1. Growth and Development

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

3. Improving child health by having knowledge of definitions n “health maintenance” n “preventive health”

4. Definitions n Mortality: the # of deaths/100,000 n Morbidity: used to express the ratio of sick to well in a community n Infant mortality: # of children per l000 live births who die before 1st birthday.

5. Major causes of death during infancy and childhood (these represent death rates for the ages of l-l4 yrs per l00,000) n Accidents n Congenital abnormalities n Cancer n Homicide n Heart disease n Pneumonia & influenza n Suicide n Human immunodeficiency disease

6. 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 vary @ different ages for specific structures n process involving the whole child

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

8. Functions of Play on Growth & Development n Physical Development n Cognitive Development n Emotional Development n Social Development n Moral Development

9. Periods of greatest growth n fetus n birth n infancy n puberty

10. Factors that Influence Growth and Development n Genetics n Environment n Culture n Nutrition n Health Status n Family

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

12. Understanding the genetic link n Genes defined n Chromosomes n autosomes n sex chromosomes n the genomes discovered in 2000! This was a project funded by the U.S. Genome project and one of the most important single finding in mankind

13. Genetic screening n Done during the 1st trimester of pregnancy n Methods: n blood studies from parents check carrier status n measure level of alphafetoprotein (AFP) in mother’s blood for incomplete development of brain or spinal cord: suggestive of neural tube defect (spina bifida)

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

15. 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

16. 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

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

18. Nutritional influences n Begins during the prenatal period n LBW/preterm can result from poor prenatal nutrition n Socio-economics may impact growth

19. Comparison of nutritional needs InfancyToddler Pre- schooler SchoolAgeAdolescence Breast, formula PhysiologAnorexia Diet similar to toddler Resp. for prep  calories Avoid Certain foods Variety Meals are social event Good time to teach re nutrition Fast foods Intro of solids Alarm of parents Enjoy helping Visual learners Peer groups imp. Egg yolk last food Intake sufficient Food jags Hands-on Social event

20. 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 n See p. 1115 “oral care” and “dental care”

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

22. Growth and development, cont. n Methods to evaluate growth: n charts: compare to norms n compare to self over time n xrays n teeth n height, weight, head circumference n size of head and legs: length of bones

23. physical growth, cont. n Intervals @ which birth weight changes: n doubles by end of fifth month of age n triples by end of 1st year n “cephalocaudal” n “proximo-distal” n “prehensile behavior”

24. Intellectual Development n review material on Piaget n “intelligence” n “habituation” n Reflect on the process of habituation and its possible role as a predictor of intelligence

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

26. Stages of play n Practice play n Symbolic play n Games

27. Types of play n Solitary play n Parallel Play n Associative play n Cooperative Play n Onlooker Play

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

29. Emotions, cont. n Love: n includes persons who help them meet their needs, share their pleasure and achievements n when the child receives love, he can give love

30. Emotions, cont. n Fear: n exhibited by crying, running, or hiding n fear can diminish; do not laugh-give love and help them feel safe

31. Anger, cont. n Ways in which anger may be displayed: n shouting n screaming n acts of disobedience n temper tantrums n act out when…. n act better when….

32. emotions, cont. n Anger: do infants have anger? n expected responses that indicate anger:

33. 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

34. Emotions, summarized n Emotions will come out one way or another n How can the nurse help the child respond constructively to these feelings?

35. Parenting: rule #l n PARENTS MUST BE CONSISTENT AND PARENT IN A STYLE APPROPRIATE TO THE CHILD

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

37. discipline, cont. n Techniques, cont. n reality principle n distractions or substitutions n time out n positive practices n point systems with rewards for good behavior n promotes self esteem in children

38. discipline, cont. n CLEAR n C: n L: n E: n A: n R:

39. The End!