NUR 112 // E5: 1-Growth and Development (Conception - Adolescence)
school-age children and adolescents developmental changes*
-develop, expand, refine, and synchronize physical, psychosocial, cognitive, and moral skills so that the individual is able to become an accepted and productive member of society -environment in which the individual develops skills also expands and diversifies -environment now includes the school, community, and church
health risks during infancy**
Injury Prevention -major cause of death in children 6 to 12 months old -as a child achieves gains in motor development and becomes increasingly curious about the environment, constant watchfulness and supervision are critical for injury prevention Child Maltreatment -includes intentional physical abuse or neglect, emotional abuse or neglect, and sexual abuse of children, usually by adults -many children suffer from more than one type of maltreatment -a pattern of injury should arouse suspicion
toddler/toddlerhood*
-12 to 36 months -children enjoy increasing independence bolstered by greater physical mobility and cognitive abilities -success = repeated attempts to control their environments -unsuccess = negative behavior and temper tantrums (most common when parents stop the initial independent action)
adolescents/adolescence*
-period during which the individual makes the transition from childhood to adulthood, usually between ages 13 and 20 years -important to promote healthy development
language during toddlerhood***
-18 months: uses approximately 10 words -24 months: has a vocabulary of up to 300 words; generally able to speak in two-word sentences, although the ability to understand speech is much greater than the number of words acquired -preoperational stage -begin to think about things more symbolically as their vocabulary develops -"me do it" and "that's mine" demonstrate the 2-year-old child's use of pronouns and desire for independence and control -36 months: can use simple sentences, follow some grammatical rules, and learn to use five or six new words each day
psychosocial changes during toddlerhood**
-a sense of autonomy emerges during toddlerhood -children strive for independence by using their developing muscles to do everything for themselves and become the master of their bodily functions -temper tantrums result when parental restrictions frustrate toddlers -need to provide toddlers with graded independence, allowing them to do things that do not result in harm to themselves or others
health risks during the school-age period**
-accidents and injuries -their developed cognitive and motor skills make them less likely to suffer from unintentional injury -risk takers and attempt activities that are beyond their abilities -infections -poverty and the prevalence of illness are highly correlated
school-age children*
-age 6 to about age 12 -foundation for adult roles in work, recreation, and social interaction is laid -develop competencies in physical, cognitive, and psychosocial skills -school or educational experience expands the child's world and is a transition from a life of relatively free play to one of structured play, learning, and work -learn to cope with rules and expectations presented by the school and peers
preschoolers/preschool period*
-ages 3 and 5 -refine the mastery of their bodies and eagerly await the beginning of formal education -children are less negative, more accurately share their thoughts, and more effectively interact and communicate -physical development occurs at a slower pace than cognitive and psychosocial development
cognitive changes during infancy**
-as infants receive stimulation through the developing senses of vision, hearing, and touch, the developing brain interprets the stimuli -infants learn by experiencing and manipulating the environment -sensorimotor period: infants explore their world through senses -infants need opportunities to develop and use their senses -infants need to be stimulated according to their temperament, energy, and age
health risks during the preschool period**
-becomes more coordinated with better balance so falls become much less of a problem -need to learn about safety, and parents need to continue close supervision of activities -great imitators, so parental example is important
family identity during adolescence***
-begin to place more value on peer relationships than on parents -many work part-time, using their income to bolster independence -parents can provide allowances for clothing and incidentals, which encourage them to develop decision making and budgeting skills -need to make choices, act independently, and experience the consequences of their actions
cognitive changes during the neonatal period**
-begins with innate behavior, reflexes, and sensory functions -initiate reflex activities, learn behaviors, and learn their desires -able to focus on objects about 8 to 12 inches (20 to 30 cm) from their faces and perceive forms -respond to human faces, black and white contrasting patterns, and bright colors -important to provide sensory stimulation -crying is a means by which newborns communicate to provide cues to parents
play during toddlerhood***
-child's imagination develops -children begin to discern the difference between past and future -do not grasp more complex concepts such as cause and effect -toddlers remain strongly attached to their parents and fear separation from them because they feel safe with them -continues to engage in solitary play during toddlerhood but also begins to participate in parallel play, which is playing beside rather than with another child -consider the safety of a toy and whether the toy supports development of the child
stress during the school-age period***
-comes from parental expectations, peer expectations, the school environment, and violence in the family, school, or community -some school-age children care for themselves before or after school without adult supervision -deep-breathing techniques, positive imagery, and progressive relaxation of muscle groups are interventions that most children can learn
cognitive changes during the school-age period**
-concrete-operational stage of growth -become less egocentric and begin to understand that their thoughts and feelings may not be shared by others -ability to think in a logical manner about the here and now and to understand how one thing relates to another -use their developed thinking abilities to experience events without having to act them out -thoughts are no longer dominated by their perceptions; thus their ability to understand the world greatly expands -have the ability to concentrate on more than one aspect of a situation -understand that others do not always see things as they do and even begin to understand another viewpoint -recognize that the amount or quantity of a substance remains the same even when its shape or appearance changes -have collections
language during the preschool period***
-continue to increase rapidly -by the age of 5 children have an average of 2100 words that they use to define familiar objects, identify colors, and express their desires and frustrations -combine four to five words into sentences and use pronouns, prepositions, adjectives, and verbs -more social, and preschoolers often question "Why?" and ask the same question repeatedly until answered -phonetically similar words cause confusion in preschool children so avoid
sexual identity during the school-age period***
-curious about their sexuality -the time for them to have exposure to sex education, including topics about sexual maturation, reproduction, and relationships
supplementation during infancy****
-depends on an infant's diet -after 6 months, iron-fortified cereal is generally an adequate supplemental source -fluoride is an essential mineral required for development of healthy teeth -in areas where fluoridation of water is inadequate, fluoride supplementation may be indicated
physical changes from intrauterine to extrauterine life -apgar score -interventions at birth
-determine the physiological functioning of the major organ systems occurs at birth -Apgar score: conducted at 1 and 5 minutes after birth and is sometimes repeated until the newborn's condition stabilizes -most extreme physiological change occurs when the newborn leaves the utero circulation and develops independent circulatory and respiratory functioning -interventions at birth: maintain an open airway (remove secretions), stabilize and maintain body temperature (radiant warmer, abdomen placement, blankets, cap), and protect the newborn from infection (instruct parents and visitors to wash their hands before touching the infant)
cognitive changes during the preschool period**
-development is through imaginative play and interactions with others -remain egocentric in their communication and believe others think as they do -have increased social interaction, as is illustrated by the 5-year-old child who offers a bandage to a child with a cut finger -become aware of cause-and-effect relationships -if two events are related in time or space, children link them in a causal fashion -age 5: begin to use or learn to use rules to understand causation; then they begin to reason from the general to the particular -believe that inanimate objects have lifelike qualities and are capable of action -knowledge of the world remains closely linked to concrete (perceived by the senses) experiences -believe that a punishment is automatically connected to an act and do not yet realize that it is socially mediated -greatest fear: bodily harm
cognitive changes during adolescence**
-develops the ability to determine and rank possibilities, solve problems, and make decisions through logical operations -thinks abstractly and deals effectively with hypothetical problems -considers an infinite variety of causes and solutions for problems -able to imagine what might be -think in terms of the future rather than just current events -receptive to more detailed and diverse information about sexuality and sexual behaviors -understand how an individual's ideas or actions influence others -believe that they are unique and the exception, giving rise to their risk-taking behaviors
language skills during adolescence***
-fairly complete by adolescence, although vocabulary continues to expand -communication skills: need to communicate thoughts, feelings, and facts to peers, parents, teachers, and other people of authority -select the people with whom to communicate, decide on the exact message, and choose the way to transmit it -good communication skills are critical for adolescents in overcoming peer pressure and unhealthy behaviors
inborn errors of metabolism (IEMs)
-genetic disorders caused by the absence or deficiency of a substance, usually an enzyme, essential to cellular metabolism that results in abnormal protein, carbohydrate, or fat metabolism -rare -neonatal screening is done to detect phenylketonuria (PKU), hypothyroidism, galactosemia, and other diseases to allow appropriate treatment that prevents permanent mental retardation and other health problems
gross motor skills vs. fine motor skills
-gross-motor skills: involve large muscle activities and are usually closely monitored by parents, who easily report recently achieved milestones -fine-motor skills: involve small body movements and are more difficult to achieve than gross-motor skills
peer relationships during the school-age period***
-group and personal achievements become important -success is important in physical and cognitive activities -play involves peers and the pursuit of group goals -learning to contribute, collaborate, and work cooperatively toward a common goal becomes a measure of success -prefers same-sex peers -develop "best friends" with whom they share secrets and with whom they look forward to interacting on a daily basis
physical changes during toddlerhood**
-grows 7.5 cm (3 inches) in height, mostly through elongation of the legs -gains approximately 4 to 6 pounds (1.8 to 2.7 kg) each year -rapid development of motor skills: allows the child to participate in self-care activities such as feeding, dressing, and toileting gross motor -toddler walks in an upright position with a broad stance and gait, protuberant abdomen, and arms out to the sides for balance -soon the child begins to navigate stairs, using a rail or the wall to maintain balance while progressing upward, placing both feet on the same step before continuing -locomotion skills soon include running, jumping, standing on one foot for several seconds, and kicking a ball -ride tricycles and run well by their third birthday fine motor -fine-motor capabilities progress from spontaneous scribbling to accurately drawing circles and crosses -3 years: able to stack a small tower of blocks -learn to hold crayons with their fingers rather than with their fists and can imitate vertical and horizontal strokes -manage feeding themselves with a spoon without rotating it and can drink well from a cup without spilling -turn pages of a book one at a time and can easily turn doorknobs
health identity during adolescence***
-healthy adolescents evaluate their own health according to feelings of well-being, ability to function normally, and absence of symptoms -often include health maintenance and health promotion behaviors as important concerns -try new roles, begin to stabilize their identity, and acquire values and behaviors from which their adult lifestyle will evolve -tend to underestimate the effect of the potentially negative consequences of their own actions
play during infancy***
-important for development of cognitive, social, and motor skills -play is solitary and exploratory as infants use their senses to observe and examine their own bodies and objects of interest in their surroundings -plan activities that promote the development of milestones and providing toys that are safe for infants to explore with their mouth and manipulate with their hands such as rattles, wooden blocks, plastic stacking rings, squeezable stuffed animals, and busy boxes
cognitive changes during toddlerhood**
-increased ability to remember events -begin to put thoughts into words at about 2 years of age -recognize that they are separate beings from their mothers, but they are unable to assume the view of another -their reasoning is based on their own experience of an event -use symbols to represent objects, places, and people as they imitate the behavior of another that they viewed earlier (e.g., pretend to shave like daddy), pretend that one object is another (e.g., use a finger as a gun), and use language to stand for absent objects (e.g., request bottle)
psychosocial changes during the school-age period**
-industry versus inferiority: children strive to acquire competence and skills necessary for them to function as adults -begin to define themselves on the basis of internal more than external characteristics -define their self-concept and develop self-esteem through ongoing self-evaluation -interaction with peers allows them to define their own accomplishments in relation to others as they work to develop a positive self-image -formal operations: ponder abstract
separation and individuation during infancy***
-infants begin to differentiate themselves from others as separate beings capable of acting on their own -through repeated experiences with the environment, they learn where the self ends and the external world begins -2-3 month old infants begin to smile responsively rather than reflexively -recognize differences in people when their sensory and cognitive capabilities improve -by 8 months most infants are able to differentiate a stranger from a familiar person and respond differently to the two; close attachment to their primary caregivers occurs and infants seek out these people for support and comfort during times of stress -the ability to distinguish self from others allows infants to interact and socialize more within their environments -trust versus mistrust -a child's temperament or behavioral style becomes apparent and influences the interactions between parent and child -when parents are not present, make an attempt to limit the number of different caregivers who have contact with the infant and to follow the parents' directions for care
nutrition during infancy***
-influence an infant's growth and development -breastfeeding is recommended for infant nutrition because breast milk contains the essential nutrients of protein, fats, carbohydrates, and immunoglobulins that bolster the ability to resist infection -iron-fortified commercially prepared formula can be used as an alternative -the use of whole cow's milk, 2% cow's milk, or alternate milk products before the age of 12 months is not recommended -breastfed or formula-fed infants under 4 months of age should not receive supplemental fluids, especially water or juice -addition of solid foods is not recommended before the age of 6 months because developmentally, infants are not ready for solid food before 6 months -one food should be introduced and consumed for approximately 1 week before introducing the next food -the use of fruit juices and nonnutritive drinks such as fruit-flavored drinks or soda should be avoided
sleep during infancy***
-many have their days and nights reversed until 3 to 4 months of age -young infants may sleep during the day -by 6 months most infants demonstrate nocturnal sleep patterns, sleeping between 9 and 11 hours at night -most infants take one or two naps a day by the end of the first year
physical changes during the neonatal period** -measurements -weight -height -head circumference -how much weight do they lose in the first few days of life? -physical characteristics -neurological function -behavioral characteristics
-measure height, weight, head and chest circumference, temperature, pulse, and respirations and observe general appearance, body functions, sensory capabilities, reflexes, and responsiveness -assess gestational age and interactions between newborn and parent that indicate successful attachment -weight: 6 to 9 pounds (2700 to 4000 g) -height: 19 to 21 inches (48 to 53 cm) in length -head circumference: 13 to 14 inches (33 to 35 cm) -neonates lose up to 10% of birth weight in the first few days of life, primarily through fluid losses by respiration, urination, defecation, and low fluid intake -regain birth weight by the second week of life -a gradual pattern of increase in weight, height, and head circumference is evident -physical characteristics: lanugo (fine downy hair) on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen; molding, or overlapping of the soft skull bones, readjust within a few days, producing a rounded appearance to the head (anterior fontanel usually closes by 12 to 18 months, whereas the posterior fontanel closes by the end of the second or third month) -neurological function: reflexes include blinking in response to bright lights, startling in response to sudden loud noises or movement, sucking, rooting, grasping, yawning, coughing, sneezing, swallowing, palmar grasp, plantar grasp, and Babinski -behavioral characteristics: periods of sucking, crying, sleeping, and activity; sporadic, symmetrical movements that are present in all 4 extremities; flexed fetal position of intrauterine life continues; watch the caregiver's face, have a nonsocial reflexive smile, and respond to sensory stimuli (caregiver's face, voice, and touch)
psychosocial changes during the neonatal period**
-most parents and newborns normally develop a strong bond that grows into a deep attachment through feeding, hygiene, and comfort measures -parents can allow siblings to participate in age-appropriate aspects of the newborn's care -consider how an illness can compromise the attachment process
health risks during toddlerhood**
-need close supervision at all times and particularly when in environments that are not childproofed -poisonings occur frequently because children near 2 years of age are interested in placing any object or substance in their mouths to learn about it -drowning is a concern -proper car seat
health promotion during pregnancy: -nutrition -weight gain -family dynamics -discomfort
-nutrition: poorly nourished before or during pregnancy can cause the fetus to not meat nutritional requirements -weight gain: 25 to 35 pounds (11 to 15 kg) over three trimesters -family dynamics impact fetal development; listen carefully to concerns expressed by a mother and her partner, and offer support through each trimester -age: increased age, increased risk of chromosomal defects and fertility difficulties increases; infants of teenage mothers have an increased risk of prematurity and low birth weight (less than 2500 g or 5.5 pounds) -discomfort due to hormone changes for the expectant mother; provide self-care education throughout the pregnancy; offer suggestions -provide accurate and complete information about health behaviors that support positive outcomes for pregnancy and childbirth
play during the preschool period***
-play becomes more social after the third birthday as it shifts from parallel to associative play -children playing together engage in similar if not identical activity; however, there is no division of labor or rigid organization or rules -most 3-year-old children are able to play with one other child in a cooperative manner in which they make something or play designated roles such as mother and baby -by age 4, children play in groups of two or three, and by 5 years the group has a temporary leader for each activity -preoperational stage: engage in make-believe play; imaginary playmates
language during infancy***
-proceed from crying, cooing, and laughing to imitating sounds, comprehending the meaning of simple commands, and repeating words with knowledge of their meaning -by 1 year, infants not only recognize their own names but are also able to say three to five words and understand almost 100 words -encourage parents to name objects on which their infant's attention is focused
psychosocial changes from intrauterine to extrauterine life**
-promote early parent-child contact to encourage parent-child attachment -most healthy newborns are awake and alert for the first hour after birth, so begin the parent-child interaction then -attachment is a process that begins during pregnancy and continues for many months after birth
communicating with adolescents
-provide privacy and a nonthreatening environment; interviews should be conducted without parents present -ensure confidentiality and explain the limitations of confidentiality, such as disclosure of abuse or suicidal ideations -be nonjudgmental and display genuine interest in the adolescent's perspective. -ask open-ended questions -start with less sensitive topics and then move to more sensitive issues
sexual identity during adolescence***
-puberty enhance achievement of sexual identity -encourages the development of masculine and feminine behaviors -depend on these physical clues because they want assurance of maleness or femaleness and they do not wish to be different from peers -identification of sexual orientation
language development during the school-age period***
-rapid during middle childhood -become more aware of the rules of syntax, the rules for linking words into phrases and sentences -identify generalizations and exceptions to rules -accept language as a means for representing the world in a subjective manner and realize that words have arbitrary rather than absolute meanings -think about language, which enables them to appreciate jokes and riddles
immunizations during infancy***
-recommended that the administration of the primary series begin soon after birth and be completed during early childhood -parents need instructions regarding the importance of immunizations and common side effects such as low-grade fever and local tenderness -be aware of measures such as auditory stimulus or swaddling to reduce or eliminate pain with procedures such as an immunization injection
psychosocial changes during adolescence**
-search for personal identity -establish close peer relationships or remain socially isolated -identity (or role) confusion -become more emotionally independent from their parents -develop their own ethical systems based on personal values -make choices about vocation, future education, and lifestyle
peer group identity during adolescence***
-seek a group identity because they need self-esteem and acceptance -similarity in dress or speech is common -peer groups provide the adolescent with a sense of belonging, approval, and the opportunity to learn acceptable behavior -popularity with opposite-sex and same-sex peers is important
physical changes during adolescence**
-sexual maturation occurs with the development of primary and secondary sexual characteristics -four main physical changes are: 1. increased growth rate of skeleton, muscle, and viscera 2. sex-specific changes, such as changes in shoulder and hip width 3. alteration in distribution of muscle and fat 4. development of the reproductive system and secondary sex characteristics -girls generally have prepubescent changes 1 to 2 years before boys do -rates of height and weight gain are usually proportional, and the sequence of pubertal growth changes is the same in most individuals -body produces gonadotropin-releasing hormones that stimulate ovarian cells to produce estrogen and testicular cells to produce testosterone --> secondary sex characteristics, such as hair growth and voice changes; acne and body odor -height and weight increases during adolescence, with peak height velocity occurring at about 12 years in girls and at about 14 years in boys -girls' height increases 5 to 20 cm (2 to 8 inches), and weight increases by 15.5 to 55 pounds (7 to 25 kg) -girls reach their full height by 16 to 17 years of age -boys' height increases approximately 10 to 30 cm (4 to 12 inches), and weight increases by 15.5 to 66 pounds (7 to 30 kg) -boys continue to grow taller until 18 to 20 years of age
physical changes during the school-age period**
-slow and consistent -appears slimmer than the preschooler as a result of changes in fat distribution and thickness -double their weight during these middle childhood years -most girls exceed boys in both height and weight by the end of the school years -become more graceful during the school years because their large-muscle coordination improves and their strength doubles -practice the basic gross-motor skills of running, jumping, balancing, throwing, and catching during play, resulting in refinement of neuromuscular function and skills -fine-motor skills improve, which allows proficiency in a wide range of activities, including handwriting, drawing, and playing -6 years: able to hold a pencil adeptly and print letters and words -12: make detailed drawings and write sentences in script -become very independent in bathing, dressing, and taking care of other personal needs -develop strong personal preferences in the way these needs are met -body appearance and posture change; more erect -eye shape alters because of skeletal growth -screening for vision and hearing problems is easier
physical changes during infancy** -growth -size -weight -height -why can you predict routines during this time? -reflexes? -motor development
-steady and proportional growth of an infant is more important -measurements recorded over time are the best way to monitor growth and identify problems -size: increases rapidly during the first year of life -weight: doubles in approximately 5 months and triples by 12 months -height: increases an average of 2.5 cm (1 inch) during each of the first 6 months and about 1.2 cm ( inch) each month until 12 months -infant's vision and hearing continue to develop -patterns of body function also stabilize, as evidenced by predictable sleep, elimination, and feeding routines -some reflexes that are present in the newborn, such as blinking, yawning, and coughing, remain throughout life, whereas others, such as grasping, rooting, sucking, and the Moro or startle reflex, disappear after several months -motor development proceeds in a cephalocaudal (head-to-toe) and proximodistal (central-to-peripheral) pattern, as does myelination of nerves
intrauterine life*
-the embryo grows from a single cell to a complex, physiological being -all major organ systems develop in utero, with some functioning before birth -full term: 38 to 40 weeks and is commonly -pregnancy is divided into equal phases of 3 months, called trimesters -preemybryonic stage: the first 14 days after fertilization -embryonic stage: lasts from day 15 until the eighth week; most vulnerable since all body organs are formed -fetal stage: lasts from the end of the eighth week until birth -placenta: begins development at the third week of the embryonic stage; produces essential hormones that help maintain the pregnancy; functions as the fetal lungs, kidneys, gastrointestinal tract, and an endocrine organ; extremely porous so teratogens and can cause abnormal development of structures in the embryo
physical changes during the preschool period**
-weight gain of about 4.5 to 6.5 pounds (2 to 3 kg) and grow 6.5 to 9 cm (2.5 to 3.5 inches) per year -average of 110 cm (43.5 inches) tall by their fifth birthday -elongation of the legs results in more slender-appearing children and little difference exists between the sexes -gross- and fine-motor coordination improves in the preschool years as evidenced by running well, walking up and down steps with ease, and learning to hop -5 years: skip on alternate feet, jump rope, and begin to skate and swim - learn to copy crosses and squares -need opportunities to learn and practice new physical skills
psychosocial changes during the preschool period**
-world expands beyond the family into the neighborhood where children meet other children and adults -curiosity and developing initiative lead to actively exploring the environment, developing new skills, and making new friends -plan and attempt many activities that are beyond their capabilities -guilt arises within children when they overstep the limits of their abilities and think that they have not behaved correctly -exhibit magical thinking and believe that if they simply think something, it will happen -allow them to do things on their own while setting firm limits and providing guidance -stress --> bed-wetting or thumb-sucking and want the parents to feed, dress, and hold them -encourage children to talk about their feelings; use play
health risks during adolescence**
Accidents -unintentional injury is the leading cause of death in adolescents because of lack of driving experience and risk-taking behaviors such as driving too fast, drinking and driving, or riding with someone under the influence -drowning and the use of firearms -think that they are invincible, which leads to risk-taking behaviors Violence and Homicide -second leading cause of death in adolescents in the United States and is the leading cause of death in African-American teenagers -most likely to be killed by an acquaintance or gang member and most often with a firearm Suicide -major leading cause of death in adolescence -changes in behavior: • decrease in school performance • withdrawal • loss of initiative • loneliness, sadness, and crying • appetite and sleep disturbances • verbalization of suicidal thought Substance Abuse -believe that mood-altering substances create a sense of well-being or improve level of performance -vaping has been associated with serious lung problems likely related to irritation or allergic reactions to contaminants Eating Disorders -anorexia nervosa, bulimia nervosa, and binge eating disorder -routine nutritional screening should be a part of the health care provided to all adolescents -assess perception of his or her body image and self-esteem or any sources of depression -have an intense fear of gaining weight and refuse to maintain body weight at the minimal normal weight for their age and height -binge eating and behaviors to prevent weight gain Sexually Transmitted Infections -affect millions of sexually active adolescents -provide education to prevent STIs, including human immunodeficiency virus (HIV) and HPV, and unwanted pregnancies Pregnancy -adolescent birth rates continue to decline due to improvements in contraceptive use, the use of long-acting reversible contraception, and safe sex practices -occurs across socioeconomic classes, in public and private schools, among all ethnic and religious backgrounds, and in all parts of the country
health promotion during adolescence**
Health Education -discussions with adolescents need to be private and confidential -more likely to use these health care services if they encounter providers who are caring and respectful -identify adolescents at risk for abuse, provide education to prevent accidents related to substance abuse, and provide resources to those in need of mental health care Minority Adolescents -experience a greater percentage of health problems and barriers to health care -poverty is a major factor that negatively affects the lives of many minority adolescents. Limited access to health services is common Gay, Lesbian, and Bisexual Adolescents -although some adolescents participate in same-gender sexual activity, they do not necessarily become homosexual as adults -adolescents who believe that they have a homosexual or bisexual orientation often try to keep it hidden to avoid any associated stigma, victimization, or bullying
health promotion during the preschool period**
Nutrition -average daily intake is 1800 calories -quality of the food is more important than quantity in most situations -consume about half of average adult portion sizes Sleep -average 12 hours of sleep a night and take infrequent naps -sleep disturbances are common; range from trouble getting to sleep to nightmares to prolonging bedtime with extensive rituals Vision -determine the presence of nonbinocular vision or strabismus -early detection and treatment of strabismus must occur by age 6 to prevent amblyopia
health promotion during toddlerhood**
Nutrition -increased emphasis on food choices -eat solid foods -requires a balanced daily intake of bread and grains, vegetables, fruit, dairy products, and proteins -limit milk intake to 2 to 3 cups per day to prevent appetite suppression -should not be offered low-fat or skim milk until age 2 because they need the fat for satisfactory physical and intellectual growth -mealtime has psychosocial and physical significance -often develop "food jags," or the desire to eat one food repeatedly -serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control Toilet Training -influenced by increased locomotion skills, the ability to undress, and development of sphincter control -important to recognize the child's patterns and urge to urinate and defecate -toddler must also be motivated to hold on to please the parent rather than letting go to please the self to successfully accomplish toilet training
health promotion during the school-age period**
Perceptions -identity and self-concept become stronger and more individualized -perception of wellness is based on readily observable facts such as presence or absence of illness and adequacy of eating or sleeping -aware of their body and are modest and sensitive about being exposed Health Education -critical to establish behaviors for a healthy adult life -must be developmentally appropriate -teaches children about their bodies and how choices, such as nutrition and routine exercise, impact their health Health Maintenance -annual health maintenance visits for immunizations, screenings, and dental care -discussions in preparation for upcoming pubertal changes -routine HPV vaccination for girls and boys, with the first dose given at age 11 to 12 Safety -encourage children to take responsibility for their own safety, such as wearing helmets during bike riding and wearing seat belts when in motor vehicles Nutrition -develop eating patterns that are independent of parental supervision -childhood obesity has become a prominent health problem -need to participate in educational programs that enable them to plan, select, and prepare healthy meals and snacks -need adequate caloric intake for growth throughout childhood accompanied by activity for continued gross-motor development
health promotion during the neonatal period** -screening -care seats -sleep and cribs
Screening -administered before babies leave the hospital to identify serious or life-threatening conditions before symptoms begin -baby's physician usually follows up with further testing and may refer the baby to a specialist for treatment if needed -screening of newborn hearing before discharge or within the first month of life Car Seats -discharge teaching involving the use of a federally approved car seat for transporting the newborn from the hospital or birthing center to home -need to learn how to fit the child in the restraint and install the car seat properly -rear-facing car safety seat until they are 2 years of age or until they reach the highest weight or height allowed by the manufacturer or their car safety seat Sleep and Cribs -position infants for sleep on their backs on a firm sleep surface ALONE to decrease the risk of sudden infant death syndrome (SIDS) -safeguards to reduce the risk for SIDS: proper positioning; removing stuffed animals, soft bedding and crib bumper pads, and pillows; and avoiding overheating the infant -prohibition of cribs with drop-side rails and require more durable mattress supports and crib slats -make sure the slats are no more than 6 cm (2.4 inches) apart -mattress should fit snugly, and crib toys or mobiles should be attached firmly with no hanging strings or straps