Exam 1: Growth & Development Flashcards
Growth (Definition and 5)
Increase in physical size
- Children grow by either length and height (linear) or weight
- When measuring children under 2, measure length from head to heel to while child is laying down
- Measure weight using scale
- Growth is cepholocaudal and proximal
- Up to 3 years old, plot growth on a chart that includes head circumference
Neurological Growth
- Most rapid period of growth is in utero (imp to look at mother’s prenatal health because of this)
- Prefrontal cortex continues to develop until ~25 years old
Development
Increase in capacity or function
- One part of development may take precedence over another part, Ex: toddlers; gross motor skills take precedence over language skills
Cephocaudal
From head to toe
Proximodistal
Growth from inside out
Body Mass Index (5 and calculations)
- Assess underweight, overweight and at risk for overweight.
- Used for ages 2 to 20 years of age
- Is gender and age specific
- BMI decreases during preschool years then increases to adulthood
- Doesn’t account for muscle mass composition
( weight in lbs ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ x703 (height in in.) x (height in in.) (weight in kg) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ x10,000 (height in cm) x (height in cm)
Weight status categories (4)
- Underweight: less than 5th percentile
- Healthy weight: 5th percentile to less than 85th percentile
- Overweight: 85th to less than 95th percentile
- Obese: equal to or greater than 95th percentile
Why is BMI for age a useful tool?
- It provides a reference that can be useful beyond puberty
- It compares well to lab measurements of body fat
- It can be used to track body size throughout life.
Infancy (birth to 1 month and first 6 months) Weight
Birth to 1 month: 2700 – 4000g (6-9lbs) gains
First 6 months: About 5-7oz./wk.
Infancy (birth to 1 month and first 6 months) Length
Birth to 1 month: 48-53 cm (19-21in.) increases
First 6 months:2.5cm/mth
Infancy (birth to 1 month and first 6 months) Head Circumference
Birth to 1 month: 33-35cm increases
2cm per month for first 3 months, then 1 cm/month until 6 months of age
Infancy Chest Circumference
2-3cm less than head circumference
- Important: up to 1 year of age, their chest circumference should be less than their head circumference
- If a newborn had the same head and chest circumference, this could mean their head is not growing (micromegaly)
Newborn (Birth-1 Month) Gross Motor Skills
may lift head if prone
*Infants should sleep on their backs to avoid SID, but they should be put on their belly with supervision to develop certain muscles
Newborn (Birth-1 Month) Fine Motor Skills
Holds hand in fist
Newborn (Birth-1 Month) Sensory
prefers faces, follows line of vision
- To check line of vision, do it with the mom, and have the mom hold the baby close to her and go back and forth to see if the baby follows the mom
When does the most rapid time of growth occur?
Before 6 months (especially at 2-4 months)
Fontanels and Sutures
Make sure fontanels and sutures are present in the newborn
- Posterior fontanel closes between 6-8 weeks
- Anterior fontanel closes around 18 months
- When palpating anterior fontanel, asses to make sure that it is there, because if there is pre-mature closure then there is nowhere for the brain to grow
- If it is compressed inwards (sunken fontanel) it is a sign of dehydration
- Pulsating (as long as it is flat) is normal
- Full bulging fontanel could be ICP or over-hydration
Rooting Reflex
Brush the infant’s cheek and the infant should turn towards the finger
- This reflex is normally used for feeding
- Usually disappears around 3-4 months but can be present until up to 12 months
Palmar Grasp Reflex
Put finger in the baby’s hand and the baby should grasp on to it
- Starts to disappear around 3 months of age
Plantar Grasp Reflex
Put thumb up the middle of the foot and you want to see that they take their toes and try to put it around the thumb
- Starts to disappear around 8 months of age
Babinski Reflex
- Want to see this reflex in children up to 18 months of age
- The toes flare as your draw an upside down C with thumb on bottom of the foot
Moro Reflex
- Pick up child and drop it down and the child should put arms up and out
- Can also just push down on the mattress
- Disappears around 4 months of age
- Will usually cry after testing this reflex
Tonic Neck Reflex
“Fencing reflex”
- Initiate it by turning the infant’s head to the side and then they will do this reflex
- This gets them prepared for gross motor skill of turning on to their belly
- Disappears no later than 6 months of age
Dance Reflex
Put on foot on a hard surface and the other foot should come up and vice versa
- Disappears around 4-8 weeks of age
Crawl Reflex
Disappears around 6 weeks
Newborn placed on abdomen and baby flexes legs under him and starts to crawl
Infant (birth to 1 month) bottle nutrition
60 to 90 cc every 2-3 hours
- There are 30cc in 1oz, so a glass of juice would be 240cc
Infant (birth to 1 month) breast feeding nutrition
every 2-3 hours on demand
-Want baby to have about 6-8 wet diapers a day, which is an indication that the baby is hydrated and breastfeeding adequately
2-4 Months Infant Growth
Same as newborn and posterior fontanels close
2-4 Months Infant Gross Motor Skills
Decrease head lag, sitting
- When you try and sit a baby up, their head goes backwards, but this is in a newborn and there is a decrease in this around 2-4 months of age
- Baby won’t be able to sit unsupported, but they may sit leaning on their hands
2-4 Months Infant Fine Motor Skills
holds rattle, loves to look and play with fingers, likes to bring object to mouth
- Give baby time to play with fingers to assess their fine motor if the baby has a developmental delay in some way
2-4 Months Infant Sensory
Turns head to voices
2-4 Months Infant Nutrition
feedings increasing to 90-120cc every 3-4 hours
- Decreased frequency of breast feeding, so also may occur 3-4 hours
2-4 Months Infant Language
“coo,” giggle, or laugh
*If baby isn’t making sounds, it could be an indication of a hearing deficit/loss
4-6 Months Infant Growth
At 6 months, birth weight doubles
4-6 Months Infant Gross Motor Skills
No head lag, rolling over, crawling
- In terms of rolling, baby will roll from BELLY TO BACK FIRST, around 4 months of age
- From back to abdomen occurs around 6 months of age
- Baby will also begin to crawl, which is when they move backwards
4-6 Months Infant Fine Motor Skills
Palmer grasp, manipulates objects
- At this time, baby should be reaching for objects; if you hold an object out, they should reach for it (whether they grab it is not important) and if they are not reaching for it then they may need a follow up
- When they have objects in their hands, they like to manipulate the object
4-6 Months Infant Nutrition
Baby food, weaning
- Babies are starting to eat solids around 6 months of age, usually will be rice cereals
- Rice cereals= easiest to digest and less chance of developing an allergic reaction
- Should wait between 4-7 days before introducing foods
- *This will allow you to tell what causes an allergic reaction if one occurs
- Starts to decrease calories from bottle or breast milk because they are getting more nutrition from solid foods
- Teeth begin erupting by 6 months (lower incisors first)
- From time the baby is born you start oral hygiene; may be taking gauze or wash clothes and clean the gums
- Babies should not get bottle feedings before bed
- *May lead to milk bottle carries
- Never give juice in a bottle
- Never mix foods in a bottle
- Give foods alone to learn new tastes and textures
- Cereal first – rice – barely – oatmeal
4-6 Months Infant Sensory
Separation Anxiety
– Separation anxiety from when the baby is separated from their mom; they will begin to cry which is normal
- At this age, babies love to smile at themselves in a mirror and mirrors are great toys for them
6-8 Months Growth
Decreasing rate
6-8 Months Gross Motor
SITTING
- Can sit totally unsupported/without hands
- May start getting up on hands and knees to get ready for creeping
6-8 Months Fine Motor
Transfers objects, pincer grasps, bangs objects
- Starting to develop a pincer grasp; will be a crude pincer grasp at this stage
- Need to be careful that baby doesn’t put things in their mouth and choke since they are now able to start grasping things (choking is a big concern at this age)
6-8 Months Sensory
Stranger anxiety, responds to names
- Have separation and stranger anxiety
- Stranger anxiety: not liking to interact with strangers even if the mother is holding the baby
- If mother leaves then it’s best for her to leave something that smells like the mother/familiar person (needs transitional object) so the baby knows she is coming back
6-8 Months Nutrition
fruits and vegetables, juice from cup
*Best juice to have is apple juice, but it’s so high in sugar that it should be cut with water
6-8 Months Language
“Da-Da”
8-10 Months Growth
Same as before (decreasing) since majority of growth is in first 6 months
8-10 Months Gross Motor
Creeping, pulls to standing, sits alone
*Can sit totally unsupported and can pull self to standing but doesn’t know how to get back down
8-10 Months Fine Motor
Pincer grasp, small objects
- Refined pincer grasp, so be even more careful about choking
8-10 Months Sensory
Object permanence
- Knowing something is there even if they don’t see it
- Understanding that objects continue to exist even when they cannot be observed
8-10 Months Nutrition
Finger foods (ex: Cheerios)
8-10 Months Language
understands “no”
- Can start to do some simple disciplining
- Don’t use no for everything; use it for things that are dangerous to to baby such as touching a socket
10-12 Months Growth
- Now, head circumference is equal to chest circumference
- Birth weight should triple
- Average of 6-18 teeth
10-12 Months Gross Motor
stands, sits from standing, walks holding on to things (ex: furniture)
- Can get down once they stand up
- Beginning to learn how to walk
10-12 Months Fine Motor
holds crayon, builds tower
- Starts to wave goodbye (waves goodbye background because that’s what they see)
10-12 Months Sensory
“Peek a boo” and patty cake
10-12 Months Nutrition
Feeds self with spoon, soft table food; can introduce whole milk or can continue breastfeeding (brain needs fat)
10-12 Months Language
3-5 words, understands “ma ma” and “da da”
- More comprehension because they understand the words as well
Infancy (birth to 1 year) Sleep (5)
- Newborns (birth to one month) sleep most of the time
- Larger infants sleep longer
- Sleeping on side or back consists of 50% REM
- 3-4 months of age develop nocturnal sleep
- Sleep problems mostly learned
Piaget Sensorimotor Stage
Birth-2 years
- Differentiates self from other objects
- Recognizes self as an agent of action and begins to act intentionally (ex: shakes a rattle to make noise)
- Achieves object permanence: realizes things continue to exist even when no longer present in the senses
- Children learn entirely through the movements they make and the sensations that result. They learn:
1. That they exist separately from the objects and people around them
2. They can cause things to happen
3. That things continue to exist even when they can’t see them
Piaget Preoperational Stage
2-7 years old
Learns to use language and once they acquire language, they are able to use symbols (such as words or pictures) to represent objects. Their thinking is still very egocentric though – they assume that everyone else sees things from the same viewpoint as they do.
They are able to understand concepts like counting, classifying according to similarity, and past-present-future but generally they are still focused primarily on the present and on the concrete, rather than abstract
- They can group things together, but generally only in one category such as by color regardless of shape
- Magical Thinking: thinking their mind can control what happened and they are responsible for certain things out of their control (occurs from 3-5 years old)
- Ex: thinking that they are in the hospital because they were bad
Piaget Concrete Operational Stage
7-11 years old
At this stage, children are able to see things from different points of view and imagine events that occur outside their own lives. Some organized, logical thought processes are now evident and they are able to:
- order objects by size, color, gradient, etc.
- understand that if 3+4=7 then 7-4=3
- understand that red square can belong to both the “red” category and the “Square” category
- understand that a short wide cup can hold the same amount of liquid as a tall thin cup
- CONSERVATION
- REVERSIBILITY
- CLASSIFICATION
*Thinking still tends to be tied to concrete reality
- Achieves conservation of number @ age 6
- Achieves conservation of mass @ age 7
- Achieves conservation of weight @ age 9
Piaget Formal Operational Stage
11+ years
Around the onset of puberty, children are able to reason in much more abstract ways and to test hypotheses using systematic logic.
- There is a much greater focus on possibilities and on ideological issues
- Becomes concerned with the hypothetical, the future, and ideological problems
Erikson’s Trust vs. Mistrust
Infancy (birth to 18 months)
- Infant develops sense of trust when caregivers provide reliability, care, and affection. A lack of this will lead to mistrust
- Needs continuity/consistency of care
IMPORTANT EVETS: FEEDING
- when they cry, someone should pick them up
- infant develops trust through feeding and routines
Autonomy vs Shame and Doubt
Early childhood (2 to 3 years)
Children need to develop a sense of personal control over physical skills and a sense of independence. Success leads to feelings of autonomy, failure results in feelings of shame and doubt.
IMPORTANT EVENTS: TOILET TRAINING
- Increased ability to control bodies and environment
- Holding on/letting go
- Needs rituals and consistent limits to be set
- Reading a book, taking a bath, going to bed, etc. type rituals at every night
- Nighttime rituals are important for security
- Consistent limit setting is important
- Toddlers like to say “No”
- Need constant limit setting
IMPORTANT EVENTS: TOILET TRAINING
Toddlers (1-3 years) Growth
- Growth Slows down
- Birth weight has quadrupled by 2 years of age
- Reach ½ adult height
- Chest circumference is greater than head circumference
- Elongation of legs (more growth is taking place in legs)
- Pot bellied appearance
- Anterior fontanel closes around 18 months
Toddlers (1-3 years) Gross Motor
Locomotion
- Running, jumping, falling, etc. (risk for injuries because of this)
Toddlers (1-3 years) Fine Motor
Scribbles, tower of blocks
- Can copy a circle if someone else has drawn it
Toddlers (1-3 years) Nutrition
Physiological anorexia; intake decreases, may want to eat the same thing over and over
- Limit milk intake 16-24 oz per day
* *If they have too much milk it will fill them up and it can interfere with ability to absorb iron
Toddlers (1-3 years) Language
Increase comprehension, not too much increase in vocabulary
- Can begin to speak in multi-vocab language
- Speech is egocentric
Toddlers (1-3 years) Play
Parallel play
- Kids play next to each other but won’t engage with each other
Toddlers (1-3 years) Toilet Training
- This is a very major task
- Physiologically ready for toilet training around 18-24 months
- If a child is not ready for toilet training, then it can cause developmental delays if the parent keeps pushing for it, so the parent should stop and try again later
- Successful bowel training comes before successful bladder training
*CHILD SHOULD NOT HAVE ENURESIS PAST 5 YEARS OLD, but before then it is normal
Preoperational during toddler years
- Understanding cause and effect
- *Ex: when putting light switch up, light goes on
- Object permanence concept is further developed
- *Knowing care provider is around even if they aren’t in the same room
- Less fearful of strangers when parents are around
- Imitation
- Begins to have a concept of time
- Try to get children in hospital involved in some of the choices that are made, good for their development
Pre-School (3-5 years) Growth
Weight slows down, growth mostly in long bones
Pre-school (3-5 years) Gross Motor
More coordinated
Pre-school (3-5 years) Fine Motor
scissors, draws circle, square, 6 part person, buttons cloths
Pre-school (3-5 years) Nutrition
3 meals, 2 snacks
Pre-school (3-5 years) Language
- 2000 words, complete sentences
- Increased vocabulary and talk in complete sentences
- Takes everything literally; can’t separate reality from fantasy, so be careful what you say!
At 3 years: mostly talk to themselves, toys and pets
At 4 years: words to transmit information other than owns needs and feelings
- Grasp of meaning literal
Pre-school (3-5 years) Sleep
- Ritualistic
2. May need transitional objects
Pre-school (3-5 years) Temperament
Gain of control of strong inner impulses
Pre-school (3-5 years) Body Image
Modesty and fear of mutilation
- Use correct terminology
- Developing a sense of modesty and fear of mutilation
- This can be extreme when in hospital, child getting tonsils out may be afraid they won’t be able to talk after the operation
- Reassure child nothing is going to happen to them
Pre-School (3-5 years) Play (4)
- Associative play
- Dramatic play
- Most important for children who are hospitalized
- Cooperative play
- Solitary play
Initiative vs. Guilt
Pre school 3-5 years old
IMPORTANT EVENTS: EXPLORATION
Children need to begin asserting control and power over the environment. Success in this stage leads to a sense of purpose. Children who try to exert too much power experience disapproval, resulting in a sense of guilt
- Children develop this by having satisfaction with their accomplishments
- Pre-schooler can develop sense of initiative by carrying their bags, help out with doing chores, involved in preparing meals, etc.
- Satisfaction in Accomplishments
School age (6-12 years) Growth (4)
- Last period in which boy and girls in close proportions
- *Girls begin to grow before boys
- There is an increase in heigh and decrease in weight
- *May look tall and thin
- Increase muscle development but strength and coordination isn’t developing as quickly
- *May try to do things they think they have the strength for but they don’t
- Jaw changes
- *By 12, all baby teeth should be gone and adult teeth should be in
School age (6-12 years) Gross Motor
Activities requiring balance and strength
School age (6-12 years) Nutrition
Food pyramid, peer pressure, fast food
*Begin to see anorexia and bulimia as peer influences begin
School age (6-12 years) Sleep
pre-adolescent growth spurt
School age (6-12 years) Social
school, peers, body image
School age (6-12 years) Piaget theory
Concrete Operational
conservation, reversibility, classification
Conservation
Theory that matter doesn’t change when form is altered
*Helps children understand science
Part of concrete operational for 6-12 y/o
Reversibility
Helps children understand math skills and is important to help kids get back home after walking somewhere
Part of concrete operational for 6-12 y/o
Classification
Grouping things by common features
Part of concrete operational for 6-12 y/o
Industry vs. Inferiority
6-11 years old
IMPORTANT EVENTS: SCHOOL
Children need to cope with new social and academic demands. Success leads to a sense of competence, while failure results in feelings of inferiority
Early adolescence
12-14 years old
Mid adolescence
15-17 years old
*Most turbulent time
Late adolescence
17-21 years old
Adolescence Growth
Identified using tanner stages (sexual maturity)
Girls first tanner stage
Thelarche - breast development
* Occurs about 1 year after growth spurt
Girls second tanner stage
Adrenarche - pubic hair
* About 2-6 months after breast development
Girls third tanner stage
Menarche – menses
- Usually around 2 years after thelarche (~12.5 years old)
- May take a year to regulate
- After menses, growth only occurs for 2-2.5 years more and it is a minimal amount of growth
When to worry about delayed development in females
if development hasn’t occurred before 13 or if there is no menses 4 years after breast development
*When looking at tanner stages in females, look at both breast development and the disbursement of pubic hair
Female growth spurt occurs
Around 9 and as late as 13.5
* Average age is 10
Boys growth spurt occurs
9 ½ to 13 ½ yrs
- Average is 13 y/o
- Boys continue to grow until ~25 y/o
Males 1st tanner stage
Testicular enlargement, which changes in scrotum (thinning and reddening of scrotum) and begin to have pubic hair
* Early puberty
Males 2nd tanner stage
Voice changes, developing facial hair, developing auxiliary hair, increased acne, increase in muscle mass, and penile enlargement
* Mid puberty
Males 3rd tanner stage
increase in auxiliary and facial hair and first ejaculation occurs
* Late puberty
When to be worried about male development?
Considered to have delayed puberty if there are none of the stages before 14 years old
Adolescents Diet
Need increased in protein, iron, calcium
*Growth spurts take a lot of energy
Identity vs. Role Confusion
Adolescence (12-18 years)
IMPORTANT EVENTS: SOCIAL RELATIONSHIPS
Teens need to develop a sense of self and personal identity. Success leads to an ability to stay true to yourself, while failure leads to role confusion and a weak sense of self
Here you can see pieces of the prior stages
**Ex: if infant didn’t develop trust from mother, they will not be able to trust others
Piaget’s Adolescent Stage
Formal Operational
The ability to have abstract thinking, inductive and deductive reasoning, the decision making ability increases, they understand consequences but they do not think things can happen to them
** Not thinking something will happen to them is due to the not fully developed frontal lobe, increasing risky behaviors
Health Concerns in Adolescents (8)
- Psychosocial adjustment
- Intentional and non- intentional injury
- *Homicide/Suicide
- Eating disorder
- Sexual behaviors
- Substance abuse
- Depression and suicide
- Physical, sexual, or emotional abuse
- School and learning problems
Signs of suicidal ideation
struggling in school, being apathetic about the future, giving things away
