Parts I and II: Pediatric Growth & Development Health Maintenance & Restoration

1. Parts I and II:Pediatric Growth & DevelopmentHealth Maintenance & Restoration Fall 2010 Susan Beggs, RN MSN CPN

2. Growth and Development

3. Directional paths of growth & development • Cephalocaudal • Proximo-distal • Prehensile

4. Concepts of growth and development • Psychosocial development: Erikson • Cognitive development: Piaget • Moral development: Kohlberg • Sexual development: Freud

5. Improving child health by having knowledge of definitions • “growth” • “development” • “maturation” • “learning”

6. Principles of Growth & Development • occur in an orderly sequence • occur continuously but rates vary- growth spurts • highly individualized rate from child to child • vary @ different ages for specific structures • process involving the whole child

7. Factors which influence growth and development • Genetics • Environment • Culture • Nutrition • Health Status • Family

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

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

10. Examples of environmental influences on a child • family composition • family position in society • family socioeconomic status • knowledge of the family • availability of healthy diets • housing • diseases present in family and child

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

12. Nutritional influences • Begins during the prenatal period • LBW (low birth weight) can result from poor prenatal nutrition • Socio-economics may impact growth as well

13. Health status of the child • Certain diseases may impact g & d • Endocrine and cardiac status included here

14. Family relationships (environmental) and the impact on child growth and development • Critical in growth and development, esp. emotional growth • Intellectual growth must be included here as well • Chronic illness can be combated with a loving environment and close family relationships

15. Patterns of growth • Rapid pace from birth to 2 yrs • Slower pace from 2 yr-puberty • Rapid pace from puberty to 15 yrs • Sharp decline from 16 -24 yrs when full adult size is reached

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

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

18. Tanner staging • Sexual Maturity Rating (SMR) • Essential for nurses to assess in adolescents • SMR greater reliability for physical development than chronological age

19. Girls: Stage 1: preadolescence Stage 2: breast buds; sparse public hair Stage 3: breast and areola enlarge; pubic hair thickens, curls Stage 4: areola and papilla form; typical female triangle in pubis, thickening hair Stage 5: mature, nipple projects; adult female triangle, spreads to medial surface of thighs Boys Stage 1: no pubic hair; all structures preadolescence Stage 2: pubic hair, slight enlargement of penis and scrotum Stage 3: pubic hair, curls, penis and testes larger Stage 4: less pubic hair than adult, but thickening; penis larger, scrotum darker Stage 4: pubic hair, adult distribution; penis and testes adult in size Tanner staging

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

21. Functions of play • Physical growth and development • Cognitive development • Emotional development • Social awareness • Moral development

22. Social aspects of play • Solitary play • Parallel Play • Associative play • Cooperative Play • Onlooker Play

23. Types of Play • Dramatic play • Familiarization play

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

25. Jealousy • A combination of anger, fear, and love • A child 1st loves something, counts it as his own and 2nd perceives that it has been taken away or interfered with • The loss may be real or perceived, ie., sibling rivalry

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

27. Part II: Health Maintenance and Restoration

28. Dental needs of the child from infancy to adolescence • Caries in infancy due to nurse for long periods of time • See text for the sequence of eruption of teeth • Braces may be indicated at the time of puberty

29. Levels of Preventive Health Maintenance Activities Primary Secondary Tertiary

30. Specific recommendations by APA: Minor infections without fever are not contraindication If reaction occurs, consult dr. before next immunization Immunizations

31. Barriers to immunizations • Complexity of the health care system • Expense of immunization services • Parental misconceptions • Inaccurate record keeping by parents • Reluctance of health care worker • Lack of public awareness

32. 4mos-6 yrs of age: DTaP (4 doses) IPV (3 doses) HepB (3 doses) MMR (@ 12 months) PCV (1 dose) 7-18 yrs of age Td (every 10 years after initial immunizations) IPV (not rec. if >18 yrs of age) Immunization schedules

33. Nurses responsibilites with immunizations Know the action of the vaccine Careful history of patient Aspirate when injecting Educate parents (schedule, side effects) Proper documentation

34. Assess for reaction 15-30 min after injection Epinephrine 1:1000 available Check immunization records with each visit Parent teaching: fever, or other symptoms Don't Forget!

35. Safety risks to developmental levels Infant Toddler Preschool School age Adolescent

36. Major childhood prevention measures Aspiration MVA Burns Drowning Bodily injury/fractures

37. Leading cause of fatal injury under 1 year of age Prevention: Inspection of toys, small parts Out of reach objects Selective elimination of certain foods Proper posturing of the infant for feeding Pacifier with one piece construction Aspiration

38. Vehicular risk greatest when child improperly restrained Pedestrian Prevention Motor Vehicle Accidents

39. Children are inquisitive Become able to climb and explore Prevention of household injury: Burns

40. Child does not recognize danger of H2O Unaware of inability to breath underwater No conception of water depth Hypoxia greatest concern Prevention Drowning

41. Still developing sense of balance Easily distracted from tasks Prevention: Bodily injury/fractures

42. Stats on drug poisonings

43. Common in early childhood (2 yrs) 75% poisons are ingested Major reason for poisoning: Poisonings

44. Sources of poison: Cosmetics Household cleaners Plants Drugs Insecticides Gasoline Household items Poisonings

45. Therapeutic interventions In every instance, medical eval is necessary Call poison control center 1st Remove child from exposure Identify poison Prevent absorption Poisonings, cont

46. Life threatening More likely to drop out of school Become disabled Disturbed brain and nervous system function Prevent child from full potential Implications of lead poisoning

47. Pathophysiology of lead poisoning System assessments Therapeutic Interventions Lead poisoning, cont

48. Criteria for treatment of lead poisoning < 9 not lead poisoned 10-14: prescreen 15-19: nutritional and educational interventions 20-44: environmental eval and medication 45-69: chelation therapy >70: medical emergency

49. Systems affected by lead • CNS: brain and nerve damage, retardation; headaches • Cognitive changes: behavioral problems; learning disabilities • M/S: slowed growth patterns; ataxia • Blood: reduction of heme (hemoglobin) leading to anemia • GI: vomiting, anorexia, colic, abd. pain

50. Make environment lead-free Inspect buildings >25 years of age Areas painted with lead paint should be covered with plywood or linoleum Educate the parents Follow up testing for lead levels Screening all school age children (required in some states) Prevention is the key!