Download Pediatric Growth and Development and more Study notes Nursing in PDF only on Docsity!
Family Centered Care
Family Types:
- Traditional Nuclear Family: Married couple and their biological children.
- Nuclear Family: Two parents and their children
- Single-parent family: One parent and one or more children
- Binuclear Family: Parents who have terminated spousal roles but continue their parental roles Other Family Situations:
- Divorce : Impacts a child socially, emotionally, and physically
- Single Parenting : Risk of financial instability
- Birth of a new child: Increased financial responsibilities. Parenting Styles:
- Authoritarian : Parents try to control the child’s behaviors and attitudes through unquestioned rules and expectations
- Permissive : Parents exert little or no control over the child’s behaviors and consult the child when making decisions
- Authoritative : Parents direct the child’s behavior by setting rules and explaining the reason for each rule
- Uninvolved : Parents are indifferent and emotionally removed.
Physical Assessment and Vitals
Age Group Pulse Respirations Max BP Toddler (1- 3 ) 80 - 140 25 - 30 91/ Preschooler (3-5) 70 - 120 20 - 25 98/ School Age ( 6 - 12) 60 - 110 20 - 25 106/ Adolescent (13-18) 50 - 100 16 - 20 120/
Toddlers (1-3)
- Physical Development: o Anterior fontanels close by 18 months
o Weight: At 30 months toddlers should weigh 4x their birth weight. Gain 4-6lb per year) o Height: grow 3in per year
- Psychosocial Development: o Autonomy vs. Shame and Doubt o Independence is paramount for toddlers o Often use negativism or negative responses o Ritualism, or maintaining routines and reliability provides a sense of comfort.
- Moral Development: o Egocentric: Toddlers are unable to see things from the perspective of others o Good behavior is rewarded, and bad behavior is punished.
- Age-Appropriate Activities: o Solitary play evolves into parallel play o Filling and emptying containers o Playing with blocks o Looking at books o Push-pull toys o Tossing balls o Finger paints o Large piece puzzles
- Toilet training can begin when toddlers have the sensation of needing to urinate or defecate o Nighttime control might develop last.
Developmental Milestones:
12 Months 15 Months 18 Months 24 Months 30 Months
Pulls up into standing position Takes few step on own Walks independently Kicks a ball and runs Uses pretend play Drinks from cup w/o lid Uses fingers to feed themselves Scribbles Walks up stairs with or without help Follows simple instructions Walks holding on to furniture Stacks 2 blocks Drinks from lidless cup Uses a spoon Speaks 50 words Attempts to build 2 block tower Two words other than mom/dad Tries to say 3 or more words Says at least 2 words together Uses parallel play Comprehends ‘no’ Follows simple directions Follows one step directions Points at 2 or more body parts
Nutrition: Consume 16-24oz of milk per day. Breast feeding can continue up to 2 years.
Juice consumption should be limited to 4 - 6oz per day
o Keep consistent bedtime routine o Use a night light in the room o Ignore attention seeking behavior
- Dental Health: o Eruption of primary teeth is finalized by the beginning of preschool years
Developmental Milestones:
3 Years 4 Years 5 Years Strings beads together Catches a large ball Hops/skips on one foot Rides a tricycle Unbuttons some buttons Throws a ball overhead Stands on one foot for a few sec. Combines 3-4 words in sentences Draws a person with three or more body parts Identifies some numbers between 1- 5 Returns demonstration of drawing a circle Says simple sentences with 4 or more words Counts to 10 Builds tower w/ 9-10 blocks Laces shoes
School-Age Children (6-12)
- Physical Development: o Weight: 4.4-6.6lb per year o Height: 2 inches per year
- Prepubescence: o Preadolescence is typically when prepubescent occurs. o Psychological changes begins around the age of 9 years. o Differences in the rate of growth and maturation between boys and girls becomes apparent. o Permanent teeth erupt. o Bones continue to ossify.
- Psychosocial Development: o Erikson: Industry vs. Inferiority o A sense of industry is achieved through the development of skills and knowledge that allows the child to provide meaningful contributions to society.
o Children should be challenged with tasks that need to be accomplished and be allowed to work through individual differences in order to complete tasks.
- Moral Development: o Eary school age: ▪ Judgment is guided by rewards and punishment. ▪ Sometimes interpret accidents as punishment. o Later school age: ▪ Understand different points of view instead of just whether or not an act is right or wrong.
- Self-Concept: o School age children develop an awareness of themselves in relation to others, as well as an understanding of personal values, abilities, and physical characteristics. o By middle school, the opinions of peers and teachers become more valuable.
- Body-Image Changes: o Curiosity about sexuality should be addressed with education regarding sexual development and reproductive process. o School age children are more modest than preschoolers and place more emphasis on privacy issues.
- Social Development: o Peer pressure begins to take effect. o Bullying actions are intended to cause harm or to control someone, and are sometimes attributed to poor relationships with peers and difficulty identifying with a group. o During early school age years, children often prefer the company of same-sex companions, but begin developing an interest in others toward the end of school age years.
- Age-Appropriate Activities: o 6 - 9 years: ▪ Jump rope, bicycles, o 9 - 12: ▪ Make crafts, solve jigsaw puzzles, join organized competitive sports, play board games
- Health Screenings: o Scoliosis: School age children should be screened for scoliosis by examining for a lateral curvature of the spine.
- Nutrition: o Obesity is an increasing concern for this age group that predisposes children to low self-esteem, diabetes, heart disease, and high blood pressure.
- Sleep and Rest:
- Autonomy: o Emotional Autonomy: Independent decision making regarding relationships. o Behavioral Autonomy: Ability to make independent decisions.
- Health Perceptions: o Adolescents can view themselves as invincible to bad outcomes of risky behaviors.
- Moral Development: o Question relevance of existing moral values to society and individuals.
- Self-Concept Development: o View themselves in relationship to similarities with peers during adolescence.
- Sleep and Rest: o About 9 hours per night o During periods of active growth, the need for sleep increases.
- Dental Health: o Corrective appliances are most common with this age group.
- Sexuality: o Provide information about preventing sexually transmitted infections and pregnancy. o Perform STI screenings for at risk adolescents.
- Bodily Harm: o Adolescent should have annual psychological screenings to identify depression, anxiety, suicidal ideations, and substance use.
Death and Dying:
- Factors influencing loss, grief, and coping ability: o Type and significance of loss. o Culture and ethnicity, spiritual and religious beliefs and practices. o Prior experience with loss and social economic status.
- Grief and Mourning: o Anticipatory Grief: When death is expected or a possible outcome. o Complicated Grief: Extensive or prolonged grief. o Parental Grief: Secondary losses related to the death of the child, such as absence of hope and dreams, disruption of the family unit, and loss of identity as the parent. o Sibling Grief: Reactions depend on age and developmental stage.
- Developmental Stages and Dying: o Infants/Toddlers: ▪ Have little to no concept of death.
▪ Egocentric thinking prevents their understanding of death. ▪ Mirror parental emotions. ▪ Can regress to an earlier stage of behavior. o Preschool : ▪ Egocentric thinking. ▪ Magical thinking allows for the belief that thoughts can cause an event. (death as a result child can feel guilt) ▪ Interpret separation from parents as punishment for bad behavior. ▪ View dying as temporary because of the lack of concept of time and because the dead person can still have attributes of the living. o School Age: ▪ Begin to have an adult concept of death. ▪ Experience fear of the disease process, death process, the unknown, and loss of control. ▪ Fear is often displayed through uncooperative behavior. o Adolescents: ▪ Can have an adult like concept of death. ▪ Can have difficulty accepting death because they are discovering who they are, establishing an identity, and dealing with issues of puberty. ▪ Can be unable to relate to peers and communicate with parents. ▪ Can become increasingly stressed by changes in physical appearance due to medications or illness than the prospect of death. ▪ Can experience guilt and shame.
- Palliative Care: o Plan care for the entire family and its individuals, in addition to the child. o Control pain
- Care for grieving families: o Emphasize open communication between the healthcare team, child, and family o Use books, movies, art, music, and play therapy to stimulate discussions and provide an outlet for emotions. o Remain neutral and accepting. o Give families unlimited time and opportunities for any cultural or religious rituals. o Allow family to stay with the body as long as they desire.
o If 4 dose series, 4th^ at 12 to 15 months
- IPV: Polio o 1 st^ at 2 months o 2 nd^ at 4 months o 3 rd^ at 6-18 months o 4 th^ at 4-6 years
- RV: Rotavirus o RV1 (2 dose) ▪ 1 st^ at 2 months ▪ 2 nd^ at 4 months o RV5 (3 dose) ▪ 3 rd^ at 6 months
- PCV13: Pneumococcal disease o 1 st^ at 2 months o 2 nd^ at 4 months o 3 rd^ at 6 months o 4 th^ at 12-15 months
- IIV: Inactivated flu o Yearly starting at 6 months
- MMR: Mumps, measles, and rubella o 1 st^ at 12-15 months o 2 nd^ at 4-6 years
- VAR: Varicella o 1 st^ at 12-15 month o 2 nd^ at 4-6 years
- Hep A: Hepatitis A o 1 st^ at 12 - 23 months o 2 nd^6 - 18 months later
Older Kid Vaccines
- MENACWY: (Meningococcal Conjugate) o 1 st^ at 11-12 years o Booster at 16 years old
- MENB: Meningococcal o 1 st^16 - 18 years o 2 nd^ 1 month later
- HPV: Hyman Papilloma Virus o 1 st^11 - 12 years
o 2 nd^ dose 6-12 months after 1st^ dose
- Tdap: o 1 st^ dose 11-12 years o TD booster every 10 years
Pediatric Emergencies
- Respiratory Emergencies: o Respiratory Insufficiency: Increased work of breathing with mostly adequate gas exchange or hypoxia with acidosis. o Respiratory Failure : Inability to maintain adequate oxygenation of the blood. o Apnea : Sensation of respirations for more than 20 seconds. o Risk Factors: ▪ Infants and toddlers o Early Indications of Resp Distress: ▪ Restlessness, tachypnea, tachycardia, diaphoresis, nasal flaring, retractions, grunting, dyspnea, wheezing o Advanced Hypoxia: ▪ Bradypnea, bradycardia, peripheral or central cyanosis, stupor, and coma. o Indications of Choking: ▪ Universal choking sign (clutching neck with hands), inability to speak, Weak and effective cough, High pitched sounds or no sounds, dyspnea, cyanosis. o Obstructed Airway: ▪ For infants use a combination of back blows and chest thrusts. ▪ For children and adolescents, use abdominal thrusts. ▪ Place the recover child into the recovery position which is side lying with legs bent at knees for stability.
- Drowning : o Children 1-4 are most at risk
- Brief Resolved Unexplained Event: o Set an event where the infant exhibits bacteria, change in color, change in muscle tone and level of consciousness. o Risk Factors: ▪ Resp infections, seizure, UTI, sepsis, neurological disorders
- Sudden Unexplained Infant Death: o Sudden unexpected death of an infant, with or without identified cause, occurring during the first year of life.
o Complex neurodevelopmental disorders with spectrum of behaviors affecting an individual's ability to communicate and interact with others in a social setting. o Expected Findings: ▪ Delays in at least one of the following:
- Social interaction, social communication, imaginative play prior to age 3. ▪ Distress when routines are changed. ▪ Unusual attachment to objects. ▪ Inability to start or continue conversation, using gestures instead of words. ▪ Inability to adjust the gaze to look at something else. ▪ Not referring to self correctly. ▪ Lack of empathy, decrease pain response ▪ Avoiding eye contact ▪ Spending time alone rather than playing with others.
