Parts I and II: Pediatric Growth & Development Health Maintenance & Restoration Fall 2010 Susan Beggs, RN MSN CPN

Growth and Development

Directional paths of growth & development n Cephalocaudal n Proximo-distal n Prehensile

Concepts of growth and development n Psychosocial development: Erikson n Cognitive development: Piaget n Moral development: Kohlberg n Sexual development: Freud

Improving child health by having knowledge of definitions n “growth” n “development” n “maturation” n “learning”

Principles of Growth & Development n occur in an orderly sequence n occur continuously but rates vary- growth spurts n highly individualized rate from child to child n different ages for specific structures n process involving the whole child

Factors which influence growth and development n Genetics n Environment n Culture n Nutrition n Health Status n Family

Genetic influences on growth and development n pattern, rate, rhythm and extent: –governed by genes interplaying with environment –intrauterine life extremely important in growth and healthy development of the child

genetic screening, cont. n later in pregnancy: l2-l6 weeks –chorionic villa l0-11 weeks n role of the genetic counselor

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

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

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

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

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

Patterns of growth n Rapid pace from birth to 2 yrs n Slower pace from 2 yr-puberty n Rapid pace from puberty to 15 yrs n Sharp decline from yrs when full adult size is reached

Growth and development, cont. n 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

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

Tanner staging n Sexual Maturity Rating (SMR) n Essential for nurses to assess in adolescents n SMR greater reliability for physical development than chronological age

Tanner staging n Girls: –Stage 1: preadolescence –Stage 2: breast buds; sparse public hair –Stage 3: breast and areola enlarge; pubic hair thickens, curls –Stage 4: areola and papilla form; typical female triangle in pubis, thickening hair –Stage 5: mature, nipple projects; adult female triangle, spreads to medial surface of thighs n Boys –Stage 1: no pubic hair; all structures preadolescence –Stage 2: pubic hair, slight enlargement of penis and scrotum –Stage 3: pubic hair, curls, penis and testes larger –Stage 4: less pubic hair than adult, but thickening; penis larger, scrotum darker –Stage 4: pubic hair, adult distribution; penis and testes adult in size

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

Functions of play n Physical growth and development n Cognitive development n Emotional development n Social awareness n Moral development

Social aspects of play n Solitary play n Parallel Play n Associative play n Cooperative Play n Onlooker Play

Types of Play n Dramatic play n Familiarization play

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

Jealousy n A combination of anger, fear, and love n A child 1st loves something, counts it as his own and 2nd perceives that it has been taken away or interfered with n The loss may be real or perceived, ie., sibling rivalry

Discipline n Techniques: –The model is to teach by example! –Listening skills n passive n acknowledgement n door openers n active listening

Part II: Health Maintenance and Restoration

Dental needs of the child from infancy to adolescence n Caries in infancy due to nurse for long periods of time n See text for the sequence of eruption of teeth n Braces may be indicated at the time of puberty

Levels of Preventive Health Maintenance Activities n Primary n Secondary n Tertiary

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

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

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

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

n Assess for reaction min after injection n Epinephrine 1:1000 available n Check immunization records with each visit n Parent teaching: fever, or other symptoms

Safety risks to developmental levels n Infant n Toddler n Preschool n School age n Adolescent

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

n Leading cause of fatal injury under 1 year of age n 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

n Vehicular risk greatest when child improperly restrained n Pedestrian n Prevention

n Children are inquisitive n Become able to climb and explore n Prevention of household injury:

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

n Still developing sense of balance n Easily distracted from tasks n Prevention:

Stats on drug poisonings

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

n Sources of poison: –Cosmetics –Household cleaners –Plants –Drugs –Insecticides –Gasoline –Household items

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

n Life threatening n More likely to drop out of school n Become disabled n Disturbed brain and nervous system function n Prevent child from full potential

n Pathophysiology of lead poisoning n System assessments n Therapeutic Interventions

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

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

n Make environment lead-free n Inspect buildings >25 years of age n Areas painted with lead paint should be covered with plywood or linoleum n Educate the parents n Follow up testing for lead levels n Screening all school age children (required in some states)

Relationship of safety to childhood development n Children are vulnerable because: –They are curious –They are driver to test and master new skills –They frequently attempt activities without having cognitive or physical capabilities –They often challenge rules –They develop a strong desire for peer approval