Parts I and II:Parts I and II:Pediatric Growth & DevelopmentPediatric Growth & DevelopmentHealth Maintenance & RestorationHealth Maintenance & Restoration
Fall 2010Fall 2010Susan Beggs, RN MSN CPNSusan Beggs, RN MSN CPN
Growth and DevelopmentGrowth and Development
Directional paths of Directional paths of growth & developmentgrowth & development
CephalocaudalCephalocaudal Proximo-distalProximo-distal PrehensilePrehensile
Concepts of growth Concepts of growth and developmentand development
Psychosocial development: EriksonPsychosocial development: Erikson Cognitive development: PiagetCognitive development: Piaget Moral development: KohlbergMoral development: Kohlberg Sexual development: FreudSexual development: Freud
Improving child health Improving child health by having knowledge by having knowledge of definitionsof definitions
“ “growth”growth” ““development”development” ““maturation”maturation” ““learning”learning”
Principles of Growth & Principles of Growth & DevelopmentDevelopment
occur in an orderly sequenceoccur in an orderly sequence occur continuously but rates vary- occur continuously but rates vary-
growth spurtsgrowth spurts highly individualized rate from highly individualized rate from
child to childchild to child vary @ different ages for specific vary @ different ages for specific
structuresstructures process involving the process involving the whole childwhole child
Factors which influence Factors which influence growth and developmentgrowth and development
GeneticsGenetics EnvironmentEnvironment CultureCulture NutritionNutrition Health StatusHealth Status FamilyFamily
Genetic influences on Genetic influences on growth and developmentgrowth and development
pattern, rate, rhythm and extent:pattern, rate, rhythm and extent:– governed by genes interplaying with governed by genes interplaying with
environmentenvironment– intrauterine life extremely important in intrauterine life extremely important in
growth and healthy development of the childgrowth and healthy development of the child
genetic screening, genetic screening, cont.cont.
later in pregnancy:later in pregnancy:– amniocentesis: @ l2-l6 weeksamniocentesis: @ l2-l6 weeks– chorionic villa sampling: @ l0-11 chorionic villa sampling: @ l0-11
weeksweeks role of the genetic counselorrole of the genetic counselor
Examples of environmental Examples of environmental influences on a childinfluences on a child
family compositionfamily composition family position in societyfamily position in society family socioeconomic statusfamily socioeconomic status knowledge of the familyknowledge of the family availability of healthy diets availability of healthy diets housinghousing diseases present in family and childdiseases present in family and child
Cultural influencesCultural influences Must be considered when Must be considered when
assessing growth and developmentassessing growth and development Customs vs. work demands from Customs vs. work demands from
different culturesdifferent cultures
Nutritional influencesNutritional influences Begins during the prenatal periodBegins during the prenatal period LBW (low birth weight) can result LBW (low birth weight) can result
from poor prenatal nutritionfrom poor prenatal nutrition Socio-economics may impact Socio-economics may impact
growth as wellgrowth as well
Health status of the childHealth status of the child
Certain diseases may impact g & dCertain diseases may impact g & d Endocrine and cardiac status Endocrine and cardiac status
included hereincluded here
Family relationships (environmental) Family relationships (environmental) and the impact on child growth and and the impact on child growth and developmentdevelopment
Critical in growth and Critical in growth and development, esp. emotional development, esp. emotional growthgrowth
Intellectual growth must be Intellectual growth must be included here as wellincluded here as well
Chronic illness can be combated Chronic illness can be combated with a loving environment and with a loving environment and close family relationshipsclose family relationships
Patterns of growth Patterns of growth Rapid pace from birth to 2 yrsRapid pace from birth to 2 yrs Slower pace from 2 yr-pubertySlower pace from 2 yr-puberty Rapid pace from puberty to 15 yrsRapid pace from puberty to 15 yrs Sharp decline from 16 -24 yrs Sharp decline from 16 -24 yrs
when full adult size is reachedwhen full adult size is reached
Growth and Growth and development, cont.development, cont.
Methods to evaluate growth:Methods to evaluate growth:– charts: compare to normscharts: compare to norms– compare to self over timecompare to self over time– xraysxrays– teethteeth– height, weight, head circumferenceheight, weight, head circumference– size of head and legs: length of bonessize of head and legs: length of bones
Assessments of Assessments of developmentdevelopment
DDST (Denver II) DOES NOT MEASURE DDST (Denver II) DOES NOT MEASURE IQIQ– Classic screening tool to assess Classic screening tool to assess
developmentdevelopment– Personal, fine motor skills, language, Personal, fine motor skills, language,
gross motorgross motor Basic assessment includes the following Basic assessment includes the following
nursing assessments: hx taking, nursing assessments: hx taking, developmental screening, growth developmental screening, growth measurements, parent teachingmeasurements, parent teaching
Tanner stagingTanner staging Sexual Maturity Rating (SMR)Sexual Maturity Rating (SMR) Essential for nurses to assess in Essential for nurses to assess in
adolescentsadolescents SMR greater reliability for physical SMR greater reliability for physical
development than chronological development than chronological ageage
Tanner stagingTanner staging Girls:Girls:
– Stage 1: preadolescenceStage 1: preadolescence– Stage 2: breast buds; Stage 2: breast buds;
sparse public hairsparse public hair– Stage 3: breast and Stage 3: breast and
areola enlarge; pubic areola enlarge; pubic hair thickens, curlshair thickens, curls
– Stage 4: areola and Stage 4: areola and papilla form; typical papilla form; typical female triangle in pubis, female triangle in pubis, thickening hairthickening hair
– Stage 5: mature, nipple Stage 5: mature, nipple projects; adult female projects; adult female triangle, spreads to triangle, spreads to medial surface of thighsmedial surface of thighs
BoysBoys– Stage 1: no pubic hair; Stage 1: no pubic hair;
all structures all structures preadolescencepreadolescence
– Stage 2: pubic hair, Stage 2: pubic hair, slight enlargement of slight enlargement of penis and scrotumpenis and scrotum
– Stage 3: pubic hair, curls, Stage 3: pubic hair, curls, penis and testes largerpenis and testes larger
– Stage 4: less pubic hair Stage 4: less pubic hair than adult, but than adult, but thickening; penis larger, thickening; penis larger, scrotum darkerscrotum darker
– Stage 4: pubic hair, adult Stage 4: pubic hair, adult distribution; penis and distribution; penis and testes adult in sizetestes adult in size
Importance of PlayImportance of Play
Allows child the learn about Allows child the learn about themselves and relate to themselves and relate to others….it is work for the childothers….it is work for the child
Functions of playFunctions of play Physical growth and developmentPhysical growth and development Cognitive developmentCognitive development Emotional developmentEmotional development Social awarenessSocial awareness Moral developmentMoral development
Social aspects of playSocial aspects of play Solitary playSolitary play Parallel PlayParallel Play Associative playAssociative play Cooperative PlayCooperative Play Onlooker PlayOnlooker Play
Types of PlayTypes of Play
Dramatic playDramatic play Familiarization playFamiliarization play
Growth of EmotionsGrowth of Emotions Emotion definedEmotion defined All emotions contain:All emotions contain:
– feelingsfeelings– impulsesimpulses– physiological responsesphysiological responses– reactions (internal and external)reactions (internal and external)
Subjective data:Subjective data: Objective data:Objective data:
JealousyJealousy A combination of anger, fear, and A combination of anger, fear, and
lovelove A child A child 1st1st loves something, counts loves something, counts
it as his own and it as his own and 2nd2nd perceives perceives that it has been taken away or that it has been taken away or interfered withinterfered with
The loss may be real or perceived, The loss may be real or perceived, ie., sibling rivalryie., sibling rivalry
DisciplineDiscipline Techniques:Techniques:
– The model is to teach by example!The model is to teach by example!– Listening skillsListening skills
passive passive acknowledgementacknowledgement door openers door openers active listeningactive listening
Part II: Health Part II: Health Maintenance and Maintenance and RestorationRestoration
Dental needs of the child Dental needs of the child from infancy to adolescencefrom infancy to adolescence
Caries in infancy due to nurse for Caries in infancy due to nurse for long periods of timelong periods of time
See text for the sequence of See text for the sequence of eruption of teetheruption of teeth
Braces may be indicated at the Braces may be indicated at the time of pubertytime of puberty
Levels of Preventive Levels of Preventive Health Maintenance Health Maintenance ActivitiesActivities
PrimaryPrimary SecondarySecondary TertiaryTertiary
Specific recommendations by APA:Specific recommendations by APA:– Minor infections without fever are not Minor infections without fever are not
contraindicationcontraindication– If reaction occurs, consult dr. before If reaction occurs, consult dr. before
next immunizationnext immunization
Barriers to Barriers to immunizationsimmunizations
Complexity of the health care Complexity of the health care systemsystem
Expense of immunization servicesExpense of immunization services Parental misconceptionsParental misconceptions Inaccurate record keeping by Inaccurate record keeping by
parentsparents Reluctance of health care worker Reluctance of health care worker Lack of public awarenessLack of public awareness
4mos-6 yrs of age:4mos-6 yrs of age: DTaP (4 doses)DTaP (4 doses) IPV (3 doses)IPV (3 doses) HepB (3 doses)HepB (3 doses) MMR (@ 12 MMR (@ 12
months)months) PCV (1 dose)PCV (1 dose)
7-18 yrs of age7-18 yrs of ageTd (every 10 years Td (every 10 years
after initial after initial immunizations)immunizations)
IPV (not rec. if >18 IPV (not rec. if >18 yrs of age)yrs of age)
Nurses responsibilites Nurses responsibilites with immunizationswith immunizations
Know the action of the vaccineKnow the action of the vaccine Careful history of patientCareful history of patient Aspirate when injectingAspirate when injecting Educate parents (schedule, side Educate parents (schedule, side
effects)effects) Proper documentationProper documentation
Assess for reaction 15-30 min after Assess for reaction 15-30 min after injectioninjection
Epinephrine 1:1000 availableEpinephrine 1:1000 available Check immunization records with Check immunization records with
each visiteach visit Parent teaching: fever, or other Parent teaching: fever, or other
symptomssymptoms
Safety risks to Safety risks to developmental levelsdevelopmental levels
InfantInfant ToddlerToddler PreschoolPreschool School ageSchool age AdolescentAdolescent
Major childhood prevention Major childhood prevention measuresmeasures
AspirationAspiration MVAMVA BurnsBurns DrowningDrowning Bodily injury/fracturesBodily injury/fractures
Leading cause of fatal injury under 1 Leading cause of fatal injury under 1 year of ageyear of age
Prevention:Prevention:– Inspection of toys, small partsInspection of toys, small parts– Out of reach objectsOut of reach objects– Selective elimination of certain foodsSelective elimination of certain foods– Proper posturing of the infant for feedingProper posturing of the infant for feeding– Pacifier with one piece constructionPacifier with one piece construction
Vehicular risk greatest when child Vehicular risk greatest when child improperly restrainedimproperly restrained
PedestrianPedestrian PreventionPrevention
Children are inquisitiveChildren are inquisitive Become able to climb and exploreBecome able to climb and explore Prevention of household injury:Prevention of household injury:
Child does not recognize danger of Child does not recognize danger of H2OH2O
Unaware of inability to breath Unaware of inability to breath underwaterunderwater
No conception of water depthNo conception of water depth Hypoxia greatest concernHypoxia greatest concern PreventionPrevention
Still developing sense of balanceStill developing sense of balance Easily distracted from tasksEasily distracted from tasks Prevention:Prevention:
Stats on drug Stats on drug poisoningspoisonings
Common in early childhood (2 yrs)Common in early childhood (2 yrs) 75% poisons are ingested75% poisons are ingested Major reason for poisoning:Major reason for poisoning:
Sources of poison:Sources of poison:– CosmeticsCosmetics– Household cleanersHousehold cleaners– PlantsPlants– DrugsDrugs– InsecticidesInsecticides– GasolineGasoline– Household itemsHousehold items
Therapeutic interventionsTherapeutic interventions In every instance, medical eval is In every instance, medical eval is
necessarynecessary Call poison control center 1Call poison control center 1stst
Remove child from exposureRemove child from exposure Identify poisonIdentify poison Prevent absorptionPrevent absorption
Life threateningLife threatening More likely to drop out of school More likely to drop out of school Become disabledBecome disabled Disturbed brain and nervous Disturbed brain and nervous
system functionsystem function Prevent child from full potentialPrevent child from full potential
Pathophysiology of lead poisoning Pathophysiology of lead poisoning System assessmentsSystem assessments Therapeutic InterventionsTherapeutic Interventions
Criteria for treatment of lead Criteria for treatment of lead poisoningpoisoning
< 9 not lead poisoned< 9 not lead poisoned 10-14: prescreen10-14: prescreen 15-19: nutritional and educational 15-19: nutritional and educational
interventionsinterventions 20-44: environmental eval and 20-44: environmental eval and
medicationmedication 45-69: chelation therapy45-69: chelation therapy >70: medical emergency>70: medical emergency
Systems affected by leadSystems affected by lead
CNS: brain and nerve damage, CNS: brain and nerve damage, retardation; headachesretardation; headaches
Cognitive changes: behavioral Cognitive changes: behavioral problems; learning disabilitiesproblems; learning disabilities
M/S: slowed growth patterns; ataxiaM/S: slowed growth patterns; ataxia Blood: reduction of heme Blood: reduction of heme
(hemoglobin) leading to anemia(hemoglobin) leading to anemia GI: vomiting, anorexia, colic, abd. GI: vomiting, anorexia, colic, abd.
painpain
Make environment lead-freeMake environment lead-free Inspect buildings >25 years of ageInspect buildings >25 years of age Areas painted with lead paint should be Areas painted with lead paint should be
covered with plywood or linoleumcovered with plywood or linoleum Educate the parentsEducate the parents Follow up testing for lead levelsFollow up testing for lead levels Screening all school age children Screening all school age children
(required in some states)(required in some states)
Relationship of safety to Relationship of safety to childhood developmentchildhood development
Children are vulnerable because:Children are vulnerable because:– They are curiousThey are curious– They are driver to test and master new They are driver to test and master new
skillsskills– They frequently attempt activities without They frequently attempt activities without
having cognitive or physical capabilitieshaving cognitive or physical capabilities– They often challenge rulesThey often challenge rules– They develop a strong desire for peer They develop a strong desire for peer
approvalapproval