Healthy Children

1. Healthy Children Infancy Early Childhood Middle Childhood

2. Learning Outcomes • To be able to discuss healthy infants and usual growth and developmental milestones. • To identify and discuss aspects of healthy children, from conception to middle childhood. • To discuss “red flags” and when to refer children for developmental delays

3. Student Health Desk

4. Prenatal Development • Period of time from conception to birth • Embryo • From about two weeks after conception to three months after conception • Fetus • Three months after conception to birth • Placenta • Connects fetus to mother • Brings oxygen and nutrients • Takes away wastes

5. Reflexes at birth • Rooting • Baby turns its head toward something that brushes its cheek and gropes around with mouth • Sucking • Newborn’s tendency to suck on objects placed in the mouth • Swallowing • Enables newborn babies to swallow liquids without choking • Grasping • Close fist around anything placed in their hand • Stepping • Stepping motions made by an infant when held upright

6. Stages of Growth and Development • Infancy • Neonate • Birth to 1 month • Infancy • 1 month to 1 year • Early Childhood • Toddler • 1-3 years • Preschool • 3-6 years • Middle Childhood • School age • 6 to 12 years

7. Principles of Growth and Development • Growth is an orderly process, occurring in systematic fashion. • Rates and patterns of growth are specific to certain parts of the body. • Wide individual differences exist in growth rates. • Growth and development are influences by are influences by a multiple factors.

8. Principles Continued • Development proceeds from the simple to the complex and from the general to the specific. • Development occurs in a cephalo-caudal and a proximo-distal progression. • There are critical periods for growth and development. • Rates in development vary. • Development continues throughout the individual's life span.

9. Growth Patterns • The child’s pattern of growth is in a head-to-toe direction, or cephalo-caudal, and in an inward to outward pattern called proximo-distal.

10. Growth Pattern

11. Break

12. Why developmental assessment? • Early detection of deviation in child’s pattern of development • Simple and time efficient mechanism to ensure adequate surveillance of developmental progress • Domains assessed: cognitive, motor, language, social / behavioral and adaptive

13. Gross Motor Skills • The acquisition of gross motor skill precedes the development of fine motor skills. • Both processes occur in a cephalo-caudal fashion • Head control preceding arm and hand control • Followed by leg and foot control.

14. Gross Motor Development • Newborn: barely able to lift head • 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms

15. Head Control Newborn Age 6 months

16. Sitting up • 2months old: needs assistance • 6 months old: can sit alone in the tripod position • 8 months old: can sit without support and engage in play

17. Sitting Up Age 2 months Age 8 months

18. Ambulation • 9 month old: crawl • 1 year: stand independently from a crawl position • 13 month old: walk and toddle quickly • 15 month old: can run

19. Ambulation 13 month old Nine to 12-months

20. Fine Motor - Infant • Newborn has very little control. Objects will be involuntarily grasped and dropped without notice. • 6 month old: palmar grasp – uses entire hand to pick up an object • 9 month old: pincer grasp – can grasp small objects using thumb and forefinger

21. Speech Milestones • 1-2 months: coos • 2-6 months: laughs and squeals • 8-9 months babbles: mama/dada as sounds • 10-12 months: “mama/dada specific • 18-20 months: 20 to 30 words – 50% understood by strangers • 22-24 months: two word sentences, >50 words, 75% understood by strangers • 30-36 months: almost all speech understood by strangers

22. Break

23. Hearing • BAER hearing test done at birth • Ability to hear correlates with ability enunciate words properly • Always ask about history of otitis media – ear infection, placement of Grommets – tubes in ear • Early referral to Dr to assess for possible fluid in ears (Glue Ear) • Repeat hearing screening test • Speech therapist as needed

24. Fine Motor Development 6-month-old 12-month-old

25. Red Flags in infant development • Unable to sit alone by age 9 months • Unable to transfer objects from hand to hand by age 1 year • Abnormal pincer grip or grasp by age 15 months • Unable to walk alone by 18 months • Failure to speak recognizable words by 2 years.

26. Fine Motor - toddler • 1 year old: transfer objects from hand to hand • 2 year old: can hold a crayon and color vertical strokes • Turn the page of a book • Build a tower of six blocks

27. Fine Motor – Older Toddler • 3 year old: copy a circle and a cross – build using small blocks • 4 year old: use scissors, color within the borders • 5 year old: write some letters and draw a person with body parts

28. Toddler Adele Piliterri, Child Health Nursing, Lippincott

29. Toddler Safety becomes a problem as the toddler becomes more mobile. Pilliterri, Lippincott

30. Toddlers

31. Issues in parenting - toddlers • Stranger anxiety – should dissipate by age 2 ½ to 3 years • Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 • Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely • Thumb sucking • Toilet Training

32. Pre-School

33. Fine motor and cognitive abilities • Buttoning clothing • Holding a crayon / pencil • Building with small blocks • Using scissors • Playing a board game • Have child draw picture of himself • Pre-school tasks

34. Red flags: preschool • Inability to perform self-care tasks, hand washing simple dressing, daytime toileting • Lack of socialization • Unable to play with other children • Able to follow directions during exam • Performance evaluation of pre-school teacher for kindergarten readiness

35. Pool Safety

36. School-Age

37. Sex role development • Gender-role awareness • Knowing appropriate behavior for each gender • Gender stereotypes • Beliefs about presumed characteristics of each gender • Sex-typed behavior • Socially defined ways to behave different for boys and girls • May be at least partly biological in origin

38. School Years: fine motor • Writing skills improve • Fine motor is refined • Fine motor with more focus • Building: models – legos • Sewing • Musical instrument • Painting • Typing skills • Technology: computers

39. School performance • Ask about favorite subject • How they are doing in school • Do they like school • By parent report: any learning difficulties, attention problems, homework • Parental expectations

40. Red flags: school age • School failure • Lack of friends • Social isolation • Aggressive behavior: fights, fire setting, animal abuse

41. School Age: gross motor • 8 to 10 years: team sports • Age ten: match sport to the physical and emotional development

42. School Age

43. School Age: cognitive • Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.

44. Mental Health • Young children may have mental health issues • May be related to attachment issues

45. Piaget’s stages of Cognitive Development • Sensory-Motor Stage (birth to 2 years) • Object permanence • Preoperational Stage (2-7 years) • Egocentric • Concrete Operations (7-11 years) • Principles of conservation • Formal Operations (11-15 years) • Understand abstract ideas

46. Resources • Bell, J. (2011). Relationships: The heart of matter in family nursing. Journal of • Family Nursing, 17(3). • Berkman, N., Sheridan, S., Donahue, K., Halpern, D. & Crotty, K. (2011). Low • health literacy and health outcomes: an updated systematic review. Annals of Internal Medicine, 155, 97-107. • Canady, R.B., Tiedje, L.B., & Lauber, C. (2008). Preconception care & • pregnancy planning: Voices of African American women. Maternal Child Nursing, 33(2), 90-97. • Clavarino, A., Mamum, A., O’Callaghan, M., Aird, R., Bor, W., O’Callaghan, • F., Williams, G., Marrington, S., Najman, J., & Alati, R. (2010). Maternal anxiety and attention problems in children at 5 and 14 years. Journal of Attention Disorders, 13(6), p658- 667. • Conde, A., Figueiredo, B., Tendais, I., Teixeira, C., Costa, R., Pachecco, A., • Rodrigues, M., & Nogueira, R. (2010). Mother’s anxiety and depression and associated risk factors during early pregnancy: effects on fetal growth and activity at 20–22 weeks of gestation. Journal of Psychosomatic Obstetrics & Gynecology, 31(2): p70–82. • Cully, G. (2008). Are pregnant women receiving support for smoking • dependence when attending routine antenatal appointments? (Unpublished Masters thesis). Dublin University, Ireland. • Duijts, L., Jaddoe, V., Hofman, A., Steegers, E., Makenbach, J., Jongste, J., • Moll, H. (2008) Maternal smoking in prenatal and early postnatal life and the risk of respiratory track infections in infancy. European Journal of Epidemiology, 23 (547), p 547- 555. • Einarson, A., & Riodan, S. (2009). Smoking in pregnancy and lactation: a • review of risks and cessation strategies. European Journal of Clinical Pharmocology, 65, 325-330. • Hammarberg, K., Fisher, J., & Rowe, H. (2008). Womens’ experiences • of childbirth and postnatal healthcare after assisted conception. Human Reproduction, 23 (7), 1567-1573. • Health and Disability Commissioner. (2009). The informed consent process • and children. Retrieved from • http://www.hdc.org.nz/education/presentations/the-informed-consent- process-and-the-application-of-the-code-to-children