Growth and Development

The nurse is caring for a newborn infant. When teaching the mother about physical development, the nurse explains that infants can control their head and neck before they can control their arms and legs. This type of development is referred to as: 1.Differentiation 2.Head-to-toe movement 3.Cephalocaudal 4.Proximodistal

3

Preschool

3-6 years

Separation in infants

- Begins @ 6 months - Infant cry when parent leaves room

Unique pediatric population

-22% of population (www.childstats.gov) -Children account for 18% of all hospital admissions -Infant mortality (%.4 to 1,000), an index of general health of a country (CDC,2020) -Greater risk for illness/injury & medication overdose -Health issues and mortality -Family-centered care-need to develop a relationship with family caregivers; definition of family may differ.

Toddler vital signs (1-2)

1-2 years -HR: 98-140 awake and 80-120 asleep -RR: 22-37 -systolic: 106-86/ 63-42 -temp: 97.7-99.5 axillary

Toddler

1-3 years

Adolescence

12-18 years

Infant nutrition

4-6 months •Should be able to sit upright before introduction of solids and cup. •Tongue extrusion reflex disappears at 4 months-indicates baby is mature enough to eat with spoon •Introduce solids-start with rice cereal, oatmeal cereal, barley cereal(mixed with EBM/formula). Next try pureed fruits and vegetables. •Serve one new food at a time •Serve new food for 3-5 days in a row 6-8 Months •Finger foods: let baby try and feed self. Don't force feed •Try baby crackers, Zwieback, peel soft fruit, dry cereal(Cheerios), pieces of cheese, soft cooked veggies, small pieces of bread or toast •Juice:1-2 oz diluted non citrus(fruit more nutritious) - can let them sip out of a cup but not with a lid

School-age

6-12 years

Signs of developmental delay

After independent walking for several months: -persistent tiptoe walking -failure to develop a mature walking pattern By 18 months: -not walking -not speaking 15 words -doesn't understand function of common household items By 2 years: -doesn't use 2 word sentences -doesn't imitate actions -doesn't follow basic instructions -cant push a toy with wheels By 3 years: -difficulty with stairs -frequent falling -cant build tower of more than four blocks -difficulty manipulating small objects -extreme difficulty in separation from parent -cant copy a circle -doesn't engage in make believe play -cant communicate in short phrases -doesn't understand simple instructions -little interest in other kids -unclear speech, persistent drooling

Teaching a child to toilet train is most likely to occur during which psychosocial developmental stage? Trust vs. mistrust Autonomy vs. shame/doubt Initiative vs. guilt Industry vs. inferiority

Autonomy

Toilet training as a major skill learned Autonomy Vs. Shame/Doubt Initiative Vs. Guilt Industry Vs. Inferiority

Autonomy vs shame/doubt During the toddler years, children become more independent and learn how to toilet train. They gain more control over their bodies and environment.

The mother of a 2-year-old asks the nurse advice on what toys are appropriate for this age. Which toy selection by the mother would be concerning for the nurse? Building blocks Tricycle Play-Doh Bead stringing toys

Bead string toys

Infant

Birth to 1 year

The nurse is assessing a 12-month old during a well child visit. Which of the following is an area of concern and needs further evaluation? A) closed anterior fontanel B) eruption of six teeth C) birth weight has doubled D) birth length increased by 50%

C posterior fontanelle closes first by 6 months and then anterior by 12-18 months Birth weight should be Trippled

Which statement would the nurse identify as an example of emotional abuse of a child? An ill child is not allowed to be taken for care due to parents' religious objections. Parents choose not to provide a hearing aid for a school-aged child due to the stigma of wearing it. A child is alone at home after school for several hours every day. A child is left alone prior to school in the morning and is expected to take their own medications.

Child is alone at home after school for several hours every day.

A 9-year-old boy is able to explain how his injury happened to the nurse. Intuitive Concrete operational Formal operational

Concrete operational Children can have more logical thought processes while beginning to think abstractly. During the concrete operational stage, children become less self-centered and their thought processes are more coherent and logical, but they are still unable to think abstractly.

A two-and-one-half-year-old child does not search for an object when it is removed from the field of vision. The nurse correctly interprets this finding as: Normal cognitive development Delayed cognitive development Delayed psychosocial development Normal psychosocial development

Delayed cognitive development

Which term does the nurse understand to describe the process of development in which simple to more complex progression of developmental milestones is achieved? Differentiation Cephalocaudal Proximodistal Interdependent

Differentiation

Billy is in the emergency room for chronic history of vomiting and diarrhea with unknown origin. The nurse plots the child's measurements, realizing Billy is below the 5th percentile for both weight and height for age. Which statement is most accurate? As long as the child is meeting normal developmental milestones, waiting until illness resolves will allow the child time to increase weight gain. The Department of Human Resources should be notified as this is a sign of abuse. Immunologic conditions typically cause significant decrease in weight and height; Billy's condition should resolve spontaneously. This finding is consistent with a diagnosis of failure to thrive.

Failure to thrive

Fine or gross A 3-month-old infant can follow an object to midline with her eyes.

Fine

A 4-year-old hides from his mother after hitting his younger brother. Autonomy Vs. Shame/Doubt Initiative Vs. Guilt Industry Vs. Inferiority

Initiative vs guilt During the preschool years, children are learning right from wrong and will establish a sense of conscience as part of the initiative vs. guilt stage. They learn about their environment through play. At this time, the child develops a conscience. Children who are constantly criticized will have feelings of guilt.

Using personal judgments to determine what is right and wrong preconventional, conventional, or postconventional

Post conventional Children 12 years and older will place their value in their own individual rights regardless of authority figures and peers according to Kohlberg's moral development theory.

Following parent's orders to eat dinner before having candy preconventional, conventional, or postconventional

Preconventional Children ages 2 to 7 years follow rules set by those in authority and know the difference between right and wrong, good and bad, according to Kohlberg's moral development theory.

A 4-year-old thinks that his temper tantrum caused the thunderstorm. Sensorimotor Preoperational Intuitive

Preoperational Magical thinking occurs from the ages of 2 to 4 in Piaget's preoperational stage. In this stage children think that their thoughts influence the world.

Language development 30 months

Receptive language •Follows a series of two independent commands Expressive language •Vocabulary of 150-300 words

Healthy practices toddlers

Sleep/Rest •12-13 hours/day •Discontinues napping around 3 years old •Consistent bedtime rituals •No reward for night waking Teeth/Gums (Full set of primary teeth by 30 months) •Dentist by age 1 years old •Begin brushing teeth at 1 years with smear of toothpaste; Use small amount of fluorinated toothpaste (pea size) after 3 years old

Language and motor skills 1 month

Socialization and gross motor skills -Reflexive behavior, fixates on moving objects, crying differentiated (parents can understand need based on cry) Gross motor skills -Head lag when pulled to sit Fine motor skills -Fists mostly clenched, strong grasp reflexInvoluntary hand movements

Language and motor skills 9 months

Socialization and language - 9-12 months- Begins to attach meaning to "mama, dada", starts imitating speech sounds and animal sounds, recognizes objects by name, uses 2-5 recognizable words with meaning but understands many more, looks at and follows pictures in books, separation anxiety Gross motor skills -Crawls, abdomen off floor -Pulls to a standing position Fine motor skills -Bangs objects together -Crude pincer grasp

Upon assessment of a hospitalized 15-month-old, the nurse notices he does not pull to a standing position. The mother states that he will stand if she holds him upright. How should the nurse interpret this finding? The child has not yet met the appropriate developmental milestone for age. The child is meeting appropriate developmental milestones. It is not anticipated the child will pull up to a standing position until the end of 1 year. Regression is normal in a hospitalized child, so the nurse would not expect him to stand at this time.

The child has not yet met the appropriate developmental milestone for age.

The nurse is assessing a 6-year-old child. According to Piaget, what should the nurse expect to observe in the child at this stage? Select all that apply. The child's thinking is influenced by fantasy. The child understands the concept of time. The child is able to think abstractly. The child is able to think about things that are not in the present. The child's language skills are fully developed.

The child's thinking is influenced by fantasy. The child is able to think about things that are not in the present.

Theories cont. Toddler

Theorist: Erik Erikson Stage: Autonomy vs. Shame & Doubt Age 1-3 Activity •Achieves autonomy and self-control •Separates from parent/caregiver •Withstands delated gratification •Negativism abounds •Imitates adults and playmates •Cannot take turns until age 3 years Theorist: Jean Piaget Stage: Sensorimotor Substage 5: Tertiary Circular Reactions Age: 12-18 months Sensorimotor Substage 6: Mental Combinations Age:18-24 months Preoperational Age: 2-7 years Activity •Differentiating self from objects •Increased object permanence (knows that objects that are out of sight still exist (e.g. cookies in the cabinet)) •Uses ALL senses to explore environment •Places items in and out of containers •Imitates domestic chores (domestic mimicry) •Imitation is more symbolic •Starting to think before acting •Understands requests and is capable of following simple directions •Has a sense of ownership (my, mine) •Time, space, and causality understanding is increasing •Uses mental trial and error rather than physical •Makes mechanical toys work •Plays make-believe with dolls, animals, and people •Increased use of language for mental representation •Understands concept of "two" •Starting to make connections between an experience in the past and a new one that is currently occurring •Sorts objects by shape and color •Completes puzzles with four pieces •Play becomes more complex

Developmental theories: toddler

Theorist: Lawrence Kohlberg Stage Moral/Spiritual Moral: Stage 2: Preconventional Level Age: 1-4 years Activity •Detects concepts of fairness and sharing •Has an instrumental-relationistic orientation •Satisfies own needs •Is at a conventional level, beginning good girl/nice boy"•Demonstrates approval-seeking behavior coupled with a desire to please Theorist: James fowler Stage: Spiritual: Stage I: Intuitive/Projective Age: 1-4 years Activity •Learns to imitate the religious affect and behavior of parents •Mimics religious gestures, although does not comprehend meaning •Formulates own conceptions and explanations of faith and belief •Cannot separate feelings from intellect •Formulates imagined descriptions of God (angel, friend child can communicate with) Theorist: Sigmund Fraud Stage: Anal Stage Age: 1-3 Activity •Focus is on achieving anal sphincter control. Satisfaction and/or frustration may occur as the toddler learns to withhold and expel stool.

Infants: physical growth/tasks

Weight •Average birth weight= 7 lbs 8 oz (3400 gms). •Newborn looses up to 10% birth weight- regaining 20-30 gm/d. •Return to birth weight by 10-14 days of age. •Double birth weight by 6 months/ Triple birth weight by 1 yr./quad. by 2 yrs Height •Average newborn 19-21" (48-53 cm) •Length increases by 1 inch (2.5 cm)/month 1st 6 months then 1/2"/month 2nd 6 months

Shaken Baby Syndrome (SBS)

a condition in which a baby or young child has injuries as a result of being violently shaken

neonate

newborn baby

Perinatal

the time and events surrounding birth Factors to consider Maternal Health History •Gestational Diabetes •Gestational Hypertension •Perinatal Substance Use •Genetic Disorders

Principles of growth and development

Each child will display individual yet predictable patterns of growth and development. Orderly and sequential. -Differentiation: development from simple to complex activities and functions. . Cephalocaudal (gross motor-head to tail). Proximodistal (fine motor- center to periphery).

Motor skills 36 months

Gross •Climbs well •Stands on one foot •Pedals tricycle •Runs easily •Walks up and down stairs with alternate feet •Bends over easily without falling Fine •Undress self •Draws circle •Builds tower of nine or ten cubes •Holds a pencil in writing position •Screws/unscrews lids, nuts, bolts •Turns book pages one at a time

Motor skills 24 months

Gross •Runs •Kicks ball •Can stand on tiptoe •Carries several toys or a large toy while walking •Climbs down from furniture without assistance Fine •Builds tower of six or seven cubes •Right- or left- handed •Imitates circular and vertical strokes •Scribbles and paints •Starting to turn knobs •Puts round pegs into holes •Turns book pages (singly with board book, multiple if paper)

Language and motor skills 11 months

Gross motor skills - cruises Fine motor skills - Offers objects to others and releases them Neat pincer

Language and motor skills 7 months

Gross motor skills - sits alone with some use of hands for support Fine motor skills - transfers objects from one hand to the other

A nurse is caring for a toddler on an inpatient unit. Which developmental milestones should be expected at this stage by the nurse? Select all that apply. Gross motor development milestones include learning to ride a bike. Speech and language milestones include learning to put three or more words together to form a sentence. Fine motor development milestones include learning to use a fine pincer grasp. Fine motor development milestones include stacking 6 or more blocks on top of one another. Cognitive development milestones include understanding the concept of object permanence.

2, 4

crude pincer grasp

8-10 months

Infant nutrition cont.

8-10 months -May eat 3 meal/day(foods mashed or finely minced) •Try introducing meat for protein -try pureed, warmed and mixed with veggie that baby likes •Healthy snacks: bananas ,rice cakes, crackers, yogurt, sweet potatoes, oatmeal, applesauce, cheese, beans, cottage cheese 10-12 months •Baby trying to feed self with spoon •BF 3-4 feedings/day •Bottle feeding 16-24 oz/day •Cereal/rice/noodles 2-4 servings/day •Cooked/raw veggies 1-2 servings/day •Fresh/cooked fruit 1-2 servings/day •Meat 1-2 tbsp 2x/day

Toddlers eat approximately______ times a day. A) 7 B) 3 C) 12 D) 20

A

The nurse asks the nursing student to provide an example of proximodistal development. Which would be an appropriate response by the student? A child is able to sit unsupported before being able to grasp objects with the fingers. An infant is able to hold the head up steadily before standing. A child learns to crawl before walking. A child is able to sit unsupported before pulling to stand.

A child is able to sit unsupported before being able to grasp objects with the fingers.

The desire to follow the rules and maintain social order. preconventional, conventional, or postconventional

Conventional This level follows the preconventional level in which rules are set by those in authority. The child adjusts behaviors to conform to good-bad/right-wrong thinking. In the conventional level the focus is on conformity and loyalty, following rules, and maintaining social order.

In terms of fine motor development, which behavior would be most characteristic of a 10 month old's milestone? A) grasping a rattle B) demonstrating evidence of palmer grasp C) passing a block from one hand to another D) showing a fine pincer grasp

D

A four-year-old is exhibiting signs of anxiety due to an upcoming invasive procedure. Which is the appropriate action by the nurse to alleviate anxiety and improve compliance for this child? Explain the procedure in concrete terminology and allow the child to ask questions. Demonstrate the procedure on a doll and allow the child to manipulate the equipment. Reassure the child that there is no reason to be fearful. Explain to parents that this is normal and to ignore the behavior so that it does not become reinforced.

Demonstrate

Which anticipatory guideline does the nurse identify as appropriate for a preschool aged child? A child this age will be learning to run. A child this age will be learning how to draw a circle with a pencil. A child this age will be learning dress themselves. A child this age will be learning to go down and upstairs independently.

Dress themselves

When assessing a 9-month-old, the nurse asks the mother if the child likes to play peek-a-boo. The nurse is determining if the child has achieved which milestone? Object permanence Use of symbols to represent objects Coordination of reflexes Coordination of secondary schema

Object permanence

The nurse identifies that a child who consistently measures below the 5th percentile for height and weight charts is demonstrating signs of this diagnosis: Failure to thrive Failure to develop Developmental delay Organic growth deficiency

Failure to thrive

Fine or gross A 5-year-old uses scissors to cut out shapes of paper.

Fine

Genetic implications

Genetic disorders: Can occur at any period in life Inherited Acquired Evaluated: •Phenotype: outward characteristics/presentation of the person •Screening: preconception/prenatal testing, newborn screening • Diagnostic testing •Human Genome Project-- NIH

Fine or gross A 7-month-old infant rolls from side to side.

Gross

Motor skills 12-15 months

Gross - walks independently - creeps up stairs Fine •Feeds self finger foods •Uses a cup well •Uses index finger to point

Motor skills 18 months

Gross •Climbs stairs with assistance •Pulls and toys while walking •Runs clumsily •Throws a ball overhand •Jumps in place with bot feet Fine •Masters reaching, grasping, and releasing: stacks blocks, puts things in slots •Removes shoes and socks •Stacks cubes (3-4) •Manages a spoon

Head and chest measurements

Head and Chest •Average HC-33-35 cm. •Head circumference increases approx. 2cm per month for first 3months •Rapid brain growth: increases to 2/3 adult size by age one. HC measured until age 3 years •Chest : 2-3cm < HC at birth (not routinely measured )

Language development 24 months

Receptive language •Points to named body parts •Points to pictures in books •Enjoys listening to simple stories •Names a variety of objects in the environment •Beginning to use "my" or "mine" •Uses multiword sentences Expressive language •Vocabulary of 40-50 words •Sentences of two or three words (me up, want cookie) •Asks questions (what that?) •Uses simple phrases •Uses descriptive words (hungry, hot) •Two thirds of what child says should be understandable •Repeats overheard words

Language development 12 months

Receptive language •Understands common words independent of context •Follows a one-step command accompanied by gesture Expressive language •Uses a finger to point to things •Imitates or uses gestures such as waving goodbye •Communicates desires with word and gesture combinations •Vocal imitation •First word

Injury prevention

Increased mobility/ reflexes •Closely monitor •Keep side rails up •Use proper restraints •Avoid elevated surfaces •No high chairs until sitting Aspiration/ poisoning •Closely monitor •Keep side rails up •Use proper restraints •Avoid elevated surfaces •No high chairs until sitting Child Abuse; Shaken Baby syndrome Suffocation/ drowning •Never leave alone in the bath •Crib safety (slats/bedding). •No strings/ bibs left around neck Burns/ exposure •Microwaved foods/formula •Hot bath water (water heater set<120*) •Never leave alone in a care •Avoid excessive sun exposure MVA •Never hold on a lap •AAP car seat recommendations •Never leave a stroller behind a car

Safety

Infants and small children are at higher risk for traumatic injury due to their size and inability to protect themselves. A & P considerations? 1.________________________________.2.________________________________3.________________________________4.________________________________5.________________________________6.________________________________7.________________________________8.________________________________9.________________________________

language development 36 months

Receptive language •Understands most sentences •Understands physical relationships (on, in, under) •Participates in short conversations •May follow a three-part command Expressive language •Speech usually understood by those who know the child about half understood by those outside family •Asks "why?" •Three- to four-word sentences •Talks about something that happened in the past •Vocabulary of 1,000 words •Can say name, age, and gender •Uses pronouns and plurals

Vitals for infant (birth to 12 months)

Neonate (less than 28 days) HR: 100-205 awake and 90-160 asleep RR: 30-53 BP: 84-67/53-35 Temp 97.7-99.5 axillary Infant (1-12 months) HR: 100-190 awake and 90-160 asleep RR: 30-53 BP: 104-72/56-37 Temp: 97.7-99.5 axillary

Nursing assessment of an infant

Newborns/Infants require time to become acquainted • use eye contact •allow parent to hold for procedures when possible

A three-year-old who is hospitalized following surgery cries every time his mother leaves the room. The mother expresses concern, as this is not normal behavior at home Which is the most appropriate response from the nurse? "This is normal behavior for toddlers who are hospitalized." "This is separation anxiety and typically disappears by 9 months. Possibly the child is showing signs of pain." "This crying will cause unnecessary stress during recovery, so you will need to stay with the child unless they are asleep." "Perhaps the child is getting spoiled from all of the attention you provided right after surgery."

Normal behavior

Language development 18 months

Receptive language •Understands the word "no" •Sometimes answers the question, "What is this?"Expressive languege •Uses at least 5-20 words •Uses names of familiar objects

Which statement would the nurse identify as an example of medical abuse of a child? An ill child is not allowed to be taken for care due to parents' religious objections. Parents choose not to provide a hearing aid for a school-aged child due to the stigma of wearing it. A child is alone at home after school for several hours every day. A child is left alone prior to school in the morning and is expected to take their own medications.

Religious objections

Language development 15 months

Receptive language •Looks at adult when communicating •Follows a one-step command without gesture •Understands 100-150 words Expressive language •Repeats words that he or she hears •Babbles in what sound like sentences

When assessing risky behavior during a visit with a 14-year-old, what should the nurse be alerted to? Select the best answer. Forgetting to study for a test Going to a party with friends Joining a swimming league Riding in a car without a seatbelt

Riding in a car without a seatbelt

An infant searches for an object placed under a pillow, exhibiting understanding of object permanence. Sensorimotor Preoperational Intuitive

Sensorimotor During this stage, which lasts from birth to 2 years, infants develop a sense of object permanence. They begin to realize an object or person still exists when it is hidden. Examples include peekaboo or hiding an object under a pillow.

Infancy- Developmental Theories

Sigmund Freud -Oral stage drives pleasure from mouth- activities of feeding and sucking Erik Erikson -Trust vs. Mistrust: Caregivers respond to basic infant needs. Infants realize they are separate beings and in time tolerate small delays. Jean Piaget -Sensorimotor- infant uses senses and motor skills to learn about world. •Object permanence begins around 1-4 months. Infant repeats actions to achieve wanted results around 4-8 months. Intentional motion to reach desired toy/ location 8-12 months. Object permanence fully present at 8 months. •Separation anxiety first seen around 8 months of age; infant well aware of different caregivers by 12 months. Begins to associate symbols with events (wave goodbye)

Language and motor skills 8 months

Socialization and language - Babbles in strings (mama, dada), responds to simple commands, object permanence well established, stranger anxiety Gross motor skills -Sits unsupported Fine motor skills - Gross pincer grasp (rakes)*also referred as palmer grasp

Language and motor skills 12 months

Socialization and language - Babbles with inflection - Fears: loud noises, sudden moves, strangers - Says 3-5 words by age one Gross motor skills - Sits from standing position - Walks with a hand held Fine motor skills -Feeds self with cup and spoon Makes simple mark on paper Pokes with index finger Turns pages of a book

Language and motor skills 6 months

Socialization and language - Squeals/ yells, smiles at own image, decrease sucking need, taste preference, comfort habits begin -6-8 month old- Enjoys social interactive games (Peek-a-boo/ Patty cake), fixates on small objects, some depth perception, cries when scolded Gross motor skills -Rolls from back(supine) to front (supine) Fine motor skills - Holds a bottle

Language and motor skills 10 months

Socialization and language - Understands "no" by 9-10 months Gross motor skills - Pulls to stand Fine motor skills -Fine pincer graspPuts objects into container and takes them out

Language and motor skills 4 months

Socialization and language - laughs and squeals Gross motor skills - rolls from back to side Fine motor skills - grasps objects with both hands

Language and motor skills 5 months

Socialization and language -4-5 month old- makes simple vowel sounds, laughs aloud, vocalizes in response to voice, responds to name, does "raspberry", begins to respond to "no" Gross motor skills -Rolls from front (supine)to back(prone) Fine motor skills - Uses a palmer grasp

Language and motor skills 2 months

Socialization and language -First real smile, watchful, coos Gross motor skills -Raises head in prone Fine motor skills -Grasp reflex diminishing, holds hands in an open position

Language and motor skills 3 months

Socialization and language -Interacts with caregiver, smiling wildly ,gurgling in response to interactions, cooing -3-4 month old- mimics parents facial movements Gross motor skills -Raises head and shoulders when in prone -Slight head lag in pull to sit Fine motor skills -Grasp reflex disappears

Understanding that basic needs will be met, such as being picked up by a parent when crying, is a task in what psychosocial development stage? Trust vs. mistrust Autonomy vs. shame/doubt Initiative vs. guilt Industry vs. inferiority

Trust vs mistrust

An infant cries and the mother picks up the baby for a feeding. Trust vs mistrust Autonomy vs shame an doubt Initiative vs guilt

Trust vs mistrust During the trust vs. mistrust stage, the infant will develop trust if basic needs are met and mistrust if basic needs are unmet. A sense of trust in his or her parents and surroundings allows the infant to see the world as a safe place.

Newborn skull

fontanelles "soft spots" (membranous connective tissue). allows for fast growth of brain, overlap of bones during birth Large fontanelles can indicate intracranial pressure Sunken fontanelles can mean dehydration

Senses

sight, taste, touch, smell, and hearing Vision -neonates are near-sighted viewing distance 8-15 inches.. prefers human faces/light-dark contrast. acuity is 20/400>>> 20/100 by 3 months Newborns- strabismus due to lack of binocular visions, fixates on moving objects Hearing - acute as adults, prefer human voice. tested prior to d/c from hospital using otoacoustic emissions or auditory brainstem response!! Touch - most important communication tool, enjoys rocking, stroking/ dislikes rough handling Smell - one week old can distinguish mothers breastmilk Taste - prefers sweet taste, will eventually accept non sweet flavors after several months

SIDS

sudden infant death syndrome •Sudden unexpected death of a healthy child •Remains unpredictable; most common in 2-4mos. •Back to Sleep campaign (1994)-have seen a 43% drop in no. of deaths •Potential contributing risk factors: being over heated, sleeping on a soft surface with blankets, smoker in the home •Pacifier-thought to help prevent SIDS-(no strings!) •Recommendations for safe sleep?

Mental representation

the ability to form internal images of objects and events

Object permanence in infants

the awareness that things continue to exist even when not perceived (9 months)

Toddler assessment

• involve child in assessment, •get on their level •explain in words he/she understands: ie bp cuff will give you a hug •explain procedures immediately before, use stories and books. •Health History •Vital Signs •Pain (FLACC) •General head to toe assessment •Remember: Inspection, Auscultation and Palpation

Autism

•Autism spectrum disorder (ASD) is a range of complex neurodevelopmental disorders, characterized by social impairments, communication difficulties, and impaired cognitive function (restricted, repetitive, and stereotyped patterns of behavior). Appears before age 3. •Experts estimate that 1 out of 59 children by age 8 will have an ASD (Centers for Disease Control, 2019). Males are four times more likely to have an ASD than females. •Etiology: genetic, biochemical, environmental •Language/Social: not babbling/talking, not responding to verbal prompts, poor eye contact, makes odd movement, displays obsessions/compulsions, or shows unusual attachment to objects. •Developmental evaluation: Screened at 18 months & 24 or 30 months, required whenever a child fails to meet any of the following milestones: babbling by 12 months; gesturing (e.g., pointing, waving bye-bye) by 12 months; single words by 16 months; two-word spontaneous (not just echolalic) phrases by 24 months; loss of any language or social skills at any age (CDC,2016). •Co-morbidities: epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder, digestive disorder, OCD, sensory integration •Treatment: Intensive skill-oriented training, medications, alternative therapies

Nutrition: breastfeeding and formula

•Breast milk/iron fortified formula-Exclusively until 4-6 months. NO COWS MILK •Should be held for feedings •Signs of hunger: sucking motions, rooting (crying is a late sign) doesn't mean you need to feed every few hours... do it when they give you signs •WHO recommends exclusive BF until 6 months of age.

Toddler nutrition

•Extended breast feeding •Wean from bottle to cup by 12-15 months •Milk intake: 24-28 oz/day •Need diet high in calcium and iron (Fortified cereals, dairy) •Offer 3 full meals and 2 snacks/ day- quarter adult size portion •Offer new foods many times- if refuse don't substitute unhealthy choice •Do not restrict fat intake for toddlers less than 2 Serve room temperature, bite size, child size utensils

Social development

•Focused on separation and self (Egocentric) •Power struggles/ temper tantrums •Relies on routines and security items •Lack of empathy/ Demonstrates aggressive impulsive behavior •Looking for control over environment- need to offer limited choices •Doesn't have clear body boundaries- fear of intrusive procedures/ loosing part of self •Separation anxiety may reemerge. Older toddlers better able to understand object constancy •Common fears: Dark, loud noise, strangers, body mutilation(intrusion of body boundaries), separation anxiety •Decision for actions for older toddler based on avoidance of punishment and attainment of pleasure

Growth and development

•Growth: an increase in physical size. •Development: behavioral aspect of growth; continuous; reflects capacity and skill of a person to adapt to the environment. •Growth and development: independent yet interrelated processes- influenced by environment and heredity. •Maturation: increase in function. •Temperament: reaction to situations

Toddlers: 1-3 year olds

•Height and weight increase in spurts (side by side pic of kora) Average wt gain 3-5 pounds/yr. Triples by 1 year. Quadruples birth weight by age 2. Ht increases 3 inches/yr. Half adult height by age 2. •Head circumference- increases 1 inch between 1-2 years old then half inch/yr until age 5 size, appears more proportional by age 3 •Swayback, potbelly appearance

System maturation toddler

•Neuro: Brain growth about 90% adult size by age 2. Myelinization completed by 24 months- results in improved coordination ,equilibrium, sphincter control. •Respiratory: Trachea and lower airway continue to grow but still small, tongue ,tonsils ,adenoids large, alveoli increase in number, Eustachian tube short and straight •CVS: HR decreased, BP increased •GI: stomach increase in size- allowing 3 regular meals/day, increased pepsin production, intestines immature (often pass difficult to digest foods) •GU: mature bladder- kidney function by age 2, urine output 1-2 ml/kg/hr, urethra short- susceptible to UTI •Sensory: vision 20/50-20/40. Depth perception, maturing taste preference for familiar flavors

System maturation

•Neurological: reflexive behavior replaced by purposeful action in 1st few months. •Primitive reflexes: moro (arms go out and they are startled like they are falling), root (baby turns when nipple touches mouth to feed), suck (when the roof of the baby's mouth is touched), tonic neck (baby head turns to the side and opposite arm stretches out), plantar (toes curl down), palmar (hold your finger in their palm), grasp, step and Babinski.. toes flare out (All disappear in 1st few months except Babinski, at one year of age) •Protective reflexes: Neck righting.. body turns where head turns (appears 4 months) and parachute... arms extend when falling (appears 6 months) -needed for establishing equilibrium and remain for life. •Healthy Neurological system indicative of presence and disappearance of reflexes Resp. system the airway is narrow, trachea and chest wall more compliant, less aioli. system not fully mature til 7 Cardiovascular system heart size doubles by age 1, less stable peripheral circulation Gastrointestinal/digestive system small stomach, decreased saline and digestive enzymes and first teeth at 6-8 months... average 12 month old has 4-8 teeth... liver is immature Genitourinary system renal structures are immature until age 2, effects ability to concentrate urine.. uric crystals can form from dehydration Immune system.. some immunity first 3-6 months from mother, gradual production of own immunoglobulin in first year of life extending into early childhood

Language development: rapid, influences by interactions

•Receptive language more advanced than expressive •Echolalia- seen in toddlers less than 30 months •"Why and what" questions common in older toddler •Telegraphic speech (Want cookie milk) •Vocabulary of > 1000 words- uses short sentences •Encouragement and elaboration conveys confidence and interest to toddler. Needs time to complete thoughts. •Onset of stuttering between 2-4 years of age; 75% resolve without treatment

Risk for morbidity/ mortality

•Under one 1 yrs old—SIDS/suffocation and congenital defects are the leading causes of death. •Over one yrs old> Trauma: MVA, Abuse, Accidents •Medical Professionals are considered to be Mandated Reporters •Anticipatory Guidance