Most children who run away from home are__ to__ years of age.
10 to 17 years of age.
Freud described three levels of consciousness:
the id-which controls physical needand instincts of the body
the ego-the conscious self, which controls the pleasure principle of the id by delaying the instincts until an appropriate time
the superego-the conscience or parental value system.
- Growth- the physical increase in the body’s size.
- Development- the progression of changes in the child toward maturity
- maturation-which is completed growth and development.
- cephalocaudal- Growth following an orderly pattern from the head downward
- Proximodistal- growth starts in the center and progresses outward.
Height and weight are monitored and plotted on growth charts to
provide a comparison of measurements and patterns of a child’s growth.
Growth charts and developmental assessment tools are used to
compare a child’s growth to other children of the same age and sex. They are also used to compare the child’s current measurements with his or her previous measurements.
Genetic factors inﬂuence a child’s physical characteristics such as
the child’s gender, race, eye color,height, and weight, as well as the child’s overall growth and development. Some diseases as well assome physical and mental disorders are genetically transmitted. Personality characteristics, including temperament, are genetically inﬂuenced.
The quality of a child’s nutrition during the growing years has a major effect on the
overall health and development of the child and throughout life. Nutrition is also a factor in the child’s ability to resist infection and diseases.
what are some environmental factors that inﬂuence a child’s growth and development?
A lower socioeconomic level, decreased caregiver time and involvement, media exposure, and living ina household in which parents are addicted to drugs or alcohol are environmental factors that may inﬂuence growth and development. Homelessness,divorce, latchkey situations, and running away fromhome are also environmental factors that inﬂuence a child’s growth and development.
According to Freud, in the oral stage of development-
the anal stage-
the phallic stage-
the latency stage-
the genital stage-
According to Freud, in the oral stage of development the newborn experiences body satisfaction throughthe mouth. During the anal stage, the child begins to learn self-control and taking responsibility. The childﬁnds a source of pride and develops curiosity regard-ing the body in the phallic stage. Moral responsibility and preparing for adult life occur in the latency stage,and in the genital stage, puberty and the drive to ﬁndand relate to a mate occurs.
Erikson’s theory of psychosocial development sets out sequential tasks that the child must successfully complete before going on to the next stage. His theory describes
developmental tasks in 8 stages:
- •Trust vs. Mistrust—the infant learns that hisorher needs will be met.
- •Autonomy vs. Doubt and Shame—the toddlerlearns toperform independent tasks.
- · Initiativevs. Guilt—the child develops aconscience and sense of right and wrong.
- •Industryvs. Inferiority—the child competes withothers and enjoys accomplishingtasks.
- •Identity vs. Identity Confusion—the adolescentgoes through physical andemotional changes ashe or she develops as an independent person withgoals andideas.
- •Intimacy vs. Isolation—the young adult developsintimaterelationships.
- •Generativity vs. Self-Absorption—the middle-aged adult ﬁndsfulﬁllment in life.
- •Ego Integrity vs. Despair—the older adult is satis-ﬁed withlife and the achievements attained.
Piaget’s four stages of cognitive development include the
- sensorimotor phase, in which the infant uses the senses for physical satisfaction.
- The young child in the preoperational phase sees the world from an egocentric or self-centered point of view.
- the concrete operations phase, thechild learns to problem solve in a systematic way,
- the formal operations phase, the adolescenthas his or her own ideas and can think in abstractways.
Kohlberg’s theory relates to the development of moral reasoning in children.
The child progresses from making decisions with no moral sensitivity to making decisionsbased on personal standards and values.
Understanding the growth and development of the child and inﬂuences on the child and family caregivers is important for effective communication. Listening, maintaining eye contact, and playing with children can encourage communication.
Infants evaluate actions and respond to sensory cues. Young children are egocentric and tend to be frightened of strangers. Use short sentences, positive explanations, familiar and nonthreatening terms,and concrete explanations. School-aged children are interested in knowing the “what” and “why” ofthings. Provide simple, concrete responses using age appropriate vocabulary. Choices should be simpleand limited. Let adolescents know that you will listen in an open minded, nonjudgmental way.Phrase questions regarding sensitive information in a way that encourages the adolescent to respond without feeling embarrassed. Includecaregivers inproviding information, problem solving, and planning of care. Keep caregivers well informed.
The nurse who understands normal growth and development is better able to develop
an appropriate plan of care for the child, including the areas ofcommunication, safety, and family teaching
According to Erikson, the developmental task for the infant is
to develop a sense of trust, which happens when the needs of the infant are consistently met.
An infant’s birth weight doubles by age __ months and triples by __ year.
An infant’s birth weight doubles by age 6 months and triples by 1 year.
At birth, an infant’s head circumference is usually slightly larger than the chest circumference.
The head and chest grow rapidly and after about 5 to 7months of age, the chest can be expected to exceedthe head in circumference.
The posterior fontanel closes by the ___ month and the anterior fontanel closes between the___ months.
The posterior fontanel closes by the second or third month and the anterior fontanel closes between the12th and 18th months
The ﬁrst tooth to erupt is usually one of the upper or lower incisors. This occurs between ___ monthsof age in most children.
The ﬁrst tooth to erupt is usually one of the upper or lower incisors. This occurs between 6 and 8 monthsof age in most children. Family history, nutritional status, and prolonged illness affect the eruption ofteeth. Fluoride is recommended to strengthen calciﬁcation of teeth and prevent tooth decay.
The average apical rate ranges from __ (asleep) to__ (awake) beats per minute and as high as ___beats per minute when the infant is crying.
The average apical rate ranges from 70 (asleep) to150 (awake) beats per minute and as high as 180beats per minute when the infant is crying.
As the infant grows, __ cells mature and ﬁne muscles begin to coordinate in an orderly pattern of development.
As the infant grows, nerve cells mature and ﬁne muscles begin to coordinate in an orderly pattern of development.
Between the ages of _ and _ months, most children develop a fear of strangers.
Between the ages of 6 and 7 months, most children develop a fear of strangers. As the infant matures enough to recognize the mother or primary caregiver, the infant becomes fearful when this person disappears. To the infant, out of sight means out of existence, and the infant cannot tolerate this.The game “Peek-a-Boo” is useful in afﬁrming self-existence to the infant and that even when temporarily out of sight others still exist.
The infant’s nutritional requirements for the ﬁrst __ months are supplied by either breast milk orcommercial infant formulas. Nutrients that may need to be supplemented are vitamins C and D,iron, and ﬂuoride. At about ___ months of age,the infant’s iron supply becomes low andsupplements of iron-rich foods are needed. At around ___ months of age, the baby begins experimenting with ﬁnger foods and self-feeding.
The infant’s nutritional requirements for the ﬁrst 4to 6 months are supplied by either breast milk orcommercial infant formulas. Nutrients that may need to be supplemented are vitamins C and D,iron, and ﬂuoride. At about 4 to 6 months of age,the infant’s iron supply becomes low andsupplements of iron-rich foods are needed. Ataround 7 or 8 months of age, the baby beginsexperimenting with ﬁnger foods and self-feeding.
Infants have a tendency to push solid food out of their mouths with their tongue thrust forward because of the
New foods are introduced one at a time to determine
the food responsible if the infant has a reaction.
An infant can be gradually weaned to a cup as her or his desire for sucking decreases, usually around the age of
Bottle mouth caries can occur when an infant is
given a bottle at bedtime; the sugar from the formula causes erosion of the tooth enamel. To prevent bottle mouth caries, a bottle of plain water or a paciﬁer for sucking can be given at bedtime.
If an infant resists drinking milk from a cup,calcium and vitamin D needs can be met by
giving foods such as yogurt, custard, and cottage cheese.
Children are immunized against hepatitis B virus,diphtheria, tetanus, pertussis,rotavirus, Haemophilus inﬂuenzae type b, polio, measles,mumps, rubella, varicella(chickenpox), pneumococcal disease, and meningococcal disease.In addition, they may be immunized against the hepatitis A virus. Immunizations should be given according to The American Academy of Pediatrics’recommended schedule.
The most common side effect is a low-grade fever and possibly tenderness,redness, and swelling at the injectionsite. Acetaminophen is given for fever and cool compresses are applied to the injection site. The child maybe fussy and eat less than usual. The child is encouraged to drink ﬂuids, and holding and cuddlingis comforting to the child.
During routine health maintenance visits, teach caregivers information regarding
normal growth and development milestones, bathing, diapering, dressing, sleep patterns,dental care, and safety.
Infants’ gums and teeth should be cleaned with a
clean, damp cloth and plain water.
Accident prevention for the infant includes
closely watching the infant and monitoring the environment for safety hazards.
In addition to nursing care, touching, rocking, and cuddling are essential for the hospitalized infant.Age appropriate sensory stimulation and play within the constraints of the infant’s condition are important.
When an infant is hospitalized, the family caregiver can give the child stimulation, care,and attention by feeding, holding, and diaperingthe infant.
The cause of the illness, its treatment, guilt about the illness, past experiences of illness and hospitalization, disruption in family life, the threat to the child’s long-term health, cultural or religious inﬂuences, coping methods within the family, and ﬁnancial impact of the
hospitalization all may affect how thefamily responds to the child’s illness.
The family caregivers’ role in educating the child about hospitals includes
helping the child develop a positive attitude about hospitals, hospitalization, and illness and giving children simple, honest answers to their questions.
Pediatric units are developed to create a comfortable and safe atmosphere for children and are decorated with a variety of colors. Treatments are done in
treatment rooms rather than the child’s room. Playrooms encourage activities for promoting normalage-related development.
Safety is an essential aspect of pediatric care. The stress that infants, children, and their caregivers experience when a child is hospitalized may increase the frequency of accidents.
Understanding the growth and development levels of eachage group helps you to be alert to possible dangers for each child.
Microorganisms are spread by
contact (direct, indi-rect, or droplet), vehicle (food, water, blood, orcontaminated products), airborne (dust particles inthe air), or vector (mosquitoes, vermin) means.
Standard precautions reduce the risk of transmission of microorganisms from recognized or unrecognizedsources of infection. Transmission based precautions are used for patients documented or suspected of having highly transmissible pathogens that require additional precautions.
Hand washing is the cornerstone of all infection control. Wash hands conscien-tiously between seeing each patient, even when gloves are worn for a procedure.
For a child placed on transmission based precautions, spending extra time in the room when performing treatments and procedures, reading astory, playing a game, or talking with the child can
help ease feelings of isolation.
The three stages of response to separation seen in the child include
- · protest (the child cries, refuses to be comforted, and constantly seeks the primary caregiver)
- ·despair (the child becomes apathetic and listless when the caregiver does not appear)
- ·denial (the child appears to accept the situation, but ignores the primary caregiver when he or she returns)
Family caregiver participation is important to relieve the child’s separation anxiety.
Rooming in is encouraged to make the child feel more secure and to provide opportunities to teach family caregivers about how to care for the child after discharge. Encourage caregivers to take breaks from the child when needed.
In a planned admission, preadmission education helps prepare the child for hospitalization.
There is time to explain procedures to the child and let the child play with equipment to become familiar with it. In an emergency admission, there may be little time for explanations because physical needsare the priority.
The family caregiver is a vital participant in the care of an ill child.
The caregiver participates in the admission interview and should be included in the planning of nursing care.
Discharge planning includes teaching the child and the family about the care needed after discharge from the hospital.
Written instructions should be provided. Teaching also includes information about how the child may respond after discharge. The family should encourage positive behavior, avoid making the child the center of attention, and provide loving but ﬁrm discipline.
In preoperative teaching, health professionals determine how much the child knows and is capable of learning, help correct any misunderstandings,explain the preparation for surgery, and explain how the child will feel after surgery.
Teaching must be based on the child’s age, developmental level, previous experiences, and caregiver support.
Preoperative preparation for the child may include
skin preparation, such as a tub bath or shower,shaving the surgical site, administering enemas,keeping the child NPO, urinary catheterization, and administering preoperative medications.
Postoperative care of the child following surgery includes
careful observation and assessing for complications, close monitoring of vital signs, dressings, intake and output, following postoperative orders, and providing patient and family teaching.
Assessment and treatment of pain is important in caring for children.
Use of assessment tools helps children express the amount of pain they are having. Behaviors such as rigidity, thrashing, facial expressions, loud crying or screaming, ﬂexion of knees (indicating abdominal pain), restlessness, andirritability may indicate the child is in pain. Physiologic changes, such as increased pulse rate and blood pressure, sweating palms, dilated pupils,ﬂushed or moist skin, andloss of appetite, also may indicate pain.
Play is the principal way in which children learn, grow, develop, and act out feelings and problems. In hospital play programs, children may express frustrations, hostilities, and aggressions through play without the fear of being scolded.
A well planned hospital play area with safe play materials and activities for children of all ages is important. Play therapy is a technique used to uncover a disturbed child’s underlying thoughts, feelings, and motivations to help understand them better. Therapeutic play is a play technique used to help the child have a better understanding of what will be happening to him or her in a speciﬁc situation.
Growth of the child follows an orderly pattern starting with the head and moving downward.
growth starts in the center and progresses toward the periphery or outside
Freud believed that a child who did not adequately resolve a particular stage of development would have a ﬁxation (compulsion) that correlated with that stage. Freud described three levels of consciousness :
the id, which controls physical need and instincts of the body; the ego, the conscious self, which controls the pleasure principle of the id by delaying the instincts until an appropriate time; and the superego, the conscience or parental value system. These consciousness levels interact to check behavior and balance each other. The psychosexual stages in Freud’s theory are the oral, anal, phallic, latency, and genital stages of development.
Positioning for administering ear drops.
(A)In the child older than 3years, pull the pinna up and back. (B)In the child younger than 3 years, the pinna is pulled down and back.
Total parenteral nutrition (TPN) is the administration of
dextrose, lipids, amino acids, electrolytes, vitamins, minerals, and trace elements into the circulatory system
Not all parts grow at same time except for
- · Different growth patterns are in brain, lymph, reproductive system
Newborn (neonat) age-
- Fetus- conception to birth,
- Newborn- birth to 4weeks(neonat)
- Infant- 4weeks to 1 year
- Toddler- age 1-3 years
- Pre-school end of age 3-6
- School age 6-10
- Adolescent age 11-18 or 21
increase in physical size ,measured in inches and pounds
progressive increase in function of the body
total way in which a person grows and develops
birth weight- ·
gain __ lbs from 1 to puberty year
puberty begins at age __ for girls, __ for boys
trunk grows a lot at __
- Newborn- length 20” average; range 19-21”, length doubles by age 4 and triples by age 13birth
- weight- baby loses 6-10 % of birth weight, they stool and have more fluid; should double their birth weight by 6 months, triple by age 1
- · gain 4-6 lbs from 1 to puberty yearpuberty begins at age 12 for girls, 13 for boys
- circumference- head size, measure head, 13-14 inches or 33-35.5 cm,
- · trunk grows a lot at infancy
Environment effected at__ tri. of preg. and puberty
Integration of skills-
Denver developmental screening-
- adolescence- body portion develop, normal to get fat deposits,
- Metabolic rate: faster in kids, infant- require more cal., minerals, vitamins, fluid;young child- lose fluid from pulmonary system and skin,
- Bone growth- best way to determine growth, through x-ray; growth plates in flat bones
- Vitamin A- soft tissue and bone growthEnvironment effected at first tri of preg. And puberty
- Integration of skills- building skills, ex: pick up pencil then write with it
- Growth standards- compare age groups,health
- Denver developmental screening- test most common, plot progress, not IQ test up to age 6
Four areas assessed: personal/social, fine-motor, language, gross motor·
- Personal/social- can they do ADL
- Fine-motor: eyes and hand coordination
- Language- hearing, understanding, and ability to use it
- Gross-motor: hop on one foot
- Performing denver testII- first calculate chronological age, 125 tasks used, percent used, 25,50,75,90%;median is 50%
Personality- unique organization of characteristics that determine individual typical or recurrent behavior Psychosocial development- maslows needed, and erik eriksons stages ,piagets theories Pyramids-maslowslook up Start at bottom and go upStage 6- morally should be mature, should achieve this stage , do what they think is right and use internal standards of integrity
- o Authoritarian- values, kids become shy, withdrawn, lack self confidence, could rebel, antisocial,
- oAuthoritative- shows respect for child, has high self esteem, more independent, happy,
- o Permissive- no control, kids insecure, irresponsible ·
Factors that influence growth and development-
inheritance: genetics, nutrition, environment, heredity, nationality, race, ordinal position(oldest, youngest, middle), gender, religion, family,·
Nursing implications: knowledge, nursing
process, teaching, age appropriate care, differences
Safety on hospitalized child-side rails up/use, never leave unattended, wash your hands, I.D., cribs away from objects, inspect toys, restraints as needed, use elevatorsDon’t- prop bottles, play with equipment, leave alone, no meds left at bedside
Childs reaction to hospitalization- age, development, preparation, coping, culture, past experience
Coping with hospitalization- differences, culture, childs reactions, fears r/t age, three principles nursing care-1st – trust,2nd –protect them, 3rd – facility social contact; discharge instructions
Basic needs – age/ development, level of understanding, explanations procedures, tour, request back round /routines, response to illness, family needsPre op. therapy: play therapy, If patient ask about pain tell them the truthIf child is NPO and thirsty, don’t let them have anything
Under 6 months no clue to what is going on·
Over 6 months notice things don’t see mom gets stressed
Fear, body intrusions as they get older
Do treatment in treatment room
Toddlers- separation (stage of anxiety) ,big issue, world revolves around caregiver,
First stage is protest, 2nd despair, 3rd denial
There is some level of separation anxiety as kids get older
Warn the kid 5 min or less before a procedure
Preschooler: 3-6 don’t touch them unless you have to, fear of mutilation, egocentric
Magical thinking- they influenced things to happen, risk for guilt or shame, loss of control
Regression- go back a stage
School age kid:6-10, bothered more by the disease or being sick, Concerned about disability or death
Don’t like privates looked at, Want to know why
They understand cause and affect
Adolescent- loss of independents, it interrupts life
style, body image importants, peers-most important thing to them, appearance,
Play therapy- parallel1-2years, cooperative3-5years, solitary infant- toddler, associate, onlookerSponge bath- 20-30 min.Cath. 8-10 FPinworms at 3amBest place for a shot- vastus laterallisNo more than .5ml in one site 1year and youngerBuretrol – IV tubing, holds solution per hourIBPB- 30min -1hour