Child Development Notes

Child development is the period of physical, cognitive, and social growth that begins at birth and continues through early adulthood. This lesson discusses the theories, stages, and major milestones of child development and ends with a quiz to test what you have learned. What Is Child Development? Have you ever wondered how you learned to crawl and then walk? How about language? How in the world do human beings learn to talk? Developmental psychologists seek to answer these types of questions. Child development refers to the process through which human beings typically grow and mature from infancy through adulthood. The different aspects of growth and development that are measured include physical growth, cognitive growth, and social growth. Child development focuses on the changes that take place in humans as they mature from birth to about age 17. Theories of Child Development Throughout history, there have been many theories on how we develop throughout childhood. Some of the most recognized include those developed by Sigmund Freud, Erik Erikson, and Lev Vygotsky. Sigmund Freud devised a psychosexual stage theory of development. He believed that children move through specific stages of development due to innate unconscious sexual drives. Freud's stage theory ends at adulthood. Erik Erikson also created a stage theory of development, but his is a bit different from Freud's. Erikson focused more on social relationships as a driving force in development and referred to the developmental tasks as psychosocial stages. Erikson's theory is one of the most comprehensive and covers human development from birth through old age. Lev Vygotsky's theory of development also focuses on social interactions as important in development. His theory views children in an apprentice role with parents mentoring them through developmental tasks. Stages of Child Development: Infancy Most everyone agrees that babies are cute, but what is going on with babies developmentally? The period of infancy begins at birth and ends at two years of age. It's the most rapid period of growth throughout the lifespan. During this period of child development, human beings go from being helpless, reflexive babies to toddlers who can communicate and reason. Specific physical milestones during this period include rolling over, sitting up, crawling, and walking. Fine motor development takes longer to develop, which is why babies generally cannot write or create refined drawings. Cognitive milestones include early problem solving and increased sensory awareness and perception. Social milestones that usually occur during this period include the development of a sense of selfawareness, or that prior to the age of 12 months, we really do not understand that we exist apart from our mothers or other caregivers. Stages of Early Development: Early Childhood When we think of early childhood, we usually think of ABCs and 123s. This period of early childhood development lasts from two years of age through six years of age. Physically, our center of gravity shifts from the breastbone, where it was when we were infants, to the belly button. Our physical growth occurs much more slowly during this period as compared to the rapid growth that took place during infancy. We also increase dramatically in our fine and gross motor skills and are now able to run, jump, climb, and balance. We can also write letters and create very detailed drawings due to fine motor development. Cognitive processing speed increases, which allows us to advance in thinking, reasoning, and problem-solving, as well as master our native language. Social development advances as we learn to understand our own emotions and those of others; our earliest playmates tend to be chosen based on availability. Neonates are a specialized cohort of patients requiring an individualized approach in nursing care. The four major components of neonatal nursing care are keeping them warm, pink, sweet and calm. Goals of care include the following: minimizing stress conserving energy and enhancing recovery promotion of growth and well being protecting sleep pattern Aim To provide safe care of a neonate on the ward, when there is no requirement for a Neonatal Intensive Care Unit (NICU) bed. Definition of Terms Neonate: An infant, less than 28 days old Term baby: 37- 41 weeks gestational age Convection: Loss of heat to air currents Conduction: Loss of heat to object in direct contact with infant Evaporation: Loss of heat by evaporation of water from the skin or respiratory tract Radiation: Loss of heat to nearby cold, solid surfaces mPAT: Modified Pain Assessment Tool FLACC: Face, Legs, Activity, Cry and Consolability WAT: Withdrawal Assessment Tool Neutral Thermal Environment: An environment in which the infant has a minimal metabolic rate, meaning oxygen consumption and energy expenditure are minimal. A Registrar or Consultant should assess the neonate and consider the neonate to be stable for ward care, and not requiring a Butterfly ward bed prior to the ward accepting care for the neonatal patient. A Registrar or Consultant should assess the neonate and consider the neonate to be stable for ward care, and not requiring a Butterfly ward bed. Observations and Monitoring Baseline and ongoing observations should occur as per the Clinical Guideline (Nursing) Observation and Continuous Monitoring and Clinical Guideline (Nursing): Nursing Assessment. The Neonate needs to be admitted onto the monitor profile so that alarm limits are specific to age and weight. For Neonatal patient’s particular attention should be placed on the following aspects of assessment: Temperature The normal temperature of a neonate ranges from 36.5oC - 37.2oC Temperatures measured per axilla every 4 hours, unless febrile or hypothermic. A medical review and full septic work up should be considered for any neonate with a temperature > 38oC A full septic work up includes: Lumbar Puncture, sterile urine culture (Suprapubic Aspirate (SPA) or by insertion of urinary catheter), Blood Cultures, Full Blood Examination, CRP and Chest X-ray. Please refer: Clinical Practice Guideline: Suprapubic Aspirate A temperature of ≤36.5oC is considered hypothermic and a medical review is required. An extra layer (clothing/blanket) should be added and the temperature should be repeated hourly. If the temperature remains at 36.5oC or below, the neonate should be considered for transfer to an incubator. Please refer to the Policy and Procedures : Isolette Use in Paediatric Wards Hourly temperatures should be checked until there are two consecutive temperatures equal to or greater than 36.6oC For more information Please refer to the: Clinical Guideline (Nursing): Temperature Management Clinical Guideline (Nursing): Thermoregulation in the Preterm Infant SEPSIS assessment and management Neutral Thermal Environment Neonates are particularly vulnerable to heat loss via convection, conduction, evaporation and radiation. Therefore ensure: They are dressed appropriately with a singlet, jumpsuit, socks, wrap, blanket and hat. Maintain bed 1 metre distance from window and avoid drafts. Minimal handling and clustering of cares. Clinical Practice Guidelines: Minimal Handling Consider the need to use an overhead radiant warmer to regulate temperature. There are two modes: manual and servo. The Manual control should only be used for bed warming and not when patient is in the cot. The servo control should be used to maintain patient’s temperature and prevent overheating. Clinical Guideline Nursing: http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Temperature_ Management/ Consider transfer to an incubator (Isolette) if neonate is hypothermic Policy and Procedures: Isolette Use in Paediatric Wards Transfers If a neonate needs to be transferred between departments, appropriate measures to maintain their temperature need to be ensured. As per RCH Policy and Procedures : Isolette Use in Paediatric Wards consider using isolettes/ incubator for neonates, immediately post operatively for a stabilisation period as per criteria (4-24 hours) Neonates returning from theatre to the wards need to have a temperature of ≥36.5, prior to leaving the department. Prior to transfer, any potential or active risks for infectious diseases should be advised to the receiving unit to maintain appropriate precautions and use of personal protective equipment for infection control. Pain Assess pain using mPAT or FLACC scale Assess withdrawal using WAT or NAS scoring, if appropriate For information regarding the mPAT Refer to: Clinical Guideline (Nursing) : Neonatal Pain Assessment, Further information regarding FLACC scale can be found via Clinical Guideline (Nursing) Pain Assessment and Measurement For more information regarding the management of procedural pain for infants please refer to: Clinical Guideline (Nursing): Sucrose oral for procedural pain management in infants. Blood Sugar Level A blood sugar level should be measured on admission for all sick neonates. Further BSL frequency dependent on: Severity of illness Risks of hypoglycaemia Clinical signs of hypoglycaemia Changes made to glucose infusions Please refer: Clinical Guidelines (Nursing): Neonatal Hypoglycaemia Enteral Intake Establish feeding routine and history: breast fed, EBM, formula fed, or on nasogastric tube feeds Assess the most appropriate feeding method (oral/nasogastric) Strict recording of enteral input including duration of breast feeds and pre and post weights and/or, formula volumes and/or EBM volumes should be recorded. If the neonate is too unwell to feed, breast-feeding mothers should be supported to express and store their breast milk. For further information please see the Clinical Guideline (Nursing): Breast Feeding Support & Promotion. If poor oral intake, the neonate needs to be assessed for insertion of a nasogastric tube or commencement of IV fluids. The following table shows suggested feeding volumes by age, however this table is an approximate guide only and requirements will differ according to gestational age and disease process. Newborn care covered in basic VHT training. ● Emphasize the importance of facility deliveries. ● Record births that take place at home. ● Identify and record newborn danger signs (difficulty breathing, weakness, fever, difficulty feeding, umbilical cord is red or discharging pus, convulsions, and vomiting). ● Encourage routine postnatal checks at the health facility at 6 hours, 6 days, and 6 weeks after birth. ● For babies born at home, practice immediate essential newborn care (dry the baby, wrap the baby, ensure that breastfeeding is initiated, check for danger signs every 1 hour, and refer if needed). ● Make home visits to the newborn after delivery: first visit within the first day after delivery, second visit on the third day after delivery, and third visit on the seventh day after delivery. ● Advise the mother and the family on healthy newborn and maternal practices, including early and exclusive breastfeeding, thermal care, clean and dry cord care, immunizations, skin to skin care, and extra breastfeeding support for small babies. Newborn care instruction provided during iCCM training. ● Initiate breastfeeding soon after delivery within 1 hour and breastfeed exclusively. ● Delay the first bath, and wrap baby in warm clothing to prevent low body temperature. ● Recognize very small babies and give extra care. ● Mothers and other caregivers should always wash hands before breastfeeding or handling the baby. ● Check on the cord regularly and ensure that it is clean and dry. ● Follow-up of the newborn in the community by the VHT member. ● Make home visits to the newborn after delivery: first visit within the first day after delivery second visit on the third day after delivery, and third visit on the seventh day after delivery. ● VHT should take opportunities such as child health days to actively look for sick newborns. The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby. A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions. (NICU) Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life: ● The lungs must breathe air. ● The cardiac and pulmonary circulation changes. ● The digestive system must begin to process food and excrete waste. ● The kidneys must begin working to balance fluids and chemicals in the body and excrete waste. ● The liver and immunologic systems must begin functioning independently. Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available. What is the neonatal intensive care unit? Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital. Some newborn babies will require care in a NICU, and giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby. Which babies need special care? Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. In the U.S., nearly half a million babies are born preterm, and many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU. The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following: ● Maternal factors: ○ Age younger than 16 or older than 40 years ○ Drug or alcohol exposure ○ Diabetes ○ Hypertension (high blood pressure) ○ Bleeding ○ Sexually transmitted diseases ○ Multiple pregnancy (twins, triplets, or more) ○ Too little or too much amniotic fluid ○ Premature rupture of membranes (also called the amniotic sac or bag of waters) ● Delivery factors: ○ Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen) ○ Breech delivery presentation (buttocks delivered first) or other abnormal presentation ○ Meconium (the baby's first stool passed during pregnancy into the amniotic fluid) ○ Nuchal cord (cord around the baby's neck) ○ Forceps or cesarean delivery ● Baby factors: ○ Birth at gestational age less than 37 weeks or more than 42 weeks ○ Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces) ○ Small for gestational age ○ Medication or resuscitation in the delivery room ○ Birth defects ○ Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing) ○ Infection such as herpes, group B streptococcus, chlamydia ○ Seizures ○ Hypoglycemia (low blood sugar) ○ Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications ○ Need for special treatment or procedures such as a blood transfusion Who will care for your baby in the NICU? The following are some of the specially trained health care professionals who will be involved in the care of your baby: ● Neonatologist. A pediatrician with additional training in the care of sick and premature babies. The neonatologist supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU. ● Respiratory therapists ● Occupational therapists ● Dietitians ● Lactation consultants ● Pharmacists ● Social workers ● Hospital chaplains The members of the NICU team work together with parents to develop a plan of care for high-risk newborns. Ask about the NICUs parent support groups and other programs designed to encourage parental involvement. Summary of tuesdays notes The knowledge and understanding of the development of the sensory systems in the fetus, neonate, and infant have progressed and grown extensively in the past twenty to thirty years. This has been a result of the advances in technology for study of brain development and the sensory systems specifically. While the basic physcial structure of the sensory receptors (i.e. eyes, ears etc.) develops early in gestation, most of the neurosensory development occurs in the last sixteen to twenty weeks. The neurological processes are not accelerated by preterm birth. Preterm birth accelerates the maturation of the kidney, gastrointestinal, lung and cardiovascular function but does not alter the sequence or timing of neurodevelopment. The stresses and the environment of the Newborn Intesive Care Unit (NICU) play a major role in the altered neurodevelopment observed in preterm infants. The brain development in the fetus, neonate, and infant includes not just sensory systems but motor systems, social/emotional systems, and the cognitive systems. These systems are connected and integrated during development. The development of the brain, both structure and function, is shaped by the influence of four major factors or processes. These inlude (1) the genetic endowment and the epigenetic effects from the environment, (2) the endogenous or internal brain activity and sleep, (3) external experiences and stimulation of the sensory organs, and (4) the physical, chemical, sensory, and social/emotional environments. These factors operate on and influence the development of each of the brain systems. These effects depend on age and developmental level of the particular system. Many of the processes and stimulations needed to facilitate brain development can result in adverse effects if exposure is at the wrong time in development or the level of intensity is not appropriate. The NICU inviroment can have very adverse consequences for healthy nuerodevelopment. It is essential that the invironment of the fetus, neonate, infant be adapted and managed to provide for the healthy early brain development. This requires both a developmentally, supportive environment and developmentally appropriate care practices. Typically, the term "baby" might be used to refer to any child from birth to age 4. Newborn usually refers to babies from birth to about two months of age. Infants are babies from two months to one year old. Toddlers are babies from one year to four years of age. Others may have different definitions of these terms. For example, some people may consider toddlers to be 18 months old to 3 years old, and a 4-year-old might be considered a preschooler. Merriam-Webster dictionary simply says a newborn is a baby who is recently born and does not put an upper limit to the term. The dictionary also defines an infant as a child in the first stage of life but doesn't give any age specifics. The World Health Organization (WHO) defines a newborn, or neonate, as a baby under 28 days old. As the name implies, a toddler is classically defined as a child who is just learning to walk or one who toddles. This is often around one year of age. There's no official definition of the upper limit of toddlerhood. However, most people consider the end of the toddler age to be around the time a child is ready to transition into preschool. For Expectant Parents or Parents of Newborns 6 Ways to Soothe a Fussy Baby Essential Products for Newborns Products You Don't Need for Newborns 8 Cool Cradles for Baby For Parents of Infants High Chair Safety Tips 7 Amazingly Chewy Teething Toys 6 Super Fun Play Saucers for Baby How to Choose a Baby Safety Gate For Parents of Toddlers 8 Great Feeding Accessories for Toddlers When Is It Safe to Switch to a Booster Seat? The Best Potty Seats for Toddlers Furniture Tip-Over Risks and Prevention Built-In Nightlights for Your Toddler's Room Newborn: 0–28 days Baby/Infant : 1–12 months Toddler: 1–3 years Pre-schooler: 3–5 years Grade schooler: 5–12 years Child: 0–18 years A newborn truly refers to the first day of life, but can refer to the first couple of days. A neonate refers to the first 28 days of life and an infant is categorized as 1 month to 12 months old. Unless the child is born in February, I guess there is no technical classification when they are 29 days old, I just find that part funny. So to recap Newborn -1st 24hrs Neonate 0-28days Infant 1-12 months Hope this helps Umbilical Cord ● Do not remove manually ● IT will fall of on it own in about 2 weeks ● Make sure you clean it Face It's disconcerting to see a newborn with a red, blotchy face, but baby acne is a common and harmless condition. Care tip: Wash your baby's face daily with a mild baby soap. Eyes Some babies have a yellowish discharge or crusting in the eye or on the lid, which is usually caused by a blocked tear duct. This condition can last several months. Care tip: Wipe the area using a cotton ball moistened with warm water. Scalp Many newborns develop a scaly scalp condition called cradle cap. It typically disappears in the first few months. Care tip: Wash your baby's hair with a gentle baby shampoo no more than three times a week and gently brush out the scales daily using a baby hairbrush or soft toothbrush. Nose Babies' narrow nasal passages tend to fill with mucus. Care tip: Gently unclog nostrils with an infant-sized nasal bulb syringe or try the traumaminimizing Nosefrida. To loosen mucus, insert saline solution with an eyedropper before suctioning. Nails A newborn's nails usually are soft, but they can scratch his sensitive skin. Care tip: Use baby nail clippers or blunt-nosed scissors. Clip after his bath when nails are soft, or when he's asleep and his fingers are relaxed. Skin Some babies develop red, itchy patches called eczema or atopic dermatitis—an inheritable skin condition. Care tip: Limit baths to 10 minutes, and use a mild, fragrance-free soap and lukewarm water; liberally apply hypoallergenic skin cream immediately afterward. Stick to cotton clothing. Bottom Too much moisture plus sensitive skin can equal diaper rash for many babies. Care tip: Change diapers frequently. Rinse your baby's bottom with water during each change and blot dry. Avoid using wipes; they may irritate skin. Barrier creams, such as petroleum jelly or white zinc oxide, may help. Umbilical cord Keep the umbilical cord stump clean and dry; it will shrivel and fall off within a few weeks. Care tip: Avoid covering the cord area with a diaper and stick to sponge baths until the stump detaches. Circumcision The tip of the penis will be swollen, and a yellow scab will appear. Care tip: Gently clean the genital area with warm water daily. Use petroleum jelly to protect the site and prevent the penis from sticking to a diaper. Legs Newborns' legs are bowed out and the feet are turned in, which is no surprise, given their previous cramped living quarters. Care tip: Don't worry about it—your baby's legs and feet will straighten in anywhere from six to 18 months. Feet Newborns' toes frequently overlap and the nails look ingrown (but aren't). Care tip: Don't sweat it—this appearance is perfectly normal. Newborn-Reflexes What reflexes should be present in a newborn? Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as part of the baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the normal reflexes seen in newborn babies: ● Root reflex. This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow and "root" in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding. ● Suck reflex. Rooting helps the baby become ready to suck. When the roof of the baby's mouth is touched, the baby will begin to suck. This reflex does not begin until about the 32nd week of pregnancy and is not fully developed until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Babies also have a hand-to-mouth reflex that goes with rooting and sucking and may suck on fingers or hands. ● Moro reflex. The Moro reflex is often called a startle reflex because it usually occurs when a baby is startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends out the arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her and trigger this reflex. This reflex lasts about 5 to 6 months. ● Tonic neck reflex. When a baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. This is often called the "fencing" position. The tonic neck reflex lasts about 6 to 7 months. ● Grasp reflex. Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp reflex lasts until about 5 to 6 months of age. ● Babinski reflex. When the sole of the foot is firmly stroked, the big toe bends back toward the top of the foot and the other toes fan out. This is a normal reflex up to about 2 years of age. ● Step reflex. This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface.