Growth and Development

Description: Growth and development follow an orderly yet individual pattern. Nurses should assess growth and the emergence of developmental skills in all pediatric clients. Knowledge of cognitive abilities allows a nurse to adapt teaching to the level of the child. Knowledge of appropriate toys and interests of children at different ages enables the nurse to use play to facilitate the child's development and minimize problems caused by the hospitalization.

INFANT (BIRTH TO 1 YEAR)

A. 1. 2. 3. 4. 5. 6. 7. 8. 9. Developmental milestones Birth weight doubles by 6 months, triples by 12 months. Birth length increases by 50% at 12 months. Posterior fontanel closes by 8 weeks. Social smile occurs at 2 months. Head turns to locate sounds at 3 months. Moro reflex disappears around 4 months. Steady head control is achieved at 4 months. Rolls from abdomen to back and back to abdomen at 5 to 6 months. Plays peek-a-boo after 6 months.

10. Transfers objects from hand to hand at 7 months. 11. Develops stranger anxiety at 7 to 9 months. 12. Sits unsupported at 8 months. 13. Crawls at 10 months. 14. Fine pincer grasp appears at 10 to 12 months. 15. Waves bye-bye at 10 months. 16. Walks with assistance at 10 to 12 months.

17. Says a few words in addition to mama or dada at 12 months. 18. Explores environment by motor and oral means. B. C. 1. Erickson's theory: Developing a sense of trust (trust versus mistrust) Nursing implications During hospitalization, the infant's emerging skills may disappear.

2. If the parents are not able to be with the infant, the baby may be inconsolable due to separation anxiety. 3. The nurse should plan to have the parents be part of the infant's care and should encourage them to do so. 4. Respect the infant's schedule at home by assessing and implementing components as possible. 5. Preparation and teaching should be directed to the family. However, the nurse should always speak to the infant and console the infant, especially while performing painful or stressful procedures. 6. Toys for hospitalized infants include mobiles, rattles, squeaking toys, picture books, balls, colored blocks, and activity boxes. HESI Hint Questions on the NCLEX-RN examination are the only ones tested. However, these are frequently tested content areas: When does birth length double? Answer: by 4 years. When does the child sit unsupported? Answer: 8 months. When does a child achieve 50% of adult height? Answer: 2 years. When does a child throw a ball overhand? Answer: 18 months. When does a child speak two- to three-word sentences? Answer: 2 years. When does a child use scissors? Answer: 4 years. When does a child tie his or her shoes? Answer: 5 years.

Be aware that a girl's growth spurt during adolescence begins earlier than a boy's (as early as 10 years of age).

 Temper tantrums are common in the toddler (i.e., they are considered normal or average behavior). Be aware that adolescence is a time when the child forms his or her identity and that rebellion against family values is common for this age group. HESI Hint Knowledge of normal growth and development is used to evaluate interventions and therapy. For example, what behavior would indicate that thyroid hormone therapy for a 4-month-old is effective? You must know which milestones are accomplished by a 4-month-old. One correct answer would be: Has steady head control, which is an expected milestone for a 4-month-old and indicates that replacement therapy is adequate for growth.

TODDLER (1 TO 3 YEARS)
A. 1. 2. 3. 4. 5. 6. 7. 8. 9. Developmental milestones Birth weight quadruples by 30 months. Achieves 50% of adult height by 2 years. Growth velocity slows. Appears to be bowlegged and potbellied. All primary teeth (20) are present. Anterior fontanel closes by 12 to 18 months. Throws a ball overhand at 18 months. Kicks a ball at 24 months. Feeds self with spoon and cup at 2 years.

10. Daytime toilet training can usually be started around 2 years. 11. Two- to three-word sentences are spoken by 2 years. 12. Three- to four-word sentences are spoken by 3 years. 13. Own first and last name can be stated by 2 to 3 years. 14. Temper tantrums are common.

B. Erikson's theory: Developing a sense of autonomy (autonomy versus doubt and shame) C. Nursing implications

1. Give simple, brief explanations before procedures, keeping in mind that a 1year-old does not benefit from the same explanation as that given to a 3-year-old. 2. During hospitalization, enforced separation from parents is the greatest threat to the toddler's psychological and emotional integrity. 3. Security objects or favorite toys from home should be provided for a toddler.

4. Teach parents to explain their plans to the child (e.g., I will be back after your nap). 5. 6. Respect the child's routine and implement when possible. Expect regression (e.g., bed-wetting).

7. Toys for the hospitalized toddler include board and mallet, push-pull toys, toy telephones, stuffed animals, and storybooks with pictures, depending on the reason for hospitalization. Toddlers benefit from being taken to the hospital playroom when able, because mobility is very important to their development. 8. 9. Toddlers are learning to name body parts and are concerned about their bodies. Very basic explanations should be given to toddlers about procedures.

10. Autonomy should be supported by providing guided choices when appropriate.

PRESCHOOL CHILD (3 TO 6 YEARS)

A. 1. 2. 3. 4. 5. Developmental milestones Each year, a child gains about 5 pounds and grows 2 to 3 inches. A child stands erect with more slender posture. A child learns to run, jump, skip, and hop. A 3-year-old can ride a tricycle. Handedness is established.

6. 7. 8. 9.

A child uses scissors at 4 years. A child ties shoelaces at 5 years. A child learns colors, shapes. Visual acuity approaches 20/20.

10. Thinking is egocentric and concrete. 11. A child uses sentences of five to eight words. 12. A child learns sexual identity (curiosity and masturbation are common). 13. Imaginary playmates and fears are common. 14. Aggressiveness at 4 years is replaced by more independence at 5 years. B. C. Erikson's theory: Developing a sense of initiative (initiative versus guilt) Nursing implications

1. Nursing care for hospitalized preschoolers should emphasize understanding of the child's egocentricity. Explain that he or she did not cause the illness and that painful procedures are not a punishment for misdeeds. 2. The child's questions should be answered at the child's level. Use simple words that will be understood by the child. 3. Therapeutic play or medical play that allows the child to act out his or her experiences is helpful. 4. Fear of mutilation by procedures is common. A Band-Aid may be quite helpful in restoring body integrity. 5. Toys and play for the hospitalized preschooler include coloring books, puzzles, cutting and pasting, dolls, building blocks, clay, and toys that allow the preschooler to work out hospitalization experiences, depending on the reason for hospitalization. 6. The preschooler needs preparation for procedures. He or she should understand what is and what is not going to be fixed. Simple explanations and basic pictures are helpful. Let the child handle equipment or models of the equipment.

HESI Hint Use facts and principles related to growth and development in planning teaching interventions. For example: What task could a 5-year-old diabetic boy be expected to accomplish by himself? One correct answer would be to let him choose the injection sites. This is possible for a preschooler to do and gives the child some sense of control.

SCHOOL-AGE CHILD (6 TO 12 YEARS)

A. 1. 2. 3. 4. 5. 6. 7. 8. 9. Developmental milestones Each year, a child gains 4 to 6 pounds and about 2 inches in height. Girls may experience menarche. Loss of primary teeth and eruption of most permanent teeth occurs. Fine and gross motor skills mature. A child is able to write script at 8 years of age. A child can dress self completely. Egocentric thinking is replaced by social awareness of others. A child learns to tell time and understands past, present, and future. A child learns cause-and-effect relationships.

10. Socialization with peers becomes important. 11. Molars (6-year) erupt. B. C. Erikson's theory: Developing a sense of industry (industry versus inferiority) Nursing implications

1. The hospitalized school-age child may need more support from parents than they wish to admit. 2. Maintaining contact with peers and school activities is important during hospitalization. 3. Explanation of all procedures is important. They can learn from verbal explanations, pictures, and books and by handling equipment.

4. Privacy and modesty are important and should be respected during hospitalization (e.g., close curtains during procedures, allow privacy during baths). 5. Participation in care and planning with staff fosters a sense of involvement and accomplishment. 6. Toys for the school-age child include board games, card games, and hobbies, such as stamp collecting, puzzles, and video games. HESI Hint School-age children are in Erikson's stage of industry, meaning they like to do and accomplish things. Peers are also becoming important for children of this age.

ADOLESCENT (12 TO 19 YEARS)

A. Developmental milestones

1. Girls' growth spurts during adolescence begin earlier than boys' (may begin as early as 10 for girls). 2. 3. 4. Boys catch up at around 14 and continue to grow. Girls finish growth at around 15, boys at around 17. Secondary sex characteristics develop.

5. Adult-like thinking begins around 15. They can problem-solve and use abstract thinking. 6. Family conflicts develop.

B. Erikson's theory: Developing a sense of identity (identity versus role confusion) C. Nursing implications

1. Hospitalization of adolescents disrupts school and peer activities; they need to maintain contact with both. 2. They should share a room with other adolescents.

3. Illnesses, treatments, and procedures that alter the adolescent's body image can be viewed by the adolescent as being devastating.

4. Teaching about procedures should include time without the parents being present. When parents are present, direct questions to the adolescent, not the parents. 5. The age of assent for making medical decisions in children and adolescents ranges from 7 to 14 years. Parental consent is also needed for treatment. 6. For prolonged hospitalizations, adolescents need to maintain identity (e.g., have their own clothing, posters, and visitors). A teen room or teen night is very helpful. Parents rooming in is discouraged. 7. Some assessment questions should be asked without parents' presence.

8. When teaching adolescents, the focus should be on the here and nowHow will this affect me today? HESI Hint Age groups' concepts of bodily injury: Infants: After 6 months, their cognitive development allows them to remember pain. Toddlers: They fear intrusive procedures. Preschoolers: They fear body mutilation. School-age children: They fear loss of control of their bodies. Adolescents: Their major concern is change in body image.

HESI Hint Accidents are a major cause of death in children and adolescents. Teach parents and children developmentally appropriate safety and accident-prevention techniques.