho$ld incl$de 1 c$p of fr$it- 'ood servin sho$ld be 1 tbsp for
each ear of ae- Prefer %ner foods beca$se of
increasin a$tonomy- 0e$lar meal times and n$trition
snack best meet n$trient needs- 'oods that are potential chokin
haCards ( n$ts> rapes> hot dos>
pean$t b$tter> raw carrots> to$h
meats> popcorn) sho$ld be
avoided- !d$lt s$pervision d$rin snack and
meal times- 3ho$ld not drink and play d$rin
activities or lyin down
/B!5 rear-facin car seats in the
back seat> preferably in the
middle> for the %rst year of life
$ntil they weih F&1 k> then
can sit in forward-facin car
seat $ntil @ years of ae andor
@lbs
!spiration of forein ob;ects5
small ob;ects> toys with small
partsO balloonsO clothin withloose b$ttons
4odily harm5 sharp ob;ect>
%rearms> animals> straners
4$rns5 same as infants
Drownin5 same as infants
close toilet lids> teach how to
swim
'alls5 same as infants keep
doors and windows closed
Poisonin5 same as infants
safety locks
3$9ocation5 same as infantsPreschool
er ( , to 6
years)
@ to 6 years old GDaPO
//0O varicellaO IPB
,6 to AF mos G seasonal
in$enCa vaccineO IBO or
live atten$ated in$enCa
vaccine (!IB) by nasal
spray
Bision screenin is done5
myopia and amblyopia are
two vision impairmentsthat can be detected
d$rin screenin of the
preschooler
*ons$me abo$t half th, amo$nt
of enery that ad$lts do (18
:cal)
'ood ;as contin$eO become
more willin to sample di9erent
foods by A years of ae
.eed 1, to 1F day of complete
protein in addition to adeK$at,
*a> 'e> folate and Bitamins ! Q *3at$rated fats sho$ld be less than
1 of preschoolerMs total caloric
intake> and total fat over several
days sho$ld be " to , of total
caloric intake
4odily harm
1& 'irm arm sho$ld be kept away"& Preschoolers sho$ld be ta$ht
straner safety,& =ear protective eK$ipment
4$rns
@& hermostat sho$ld be t$rned
down on hot water heatersA& 3$nscreen
Drownin
6& 3ho$ld not be left $nattended in
bath t$bs
E& 3$pervised when near pool8& a$ht to swim
/BI
F& =hen the forward facin car
seat is o$trown> the
preschooler transitions to a
booster seat1& 3afest area for children is the
back seat of the car11& =ear seat belt1"& Do not allow them to play near
c$rb or parked cars1,& each pedestrian safety r$les to
preschool ae children
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1@& G stand back from c$rb while
waitin to cross the street1A& =ear liht colored clothin with
$orescent materials attached3chool
ae (6 to
1" years)
4y 6 years of ae> if not
iven between @-A years
of ae5 DaPO IPBO //0O
varicella
11-1" years old5 dapO
HPB " (for females) in ,doses and HPB@ (for
males)
In$enCa vaccine
3coliosis screenin sho$ld
be done
4y the end of school ae> children
sho$ld eat ad$lt portion of foo&
!void $sin food as reward
mphasiCe physical activity
each children to make healthy food
selections for meals and snacks
!void eatin fast food freK$ently
!void skippin meals
/odel healthy behavior
- 4odily harm
:eep away from %rearms
3ho$ld not be allowed to $se
trampolines
Identify safe play areas
3traner safety
=ear helmets and pads- 4$rns
'ire safety
=orkin smoke etector
3$nscreen
Preca$tion to take whle cookin
- /BI
*hildren $se approved car
restraint when they achieved
@MF
- Poisonins$bstance
ab$se*hemicals sho$ld be locked
each abo$t illeal dr$s and
alcohol!dolesce
nce (1"
to "
yearsR
If not ive at ae 11 G 1"
years of ae5 dapO /*B@O
P0B" series for females
and HPB@ series for males
In$enCa vaccine
3coliosis screenin
0apid rowth and hih metabolism
reK$ire increases in K$ality n$trients
- *a> fe> Cinc- 'olic acid- Bitamin 46> !> iron> calci$m>
and Cinc
4oth overeatin and $nder eatin
need to be checked
!void $sin food as reward
mphasiCe physical citivity
1& 4odily harm
:eep %rearms $nloaded and in a
locked cabinet or bo#
Proper $se of sportin eK$ipment
prior to $se
4e aware of chanes in mood
- Poor school performance- ack of interest in thins
that were of interest
- 3ocial isolation- Dist$rbance in sleep or
appetite- #pression of s$icidal
tho$hts"& 4$rns
each %re safety
!void tannin beds
!pply s$n 3creen
,& Drownin
each adolescents to swim
@& /BI5
DriverMs ed$cation
A& 3$bstance ab$se each to say no
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3leep> dental> and se#$ality
!e 3leep Dental 3e#$alityInfants ( 1 month to 1 year) 1& .oct$rnal sleep pattern
is established by , to @
months of ae"& Infant sleeps 1@ to 1A
ho$rs daily and F to 11
ho$rs at niht aro$nd
the ae of @ months,& Infant sleeps thro$h
the niht and takes one
to two naps d$rin the
day by the ae of 1"
months oddler ( 1 to , years) 1& ypically 11 to 1" hr of
sleep per day> incl$din
one nap"& .aps often are
eliminated in older
toddlerhood,& 0esistance to bed time
1& 3ho$ld have an
established dental home
by the ae of 1 year"& 'lossin and br$shin
sho$ld be performed by
the ad$lt careiver> and
is the best method of
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and e#pression of fears
are common in this ae
ro$p@& /aintainin a re$lar
bedtime and bedtime
ro$tines are helpf$l to
promote sleeS
removin plaK$e,& 4r$shin sho$ld occ$r
after meals and at bed
time& .othin to eat or
drink> e#cept water> is
iven to the child after
the bed time cleanin@& 'l$oride is
s$pplemented to
children livin in areas
witho$t adeK$ate levels
in drinkin waterA& arly childhood caries is
a form of tooth decay
that develops in the
toddlers> and is more
common in children who
are p$t to bed with a
bottle of ;$ice or milk6& *ons$mption of
carioenic foods sho$ld
be eliminated if
possible& If not> the
freK$ency of
cons$mption sho$ld be
limited&Pre 3chool (, to 6 years) 1& .eed abo$t 1" ho$rs of
sleep per day& 3ome
may still reK$ire a
daytime nap"& :eep consistent bed
time ro$tine,& and is
dependent on- !e- evel of activity- Health stat$s
"& F ho$rs of sleep is
needed each niht at
the ae of 1" years,& 0esistance to bed time
is sometimes
e#perienced aro$nd theae of 8 and F years>
and aain aro$nd the
ae of 11 years> b$t is
typically resolved by the
ae of 1"
- 4r$sh after meals
and snacks> and at
bedtime- 'loss daily- Have re$lar check
$ps- Have re$lar
$oride treatments
!dolescents (1" to " years) - 3leep habits chane
with p$berty d$e to
increased
metabolism and
rapid rowth- end to stay $p late>
sleep in later in the
- *orrective
appliances are most
common with this
ae ro$p- 4r$sh after meals
an snacks> and at
bedtime
- Provide adolescents
with acc$rate
information and
disc$ss what is
heard from peers- mphasiCe
abstinence and
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mornin> sleep mre
than d$rin the
school ae years- D$rin the periods
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