1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 2 Concepts of Altered Health in Children

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Growth and Development (Definitions) Physical Growth –Changes in the body as a whole or in its individual parts (percentile) Growth and Development –The process whereby a fertilized ovum becomes an adult person Development –Embraces aspects of differentiation, such as changes in body function and psychosocial behaviors

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The Prenatal Period Begins with implantation of the blastocyst The prenatal period is divided into two periods: –Embryonic (2 nd to 8th week of gestation): formation of germ layers, early tissue differentiation, development of major organs and systems of the body –Fetal period (9th week to birth): rapid growth and differentiation of tissues, organs, and body systems

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Three Stages of Embryonic Development First Stage –Growth occurs through increase in cell numbers and elaboration of cell products. Second Stage –Morphogenesis (development of form) occurs, including mass cell movement. Third Stage –The stage of differentiation or maturation of physiologic processes.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Birth weight less than two standard deviations below the mean for gestational age describes which of the following? –A. Normal birth weight –B. Low birth weight –C. High birth weight

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Low birth weight Rationale: Low birth weight describes the condition of birth weight less than two standard deviations below the mean for gestational age or below 10th percentile.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Abnormal Intrauterine Growth Low Birth Weight –Infants weighing 2500 g or less at birth Small for Gestational Age –Birth weight less than two standard deviations below the mean for gestational age or below 10th percentile Large for Gestational Age –Birth weight greater than two standard deviations or above 90 percentile

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Measures for Gestation Prenatal Assessment –Careful menstrual history, physical milestones during pregnancy, prenatal tests for maturity Postnatal Assessment –Examination of external physical and neuromuscular characteristics alone or in combination –Ballard method –Dubowitz method

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Criterion for Apgar Score Heart rate Respiratory effort Muscle tone Reflex irritability Color

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Health Problems of Newborns Distress at birth and the Apgar score Neonatal hypoglycemia Neonatal jaundice Birth injuries –Caput succedaneum –Cephalhematoma –Brachial plexus injuries –Klumpke paralysis Congenital malformations

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question The Apgar score is a measure of all of the following except what? –A. Heart rate –B. Respiratory effort –C. Muscle tone –D. Reflex irritability –E. Pupillary reflexes

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer E. Pupillary reflexes Rationale: Pupillary reflexes cannot be measured on a full-term infant.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Growth and Development Skull development Organ systems continue to grow and mature in an orderly fashion. –At a minimal level of functioning at birth

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Needs of the Premature Infant Respiratory problems: –Respiratory distress syndrome –Apnea and periodic breathing Intraventricular hemorrhage Necrotizing enterocolitis Infection and sepsis

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Problems of the Infant Issues related to nutrition Irritable infant syndrome or colic Failure to thrive Sudden infant death syndrome injuries Infectious disease

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Failure to Thrive Inadequate growth of the child due to the inability to obtain or use essential nutrients Organic –Physiologic cause Inorganic –Psychological factors

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Early Childhood Period from 18 months through 5 years Child passes through two stages: –Toddler –Preschooler Major achievements are development of locomotion and language. Learning is ongoing and progressive.

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Risks of Early Childhood Injuries Infectious diseases Child maltreatment

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Characteristics of Middle Childhood Period occurs from 6 to 12 years. Growth averages 3 to 3.5 kg and 6 cm per year. Muscular strength, coordination, and stamina increase. Ability to perform complex movements increases. Can consider several factors simultaneously. Can evaluate self and perceive others’ evaluations.

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Risks of Middle Childhood Respiratory infections Accidents Dental caries Infections involving bacterial and fungal agents Surfacing of acute and chronic problems

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Adolescent Period Extends from 13 years through 19 years of age. Rapid changes occur in body size and shape and physical and psychological functioning. Is a time when hormones and sexual maturation interact with social structures.

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Adolescent Growth and Development CNS-mediated hormonal activity. Physical growth occurs simultaneously with sexual maturation. Growth patterns: 1.Arms, legs, hands, feet, and neck 2.Followed by increases in hip and chest size 3.Several months later by increases in shoulder width and depth and trunk length

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Physical growth occurs first, followed by sexual maturation.

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: They occur at the same time.

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Adolescent Period (cont.) Developmental tasks include –Achieving independence from parents –Adopting peer codes –Making lifestyle choices –Forming and adapting to body image

26. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Risks of Adolescence Unintentional injuries –Vehicle accidents, drowning, falls, firearm mishaps, poisoning, and sports Intentional injuries –Homicide and suicide Sexual activity –Pregnancy and STDs Substance abuse