1

Growth- a quantitative change/ measured in terms of quantity - Increase in number and size of cells/increase in physical size - Height, weight, circumference, length of extremities - Affected by nutrition, health and parents Development advancement of capacity of functioning/ skills - Advancement from a lower to advance complexities ( unpredictable) - Changes in body function and psychomotor behaviors - A qualitative change/ measured in quality - MATURATION is synonymous of development

PATTERNS/ CHARACTERISTICS/ PRINCIPLES OF GROWTH AND DEVELOPMENT:

1. Unique individualized 2. Continuous process begins at conception and ends with death 3. Rate of growth varies Rapid stages/ Growth Spurts- infancy and adolescence Slow periods/ Growth Gaps toddler Pre-school School-age

4. Directional- reflect the physical development and motivation of neuromuscular functions Growth vertical and horizontal Devt cephalocaudal (gross motor) - Proximodistal (fine motor) from midlineperipheral - General to specific
Developmental task or milestones are basic achievements associated with each stage of development

5. Sequential definite, predictable sequence, with each child normally passing through every stage 6. Developmental does not progress at the same rate/pace

ASSESSMENT OF GROWTH:

1. Physiologic loss of weight, a couple of weeks after birth: 510% of birth weight, but within days they begin to gain weight and by 2 weeks, they are back to original birth weight.

2. Most rapid during infancy and adolescent stages 6 mo doubles birth weight 1 yr triples birth weight 2 yr quadruples birth weight

At birth, the ave. weight of the full term NB is 3,000-4,000 gm

3. During fetal stage and early infancy, the head is the dominant part, whereas during later infancy, toddler stages, the trunk dominates, and in childhood, the legs dominate. -Head circumference 33-35cm; normally larger than 2-3cm to chest circumference -Chest circumference 30.5-33cm - Head is of the total height -increase head circumference (macrocephaly) common in mothers with DM - decrease head circumference (microcephaly) common in alcoholic mothers 4. Height monitoring Body height = 50 to 55 cm (2.54cm = 1 inch) BH on 1st 6 months = + 1 inch/month Up to 12 months = + 1 inch/month Above 1 yr = age in year 2 (+32) Growth rate monitoring (in lb.) Body weight 6 months BW 2 12 months BW 3 2 years BW 4 3 years BW 5 5 years BW 6 7 years BW 7 10 years BW 10

FACTORS INFLUENCING GROWTH AND DEVELOMENT: 1. GENETICS - Gender - Health - Intelligence - Temperament is the combination of all an individuals characteristics, the way the person thinks, behaves, and reacts to something that happens in his or her environment o Elements = activity level Rhythmicity/pattern Approach Adaptability Intensity of reaction Distractability Attention span and Threshold of response Mood quality Categories of a child according to temperament: A. Easy Child - Easy to care for B. Difficult Child - Irregular in habits - Have a (-) mood quality C. Slow to warm-up Child - Have a general (-) mood - Fairly inactive - Responds mildly and adapt to new situations 2. ENVIRONMENT

persistence

- Socioeconomic level - Parent-child relationship time spent - Ordinal position in the family - Health FRAGILE CHILD SYNDROME treating the child as if he is sick/ vulnerable to sickness - Nutrition 55-70% CHO 20-30% Fats 10-15% CHON

Vitamins fat soluble (ADEK) H20 soluble (B &C)

Iron- best sources are meats

Minerals build new cells and regulate body processes If more than 100mg macronutrient

VEGETARIAN DIETS: 1. Lacto-ovovegetarian dairy products, eggs, plants ( veggies, fruits, grains) 2. Ovovegetarian exclude dairy products 3. Lactovegetarian exclude eggs

4. Vegan diet/ Strict vegetarian exclude animal products; veggies, fruits, and grains Reasons: -economic - ecologic - medical/health related - philosophic belief - religious

PERSONALITY DEVELOPMENT
Comparative Summary of Theories of Freud, Erikson, Piaget, and Kohlberg Age stage Freud Erikson Piaget Kohlberg (year (psychosexual (psychosocial (intellectual (moral s) development) development) development) development) 1 2- 3 Infancy Toddlerhood oral stage anal stage Trust v. mistrust Autonomy vs. shame & doubt Sensorimotor phase Stage 0 do what pleases me

4-6

Preschool (early childhood)

phallic (infant genital) Oedipal stage Latency stage

Initiative vs. guilt

7-12 School-age (middle childhood)

Industry vs. inferiority

13 18

adolescence

Genital stage (puberty)

Identity vs. role confusion

Preoperational phase Preconventional level Stage 1 avoid punishment Concrete operational Preconventional phase level Stage 2 do what benefits Formal me operational phase Conventional level Stage 3 (ages 7-10) avoid disapproval Stage 4 (ages 10 -12) do duty, obey laws

Postconventional level Stage 5 (age 13) maintain respect for others Stage 6 (age 15) Implement personal principles

SIGMUND FREUD founder of psychoanalysis - all human behavior is energized by psychodynamic forces. - LIBIDO - instinctual drives - Repressed anger and fears could lead to mental disorder - Freud believed that a child who did not adequately resolve a particular stage of development would have a fixation (compulsion) that correlated with that stage 3 COMPONENTS OF PERSONALITY/ three levels of consciousness ID pleasure principle - Immediate gratification - Common in infancy EGO/self reality principle - Balances - develops later in toddler adolescence SUPEREGO - moral principle - Conscience

- Develops during preschool to school-age

1. ORAL STAGE (birth 18 months) (0 1 yr) - Infancy - Shortest of all development period - Gender identification should start at this age - Gratification of oral needs are met through sucking, biting, chewing, talking

- Zone of pleasure mouth - oral fixations if not met thumbsucker Glutton pencil chewer nail biter smoker oral sex

2. ANAL STAGE (1-3 years / toddler) - Finds pleasure in controlling his elimination function - Holds on or lets go of the bowel

- Zone of pleasure anus - Bladder control at 2 years old - Bowel control at 2 - 3 years - Night bladder training 4- 5 years

- it represents the beginnings of the desire to mold and control the environment - Cleanliness and this natural pride do not always go together, so it may be necessary to help direct this pride and interest into more acceptable behaviors - Playing with such materials as modeling, clay, crayons, and dough helps put the childs natural interests to good use, a process called sublimation

3. PHALLIC STAGE ( 3- 6 years/ pre-school) - superego begins to develop during this stage - Genitals become an interesting and sensitive area of the body - Masturbation redirect / redivert attention - Unconscious attraction to the parent of the opposite sex OEDIPUS boy to mother ELECTRA girl to father - Fear of castration/mutilation/bodily harm ( not advisable for circumcision) 4. LATENCY STAGE (6-12 years/ school-age) - the silent stage - Rapid mental development - More interested in school activities

10

- Groups themselves with the same sex/ normal homosexual relationship starts Iinvolved with learning, developing cognitive skills, and actively participating in sports activities - The childs main relationships are with peers of the same sex 5. GENITAL STAGE ( 12 / adolescence) - Development of secondary sex characteristics - Resurgence of sexual drives - Sexual preferences develop - Energies are invested also in forming friendships and preparation for marriage - Interruptions may cause regression to an earlier stage, such as the older child who begins to wet the bed when hospitalized ERIK ERIKSON - More accepted than Freuds - Stresses the importance of CULTURE and SOCIETY in the development of personality

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Child and Parent Developmental Tasks According to Erikson

Developmen tal Level Infant Basic Task Trust Stage of Parental Development Learning to recognize and interpret infants cues Parental Task To interpret cues and respond positively to the infants needs; hold, cuddle, and talk to the infant To accept childs growing need for freedom while setting consistent, realistic limits; offer support and understanding when separation anxiety occurs To allow independent development while modeling necessary standards; generously praise childs endeavors to build childs selfesteem To accept childs successes and defeats, assuring child of acceptance to be there when needed without intruding unnecessarily

Toddler

Autonomy Learning to accept childs need for selfmastery

Preschooler

Initiative Learning to allow child to explore surrounding environment

School-age

Industry Learning to accept rejection without deserting

Adolescent

Identity

Learning to build a new life, supporting the emergence of the adolescent as an individual

To be available when adolescent feels need; provide examples of positive moral values; keep communication

12

channels open; adjust to changing family roles and relationships during and after the adolescents struggle to establish an identity

1. TRUST VS. MISTRUST (infancy/ 0-18 months) -developed through oral needs, gratification, touch, warm and consistent quality of care

-infants needs should be met consistently and effectively -recognizes and attaches to primary caregiver

-if infants cannot trust, they cannot enjoy deeply satisfying interactions with others and can have difficulty trusting

-they may have difficulty establishing a close relationship as adults -faithful/paranoia, unfaithfulness results -touch most sensitive during this period

2. AUTONOMY VS. SHAME & DOUBT ( toddler/ 1-3yrs) - Very cooperative

13

- Struggles for independence - Learns to manipulate the environment - wants to feel in control and needs to learn to perform tasks independently, even when this takes a long time or makes a mess - The toddler gains reassurance from self-feeding, from crawling or walking alone where it is safe, and from being free to handle materials and learn about things in the environment - A high level of autonomy is achieved when parents are able to encourage independence while still maintaining sound rules for safety - Confidence/ low self-esteem results

3. INITIATIVE VS. GUILT ( Preschool/ 3-6 yrs) - Learning how to do things - Develops if the child is allowed the freedom to initiate small activities and is appreciated for it - Wants to volunteer to do activities - The child with a well-developed sense of initiative will become a good leader/ high self-esteem - Those who leave the pre-school period with guilt will lack confidence and self-esteem; difficulty in making decisions about everything; incapable of solving associated problems

14

4. INDUSTRY VS. INFERIORITY ( school-age/ 6-12 yrs) - Learning how to do things well - Involved in competitive works - Competition is healthy as long as the standards are not so high that the child feels there is no chance of winning - Praise, not criticism, helps the child to build self-esteem and avoid feelings of inferiority - Fears: failure, punishment, and discipline - Moralistic - Industry develops if child is permitted to do things himself and praised for the results - Achievement oriented years - Children concentrate their questions on the how of tasks - Reassurance should be given frequently

5. IDENTITY VS. ROLE CONFUSION ( adolescent/ 13-18yrs) - Struggles to fit in - Identity develops when there is the feeling of belongingness and acceptance by others - Who Am I? - Role confusion - Adolescents may break rules just to prove that they can - Stress, anxiety, and mood swings are typical of this phase

15

- Relationships with peers are more important than ever

6. INTIMACY VS. ISOLATION ( adulthood/ 18-25yrs) - Tries to relate with others especially with S.O. - Difficulty in establishing intimacy results in feelings of isolation 7. GENERATIVITY VS. STAGNATION ( 25-65yrs) - Looks beyond self and counts accomplishments - Characterized by productivity, creativity, parental responsibility and concern for the new generation - this phase means marriage and family, but for others it may mean fulfillment in some other way - INTEGRITY VS. DESPAIR - Characterized by unifying philosophy in life - There is acceptance of death - If the elderly has a satisfying past recollection INTEGRITY develops

JEAN PIAGET

- Intelligence enables individuals to make adaptations to the environment that increase probability of survival 1. SENSORIMOTOR (1-2 years) - Learning thru senses

16

- Children relate with the environment thru behavioral reflexes - Becomes aware of OBJECT PERMANENCE - Primary circular reaction - Secondary circular reaction 4-8months o understanding of cause and effect develops 2. PRE-OPERATIONAL (2-7 years) - The child in this phase of development is egocentric that is, he or she cannot look at something from anothers point of view - has no concept of quantity; if it looks like more, it is more - Cant distinguish fact from from fiction - Poor recognition of hazards - Use symbols to represent objects - assimilation - Lack of conservation (ability to discern truth) - sense of time is not yet developed; - Tertiary circular reaction - CONCRETE OPERATIONAL (7-12 years) - Logical thought/reasoning - Develops skills in problem solving - Structured and formal learning - Makes and follows rules - Recognize cause and effect relationships 3. FORMAL OPERATIONAL (12 ) - Characterized by adaptability and flexibility - Address logical conclusions - begins to understand jokes based on double meanings and enjoys reading and discussing theories and philosophies - Makes and tests hypothesis/scientific reasoning - Abstract thought LAWRENCE KOHLBERG

17

Kohlbergs theory is about the development of moral reasoning in children Level I: PRECONVENTIONAL - During the first 2 years (stage 0), there is no moral sensitivity - This is the time of egocentricity - The child is not aware of how his or her behavior may affect others - The child simply reacts to pleasure with love and to hurtful experiences with anger Stage 1: PUNISHMENT AND OBEDIENCE ORIENTATION (2-3 years) - Ones activity is judge as right or wrong based on punishment - simply obeys the person in power with no understanding of the underlying moral principle Stage 2: INSTRUMENTAL RELATIVIST ORIENTATION/ nave instrumental self-indulgence (47 years) - Actions are directed towards satisfying ones needs; will do something if the person does something for him - follow the rules to benefit themselves - This is basically the attitude of an eye for an eye Level II: CONVENTIONAL Stage 3: INTERPERSONAL CONCORDANCE ( 7-10 years) (good boy, nice girl) - Actions are taken to gain approval of others

18

- Pleasing others is very important Stage 4: LAW AND ORDER ORIENTATION ( 10-12 years) - Following the rules and obeying the law are considered the right behavior - Right is defined as something that finds favor with family, teachers, and friends Level III: POST-CONVENTIONAL Stage 5: SOCIAL CONTRACT, LEGALISTIC ORIENTATION (12) - Activities that violates the rights of others are avoided - Adherence of laws are considered the standard behavior - The end no longer justifies the means Level IV: UNIVERSAL ETHICAL PRINCIPLES - Universal moral principles are internalized - The person who reaches this level does what he or she thinks is right without regard for legal restrictions, the cost to self, or the views of others - Because of this persons deep respect for life, he or she would not do anything that would intentionally harm him-or herself or another

1.

PRENATAL AND NEWBORN

- Human development is considered to begin with fertilization Divided into 2 parts: a. Embryonic period 2 wks 8wks b. Fetal period 9 wks/2 mos birth NB 0-28 days Newborn:

19

Ave. weight at birth is 3000-4000 grams Median height is 49.9 50.5 cm Median head is 33- 35 cm Chest circumference at birth is smaller than head circumference. By 1 yr, the head and chest are approx. equal. After 1 yr, chest circumference exceeds head circumference

V/S of NB: Temp: axillary 96.8-99 Apical rate: 120-160 bpm Respi: 30-80 cpm BP: 73/55mmHg IMMEDIATE CARE OF THE NEWBORN: 1. ESTABLISH AIRWAY - Mouth, then nose (suctioning amniotic fluid aspirated by mouth; 5-10 secs - Postural drainage by gravity 2. PREVENT HYPOTHERMIA, INFECTION AND BLEEDING A. EVAPORATION conversion of liquid to vapor B. RADIATION heat loss to a cooler object not in direct contact with the baby (aircon) C. CONDUCTION- heat loss to a cooler object in direct contact with the infant D. CONVECTION same with conduction and aided by surrounding air current (electric fan and open windows) - Teach the parents to swaddle the newborn

20

- Swaddling gives the newborn a sense of security and is comforting

BROWN FAT- is the main insulation thru intensified metabolic activity, after 8-12 hrs, temp must be stabilized - Measure the axillary temperature at least every 30 minutes until the temperature stabilizes - Then check the temperature again at 4 hours and at 8 hours - If the temperature remains stable, it may be assessed every 8 hours until discharge - Cold stress increases the amount of oxygen and glucose needed by the newborn - She can quickly deplete glucose stores and develop hypoglycemia - She can also develop respiratory distress and metabolic acidosis if chilling is prolonged - Quickly dry the newborn on the mothers abdomen, swaddle him snugly, and apply a cap to prevent heat loss

21

- This method of keeping the newborn warm is called kangaroo care

CREDES PROPHYLAXIS- to prevent ophthalmia neonatorum Agent-Neisseria gonorrhea, chlamydia - Use silver nitrate 1%, erythromycin 5%, or tetracycline 1% VIT K OR AQUAMEPHYTON synthesized by bacterial activity of GIT - Infants GI is still sterile -necessary for blood coagulation -produced in the intestines thru bacterial action - Therefore, it is critical for the nurse to know signs and symptoms of hypoglycemia in the newborn, which include: o Jitteriness or tremors o Exaggerated Moro reflex o Irritability o Lethargy o Poor feeding o Listlessness o Apnea or respiratory distress o High-pitched cry

22

- The main signs of hypoglycemia is jitteriness, which can be exhibited as an exaggerated Moro reflex - Conversely, the hypoglycemic newborn may have no symptoms - If hypoglycemia is prolonged without treatment, the newborn may have seizures or lapse into a coma - Permanent brain damage can result, leading to lifelong disability Risk Factors for Hypoglycemia: History of any of the following during the pregnancy increases the risk that the newborn will develop hypoglycemia: Gestational hypertension Maternal diabetes (pre-existing or gestational) Prolonged labor Fetal distress during labor Ritodrine or terbutaline administered to mother Newborn characteristics that increase the risk for hypoglycemia. Note that many of these conditions result from an at-risk pregnancy: Intrauterine growth restriction (IUGR) Macrosomia (a very large body) Large-for-gestational body Small-for-gestational body Prematurity Postmaturity Respiratory or cardiovascular depression requiring resuscitation

- If the mothers blood sugar was elevated during the latter part of the pregnancy, such as in maternal diabetes, or if she

23

received medications that elevate her blood sugar, the newborn also is at risk for hypoglycemia - If the newborn is exhibiting signs of, or is at risk for, hypoglycemia, check the glucose level using a heel stick to obtain a blood sample for testing - Blood levels between 40 and 60 mg/dl during the first 24 hours of life are considered normal - Levels less than 40mg/dl are indicative of hypoglycemia in the newborn

3.ASSESS FOR INFANT ADAPTATION

Devised by Dr. Virginia Apgar - Is a scoring system tht evaluates infants well-being at birth - 1 min (1st) - 5 min ( 2nd) Addresses 5 categories: Heart rate/apical pulse Respi. Effort/ cry Muscle tone/flexion Reflex irritability/grimace Color/appearance pulse Respiratory effort/cry 0 absent absent 1 100 Weak cry 2 100 Strong, lusty cry

24

flexion grimace appearance

limp No response Blue/ pale all over

Some flexion grimace

Well-flexed

Cry, gag, cough acrocyano Pink/ red all sis over

A score of 0-3 is indicative of severe distress; poor condition; resuscitation needed - 4-6 of moderate distress; fair condition, but guarded; close monitoring - 7-10 of mild to no distress; good condition; baby goes to regular nursery care 4.IDENTIFY THE INFANT - wrist band

- foot and fingerprinting 5.PROMOTE MOTHER-INFANT BOND - rooming in as soon as vital signs are stable - have the mother breastfeed immediately 6.NEWBORN SCREENING
Newborn Screening Disorders for which newborn screening is commonly

25

done: Phenylketonuria (PKU) Congenital hypothyroidism Galactosemia Maple syrup urine disease Homocystinuria Biotinidase Sickle cell disease Congenital adrenal hypoplasia Cystic fibrosis

A hearing screen is now encouraged for all newborns before they are discharged home There are two tests that are used to screen a newborns hearing: o The auditory brainstem response (ABR)

o Otoacoustic emissions (OAE)

Both tests use clicks or tones played into the newborns ear The ABR measures how the brain responds to sound through electrodes placed on the newborns head

26

OAE measures sound waves produced in the inner ear A probe is placed inside the newborns ear canal, and the response or echo is measures

VACCINE DOSE BCG

Hep B DPT Hep B 2nd & 3rd

Infant: 0.5 ml School entrants: 1 ml 0.5 ml IM 0.5ml IM

ROUT E ID

SITE Right upper arm Vastus lateralis Vastus lateralis

AGE Anytime after birth

NO. OF DOSES 1

polio measles TT

2-3 drops 0.5ml 0.5ml

oral SC Deep IM

Mouth Upper arm Deltoid

1stimmediately after birth 6 weeks 2nd Hep B-6 wks 3rd Hep B2mos after the 1st 6 weeks 9 mos

3 3

3 1

2.

INFANCY
- 0-18 mos/0-1yr - 28 days-18 mos - Period of rapid physical growth and maturation

V/S: Respi:30-60 cpm Temp.(axillary)- 96.8-99

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Apical rate: 90-130bpm BP: 90/56mmHg SYSTEMS: A. RESPIRATORY -characteristics: irregular with short periods of apnea; abdominal -trachea is small and close to bronchi, which enables infectious agents to be easily transmitted thru-out the lungs -risk for airway obstruction -auditory/eustachian tubes are short and straight and closely communicates the ear, putting at risk for middle ear infections

B. CARDIOVASCULAR - Apical beat: 120-160bpm - Pulse: easily palpable femoral and brachial - The size and weight of heart doubles the ist year Structures tht functionally close at birth: - Foramen ovale - Ductus venosus

28

- Ductus arteriosus C. DIGESTIVE -regurgitation is common in the 1st 3 months - -stomach has limited capacity and has rapid emptying; infants require frequent feedings ( feed per request) D.ELIMINATION

STOOLS:
A. Meconium (1-2 days) o Dark green and pasty B. Transitional (2-4 days) o Greenish yellow and liquid C. Milk Stools (4-6 days) BREASTFED INFANTS : colostrum deep-yellow, provides passive immunity - Stools are orange-yellow and have a soft, even consistency/ golden yellow - Stools have a sour, but clean odor - Have several stools a day in the 1st 2 months and up to 4-5 a day in the later months BOTTLEFED INFANTS: - Light-yellow and firmer in consistency - Quite offensive odor

URINATION:
- Initial: 1st 24 hr - Frequency: initially 6-10/day E.INTEGUMENTARY SYSTEM: the most sensitive during this period COLOR: CYANOSIS signs of NB distress

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ACROCYANOSIS due to sluggish peripheral circulation JAUNDICE physiologic if it appears on the 2nd/3rd day GRAY may indicate infection LANUGO fine downy hair

ERYTHEMA TOXICUM NEONATORUM pink, papular rash, transient

VERNIX CASEOSA white cheesy substance on the skin

MILIA white pinpoint papules on the nose,chin,cheeks; clogged sebaceous glands

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DESQUAMATION dry peeling on the skin

MONGOLIAN SPOTS bluish pigmentation on lower back/buttocks; may disappear in 1-5 yrs

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NEVI (stork bites)- reddish spots

HARLEQUIN SIGN- darkening of the color of dependent part of the body when the NB is placed on the side

BIRTHMARKS nevus flammeus/port wine stain (purple)

- Strawberry hemangiomas (red) capillary angioma;rough;raised

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- Cavernous hemangiomas (red), may last a lifetime

F.NEUROMUSCULAR FEEDING REFLEXES: ROOTING turning of the head to the direction of the stimulus SUCKING sucking anything that touches the lips; disappears at 6 mos SWALLOWING anything that touches the post. Tongue is swallowed

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EXTRUSION a protective reflex in which anything that touches the ant. Tongue is extruded; disappears in 4-6 mos PROTECTIVE REFLEXES: BLINKING involves rapid closure of the eyelids when an object comes near it SNEEZING, COUGHING protects the airway YAWNING increases cellular oxygenation GAGGING lifelong OTHER REFLEXES: MORO startle reflex - It is the most sensitive index of CNS integrity; assess hearing; C-shaped finger - Disappears in 5th month http://youtu.be/PhOleckx1-Y BABINSKI - Elicited by stroking the lateral sides of the sole of the feet from the heel upwards. This results to dorsiflexion of the great toe and fanning of the other toes. - Gradually disappears until the 12th month http://youtu.be/oI_ONptx2Ns TONIC NECK - Also known as the FENCING REFLEX - The arms and legs extend toward the direction of where the head is turned - Disappears in 3-4 months http://youtu.be/XMCw7IKN0xI DARWINIAN - Dancing reflex/walk reflex/stepping reflex - Disappears at 4 months http://youtu.be/mJIcKkxx7wg

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GRASP/MAGNET - Pushing feet against any form of pressure applied to it http://youtu.be/lO1GBU7OgY0 http://youtu.be/xUIlWVboozA LANDAU - When baby is held in a prone position, he demonstrates some head control by trying to keep the head in line with the trunk http://youtu.be/XSS0GibDyBk DDST DENVER DEVELOPMENTAL SCREENING TEST - Test for skills Areas: - gross motor - fine motor - interpersonal, social - language

CEPHALOCAUDAL

- Gross motor - Every 2 months

0 head lags 2 mos lifts head 4 mos lifts head with upper chest 6 mos can sit with support 8 mos can sit without support 10 mos stands with support 12 mos stands without support; walks with support 14 18 mos walks alone 2 yrs runs without falling, climbs stairs, stepping one foot at a time 2 yrs walks up and down stairs

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3 yrs rides a tricycle, climbs stairs with alternate steps

PROXIMODISTAL
-fine motor skills - every 3 months 0 useless/strong grasp reflex 3 mos grasp reflex gone; hands held open; hand regard; hand to mouth 6 mos palmar grasp; holds feeling bottle with 2 hands 9 mos pincer grasp (thumb and finger used to hold objects)

DEVELOPMENTAL LANDMARKS 1st social smile 2 mos 1st teeth 6 mos 1st word 9-10 mos 1st dental check up 2-3yrs Ponterior fontanelle starts to close at 2 mos; closes in about 8-12 weeks Anterior fontanelle closes in about 18 mos DENTITION -complete deciduous teeth (20) at age 2 yrs - 2 yrs-best time to use toothbrush -2 -3 visitation to dentist Formula: age in months minus 6 ( no. of teeth Eg. 8 mos 6 2 teeth 11mos 6 5 teeth 6)

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CRITERIA FOR TOY SELECTION - safety and specific for age: no sharps, small parts,not removable, non-toxic, hypo-allergenic - suitability - durability - expense NUTRITIONAL CONSIDERATION: a. food supplementation at 6 mos b. EBF until 6 mos c. Iron supplements d. SOLID food - 4-6 mos grains and cereals - 6 mos vegetables and fruits (yellow then green)yellow is softer to digest - 9 mos meat, fish, then eggs Nsg alert: - Solid food interval of 3-4 days to assess for sensitivity to a particular food - Avoid nuts, raisins, and any food with seeds. May cause choking/obstruction WEANING: from breast to bottle 6 mos From bottle to cup 12 mos PLAY: -solitary - social affective - infants take pleasure in relationship with people - sense pleasure - non-social stimulating experience that originates from the environment 1 month: - Interested in watching mobile over their crib/playpen

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- Watching the parents face; may become their favorite toy - Music box/musical rattle (hearing is the 2 nd sense that is a source of pleasure for the child in early infancy 2 months: - Rattle - Watching people 4 months rolling over 9 months creeping 10 months peek-a-boo 12 months enjoys putting things in and taking things out of container FEAR: STRANGER ANXIETY - Starts at 6 mos; peaks at 8 mos - Avoid sudden intrusive gestures - Reassure parents that such behavior is healthy, desirable, and necessary for the childs optimum, emotional development - Best approach is to talk to the parents, talk softly, meet the child at eye level, and maintain safe distance from the infant SIGNIFICANT PERSON: - Mother/primary caregiver SAFETY ISSUES: - Common cause of accident: aspiration, poisoning, falls

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COMMON BEHAVIORAL PATTERN: 1. Stranger anxiety 2. Thumbsucking - May be beneficial, may increase weight gain in premature infants and may decrease crying - In general, there is no need to restrain non-nutritive sucking during infancy - Malocclusion may occur if thumbsucking persists past 4 yrs of age when the permanent teeth begins to erupt - Peaks at 18-20 mos and it is prevalent when the child is hungry or tired SLEEPING PATTERN: - Deep sleep 4-5 hours/day - Light sleep 12-15 hours/day
3.

TODDLER

1-3 years - Prominent abdomen - Waddles/ walks with a wide stance

V/S: Temp (axillary) 97.5 98.6 - Apical rate: 80 120 bpm - Respi. 20 -30 - BP: 92/55mmHg
-

BEHAVIORS TO OBSERVE: A. Shows a sense of will me, myself, I - Egocentrism B. Negativism NO stage, serves as an assertion of self control/ independence MGT: -set limits/limit setting -reduce the opportunities for a no answer -provide appropriate choices for the child C. Ritualistic

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D. Temper Tantrums Interventions: - The best approach is to ignore it, provided the behavior is not injuring the child. When the tantrum has subsided, a toy or a favorite activity can be substituted for the ungranted request E.Selfish/ difficulty sharing F.Sibling Rivalry natural jealousy and resentment of children to a new child in the family Interventions: prepare the toddler for the birth of the new baby when they begin to become aware of the pregnancy - Provide a doll in which toddlers can imitate parental behaviors PLAY - Parallel play; playing independently but among children - Assimilation, imitating adult axns - Appropriate toy: push and pull toys COGNITIVE DEVT - Tertiary circular reaction trial and error process TOILET TRAINING - Readiness of the child stated at 18 months and completed by 4 y.o - Bowel control 2 - 3 years - Bladder control 2 y.o - Night bladder control 4 5 y.o Signs of readiness for toilet training: - Can sit, walk or squat - Can verbalize desire - Wants to have soiled diaper changed

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- Exhibits willingness to please parents - Stays dry for 2 hours with regular bowel movement COMMON ACCIDENT: poisoning FEAR: separation anxiety SIGNIFICANT PERSON: parents SLEEPING PATTERN: ave. 12 hours/day Bedtime rituals

4.

PRE-SCHOOL

3-6 y.o

V/S : temp (axillary) 97.5 98.6 Apical rate: 70 110 bpm Respi: 16 22 cpm BP: 95/57mmHg - Characterized by vigorous, intrusive behavior, enterprise, and a strong imagination - Mimics adult - Boastful, liar, long-story telling, sibling rivalry, selfish/difficulty sharing - Conscience is developed/superego - Magical thinking - Most children wants to do things for themselves; selfcare - OEDIPUS & ELECTRA complexes - Very curious; why stage, asks many ?s - Exhibits interest in sex differences - Exhibits fear of bodily injury; castration/mutilation PLAY - Cooperative play

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- Begins to develop best friends COMMON FEARS OF PRE-SCHOOLERS: Fear of mutilation Fear of the dark-due to vivid imagination Fear of separation/abandonment SIGNIFICANT PERSON: parents and siblings COMMON ACCIDENT: MVA-motor vehicle accident followed by falls and poisoning SLEEPING PATTERN: ave. 12hrs/night with daytime naps Nightmares

BEHAVIORS TO OBSERVE: 1. Nightmares scary dreams that are followed by full waking Intervention: Accept the dream as real fear Sit with the child; offer comfort, assurance and sense of protection Lie down with child or take to own bed only if the child is not calmed by other measures Consider professional counseling for recurrent nightmares

2. Night grinding/ bruxism - A way of letting go to release tension and allow themselves to fall asleep 3. Regression - In relation to stress - Revert to behavior they previously outgrew such as: Thumbsucking Negativism Loss of bladder control

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Inability to separate from parents It is usually the result of: A new baby in the family A new school experience Marital difficulties between parents Separation caused by hospitalization Mgt: - removing the stress is the best way to help the child discontinue this behavior -thumbsucking is best ignored 4. Sibling rivalry 5. Sex Education - May engage in masturbation - Important part is to help them avoid sexual abuse. They need to be taught that they do not have to allow anyone to touch their bodies unless they agree it is alright - Many new books explain where babies come from. These are helpful for parents to read to the child to increase understanding 6. Broken Fluency - Repetition and prolonging of sounds, syllables and words. It is often referred to as secondary stuttering - It is part of normal development and should be accepted as such A Major Parental Role to Encourage Vocabulary Devt : - Reading aloud to the child - Answer their ?s Colds, ear infxns, flu sxs are common

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5.

SCHOOL- AGE

6-12 y.o

V/S: Temp (oral) 97.5 98.6 Apical rate: 60 100 bpm Respi: 16-20cpm BP: 107/64 mmHg Sexual drive is controlled and repressed Loves collecting things eraser 10 -12 yrs pre-adolescent yrs changes begins; puberty MALE: Ave. Fil 14-16 Growth of testes Growth of face, axillary, & pubic hair Voice changes Penile growth in height Spermatogenesis nocturnal emissions

FEMALE: - Growth spurt - in the transverse diameter of the pelvis - Breast development thelarche - Growth of pubic and axillary hair - Vaginal secretions: Menarche ave. 10 - 15 y.0 -usually unovulatory -regular menstruation and ovulation 6-14 months after menarche COMMON CAUSE OF ACCIDENT: MVA FEAR: Lack of belongingness Failure Punishment

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Discipline PLAY: competitive SLEEPING PATTERN: variable, usually 8 9 hours Behaviors to Observe: 1. Lying is usually done to escape punishment 2. Cheating most common between age 5 6 yo 3. Stealing most common between 5-8 yo The Latchkey Child: - The term was coined because this child often wears the house key around her or his neck
Tips for Latchkey Children: Teach the child to keep the key hidden and not show it to anyone Plan with the child the routine to follow when arriving home; plan something special each day Plan a telephone contact on the childs arrival home; either have the child call you or you call the child Always let the child know if you are going to be delayed Review safety rules with the child. Post them on the refrigerator as a reminder Use a refrigerator chart to spell out daily responsibilities, and have the child check off tasks as they are completed Let the child know how much you appreciate his or her responsible behavior Have a trusted neighbor for backup if the child needs help; be sure the child knows the telephone number, and post it by the telephone Post telephone emergency numbers that the child can use; practice when to use them Teach the child to tell telephone callers that the caregiver is busy but never to say that the caregiver is not home Teach the child not to open the door to anyone Be specific about activities allowed and not allowed Carefully survey your home for any hazards or dangerous temptations (guns, motorcycle, ATV, swimming pool).

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Eliminate them, if possible, or ensure that rules about them are clear See if your community has a telephone friend program available for latchkey children A pet can relieve loneliness, but give the child clear guidelines about care of the pet during your absence

6.

ADOLESCENCE

bet 13 & 18-20 yrs

V/S : Temp. (oral) 97.5 98.6 Apical rate: 55 -90 bpm Respi: 12 20 cpm BP: 121/70mmHg Resurgence of sexual drives Develops relationship with members of the opposite sex Bodily changes corresponding to puberty Poor posture/scoliosis

SLEEPING PATTERNS: - Variable usually 8-9 hrs - Ave. 8 hrs COMMON CAUSE OF ACCIDENT: MVA SIGNIFICANT PERSONS: peers FEARS: loss of control and independence BEHAVIORS TO OBSERVE: - Moody and unpredictable - Attempts to make decision for themselves COMMON HEALTH PROBLEMS: 1. HPN obese - Diet high in salt

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- Family hx 2. Poor posture 3. Body piercing and tattooes - To make a statement/unique 4. Fatigue - Due to diet, sleep patterns and activity schedules 5. Menstrual irregularities 6. Acne - Mainly on the face and shoulders - Frequently in boys than girls - Occur in girls (14-17 yrs) boys (16-19) - Genetic factors and smoking play a part in their development - Common locations: face Neck Back Upper arms Chest 7. Obesity genetics and environment 8. Sexuality and sexual activity - Counseling can help them improve their perspective and learn how to say no - Be certain to provide info. on date rape prevention, because they are in a high risk group for date rape 9. On subs. Abuse Assessment of Subs. Abuse: - Failure to complete assignment in school - Demonstration of poor reasoning ability - school attendance - Frequent mood swings - Deteriorating physical appearance - Recent change in peer group - Expressed (-) perceptions of parents

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Alcohol - Commonly abused subs. Possible outcome of alcoholism: brain damage Alcoholic hallucinations Death Withdrawal effects: hallucinations, visual and tactile Increased V/S Tremors Sweating, seizures Subs. A. stimulants Amphetamines (shabu) Common Used Substances: Physical Signs Withdrawal effects Wt loss Hyperactivity V/S Loss of appetite euphoria Perforated nasal septum MI Respiratory arrest Pinpoint pupils Drowsiness incoordination Dilated pupils hallucinations Depression Irritability psychosis

cocaine

Psychomotor agitation seizure

B. narcotics / opiates Heroin Codeine morphine C. hallucinogens Marijuana LSD

D-Lysergic Acid Diethylamide

Runny nose Impotence piloerection none

PCP

Phencyclidine

10.

Runaways

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1. A child can be considered a runaway after being absent from home overnight or longer without permission from a family caregiver 2. Most children who run away from home are 10 to 17 years of age 3. A child may run away from home in response to circumstances that he or she views as too difficult to tolerate 4. Physical or sexual abuse, alcohol or drug abuse, divorce, stepfamilies, pregnancy, school failure, and truancy may contribute to a childs desire to escape 5. However, some adolescents are not runaways but rather throwaways who have been forced to leave home and are not wanted by the adults in the home 6. Often the throwaways have been forced out of the home because their behavior is unacceptable to family caregivers or because of other family stresses, such as divorce, remarriage, and job loss 7. Runaway or throwaway adolescents often turn to stealing, drug dealing, and prostitution to provide money for alcohol, drugs, food, and possible shelter 8. Many of these adolescents live on the streets because they cannot pay for shelter; they avoid going to public shelters for fear of being found by police 9. They may become victims of pimps or drug dealers who use the adolescents for their own gain 10. There are numerous programs to help runaways, especially in urban areas 11. This service may help the runaway to find a safe place to stay and may provide counseling, shelter, health care, legal aid, message relay to the family, and transportation home if desired 12. Runaways are not forced to go home but may be encouraged to inform their families that they are all right 13. A sexually transmitted disease, pregnancy, acquired immunodeficiency syndrome (AIDS), or drug overdose are the usual reasons that runaways are seen at a health care facility 14. When caring for such a child, be nonjudgmental 15. Any indication of being disturbed or disgusted by the adolescents lifestyle may end any chance of cooperation and cause the adolescent to refuse to give any additional information 16. Try to build a trusting relationship with the child

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17. Remember that the runaway viewed his or her problems as so great that escaping was the only way to resolve them 18. Counseling is necessary to begin to resolve the problems 19. Health teaching for the runaway must be suited to his or her lifestyle and must be at a level the child can understand 20. Without prying excessively, try to find out the runaways living circumstances and adjust the teaching plans accordingly 21. Remember that the childs problems did not come about overnight, and they will not be resolved quickly

2. Suicide DEATH AND DYING CONCEPTS: Under the age of 3 have no awareness or understanding of death 3 5 yo denies death and do not consider it as permanent; form of sleep 6 yo & - accommodate the fact that death is final -boogeyman, devil, monster, kamatayan 9-10 yo realistic concept of death as a permanent biologic process -irreversible