Chapter 28 - Developmental and Genetic Influences on Child Health Promotion

Growth

- A change in quantity - Occurs when cells divide and synthesize new proteins - Results in increased size and weight of whole or any parts - Proceeds in predictable patterns of direction sequence and pace - i.e. height and weight

Temperament

- A manner of thinking, behaving or reacting, characteristic of an individual - Refers to the way in which a person deals with life - Refers to behavioral tendencies, NOT to discrete behavioral acts - There are no implications of good or bad - 35% of children either have some, but not all of the characteristics of one of the categories or are inconsistent in their behavioral responses. Many normal children display this wide range of behavioral patterns

Individual Differences

- Each child grown in his or her own unique and personal way - Great individual variation exist in the age at which development milestones are reached - The sequence is predictable, but the exact timing is not - Rates of growth vary - Measurements are defined in terms of ranges to allow for individual differences - Some children are fast growers, others moderate and some slow - Pubescent growth spurts may begin earlier or later in some more than others - Gender is and influential factor as girls seem to be more advanced in physiologic growth at all ages

Differentiation

- Early cells are systematically modified and altered - The achievement of specific characteristic physical and chemical properties - Development from simple operations to more complex activities and functions - Generalized development b4 specific/specialized development - Gross, random muscle movements b4 fine-muscle control

The Easy Child (40% of children)

- Even tempered - Regular and predictable in their habits - Have a positive approach to new stimuli - Open and adaptable to change - Display mild to moderately intense mood that is typically positive

Lymphoid Tissue

- Follow a growth pattern very different from other body tissue - Well developed, but small at birth - By 6 years of age, they have reached adult dimensions - By 10-12yrs, they reach maximum development and are approx. twice their adult size - By the end of adolescence, they rapidly decline to a stable adult dimension

Early Childhood Developmental Age Period

- From 1 - 6yrs - Extends from beginning of walking until school entry - Intense activity and discovery - Market physical and personality development - Motor development advances steadily - Acquisition of language and wider social relationships - Learn role standards - Begin to develop self-concept - Gain self-control and mastery - Increasing awareness of dependence and independence

Middle Childhood Developmental Age Period

- From 6 - 11/12yrs - Referred to as "school age" - Critical period in the development of a self-concept - Social cooperation and early moral development important and relevance for later life stages - Directed away from the family group - Centered around the wider world of peer relationships - Mental, and social development, with emphasis on developing skill competencies

Infancy Developmental Age Period

- From birth to 12 months - Rapid motor, cognitive and social development - Infant establishes a trust in the world through caregiver/parent - Infant establishes the foundation for future interpersonal relationships - 1st month od life critical because of major adjustment to extrauterine existence and psychologic adjustment of the parent

Neurological Maturation

- Grows more proportionately more rapidly before birth - Provide the foundation for language, learning and behavior development - Sometimes used as an indicator of maturational age in the early weeks of life

Cephalocaudal

- Head to tail - Head end develops first; is large and complex - Lower end is small and simple; takes shape at a later period - Most apparent during period before birth and postnatal behavior development - Head b4 trunk/extremities - Erect back b4 standing - Eyes b4 hands - Hands b4 feet

Directional Trends in Growth and Development

1. Cephalocaudal 2. Proximodistal 3. Mass to specific

Water requirements

1.5ml/calorie of energy expended throughout life

Sleep and Rest

- A protective function in all organisms - Allows for repair and recovery of tissues after activity - Restful sleep increases from 50% in infancy to 90% in older children - 1st year: during the latter part, most children sleep through the night and take one or two naps during the by - 12-18mos: they have eliminated the 2nd nap - After 3yrs: children usually have given up daytime naps except in cultures where it is customary - 4-10yrs: sleep time declines - Puberty: sleep time increases

Maturation

- A qualitative change - The aging process - An increase in competence and adaptability - Functioning at a higher level

Later Childhood Developmental Age Period

- Adolescence - Tumultuous period of rapid maturation and change - A transitional period - Begins at the onset of puberty - Extends to entry into the adult world at H.S. graduation - Biologic and personal maturity along with physical and emotional turmoil - Redefining of the self-concept - In the late adolescence period, begin to internalize previously learned values and focus on an individual rather than a group identity

Adolescent

- Board games

Development

- Change from a lower to a more advanced stage of complexity - A gradual change and expansion - Mental and cognitive attainment of skills - Proceeds in predictable patterns of direction, sequence and pace

Prenatal Developmental Age Period

- Conception to Birth - One of the most crucial periods in the developmental process - Rapid Growth - Total dependency - The relationship between maternal health and newborn health determine well-being and health of the infant

Developmental Pace

- Does not progress at the same rate or pace - Period of accelerated growth and decelerated grown in total body growth and growth of subsystems - The rapid growth before and after birth levels off throughout early childhood - Growth is relatively slow during middle childhood - Growth markedly increased at the beginning of adolescence - Growth levels off in early adulthood - Each child grows at his or her own pace - Distinct differences are observed among children as they reach "developmental milestones"

The Difficult Child (10% of children)

- Highly active - Irritable - Irregular in their habits - Negative withdrawal responses are typical - Require a more structured environment - Adapt slowly to new routines, people and situations - Mood expressions are typically intense and primarily negative - Exhibit frequent periods of crying - Frustration often produces violent tantrums - More vulnerable to the development of behavior problems in early and middle childhood - May be more prone to Colic in infancy - Require more vigilance to prevent injury - School entry requires different approaches - Unadaptable infants can raise doubts in mothers about their copetance

School Age Play

- Magic - Dress-up - Stuffed animals

Proximodistal

- Near to far - Midline to peripheral - Shoulder control b4 hand mastery - Whole hand used b4 finger manipulation - CNS b4 PNS

Thermoreglation

- One of the most important adaptation responses of infants from intrauterine to extrauterine life - Caused by Hypoglycemia, elevated Bilirubin levels and Metabolic acidosis - Kangaroo Care is an effective prevention - Girls tend to have higher temps than boys. Girls stabilize at about 12yo and boys continue to fall

Infant Play

- Patting - Raising arms - Stroking - Bicycling legs - Colors - Sounds (i.e. bells)

Toddler Play

- Peek-a-boo - Patty-cake - This little piggy

Sensitive Periods

- Periods of times during the process of growth when the organism interacts with a particular environment in a specific manner - Periods are deemed Critical, Sensitive, Vulnerable and Optimal are time when the child/organism is more susceptible to positive or negative influences - The quality of the interaction during these periods determine whether the effects of the interaction will be beneficial or harmful - Physiologic maturation of the CNS is influenced by the timing of stimulation and nutrition - The first 3 months of prenatal life are sensitive periods for physical growth of the fetus - Primary socialization occurs during the first year of an infant when they make initial social attachments and establishes basic trust in the world - A warm relationship with a parent is fundamental to a healthy personality - There appears to be an opportune time when a skill is best learned

5 Developmental Age Periods

- Prenatal (Conception to Birth) - Infancy (Birth to 12 months) - Early Childhood (1 - 6yrs) - Middle Childhood (6 - 11/12yrs) - Later Childhood (11 - 19yrs)

Child Temperament Broad Classifications

- The Easy Child - The Difficult Child - The Slow To Warm Up Child

External Proportions of Biologic Grown the Physical Development

- The head is the fastest growing body part during fetal development - At 2mos of gestation, the head constitutes 50% of total body weight - During infancy, growth of the trunk predominates - The legs are the most rapidly growing part during childhood - In adolescence, the trunk again - In newborns, the lower limbs are one third the total body length, but only 15% of the total body weight

Skeletal Development/Bone Age

- The most accurate measure of general development - Appears to correlate more closely with other measure of physiologic maturity such as the onset of menarche than with chronological age or height - Interference with the epiphyseal growth plate by trauma (i.e. bone fractures) or infection can result in deformity - Protection from injury includes: * protective sports equipment * emphasis on conditioning, especially flexibility * for adolescents: rapid rate of growth cause more fractures than ligamentous ruptures

Biologic Determinants of Growth

- The most prominent feature of childhood and adolescence is physical growth - Down Syndrome: have slower growth velocity between 6mos - 3yrs and then again in adolescence. Puberty comes earlier and they have shorter stature. - The Down Syndrome growth chart is beneficial to these parents as they often multiple providers and are frequent users of the health care system - Linear/height growth is considered a stable measurement of general growth and is almost entirely a result of skeletal growth - Height growth is not uniform throughout life and ceases when maturation of the skeleton is complete - The maximum rate of growth in height occurs before birth - Newborns continue to grow at a rapid, but slower rate - At birth, weight varies more than height - Weight to a great extent is a reflection of the intrauterine environment - Average newborn weighs 7-7.5lbs (3175 - 3400g) - Birth weight doubles by the end of 4-7months - Birth weight triples by the end of the 1st year - Birth weight usually quadruples by the age of 2-2.5yrs - After this the "normal" rate of weight gain assumes a steady annual increase of approx. 4.4 -6lbs (2 - 2.75kg) until the adolescent growth spurt - Indicators of development are Bone Age and State of Dentition

Basal Metabolic Rate

- The rate of metabolism when the body is at rest - Highest in Newborns - Boys tend to progress to higher than girls during puberty - Determines the caloric requirements of the child - Infants require 108 kcal/kg. This decreases to 40-45 kcal/kg at maturity - The energy requirement to build tissue steadily decreases with age after the general growth curve (represents overall changes in body size like rapid growth in infancy, slower in early/middle childhood, rapid in adolescence - An infant produces more heat per unit than adolescents i.e. infants tend to get overheated if heavily clothed and if heavily clothed during active play

Sequential Trends

- There is a definite and predictable sequence in all dimensions of growth and development - Each child normally passes through every stage - Crawl b4 creeping - Creep b4 standing - Stand b4 walking - Babbles b4 word formation - Words b4 sentences - Scribbling b4 writing

Preschool Play

- Toys - Doll house - Cars/trains

The Slow To Warm Up Child (15% of children)

- Typically react negatively and with mild intensity to new stimuli unless pressured - Adapt slowly with repeated contact - Respond with only mild but passive resistance to novelty or changes in routine - Inactive and moody, but show only moderate irregularity in functions - More vulnerable to the development of behavior problems in early and middle childhood

Nutrition

PROBABLY THE SINGLE MOST IMPORTANT INFLUENCE ON GROWTH - Related to good health throughout life - Overall improvement is evidenced by the gradual increase in size and early maturation in children in this century

Physical Development

Increases in: - height - weight Changes in: - body proportion - dentition - some body tissues