Normal Normal Growth and Growth and DevelopmentDevelopment

Why do Nurses need to Why do Nurses need to Understand Child Understand Child

Development?Development?

Freud-Freud-Psychosexual DevelopmentPsychosexual Development

1.1. Oral stageOral stage

2.2. Anal stageAnal stage

3.3. Phallic stagePhallic stage

4.4. Latency stageLatency stage

Theories of Child Theories of Child DevelopmentDevelopment

EriksonErikson - -The Four Ages of The Four Ages of ChildhoodChildhood

1.1. InfancyInfancy trust vs mistrusttrust vs mistrust2.2. ToddlerhoodToddlerhood autonomy vs autonomy vs

shame shame and and doubtdoubt

3.3. PreschoolerPreschooler initiative vs guiltinitiative vs guilt4.4. School-ageSchool-age industry vs industry vs

inferiority inferiority

Autonomy VS. Doubt & Shame???

Theories of Child Theories of Child DevelopmentDevelopment

Piaget- Theory of Intellectual Piaget- Theory of Intellectual DevelopmentDevelopment

Sensoriomotor ThoughtSensoriomotor Thought 0-2 yrs0-2 yrs Preoperational ThoughtPreoperational Thought 2-7 yrs2-7 yrs(Egocentrism, Transductive reasoning, (Egocentrism, Transductive reasoning,

Centration, Animism, Magical Thinking)Centration, Animism, Magical Thinking)

Concrete OperationsConcrete Operations 7-11 yrs7-11 yrs Formal OperationsFormal Operations >11 yrs>11 yrs

Basic Principles of Child Basic Principles of Child DevelopmentDevelopment

#1 Children are competent#1 Children are competent

#2 Children resemble one #2 Children resemble one anotheranother

#3 Each child is unique#3 Each child is unique

#4#4

DevelopmenDevelopment is t is DirectionalDirectional

CephalocaudCephalocaudalal

ProxiimodistProxiimodistalal

Body Body midlinemidline

Which body systems grow most rapidly during early childhood?

#5 Development is Timely#5 Development is Timely

There are There are recognized recognized critical critical (sensitive) (sensitive) periods of periods of developmedevelopmentnt

Factors Influencing G&DFactors Influencing G&DENVIRONMENTENVIRONMENT

Socioeconomic levelSocioeconomic level Parent-child Parent-child

relationshiprelationship Family positionFamily position Health/GeneticsHealth/Genetics NutritionNutrition GeneticsGenetics TemperamentTemperament

INFANT INFANT 1 –12 months1 –12 monthsTTrust vs Mistrustrust vs Mistrust Double birth weight at 6 Double birth weight at 6

monthsmonths Triple at 12 monthsTriple at 12 months Rolls over 4 monthsRolls over 4 months Holds head steady at 6 Holds head steady at 6

monthsmonths Sitting 6-8 monthsSitting 6-8 months Walking 12 monthsWalking 12 months Pincer grasp 10 monthsPincer grasp 10 months 2 words by 12 months2 words by 12 months Solid food @ 6 monthsSolid food @ 6 months Object permanenceObject permanence Separation anxietySeparation anxiety Risk for aspirationRisk for aspiration

6 Months

8 Months

Eruption of Teeth-lower Eruption of Teeth-lower incisor are 1incisor are 1stst teeth @ 6-10 teeth @ 6-10

monthsmonths

Separation Anxiety ~ 8 monthsSeparation Anxiety ~ 8 months

First Steps

~ 12 Months

Nursing Management-Nursing Management-InfancyInfancy

1.1. Discuss age-appropriate Discuss age-appropriate recommendationsrecommendations

2.2. Teach nutritionTeach nutrition

3.3. Sleep patternsSleep patterns

4.4. Foster attachmentFoster attachment

5.5. Explore family support systemsExplore family support systems

6.6. SafetySafety

Nutrition in InfancyNutrition in Infancy Breast milk a/o formula Breast milk a/o formula

11stst year year Solids @ 4-6 months-Solids @ 4-6 months-

iron fortified rice cereal iron fortified rice cereal 11stst

Next veggies, fruit, then Next veggies, fruit, then meat 8-10monthsmeat 8-10months

Toddler Toddler 1 – 3 years1 – 3 years

2 word sentences 2 word sentences by age 2by age 2

Screening for lead Screening for lead poisoningpoisoning

Decreased appetiteDecreased appetite(physiologic anorexia)(physiologic anorexia) Temper tantrumsTemper tantrums Toilet trainingToilet training NegativismNegativism

NO!

Toddler Years include…..Toddler Years include….. Sibling Rivalry Sibling Rivalry

(expect regressive (expect regressive behavior with arrival behavior with arrival of new baby)of new baby)

Parallel play (won’t Parallel play (won’t share!)share!)

Toddler years include…..Toddler years include…..

Transitional objectsTransitional objects Temper TantrumsTemper Tantrums

Toddler Years include….Toddler Years include…. Parallel Play Parallel Play

Nursing Management-Nursing Management-ToddlerToddler

1.1. Discuss age-appropriate Discuss age-appropriate recommendationsrecommendations

2.2. Growth & DevelopmentGrowth & Development

3.3. Toilet Training Toilet Training

4.4. NegativismNegativism

5.5. Encourage gross motor skillsEncourage gross motor skills

6.6. Sibling Rivalry Sibling Rivalry

7.7. RegressionRegression

8.8. Sleep patternsSleep patterns

9.9. SafetySafety

Nutrition – Toddler yearsNutrition – Toddler years

Physiologic Physiologic anorexiaanorexia

Food jagsFood jags Serving amounts?Serving amounts?

If on a food jag may only If on a food jag may only eat yogurt for days!eat yogurt for days!

Provide for self feeding: Provide for self feeding: finger foods/spoonfinger foods/spoon

Toddlers are at high risk for Toddlers are at high risk for injuries r/t their increasing injuries r/t their increasing cognitive and motor skills cognitive and motor skills

curiosity. What measures could curiosity. What measures could prevent injury from the following prevent injury from the following

hazards?hazards? FallsFalls PoisoningPoisoning BurnsBurns Motor Vehicle CrashesMotor Vehicle Crashes DrowningDrowning

Preschooler Preschooler 3-5 years3-5 years Body contour changesBody contour changes Social/language skills Social/language skills

^̂ Appetite is diminishedAppetite is diminished Fear of dark, Fear of dark,

mutilation, and mutilation, and abandonmentabandonment

Self-centeredSelf-centered Magical Thinking Magical Thinking “If I “If I

am mad at Mommy & she am mad at Mommy & she gets sick, I caused it!”gets sick, I caused it!”

Bedtime issuesBedtime issues

Preschool years Preschool years include….Associative Playinclude….Associative Play

Associative Play with strong Associative Play with strong imaginative & dramatic themes imaginative & dramatic themes …like to assume adult roles in …like to assume adult roles in playplay

Nursing Management-Pre Nursing Management-Pre SchoolSchool

Discuss age-appropriate Discuss age-appropriate recommendationsrecommendations

Teach nutritionTeach nutrition Sleep patternsSleep patterns Discuss G&DDiscuss G&D FamilyFamily FearsFears SafetySafety

School-age School-age 6-12 years 6-12 years Slimmer, stronger, ^ fine motor skillsSlimmer, stronger, ^ fine motor skills Growth spurt/prepubescent periodGrowth spurt/prepubescent period girls ~10yrs, boys ~13 yrsgirls ~10yrs, boys ~13 yrs Permanent teeth eruptPermanent teeth erupt Latch-key childrenLatch-key children Concrete thoughtConcrete thought Cooperative Play/Rules/RoutineCooperative Play/Rules/Routine Obesity risk beginsObesity risk begins Peer group bigger influencePeer group bigger influence Sexuality/Inappropriate touchSexuality/Inappropriate touch

Nursing Management-Nursing Management-School AgeSchool Age

Discuss age-appropriate recommendationsDiscuss age-appropriate recommendations Teach nutritionTeach nutrition Sleep patternsSleep patterns Discuss G&DDiscuss G&D FamilyFamily Promote skill development in school, Promote skill development in school,

sports and playsports and play SafetySafety

Kids want to know: Why do I wake up at night with leg cramps?

Nursing Interventions: Nursing Interventions: Health Care SettingHealth Care Setting

1.1. Infant: consistent contact/feeding, Infant: consistent contact/feeding, crib rails @ all timescrib rails @ all times

2.2. Toddler: allow transitional objects, Toddler: allow transitional objects, prepare for “NO!”; remember can’t prepare for “NO!”; remember can’t “conserve” when giving liquid “conserve” when giving liquid meds, FULL CRIB RAILSmeds, FULL CRIB RAILS

3.3. Preschooler: “dramatic play” to Preschooler: “dramatic play” to explain care-”you listen to explain care-”you listen to Daddy’s heart 1Daddy’s heart 1stst, apply concept of , apply concept of animism!animism!

4.4. School Age: can give more detailed School Age: can give more detailed explanations, same age roommateexplanations, same age roommate

**Involve parents (rooming in) for all **Involve parents (rooming in) for all age groupsage groups

**Select age appropriate play activities**Select age appropriate play activities

Safety in ChildhoodSafety in ChildhoodPrevent aspirationPrevent aspiration-especially 1-especially 1stst year year

Prevent fallsPrevent falls-from birth-from birth

Prevent PoisoningsPrevent Poisonings-especially after -especially after walking & during toddlers yearswalking & during toddlers years

Prevent BurnsPrevent Burns-especially after walking and -especially after walking and thru school agethru school age

Prevent injury from firearms Prevent injury from firearms especially especially school-ageschool-age

Prevent drowning- Prevent drowning- especially after walkingespecially after walking

Implement Car SafetyImplement Car Safety-from birth-from birth

Safety: 1Safety: 1stst year of life year of life

Promoting Safety Promoting Safety Throughout ChildhoodThroughout Childhood