1 Growth and DevelopmentBy: Kara Potter RN, MSN Revised and Presented by P. Braun RN, MSN

2 SLO’s Differentiate between normal and abnormal growth and developmentExamine the use of play throughout the developmental stages Analyze safety concerns through the developmental stages

3 Factors influencing developmentGenetics Nutrition Prenatal and environmental factors Family and Community Cultural Factors

4 Developmental Stages Middle Childhood Late Childhood Prenatal InfancyNeonatal-birth to 28 days Infancy-1 to 12 months Early Childhood Toddler-1 to 3 years Preschooler-3 to 6 years Middle Childhood School age-6 to 12 years Late Childhood Prepubertal-10 to 13 years Adolescence -3 to 18 years

5 Neonatal Newborn Head ¼ of body lengthWeight- gains 5 to 7 oz weekly for first 6 months Height- grows 1 inch monthly for first 6 months Head circumference greater than chest See charts, pp in Wong Reflexes- Moro, Tonic Neck, Gag, Grasp, Rooting, Babinski

6 Newborn Visit 2 weeks or 1 monthOnly feed breast milk or formula, q 2-3 hrs Umbilical cord falls off 7-21 days Should cry when needs to be fed etc.. More fussy in evening Trust vs Mistrust Piaget- reflex stage

7 Infant (1 to 12 mo) Double birth weight in 5 to 6 months, triples by 1year (use growth charts) Height increases by 50% in a year Head growth rapid Head circumference exceeds chest Posterior fontanel 2 to 3 months Anterior fontanel closes 12 to 18 months Reflexes Parachute, Landau, Labyrinth, body righting

8 Infancy well child checks2 months 4 month 6 month 9 month

9 Head Control

10 Development of Sitting

11 2 month check Holds head up when on stomach Mini pushup 2-4moSmiles on own Cooing Simple reflex activity such as grasping, sucking Should turn head to sound at ear level

12 4 month Start Teething Increased salivaMaternal antibodies wear off start to catch viruses Should start to babble Reflexive behaviors occur in repetition such as opening and closing fingers repetitively

13 6 months Rolls over and sits without supportTeething first tooth at about 4-6 months Exploratory play banging things, dropping, puts things in mouth Grabs things, transfers hand to hand Repetition of change actions to reproduce interesting consequences such as kicking feet to move a mobile suspended over the crib. 7 Months

14 6 months language Babble with inflectionRespond to his or her own name Respond to sound by making sounds Babble chains of consonants (usually sounds for m, b, d) Use his or her voice to express pleasure and displeasure 6 month child vocalizing and responding https://youtu.be/Y02R7yxvZFw

15 9 months Child becomes mobile, is standing pulling up.Points at objects Pincer grasp Separation anxiety Responses become coordinated into more complex sequences.  Actions take on an "intentional" character such as the infant reaches behind a screen to obtain a hidden object. Safety proof house! No hanging cords, electrical sockets etc.. Health Screenings: Anemia and lead tests Fetal iron stores are depleted after 4 months of life.

16 Infancy/ motor developmentHead control by 4 months Roll back to side 4 months Abdomen to back 5 months Back to abdomen 6 months Sit alone without support 8 months Stand holding furniture 9 months Crawl 10 months Cruises months Walks holding a hand 12 months

17 Development of Locomotionp. 421,Hockenberry, 10th edition

18 Infancy fine motor Desire to grasp 3 moTwo handed voluntary grasp by 5 mo Holds bottle 6 mo Transfers objects hand to hand 7 mo Pincer grasp 10 mo Refined pincer 12 mo

19 Crude Pincer Grasp Develops at 10 mo

20 Neat Pincer Grasp

21 Sensory Development Hearing and touch well developed at birthTurns head to sound 2 months Sight not fully developed till 6 years Smiles 2 months Responds to name 7 months Should have 4 words by 1 year Teeth erupt 4 to 6 months with increased saliva

22 Infant Safety Back to bed! Car seats backward till 1 year and 20 lbs.In 2017 will change to 2 years and 40 pounds Side-rails of crib up Never leave infant unattended on table, bed, bath tub No bottles at bed or nap time Injury prevention Aspiration Suffocation Falls Poisoning Burns See pages , Hockenberry, 10th edition

23 Psychosocial DevelopmentErikson’s phase I: developing a sense of trust Trust vs. mistrust Importance of caregiver-child relationship Importance of consistency of care

24 Cognitive DevelopmentPiaget Sensorimotor phase Birth to 2 month: reflex stage 2 to 4 months: primary circular reactions 4 to 8 months: secondary circular reactions 8-12 months: Coordination of Secondary Reactions Imitation Play Object Permanence (Affect) object permanence https://youtu.be/cSGWh2CWJnA (Pg.420, Hockenberry, 10th edition)

25 Toddler (12 months to 3 years)Weight gain slows Height at 2 year ½ of future adult height Head circumference 90% of adult size by 2 years Anterior fontanel closed by 18 months

26 Toddler Check 12 mo Nutrition- switch child from formula to whole milk! Should use cup, all foods cut up in small pieces. Worry about choking, no grapes, hot dogs! Shows definite understanding of some words Has some simple words Mama, Dada Walks with assistance (some walk without assistance) Stands independently, can seat self on floor

27 12 months language + cognitiveTry to imitate words Say a few words, such as "dada," "mama," "baba" and "uh-oh" Understand simple instructions, such as "Please drink your milk" Understand "no" Discovery of new ways to produce the same consequence or obtain the same goal

28 Toddler check mo Family meals, baby feeds self, uses cup and spoon, bottle to be removed between 12 to 15 months! Walks, runs awkwardly, Object permanence Vocabulary of 3-50 words Can link words together

29 18 months language Point to an object or picture when it's namedRecognize names of familiar people, objects and body parts toddler points to body partshttps://youtu.be/vqe6wGYJvew Follow simple directions, such as "Throw me the ball" Say up to 20 words

30 Toddler check 24 months change from high fat to low fat (switch to skim milk) potty training begins (between 2 and 4 years) ask for common foods by name use simple phrases, such as "more milk" begin to use pronouns, such as "mine" begin to use prepositions, such as "in" and "under" ask one- to two-word questions, such as "go bye-bye?" respond to two-step verbal requests, such as "please put the book down and bring me your shoes" say up to 50 to 100 words

31 Toilet Training Which developmental stage is toilet training according to: Erikson? Piaget? Freud?

32 Toddler Walks independently by 15 mo Jumps in place by 18 moStairs by 24 mo Runs by 24 mo

33 Toddler Fine Motor Uses cup well by 15 mo.Builds tower of 2 cubes by 15 mo. Holds crayon with fingers 24 to 30 mo Copies circle by 3 years

34 Toddler Sensory Knows name 12 mo refers to selfFollows simple directions by 2 years Identifies geometric forms by 18 mo Uses short sentences by 18 mo to 2 years Remembers and repeats 3 numbers by 3 years 300 word by 2 years Object permanence Ritualism

35 Toddler Safety Car Seats Supervise Play Childproof home SuffocationBurns Falls Aspiration/ Poisoning

36 Forward-Facing Convertible SeatEffective January 1, 2017: Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. The child shall be secured in a manner that complies with the height and weight limits specified by the manufacturer of the car seat.  .

37 Matches Are a Potentially Deadly Hazard

38 Plastic Caps for Electrical Sockets

39 Storage of Cleaning Agents

40 Toddler Play Begins make believe play May use imitationProvide Blocks, Wheel toys, push toys, simple puzzles, crayons, develop motor skills Often enjoy repetitive stories and songs with rhythm Often engage in parallel play

41 Psychosocial DevelopmentErikson: developing autonomy “Autonomy” vs. “shame and doubt” “Negativism” “Ritualization” provides sense of comfort Psyco-sexual is anal stage from 18mo-3 years

42 Cognitive DevelopmentPiaget: sensorimotor continued: Tertiary circular reactions (12-18months) Invention of new means through mental combination ( months) Begin preoperational (2-4yrs) Increased use of verbal representation but speech is egocentric, beginnings of symbolic rather than simple motor play.  Awareness of causal relationships between two events Learn spatial relationships

43 Preschool 3 to 6 years Growth slow and steady 4 to 5 lbs a yearHeight increases 2 to 3 inches a year

44 Preschool Check @ 4 yearsNow start well child checks every year Behavior issues often a concern

45 Preschool language 3-4 yrsfollows 2 related directions e.g. "close the book and give it to me" tells first and last name understands questions about a picture story e.g. "Where did the bunny go?" reasons - answers "What do you do when you're hungry?" tells a short story e.g. "two kids played ball" sentences are usually 3 and 4 words long gives directions such as "Fix this for me" asks many questions: "what", "where", "why"

46 Preschool language 4-5yearsfollows 3 related directions such as "get your crayons, make a picture and give it to the baby" speaks sounds accurately except perhaps for l, r, s, k, th, ch, sh more reasoning - answers questions such as "What do you do when you are sleepy?" describes objects and events can show you "top", "bottom", and several colors can give meanings of words

47 Preschool Motor Skips/hops on one foot by 4 yearsRides tricycle by 3 years Can throw/catch ball by 5 years Balances alternating feet 5 years

48 4-Year-Old Hops on One Foot

49 Preschool Safety Teach: Traffic safety StrangersFire prevention/safety Water safety

50 Preschool Play Enjoy imaginative and dramatic playStarts role play identifies with same sex Need toys to develop motor and coordination May enjoy sing along songs

51 Preschooler Play Preschoolers enjoy imaginative and imitative play

52 Preschooler Play Enjoy a Sense of Accomplishment

53 Psychosocial Development: EriksonDeveloping a sense of initiative Initiative vs. guilt Development of superego (conscience)

54 Psychosexual Development: FreudOedipal (phallic) stage Oedipal and Electra complexes

55 Cognitive Development: PiagetPreoperational phase—ages 2 to 7 preconceptual phase: ages 2 to 4 intuitive thought: ages 4 to 7 speech becomes more social the child has an intuitive grasp of logical concepts in some areas.   easy to believe in magic reality not firm.  moral-ethical- the child is not able to show principles underlying best behavior. They use simple do's and don'ts imposed by authority.

56 School Age “school age” generally defined as 6 to 12 yearsphysiologically begins with shedding of first deciduous teeth and ends at puberty with acquisition of final permanent teeth gradual growth and development progress with physical and emotional maturity

57 Shedding Deciduous Teeth

58 School age (6-12yrs) Steady weight gain of about 5lbs a yearHeight increases by 1 to 2 inches a year Motor Sensory bone growth is faster than muscle/ligament = growing pain Susceptible to green stick fracture Movements become more graceful and coordinated Vision 20/20 by 6 or 7 years

59 Safety Teach proper use of sports equipmentDiscourage risk-taking behaviors Teach injury prevention Bicycle safety, include helmet law Firearms Smoking Introduce sex education

60 Bicycle Safety

61 School age Play Can comprehend rules and rituals of gamesCan play team games Encourage athletic activities Provide constructional toys (legos, puzzles etc.) Begin interest in video games due to increased hand eye coordination

62 School-Age Children Are Motivated to Complete Tasks

63 School-Age Children Are Often Avid Collectors

64 Engaging in Activities with a “Best Friend”

65 Activities Vary by Interest and Opportunity

66 Psychosocial DevelopmentRelationships center around same-sex peers Freud described it as “latency” period of psychosexual development

67 Erikson: Developing a Sense of IndustryEager to develop skills and participate in meaningful and socially useful work Acquire sense of personal and interpersonal competence Growing sense of independence Peer approval is strong motivator

68 Pride in Learning New Skills

69 Erikson: Inferiority Feelings may derive from self or social environment May occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment All children feel some degree of inferiority regarding skill(s) they cannot master

70 Piaget: Cognitive DevelopmentConcrete operations Use thought processes to experience events and actions Develop understanding of relationships between things and ideas Able to make judgments based on reason (“conceptual thinking”)

71 Kohlberg: Moral DevelopmentDevelopment of conscience and moral standards Age 6 to 7: reward and punishment guide choices Older school age: able to judge an act by the intentions that prompted it Rules and judgments become more founded on needs and desires of others

72 Adolescent Growth (13-18yr)Rapid period of growth Attain final 20% of height rapid gain Boys 4 in./Year Girls 3 in./Year Puberty Appearance of acne on face and trunk Development of secondary sex characteristics Tanner stages

73 Tanner Stages pp , Hockenberry, 10th edition

74 Snacking on Empty Calories Is Common Among Adolescents

75 Piaget: Emergence of Formal Operational ThoughtFormal operational thinking: ages 11 to 14 Abstract terms, possibilities, and hypotheses Decision-making abilities increase May not use formal operational thought and reasoned decision making all the time

76 Romantic Relationships Are Important During Adolescence

77 The Peer Group Influences Adolescent Development

78 Intimacy Intimate relationship begins to emerge in adolescenceDevelopmental course of intimacy Self-focused Role focused Individual connected

79 Promoting Optimum Health During AdolescenceEmpowering individuals, families, and communities Power, authority, and opportunities to make healthy choices Risk reduction in areas of mental health, substance use, sexual behavior, violence, unintentional injury, nutrition, physical activity and fitness, and oral health

80 Adolecent Safety Accidents leading cause of deathEducate on drugs and alcohol Screen for depression and suicide risk

81

82 References Hockenberry, M. J., Wilson, D., (2015) Wong’s Nursing Care of Infants and Children 10th Edition. Mosby, St Louis MO Hogan, M. A., White, J. E., Falkenstein, K., Brancato, V., (2007) Child Health Nursing Reviews & Rationales 2nd edition. Prentice Hall, Upper Saddle River, NJ.