Chapter 015 lo

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  • Review Box 15-1 on page 348 and discuss the emerging behavior patterns that can be anticipated based on age. Growth, such as height and weight, is measurable. The process of development is the mastery of a skill that allows the infant or child to progress to the next skill. Give examples of growth and developmental skills for each of these categories: physical, social, emotional, and intellectual skills.
  • Children are not miniature adults. For this reason, their plan of care is different than the plan of care for an adult. Recognizing developmental and growth delays will assist the nurse in formulating his/her plan of care but may also provide an opportunity for early intervention by the health care team to prevent further developmental delays. How are infants and children different from adults?
  • Give examples of different methods to obtain height and weight on a neonate, infant, and child. What is the purpose of a growth chart? What are some developmental milestones for an infant? How will the nurse obtain the information to assess developmental milestones?
  • Review Box 15-2 on page 349, The Nursing Process Applied to Growth and Development. Examples of appropriate nursing diagnoses: Breastfeeding, ineffective, related to inability of infant to nurse properly Caregiver role strain, related to inexperience Family coping, compromised, related to infant’s medical diagnosis
  • Give an example of how a nurse might evaluate effective communication between a parent and a toddler. Why is evaluation an ongoing process for growth and development?
  • How can these terms related to age benefit health care professionals? Give an example of a toddler and maturation. Give an example of progressing development of a preschool child. Stages of growth and development Fetus: 9 th gestational week to birth Neonate: birth to 4 weeks Infant: 4 weeks to 1 year Toddler: 1-3 years Preschool: 3-6 years School-age: 6-12 years Adolescent: 12-18 years
  • What are examples of cephalocaudal development? Raising head and chest precedes sitting; sitting precedes standing. Proximodistal begins at the central portion of the body and extends outward to the extremities (i.e., the infant grasps with the hands before developing the pincer grasp or the infant bats at an object before being able to grasp the object). Audience Response Question #1 Cephalocaudal : head to toe as proximodistal : __________________. 1. midline to periphery 2. crown to rump 3. neck to waist 4. weight to length
  • Why is it important for the nurse to recognize the differences between children and adults? How is an infant’s metabolic rate different from an adult’s? How are the following body systems of a child different from an adult’s: renal, nervous, musculoskeletal, respiratory, immune, and cardiovascular?
  • Why do we have growth standards? How does this benefit the nurse, pediatric patient, and/or parent? Why does the nurse compare a child’s former growth rate to the current growth rate?
  • Give an example of when this tool might be utilized. Why are there separate growth charts for boys and girls? Audience Response Question #2 Childhood obesity is decreasing in the United States. 1. True 2. False
  • In what instances would the Denver Developmental Screening Test be utilized? Why would a nurse want this information?
  • How do these factors affect growth and development of a child? Audience Response Question #3 Environment plays a minimal role in childhood development. 1. Strongly agree 2. Agree 3. Disagree 4. Strongly disagree 5. Unsure
  • Give an example of each of the types of families listed. How do these different types affect children of school age?
  • Adaptation: How the family helps and shares resources. Give examples of types of resources. Partnership: Lines of communication and partnership in the family. Give an example of a familial partnership. Growth: How responsibilities for growth and development of child are shared. Give an example of shared responsibilities. Affection: Overt and covert emotional interactions among family members. Give an example of overt and covert emotions. Resolve: How time, money, and space are allocated to prevent and solve problems. Give an example of how time, money, and space can be manipulated to solve a familial problem.
  • How do these factors affect the family? What can nurses do within their community to cause effective change in the community?
  • How does homelessness affect growth and development of a child? How can the nurse assist these families to receive adequate health care? How can the nurse become informed regarding available resources within his/her community?
  • Give an example of how one’s environment can affect one’s personality. Why is nursing concerned about a child’s personality?
  • Why does nursing focus on these developmental theorists? How do they affect the nursing plan of care? Audience Response Question #4 The theorist that has most influenced knowledge on childhood development is: 1. Freud. 2. Erikson. 3. Piaget. 4. Kohlberg.
  • Describe how Maslow’s Hierarchy of Basic Needs affects nursing care. How would you utilize this pyramid in your nursing plan of care?
  • Give an example of how the child must adjust to his/her environment. Give an example of how the nurse might instruct a parent on caring for the infant.
  • Give an example of how a child might interact with his/her parent if trust hasn’t been developed. What cues might the parents assess regarding their infant?
  • Give an example of a toddler who is striving to attain autonomy. How might the nurse educate the parents during this frustrating developmental stage?
  • Give an example of a child asserting initiative. Why must the parent learn to separate from the child? Why are these children striving for independence? How does this help them in the future?
  • Give an example of industry. Why must parents practice patience at this stage? How does patience on the parent’s part assist the child’s development?
  • Give an example of a cognitive skill for each of Piaget’s stages. Why would nurses want to assess cognitive ability? Give an example of a child who has not progressed to the cognitive level of a peer.
  • Why would a nurse want to assess moral development? Give an example of moral development for each of the three levels.
  • Refer to Table 15-6, page 369, for culturally diverse food patterns. Why should the nurse be informed regarding food and one’s culture? Give examples of how a nurse might apply this information in his/her plan of care.
  • Give an example of a well-balanced diet for a school-age child. What can result if a child has a poor diet?
  • Give an example of how a good versus a poor diet might affect a child’s body when recovering from an illness.
  • Describe how a nurse might apply this food pyramid to the plan of care. How could an elementary school nurse utilize this Food Guide Pyramid?
  • Describe a situation in which the nurse might utilize this Food Guide Pyramid. Is this child receiving proper nutrition utilizing this pyramid?
  • Why do infants require more of these nutrients than a toddler? Why does the nurse assess the infant’s hydration status?
  • Does the American culture obtain enough fiber in its diet? Why should the growing child receive fewer calories? Why is this an issue in the American culture?
  • Describe the process of digestion. Why does water absorption take place? In what area does the body absorb most of the nutrients from food?
  • Give an example of a nutritional care plan for each: hospital, home, and outpatient departments. Why should the information be kept in one place?
  • Why must foods be introduced slowly during the first year of life? At what age are complex carbohydrates digested efficiently? How does the liver function during the first year of life?
  • Why is the development of the central nervous system crucial during the first year of life? Give an example of parenteral and enteral nutrition. When might these types of feeding be implemented?
  • Provide a nursing intervention for the infant who is failing to gain weight. Provide a nursing intervention to address overfeeding an infant.
  • Why should whole milk not be introduced during the first year of life? Why does a child require whole milk during the second year of his/her life?
  • Why is it important for a toddler to develop a sense of independence? Why should a parent be present at mealtimes? Why might the parent be anxious?
  • Give examples of finger-foods. What is dawdling? Why is this population more vulnerable to protein deficiencies?
  • How does an increase in sweets affect the child’s appetite? How might the parent impact this population’s diet?
  • Give an example of types of foods adolescents typically consume. How could parents impact their adolescent’s diet? Why is fatigue common at this age?
  • Why does the U.S. struggle with an obesity problem? What types of foods do Americans typically consume? How can nursing affect this cultural problem?
  • How might the nurse manage feeding a child with lesions in his/her mouth? How would the nurse assess the hydration status of a child?
  • Give an example of educating a parent about feeding an infant, toddler, and preschool child.
  • Give an example of a food-drug interaction. How should the nurse plan care of an infant who is receiving medications and formula? Give an example of drug-environment interactions.
  • What are deciduous teeth? How do teeth affect digestion? When does the first tooth typically appear in an infant?
  • What is bottle mouth? Why is it important for the permanent teeth to develop in alignment? How would the nurse instruct a parent to care for his/her infant’s teeth?
  • How does eating a balanced diet affect the development of the infant’s teeth? How does sugar affect teeth? At what age should toothbrushing begin?
  • How might nursing caries affect the infant’s permanent teeth? Give an example of a nursing intervention regarding nursing caries.
  • Why should a toothbrush be replaced every 3 months? Why should closed toothbrush containers be avoided? Why should parents avoid tasting their baby’s food?
  • Describe how play is a child’s work. How do children benefit from play? Why should stuffed animals be avoided in the asthmatic child? Give an age-appropriate activity for each of the following: infant, toddler, preschooler, school-age child, and adolescent.
  • Chapter 015 lo

    1. 1. Chapter 15 An Overview of Growth,Development, and Nutrition
    2. 2. Objectives• Explain the differences among growth, development, and maturation.• Recognize and read a growth chart for children.• List five factors that influence growth and development.• Discuss the nursing implications of growth and development.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2
    3. 3. Objectives (cont.)• Discuss the importance of family-centered care in pediatrics.• Recognize the influence of the family and cultural practices on growth, development, nutrition, and health care.• Describe three developmental theories and their impact on planning the nursing care of children.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3
    4. 4. Objectives (cont.)• Discuss the nutritional needs of growing children.• Differentiate between permanent and deciduous teeth, and list the times of their eruption.• Understand the characteristics of play at various age levels.• Describe the relationship of play to physical, cognitive, and emotional development.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4
    5. 5. Objectives (cont.)• Understand the role of computers and computer games in play at various ages.• Define therapeutic play.• Understand the use of play as an assessment tool.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5
    6. 6. Growth and Development• Differences between adult and child – The child is in a continuous process of growth and development – Growth spurts followed by plateaus – The growth is measurable, can be observed and studied – Not all parts mature at the same timeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6
    7. 7. The Impact of Growth and Development on Nursing Care• Developmental needs will have an impact on a child’s response to illness• The nurse must know what is normal in order to recognize any deviations within a given age group and plan care accordingly – A child differs in anatomy and physiology as compared to the adult; therefore, illnesses and their responses to them, including treatments, may be differentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7
    8. 8. The Nursing Process Applied to Growth and Development• Data collection – Height and weight, plot standard growth chart – Record developmental milestones achieved related to age of child – Observe infant; interview parents• Analysis/nursing diagnosis – Determine appropriate nursing diagnoses related to parenting, coping skills, and unmet developmental needsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8
    9. 9. The Nursing Process Applied to Growth and Development (cont.)• Planning – Offer guidance and teaching to family, school personnel, and child to meet developmental needs• Implementation – Interventions that foster growth and development in the hospital setting can include encouraging age-appropriate self-care – Anticipatory guidance may be given to parents so they understand changes in behavior, eating habits, and play for the growing childElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9
    10. 10. The Nursing Process Applied to Growth and Development (cont.)• Evaluation – Ongoing evaluation of growth and development of the child and follow-up of teaching and guidance offered at prior clinic/home visits are essentialElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10
    11. 11. Key Terms in Child Development• Development – A progressive increase in the function of the body• Growth – An increase in physical size, measured in feet or meters and pounds or kilograms• Maturation – The total way in which a person grows and develops, as dictated by inheritanceElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11
    12. 12. Directional Patterns• Fundamental to all humans – Cephalocaudal • Proceeds from head to toe – Proximodistal • From midline to peripheryElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12
    13. 13. Some Developmental Differences Between Children and Adults• Height • Kidney function• Weight • Nervous system• Body proportions • Sleep patterns• Metabolic rates • Bone growth• Respirations • Critical periods• Cardiovascular • Integration of skills system• ImmunityElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13
    14. 14. Growth Standards • Measured in • Standardized dimensions – Compare the – Height measurement of a child – Weight to others of the same age and sex – Volume – Compare the child’s – Tissue thickness present measurements with the former rate of growth and pattern of progressElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14
    15. 15. Growth Charts• Children who are in good health tend to follow a consistent pattern of growth• At any age, there are wide individual differences in measured values• There are separate charts for boys and girlsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15
    16. 16. Developmental Screening• Denver Developmental Screening Test – Assesses the developmental status of children during the first 6 years of life in four categories • Personal-social • Fine motor-adaptive • Language • Gross motor – Purpose is to identify children unable to perform at an age-appropriate level – Not an intelligence testElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16
    17. 17. Influencing Factors• All of the following factors are closely related and dependent on one another in their effect on the growth and development of the child – Heredity – Nationality and race – Ordinal position within the family – Gender – EnvironmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17
    18. 18. Types of Families• Nuclear • Dual career• Extended • Blended• Single parent • Polygamous• Foster parent • Homosexual• Alternative • CohabitationElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18
    19. 19. Family Apgar• Used to assess family function – Adaptation – Partnership – Growth – Affection – Resolve• Enables the nurse to develop interventions that aid the family to achieve a healthier adaptation to the child’s health needsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19
    20. 20. Family as Part of a Community• Factors to consider – Housing – Access to public transportation – City services – Safety – Health care delivery system – Assessment of community is important in creating discharge plans for familyElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20
    21. 21. Homeless Family• Has an impact on the growth and development of a child• Support system and financial resources often lacking• School or emergency department nurse may be the only contact with health care or may be the first to identify the status of the family• Community referrals for food, housing, education, and financial assistance are essentialElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21
    22. 22. Personality Development• Personality is the result of interaction between biological and environmental heritages• Unique organization of characteristics that determine the individual’s typical or recurrent pattern of behaviorElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
    23. 23. Developmental Theorists• Erikson• Freud• Kohlberg• Sullivan• Piaget• MaslowElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23
    24. 24. Maslow’s Hierarchy of Needs• The needs at the bottom of the pyramid must be met before one can fulfill needs at the next higher levelElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24
    25. 25. The Growth and Development of a Parent• First prenatal trimester – Child’s tasks • Growth – Parent’s task • Develop attitude toward newborn. Happy? Parent of disabled child? Unwed mother? These factors and others affect the developing attitude of the mother. – Nursing intervention • Develop positive attitude in both parents concerning expected birth of child. Use referrals and agencies as needed. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25
    26. 26. The Growth and Development of a Parent (cont.)• Second prenatal trimester – Child’s task • Growth – Parent’s task • Mother focuses on infant because of fetal movements felt. Parents picture what infant will look like, what future he or she will have, and other ideas. – Nursing intervention • Parents on child care and needs and providing physical environment for expected infant. Information about newborn care should be given at this time.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
    27. 27. The Growth and Development of a Parent (cont.)• Third prenatal trimester – Child’s task • Growth – Parent’s task • Mother feels large. Attention focuses on how fetus is going to get out. – Nursing intervention • Detailed information should be presented at this time concerning the birth processes, preparation for birth, breastfeeding, and care of sibling at home.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27
    28. 28. The Growth and Development of a Parent (cont.)• Birth – Child’s task • Adjust to external environment. – Parent’s task • Elicit positive responses from child and respond by meeting child’s need for food and closeness. If parents receive only negative responses (e.g., sleepy infant, crying infant, difficult feeder, congenital anomaly), parental development will be inhibited. – Nursing intervention • Encourage early touch, feeding, and other practices. Explain behavior and appearance of newborn to allay fears. Help parents to identify positive responses. (Use infant’s reflexes, such as grasp reflex, to identify a positive response by placing mother’s finger into infant’s hand.) Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28
    29. 29. The Growth and Development of a Parent (cont.)• Infant – Child’s task • Develop trust. – Parent’s task • Learn “cues” presented by infant to determine individual needs. – Nursing intervention • Help parents assess and interpret needs of infant (avoid feelings of helplessness or incompetence). Do not let grandparents take over parental tasks. Help parents cope with problems such as colic. Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29
    30. 30. The Growth and Development of a Parent (cont.)• Toddler – Child’s task • Autonomy – Parent’s task • Try to accept the pattern of growth and development. Accept some loss of control but maintain some limits for safety. – Nursing intervention • Help parents cope with transient independence of child (e.g., allow child to go on tricycle but don’t yell “Don’t fall” or anxiety will be radiated).Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30
    31. 31. The Growth and Development of a Parent (cont.)• Preschool – Child’s task • Initiative – Parent’s task • Learn to separate from child. – Nursing intervention • Help parents show standards but “let go” so child can develop some independence. A preschool experience may be helpful.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
    32. 32. The Growth and Development of a Parent (cont.)• School-age – Child’s task • Industry – Parent’s task • Accept importance of child’s peers and learn to accept some rejection from child at times. • Patience is needed to allow children to do for themselves, even if it takes longer. Do not do the school project for the child. Provide chores for child appropriate to his age level. – Nursing intervention • Help parents understand that child is developing his or her own limits and self-discipline. Be there to guide child, but do not constantly intrude. Help child get results from his or her own efforts at performance.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32
    33. 33. The Growth and Development of a Parent (cont.)• Adolescence – Child’s task • Establishing identity • Accepting pubertal changes • Developing abstract reasoning • Deciding on career • Investigating lifestyles • Controlling feelingsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33
    34. 34. The Growth and Development of a Parent (cont.)– Parent’s task – Nursing intervention • Parents must learn to let • Help parents adjust to child live his or her own changing role and life and not expect total relationship with control over the child. adolescent. • Expect, at times, to be • Expose child to varied discredited by teenager. career fields and life • Expect differences in experiences. Help child opinion and respect to understand them. Guide but do not emerging emotions push. and feelings brought about by puberty.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    35. 35. Erikson’s Stages of Development• Tasks must be mastered at each stage to achieve optimum maturity• Each builds on the successful completion of the previous stage• Parents must interact with their child to assist the child to master the various stagesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35
    36. 36. Piaget’s Theory of Cognitive Development • Intellectual ability • Ages for each stage • Intellectual maturity is are approximate attained through four and each builds orderly and distinct upon the others stages of development, • Consists of all are interrelated interactions and – Sensorimotor coping with the – Preoperational environment – Concrete operations – Formal operationsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36
    37. 37. Kohlberg’s Theory of Moral Development• Sequential• Theory is based upon Piaget’s• Three levels – Preconventional – Conventional – Postconventional• Each level contains two stages• Emphasis on the conscience of the individual within societyElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37
    38. 38. Parent Teaching• Experiences in dealing with challenges and disappointments prepare the child to function independently in adulthood• Encourage child to deal with successes and failures, provide socially acceptable outlets, and intervene only if the frustrations become overwhelming• Parent’s task is to provide the child with skills and tools appropriate for each age level to deal with current eventsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38
    39. 39. NutritionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39
    40. 40. Nutritional Heritage• Some families do not consider food a priority• A lack of adequate nutrition can lead to mental retardation• The obese child may be subject to decreased motor skills and peer rejection• The nurse identifies children at risk and assists the family in modifying eating habits to ensure adequate nutrition is provided for growth and developmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40
    41. 41. Family Nutrition• USDA dietary guidelines – Intended to help families make informed decisions about what they eat• A well-balanced diet supplies all essential nutrients in the necessary amountsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41
    42. 42. Food• Provides heat and energy• Builds and repairs tissues• Regulates body processes• Is given in a mixture of elements – Minerals – Compounds – WaterElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42
    43. 43. Children’s Food PyramidElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 43
    44. 44. Vegetarian Diet PyramidElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 44
    45. 45. Infant Nutritional Needs• Require more – Calories – Protein – Minerals – Vitamins – Higher fluid requirementsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 45
    46. 46. Fiber Needs of the Young Child• The American Academy of Pediatrics recommends 0.5 g of fiber/kg of body weight in childhood, gradually increasing to adult levels of 20 to 35 g/day by the end of adolescence• High-fiber foods can fill the small stomach capacity and provide few of the nutrients and calories needed by the active, growing childElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 46
    47. 47. Nutrient DigestionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 47
    48. 48. Nutritional Care Plan• Can be used in – Hospital – Home – Outpatient departments• Provides information and stores it in one placeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 48
    49. 49. Nutrition and Health• Digestive system of the newborn – Immature and functions minimally for the first 3 months of life – Saliva is minimal – Hydrochloric acid and rennin in the stomach and trypsin found in the intestines aid in the digestion of milk – The physiology of the digestive tract is the basis for introduction of various foods in the first year of lifeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 49
    50. 50. Nutrition and Health Promotion• To help prevent some illnesses, it is not recommended to significantly restrict fat and cholesterol as they are needed for calories and the development of the central nervous system• Nutritional needs may be changed due to the severity of illness – Total parenteral nutrition and enteral feedings allow children who need nutritional support to be cared for at homeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 50
    51. 51. Feeding the Healthy Child: Infant• Symptoms of • High-fat diets cause underfeeding – Delayed gastric – Restlessness emptying – Crying – Abdominal distention – Failure to gain weight • High carbohydrates• Symptoms of – Abdominal distention overfeeding – Flatus – Regurgitation – Excessive weight gain – Mild diarrhea • Constipation – Too rapid weight gain – Too much fat or protein – Deficiency in “bulk”Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 51
    52. 52. Nursing Tip• Whole milk should not be introduced before 1 year of age• Low-fat milk should not be introduced before 2 years of ageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 52
    53. 53. Feeding the Healthy Child: Toddler• Can feed themselves by end of second year – Important in order to develop a sense of independence• Parent should be present at mealtimes• Difficulties may arise from parental anxiety and/or a lack of time during mealsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 53
    54. 54. Feeding the Healthy Child: Preschool• Likes finger-foods• Dawdling and regression common in this age group• More vulnerable to protein-calorie deficienciesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 54
    55. 55. Feeding the Healthy Child: School-age• Attitude toward food unpredictable• Intake of protein, calcium, vitamin A, and ascorbic acid tends to be low• Intake of sweets decreases appetite and provides “empty” caloriesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 55
    56. 56. Feeding the Healthy Child: Adolescent• Grow rapidly and expend large amounts of energy• Important to involve adolescent in food selections that are nutritious and appetizing• Fad food drives a lot of food selections• Fatigue is common in this age groupElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 56
    57. 57. Childhood Obesity• One-third of all children in the U.S. are overweight – 30% to 40% of those are considered obese• Related to obesity in adulthood• Most often related to diet and inactivity• Basal metabolic index (BMI) percentile Weight in pounds Height in inches2 × 705Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 57
    58. 58. Feeding the Ill Child• Many hospitalized • Nurse should assess children have poor – Does child have any appetites teeth?• Causes vary – Are there any lesions in the mouth? depending on – Can child eat illness/disease independently or is• May also refuse food assistance needed? as a means of manipulating parentsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 58
    59. 59. Feeding the Ill Child (cont.)• A tablespoonful of food for each year of age is a good guide to follow when feeding a child• Sweet drinks and snacks should not be served just before meals• Infants who are placed on NPO status should be provided with a pacifier to meet their sucking needsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 59
    60. 60. Food-Drug Interactions • Drug-drug: nurse needs to know the side effects of each drug prescribed and administered • Drug-environment: involves interaction of the effects of a drug on the response of the patient to the environment (i.e., certain antibiotics cause pronounced photosensitivity) • Drug-food: nurse needs to know if any foods are contraindicated when child is receiving certain drugs (i.e., Coumadin and foods containing high levels of vitamin K)Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 60
    61. 61. The Teeth Permanent and deciduous teeth and age of eruption.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 61
    62. 62. The Teeth (cont.)• Important not to neglect baby teeth• Deciduous teeth serve not only in the digestive process but also in the development of the jaw• If these teeth are lost too early, the permanent teeth can come in poorly aligned• Delayed or early eruption can be indicative of certain endocrine disorders or other pathologic conditionsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 62
    63. 63. Oral Care in Health and Illness• Sticky foods have more • Recommended potential to cause snack foods dental caries than do – Cheese, milk, sugarless gum, raw vegetables sugared drinks • Brushing after each• Snack foods to avoid – Sugared gum, dried fruits, meal/snack sugared soft drinks, cake, and • Eating a healthy, candy balanced diet enhances tooth developmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 63
    64. 64. Dental Caries• Occurs when infant falls asleep while breastfeeding or is put to bed with a bottle of milk or sweetened juice• Sugar pools in the oral cavity• Most often seen in children 18 months to 3 years of ageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 64
    65. 65. Education on Tooth Hygiene• Starts with first tooth • Replace toothbrush eruption every 3 months or• Brush before bedtime after a viral illness – Protective bactericidal • Avoid rinsing bristles effects of saliva decrease in hot water during sleep • Do not use a closed• Fever is not associated container for with teething; therefore, toothbrush storage cause should be • Avoid sharing assessed toothbrushesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 65
    66. 66. Play• Play is the “work” of • Nursing interventions children should focus on• Hospital playrooms are – Encouraging optimal used by children who do play activities that are age-appropriate not have communicable – Helping parents select illnesses (e.g., measles age- and illness- or a draining wound) appropriate toys• Art allows for creative • An asthmatic child should expression not be given a stuffed animal to play with• Computer games Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 66
    67. 67. Medical Problems and Dental Health • Health problem • Effect on teeth – Asthma – Sucrose content of – Hemophilia medications can cause – decay Seizure disorders – – Can cause oral bleeding, Bulimia impaired healing – Causes decreased saliva; gingival overgrowth – Erosion of teeth from acid content during vomitingElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 67
    68. 68. Question for Review• Why is introduction of solid foods to infants delayed until 4 to 6 months of age?Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 68
    69. 69. Review• Objectives• Key Terms• Key Points• Online Resources• Critical Thinking Question• Review QuestionsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 69

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