Growth and Development

Infancy Early Childhood Middle Childhood Adolescent

7:1 Life Stages

Growth and development begins at birth and ends at death During an entire lifetime, individuals have needs that must be met Health care workers need to be aware of the various stages and needs of the individual to provide quality health care

Life Stages

(continued)
Infancy: birth to 1 year Early childhood: 1-6 years Late childhood: 6-12 years Adolescence: 12-20 years Early adulthood: 20-40 years Middle adulthood: 40-65 years Late adulthood: 65 years and up
3

Life Stages

(continued)
Infancy: birth to 1 year Early childhood: 1-6 years Late childhood: 6-12 years Adolescence: 12-20 years Early adulthood: 20-40 years Middle adulthood: 40-65 years Late adulthood: 65 years and up
Mevelle L. Asuncion, RN 4

Stages of Growth and Development

Infancy

Middle Childhood

Neonate Infancy

Birth to 1 month

School age 6 to 12 years Adolescent 13 years to approximately 18 years

1 month to 1 year
1-3 years 3-6 years

Late Childhood

Early Childhood

Toddler

Preschool

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.

Principles Continued

Development proceeds from the simple to the complex and from the general to the specific. Development occurs in a cephalocaudal and a proximodistal progression. There are critical periods for growth and development. Rates in development vary. Development continues throughout the individual's life span.

Growth Pattern

Growth Patterns

The childs pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal.

Why developmental assessment?

Early detection of deviation in childs pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive

Gross Motor Skills

The acquisition of gross motor skill precedes the development of fine motor skills. Both processes occur in a cephalocaudal fashion

Head control preceding arm and hand control Followed by leg and foot control.

Social and Emotional Development in Infancy and Toddlerhood

I. PHYSICAL GROWTH AND DEVELOPMENT

Length-

1 inch/month from 0-6 months Increase by 50% by 6-12 months Doubles by 6 months Triples by 12 months Diamond anterior fontanelle closes by 12-18
months Triangular posterior fontanelle closes by 2 months

Weight-

Fontanelles

II. MOTOR DEVELOPMENT

Gross- uses large muscle groups

Fine- uses smaller muscle groups

Gross Motor Development

Newborn: barely able to lift head 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms

VENTRAL SUSPENSION POSITION

1 month- head lift and drop 2 month hold heads in same plane 3rd month- heads maintains above the plane of the rest of the body

LANDAU REFLEX

When the infant is suspended by the examiners hand in the prone position, the head will extend above the plane of the trunk. The trunk is straight and the legs are extended so the baby is opposing gravity. When the examiner pushes the head into flexion, the legs drop into flexion. When the head is released, the head and legs will return to the extended position. The development of postural reflexes is essential for independent sitting and walking.

PARACHUTE POSITION

It usually appears at 6-9 months of age. When the baby is turned face down towards the mat, the arms will extend as if the baby is trying to catch himself. Prior to developing this reflex, the baby will actually bring the arms back to the plane of the body and away from the mat.

Head Control

Newborn

Age 6 months

At 4 months

No head lag when pulled in

sitting position Baby rolling

A teenage father wants to hold baby boy Anecito, 2 months old, on a sitting position. What is the most important tip you will teach him
a.
b. c. d.

Hold the babys legs Hold the babys back Hold the babys neck and head Hold the babys abdomen

You are making home visits, you observed that the baby is banging his head on the crib, what will you instruct to the mother?
a.

b.

c.

d.

Pad the crib with cloth Spank the baby when he bangs his head Buy a baby helmet Do not put the baby in the crib

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

Sitting Up

Age 2 months

Age 8 months

Armand is 2 months old, at what age would you expect him to sit securely?
a.
b. c.

d.

2.5 months 6 months 8 months 12 months

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

Ambulation

13 month old

Nine to 12-months

When will be the best time to change the cloth shoes to rubber non-skid shoes?
a.
b. c.

d.

2 months 5 months 8 months 9 months

At what month does the baby begins to cruise around the house
a.
b. c.

d.

6 months 9 months 11 months 18 months

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

Pincer grasp

Fine Motor Development

6-month-old
12-month-old

Nursing considerations

Accidental injuries- major causes of death

Falling off beds and downstairs Aspiration of small objects Poisoning of overdose of medication or

ingestion of toxic household substances Suffocation Burns Motor vehicles accidents.

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

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.

Which among the following assessment finding would warrant referral to the doctor?
a.

b.

c.
d.

Failure to speak recognizable words by two years Can walk at 11 months Cant sit alone by 4 months With head lag at 2 months

III. PSYCHOSOCIAL DEVELOPMENT

Overview

Erikson

Crisis is Trust vs Mistrust Sense of trust The foundation for all future psychosocial
tasks Consistent caregiver Infants whose needs are unmet/delayed will develop uncertainty leading to mistrusts of caregivers and the environment

Trust vs. Mistrust

Conflict of infancy-trust vs. mistrust 1st stage- oral stage- infants obtain pleasure through mouth Healthy outcome depends on quality of mothers behavior during feeding not amount of food or oral stimulation Dilemma is resolved positively if caregiving is sympathetic and loving

What will be the most appropriate toy for an infant to to foster trust?
A.

B.

C.

D.

Ask the parent to hold the child, when inserting IVF Encourage the mother to hold the baby and massage the back while breastfeeding Have the father play with the baby while asleep Baby should be in the crib most of the time not on the mothers bed.

Baby Ryan has pneumonia, severe, and has an NPO order. What will you do to satisfy his oral needs?
a.

b.

c. d.

Ask the mother to continue breastfeeding in small amounts Encourage the mother to continue breastfeeding with proper burping techniques Give pacifier to the baby Dont give something to the mouth, the baby is on nothing per orem

Emotional Development
Facial features are most reliable cues for emotional expression in infancy Basic emotions- happiness, interest, surprise, fear, anger, sadness and disgust 6 months- faces, voice and posture forms patterns that clearly related to social events Stranger anxiety begins at 6 months and peaks at 8 months

Happiness

Binds parent and baby and fosters the infants developing competence Social smile- the smile evoked by the stimulus of the human face- first appears between 6 to 10 weeks Laughter first appears around 3 to 4 months in response to active stimuli

Happiness

Binds parent and baby and fosters the infants developing competence Social smile- the smile evoked by the stimulus of the human face- first appears between 6 to 10 weeks Laughter first appears around 3 to 4 months in response to active stimuli

Anger and Fear

Anger is expressed during first months through crying in response to unpleasant stimulus Fear increases about the sixth month and after : reasoning- survival, keep exploration in check; social signals to motivate caregivers Stranger anxiety- expression of fear in response to unfamiliar adults. Dependent on childs temperament, past experiences with strangers and the situation in which the stranger is met.

Understanding and Responding to the Emotions of Others

Between 7 10 months infants perceive facial expressions as organized patterns, and they can match the emotional tone a voice with the appropriate face of the speaking person

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

Plays and toys

Age appropriate Solitary Bright colored 1-3 months

Mobiles Mirrors Rattles Music Boxes Stuffed animals without detachable parts

Plays and toys

4-6 months Squeeze toys Busy boxes Play gyms

7-9 months

Cloth-textured toys Splashing bath oys, large balls, large blocks

Discipline

The earlier the disciplinary actions the better

Negative voice Stern look NO Corporal punishments

IV. PSYCHOSEXUAL DEVELOPMENT

Oral stage Infant suck for enjoyment and nourishment Gratified by

Swallowing Sucking chewing

V. Cognitive Devt

John Piaget

Sensorimotor stage
Substage 1- birth to 1 month

5 substages

Survival reflexers (sucking, grasping)

Substage 2- 1-4 months

primary circular reactions, centers own body parts

Secondary circular reactions, shift attention to environment and objects (eg. Search for objects

Substage 3- 4-8 months

V. Cognitive Devt
Substage 4- (8-12 months) Intentionality and consolidation of schemes Infant actively searches for hidden objects Substage 5- 12-18 months Tertiary circular reactions Interest in novelty, creativity and discorvery. Sense of permanence Child sense self as separte from others

V. Cognitive Devt
Language Crying- first means of communication Coos by 1-2 months Laugh babbles consonant sound by 3-4 months Imitate sounds by 6 months Pronounce syllables (mama) 8 months Understand no-no @ 9 months Mama and dada @ 10 months

Tips to prevent injury

Do not feed infant with pop corns or peanuts Place a gate at the top and bottom of stairways Avoid using infant walker No plastic bags within infants reach Remove constricting clothing or bib from neck at bedtime Dont leave infants in bath tub or high chair Never take meds in front of an infant, meds should be locked inside the cabinet

NUTRITION FOR INFANTS

Purely breastfeeding up to 6 months. Introduce one food at a time, waiting 5-7 days between new items Do not place food in bottles with formula, nor cut larger holes on bottles First solid food-cereal: rich in Vit B and iron fortified

Cereal Vegetables-green and yellow Fruit -banana Meat beef and pork than chicken Egg yolk

NUTRITION FOR INFANTS

Weaning by 8-9 months Allow infants at 6 months to handle spoons No honey!!

Brush with damp cloth

Could be source of infant botulism

When you become a mother, what will you do in situation like these

Baby has seborrhea Diaper rash First appearance of tooth Sleeping infants Thumb sucking Head banging Constipation Loose stool Spitting up

Colic Diaper rash Miliaria Baby bottle syndrome

Bryans mother is concerned about him-bottle syndrome, what would be her best action to prevent this?
a.

b.
c. d.

Use a plastic rather than glass bottles Boil formula to redce the curd Dont put brayian to bed with a bottle Check the expiration date of the formula

Q and A
When assessing the weight of a 5 month infant, which of the following indicates healthy growth? a) Double of birth weight b) Tripling of weight c) Quadrupling of birth weight d) Stabilizing of birth weight

Q and A
While performing physical assessment of a 12 month old infant, the nurse notes that the infant anterior fontanelle is still slightly open. Which of the following is the nurses most appropriate action? a) Notify the doctor STAT b) Perform a neurological exam c) Perform an extensive developmental exam d) Do nothing because this is normal

Q and A
When teaching a mother about introducing solid foods to her infant, what age in months should the nurse indicate as the earliest age to start.
__________________

Q and A
When teaching a mother about introducing solid foods to her infant, what age in months should the nurse indicate as the earliest age to start.
4 months

Q and A
4. When assessing a 4 month old infant which of the following sounds would the nurse expect to find as being most recently developed? a) Cooing sounds b) Babbling sounds c) Imitated sounds d) Combined syllables

Q and A
5. The infant of a substance-abusing mother is at risk of developing sense of which of the following a) Mistrust b) Shame c) Guilt d) inferiority

Q and A
6. Which of the following toys should the nurse recommend for a 5 month old infant? a) Big red balloon b) Teddy bear with button eyes c) Push pull wooden truck d) Colorful busy box

Q and A
7. The mother of a 2-month-old is concerned that she may be spoiling her child by picking her up when she cries. Which of the ff would be the nurses best response a) Let her cry for a while before picking her up, so you dont spoil her b) Babies need to be held and cuddled you wont spoil her this way c) Crying at this age means the baby is hungry, give her a bottle d) If you will leave her alone she will learn how to cry herself to sleep

Q and A
8. Which of the ff is the primary nursing intervention used to help a 1-month-old infant tolerate hospitalization? a) Consistent caregivers b) Providing sensorimotor stimulation c) Follow home schedule as closely as possible d) Keeping the infant warm and dry

Q and A
9. Which of the ff types of play would the nurse expect to see when assessing a 10-month-old infant? a) Parallel b) Solitary c) Associative d) cooperative

Q and A
10. Which of the following signs of socialization would the nurse expect to see when assessing a 5-monthold infant? a) Social smile b) Enjoy social interactions c) Smiling at mirror image d) Exhibit fear of strangers

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

Toddler

Adele Piliterri, Child Health Nursing, Lippincott

Toddler

Safety becomes a problem as the toddler becomes more mobile.

Pilliterri, Lippincott

Toddlers

Toddlers-terrible twos

Growth & Development Toddler Ages 1-3 years Erikson says Autonomy vs.Shame & Doubt Remember PRAISE P push/pull toys & parallel play R rituals & routines & regression A autonomy vs shame & doubt & accidents I involve parents S separation anxiety E elimination & explore

Physical Growth
Wt gain avg. 5 #/yr Ht gain avg. 3yr. Head / chest are usually equal 1-2 years then chest begins to exceed Anterior fontanel closes 12-18months Able to achieve urethral and anal sphincter control between 18-24 months because spinal cord completes myelination Learns to walk between 1 & 2 years

Resp. rate slows pulse slows & BP rises respirations are still abdominal Study developmental milestones Erikson: Autonomy vs. Shame/doubt more independent yet still has anxiety Age of explorer

Nutrition
Physiologic anorexia @ 18 mo Food jags common Ritualistic table behaviors 2 year olds have definite likes & dislikes assure parents this is normal Avoid foods that may be aspirated

Issues in parenting - toddlers

Stranger anxiety should dissipate by age 2 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

Sleep
12 hours a day Afternoon nap only Rituals help prepare child for bed Temper tantrums common DO NOT BE MANIPULATED

Accident Prevention
Main cause of death in this age group MVAs # 1, drowning, burns, poisoning, falls, aspiration Toddlers require constant supervision Must be properly secured while in car; should be in car seat until 40 lb.s or 40 or 4 years old

Poisoning toddlers learn about their world from their mouths (keep syrup of ipecac on hand, 15mls follow with water may repeat in 20 minutes)

Dental Care

Deciduous teeth all in by 2 years Brushing and flossing should begin Beware of cariogenic foods such as molasses, syrup, raisins No bedtime bottles

Toilet Training
Physically able 18-24 months Psychologically: ability to recognize urges ability to communicate desire to please parents Major Developmental Task

Indicators for toilet training dry for 2 hours dry after nap regular BMs ability to walk,sit,squat, ability to undress ability to sit 5-10 minutes dislike of soiled diapers Do not expect perfection Night control may be achieved until 4-5 yrs.

Autonomy vs. Shame and Doubt

Conflict of toddlerhood-autonomy vs. shame and doubt 2nd stage- anal stage- take pleasure in retaining and releasing urine and feces at will Resolved positively if parents provide suitable guidance and appropriate choices

Psychosocial Development
Negativism: No me do it Mood swings Temper tantrums childs way of dealing with frustration Ritualism need to maintain sameness & reality Regression retreat from current behavior In hospital: despair & protest is not a personal attack on nurse

Play
Parallel Toys: locomotion, tactile, talking (remember safety) gross motor toys push/pull, large blocks, balls, rocking horse: fine motor toys, thick crayons, play dough, wooden puzzles, finger paints A 2 yr old can walk up & down stairs one step at a time An 18 can build a 3-4 block tower

Discipline
To instruct to produce a particular behavior Time out rule one minute per year Consistent Redirection Discipline should address the behavior & not the child bad boy

Cognition/ Language
Pre operational thinking: Age 2 only think of events in relation to their perception Magic thinking Animism Vocabulary 300 words @ 2 years

Social Skills
Enjoy visiting going May need transitional objects for security Learns to tolerate being separated from parents

Pre-School

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

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

Pool Safety

School-Age
I am competent enough" or "I am not competent enough.

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

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

Red flags: school age

School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse

School Age: gross motor

8 to 10 years: team sports Age ten: match sport to the physical and emotional development

School Age

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.

Focus on industry and achievement

Take tasks from start to finish Competitive, cooperative, teamwork. Need to feel significant Feelings of inferiority may surface from high expectations of peers and parents Hospitalization: Be honest about procedures, what will hurt. Explain everything in detail, to alleviate fears.

Encourage involvement in wound care. Keep busy. Design a daily schedule, similar to home, involve in development. Bring in favorite things

from home.

Adolescence 13 to 18 Year Old I am a unique self or I am unsure of myself.

Stage V Adolescent 12-18 years Developmental Goal: Preserve Identity

Focus on identity Self conscious about appearance Progresses through puberty, body changes occur. Life away from parents Role confusion may result Begins to make career decisions. Hospitalization: Assist to maintain physical appearance during hospital stay. Provide privacy. Encourage contact with peers regarding school and activities. Explain procedures and involve them in decision making. Active listening, avoid giving advice.

Adolescent

As teenagers gain independence they begin to challenge values Critical of adult authority Relies on peer relationship Mood swings especially in early adolescents

Adolescents

Adolescent behavioral problems

Anorexia Attention deficit Anger issues Suicide

Adolescents

Adolescent Teaching

Relationships Sexuality STDs / AIDS Substance use and abuse Gang activity Driving Access to weapons

Young Adult 18-30

"I can commit to close relationships and career" or "I cannot commit to close relationships/ career".

Stage VI Young Adult 18-30 Developmental Goal: Intimacy/Address Commitments

Becomes committed to life socially, occupationally, and sexually. Intimacy develops Develop strong ties in life Must focus on economic status Have a need for love, commitment, and compassion. Isolation may result in those who avoid commitment Hospitalization: May mask symptoms hoping to return to normal immediately. Gradually increase in activity, address concerns related to family, work, and financial obligations. Involve significant others in care.

Nurses are for Engineers

Generativity 30-60 years

I can grow and nurture growth", or "I cannot grow or nurture growth".

Stage VII Generativity 30-60 years Developmental Goal: Generativity/Evaluate Expectations

Focus on obligation to care for self and others. Strive to maintain economic status Stress may result when obligations are not met or when unrealistic expectations are place on self. Hospitalization: Assess family, work, and economic concerns. Encourage delegation of work and home obligations during hospitalization. Involve in decision making. Keep patient and family informed. Encourage family visits.

Elderly > 60 years of age

I am satisfied enough with my life and am ready to face death", or "I am not satisfied enough with my life and cannot face death without despair".

Stage VIII Elderly > 60 years of age Developmental Goal: Assess Integrity

Looking back at life and evaluating choices. Family relations and financial status affect feelings of accomplishment Despair may result if focusing only on mistakes made in life Mastery of feelings of distinction and honor result when integrity is maintained. Hospitalization: Assess to determine feelings of hopefulness, or despair. Identify family or support structure in place. Address spiritual concerns and feelings of fear related to the unknown. Use open ended questions to encourage verbalization of feelings and concerns. Encourage family visits and participation of care.