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Growth & development nurs 3340 fall 2014 slideshare Growth & development nurs 3340 fall 2014 slideshare Presentation Transcript

  • Growth & Development Joyce Buck, MSN, RN-C, CNE Joy A. Shepard, PhD(c), RN-C, CNE 1
  • Objectives • Describe principles, patterns, and rates of growth and development • Describe major developmental theories • Plan for the nursing management of children with learning and intellectual disabilities • Describe the nursing role in prevention and treatment of child abuse and neglect • Summarize major nutritional concepts pertaining to the growth and development of children • Describe nursing interventions for children who are overweight or obese • Plan care for the child with an inherited biochemical abnormality 2
  • Nursing Diagnoses • Delayed Growth & Development • Readiness for Enhanced Parenting • Readiness for Enhanced Family Processes • Compromised Family Coping • Dysfunctional Family Processes • Caregiver Role Strain • Risk for Impaired Parenting • Risk for Injury • Imbalanced Nutrition: More than body requirements • Imbalanced Nutrition: Less than body requirements • Sedentary Lifestyle 3 View slide
  • 4 Principles of Growth & Development View slide
  • Growth • GROWTH-  in physical size of a structure or whole (Quantitative) • 2 PARAMETERS • WEIGHT- most sensitive • Birth weight: 2X by 6 mos • 3x by 1 yr • 4X by 2 yrs • LENGTH/ HEIGHT •  1.5 cm/ mo 1st 6 mos •  1 cm/ mo. 7-12 mos • Ave.  in ht. during 1st yr is 50% • Approx. ½ of adult ht. at 2 yrs 5
  • Development • DEVELOPMENT- in the skills or capacity to function (Qualitative) • How to Measure Development • By simply observing a child doing specific task • By noting parent’s description of the child’s progress • By comparing child’s performance to developmental milestones • By Denver Developmental Screening Tool (DDST) • DDST 4 Main Rated Categories • Language • Personal-Social • Fine Motor Adaptive • Gross Motor Skills 6
  • Maturation • MATURATION- synonymous with development , also known as READINESS • COGNITIVE DEVELOPMENT- is the ability to learn (to change behavior) and understand from experience, to acquire and retain knowledge, to respond to a new situation and to solve problems • Basis of Intellectual Disability • IQ= mental age X 100 chronological age • 0-20 profound intellectual disability (infant) • 20-35 severe (0-2 yo) • 35-50 moderate (2-7 yo) trainable • 50-70 mild (7-12 yo) educable • 70-90 borderline • 90-110 normal (average IQ) •  130 gifted 7
  • Basic Divisions of Life • 1st Stage- Prenatal (from conception to birth) • 2nd Stage- Infancy • Neonatal: 1st 28 days of life • Infancy: Birth to 12 months • 3rd Stage- Early Childhood • Toddler: 1-3 yrs • Preschool: 3-6 yrs • 4th Stage- Middle Childhood • School age: 6-12 yrs 8
  • Principles of Growth & Development 1. Growth and development is a continuous process (from womb to tomb) 2. Not all parts of the body grow at the same time or at the same rate (Principle of Asynchronism) 9
  • Patterns of Growth & Development • Renal, GI track, Musculoskeletal, Cardiovascular- fairly smoothly during childhood • CNS- rapidly at 1-2 yrs • Immune System- rapidly during infancy and childhood • Tonsils: adult proportion by 5 yrs • Reproductive System- rapidly during puberty 10
  • Rates of Growth & Development • Fetal and Infancy- most rapid • Toddler- slow • Preschool- alternating rapid and slow • School age- slower • Adolescent- rapid 11
  • Each Child is Unique • 2 Primary Factors • Heredity (Non- modifiable) or “Nature” • Race • Intelligence • Sex • Nationality • Environment (Modifiable) or “Nurture” • Quality of Nutrition • Socioeconomic status • Health • Ordinal position in the family • Parent-child relationship 12
  • Directional Trends • Growth and Development occurs in a regular direction reflecting a definite and predictable patterns or trends • DIRECTIONAL TRENDS- occurs in a regular direction reflecting the development of neuromuscular functions: these apply to physical, mental, social and emotional developments • Cephalocaudal: “ head to tail”. It occurs along body’s long axis in which control over head, mouth and eye movements and precedes control over upper body torso and legs. • Proximodistal: from center of the body to extremities (e.g. baby uses whole arm in crawling then hand pincers) • Symmetrical: each side of the body develop on the same direction at same time and rate • Mass-Specific (Differentiation): the child learns from simple operations before complex functions or move from a broad general pattern of behavior to a more refined pattern (e.g., crying infant suggests wet diaper, hunger, thirst or pain until can use words for milk etc.) 13
  • 14
  • Sequential Trends, Secular Trends • SEQUENTIAL TRENDS- involves a predictable sequence of growth and development to which the child normally passes a) Locomotion b) Language and social skills • SECULAR TRENDS-refers to the worldwide trend of maturing earlier and growing larger as compared to succeeding generations 15
  • Behavior & Play • BEHAVIOR is the most comprehensive indicator of developmental status • PLAY is the universal language of the child • A great deal of skill and behavior is learned by PRACTICE • There is an optimum time for initiation of experience or learning 16
  • Infant Primitive Reflexes • Infant primitive reflexes must be lost first before development can proceed (e.g., spitting/extrusion reflex must be overcome before infant can be fed with solid foods; tonic neck reflex must be diminished before the infant can turn over) • REFLEXES- different involuntary reactions to specific forms of stimulation • Importance: • For neonate’s survival (e.g., feeding reflexes: rooting, sucking, swallowing; protective reflexes: blink, gag, cough, Moro) • Reflects how well CNS is functioning • Forms the basis for later, more sophisticated behavior • (Specific infant primitive reflexes covered in Newborn Lecture) 17
  • 18 Theories of Development
  • Theories of Development • Developmental Task: • Skill or growth responsibility arising at a particular time in the individual’s life • Successful achievement provides a foundation for the accomplishments of the future tasks • Freud: Psychosexual Theory • Erikson: Psychosocial Theory • Piaget: Cognitive Theory • Kohlberg: Theory of Moral Development 19
  • Psychosexual Theory/ Psychoanalytic Theory • Sigmund Freud (1856-1939) – an Austrian neurologist, founder of psychoanalysis • Libido (sexual energy) goes to one part of the body to another where it is responsible for survival • 5 PHASES • 1. ORAL- (Birth-12 mos) Infant • mouth- site of gratification • Activity: biting, sucking, crying (for enjoyment and release of tension) • Never discourage thumb sucking • Offer pacifier when NPO • ID- source of all drives; present at birth; striving for gratification of needs • EGO- for reality testing and problem solving, develops at 4-5 mos. When infant begins to see self separate from mother (development of sense of self) 20
  • Psychosexual Theory Cont’d…. • 2. ANAL-(1-3 yrs) Toddler • anus- site of gratification where elimination takes place • Principles in Toilet Training: • “Holding on”- child wins, becomes stubborn or antisocial • “Letting go”- mother wins, child becomes obedient, kind, perfectionist, obsessive-compulsive • 3. PHALLIC-(3-6 yrs) Preschool • genitalia- site of gratification •  knowledge on 2 sexes , exhibitionism is normal • Accept child fondling his/her genitalia as normal area of exploration • Answer child’s questions directly • SUPEREGO is a necessary part of socialization develops at 3-6 yrs; includes internalization of values, ideas and moral standards of parents and society; development of CONSCIENCE 21
  • Psychosexual Theory Cont’d…. • 4. LATENT-(6-12 yrs) School Age • Period of suppression, no obvious development • Help child achieve positive experiences so that he/she will become ready to face the conflicts of adolescence • • 5. GENITAL- ( 12yrs) Adolescent • Focused on sexuality • Developing sexual maturity; learning how to establish a satisfactory relationship with opposite sex 22
  • Psychosocial Theory • Erik Erikson (1902- 1994) - trained in psychoanalysis theory • Focuses on psychosocial tasks that are accomplished throughout the life cycle • Stresses the importance of culture and society to the development of one’s personality • Unsuccessful resolution of psychosocial crisis leaves the individual emotionally handicapped • 8 Stages 23
  • Psychosocial Theory Cont’d…. • 1. Trust vs Mistrust (Birth to 1 year) *Feeding • Foundation of all psychosocial tasks • Psychosocial Theme: “To give is to receive” • Developed by: • Satisfying needs at all times: feed upon demand (because stomach capacity is low and baby easily gets hungry • Parental caring must be consistent and adequate • Giving an experience that will add to security (e.g. touch, hugs and kisses, eye-to-eye contact, soft music) • 2. Autonomy vs Shame and Doubt (1-3 yrs) Toddler *Toilet Training • If everything is planned or done for the child, autonomy is not developed • Developed by: • Giving opportunity for decision-making, offering choices, rather than judge • Setting limits is the parents’ moral obligation 24
  • Psychosocial Theory Cont’d…. • 3. Initiative vs Guilt (3-6 yrs) Preschool *Doing basic things • Guilt: anger turned inward • See play as work and take it seriously, if failed the child cry so much • Developed by: • Giving opportunity to explore new places and events • Provide activities that can enhance imagination, creativity and fine motor skills e.g. modeling clay, finger painting • If child fails in a play, don’t say “It’s just a game”, instead encourage child to accept defeat and to do his/her best next time 25
  • Psychosocial Theory Cont’d…. • 4. Industry vs Inferiority (6-12 yrs) School age *School • Learns how to do things well • Developed by: • Giving opportunity on short assignments and projects • 5. Identity vs Role Confusion (12-18 yrs) Adolescent *Peers • Learns who he/she is, what kind of person will he/she become by adjusting to new body image • Emancipation from parents: liberation/freedom 26
  • Psychosocial Theory Cont’d…. • 6. Intimacy vs Isolation (19-40 yrs) Young Adult *Love • Looking for lifetime partners, career-focused • 7. Generativity vs Stagnation (40-65 yrs) Middle Adult *Parenting • 8. Ego Integrity vs Despair (65 yrs) Late Adult *Reflection 27
  • Cognitive Theory • Jean Piaget (1896- 1980)- Swiss Psychologist • Defines cognitive acts as ways in which the mind organizes & adapts to its environment • SCHEMA- individual’s framework of thought • 4 Stages of Cognitive Development 28
  • Stages of Cognitive Development: Sensorimotor • Sensorimotor (Birth-2 yrs): “Practical Intelligence”, words and symbols not yet available 29 A. SCHEMA AGE BEHAVIOR Neonatal Reflex/ Stimulus Response 1 mo All reflexes Primary Circular Reaction 1-4 mos Activities r/t body, discover persons, no object permanence, repetition of behavior Secondary Circular Reaction 4-8 mos Activities not r/t body, object permanence, memory traces present, anticipate familiar events Coordination of Secondary Circular Reaction 8-12 mos Exhibit goal-directed activities,  sense of permanence Tertiary Circular Reaction 12-18 mos Use trial and error in discovering places and events, space and time perception Invention of new means thru mental combination 18-24 mos Invent new means by active experimentation, Transitional phase to Preoperational thought period
  • Stages of Cognitive Development: Preoperational Thought • Preoperational Thought (2-7 yrs) 30 SCHEMA AGE BEHAVIOR Preconceptual 2-4 yrs Thinking basically complete, literal and static Concept of time: NOW Concept of distance: what can be seen ANIMISM- inanimate object has life SYMBOLIC PLAY Irreversibility of thinking Intuitive 4-7 yrs Beginning of causation Egocentric in play, thought and behavior Unidimensional classification (texture, color, length one at a time)
  • Stages of Cognitive Development: Concrete Operational Thought • Concrete Operational Thought (7-11 yrs) • BEHAVIOR • Find solution to everyday problems with systematic reasoning • Concept of REVERSIBILITY • Concept of CONSERVATION • Cooperative Interaction- relates own point of view with others • Activity: Collecting • Multidimensional classification 31
  • Stages of Cognitive Development: Formal Operational Thought • Formal Operational Thought (11 yrs) • BEHAVIOR • Cognition achieved its final form • Solve hypothetical problems with scientific reasoning • ABSTRACT THINKING and mature thought • Concept of time: past, present and future • Activity: Talk time- sort out opinions and current events 32
  • Theory of Moral Development • Lawrence Kohlberg (1984) – recognized the theory of moral development as considered to closely approximate cognitive stages of development • Not all persons may reach all stages; may be fixated in one stage 33
  • Stages of Moral Development STAGE DESCRIPTION Premoral/Amoral or Pre- religious (Birth to 4 yrs) Not concerned with what is right or wrong Preconventional (4 to 7 yrs) Punishment/ obedience orientation (heteronomous morality). Child does right because parents tell him/her to and to avoid punishment Individualism. Instrumental purpose and exchange. Carries out action to satisfy own needs and rather than society. Will do something for another if that person do something for the child (“Do for me and I do for you”) Conventional (7 to 11 yrs) Orientation to interpersonal relations of mutuality. Child follows rules because of a need to be a “good” person in own eyes and the eyes of others (“Good boy, Nice girl social concept”) Maintenance of social order, fixed rules and authority. Child finds following rules satisfying. Follows rules of authority figures as well as parents in an effort to keep the “system” working (“Law and Order Orientation”) Post Conventional (12 yrs and Older) Social contract, utilitarian law- making perspectives. Follows standards of society for the GOOD OF ALL people Universal ethical principle orientation. Follows INTERNALIZED STANDARDS of conduct 34
  • 35 Learning & Intellectual Disabilities
  • Learning & Intellectual Disabilities (pp. 933-939) • Learning disability: normal intelligence, but has difficulty learning in a typical manner • Brain cannot receive or process information in the normal manner • 5-10% school-age children • Affects many parts of a child's life: school, daily routines, family life, and sometimes even friendships and play • Common types: dyslexia, dyscalculia, dysgraphia, dyspraxia 36
  • Learning & Intellectual Disabilities Cont’d… • Intellectual disability (NOT “mental retardation”) • Limitation in intellectual functioning, adaptive behavior • Differences in conceptual, social, and adaptive skills, before age 18 yrs • IQ below 70 to 75 • Adaptive functioning deficits in at least two areas (e.g., communication, self-care, social/ interpersonal skills, academic skills, or work) • Etiology: prenatal development of CNS, postnatal changes or external forces leading to CNS damage 37
  • Down Syndrome (p. 934) • Trisomy 21: Chromosomal alteration (aneuploidy) • Extra chromosome (47 instead of 46) • 3 chromosomes 21 • Most common chromosomal condition in US • 5,500 infants each year; 1 in 800 infants • Syndrome: umbrella term with characteristic features and anomalies of several organs • Poor muscle tone, flattened face, single palmar crease, almond-shaped eyes that slant up, protruding tongue, short neck, low-set ears • IQ in mildly-to-moderately low range; developmental delays (e.g., slower to speak than other children) • At risk for: congenital heart defects, hearing loss, otitis media, obstructive sleep apnea, strabismus, Hirschsprung disease, thyroid disease, leukemia, Alzheimer’s disease 38
  • 39
  • Nursing Management for Children with Disability • Developmental approach rather than a chronological one • Assess the child for developmental milestones • Assess the child for adaptive functioning (ability to effectively interact with society on all levels and care for one's self) • Assess functioning and coping of ALL family members • Facilitate early intervention • Partner with the family and multidisciplinary team • Open communication • Parents are an ESSENTIAL part of “the team” • Observe how the family is managing (parents are often stretched to the limit) • Collaboration is a MUST – need well-coordinated, seamless plan of care • Goal: accessible, continuous, comprehensive, family- centered, coordinated, compassionate, and culturally effective care 40
  • Nurse’s Role with Families of Children with Disabilities • Assessment • Strengths and focus on abilities (not disabilities) • Support • Accept reactions and encourage expression of feelings • Identification of resources • Discuss realistic Goal Setting • “Child First” language • A child with Down syndrome, NOT a Down syndrome child 41
  • 42 Child Maltreatment
  • Child Maltreatment (pp. 455-462) • Physical, emotional, or sexual • Abuse or neglect • “Non-accidental trauma” • Nurses are legally required to report • Suspicions, signs of abuse • Children as victims • Abandonment, hazing, bullying, domestic violence, dating violence, Munchausen's syndrome by proxy
  • Table 17-7 Methods of Physical Abuse in Children (p. 456)
  • Munchausen Syndrome by Proxy (pp. 461-462) • Fabrication of signs and symptoms of a health condition in a child; potentially deadly form of child abuse • Occurs most often in parent-child relationships; mothers most often perpetrator; victim usually under 6 yrs • Unexplained, recurrent, or extremely rare conditions; illness unresponsive to treatment; symptoms change frequently; history and clinical findings inconsistent; symptoms occur in presence of same caretaker, disappear when child is separated from caretaker • Diagnosis: difficult because perpetrator is expert at faking illness; must carefully review health records, talk with friends or family • Mandatory reporting to Child Protective Services & law enforcement; child placed in safe environment 45
  • Psychological Maltreatment • Not all abuse is physical! • Psychological maltreatment • Occurs when parents or other caretakers harm children’s behavioral, cognitive, emotional, or physical functioning • May take form of neglect in which parents may ignore or act emotionally unresponsive • Not as easily identified without outward physical signs 46
  • What are Consequences of Psychological Maltreatment? • Some children survive and grow into psychologically healthy adults • Others suffer long-term damage • Low self-esteem, depression, suicide • Lying • Misbehavior • Underachievement in school • Criminal behavior 47
  • Range of Abuse and Maltreatment of Children in the US 48
  • Risk Factors Common in Families with Child Victims of Violence • Poverty • History of mental illness, domestic violence, incarceration, or substance abuse in the home • Family stresses (e.g., single-parent households, high levels of marital discord) • Inadequate child care or supervision • Inadequate family social support • Gang membership in family or neighborhood • High exposure to media violence • Children with chronic illnesses and special health care needs • Child hyperactivity or other developmental behavior disorders
  • True or False? •Child abuse can occur in any home or child care setting 50
  • Table17-6 RiskFactorsforChildAbuseandNeglect
  • Nursing Interventions & Goals • Assess the family for ineffective coping and the potential for abuse • Make appropriate referrals to support services such as mental health counseling, social services, and respite • Work with family to: • Understand present and future risks • Change social and physical environment • To achieve goals: • Educate families, connecting them with resources • Plan measurable behavior changes
  • Difference is the key... Dramatic changes or shifts in behavior without logical explanation warrant inquiry 53
  • 54 Nutrition
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  • 56
  • Calorie Requirements 57
  • Infant Feeding: Breast is Best! 58
  • Formula Feeding 59
  • Unsuitable Milk for Babies Under 1 Year…. 60
  • Guide to Formula Infant Feeding 61
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  • 67 Childhood Obesity
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  • Childhood Obesity Epidemic (p. 348) • 33% of children in the US are overweight or obese • Associated with a wide array of health problems, as well as depression & low self- esteem • Helps bring on during childhood many of the chronic diseases of middle age and old age: • Type II Diabetes in youth, stroke, cardiovascular disease, hypertension, dyslipidemia, gallbladder disease, osteoarthritis, respiratory problems (e.g. obstructive sleep apnea) 70
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  • Evaluation Overweight Child 72
  • Acanthosis Nigricans 73
  • Evaluation of Nutrient Intake 74
  • Goals of Weight Management 75
  • Early Intervention: Healthy Food Choices, Active Lifestyle • Early diagnosis with interdisciplinary monitoring and appropriate interventions along with healthy food choices beginning in childhood and an active lifestyle are the keys to better health and a longer life • See Nursing Care Plan: The Child Who is Overweight, pp. 350- 352 76
  • 77 Inborn Errors of Metabolism
  • Inborn Errors of Metabolism (pp. 1023-1026) • Large class of genetic diseases involving disorders of metabolism • Body cannot properly turn food into energy • Caused by defects in specific proteins (enzymes) that help break down (metabolize) parts of food • Manifestations usually occur within days or weeks of birth • Untreated: irreversible organ damage, life- threatening problems, coma, death • North Carolina Newborn Metabolic Screening: phenylketonuria, galactosemia, maple syrup urine disease (among other conditions) 78
  • Phenyketonuria (pp. 1023-1024) • Autosomal recessive inheritance pattern • Missing an enzyme (phenylalanine hydroxylase), which is needed to properly break down phenylalanine • Untreated: irreversible brain damage, severe intellectual disability • Clinical manifestations: lighter skin, hair, and eyes; “mousy” or “musty” odor; irritability; vomiting; hyperactivity, hypertonia, and hyperreflexia; seizures and jerking motions; skin rashes • Treatment: special formula (Lofenalac); low phenylalanine-diet (avoid high protein foods, such as milk, dairy products, meat, fish, chicken, eggs, beans, and nuts; aspartame) • Nursing management: support & educate parents; confer with nutritionist • All states require PKU newborn screening 79
  • Guthrie Test: PKU 80
  • This target is an easy way to visualize the foods allowed on the diet for PKU 81
  • Galactosemia (p. 1024) • Autosomal recessive inheritance pattern • Unable to use (metabolize) the simple sugar galactose • Untreated: irreversible damage to eyes, liver, kidney, and brain • Clinical manifestations: poor feeding, poor weight gain, jaundice, vomiting, irritability, lethargy, seizures, coma, death • Treatment: lactose-free formula (e.g., soy formula, Nutramigen), galactose-free diet • Avoid all milk, breastmilk, milk-containing products (including dry milk), and other foods that contain galactose for life • Nursing management: support & educate parents; confer with nutritionist • All states require galactosemia newborn screening 82
  • 83
  • Maple Syrup Urine Disease (MSUD) (p. 1025) • Autosomal recessive inheritance pattern • Cannot break down the amino acids leucine, isoleucine, and valine • Untreated: cerebral edema, progressive neurologic impairment, death • Clinical manifestations: poor appetite, feeding difficulties, lethargy, vomiting, urine that smells like maple syrup, ketoacidosis, seizures, coma, death • Treatment: specially-designed formulas, low-protein foods, daily urine testing for ketones; liver transplant • Nursing management: support & educate parents; confer with nutritionist • Most states require MUSD newborn screening 84