Parts I and II: Pediatric Growth & Development Health Maintenance & Restoration

1. Parts I and II:Pediatric Growth & DevelopmentHealth Maintenance & Restoration Spring 2012 Christina Hernandez RN, MSN

2. Growth and Development

3. Improving child health by having knowledge of definitions • “growth” • “development” • “maturation” • “learning”

4. Stages of Growth & Development • Newborn- 0 to 1 month • Infant- 1 month to 1 year • Toddler- 1 year to 3 years • Preschool- 3 years to 6 years • School age- 6 to 11 or 12 years • Adolescence- 11 or 12 years to 21 years

5. Patterns of growth • Rapid pace from birth to 2 yrs • Slower pace from 2 yr-puberty • Rapid pace from puberty to 15 yrs • Sharp decline from 16 -24 yrs when full adult size is reached

6. Directional paths of growth & development • Cephalo-caudal • Proximo-distal • Prehensile

7. 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

8. Factors which influence growth and development • Genetics • Environment • Culture • Nutrition • Health Status • Family

9. 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

10. genetic screening, cont. • later in pregnancy: • amniocentesis: @ l2-l6 weeks • chorionic villa sampling: @ l0-11 weeks • role of the genetic counselor

11. 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

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

13. Nutritional influences • Begins during the prenatal period • LBW (low birth weight) can result from poor prenatal nutrition • Socio-economics may impact growth as well

14. Health status of the child • Certain diseases may impact g & d • Endocrine and cardiac status included here

15. 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

16. Theories of growth and development • Psychosocial development: Erikson • Cognitive development: Piaget • Moral development: Kohlberg • Sexual development: Freud

17. Assessment of growth • 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

18. Assessment of development • DDST 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

19. Importance of Play • Allows child the learn about themselves and relate to others….it is work for the child

20. Classifications of play • Functional or practice play • Symbolic play • Games

21. Functions of play • Physical growth and development • Cognitive development • Emotional development • Social awareness • Moral development

22. Social aspects of play • Solitary play • Parallel Play • Associative play • Cooperative Play • Onlooker Play

23. Types of Play • Dramatic play • Familiarization play

24. Growth of Emotions • Emotion defined • All emotions contain: • feelings • impulses • physiological responses • reactions (internal and external) • Subjective data: • Objective data:

25. 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

26. Discipline • Techniques: • The model is to teach by example! • Listening skills • passive • acknowledgement • door openers • active listening

27. Part II: Health Maintenance and Restoration

28. Levels of Preventive Health Maintenance Activities Primary Secondary Tertiary

29. Specific recommendations by APA: Minor infections without fever are not contraindication If reaction occurs, consult dr. before next immunization Immunizations

30. Barriers to immunizations • Complexity of the health care system • Expense of immunization services • Parental misconceptions • Inaccurate record keeping by parents • Reluctance of health care worker • Lack of public awareness

31. 4mos-6 yrs of age: DTaP (4 doses) IPV (3 doses) HepB (3 doses) MMR (@ 12 months) PCV (1 dose) 7-18 yrs of age Td (every 10 years after initial immunizations) IPV (not rec. if >18 yrs of age) Immunization schedules

32. Nurses responsibilites with immunizations Know the action of the vaccine Careful history of patient Aspirate when injecting Educate parents (schedule, side effects) Proper documentation

33. Assess for reaction 15-30 min after injection Epinephrine 1:1000 available Check immunization records with each visit Parent teaching: fever, or other symptoms Don't Forget!

34. Nutritional Needs for Growth • Infancy- breast milk is best… Why? • Toddler- physiologic anorexia food presentation preferences • Preschool- food jags • School aged- what teaching techniques would you use to teach these children? What developmental stage? • Adolescent- what additional information regarding growth spurt?

35. What teaching should the nurse include regarding… • Bottle feeding? • Dental caries- prevention and treatment? • Eruption of teeth (deciduous & permanent) • Orthodonture • Oral hygiene • Referral to Dentist

36. Safety risks to developmental levels Infant Toddler Preschool School age Adolescent

37. Major childhood prevention measures Aspiration MVA Burns Drowning Bodily injury/fractures

38. Leading cause of fatal injury under 1 year of age Prevention: Inspection of toys, small parts Out of reach objects Selective elimination of certain foods Proper posturing of the infant for feeding Pacifier with one piece construction Aspiration

39. Vehicular risk greatest when child improperly restrained Pedestrian Prevention Motor Vehicle Accidents

40. Children are inquisitive Become able to climb and explore Prevention of household injury: Burns

41. Child does not recognize danger of H2O Unaware of inability to breath underwater No conception of water depth Hypoxia greatest concern Prevention Drowning

42. Still developing sense of balance Easily distracted from tasks Prevention: Bodily injury/fractures

43. Stats on drug poisonings

44. Common in early childhood (2 yrs) 75% poisons are ingested Major reason for poisoning: Poisonings

45. Sources of poison: Cosmetics Household cleaners Plants Drugs Insecticides Gasoline Household items Poisonings

46. Therapeutic interventions In every instance, medical eval is necessary Call poison control center 1st Remove child from exposure Identify poison Prevent absorption Poisonings, cont

47. Life threatening More likely to drop out of school Become disabled Disturbed brain and nervous system function Prevent child from full potential Implications of lead poisoning

48. Pathophysiology of lead poisoning System assessments Therapeutic Interventions Lead poisoning, cont

49. Criteria for treatment of lead poisoning < 9 not lead poisoned 10-14: prescreen 15-19: nutritional and educational interventions 20-44: environmental eval and medication 45-69: chelation therapy >70: medical emergency

50. Systems affected by lead • CNS: brain and nerve damage, retardation; headaches • Cognitive changes: behavioral problems; learning disabilities • M/S: slowed growth patterns; ataxia • Blood: reduction of heme (hemoglobin) leading to anemia • GI: vomiting, anorexia, colic, abd. pain