Growth & Development

GROWTH & DEVELOPMENT From Birth to Adolescence K. KEENEY, MSN, RN, SANE, PSANE NUR 315 ALVERNIA UNIVERSITY Learning Outcomes At the end of this presentation, students will be able to describe the physical, cognitive, and psychosocial milestones of each childhood age group. explain how to support growth and development for children ages 1 month to 18 years. identify harm prevention strategies for each childhood developmental level. KEY TERMS GROWTH: PHYSICAL SIZE DEVELOPMENT: PROGRESSION TOWARDS MATURITY DEVELOPMENTAL MILESTONES TEMPERAMENT: INDIVIDUAL MANNER OF THINKING/BEHAVING/REACTING (SILBERT-FLAGG, 2022) (CENTERS FOR DISEASE CONTROL AND PREVENTION, 2024) NEONATE INFANT TODDLER PRESCHOOLER SCHOOLAGED <28 DAYS 1 MONTH 1 YEAR 1-3 YEARS 3-5 YEARS 6-12 YEARS ADOLESCENT 13-18 YEARS Basic Divisions of Childhood (SILBERT-FLAGG, 2022) DIFFERENT TYPES OF DEVELOPMENT PHYSICAL COGNITIVE PSYCHOSOCIAL PHYSICAL DEVELOPMENT Height & Weight Head circumference 2 years old and under Growth Charts Occurs in a generally predictable pattern Cephalocaudal Proximal to distal Gross to refined skills Loss of neonatal reflexes Affected by genetics, sex, and environmental factors (SILBERT-FLAGG, 2022) (CENTERS FOR DISEASE CONTROL AND PREVENTION, 2024) COGNITIVE COGNITIVE DEVELOPMENT Affected by a multitude of factors Social Determinants of Health The caregiver-child relationship Adverse Childhood Experiences Sibling and peer socialization Overall health Piaget’s Theory of Cognitive Development COGNITIVE (SILBERT-FLAGG, 2022) https://www.youtube.com/watch? v=TRF27F2bn-A PSYCHOSOCIAL DEVELOPMENT Refers to the development of social skills and personality traits Erikson’s Theory of Psychosocial Development https://www.youtube.com/watch?v=aYCBdZLCDBQ G&D in Nursing Practice Assess growth and development at each encounter Involve other healthcare specialties Notify healthcare providers of delayed development concerns Provide education to parents about expected growth and development milestones Educate about implementing safety precautions, and how parents can support their children to help them grow (SILBERT-FLAGG, 2022) THE STANDARD SCHEDULE FOR PCP VISITS IS: 2 WEEK 2 MONTH 4 MONTH 6 MONTH 9 MONTH 12 MONTH INFANT G&D 1 month to 1 year (SILBERT-FLAGG, 2022) Trust vs. Mistrust *One of the most important time frames for development IMPORTANT ASPECTS OF ASSESSING INFANT G&D INTERVIEW THE PRIMARY CAREGIVERS (SILBERT-FLAGG, 2022) HEIGHT/LENGTH/ HEAD CIRCUMFERENCE ASSESS FOR TYPICAL INFANT APPEARANCE INVOLVE CAREGIVERS DURING ASSESSMENT WE SHOULD COMPARE A CHILD TO THEIR OWN GROWTH CURVE. WEIGHT AND HEIGHT ARE ONLY RELEVANT TO THEMSELVES. Typical Infant Appearance and Growth Double birth weight: 4 to 6 months Triple birth weight: 1 year Average 1 year old male: 10 kg Average 1 year old female: 9.5kg Length increases by 50% the first year Head circumference increases rapidly Head asymmetric Protuberant abdomen Heart rate: 110-160 bpm --> 100-120 bpm Respiratory rate: 30-60 --> 20-30 Extrusion reflex Difference in intra- and extracellular fluid Anterior and posterior fontanelles (SILBERT-FLAGG, 2022) Physical/Motor Development 1-3 months NOTICES OWN HANDS RAISES HEAD AND CHEST KICK AND STRETCHES LEGS OUT POSTERIOR FONTANELLE CLOSES (2 MONTHS) (DEBOER, 2014) (SILBERT-FLAGG, 2022) 4-6 months REACHES FOR OBJECTS TRANSFERS OBJECTS BETWEEN HANDS ROLLS BOTH DIRECTIONS PUSHES UP ON KNEES AND HANDS ROCKING BACK AND FORTH ON KNEES SITS WITH SOME SUPPORT TEETHING BEGINS 7-9 months DEVELOPS PINCER GRASP MOUTHS OBJECTS FEEDS SELF SIT WITHOUT ASSISTANCE CRAWLING STANDS UP WITH SUPPORT 10-12 months CLAP HANDS WAVE BYE GETS INTO SITTING POSITION CRAWLING PULLS SELF TO STAND CRUISES WALKS WITH SUPPORT TAKES FIRST STEPS* THERE IS SOME VARIABILITY IN TAKING FIRST STEPS (12 MONTHS BUT CAN BE UP TO 15-16 MONTHS) If you remember NOTHING ELSE about growth and development, REMEMBER THIS! Head, shoulders, knees, & toes! 2 months: Head --> Holds head up 4 months: Shoulders --> Rolls over 8 months: Knees --> Sits unsupported/Crawling 1 year: Toes --> Walking (DEBOER, 2014) Socialization/Cognition/ Senses 1-3 months BABBLES TURNS HEAD TOWARDS SOUND INSTINCTUAL SMILE, THEN SOCIAL SMILE FACIAL EXPRESSIONS VISION POOR, BLACK & WHITE WATCHES FACES FOLLOWS OBJECTS WITH EYES (DEBOER, 2014) (SILBERT-FLAGG, 2022) 4-6 months FINDS PARTIALLY HIDDEN OBJECTS EXPLORES HANDS AND MOUTH RESPONDS TO NAME BABBLING SOCIAL PLAY STANGER ANXIETY COLOR VISION DISTANCE VISION TRACK OBJECTS SLEEPS THROUGH NIGHT 7-9 months OBJECT PERMANENCE UNDERSTANDS “NO” IMITATES EXPRESSIONS CLAPS HANDS LIKES TO PLAY USES A CUP 10-12 months FINDS HIDDEN OBJECTS LOOKS AT IMAGES WHEN NAMED EXPLORES OBJECTS RESPONDS TO VERBAL REQUESTS SIMPLE GESTURES SAY ABOUT 5 WORDS SAYS “DADA” AND “MAMA” CRIES WHEN CAREGIVER LEAVES TESTS BOUNDARIES AND RESPONSES REPEATS SOUNDS (SILBERT-FLAGG, 2022) Supporting Infant Growth & Development TUMMY TIME*** SKIN TO SKIN SMILE AND TALK BRIGHTLY COLORED AND MUSICAL TOYS READING SOCIALIZATION WITH FAMILY MEMBERS INTRODUCTION OF SOLIDS INCLUDE BABY IN FAMILY TIME SUPPORT DEVELOPMENT OF TRUST (VS. MISTRUST) HANDLE BABY GENTLY FAMILIAR CAREGIVERS RESPOND TO CRYING AND CUES ROUTINE (SILBERT-FLAGG, 2022) Promoting Infant Safety ASPIRATION PREVENTION AIRWAY IS SMALLER IN DIAMETER LARGER TONGUES PREFERENTIAL NOSE BREATHERS LARYNX IS HIGH AND ANTERIORLY POSITIONED FALL PREVENTION CAR SEAT SAFETY PA CAR SEAT LAW SIBLING SAFETY BURNS CHILDPROOF POISONINGS/CHOKING MEDICATION LOOKS LIKE CANDY BUTTON BATTERIES ABCs OF SAFE SLEEP A- ALONE B- on their BACK C- in a CRIB or bassinet Healthy People 2030 Goals: Increase the proportion of infants who are placed to sleep in a safe sleep environment (MICH-D03) Increase the proportion of infants who are placed to sleep on their backs (MICH-14) (AMERICAN ACADEMY OF PEDIATRICS, 2024) (SILBERT-FLAGG, 2022) Infant Health Promotion REASSURE PARENTS ABOUT MILESTONES REDUCE TEETHING PAIN 1st tooth: 6 months Bottom middle teeth first Fussiness, rubbing face and ears PACIFIER CONSTIPATION/LOOSE STOOLS COLIC SPITTING UP DIAPERING/RASH CONCERNS Fungal rashes BABY-BOTTLE TOOTH DECAY VACCINES (KOTTAIT, 2018) TODDLER G&D 1-3 years (SILBERT-FLAGG, 2022) Autonomy vs. Shame and Doubt Large leaps in developmental and verbal milestones IMPORTANT ASPECTS OF ASSESSING TODDLER G&D OBTAIN A THOROUGH HEALTH HISTORY (SILBERT-FLAGG, 2022) HEIGHT/WEIGHT ASSESS FOR TYPICAL TODDLER APPEARANCE/ BEHAVIOR INVOLVE CAREGIVERS DURING ASSESSMENT Typical Toddler Appearance and Growth Weight gain: 5-6 lbs a year Height increases by about 5 in. a year Subcutaneous tissue disappears BMI screening: 24 months Pouchy abdomen Lordosis Wide gait Chest circumference > head circumference HR: 90-130 RR: 20-30 IgG and IgM antibody production matures Loss of passive immunity (SILBERT-FLAGG, 2022) Physical/Motor Development 12-18 months ANTERIOR FONTANELLE CLOSES WALKS UNASSISTED CLIMB UP STEPS STACK BLOCKS (DEBOER, 2014) 18-24 months FEEDS SELF TURN BOOK PAGES RUN AND JUMP SHOWS INTEREST IN TOILET TRAINIING 24-36 months WALKS UP AND DOWN STAIRS DRESSES WITH HELP USE CUP WITHOUT LID RIDES TRICYCLE Socialization/Cognition/ Senses 12-18 months OBEY SIMPLE COMMANDS SHOWS INDEPENDENCE “NO” 5 WORDS BY 12 MONTHS 50 WORDS BY 18 MONTHS POINTS TO OBJECTS DECREASE STRANGER ANXIETY SHOWS FRUSTRATION (DEBOER, 2014) 18-24 months SAYS 2-3 WORD SENTENCES REPEATS WORDS SAYS NAME TEMPER TANTRUMS DIFFICULTY SHARING “MINE” PARALLEL PLAY TESTS BOUNDARIES 24-36 months FULL VOCABULARY 3-5 WORD SENTENCES 11,000 WORDS A DAY BY AGE 3 FIRST AND LAST NAME KNOWS GENDER AND AGE PRETEND PLAY MAGICAL THINKING INTERACTIVE PLAY INCREASED SOCIAL CONFORMITY (SILBERT-FLAGG, 2022) Supporting Toddler Growth & Development PROMOTE CONVERSATIONS LIMIT TV/SCREEN TIME NAME OBJECTS DURING EVERYDAY ACTIVITIES READING/DESCRIBING PICTURES KEEP A ROUTINE SET CLEAR RULES/BOUNDARIES ALLOW FOR AUTONOMY WHEN POSSIBLE GIVE CHOICES ALLOW EXPLORATION (AS LONG AS IT IS SAFE) 1,000-1,400 CALORIES A DAY PROVIDE ADEQUATE SLEEP/NAPS DENTAL CARE TOILET TRAINING Promoting Toddler Safety ACCIDENTAL INJURY IS LEADING CAUSE OF DEATH INGESTION OF CLEANING PRODUCTS INGESTION OF SMALL OBJECTS MITIGATE IMPULSIVITY FALLS ARE COMMON CRIB IN LOWEST POSITION ENCOURAGE HELMET USE CAR SEAT SAFETY LEAD SCREENING WATER SAFETY CAN BEGIN SWIMMING LESSONS AT 1 YEAR ANIMAL SAFETY BE AWARE OF UNSAFE PRODUCTS BURNS (SILBERT-FLAGG, 2022) ON THE MARKET (ABA PROGRAMS,2022) PRESCHOOL G&D 3-5 years (SILBERT-FLAGG, 2022) Initiative vs. Guilt Learning how to be themselves IMPORTANT ASPECTS OF ASSESSING PRESCHOOL G&D OBTAIN A THOROUGH HEALTH HISTORY (SILBERT-FLAGG, 2022) HEIGHT/WEIGHT ASSESS FOR TYPICAL PRESCHOOLER APPEARANCE/ BEHAVIOR INVOLVE CAREGIVERS DURING ASSESSMENT Typical Preschooler Appearance and Growth Weight gain: about 4.5 lbs per year Height increase: 2-3.5 inches per year Develops child-like appearance Tonsils appear enlarged Genu valgus (knock knees) Increased coordination IgG and IgA antibodies increase HR: 70-110 bpm RR: 20-30 Usually have all 20 deciduous teeth (SILBERT-FLAGG, 2022) Physical/Motor Development 3 years DRESSES SELF WALKS BACKWARDS USES TOILET DRAWS CAN USE SCISSORS BUILDS TOWER OF >6 BLOCKS (DEBOER, 2014) (SILBERT-FLAGG, 2022) 4 years HOPS AND STANDS ON ONE FOOT THROWS AND CATCHES BALL WRITES SOME LETTERS COPIES SHAPES DRAWS A PERSON WITH 2-4 BODY PARTS 5 years RUNS, JUMPS, SKIPS CAN UNDRESS AND DRESS SELF WELL Socialization/Cognition/ Senses 3 years SENSE OF BODY IMAGE UNDERSTANDS CAUSALITY SEXUAL CURIOSITY 3-4 WORD SENTENCES FEARS DEVELOP COOPERATIVE PLAY SELF IDENTITY PLAYS PRETEND WITH DOLLS AND TOYS (DEBOER, 2014) (SILBERT-FLAGG, 2022) 4 years 4-5 WORD SENTENCES COUNTS NAMES COLORS INCREASED PRETEND PLAY COMES UP WITH SOLUTIONS TO PROBLEMS BUTTONS 5 years >5 WORD SENTENCES TELLS STORIES KNOWS FANTASY VS. REALITY WANTS TO BE LIKE FRIENDS SINGS AND DANCES DRAWS 6 PART FIGURE 2,100 WORDS Supporting Preschooler Growth & Development SUPPORT IMAGINATIVE PLAY IMAGINARY FRIENDS SUPPORT EXPLORATION ROLE MODEL WANTED BEHAVIORS SUPPORT FRIENDSHIPS EXPLAIN AND HELP DESENSITIZE FEARS DARK MUTILATION SEPARATION LIMIT SUGAR INTAKE EXERCISE ORAL CARE AGE APPROPRIATE SEXUAL EDUCATION (SILBERT-FLAGG, 2022) Promoting Preschooler Safety HOLDING HANDS WHEN CROSSING THE STREET ENCOURAGE THE USE OF A HELMET COMMUNITY SAFETY STRANGERS GOOD AND BAD TOUCH USE A BOOSTER SEAT AND SEAT BELTS WATER SAFETY - LEARNING HOW TO SWIM GUN SAFETY FIRE SAFETY CHILDPROOF MEDICATIONS TOXIC SUBSTANCES (SILBERT-FLAGG, 2022) SCHOOL AGE G&D 6-12 Years (SILBERT-FLAGG, 2022) Industry vs. Inferiority Initiation of independent decision making IMPORTANT ASPECTS OF ASSESSING SCHOOL AGE G&D OBTAIN A THOROUGH HEALTH HISTORY FROM PARENT AND PATIENT (SILBERT-FLAGG, 2022) HEIGHT/WEIGHT ASSESS FOR TYPICAL SCHOOL AGE APPEARANCE/ BEHAVIOR INVOLVE CAREGIVERS DURING ASSESSMENT, BUT PROVIDE PRIVACY IF NEEDED Typical School Age Appearance and Growth Weight gain 3-5 lbs per year Height increases 1-2.5 inches per year Brain growth complete at 10 years IgG and IgA reach adult levels Lymphatic tissue continues to grow HR: 70-100 bpm RR: 15-25 Secondary sex characteristics Permanent teeth (SILBERT-FLAGG, 2022) DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS 12-13 YEARS 9-11 YEARS Males: Prepubertal weight gain Females: Breast bud formation (SILBERT-FLAGG, 2022) 11-12 YEARS Males: Pubic hair, growth of penis and testes, increased perspiration Females: Pubic hair, increased perspiration, growth spurt Males: Penis lengthens, growth spurt Females: Breasts enlarge, axillary hair, onset of menarche* Tanner Staging: Stages 1-5 Determines puberty stage Physical/Motor Development 6-12 years PERMANENT TEETH MATURE VISION SECONDARY SEX CHARACTERISTICS IMPROVED COORDINATION TIES SHOES WRITE LETTERS RIDE BIKE SKATE (DEBOER, 2014) (SILBERT-FLAGG, 2022) Socialization/Cognition/ Senses 6-12 years COMPLETE LANGUAGE DEVELOPMENT CONCEPT OF SPACE AND TIME CONCRETE OPERATIONAL THOUGHT CAN READ AND SPELL MATH STRATEGY GAMES UNDERSTANDS RULES TEAM PLAY PEER INFLUENCE MORALITY (DEBOER, 2014) (SILBERT-FLAGG, 2022) Supporting School Age Growth & Development ANSWER QUESTIONS ABOUT SEXUAL AND PHYSICAL CONCERNS SUPPORT THEIR INTERESTS HONEST AND DESERVED PRAISE ENCOURAGE PROBLEM SOLVING HEALTHY EATING EXERCISE HYGIENE ORAL CARE HELP DESENSITIZE FEARS SCHOOL (SILBERT-FLAGG, 2022) Promoting School Age Safety SEAT BELT USE HELMET AND BIKE SAFETY COMMUNITY SAFETY SEXUAL EDUCATION SWIMMING SAFETY BURNS FALLS SPORTS INJURIES AVOIDANCE OF DRUGS AND ALCOHOL FIREARM SAFETY COPING DURING DISASTER BULLYING (SILBERT-FLAGG, 2022) ADOLESCENT G&D 13-18 Years (SILBERT-FLAGG, 2022) Identity vs. Role Confusion Intimacy vs. Isolation IMPORTANT ASPECTS OF ASSESSING ADOLESCENT G&D OBTAIN A THOROUGH HEALTH HISTORY FROM PATIENT SEPERATELY FROM PARENTS (SILBERT-FLAGG, 2022) HEIGHT/WEIGHT ASSESS FOR TYPICAL ADOLESCENT APPEARANCE/ BEHAVIOR PROVIDE PRIVACY DURING ASSESSMENT Typical Adolescent Appearance and Growth Weight gain varies greatly Males and females grow about 2-12 inches Closure of epiphyseal lines in bones HR: 60-100 bpm RR: 12-20 Androgen stimulation Increase in apocrine sweat gland activity Gain second molars at 13 & wisdom teeth Continuation of Puberty (SILBERT-FLAGG, 2022) Physical/Motor Development 13-18 years RAPID INCREASE IN HEIGHT AND WEIGHT PUBERTAL CHANGES (DEBOER, 2014) (SILBERT-FLAGG, 2022) Socialization/Cognition/ Senses 13-18 years SELF-IMAGE/CHANGING BODY EGOCENTRIC THINKS HYPOTHETICALLY USES PAST EXPERIENCE FOR JUDGEMENT IMPORTANCE OF PEER GROUPS SEXUALITY/DATING (DEBOER, 2014) (SILBERT-FLAGG, 2022) Supporting Adolescent Growth & Development JOBS & EXTRACURRICULAR ACTIVITIES EXPLORE IDENTITY HELP SUPPORT POSITIVE BODY IMAGE BUILD SELF-ESTEEM IDENTIFY RISK BEHAVIORS OFFER GUIDANCE AND SUPPORT KEEP ESTABLISHED BOUNDARIES HEALTHY EATING EXERCISE (SILBERT-FLAGG, 2022) Promoting Adolescent Safety SAFE DRIVING/SEAT BELT USE FIREARM SAFETY SPORTS INJURIES AVOIDANCE OF ALCOHOL AND DRUGS BULLYING SUN EXPOSURE BODY PIERCINGS AND TATTOOS STALKING DEPRESSION/ANXIETY/SELF INJURY/SUICIDE (SILBERT-FLAGG, 2022) QUESTIONS? References American Academy of Pediatrics. (2024, October 15). Safe sleep. Patient Care. https://www.aap.org/en/patient-care/safe-sleep/ DeBoer, S. (2014). Certified pediatric emergency nurse review: Putting it all together (3rd edition). Pedi-Ed-Trics Emegency Medical Solutions. Silbert-Flagg, J. (2022). Maternal and child health nursing: Care of the childbearing and childrearing family (9th edition). Philadelphia: Lippincott Williams & Wilkins.