Peds exam 1: growth from birth to adolescence Flashcards
What is the pediatric population defined as?
Birth-20 years
Roughly ¼ of the population
What is a major goal of pediatric nursing?
Improve quality of health care for children and their families
What is the goal of Healthy People 2030?
Increase quality and length of healthy life and eliminate health disparities
What challenges do children face during a disaster?
May not be able to follow directions or make decisions to keep them safe
How do children’s bodies differ from adults’ in terms of energy use?
Children use energy quicker and need food and water more often
True or False: Children are less likely to take in harmful substances through the skin.
False
Thinner skin, breathe faster, weaker immune system, and more likely to come in contact with enviornmental dangers.
What are some common childhood health concerns?
- Obesity and Type 2 Diabetes
- Childhood injuries (Accidents)
- Violence
- Bullying
- Mental health problems (stress, social media)
What is a major determinant of neonatal death?
Birth weight
Which age group has the lowest death rate?
Ages 5 to 14
What is the trend in childhood mortality rates during adolescence?
Sharp increase occurs in adolescence (15-19 yrs)
Who are the specific groups of children with increased morbidity?
- Homeless
- Living in poverty
- Low birth weight
- Chronic illness
- Foreign born adopted children
- Children in day care centers
Morbidity= illness
Define ‘Growth’ in the context of pediatric nursing.
An increase in number and size of cells, resulting in increased size and weight
Define ‘Development’ in pediatric nursing.
A gradual change and expansion; advancement from lower to more advanced stages of complexity
What is ‘Maturation’?
An increase in competence and adaptability, described as a qualitative change
What is ‘Differentiation’?
The processes by which early cells and structures are systematically modified
List the stages of growth and development.
- Infant Stage: birth-1 years
- Toddler Stage: 1-3 years
- Preschool Stage: 3-6 years
- School Age: 6-12 years
- Adolescence: 12-20 years
What does ‘Cephalocaudal’ refer to?
Growth and development from head to toe
General to specific systems.
Fill in the blank: The _______ is the standard by which all children are measured.
Growth chart
What is the single most important influence on growth?
Nutrition
What age group is typically the most picky eaters?
Toddlers
What types of play are identified in child development?
- Solitary play
- Onlooker play
- Parallel play
- Associative play
- Cooperative play
What are some functions of play?
- Sensorimotor development
- Intellectual development
- Socialization
- Creativity
- Self-awareness
- Therapeutic value
- Morality
Who proposed the theory of Psychosocial Development?
Erik Erikson
What is the focus of Jean Piaget’s theory?
Cognitive Development
What are the stages of Freud’s Psychosexual Development?
- Oral Stage (Birth-1 year)
- Anal Stage (1-3): toilet training
- Phallic Stage (3-6): oedipus complex
- Latency Stage (6-12): friends of same sex preferred
- Genital Stage (12+): sexual attraction begins
Oedipus complex is attachment of child to parent of opposite gender and envious behaviors towards other
What are the three levels of Kohlberg’s Moral Development?
- Preconventional Morality (birth-2- egocentric, 2-4 punishment obedient, 4-7 instrumental relativist)
- Conventional Morality (good boy or girl- 7-10; law and order- 10-12)
- Postconventional Morality (social contact and universal ethical principles)
What is the age range for the ‘Trust vs Mistrust’ stage?
0-1.5 years
What is the age range for the ‘Autonomy vs Shame and Doubt’ stage?
1.5-3 years
What is the age range for the ‘Initiative vs Guilt’ stage?
3-6 years
What is the age range for the ‘Industry vs Inferiority’ stage?
6-12 years
What is the age range for the ‘Identity vs Identity Confusion’ stage?
13-21 years
What is the percentage increase in birth length by 1 year of age?
50%
Birth length increases significantly during the first year.
By how much does the head increase in size during the first year?
33%
This growth is a crucial aspect of physical development.
At what age does the posterior fontanel close?
6-8 weeks
This is an important milestone in cranial development.
At what age does the anterior fontanel close?
12-18 months
Closure of the anterior fontanel indicates maturation of the skull.
What is the typical weight gain for an infant in the first months?
5-7 oz weekly
Consistent weight gain is a sign of healthy growth.
By what age should an infant triple their birth weight?
1 year
Tripling of weight is a benchmark for physical development.
Motor skills 1-3 months
- Gross: head lag; Fine: strong grasp reflex
- Gross: lifts head off matress when prone; Fine: holds hands in open position and grasp reflex fading
- Gross: raises head and shoulders off matress when prone and only slight head lag; Fine: no grasp reflex and keeps hands loosely open
Motor skills 4-6 months
- Gross: rolls from back to side; Fine: grasps objects with both hands
- Gross: rolls from front to back; Fine: uses palmar grasp dominantly
- Gross: rolls from back to front; Fine: holds bottle
Motor skills 7-9 months
- Gross: bears full weight on feet and sits leaning forward on both hands; Fine: moves objects from hand to hand
- Gross: sits unsupported; Fine: begins using pincer grasp
- Gross: pulls to standing and creeps on hands and knees; Fine: crude princer grasp and dominant hand evident
Motor skills 10-12 months
10: Gross: changes from prone to sitting; Fine: grasps rattle by handle
11. Gross: cruises or walks while holding something; Fine: places objects into container and neat pincer grasp
12. Gross: sits down from standing position without help and walks with one hand held; Fine: tries to build a 2-block tower with no success and can turn pages in a book
What stage of cognitive development occurs from 0-24 months?
Sensorimotor phase
This phase includes reflexive actions and the development of object permanence.
What are the 4 stages of the sensorimotor phase?
- Reflexive stage: sucking, rooting, grasping, crying
- Primary circular reactions stage: simple repetition, coordinating movements, voluntary acts replace reflecive behavior
- Secondary circular reaction stage: imitation of familiar behaviors, separation from enviornment
- Coordination of secondary schemas: intentional, goal-directed behavior, object permanance
First month of life through 12 months.
What is the psychosocial crisis faced by infants according to Erikson?
Trust vs Mistrust
Successful resolution leads to trust in caregivers and the environment.
At what age does separation anxiety begin?
4-8 months
This is a normal part of emotional development.
At what age does stranger fear begin?
6-8 months
Birth to 12 months language development
3-4 months: coos and babbles
5-6 months: “talk back”- realizes speech influences other
8-9 months: begins to understand simple comands like “wave bye-bye”
10-12 months: says around 5 words
What type of play is dominant in infants?
Solitary play
Infants primarily focus on their own bodies during play.
What are some examples of toys appropriate for infants?
- Rattles
- Soft, stuffed toys
- Blocks
- Mirrors
- Balls
- Nesting toys
- Books
These toys promote sensory and motor development.
What is the recommended sleep duration for a 2-month-old vs a 12-month-old infant?
2 months: 15 hours total
3-4 months: night sleep lasts 9-11 hours
12 months: 13 hours total
Sleep needs gradually decrease as infants grow.
What dental care should begin when primary teeth erupt?
Cleaning
Preventative dental care is important to avoid caries.
What are key aspects of injury prevention for infants?
Motor vehicle safety, electical and water burns, aspiration, falls, poison, bodily damage, drowning
Ensuring safety in various environments is crucial.
What should be limited to promote healthy development in infants?
Television and videos
Excessive screen time can hinder development.
By what age do infants typically begin to understand simple commands?
8-9 months
This indicates progress in language development.
Fill in the blank: Infants show more discriminant interest in stimuli by _____ months.
3-6 months
This is a sign of cognitive and sensory development.
Infant nutrition
- First 6 months: human milk/formula
- Supplements: vitamin D and iron
- Second 6 months: introduction of solid foods, weaning from breast to bottle
What is the typical weight gain for toddlers aged 1-3 years?
4 to 6 lbs/year
Weight gain slows down as toddlers grow, reflecting their changing nutritional needs.- picky eatera and dont eat at night
By what age should a child’s birth weight be quadrupled?
By age 2½ years
This indicates significant growth in the early years of life.
How much does a toddler’s height typically increase each year?
About 3 inches/year
Height growth is primarily due to elongation of the legs rather than the trunk.
How does growth occur during toddlerhood?
Step-like rather than linear
Growth patterns during this stage are not smooth but occur in spurts.
What common infections are toddlers prone to?
Upper respiratory infections, otitis media, and tonsillitis
These infections are frequent due to the developing immune system.
How well do toddlers fight off infections?
Much better than infants because they are exposed to more antibodies, so the body knowz how to fight off those illnesses.
What physiological capability develops by the end of toddlerhood?
Child is physiologically able to control elimination
This is a significant milestone in a toddler’s development.
15 months fine and gross motor skills
Fine: uses a cup well, builds a tower of 2 or more blocks
Gross: walks without help, creeps up stairs
18 months fine and gross motor skills
Fine: manages a spoon without rotation, turns pages in a book a few at a time, builds towers of 3-4 blocks
Gross: runs clumsy, falls ofen, throws ball overhead, jumps in place with both feet, pulls and pushes toys
Fine and gross motor skills 2 years
Fine: builds a tower of 6-7 blocks, turns book pages one at a time
Gross: walks up and down the stairs by placing both feet on each step
Fine and gross motor skills 2.5 years
Fine: draws circles, has good hand-finger coordination
Gross: jumpas across the floor and off of a chair or step using both feet, stands on one foot momentarily, takes a few steps on tiptoes
What cognitive processes develop rapidly between ages 12 and 24 months?
Tertiary circular reactions, active experimentation, complete understanding of object permanence, imitation of behaviors, can visualize things mentally
Sensorimotor
This stage marks a critical period for cognitive growth.
What is the primary characteristic of preoperational thought?
Children cannot think in terms of operations
This phase is marked by symbolic thinking but lacks logical processing.
What psychosocial crisis do toddlers face according to Erickson?
Autonomy versus shame and doubt
This stage emphasizes the development of independence and self-control.
What social development occurs in toddlers regarding self-identity?
Differentiation of self from mother and significant others
This stage includes understanding personal identity and relationships.- transitional objects used
At what age typically do toddlers have a gender identity?
By age 3
This is an important aspect of social and personal development.
What are the toddlers personal social behaviors like?
Developing skills of independence and become strong-willed, determine and volatile. Starting to develop feeling of concern towards others.
What type of play helps toddlers transition into interactive play?
Parallel play
This type of play facilitates socialization and interaction with peers.
What kinds of toys are used at toddler age?
Push and pull toys, climbing, imitation, tactile play
What is a key aspect of discipline for toddlers?
Consistency is key!
-avoid physical punishements and threats
-time-out used
Consistent responses help establish boundaries and expectations.
What are common age-related concerns for toddlers?
Toilet training, sibling rivalry, temper tantrums, negativism, regression
These issues often arise as children navigate their developmental stages.
What is the second highest cause of accidental death in toddlers?
Motor vehicle accidents
Injury prevention is critical during this stage of development.
What is the primary thing that magnifies physical and psychosocial development in toddlers?
PLAY
Play is essential for growth and learning in toddlers.
Fill in the blank: By age 1 year, a child uses _______.
one-word sentences ‘holophrases’
This marks the beginning of verbal communication.
What are some common injury risks for toddlers?
Drowning, burns, accidental poisoning, falls, aspiration and suffocation, bodily injury
Second highest rate in accidental deaths behind adolescents
Awareness of these risks can significantly enhance safety measures.
What is the average height increase for preschoolers per year?
2.5-3.5 inches/year
This growth rate is typical for children aged 3-6 years.
What is the average weight gain for preschoolers per year?
3-5 lbs/year
This weight gain is consistent for children in the preschool age range.
At what age do children typically no longer appear pot-bellied?
By age 3
Children become more slender and sturdy as they grow with the limbs growing the fastest.
What are some examples of motor skills developed by a 3-year-old?
Riding a tricycle, jumping off the bottom step, standing on one foot for a few seconds, building a tower of 9-10 blocks, copying a circle and a cross, using a fork well
What are some examples of motor skills developed by a 4-year-old?
Skips and hops on one foot, throws ball overhead, catches ball reliabily, copies a square, uses scissors to cut out a picture following an outline, draws a person or stick figure with 3-4 parts
What are some examples of motor skills developed by a 5-year-old?
Jumps rope, walks backwards, throws and catches a ball well. can write simple letters/number such as their name, ties shoe laces, draws a person or stick figure with 7+ parts
What significant cognitive development phase occurs between ages 2-7 according to Piaget?
Preoperational phase
-Shifting from egocentric thinking to social awareness and considers others views
This phase includes sub-stages such as the preconceptual phase (2-4 years) and intuitive thought phase (4-7 years).
What is ‘magical thinking’ in preschoolers?
The belief that thoughts can influence reality (animism).
This reflects a child’s imaginative and sometimes irrational thought processes.
What psychosocial stage do preschoolers experience according to Erikson?
Initiative vs. guilt
-Development superego (conscience)
-Simple reasoning
-Right from wrong (moral development)
-Delayed gratification
This stage involves developing a sense of initiative while learning to manage feelings of guilt and anxiety.
What type of play is characterized by cooperation but lacks rules?
Associative play
This type of play is common among preschoolers as they interact with peers.
What is the recommended daily caloric intake for preschoolers?
1200-1400 calories per day
-Pickiness is usually outgrown by 5
This intake supports their growing bodies and active lifestyles.
How often should preschoolers have dental appointments?
Every 6 months
-Able to brush on own with assistance
Regular dental check-ups are essential for maintaining oral health.
What are common fears experienced by preschoolers?
Dark, being left alone, large animals, ghosts
These fears are part of normal development and can be addressed through reassurance.
What is the focus of childcare during the preschool years?
Education about safety and potential hazards
This shift emphasizes understanding and preventing injuries rather than solely protection.
Fill in the blank: Preschoolers may begin having concerns about _______.
modesty
Awareness of body image and societal standards starts to develop during this time.
What type of play involves role-playing and fantasy?
Imaginative play
This type of play is crucial for cognitive and social development.
What are the kindergarten vaccines recommended between ages 4-6?
DTaP, MMR, Varicella, IPV
These vaccinations are essential for preventing serious diseases.
True or False: Preschoolers typically have a well-defined understanding of body boundaries.
False
Preschoolers often have poorly defined body boundaries and may fear injury.
What is the average vocabulary size for a preschooler by age 5?
11,000 words
-Becomes more sophisticated
-3-4 word sentences at 3
-5-6 word sentenes at 5
This reflects significant language development from ages 2 to 5.
Describe the typical sleep pattern for preschoolers.
12 hours per night with infrequent naps
Sleep needs may vary, and waking during the night can be common.
What is a common social development milestone for preschoolers?
Overcoming stranger anxiety
Children begin to feel more secure and comfortable in social situations.
What is the primary focus of nutrition for preschoolers?
Balanced diet with adequate calories
Ensuring proper nutrition supports growth and development.
What is the typical age range for school-age children?
6-12 years
What is the average height increase per year for school-age children?
2 inches/year
Total of 1-2 feet
How much weight do school-age children typically gain each year?
2-3 kg/year
What are the key physical developments during school age?
Slow growth, limbs grow fastest, skeletal lengthening, fat diminution, increased muscle tissue, decrease in head circumference related to height, change in facial proportions
What is the significance of the term ‘loose teeth’ in school-age children?
Indicates dental development and maturation
What happens to the heart and respiratory rate during school age?
Heart and respiratory rate decrease, blood pressure increases
What happens to the GI system and bones during school age?
Bones continue to ossify
GI has fewer upset stomach and better BG maintenance.
At what age does prepubescence usually begin?
Around age 9
Rapid growth in height and weight
What does Tanner staging help predict?
Timing of puberty
What cognitive development stage do school-age children reach according to Piaget?
Concrete operations
-Uses thought process
-Judgements based on reason
-Major developmental tasks include acheivement in school and peer acceptance.
What is the concept of conservation?
Understanding that quantity does not change despite changes in shape or appearance
What psychosocial conflict do school-age children face according to Erikson?
Industry vs inferiority
Strong need for peer approval, wants to have REAL accomplishments, need to face some failure to develop, sense of accomplishment and wanting to participate in useful work
What major task do children need to achieve during school age?
Achievement in school and acceptance by peers
What motivates school-age children strongly in their development?
Peer approval
What role do parents play in a child’s development during middle childhood?
Primary influence in shaping personality, behavior, and value system
How does a child’s self-concept develop during school age?
Through conscious awareness of self-perceptions influenced by significant adults
What is the trend regarding body image as children grow older?
Children generally like their physical selves less as they grow older
Head is the most important part, influenced by peers, increased awareness of “differences”
What type of play becomes more prevalent during school age?
Cooperative and competitive play
Increased attention span
What health promotion activities are important for school-age children?
Proper nutrition, sleep and rest, exercise, dental hygiene, sex education
What vaccines are recommended for children aged 11-12 years?
Tdap, HPV, Meningococcal
What is the leading cause of severe injury and death in school-age children?
Motor vehicle crashes
Fill in the blank: The immune system in school-age children is increasingly _______.
effective
True or False: Physical maturity is always correlated with emotional and social maturity.
False
What should parents adjust to as their child becomes more independent?
Provide support as unobtrusively as possible
What is one common activity that helps communicate with school-age children?
Play
What is a common developmental task that school-age children strive for?
Sense of accomplishment through cooperation and competition
What influences the development of sex roles in school-age children?
Peer relationships
What percentage of total height is achieved during puberty?
20-25%
This growth is part of the adolescent growth spurt.
What are the primary sex characteristics?
External and internal organs necessary for reproduction
These characteristics develop during puberty.
What is the ‘formal operations period’ according to Piaget?
A stage characterized by abstract thinking and hypothetical reasoning
-Thinking beyond the present
-Hypothetical situations
-Longer attention spans
-Concern about others
This period occurs during adolescence.
What developmental conflict occurs during adolescence according to Erikson?
Identity vs Role Confusion
-Group identity: middle school
-Individual identity: high school
This conflict involves developing a sense of identity.
What is thelarche?
Appearance of breast buds in girls
Occurs between ages 9-13.
What is adrenarche?
Growth of pubic hair on mons pubis
2-6 months after thelarche
What is menarche?
Initial appearance of menstruation
Typically occurs 2 years after the first pubescent changes.
What are secondary sex characteristics?
Changes such as voice change, hair growth, and breast enlargement
These result from hormonal changes but do not play a direct role in reproduction.
What is the goal of puberty?
Development of secondary sex characteristics
This marks the transition into sexual maturity.
Fill in the blank: The period of approximately 2 years before the onset of puberty is called _______.
Prepubescence
What is postpubescence?
Period of 1 to 2 years after puberty when skeletal growth is complete
Reproductive functions also become well established.
What are common feelings experienced during early adolescence regarding body image?
Feelings of confusion and heightened awareness of appearance
Teenagers may compare their appearance with others and magnify blemishes.
What health promotion activities should be prioritized for adolescents?
- Sleep
- Activity
- Scoliosis screening
- Sex education
- Personal care
- Vision and hearing checks
- Posture
- Body art
- Tanning
- Dental health
- Substance abuse prevention
- Stress reduction
- Immunizations
These activities address various health concerns during adolescence.
What are common clinical manifestations of anorexia nervosa?
- Fatigue
- Constipation
- Metabolic alkalosis
- Secondary amenorrhea
- Irritability
These symptoms may vary in each individual.
True or False: The prefrontal cortex is fully developed in adolescents.
False
The prefrontal cortex continues to develop, impacting decision-making and risk assessment.
What is a significant cause of mortality in adolescents?
Motor vehicle-related injuries
This is the #1 cause of mortality in this age group.
What is one characteristic of adolescent social development?
Intense sociability and intense loneliness
Adolescents often seek acceptance from peers while navigating their identity.
What is the role of peers in adolescent development?
Provide support and influence identity formation
Adolescents often look to peers for validation and guidance.
Fill in the blank: The temporary condition of breast tissue enlargement in boys during puberty is called _______.
Gynecomastia
Happens in 1/3 of boys and usually disappears within 2 years
What are the first pubescent changes in boys?
Testicular enlargement; thinning, reddening, and increased looseness of scrotum
9.5-14 years
What should a nurse prioritize for an adolescent with multiple body art and piercings?
- Screen for HIV
- Provide education on avoiding sunburns
- Schedule for hepatitis vaccine
These interventions address health risks associated with body art.
What are the nutritional requirements during adolescence?
Higher caloric and protein requirements than at almost any other time
This is due to rapid physical development.
What are the two main types of vaccines?
Live, Attenuated and Inactivated Vaccines
Live, attenuated vaccines use a weakened form of the germ that causes a disease, while inactivated vaccines contain killed germs.
What is the role of nurses in immunizations?
Nurses play a crucial role in administering vaccines and educating patients about the importance of immunizations
This includes ensuring proper vaccine storage, handling, and patient follow-up.
What is herd immunity?
Herd immunity occurs when a large portion of a community becomes immune to a disease, making its spread unlikely
This protects those who are not immune.
How is Hepatitis B spread?
Through blood or body fluids
This includes sharing needles or other equipment to inject drugs.
What are the common symptoms of Rotavirus (RV)?
Diarrhea
Rotavirus can lead to severe dehydration in infants and young children.
True or False: Diphtheria is spread through air and direct contact.
True
Diphtheria can be transmitted by respiratory droplets.
Fill in the blank: The vaccine for __________ protects against polio.
IPV
IPV stands for Inactivated Poliovirus Vaccine.
What are the symptoms of Varicella (chickenpox)?
Rash, headache
Varicella is caused by the varicella-zoster virus.
What is the mortality rate associated with MenACWY?
10% mortality rate
MenACWY is a vaccine that protects against meningococcal disease.
What is a common misconception about vaccines?
That vaccines cause injuries or long-term side effects
The WHO has declared the anti-vaccine attitude a significant threat to public health.
What is the primary mode of transmission for the MMR vaccine-preventable diseases?
Air and direct contact
This includes respiratory droplets from coughing or sneezing.
What are the potential long-term effects of HPV infection?
Cervical, vaginal, vulvar, penile, anal, oropharyngeal cancers
Certain strains of HPV are associated with these cancers.
How often is MenACWY vaccine given?
9-10 years then again at 16-18 years before college
Meningococcal vaccine
Which vaccines are live?
RV (rotavirus)
MMR
Varicella
Not given to immunocompromised patients
What vaccines are inactivated?
Hep B
Hep A
DTap (Diptheria)
Hib (Haemophilus)
PCV13 (Pnuemococcal)
IPV (Polio)
Flu shot
HPV
Meningococcal
What vaccines are given at birth?
Hepatitis B
What vaccines are given at 2 months of age?
RV, DTaP, Hib, PCV13, IPV
When can the yearly flu shot first be given?
6 months
What vaccines are given at 12 months of age?
MMR, Varicella, Hepatitis A
What vaccines are given at 9-10 years of age?
HPV and meningococcal
