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PEDS - Chapter 1
Growth and development infant, Toddler, preschooler, school-age, adolescent
| Term | Definition |
|---|---|
| Newborn and infant Developmental changes Growth | Increase in physical size Plotted on standardized growth charts to assess adequate growth for age and gender Children typically remain in same percentiles over time. Major deviations warrant investigation Specialized growth charts for children with specific diagnoses (i.e. Downs Syndrome) and breastfeeding infants |
| Newborn and infant Developmental changes Development | Sequential process by which infants and children gain various skills and functions Utilize screening tools to assess (i.e. Denver II, Ages and Stages, etc.) |
| Newborn and infant Developmental changes Maturation | Increase in functionality of various body systems or developmental skills |
| Newborn and infant physical growth Weight | Average is 7.5 lbs Doubles by 4-6 months Triples by 1 year |
| Newborn and infant physical growth Height | Average is 20 inches by 1 year, length increases by 50% |
| Newborn and infant physical growth Head Circumference | Average is 14 inches 4-inch gain by 1 year |
| Newborn and infant physical growth – Organ system maturation Neurologic System: | Reflexes: Moro, Root, Suck, Asymmetric Tonic Neck, Plantar and Palmar Grasp, Step, Babinski Diminish over first few months (except Babinski which takes 1 year) Gives way to protective reflexes (righting and parachute reactions) *During the first few months of life, reflexive behavior is replaced with purposeful action. |
| Newborn and infant physical growth – Organ system maturation Respiratory System: | Respiratory rate slows from 30-60 in newborn to 20-30 in 12 month old Respiratory system do not reach full maturity until about 7 years old Comparison to Adults: Nasal passages are narrower Larynx is more funnel shaped Trachea and chest wall are more compliant Bronchi and bronchioles are shorter and narrower Significantly fewer alveoli |
| Newborn and infant physical growth – Organ system maturation Cardiovascular System: | Heart doubles in size in the first year Average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1 year old Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12 month old Peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss Thermoregulation becomes more effective |
| Newborn and infant physical growth – Organ system maturation Gastrointestinal System: | Tongue is larger relative to oral cavity size; it must be able to latch onto the nipple for the infant to feed Stomach capacity increases as the infant grows First primary teeth erupt between the ages of 6 and 8 months (incisors). Teeth emerge in a predictable pattern Consistency and frequency of stools change over the first year of life based on intake (breast or bottle) and age (i.e. meconium) |
| Newborn and infant physical growth – Organ system maturation Genitourinary and Integumentary Systems: | Infants more susceptible to dehydration Frequent urination with low specific gravity (not concentrated until glomeruli mature) Lanugo and vernix may be seen in the newborns Acrocyanosis is normal in the newborn and decreases over the first few days of life Skin is relatively thinner than that of adults with peripheral capillaries more superficial |
| Newborn and infant physical growth – Organ system maturation Hematopoietic and Immunologic Systems: | Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Therefore, premature infants miss this transfer and are at increased risk of iron deficiency anemia. Newborns receive immunity through the placenta and utilize those antigens for first 3-6 months of life until they synthesize their own IgG, reaching adult levels by 9 months. |
| Developmental theories INFANT STAGE Erik Erikson (1963) | Identifies Psychosocial crisis of infancy as Trust vs. Mistrust (birth to 1 year) |
| Developmental theories INFANT STAGE Jean Piaget (1969) | Theory of Cognitive development Sensorimotor (birth to 2 years) Infant uses senses and motor skills to learn Sucking may occur by chance, but then repeats it purposefully to bring pleasure Infant repeats action to achieve wanted results Infant coordinates previously learned schemes with learned behaviors (i.e. grasping rattle to shake for noise or crawling to get a toy) Develops Object Permanence (solidified by 8 months of age) – if an object is taken from an infants sight, they will search for it |
| Developmental theories INFANT STAGE Sigmund Freud | Oral stage (birth to 1 year); pleasure is focused on oral activities (feeding and sucking) |
| Newborn and infant SENSORY DEVELOPMENT Sight: | View objects 8-15 inches away, prefer human face Binocularity – ability to fuse 2 ocular images into 1, begins at 6 weeks and established by 4 months. Color vision, distance, tracking by 7 months. |
| Newborn and infant SENSORY DEVELOPMENT Hearing | Intact at birth |
| Newborn and infant SENSORY DEVELOPMENT Smell and Taste: | Newborns can smell and prefer sweet tastes |
| Newborn and infant SENSORY DEVELOPMENT Touch: | Most important |
| Newborn and infant motor skill development: Gross motor skills | *GROSS MOTOR Skills develop CEPHALOCAUDAL HEAD TO TOE |
| Newborn and infant motor skill development: FINE motor skills | *FINE MOTOR Skills develop PROXIMODISTAL CENTER TO PERIPHERY |
| Newborn and infant communication and language development First several months | , crying is only form of communication |
| Newborn and infant communication and language development 1-3 month old | coos |
| Newborn and infant communication and language development 4-5 months | vowel sounds, laughs, responds to voices, responds to name |
| Newborn and infant communication and language development 6 months | squealing and yelling |
| Newborn and infant communication and language development 7-10 months | babbling, saying mamma dada without meaning |
| Newborn and infant communication and language development 9-12 months | attach meaning to words, recognizes objects by name, imitates words |
| Newborn and infant communication and language development 12 months | babbles with inflection |
| Newborn and infant social and emotional development Stranger anxiety | Indicates infant recognizes self as separate from others |
| Newborn and infant social and emotional development Separation anxiety | Infant becomes distressed when parent leaves |
| Newborn and infant social and emotional development Temperament | Ranges from low to moderately active, regular, and predictable, to highly active, more intense, and less adaptable |
| Newborn and infant cultural influences on development | Cultural nutrition (vegetarian), Sharing a bed Ethicity stature Parenting styles and health promotion behavior Religious and spiritual Must practice Transcultural Nursing directed by cultural aspects and respects individual’s preferences |
| Newborn and infant prematurity | Assessments of growth and development must include adjustments for prematurity Use the infant’s adjusted age to determine expected outcomes Subtract the number of weeks that the infant was premature from the infant’s chronological age Plot growth parameters and assess developmental milestones based on adjusted age |
| Newborn and infant promoting healthy growth and development Safety: | Correct positioning and securing children in car seats Positioning infants “back to sleep” to decrease risk of SIDS Use of current recommendations for infant furniture Safety on the changing table and use of mobility devices for infants Safety in the home using safety gates, outlet covers Identify choking hazards (small toys, foods) Water safety (bathrooms, buckets, and tubs) |
| Newborn and infant promoting healthy growth and development Nutrition: | Breastfeeding AAP, NAPNAP, WHO, ACOG, ADA all recommends breastfeeding as the natural and preferred method of infant feeding. AAP recommends newborns to be breastfed exclusively for the first 6 months of life, then introducing solids with the continuation of breastfeeding until 1 year of age. Benefits for both mother and baby Perfectly matched nutrition |
| Newborn and infant promoting healthy growth and development Promoting Healthy Eating Habits: | Newborns and young infants feed “on demand” Family models acceptable eating behaviors Can start to introduce solids at 4-6 months of age Infants can require exposure to new foods up to 20 times before accepting the food Introduce a new food and wait 3 to 4 days before introducing a different food to observe for any allergies The child will decide how much to eat---the parent provides the food Introduce the cup early (~6 months) to start Solid food should be soft and mashed until teeth erupt |
| Newborn and infant common developmental concerns | Colic Spitting up Thumb sucking, pacifiers, security items Teething |
| Toddler 1-3 years old -physical growth | Height and weight increase steadily in spurts at a slower rate than the infant Generally reach half adult height by age 2 Average weight gain is 3 to 5 lb per year Height increases by an average of 3 in per year Anterior fontanelle closes by 18 months Head size more proportional to body by age 3 |
| Toddler organ system maturation Neurologic system | Brain reaches about 90% of size by age 2. Increased myelination improves coordination, balance, and sphincter control |
| Toddler organ system maturation Respiratory system | Alveoli increase in number until age 7; trachea and airways small compared to adult; tonsils and adenoids are large relative to size of oral cavity |
| Toddler organ system maturation Cardiovascular system | Heart rate decreases; blood pressure increases |
| Toddler organ system maturation Neurologic system | Brain reaches about 90% of size by age 2. Increased myelination improves coordination, balance, and sphincter control |
| Toddler organ system maturation Respiratory system | Alveoli increase in number until age 7; trachea and airways small compared to adult; tonsils and adenoids are large relative to size of oral cavity |
| Toddler organ system maturation Cardiovascular system | Heart rate decreases; blood pressure increases |
| Toddler organ system maturation Gastrointestinal system | Stomach increases in size; small intestine grows in length; less frequent stools; stool color may be variable based on diet; bowel control typically achieved by end of toddler period |
| Toddler organ system maturation Genitourinary system | Bladder and kidney reach adult function by 16 to 24 months; bladder capacity increases; urethra remains relatively short |
| Toddler organ system maturation Musculoskeletal system | Bones increase in length; muscle matures; swayback and pot belly appear due to weak muscles until 3 years old |
| Toddler developmental theories Erikson | Psychosocial theory describes the toddler period as a time of Autonomy vs. Shame and Doubt (1-3 years) Toddler is learning to do for herself what others have been doing for her. Ambivalence about the move from dependence to autonomy causing emotional lability. |
| Toddler developmental theories Piaget | Cognitive development: Preoperational (2-7 years old) Differentiates self from objects (increased object permanence) Think before acting, time space causality understanding, make believe, connections with past Symbolic play – Animism: human feelings attached to objects |
| Toddler developmental theories Freud | Anal stage: focus on achieving anal sphincter control |
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bonitasoul
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