Helpful for the students of GNM 2 year and Bsc Nursing third year

1. PEDIATRIC NURSING
(CHILD HEALTH NURSING)
BASIC CONCEPT OF GROWTH AND DEVELOPMENT
PREPARED BY
MR. VIPIN JAIN
PROFESSOR & HEAD OF DEPARTMENT
PEDIATRIC NURSING, CIN

7. The term pediatrics is derived from Greek words,
‘pedia’ means child , ‘iatrike’ means treatment and ‘ics’
means branch of science.
Thus it means pediatrics is the branch of medical science
which deals with the care and treatment of children from
conception to adolescence in health and illness. It is also
concerned with preventive, promotive, curative and
rehabilitative care of children.
In India about 35% of total population are children below
15 years age. Children are vulnerable to diseases , death
and disability. They need appropriate care for survival
and healthy development.

8. Concept of pediatric nursing:
“Today's Children's are the future of tomorrow”.
Pediatric nursing concerned with preventive,
promotive, curative and rehabilitative care of
children. It belongs with all round development of
body, mind, and spirit of the individual. CHN
concerned with:
i. wellbeing of children towards max.functioning.
ii. Implement of scientific principles and theory
related to nursing practice.
iii. Provie care to mother, child and family.
iv. Using team approach to solve problems
V. focusing on ethical, moral and legal problems
regarding child care.

9. Goals of pediatric nursing:
@ to provide skillful, intelligent and need based care of
children specially in sick child(LBW).
@ To promote G&D of children for healthy nation
@ to elevate the standard of child health.
@ to prevent the diseases at primary and secondary level.
@ provide good post natal care to mother & baby.
Qualities of pediatric nurse:
@ be loving and liking for children.
@ ability to understand child’s GD & behavior.
@ have good observation, judgment and communication
skills.
@ be friendly, honest, gentle, responsible, and trustworthy.

10. Role of pediatric nurse: nurse is both caring and curing.
caring is must in wellness and illness. The role of
pediatric nurse is expanded and vary according to time.
1. Primary care giver
2.Health educator
3. Nurse counselor
4.Social worker
5.Team coordinator and collaborator
6.Manager
7.Child care advocate
8.Recreationist
9.Nurse consultant
10.Researcher

11. Child growth and development
Growth and Development occurs in the following
order
Infancy
Early Childhood
Middle Childhood
Adolescent

Stages of Growth and Development
 infancy
•Neonate : Birth to 1 month
•Infancy : 1 month to 1 year

Early Childhood
•Toddler:1-3 years
•Preschool:3-6 years

12. Middle Childhood
•School age : 6 to 12 years
Late Childhood
•Adolescent : 13 years to approximately 18 years
Growth and development are similar words but
different from each other though it is not possible to
separate them totally.
It is a whole process which includes growth of the
body as well as growth of various aspects of child's
personality, e.g., the physical, emotional, social and
cognitive development.
Development is a progressive change the child
undergoes which increases the physical, social,
mental and emotional capacities of the child.

13. Growth
1. Growth is quantitative.
2. Growth comprises of height, weight, size and shape
of body organs like brain, etc.
3. It is due to cell division.
4. Growth is for limited period.
5. Growth can be measured.
6. Growth tells about one aspect of personality but in
limited scope.

14. Development
1. Development is quantitative as well as qualitative.
2. In this with the physical changes cognitive, social
and emotional change are also included.
3. It happen due to motor and adjust mental
processes and their interplay.
4. Development takes place till death.
5. It can be observed by matured behavior.
6. Development deals with all the aspect of
personality and has a vast scope.


15. Principles of Growth and Development
1.Growth is an orderly process, occurring in systematic
fashion.
2.Rates and patterns of growth are specific to certain parts of
the body.
3.Wide individual differences exist in growth rates.
4.Growth and development are influences by multiple
factors.
5.Development proceeds from the simple to the complex and
from the general to the specific.
.

16. 6. The child’s pattern of growth is in a head-to-toe direction,
or cephalocaudal, and in an inward to outward pattern called
proximodistal.
7.There are critical periods for growth and development.
8.Rates in development vary.
9.Development continues throughout the individual's life
span.

17. Aspects/dimensions of growth & development-
SMILE-
1. Social development
2.Spiritual development
3.Motor development(fine/gross motor)
4.Moral development
5.Intellectual development
6.Language development
7.Emotional development

18. FACTORS AFFECTING GROWTH AND DEVELOPMENT
(i) Heredity - It is the process by which the features and
characteristics are passed from parents to the child before
the child is born. Thus features like the colour of the skin
and eyes, the height, body build, intellect and talents,
etc., are all fixed and no one can change them beyond a
limit.
(ii) Prenatal environment - This is the environment of the
foetus in the womb. If the mother gets poor nutrition, is
emotionally upset or smokes, drinks, or takes some
medicine or suffers from certain diseases, the growth of
the child can be adversely affected.
(iii) Nutrition - Proper nutrition is essential for the
healthy development of the child. A malnourished child’s
growth may be retarded or slow.

19. (iv)Intelligence - Higher intelligence is associated with
faster development while lower intelligence is associated
with retardation in various aspects of development.
(v) Emotional climate of home - If there is a lot of
discord/fights at home or the child is not given enough
love and attention or there is physical/ mental abuse of
the child, then the child’s development is adversely
affected.
(vi) Health of the child - If the child frequently falls sick,
suffers from some disorder, is disabled or has disturbed
endocrine functioning, the development is likely to
suffer.

20. (vii) Level of stimulation - The amount of stimulation
the environment provides to the child i.e., the
opportunities for exploration of environment,
opportunities of interaction with other people, etc., all
influnence the rate of development.
(viii) Socio-economic status - It also influences the
development by deciding the kind of nutrition,
stimulation, facilities, opportunities, genetic endowment
the child gets.

21. (ix) Sex - All children follow the same sequence of
development. However, certain skills are faster in girls
than in boys and some other skills are faster in boys than
girls. For example, language acquisition is faster in girls
and skills like jumping catching, throwing are faster in
boys. Sex is also a factor that decides the potential of a
child in physical development - boys grow up to be taller,
heavier and more muscular than girls.

22. Rights of children's-
1) The right to love and affection from parents.
2)Right to free education
3)Right to name & nationality.
4)The right to get adequate nutrition and medicine.
5)Right to opportunity for play and recreation
6)Right to get special care if baby is handicapped.
7) right to get relieve first in disaster.
8)Right to be part of society and develop own abilities.
9)Right to be brought up in a spirit of peace and
brotherhood.
10)Right to enjoy these rights regardless of race,
colour,sex,religion,nation etc.

23. Areas of development-
Social development-

27. Growth Patterns
The child’s pattern of growth is in a head-to-toe
direction, or cephalocaudal, and in an inward to
outward pattern called proximodistal.
Why developmental assessment?
Early detection of deviation in child’s pattern of
development
Simple and time efficient mechanism to ensure
adequate surveillance of developmental progress
Domains assessed: cognitive, motor, language, social /
behavioral and adaptive


28. Gross Motor Skills
The acquisition of gross motor skill precedes the
development of fine motor skills.
Both processes occur in a cephalocaudal fashion
Head control preceding arm and hand control
Followed by leg and foot control.
Gross Motor Development
Newborn: barely able to lift head
6 months: easily lifts head, chest and upper abdomen
and can bear weight on arms
Head Control
Sitting up
2months old: needs assistance
6 months old: can sit alone in the tripod position
8 months old: can sit without support and engage in
play

29. Sitting Up
Age 2 months
Age 8 months

30. Ambulation
9 month old: crawl
1 year: stand independently from a crawl position
13 month old: walk and toddle quickly
15 month old: can run
Fine Motor - Infant
Newborn has very little control. Objects will be
involuntarily grasped and dropped without notice.
6 month old: palmar grasp – uses entire hand to pick up
an object
9 month old: pincer grasp – can grasp small objects using
thumb and forefinger

31. Nine to 12-months 13 month old
Ambulation

32. Speech Milestones
1-2 months: coos
2-6 months: laughs and squeals
8-9 months babbles: mama/dada as sounds
10-12 months: "mama/dada specific
18-20 months: 20 to 30 words – 50% understood by
strangers
22-24 months: two word sentences, >50 words, 75%
understood by strangers
30-36 months: almost all speech understood by
strangers


33. Hearing
BAER hearing test done at birth
Ability to hear correlates with ability enunciate words properly
Always ask about history of otitis media – ear infection,
placement of PET – tubes in ear
Early referral to MD to assess for possible fluid in ears
(effusion)
Repeat hearing screening test
Speech therapist as needed
Red Flags in infant development
Unable to sit alone by age 9 months
Unable to transfer objects from hand to hand by age 1 year
Abnormal pincer grip or grasp by age 15 months
Unable to walk alone by 18 months
Failure to speak recognizable words by 2 years.


34. 6-month-old 12-month-old
Fine Motor Development

35. Fine Motor – Older Toddler
3 year old: copy a circle and a cross – build using small
blocks
4 year old: use scissors, color within the borders
5 year old: write some letters and draw a person with
body parts
Toddlers(Issues in parenting – toddlers)
Stranger anxiety ( crying when baby sees someone she
doesnt know and they are trying to carry her) – should
dissipate by age 2 ½ to 3 years
Temper tantrums: occur weekly in 50 to 80% of children
– peak incidence 18 months – most disappear by age 3
Sibling rivalry: aggressive behavior towards new infant:
peak between 1 to 2 years but may be prolonged
indefinitely
Thumb sucking
Toilet Training

36. Pre-School
Fine motor and cognitive abilities
Buttoning clothing
Holding a crayon / pencil
Building with small blocks
Using scissors
Playing a board game
Have child draw picture of himself
Pre-school tasks
Red flags: preschool
Inability to perform self-care tasks, hand washing simple
dressing, daytime toileting
Lack of socialization
Unable to play with other children
Able to follow directions during exam
Performance evaluation of pre-school teacher for
kindergarten readiness

37. School-Age
School Years: fine motor
Writing skills improve
Fine motor is refined
Fine motor with more focus
Building: models – legos, Sewing
Musical instrument
Painting,Typing skills
Technology: computers
School performance
Ask about favorite subject
How they are doing in school
Do they like school
By parent report: any learning difficulties, attention
problems, homework
Parental expectations

38. Red flags: school age
School failure
Lack of friends
Social isolation
Aggressive behavior: fights, fire setting, animal abuse

School Age: gross motor
8 to 10 years: team sports
Age ten: match sport to the physical and emotional
development
School Age: cognitive
Greater ability to concentrate and participate in self-initiating
quiet activities that challenge cognitive skills, such as reading,
playing computer and board games.


39. 13 to 18 Year Old
Adolescent
As teenagers gain independence they begin to
challenge values
Critical of adult authority
Relies on peer relationship
Mood swings especially in early adolescents
Adolescent behavioral problems
Anorexia
Attention deficit
Anger issues
Suicide

40. Adolescent Teaching
Relationships
Sexuality – STD’s / AIDS
Substance use and abuse
Gang activity
Driving
Access to weapons