Chapter 5: Developmental Influences on Child Health Promotion

1. Chapter 5: Developmental Influences on Child Health Promotion Laura Salisbury RN, MSN/Ed.

2. Definitions • Growth • Development • Maturation • Differentiation

3. The Developmental Age Periods • Prenatal • Germinal, Embryonic, Fetal • Infancy • Neonatal, Infancy • Early Childhood • Toddler, Preschool • Middle Childhood • School-age • Later childhood • Prepubertal, Adolescence

4. Patterns of Growth and Devleopment • Directional • Cephalocaudal • Proximodistal • Differentiation • Sequential trends • Developmental pace • Sensitive periods • Individual differences

5. Biological growth and Physical development • Skeletal proportion Changes • Changes in Weight • Changes in Height

6. Changes in Weight • Doubles from birth to 6 months • Triples by end of first year • Quadruples by 2.5 years • 2-3 kg growth per year preschool/school age • Growth spurt starts 10-14 years (females) 11-16 years (males)

7. Changes in Height • Changes in Height • Length increase by 50% by 1st birthday • Length doubles by age four • Height at age 2 approximately 50% of average adult height • Skeletal age: how is it determined? • Hand and wrist x-rays • Why do adolescents get more fractures than ligamentous ruptures?

8. Physiologic changes • Metabolic Rate • Sleep and Rest

9. Types of Temperment • Easy child • Difficult child • Slow-to-warm-up child • Significance of temperament

10. Freudian Developmental theory • Id • Ego • Superego • Freudian stages • Oral • Anal • Phallic • Latency • Genital

11. Ericksons Psychosocial developmental theory • Trust vs. mistrust • Autonomy vs. shame and doubt • Initiative vs. guilt • Industry vs. inferiority • Identity vs. role confusion

12. Piaget Cognitive developmental theory • Sensorimotor • Preoperational • Egocentric thinking • Intuitive reasoning • Transductive reasoning • Concrete operations • Conservation • Inductive reasoning • Formal operations

13. Kholberg moral development • Preconventional • Conventional • Postconventional

14. Development of self concept • Body Image • Self Esteem

15. Types of Play • Social-affective • Sense-pleasure • Skill play • Unoccupied behavior • Dramatic/pretend play • Games • Imitative • Formal • Competitive

16. Social Character of play • Onlooker play • Solitary play • Parallel play • Associative play • Cooperative play

17. Functions of Play • Development • Socialization • Creativity • Self-awareness • Therapeutic

18. Choosing Toys • Toy safety: pg 87 • Selection • Supervision • Maintenance • Storage

19. Factors that Influence Development • Heredity • Neuro-endocrine • Nutrition • Single most important influence on growth • Interpersonal relationships • Emotional deprivation • Socioeconomic level • Disease • Environmental hazards

20. Factors that Influence Development • Stress in childhood • Mass media influence • Reading • Movies • Television • Read “Family-Centered Care” • Video games • Internet

21. Developmental Screening • DDST • Denver Developmental Screening Tool

22. Chapter 6: Communication and Physical assessment of the child Laura Salisbury RN, MSN/Ed.

23. Communication and Physical assessment of the child • Establish a setting • Privacy and confidentiality • When is confidentiality limited? • Introductions • Just the child vs. child and parent • (Legal issues in telephone triage)

24. Interviewing the parent • Encouragement • Direction • Cultural variables • Using silence • Empathy versus sympathy • “Anticipatory guidance” • What are blocks to communication (Table 6-2) • Use of interpreter (box on page 102) • Avoid using the child as interpreter!!!

25. Communication with the child • Infancy • Nonverbal behaviors • Early childhood • Remember that they take things literally • They may assign human attributes to inanimate objects • School-age • Concerned with body integrity • Adolescence • Establish trust • Demonstrate positive communication to child and parent • Creative Communication (use of play)

26. Health History • Chief complaint • History of present illness • Past history • Birth history, Dietary history, Previous illness/surgery • Allergies, Medications, Immunizations • Growth and development milestones, Habits • Sexual history • Family medical history • Geography • Family structure • Psychosocial history • Review of systems

27. Clinical Exam • Head to toe sequence • Preparing the child • See guidelines, p. 119 • See table 6-2, p. 120

28. Growth Measurements • When are growth charts different? • Length vs. height • Skin-fold thickness: to measure fat percentage

29. Physiological Measurements • Temperature • Which way? Box 6-11 p. 125 • Pulse • Apical or radial? • Respiration • Blood pressure • Annually starting age 3 • How to measure cuff appropriately, p. 130

30. Physical Assessment • General appearance • Posture • Behavior • Skin • Accessory structures: hair, scalp, nails • Lymph nodes • Head and neck • Head lag: after 6 months=worrisome symptom • Head control in infant/toddlers • Pain on neck flexion=worrisome symptom

31. Physical Assessment • Eyes • PERRLA • Visual acuity • Use Snellen letter chart • Ears • Must restrain child when using otoscope on infant/toddler • Positioning: see figure 6-23 p. 140 • Nose • Mouth and throat

32. Physical Assessment • Chest • Normal breath sounds: p. 145 • Facilitating auscultation/deep breaths: p. 145 • Heart • Capillary refill time: how to assess? • Heart murmurs: Innocent, functional, organic • Abdomen • Umbilical hernia • Inguinal hernia • Femoral hernia

33. Physical Assessment • Genitalia • Anus • Back and extremities • Joints • Neurologic assessment • Cerebellar function: Romberg test • Reflexes • Cranial nerves