Growth and Development

1. Growth and Development

2. Concepts of growth and development Psychosocial development: Erikson Cognitive development: Piaget Moral development: Kohlberg Sexual development: Freud Eri8kson�s most widely accepted, although cannot be empirically tested. Each stage has a core conflict to be resolved by individuals and an outcome goal for healthy personality developmentEri8kson�s most widely accepted, although cannot be empirically tested. Each stage has a core conflict to be resolved by individuals and an outcome goal for healthy personality development

3. Improving child health by having knowledge of definitions �health maintenance� �preventive health� Health maintenance: what to guard against, ie., take precautions on an individual basis such as nutrition, rest, activity Preventive health: immunizations, safety laws and codes, spending research $ to prevent common diseases and it gives the motivation for good NUTRITION< REST< ACTIVITYHealth maintenance: what to guard against, ie., take precautions on an individual basis such as nutrition, rest, activity Preventive health: immunizations, safety laws and codes, spending research $ to prevent common diseases and it gives the motivation for good NUTRITION< REST< ACTIVITY

4. Definitions Mortality: the # of deaths/100,000 Morbidity: used to express the ratio of sick to well in a community Infant mortality: # of children per l000 live births who die before 1st birthday.

5. Major causes of death during infancy and childhood (these represent death rates for the ages of l-l4 yrs per l00,000) Accidents Congenital abnormalities Cancer Homicide Heart disease Pneumonia & influenza Suicide Human immunodeficiency disease Not on this list but the disease causing the most morbidity is Type I Diabetes�the most common and serious chronic illness of childhood. It is twice as common as all childhood cancers combined.Not on this list but the disease causing the most morbidity is Type I Diabetes�the most common and serious chronic illness of childhood. It is twice as common as all childhood cancers combined.

6. Principles of Growth & Development occur in an orderly sequence occur continuously but rates vary- growth spurts highly individualized rate from child to child vary @ different ages for specific structures process involving the whole child Growth: implies increases in size Development: improvement in skill and function Charts were revised in 2000. Changes include the combination of breast-fed and formula-fed infants and the addition of the BMI beginning at 2 yrs to replace the weight for height assessment. Findings that require further evaluation include crossing multiple percentiles over a short period of time, measurment at or below the 5th percentile, and a BMI of greater than 85%Growth: implies increases in size Development: improvement in skill and function Charts were revised in 2000. Changes include the combination of breast-fed and formula-fed infants and the addition of the BMI beginning at 2 yrs to replace the weight for height assessment. Findings that require further evaluation include crossing multiple percentiles over a short period of time, measurment at or below the 5th percentile, and a BMI of greater than 85%

7. Assessments of development DDST (Denver II) DOES NOT MEASURE IQ Classic screening tool to assess development Personal, fine motor skills, language, gross motor Basic assessment includes the following nursing assessments: hx taking, developmental screening, growth measurements, parent teaching

8. Functions of Play on Growth & Development Physical Development Cognitive Development Emotional Development Social Development Moral Development Play enhances the child�s growth and development and contributes to these areas: Physical development: they do as they see�.story about learning fine and gross motor activitiy. They repeat certain movements and these in turn aid in the development of body control. For instances, jumping, grashing, walking Cognitive Development: they increase their problem-solving abilities through games and puzzles. Reading to the very young child increases their desire to see pictures, and eventually they can repeat a sequence in a familiar story�.examples? Emotionsal development: learning that mom will be back; play can provuide a way of escape for an emotionally frightening situation; also increases the child�s self-awareness by role playing. Social development: learning to play with others, sharing, joy of interacting with others and behaviors that involve others. Peers eventually replace the importance of parents as the child matures. Moral development: they begin to learn which behaviors are acceptable and which are not�the extremely moralistic children are those school-aged, esp. as they approach middle school. They momic what they have learned at home; what is done at home, or taught, is the morally right thing to do. They learn that taking turns is rewarded and cheating is not. This is when they have on their report cards �good citizenship� or �respects others�. Some schools recognize �principal pride� awards, or ___traits, whereby the child is recognized for integrity, attentiveness, respect for others, etc. And is attached to the record of grades.Play enhances the child�s growth and development and contributes to these areas: Physical development: they do as they see�.story about learning fine and gross motor activitiy. They repeat certain movements and these in turn aid in the development of body control. For instances, jumping, grashing, walking Cognitive Development: they increase their problem-solving abilities through games and puzzles. Reading to the very young child increases their desire to see pictures, and eventually they can repeat a sequence in a familiar story�.examples? Emotionsal development: learning that mom will be back; play can provuide a way of escape for an emotionally frightening situation; also increases the child�s self-awareness by role playing. Social development: learning to play with others, sharing, joy of interacting with others and behaviors that involve others. Peers eventually replace the importance of parents as the child matures. Moral development: they begin to learn which behaviors are acceptable and which are not�the extremely moralistic children are those school-aged, esp. as they approach middle school. They momic what they have learned at home; what is done at home, or taught, is the morally right thing to do. They learn that taking turns is rewarded and cheating is not. This is when they have on their report cards �good citizenship� or �respects others�. Some schools recognize �principal pride� awards, or ___traits, whereby the child is recognized for integrity, attentiveness, respect for others, etc. And is attached to the record of grades.

9. Periods of greatest growth fetus birth infancy puberty

10. Factors that Influence Growth and Development Genetics Environment Culture Nutrition Health Status Family

11. Genetic influences on growth and development pattern, rate, rhythm and extent: governed by genes interplaying with environment intrauterine life extremely important in growth and healthy development of the child Genetics gives the possible; the environment gives the actualGenetics gives the possible; the environment gives the actual

12. Understanding the genetic link Genes defined Chromosomes autosomes sex chromosomes the genomes discovered in 2000! This was a project funded by the U.S. Genome project and one of the most important single finding in mankind About 1/4 of the children hospitalized for disease or defects has genetic disorders Bec. Diseases that occur on a genetic basis can have a profound effect on G & D, we need to gain an understanding about how these diseases are passed on from parent to child Genes are defined as lengths of DNA located on strucctures called: Chromosomes (46) and the genetic code Autosomes: paired 1 from each parent Sex chromosomes X from mother Y from father XX: girl XY: male About 1/4 of the children hospitalized for disease or defects has genetic disorders Bec. Diseases that occur on a genetic basis can have a profound effect on G & D, we need to gain an understanding about how these diseases are passed on from parent to child Genes are defined as lengths of DNA located on strucctures called: Chromosomes (46) and the genetic code Autosomes: paired 1 from each parent Sex chromosomes X from mother Y from father XX: girl XY: male

13. Genetic screening Done during the 1st trimester of pregnancy Methods: blood studies from parents check carrier status measure level of alphafetoprotein (AFP) in mother�s blood for incomplete development of brain or spinal cord: suggestive of neural tube defect (spina bifida) Studying and mapping of chromosomes and their genes is funded by the US Genome Project There are an estimated 50,000-100,000 genes..so far only about 1,500 have been mapped So if inheritance seemsimprecise and confusing it is bec. We are only at the beginning The closer the parents are in common ancestors the more common genes for disease they will have Studying and mapping of chromosomes and their genes is funded by the US Genome Project There are an estimated 50,000-100,000 genes..so far only about 1,500 have been mapped So if inheritance seemsimprecise and confusing it is bec. We are only at the beginning The closer the parents are in common ancestors the more common genes for disease they will have

14. genetic screening, cont. later in pregnancy: amniocentesis: @ l2-l6 weeks chorionic villa sampling: @ l0-11 weeks role of the genetic counselor Amnio takes 3-4 wks for the results CVS done earlier and resuts in 1-10 days Role of the genetic counselor: l. Communicate to the parents: magnitude, implications, alternatives for dealing with the risk of hereditary disorders occurring within a family 2. Form of preventive medicine 3. Supportive counseling 4. Resource person The genetic counselor does not make decisions for the family: they only show alternatives and give supportAmnio takes 3-4 wks for the results CVS done earlier and resuts in 1-10 days Role of the genetic counselor: l. Communicate to the parents: magnitude, implications, alternatives for dealing with the risk of hereditary disorders occurring within a family 2. Form of preventive medicine 3. Supportive counseling 4. Resource person The genetic counselor does not make decisions for the family: they only show alternatives and give support

15. Examples of environmental influences on a child family composition family position in society family socioeconomic status knowledge of the family availability of healthy diets housing diseases present in family and child

16. Family relationships (environmental) and the impact on child growth and development Critical in growth and development, esp. emotional growth Intellectual growth must be included here as well Chronic illness can be combated with a loving environment and close family relationships

17. Cultural influences Must be considered when assessing growth and development Customs vs. work demands from different cultures

18. Nutritional influences Begins during the prenatal period LBW/preterm can result from poor prenatal nutrition Socio-economics may impact growth

19. Comparison of nutritional needs Infancy: breast milk and formula rec by APA for first 6 months; see p. 931 for advantages vs disadvantages of formula preparation. Introduction of solid foods�usually rice cereal at 4-6 months. Avoid honey, peanut butter, wieners, grapes, egg whites. Egg yolk is last food to be introduced. Toddler: go through physiologic anorexia (p. 933) where they don�t seem to eat much for days; parents become alarmed. Intake over days or a week is generally sufficient and balanced enough to meet the body�s demands for nutrients and energy. Parents should be advised to offer a variety of nutritious foods several times daily. Preschoolers:meals become a social event liking the company of others while they eat. Enjoy helping with food prep and table setting. Food jags in which they eat only a few foods for several days or weeks. School age: this age is increasinly resp. for preparing snacks, lunches and even some other meals. Good time to teach about nutrition and well-balanced meals. Because this age operates at the concrete level of cognitive thought, nutrition teaching is best presented by using pictures, samples of foods, videa, handouts and hands-on experiences. Adolescence: most need over 2000 calories daily to support the growth spurt and some adolescent boys, esp. those in sports, may consume over 3000 calories a day to meet their nutritional needs. Fast food represents a significant intake for many adolescents. Peer group influence is imp. so group sessions in which adolescents eat lunch together can provide a forum for influencing food habits.Infancy: breast milk and formula rec by APA for first 6 months; see p. 931 for advantages vs disadvantages of formula preparation. Introduction of solid foods�usually rice cereal at 4-6 months. Avoid honey, peanut butter, wieners, grapes, egg whites. Egg yolk is last food to be introduced. Toddler: go through physiologic anorexia (p. 933) where they don�t seem to eat much for days; parents become alarmed. Intake over days or a week is generally sufficient and balanced enough to meet the body�s demands for nutrients and energy. Parents should be advised to offer a variety of nutritious foods several times daily. Preschoolers:meals become a social event liking the company of others while they eat. Enjoy helping with food prep and table setting. Food jags in which they eat only a few foods for several days or weeks. School age: this age is increasinly resp. for preparing snacks, lunches and even some other meals. Good time to teach about nutrition and well-balanced meals. Because this age operates at the concrete level of cognitive thought, nutrition teaching is best presented by using pictures, samples of foods, videa, handouts and hands-on experiences. Adolescence: most need over 2000 calories daily to support the growth spurt and some adolescent boys, esp. those in sports, may consume over 3000 calories a day to meet their nutritional needs. Fast food represents a significant intake for many adolescents. Peer group influence is imp. so group sessions in which adolescents eat lunch together can provide a forum for influencing food habits.

20. Dental needs of the child from infancy to adolescence Caries in infancy due to nurse for long periods of time See text for the sequence of eruption of teeth Braces may be indicated at the time of puberty See p. 1115 �oral care� and �dental care� Caries erupt when infants are allowed to nurse for long periods of time and when given a bottle at the time of sleep. See p. 986-987 for sequence of eruption of teethCaries erupt when infants are allowed to nurse for long periods of time and when given a bottle at the time of sleep. See p. 986-987 for sequence of eruption of teeth

21. Health status of the child Certain diseases may affect g & d Endocrine and cardiac status included here Malabsorption diseases such as celiac, cystic fibrosis, short gut, Metabolic diseasesMalabsorption diseases such as celiac, cystic fibrosis, short gut, Metabolic diseases

22. Growth and development, cont. Methods to evaluate growth: charts: compare to norms compare to self over time xrays teeth height, weight, head circumference size of head and legs: length of bones

23. physical growth, cont. Intervals @ which birth weight changes: doubles by end of fifth month of age triples by end of 1st year �cephalocaudal� �proximo-distal� �prehensile behavior� Cephalocaudal: head to tail (growth pattern) Proximo-distal: center body too far; trunk to fingers and toes Prehensile behavior: effective use of hands to pick up small objectsCephalocaudal: head to tail (growth pattern) Proximo-distal: center body too far; trunk to fingers and toes Prehensile behavior: effective use of hands to pick up small objects

24. Intellectual Development review material on Piaget �intelligence� �habituation� Reflect on the process of habituation and its possible role as a predictor of intelligence Intelligence: ability to solve problems or achieve a goal Habituation: period of time that elapses between the infant�s initial response and the cessation of that response The shorter the habituation the higher the potential intelligence; bored by repetition Is this theory or fact? Yet to be determined completely. While we have four theorists in the book, p.57-60. Our major emphasis will be on EricksonIntelligence: ability to solve problems or achieve a goal Habituation: period of time that elapses between the infant�s initial response and the cessation of that response The shorter the habituation the higher the potential intelligence; bored by repetition Is this theory or fact? Yet to be determined completely. While we have four theorists in the book, p.57-60. Our major emphasis will be on Erickson

25. Importance of Play Allows child the learn about themselves and relate to others�.it is work for the child

26. Stages of play Practice play Symbolic play Games Practice play: repeating over and over (peek a boo), riding a bicycle Symbolic play: seen in the hospital to orient the patient to a procedure, predominant type of play for the toddler�Leah and playing nurse; �having to improve her nursing skills�! Games: School age child esp loves this type of play�.board games, competitive sports, while preschooler can play games on the playground. The preschooler and toddler esp love hide and seekPractice play: repeating over and over (peek a boo), riding a bicycle Symbolic play: seen in the hospital to orient the patient to a procedure, predominant type of play for the toddler�Leah and playing nurse; �having to improve her nursing skills�! Games: School age child esp loves this type of play�.board games, competitive sports, while preschooler can play games on the playground. The preschooler and toddler esp love hide and seek

27. Types of play Solitary play Parallel Play Associative play Cooperative Play Onlooker Play

28. Growth of Emotions Emotion defined All emotions contain: feelings impulses physiological responses reactions (internal and external) Subjective data: Objective data: Subjective data: happy, joy, anxious, fretful,contented, angry, frightened, loving Objective: facial expressions, laughter, crying, > HR, > Resp., > BP, Subjective data: happy, joy, anxious, fretful,contented, angry, frightened, loving Objective: facial expressions, laughter, crying, > HR, > Resp., > BP,

29. Emotions, cont. Love: includes persons who help them meet their needs, share their pleasure and achievements when the child receives love, he can give love Ask, the role of neglect on adult? Thought to be �most important emotion�; 1st centered on mother and gradually expands to take in other. It is the foundation on which all positive relationships are built Ask, the role of neglect on adult? Thought to be �most important emotion�; 1st centered on mother and gradually expands to take in other. It is the foundation on which all positive relationships are built

30. Emotions, cont. Fear: exhibited by crying, running, or hiding fear can diminish; do not laugh-give love and help them feel safe Not all fear is bad; some is realistic and serves to keep us out of trouble and/or safe Ie., young children fear some objects or persons in immediate environment. With age, the child�s fears become more specific and cause withdrawal from the fearful situation;later they learn to avoid the situation. For example, fear of dogsNot all fear is bad; some is realistic and serves to keep us out of trouble and/or safe Ie., young children fear some objects or persons in immediate environment. With age, the child�s fears become more specific and cause withdrawal from the fearful situation;later they learn to avoid the situation. For example, fear of dogs

31. Anger, cont. Ways in which anger may be displayed: shouting screaming acts of disobedience temper tantrums act out when�. act better when�. Act out more when�tired, hungry, without sleep, usual patterns or habits disturbed or ill Act better when�.above needs are tended to: routine is kept, health is good, and consistent controls are appliedAct out more when�tired, hungry, without sleep, usual patterns or habits disturbed or ill Act better when�.above needs are tended to: routine is kept, health is good, and consistent controls are applied

32. emotions, cont. Anger: do infants have anger? expected responses that indicate anger: Development of anger: responses of anger by the child: crying, biting, kicking, screaming, hittingDevelopment of anger: responses of anger by the child: crying, biting, kicking, screaming, hitting

33. Jealousy A combination of anger, fear, and love A child 1st loves something, counts it as his own and 2nd perceives that it has been taken away or interfered with The loss may be real or perceived, ie., sibling rivalry Sibling rivalry involved sharing time of the caregiver which in the mind of a child is as = as division and loss of love. The child may act out in many ways: not eating, wetting pants, tantrums, sulking, hitting, As we get older this becomes more subtle, less direct and open Sibling rivalry involved sharing time of the caregiver which in the mind of a child is as = as division and loss of love. The child may act out in many ways: not eating, wetting pants, tantrums, sulking, hitting, As we get older this becomes more subtle, less direct and open

34. Emotions, summarized Emotions will come out one way or another How can the nurse help the child respond constructively to these feelings? Help child expres emotion through �talking out� rather than �acting out�; it is OK to be angry�how we respond is the key!Help child expres emotion through �talking out� rather than �acting out�; it is OK to be angry�how we respond is the key!

35. Parenting: rule #l PARENTS MUST BE CONSISTENT AND PARENT IN A STYLE APPROPRIATE TO THE CHILD I�m giving this to you as an aide to identify the parenting styles you observe when you have a pediatric patient and a parent at the bedside. Types: autocratic Permissive-laissez-Faire Authoritative/Democratic What problems can you see with mixing these styles of parenting so that ends up be �situational parenting�? Parenting needs to be consistent and appropriate to the particular child Some children respond with frowns from the parent of disapproval Others are disruptive and must have firmer punishment. As the child ages, deprivation is the most appropriate, whether it is by isolation (being removed from the fun), grounding, or privileges taken awayI�m giving this to you as an aide to identify the parenting styles you observe when you have a pediatric patient and a parent at the bedside. Types: autocratic Permissive-laissez-Faire Authoritative/Democratic What problems can you see with mixing these styles of parenting so that ends up be �situational parenting�? Parenting needs to be consistent and appropriate to the particular child Some children respond with frowns from the parent of disapproval Others are disruptive and must have firmer punishment. As the child ages, deprivation is the most appropriate, whether it is by isolation (being removed from the fun), grounding, or privileges taken away

36. Discipline Techniques: The model is to teach by example! Listening skills passive acknowledgement door openers active listening Review Kohlberg stages of moral development here�.infants (no moral sensitivity); toddler (punishment-obedience); preschool (conformity to self-interest; eye for an eye mentality); school age (morality based on conscience, child becoming socially sensitive) pre-pubescience: right takes on a religious or metaphysical quality, respect for authority; adolescence (right is determined by what is best for the majority�..peer pressure; adulthood (achieved only by the morally mature individual; do what they think is right, regardless of others� opinions�.becoming more clouded every day. Murderers and pedophiles blaming their crimes on what happened to them Listening skills: passive: silence by the parent acknowledgment: uh, uh huh door openers; �would you like to talk about it?� active listening: reflecting feelings back NO> 2,3,and 4 use �I� messages to communicateReview Kohlberg stages of moral development here�.infants (no moral sensitivity); toddler (punishment-obedience); preschool (conformity to self-interest; eye for an eye mentality); school age (morality based on conscience, child becoming socially sensitive) pre-pubescience: right takes on a religious or metaphysical quality, respect for authority; adolescence (right is determined by what is best for the majority�..peer pressure; adulthood (achieved only by the morally mature individual; do what they think is right, regardless of others� opinions�.becoming more clouded every day. Murderers and pedophiles blaming their crimes on what happened to them Listening skills: passive: silence by the parent acknowledgment: uh, uh huh door openers; �would you like to talk about it?� active listening: reflecting feelings back NO> 2,3,and 4 use �I� messages to communicate

37. discipline, cont. Techniques, cont. reality principle distractions or substitutions time out positive practices point systems with rewards for good behavior promotes self esteem in children Reality principle: responsbility for own actions Postive practices: righting the wrong; sincere apology, repair what is broken Point systems: if start with zero and add rewards works better than starting with reward and taking it away for bad behaviorReality principle: responsbility for own actions Postive practices: righting the wrong; sincere apology, repair what is broken Point systems: if start with zero and add rewards works better than starting with reward and taking it away for bad behavior

38. discipline, cont. CLEAR C: L: E: A: R: C: conscious communication information the child can put into action focusing on behaviors like, �I liked the way you picked up your toys� Limitis & Guidelines: children do better when they know limits. Should be clear, concise, and consistent Employ observation from the child�s perspective (try to see from the child�s view) Acceptance that the child is not you, is not going to do what you did. Todays world is different; appreciate their uniqueness Responsiveness: listening When used, (corporal punishment), the text suggests reserving for �willful disobedience or disrespect for parental authority. Know your child: what works for one may be a reward for another (go to your room) What effect does �do as I say, not as I do� have on a child or a patient? (the obese nurse giving weight reduction instructions? Or the nurse who smells of smoke and preaches for the pt. to quit smoking) Single parent families: have special needs and may have modeling from gender of absent parent? Pastors, older children, family members and nurses and everyone else. Some behaviors will have a �I�ll never do that� effect on the child but still it is the parents� behavior not their words that influence the child.C: conscious communication information the child can put into action focusing on behaviors like, �I liked the way you picked up your toys� Limitis & Guidelines: children do better when they know limits. Should be clear, concise, and consistent Employ observation from the child�s perspective (try to see from the child�s view) Acceptance that the child is not you, is not going to do what you did. Todays world is different; appreciate their uniqueness Responsiveness: listening When used, (corporal punishment), the text suggests reserving for �willful disobedience or disrespect for parental authority. Know your child: what works for one may be a reward for another (go to your room) What effect does �do as I say, not as I do� have on a child or a patient? (the obese nurse giving weight reduction instructions? Or the nurse who smells of smoke and preaches for the pt. to quit smoking) Single parent families: have special needs and may have modeling from gender of absent parent? Pastors, older children, family members and nurses and everyone else. Some behaviors will have a �I�ll never do that� effect on the child but still it is the parents� behavior not their words that influence the child.

39. The End! One of today�s popular approaches to discipline and one that can help in the hospitalOne of today�s popular approaches to discipline and one that can help in the hospital