Pediatric nursing chapter 6 Flashcards
GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT
Although highly individualized, growth and development follow an orderly pattern characterized by periods of rapid growth and plateaus (spurts and lulls):
Cephalocaudal
Cephalocaudal—starts at the head and moves downward
Example: The child can control his or her head and neck before it can control his or her arms and legs.
Proximodistal
Proximodistal—starts in the center and processes to the periphery
Example: Movement and control of the trunk section of the body occurs before movement and control of the arms.
Differentiation
Differentiation—simple to complex progression of achievement of developmental milestones
Example: The child learns to crawl before learning to walk.
Developmental tasks
Variation at different ages is based on specific body structure and organ growth.
Developmental tasks are the sets of skills and competencies that are unique to each developmental stage. Certain tasks must be mastered for the child to progress to the next level. Developmental tasks for each stage are detailed in Table 6–1.
Childhood is divided into the following five stages:
Infant—birth to 1 year Toddler—1 to 3 years Preschool—3 to 6 years School-age—6 to 12 years Adolescence—12 to 18 years
Failure to thrive
Failure to grow and develop at an expected rate can mean that a child is failing to thrive. The diagnosis of failure to thrive (FTT) is given to children who fall below the 5th percentile ranges on height and weight charts. For infants, it usually presents first with an absence of weight gain or weight loss (Price & Gwin, 2012). Then a drop in height is followed by a drop in head circumference. FTT be caused by organic or nonorganic causes, which can contribute to developmental delays in the child.
Reflexes
Nurses need to know normal infant reflexes and recognize when they are not present. Reflexes that remain can be a sign of growth and developmental issues and delays (Beckett & Taylor, 2016). A few of the most common reflexes to watch for are:
Tonic neck/fencing reflex—disappears around 4–6 months
Moro/startle reflex—disappears around 4–6 months
Babinski’s—disappears by 1 year of age
Family centered care
As part of family-centered care, nurses need to adapt their care and nursing interventions to the child’s stage of growth and development. They will need to explain what is happening to a child in language and on a developmental level the family can understand. A child’s caretaker should always be included in the child’s care and interventions. Nurses need to remember that we are not caring for just a child, but for the entire family unit
Developmental milestones; age, fine motor, gross motor
2-3 months
2–3 months Grasps toys, can open and close hands Raises head and chest when lying on stomach
Eyes follow object to midline Supports upper body with arms when lying on stomach
Blows bubbles Stretches legs out and kicks when lying on stomach or back
6-8 months
6–8 months Bangs objects on table Can roll from side to side
Can transfer objects from hand to hand Can sit unsupported by 7 or 8 months
Start of pincer grasp Supports whole weight on legs
1 year
1 year Can hold crayon, may mark on paper Pulls self up to stand
Walks holding on to furniture
Begins to use objects correctly May walk two or three steps independently
2-3 years
Learning to dress self Jumps
Kicks ball
Can draw simple shapes (e.g., a circle) Learning to pedal tricycle
4-5 years
4–5 years Dresses independently Goes up and down stairs independently
Uses scissors Throws a ball overhand
Learning to tie shoes Hops on one foot
Brushes teeth
PSYCHOINTELLECTUAL DEVELOPMENT
Jean Piaget
The key theorist within cognitive development is Jean Piaget, a Swiss child psychologist who lived from 1896 to 1980. Piaget identified the following characteristics of cognitive development:
Development is a sequential and orderly process, moving from stages that are relatively simple to more complex (Table 6–3).
Cognitive acts occur as the child adapts to the surrounding environment.
The child’s experience with the environment naturally encourages growth and maturation.
The child must accommodate to new or complex problems by drawing on past experiences.
There can be overlap between the child’s age and stage of development. Each stage does not start and end at exactly the same age for each child.
Overview of Growth and Development by Age
Infant: age birth to 1 year Weight: •Doubles by 5–6 months •Triples by 1 year Height: •Increase of 1 foot by 1 year of age Teeth: •Erupt by 6 months •Has six to eight deciduous teeth by 1 year of age
Toddler: age 1–3 years
Weight:
•Gains 8 oz or more a month from 1–2 years
•Gains 3–5 lb a year from 2–3 years of age
Height:
•From 1 to 2 years of age, grows 3–5 inches
•From 2 to 3 years of age, grows 2–2.5 inches per year
Teeth:
•By 3 years of age, has 20 deciduous teeth
Preschool: age 3–6 years
Weight:
•Gains 3–5 lb a year
Height:
•Grows 1.5–2.5 inches a year
School-age: age 6–12 years
Weight:
•Gains 3–5 lb a year
Height:
•Grows 1.5–2.5 inches a year
Adolescence: age 12–18 years
Puberty usually will last somewhere around 2–5 years.)
Variations
(Puberty usually will last somewhere around 2–5 years.) Weight: The gain that occurs during puberty years
•Girls: Gain 15–55 pounds
•Boys: Gain 15–65 pounds
Height: The growth that occurs during puberty years
•Girls: 2–8 inches
Growth occurs during puberty. Girls usually stop growing taller 2 years after the start of their menstrual periods.
•Boys: 4.5–12 inches
Key Stages of Piaget’s Theory
Piaget’s theory of cognitive development defines developmental stages as follows:
Sensorimotor—birth to 2 years: The child learns through motor and reflex actions, and begins to understand that he or she is separate from the environment and from others.
Stage 1: Reflexes—birth to 2 months
The child understands the environment purely through inborn reflexes such as sucking.
Stage 2: Primary circular reactions—1 to 4 months
The child begins to coordinate reflexes and sensations. For example, he or she may find the thumb by accident, find pleasure in sucking it, then later repeat sucking it for pleasure.
Stage 3: Secondary circular reactions—4 to 8 months
The child focuses on his or her environment and begins to repeat actions that will trigger a response. For example, the child puts a toy rattle in his or her mouth.
Stage 4: Coordination of secondary schemata—8 to 12 months
To achieve a desired effect, the child will repeat the action, such as repeatedly shaking a rattle to make the sound.
Stage 5: Tertiary circular reactions—12 to 18 months
The child begins trial-and-error approaches: for example, making a sound to see whether it will get attention from the caregiver.
Stage 6: Inventions of new means/mental combinations—18 to 24 months
The child learns that objects and symbols represent events, such as that the appearance of a bowl and spoon means dinner is coming.
Preoperational—2 to 7 years
Application of language
Use of symbols to represent objects
Ability to think about things and events that are not immediately present
Oriented to the present; difficulty conceptualizing time
Thinking influenced by fantasy
Teaching must account for the child’s vivid fantasies and undeveloped sense of time
Concrete operational—7 to 11 years
Shows increase in accommodation skills
Develops an ability to think abstractly and to make rational judgments about concrete or observable phenomena
In teaching, give the opportunity to ask questions and explain things back to the nurse. This allows the child to mentally manipulate information.
Formal operational—11 years to adulthood
This stage brings cognition to its final form.
The individual no longer requires concrete objects to make rational judgments.
Individuals are capable of hypothetical and deductive reasoning.
Teaching for adolescents may be wide ranging because they can consider many possibilities from several perspectives.
Object Permanence
Object permanence is one of the most important developments in the sensorimotor stage. The child now knows that an object exists even when it cannot be seen or heard. This is a wonderful time to introduce the game peekaboo; by the end of this stage the child will understand that you did not disappear just because your hands are over your face.
The Procedure From the Child’s Perspectiv
In this stage the child is egocentric, or unable to take the view of others. While the child is hospitalized, the nurse should introduce role-playing and medical play therapy. The child needs to understand the procedure from his or her own perspective, such as by touching and playing with the equipment before its use. In addition, language is not fully developed; therefore, teaching through discussion will not be effective.
Formal Operational
The child in this stage begins to consider that his or her actions will result in possible consequences. It is important to remember when caring for a patient in this stage that you should explain reasons for the hospitalization, the disease process, and possible outcomes, especially those related to the patient’s behavior.
PSYCHOSEXUAL DEVELOPMENT
Freud, a physician from Vienna, Austria, who lived from 1856 to 1939, proposed a theory of psychosexual development and an approach called psychoanalysis to explore the unconscious mind. His psychosexual theory is based on the belief that experiences from our early childhood form the unconscious motivation for the things we do later in life as adults. The theory proposes that sexual energy is stronger in certain parts of the body at specific ages. Sexual feelings are present in different forms depending on age. Fixation of development can occur at a specific stage if needs are not met or conflicts are not resolved. Freud’s theory views the personality as consisting of three parts: the id, the ego, and the superego
Id
Id—the basic sexual energy that is present at birth and drives the seeking of pleasure
Ego
Ego—the realistic part of a person, which develops during infancy and searches for acceptable methods to meet impulses