1 / 68

Pre-school, School age and Adolescent

Pre-school, School age and Adolescent. Elisa A. Mancuso RNC, MS, FNS Professor of Nursing. Growth and Development Preschool 3-5 years. Biological Growth slows and stabilizes during preschool Average weight gain 2.2 kg (5lbs)/yr Height 7.5 cm (3”)/yr 3 yr: 32 lbs & 37” 4 yr: 37 lbs & 40”

chauncey
Download Presentation

Pre-school, School age and Adolescent

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pre-school, School age and Adolescent Elisa A. Mancuso RNC, MS, FNS Professor of Nursing

  2. Growth and Development Preschool 3-5 years Biological • Growth slows and stabilizes during preschool • Average weight gain 2.2 kg (5lbs)/yr Height 7.5 cm (3”)/yr • 3 yr: 32 lbs & 37” • 4 yr: 37 lbs & 40” • 5 yr: 42 lbs & 43” • Growth occurs in legs rather than trunk. • No longer resemble the “pot belly” toddler!

  3. Psychosocial Development • Erickson: Initiative vs Guilt • Ability to learn & play. • Development of “can do attitude” • Behavior becomes goal directed, competitive and imaginative. • Imitate parents & gender roles. • Proud when accomplish new goals. • When criticized show feelings of guilt. • Conscience develops along with moral development

  4. Psychosocial Development • Freud: Phallic Stage • ↑ Focus on genitals • masturbation and exploration common • Oedipal conflict • Possessive love for opposite sex parent • “Super-ego” conscience develops • guilt feelings emerge

  5. Psychosocial Development Piaget • Pre-operational Stage 2-7 years • Readiness for school • ↑ physical activities & loud • vivid imagination and curious • Limited attention span • Time- recognizes past and future • Idiosyncratic system for organizing events • Egocentric • See the world via me • Fear of Bodily harm • Ban-aids keep everything in place!

  6. Piaget • Centering • one characteristic of an object • Concrete thought process • Literal • Magical thinking • Animism • Ascribe human characteristics to objects

  7. Developmental Skills 3 years • Walking, running and jumping well @ 36 • 900 word vocabulary/3-4 word sentence • Copy a circle and cross • Builds a tower of 9 blocks • Ride tricycle, walk stairs alternating feet • Pour from pitcher • Asks a lot of questions!!

  8. Developmental skills 4 years • 1,500 word vocabulary/4-5 word sentence • Can copy a square • Very noisy, talkative • Exaggerates stories • Loves Rhymes & songs • Names 3 colors • Hop on one foot • Catch a ball with both hands, throws overhand • ↑ Self-Care: Brushes teeth • Gets dressed ↑ Cooperation

  9. Developmental skills 5 year old • 2,100 word vocabulary/6-8 sentence • Copy diamond and triangle • Prints name • Draw person with 6 parts • Head, body, 2 arms & 2 legs • Talk constantly • Names 4 colors • Skip & Hop on alternating feet • Walks backwards • Hits a ball • Ties shoes & manage big zippers

  10. Socialization • ↑ Peer interaction & communication • Learn to relate to others • Increased cooperation & Sharing • Conform to expectations • Enjoy games with simple rules • PreSchool play- • dramatic & creative • Recognizes sociocultural • differences

  11. Developmental Tasks • Large and small muscle coordination • Uses initiative with a conscience • Becomes a participating family member • Settles into a daily routine • Dental & personal Hygiene • Sleep

  12. Health Concerns Safety • MVA # 1 cause of injury • Being struck by car is ↑ risk • Drowning and falls • Doesn’t fully understand danger • Magical thinking & cartoons minimize the danger • Integrate safety education • Puppets, songs, rhymes and games

  13. Health Concerns • ↑ Exposures to germs • Frequent colds and ear infections • Girls ↑ UTI’s • RT anatomy and poor hygiene • Stress hand washing and proper hygiene • No sharing of utensils, pencils or pens!

  14. Health Concerns Eyes • Visual acuity and depth perception fully developed by age 7 • Vision testing begun at 3 years • Objective screening using appropriate chart • 3 years- Allen cards-images • >4 years utilize E chart • indicate direction of E • 4 year 20/30-20/40 • 5 year 20/20-20/30

  15. Common Eye Disorders Strabismus • ↓ Coordination of EOM • Eyes are not aligned • One or both eyes can turn • In (Esotropia) • Out (Exotropia) • Up (Hypertropia) • Down (Hypotropia)

  16. Eye • Amblyopia- “Lazy Eye” • Only uses 1 eye for vision • No binocular vision • ↓ vision in the deviated eye • Distorted visual field • Can develop if strabismus is not treated early • If left untreated → Blindness in deviated eye • Therapy • Patch normal eye x 24 hours/day • Deviated eye must work • Surgery

  17. Hearing • Early detection = better outcome • Mandatory newborn hearing screenings • Routine Audiometry screening by age 3 • Various tones @ various frequencies • Standard volume (usually 20 db) • Normal hearing ranges from 10 → +15 • By age 5 hearing is fully developed

  18. Hearing Impairments Sensorineural (Nerve deafness) • Damage or malformation of structures of • inner ear/and or auditory nerve • Causes: • Infections: CMV, Rubella, Herpes, Meningitis • Heredity • Prematurity (Hypoxia) • Ototoxic meds • Hearing Loss is usually permanent • Therapy • Hearing Aids- worn ASAP to help facilitate language development • Cochlear implants = Controversy • American sign language ↑ communication

  19. Hearing Impairments Conductive • Middle hearing loss affected by • inflammation, obstruction or damage • OME/OM • Cerumen impaction • Perforation • Temporary & restores to prior hearing level • Therapy • Antibiotics for infection • Myringotomy & Tympanostomy tubes

  20. Biological Development School Age 6-12 years • Growth slows down • Weight: 5 - 6 lbs/year • Height: 1 - 2 inch/year • Average 6 year old • 46 lbs & 45 inches • Lose baby teeth @ 6 years. • First permanent teeth @ 6yrs (6 year molar) • “Ugly Duckling Stage” • Distorted facial proportions • Wide range of physical differences • Age 7 could look like 10-years or 5-years • Treat according to their age not appearance!

  21. Psychosocial Erickson- Industry vs Inferiority • Industry • Interest in doing work • Learn and solve problems • ↑ accomplishment RT ↑ motivation • Desire to master & do well in everything • If they don’t they will feel inferior. • Reinforce that they cannot do well in everything • Perseverance • Self-control • Compromise

  22. Psychosocial Juvenile Stage: 6-9 years • ↑ need for peers, friends • “Stage of Accomplishment” • Work concept = chores, schoolwork • Carry tasks to completion • ↑ skill and coordination • Develop + self esteem • Greater intellectual capacity • Role models = teachers/coaches • Manipulate environment • Reinforcement via grades with material reward • Move to external focus and socialization • Parents needed in times of stress

  23. Psychosocial Preadolescent Stage 9-12 years • Ability to love (same sex) = best friend • Pre Pubescence • 2 years before onset of puberty. • Puberty • Period of rapid growth • Development of primary and secondary sex characteristics • girls @ 12yrs • boys @ 13 ½ yrs )

  24. Psychosocial Freud - Latency period • Sexuality • plays less prominent role • Best friend same sex • Usually do not want to play with opposite sex (icky!)

  25. Cognitive Development • Concrete operations and Systematic reasoning: • Conservation • Change shape but still has same volume • Classification • Group according to attributes: 1st friend, 2nd friend • Seriation • Putting things in order or series: smallest →largest • Nesting • How one concept fits into another: puzzles • Reversibility • Opposite function: Addition & Subtraction • Use thought process to experience events and • actions & see things from another point of view.

  26. Developmental Skills 6 years • Period of Transition • Self centered • Normal to cheat at board games • Impulsive • ↑Activity RT ↑coordination • ↑Dexterity = drawing & writing

  27. Developmental Skills 7 years • Quiets down • Solitary play • Attentive • Sensitive listener • Modest (Need Privacy) • Companionable

  28. Developmental Skills 8 years • Fluctuating Behavior • ↑Graceful movements • ↑Interest in nature • Very self-critical

  29. Developmental Skills 9 years • ↑ Independence • Refined eye-hand control • Musical instruments • Best friend • Collections • Well organized • ↑Physical complaints with stress May have boy/girl relationship but won’t admit

  30. Development Skills 10 years • ↑ Stamina • Budgets time • ↑ Energy • Enjoys family activities • ↑ Appetite

  31. Development 11 years • Moody • Strict superego-conscience • Strong morals/values • Best behavior is away from home

  32. Development 12 years • ↑ Personality integration • ↑ Self discipline • ↑ Self control • Tactful • Mutual understanding with parents

  33. Developmental Tasks • ↓ Dependence on family • ↑ Neuromuscular skills • Must adjust to changes in body image • Develop positive attitude: • Multicultural • Social • Economic groups

  34. Health Problems • Generally not a sick age • Injury Prevention • Unintentional accidents/injury are the leading cause of death in any age group • MVC remains # 1 • No Seat belts, air bag injuries or hit as pedestrian/riding bike • Sports- • skateboards, bikes, all-terrain vehicles need helmets!! • Burns- • cooking, firecrackers, matches, candles Guns Access to loaded guns

  35. Attention Deficit Hyperactivity Disorder ADHD • Most common chronic behavioral disorder • Affects 6-9 % school age children • 40 % persist into adult • ADHD has 3 cardinal signs: • Inattention • Impulsiveness • Hyperactivity • Unable to self regulate & inhibit behaviors • ↓ Academic Performance • RT ↑ Distractible & ↓ Task completion • ↓ Self Esteem = ↓ Peer relationships • ↑ Risky Behavior = ↑ Substance Abuse & MVA Sequela: Conduct, Mood & Anxiety Disorders

  36. ADHD Etiology • Familial Tendency with 1st degree relative • Males 3x more than females • Environment • Toxins (Pb), meds, food allergies, lead, smoking, alcohol, sugar??? • ↓Neurotransmitters: ↓ NE, ↓ DA and ↓ 5-HT • NE - attention, impulsivity and control • DA - motivation/reward. • Needed for prioritizing and learning • 5-HT – mood, aggressive/impulsive behavior • Other neurological disorders can impact: • Fragile X, Turner or Klinefelter

  37. Diagnosis • ADHD is an all day all domain disorder • Based on report of parent, teacher and child • Onset by age 7 • symptoms persist for >6 months • Behavior Rating Scale • Have 6/9 characteristics listed in DSM-IV • Affect 2 - 3 areas; • school, home or social situations • Complete multidisciplinary evaluation Medical, developmental and behavioral history & R/O: Absence seizures, Learning Disability ↓Hearing

  38. Meds Psychostimulants (↑ DA and NE) • stimulates inhibitory CNS • 1st line medication ↑ efficacy = ↑ response • Methylphenidates (MPH): > 6 years • Concerta- 12H duration • Adderal XR- 10-12H duration • Ritalin- 4H Duration & Ritalin LA 8H duration • Daytrana patch- 12H duration (remove after 9H) • SE:√ Tics, ↓ appetite, sleep disruption, • H/A, slight ↑ BP & HR • Contraindications: • TIC disorders: Tourette Syndrome, • Anxiety Disorder • Risk for Abuse Potential

  39. Meds Non-stimulant • Inhibits NE (NE Reuptake Inhibitor) • Better for pts who can’t tolerate MPH • atomoxetine (Strattera) • 24H Duration • SE: N & V ↓appetite & wt. Tricyclic antidepressents TCA’s • Blocks re-uptake of NE and 5-HT • imipramine (Tofranil) nortryptyline (Pamelor) • SE: anticholinergic- dry mouth, • Urinary Retention, orthostatic ↓ BP

  40. Behavior Therapy • Education & Psychosocial • Consistent approach by family & school • Follow rules • Complete tasks • ↑ Self control • Positive Reinforcement • Time Out • Modify Environment • ↓ Distractions • Predictable • clearly define acceptable behavior & consequences • Diet Therapy?? Not EB (evidence Based) • Limit sugar, aspartame (NutraSweet), Chocolate, Cow’s milk & eggs

  41. Autism Spectrum Disorder ASD • Complex neurodevelopmental disorders • Core deficits in 3 areas: • Social Interaction • Verbal & nonverbal communication • Restricted interests, repetitive behaviors & resistant to change • Male 3-4x > Female • Genetic Predisposition: • Affects prenatal & postnatal brain development NO correlation with MMR vaccine • Related Disorders: Pervasive Developmental Disorder (PDD) Asperger’s Syndrome, Childhood Disintegrative Disorder (CDD) Rhett’s Syndrome

  42. ASD Clinical Signs • Inappropriate social behavior • Unable to maintain eye contact • Avoid body contact • Lack emotional reciprocity • Impaired expressive & receptive language skills • Delayed echolalia • Inability to sustain or initiate conversation • Repetitive behaviors: • Opening & closing doors, flipping light switches, • H2O play, shredding paper, prefer item movements & ritualistic behaviors • Insist on “sameness” • Self-Stimulatory behaviors: • Finger licking, hand flapping, body rocking, run in circles • Deep pressure stimulation-crawl into tight spaces • Self-injury RT ↟↟ Pain Threshold, aggressive behaviors • GI Symptoms- Constipation ➔Mega rectum

  43. Treatment • Developmental Screening • DDST, Modified Checklist for Autism in Toddlers (M-CHAT) • Childhood Autism Rating Scale (CARS) • Physical Exam • Hearing & Vision screening, Neuro, EEG, Metabolic studies (Pb), Genetic testing • Multidisciplinary approach • Early intervention programs • Highly structured and intensive behavior modification programs; • Promote positive reinforcement • Increase social awareness of others • Increase verbal communication skills • Decrease unacceptable behavior • Use brief, concrete communication • Minimal holding & eye contact to avoid outbursts • Gradually introduce new situations • Medications Atypical antipsychotic- Risperidone ↡ behavioral symptoms only

  44. Scoliosis • Abnormal lateral curvature • >10% of the spine • Severe type can ↓ thoracic capacity • ↑ risk for osteopenia • Develops in preadolescent growth spurt • Higher risk in females 85%

  45. Functional/Idiopathic/Secondary • Most common • Rapid growth & Poor posture • Unequal leg Therapy Exercises PT for posture Shoe Lifts

  46. Structural/Congenital/Neuromuscular • Muscle or bone deformity • congenital or result of neuromuscular disorders • S shaped curved with vertebral rotation • Asymmetric • thoracic cavity • scapula, breasts, shoulders and hips • ↑ deformity during periods of growth

  47. Therapy Depends on degree of curve • 10-20 degree • observe and follow-up X-Rays q 4-6months • Exercises and improving posture • >20-40 degrees Milwaukee brace-worn 23 hours/day • ↓ compliance (15%) • ↓ comfort and body image • Prevents disease progression • will not resolve current distortion.

  48. Therapy • Boston Brace- • low profile (lowest angle) • Thoracolumbar -sacral orthosis • Most widely used • ↑ 61 % compliance • Providence Brace- -New shows promise used only at night!!!! ↑↑ compliance

  49. Therapy Surgery- curvature >40% • Harrington Rod- • internal spinal fixation- “flat back” • post-op immobilization required • Lugue Segmental System- • flexible wires threaded through spine- • no post-op immobilization required, • ↑ risk for nerve damage • Spinal fusion for severe scoliosis • Iliac bone graft

  50. Post-op Care • Log rolling • Neurovascular checks • Pain management • Skin care • Urinary retention • Mesenteric Artery Syndrome- • Shift of abdominal organs = Abdominal distension/emesis

More Related