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CHAPTER 5: DEVELOPMENTAL INFLUENCES ON CHILD HEALTH PROMOTION
Laura Salisbury RN, MSN/Ed.
DEFINITIONSGrowth
Development
Maturation
Differentiation
THE DEVELOPMENTAL AGE PERIODS
PrenatalGerminal, Embryonic, Fetal
InfancyNeonatal, Infancy
Early ChildhoodToddler, Preschool
Middle Childhood School-age
Later childhoodPrepubertal, Adolescence
PATTERNS OF GROWTH AND DEVLEOPMENT
DirectionalCephalocaudalProximodistal
DifferentiationSequential trendsDevelopmental paceSensitive periodsIndividual differences
BIOLOGICAL GROWTH AND PHYSICAL DEVELOPMENT
Skeletal proportion Changes
Changes in Weight
Changes in Height
CHANGES IN WEIGHT
Doubles from birth to 6 months
Triples by end of first year
Quadruples by 2.5 years
2-3 kg growth per year preschool/school
age
Growth spurt starts 10-14 years (females)
11-16 years (males)
CHANGES IN HEIGHT
Changes in HeightLength increase by 50% by 1st birthdayLength doubles by age fourHeight at age 2 approximately 50% of average adult height
Skeletal age: how is it determined? Hand and wrist x-rays
Why do adolescents get more fractures than ligamentous ruptures?
PHYSIOLOGIC CHANGES
Metabolic Rate
Sleep and Rest
TYPES OF TEMPERMENT
Easy childDifficult childSlow-to-warm-up childSignificance of temperament
FREUDIAN DEVELOPMENTAL THEORY
IdEgoSuperegoFreudian stages
OralAnalPhallicLatencyGenital
ERICKSONS PSYCHOSOCIAL DEVELOPMENTAL THEORY
Trust vs. mistrustAutonomy vs. shame and doubtInitiative vs. guiltIndustry vs. inferiorityIdentity vs. role confusion
PIAGET COGNITIVE DEVELOPMENTAL THEORY
SensorimotorPreoperational
Egocentric thinkingIntuitive reasoningTransductive reasoning
Concrete operationsConservationInductive reasoning
Formal operations
KHOLBERG MORAL DEVELOPMENT
PreconventionalConventionalPostconventional
DEVELOPMENT OF SELF CONCEPT
Body Image
Self Esteem
TYPES OF PLAY
Social-affectiveSense-pleasureSkill playUnoccupied behaviorDramatic/pretend playGames
ImitativeFormalCompetitive
SOCIAL CHARACTER OF PLAY
Onlooker playSolitary playParallel playAssociative playCooperative play
FUNCTIONS OF PLAY
DevelopmentSocializationCreativitySelf-awarenessTherapeutic
CHOOSING TOYS
Toy safety: pg 87SelectionSupervisionMaintenanceStorage
FACTORS THAT INFLUENCE DEVELOPMENT
HeredityNeuro-endocrineNutrition
Single most important influence on growthInterpersonal relationships
Emotional deprivationSocioeconomic levelDiseaseEnvironmental hazards
FACTORS THAT INFLUENCE DEVELOPMENT
Stress in childhoodMass media influence
ReadingMoviesTelevision
Read “Family-Centered Care” Video gamesInternet
CHAPTER 6: COMMUNICATION AND PHYSICAL ASSESSMENT OF THE CHILD
Laura Salisbury RN, MSN/Ed.
COMMUNICATION AND PHYSICAL ASSESSMENT OF THE CHILD
Establish a settingPrivacy and confidentiality
When is confidentiality limited?IntroductionsJust the child vs. child and parent
(Legal issues in telephone triage)
INTERVIEWING THE PARENTEncouragementDirectionCultural variablesUsing silenceEmpathy versus sympathy“Anticipatory guidance”What are blocks to communication
(Table 6-2)Use of interpreter (box on page 102)
Avoid using the child as interpreter!!!
COMMUNICATION WITH THE CHILD
InfancyNonverbal behaviors
Early childhoodRemember that they take things literallyThey may assign human attributes to inanimate
objectsSchool-age
Concerned with body integrityAdolescence
Establish trustDemonstrate positive communication to child and
parentCreative Communication (use of play)
HEALTH HISTORY
Chief complaintHistory of present illnessPast history
Birth history, Dietary history, Previous illness/surgeryAllergies, Medications, ImmunizationsGrowth and development milestones, Habits
Sexual historyFamily medical history
GeographyFamily structurePsychosocial historyReview of systems
CLINICAL EXAM
Head to toe sequencePreparing the childSee guidelines, p. 119See table 6-2, p. 120
GROWTH MEASUREMENTS
When are growth charts different?Length vs. heightSkin-fold thickness: to measure fat
percentage
PHYSIOLOGICAL MEASUREMENTS
TemperatureWhich way? Box 6-11 p. 125
PulseApical or radial?
RespirationBlood pressure
Annually starting age 3How to measure cuff appropriately, p. 130
PHYSICAL ASSESSMENTGeneral appearance
PostureBehavior
SkinAccessory structures:
hair, scalp, nailsLymph nodesHead and neck
Head lag: after 6 months=worrisome symptom
Head control in infant/toddlersPain on neck flexion=worrisome symptom
PHYSICAL ASSESSMENT Eyes
PERRLAVisual acuity
Use Snellen letter chart Ears
Must restrain child when using otoscope on infant/toddler
Positioning: see figure 6-23 p. 140 Nose Mouth and throat
PHYSICAL ASSESSMENTChest
Normal breath sounds: p. 145Facilitating auscultation/deep breaths: p.
145Heart
Capillary refill time: how to assess?Heart murmurs: Innocent,
functional, organicAbdomen
Umbilical herniaInguinal herniaFemoral hernia
PHYSICAL ASSESSMENTGenitaliaAnusBack and extremities
JointsNeurologic assessment
Cerebellar function: Romberg test
ReflexesCranial nerves
