Transcript Chapter 5: Developmental Influences on Child Health Promotion

CHAPTER 5:
DEVELOPMENTAL
INFLUENCES ON CHILD
HEALTH PROMOTION
Laura Salisbury RN, MSN/Ed.
DEFINITIONS
 Growth
 Development
 Maturation
 Differentiation
THE DEVELOPMENTAL AGE
PERIODS
 Prenatal
Germinal, Embryonic, Fetal
 Infancy
Neonatal, Infancy
 Early Childhood
Toddler, Preschool
 Middle Childhood
School-age
 Later childhood
Prepubertal, Adolescence

PATTERNS OF GROWTH AND
DEVLEOPMENT

Directional
Cephalocaudal
 Proximodistal




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
Differentiation
Sequential trends
Developmental pace
Sensitive periods
Individual differences
BIOLOGICAL GROWTH AND
PHYSICAL DEVELOPMENT
 Skeletal
proportion Changes
 Changes
in Weight
 Changes
in Height
CHANGES IN WEIGHT

Doubles from birth to 6 months

Triples by end of first year

Quadruples by 2.5 years

2-3 kg growth per year preschool/school
age

Growth spurt starts 10-14 years (females)
11-16 years (males)
CHANGES IN HEIGHT
 Changes
in Height
Length increase by 50% by 1st birthday
 Length doubles by age four
 Height at age 2 approximately 50% of
average adult height


Skeletal age: how is it determined?


Hand and wrist x-rays
Why do adolescents get more fractures
than ligamentous ruptures?
PHYSIOLOGIC CHANGES
 Metabolic
 Sleep
Rate
and Rest
TYPES OF TEMPERMENT
Easy child
 Difficult child
 Slow-to-warm-up child
 Significance of temperament

FREUDIAN DEVELOPMENTAL
THEORY
Id
 Ego
 Superego
 Freudian stages

Oral
 Anal
 Phallic
 Latency
 Genital

ERICKSONS PSYCHOSOCIAL
DEVELOPMENTAL THEORY

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
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
Trust vs. mistrust
Autonomy vs. shame and doubt
Initiative vs. guilt
Industry vs. inferiority
Identity vs. role confusion
PIAGET COGNITIVE
DEVELOPMENTAL THEORY
Sensorimotor
 Preoperational

Egocentric thinking
 Intuitive reasoning
 Transductive reasoning


Concrete operations
Conservation
 Inductive reasoning


Formal operations
KHOLBERG MORAL DEVELOPMENT
Preconventional
 Conventional
 Postconventional

DEVELOPMENT OF SELF CONCEPT
 Body
 Self
Image
Esteem
TYPES OF PLAY






Social-affective
Sense-pleasure
Skill play
Unoccupied behavior
Dramatic/pretend play
Games
Imitative
 Formal
 Competitive

SOCIAL CHARACTER OF PLAY



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Onlooker play
Solitary play
Parallel play
Associative play
Cooperative play
FUNCTIONS OF PLAY

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Development
Socialization
Creativity
Self-awareness
Therapeutic
CHOOSING TOYS

Toy safety: pg 87
Selection
Supervision
Maintenance
Storage
FACTORS THAT INFLUENCE
DEVELOPMENT
Heredity
 Neuro-endocrine
 Nutrition



Single most important influence on growth
Interpersonal relationships

Emotional deprivation
Socioeconomic level
 Disease
 Environmental hazards

FACTORS THAT INFLUENCE
DEVELOPMENT
Stress in childhood
 Mass media influence
Reading
Movies
Television
Read “Family-Centered Care”
Video games
Internet

DEVELOPMENTAL SCREENING

DDST

Denver Developmental Screening Tool
CHAPTER 6:
COMMUNICATION AND
PHYSICAL ASSESSMENT
OF THE CHILD
Laura Salisbury RN,
MSN/Ed.
COMMUNICATION AND PHYSICAL
ASSESSMENT OF THE CHILD
 Establish

a setting
Privacy and confidentiality

When is confidentiality limited?
Introductions
 Just the child vs. child and parent


(Legal issues in telephone triage)
INTERVIEWING THE PARENT
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Encouragement
Direction
Cultural variables
Using silence
Empathy versus sympathy
“Anticipatory guidance”
What are blocks to communication
(Table 6-2)
Use of interpreter (box on page 102)

Avoid using the child as interpreter!!!
COMMUNICATION WITH THE CHILD

Infancy


Nonverbal behaviors
Early childhood
Remember that they take things literally
 They may assign human attributes to inanimate
objects

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School-age


Concerned with body integrity
Adolescence
Establish trust
 Demonstrate positive communication to child and
parent
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HEALTH HISTORY



Chief complaint
History of present illness
Past history
Birth history, Dietary history, Previous
illness/surgery
 Allergies, Medications, Immunizations
 Growth and development milestones, Habits


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Sexual history
Family medical history
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Geography
Family structure
Psychosocial history
Review of systems
CLINICAL EXAM
Head to toe sequence
 Preparing the child
 See guidelines, p. 119
 See table 6-2, p. 120

GROWTH MEASUREMENTS
When are growth charts different?
 Length vs. height
 Skin-fold thickness: to measure fat
percentage
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PHYSIOLOGICAL MEASUREMENTS

Temperature


Which way? Box 6-11 p. 125
Pulse

Apical or radial?
Respiration
 Blood pressure

Annually starting age 3
 How to measure cuff appropriately, p. 130

PHYSICAL ASSESSMENT
 General


appearance
Posture
Behavior
 Skin

Accessory structures:
hair, scalp, nails
 Lymph
nodes
 Head and neck



Head lag: after 6 months=worrisome
symptom
Head control in infant/toddlers
Pain on neck flexion=worrisome
symptom
PHYSICAL ASSESSMENT
 Eyes
PERRLA
 Visual acuity
Use Snellen letter chart
 Ears
 Must restrain child when using
otoscope on infant/toddler
 Positioning: see figure 6-23 p. 140
 Nose
 Mouth and throat

PHYSICAL ASSESSMENT
 Chest


Normal breath sounds: p. 145
Facilitating auscultation/deep breaths:
p. 145
 Heart


Capillary refill time: how to assess?
Heart murmurs: Innocent,
functional, organic
 Abdomen



Umbilical hernia
Inguinal hernia
Femoral hernia
PHYSICAL ASSESSMENT
 Genitalia
 Anus
 Back
and extremities
 Joints
 Neurologic assessment
 Cerebellar function: Romberg test
 Reflexes
 Cranial nerves