growth and development- infants & toddlers

health promotion 2

§APNEA OF INFANCY (AOI) §Pathologic apnea in infants of more than 37 weeks §ALTE- Apparent Life Threatening Event §Caregiver states the child would have died without vigorous intervention §Apnea was greater than 20 seconds §Color changes were present §Marked changes in muscle tone §Choking/gagging may have been present §Can be a symptom of disorder but most often no cause is identified §Pnuemogram is the tool most frequently utilized for Dx §Home monitoring and use of respiratory stimulants; Educate parents on CPR, monitor alarms, appropriate interventions and compliance with treatment regimen

injury prevention in infants

§Aspiration of foreign objects §Leading cause of fatal injuries in children younger than 1 year of age §Suffocation §MVA §Falls §Poisoning §Burns §Drowning §Injury prevention- be aware of developmental dangers; discuss with caregivers before the child reaches susceptible age group. Infant and young children can not anticipate danger

sleep

§Birth to 3 months of age- 10-16 hours of sleep daily in about five sleep periods of 30 minutes to 3 hours; 3-6 months 14 hours of sleep daily with a longer sleep at night plus 2-3 naps daily; 6-12 months 12-14 hours of sleep daily with longer sleep at night plus one or two naps daily §Position infant supine or side lying until the roll over §Sleep Problems: an effective approach to night crying is graduate extinction (allowing child to cry progressively longer between parent interventions). Prevent these problems from occurring: PUT THE INFANT TO BED AWAKE

Erikson's Stages of Development- infants and toddlers Piagets stages of development- infants and toddlers

ERIKSONS Stage 1: Trust vs. Mistrust (Infancy from birth to 18 months) Stage 2: Autonomy vs. Shame and Doubt (Toddler years from 18 months to three years) PIAGET Sensorimotor. Birth through ages 18-24 months. Preoperational. Toddlerhood (18-24 months) through early childhood (age 7)

7-9 months of age

FINE MOTOR SKILLS §Grasp is more refined; progresses from holding things in palm to using thumb, first and second fingers §Rakes at tiny objects and picks up shoe laces, cereal or crumbs with thumb and forefinger §Drops objects unintentionally and then looks for them §Feeds self some finger foods such as a cookie or cracker §Picks up, holds and manipulates an object, in each hand simultaneously; bangs objects together at center of his body §Explores objects by grabbing, shaking, sliding and banging IMPORANCE OF PINCER GRASP GROSS MOTOR SKILLS §Balances himself while sitting; sits alone steadily for longer periods without holding on; sits and bounces on his buttocks §Pushes up on hands and knees and rocks back and forth; sits up by pushing up from crawl position with arms at side §Crawls with an object in one or both hands; may also move by "bum" shuffling or turning in circles on stomach §Helps out when you pull him to stand; sometimes pulls himself up using furniture; stands firmly on his legs when held in standing position PSYCHOSOCIAL DEVELOPMENT §Feels strongly about what she does or does not want to do §Laughs because she has discovered she can laugh whenever she wants §Looks worried when she hears a loud noise, such as a balloon popping or the vacuum running or when someone speaks in a very stern voice §Displays fear of separation, i.e., is clearly attached to familiar caregivers, follows and wants to stay close to them. §Expresses fright, i.e., is frightened by new experiences, new people and will fuss or cry if you look or behave differently Object permanence INTELLECTUAL DEVELOPMENT §Says several sounds like ma, mu, da, di, and ba all in one breath as well as multi-syllabic babbling, e.g., da-da-da or ga-ga-ga §Recognizes some words; shows excitement when she hears "bottle" or some other familiar word; looks toward mommy when asked, "Where's Mommy?" §Can do simple things when asked, for example,

2 months of age

FINE MOTOR SKILLS §Keeps hands closed in a tight fist most of the time §Follows objects with eyes, for example, a mobile is a source of pleasure §Fascinated by own hands; watches them and turns them over momentarily §Holds objects briefly GROSS MOTOR SKILLS §Movements are more deliberate, for example, turns head to both sides when lying down §Moves arms and legs and 'bicycles' with legs when excited §Lifts head temporarily when lying on stomach §When sitting, keeps head erect; head may bob as she tries this out §Rolls from side to back §Muscle reflex is developing, e.g., body startles involuntarily PSYCHOSOCIAL DEVELOPMENT §Shows different moods such as distress with different cries and excitement and delight with small throaty sounds §Can quiet himself by sucking his fingers, a pacifier, etc. §Expresses contentment when touched and cuddled §Able to express discontent, e.g., fusses at loud noises §Displays different emotions as seen with peaks of irritability and crying INTELLECTUAL DEVELOPMENT §Gurgles, coos and squeals §Shows responsiveness to touch and to oral and visual stimulation §Stares at surroundings or attractive large, moving objects from several feet; moving or contoured objects hold his attention longer §Clearly discriminates voices, people, tastes, proximity and object size §Recognizes a few objects, for example, a bottle or rattle

6 months of age

FINE MOTOR SKILLS §Reaches for objects with one hand; picks things up with a raking motion; still usually holds things in the palm of her hand (example, holds a block skillfully) §Uses hands to grasp, bang and splash, for example, hold bottle, bang spoon on table §Puts hand on breast or bottle while drinking and may pat gently; pats and pulls at hair, glasses and face §Follows a moving object with her eyes §Transfer objects from one hand to the other while still bringing hands or toy to mouth GROSS MOTOR SKILLS §Rolls from back to stomach, stomach to back §Sits by himself with support either leaning forward on arms or propped up against a pillow; sits well in a chair §Pulls himself up from lying on his back when you grasp his hands §Bears large amount of weight on legs and bounces when held in standing position §On tummy, lifts and extends legs high; may get up on hands and knees in crouch position, to move forward or backward or rock back and forth PSYCHOSOCIAL DEVELOPMENTAL §Vocalizes pleasure and displeasure, i.e., squeals with delight and grunts with anger §Responds sometimes to the emotional tones of parents' voices §Begins to quiet down on his own after getting upset §Displays strong likes/dislikes about food §Can be content to play in crib/playpen for a while with one or two toys May communicate discomfort with strangers INTELLECTUAL DEVELOPMENT §Makes some vowel-consonant sounds using such consonants as f, v, th, s, sh, sz, m and n §Has a 'conversation' by babbling with family members §Begins to understand some words by tone of voice, intonations and a look on your face §Turns when he hears his name to show understanding §Looks at and studies things for a long time; turns objects upside down to get another view of them (example, lifts cup by handles) §Looks for family members or pet when the name is called §Picks things up, shakes them, listens to sounds they make when dropped; senses the relationship between her hands and objects §Follows path of fast moving object with eyes

13-18 months of age

FINE MOTOR SKILLS §Releases object to other person on request or gesture §Picks up and eats finger foods, e.g., raisin, cheerio, cracker, etc. §Turns container upside down to get an item out §Puts pegs into a pegboard §Turns pages of a book §Stacks three or more blocks §Scribbles with a big crayon GROSS MOTOR SKILLS WAlks alone §Crawls or walks upstairs one step at a time holding onto banister or hand §Pushes and pulls toys while walking §Squats to pick up toy without falling §Climbs on things by himself, for example, chairs, sofas, tables or out of cribs, high chairs, strollers PSYCHOSOCIAL DEVELOP §Is more confident, exploring and trying new things, taking risks when a trusted adult is present or has provided reassurance §Shows particular interest in a music tape, special picture books or fish in a tank §Identifies self in mirror or photograph; becomes more of an individual §Hugs and kisses parents and other very familiar people and pets §Enjoys being the center of attention INTELLECTUAL DEVELOP § §Points to show you something §Understands far more words than can speak, e.g., can point to at least 3 different body parts when asked, "Where's your mouth?" §Uses "no" correctly, often with a shake of the head §Uses 5 or more words to express needs, desires or expressions such as "all gone" §Tries to sing songs §Realizes things exist when they are out of sight §Shows understanding of some colors and shapes, e.g., matches circles and squares on a form board §Identifies pictures when requested, e.g., "Show me" or "Where's the ___?" §Gains new understanding of the world around him while exploring the environment by looking for something to fit in holes; mix, fill, pile and dump sand at the sand table; stack, knock over or restack a set of boxes, blocks. §Shows increased memory skills, e.g., uses her own plastic screwdriver the same way she saw an adult turn the tool; tries to insert a key into the lock of a door; shows recognition of sounds such as footsteps or water running in the bathtub

19-24 months of age

FINE MOTOR SKILLS §Takes lids off jars §Fits cups and boxes inside each other (nesting) §Takes off shoes, hat and socks §Strings large beads, using one hand to slide the bead while the other hand holds the string §Raises and drinks from a cup then replaces it on table GROSS MOTOR SKILLS §Rides on small wheeled toys §Carries a large toy while walking §Kicks a ball §Squats while playing §Walks backwards or sideways pulling a toy §Backs into chair to sit down PSYCHOSOCIAL §Beginning to develop a range of emotions; is subject to mood swings and tantrums; shows some aggressive tendencies, e.g., biting and hitting §Shows concern for others §Shows fears, but can be settled down §Is pulled between the need to show independence and still being dependent for certain things §Still cautious around unfamiliar adults i.e. allows self to be drawn into play with a new adult as long as a familiar person is nearby INTELLECUAL DEVELOP §Uses two word sentences, e.g., "more juice" or "want cookie" §Asks for help using words or actions §Jabbers in run-on flow of words while talking to stuffed animals or self §Names some pictures in a book §Imitates new words and phrases, e.g., "Go bye-bye" and "Mommy's car" §Understands how familiar objects are used, e.g., spoon for eating, cup for drinking, ball for throwing, hammer for banging, etc. §Understands the passing of time and the meaning of "not now" and "when we go home" §Recognizes and names familiar people in photos §Busy mastering existing skills which leads to the emergence of new ones §Shows increased memory for details and routines, e.g., says "hot" when reaching for a coffee cup; holds up seat belt in car seat to indicate it needs to be secured; remembers where objects go

10-12 months of age

FINE MOTOR SKILLS §Uses pincer grasp (tips of index finger and thumb) to pick up small items §Puts objects in and takes them out of container §Points, pokes, touches and pries with extended index finger §Places one block on top of another without balancing §Voluntarily releases objects to another person on request §Holds spoon but needs help with its use GROSS MOTOR SKILLS §Turns in a circle when sitting - twists to pick up objects §Stands by flexing knees, pushing off from squat §Walks while holding on to furniture §Walks when you hold both hands §Crawls up stairs §Crawls on the floor expertly PSYCHOSOCIAL DEVELOP §Is able to seek comfort when upset, i.e., reaches up to be held §Expresses many emotions and recognizes them in others, e.g., sad, happy, mad, scared, hurt, discomfort §Feels guilty when he does something wrong §Will communicate his need to be in constant sight and hearing of an adult §Displays affection in hugs, kisses, pats and smiles INTELLECTUAL DEVELOP §Understands simple sentences, questions and requests, for example, 'Give the book to me,' 'Find your ball', 'Where's your shoe?' §Learns words and appropriate gestures like saying 'no' and shaking his head, saying 'bye-bye' and waving, also exclamations such as 'oh-oh!' §Starts to anticipate when a surprise happens in a song §Takes turns making sounds with you §Searches for object if he knows it is hidden, e.g., lifts inverted cup, looks in box for toy or unwraps toy §Tries out new actions for same goal; modifies old ones through trial and error §Associates actions and sounds with things for example, meows for kitten, points up when he sees a bird §Is aware of his own actions and some of their implications; compares same action done with both sides of his body §Develops stronger memory skills

1 month age

FINE MOTOR SKILLS §Generally keeps hands closed in a fist or slightly open §When fingers are pried open (usual position is a fist), grasps handle of spoon or rattle, but drops it quickly Draws arms and legs to the body when crying GROSS MOTOR SKILLS §Lifts his head when held against your chest; his head sags, flops forward or backwards when not supported. §When on tummy, turns head to clear nose from bed; lifts head briefly. §Inborn reflexes such as startle and rooting are predominant activity. §Comforts with touch PSYCHOSOCIAL DEVELOPMENT §Enjoys/needs a great deal of physical contact and tactile stimulation §Responds positively to comfort and satisfaction §Cries when in pain or discomfort INTELLECTUAL DEVELOPMENT §Cries when hungry or uncomfortable §May make throaty sounds like 'ooooh' or 'aaaah' §Enjoys being talked to and responds to voices/sounds §Pays close attention to faces of those closest to him §Responds to loud or sudden noises with a sudden start (early signs of a developing response system) §Focuses on high contrast patterns and faces; prefers these to bright or big objects

infancy 2

INFANTS • Body Image (infant does not have) - Mouth is the principal area of pleasurable sensation - By end of 1st year, infants recognize that they are distinct from their parents (could see body image) - Very important at this young age to transmit positive messages to infants about their bodies • Social Development - Will depend on the interaction between the infant & the caregivers - Social smile is an early step in social communication - 4 months laugh aloud - 6 months play peek a boo, infants spend much of their time in solitary play Attachment during Infancy • Based on 2 factors that prepare the infant to tolerate separation from the caregiver: - The ability to discriminate from the caregiver - Object permanence Initially attachment is facilitated by eye contact & being held close. By 6 months of age infants show a distinct preference for primary caregiver Stranger Anxiety: peaks at 8 months; by 11-12 months infants are able to anticipate the departure & begin protesting before the caregiver leaves

5 months of age

MILESTONES - loves to play with hands/feet - roll over - may be ready for solids/knows their name - stranger anxiety FINE MOTOR SKILLS §Eyes and fingers co-operate in grasping and manipulating and can reach the target with good aim §Drops and picks up objects §Grasps object with partial thumb and forefinger §Holds bottle with one or two hands Grabs or waves object with either hand GROSS MOTOR SKILLS §Brings feet to mouth and sucks on toes §Moves by either rocking, rolling or pivoting around in a circle on his stomach §Sits supported for long periods (30 minutes) with a firm back §When held in standing position, stamps feet and jumps up and down, bearing almost all weight on legs shoulders §Rolls from stomach to back; on tummy, pushes on hands and draws up knees PSYCHOSOCIAL DEVELOPMENT §Displays awareness and wariness of strangers §Expresses anger when can't get desired effect §Clings to parent when held §Shows fear, anger and disgust §Pushes away when he doesn't like what you're doing to him, for example, wiping his nose INTELLECTUAL DEVELOPMENT § Language §Watches your mouth, listens to your voice, then experiments with her own sounds §Tries to imitate sing-song quality of voice (inflections) §Babbles double consonants (baba, dada, mama) §Makes "raspberry" sound - tongue out and blowing Looks up when she hears her own name

4 months of age

MILESTONES -bear weight on legs with support from others and responds with coos - may roll over, reach out for toys, grasp toys - stranger anxiety (sit without support for a few moments) FINE MOTOR SKILLS §Relaxes with hands mostly open, not in fists as before §Reaches for objects when supported in sitting position, and then brings them to mouth §Uses mitten grasp, i.e., fingers close on open palm with thumb sticking out §Glances from one object to another and looks at toys placed nearby §Tries to swipe at objects, but still inaccurate; may look from object to hand, and back to object; often misses, but can grab it sometime GROSS MOTOR §Lifts head and chest when on her stomach and supports herself on forearms or on outstretched arms §Turns head in all directions to follow a toy when lying on stomach §Brings both hands to chest and keeps head in midline when lying on back §Holds head steady when supported in a sitting position; may prefer sitting to lying down §Thrusts legs and feet against bottom of crib over and over §Rolls from side to side on stomach PSYCHOSOCIAL DEVELOPMENT §Fusses or cries to gain attention from familiar adults, or when attention or toy is taken away from him §Yawns and arches back or turns away when he has had enough interaction or there is too much noise §Shows anticipation and excitement by breathing heavily §Shows he's not sure (stops cooing and smiling) or he's afraid (fusses) if a new person moves toward him; turns his head into shoulder of parent when a new person approaches §Stops crying when he hears your voice or caregiver's; attempts to soothe himself INTELECTUAL DEVELOPMENT §Babbles strings of syllable-like sounds §Experiments with sounds using variation in pitch and tone §Communicates pain, fear, and loneliness through crying; joy or interest by cooing sounds §Uses his own special kind of cry when hungry §Makes babbling sounds when looking at toys or people §Listens to music or a music box §Starts to explore things by bringing them to his mouth §Turns head toward sound to find out where it comes from §Uses entire body (arching, kicking, stretching) to reach towards a toy that intrigues him §Has mental model for human face; knows mother or father and may resent strang

3 months of age

MILESTONES -Laughing time!!!! Recognizes parents by face and smell -May squeak. Recognizes voice and may lift head/shoulder -Bloom a tooth/imitate speech sounds FINE MOTOR SKILLS §Plays with hands by bringing them together and clasping them §Hands/fingers stay open more as grasp reflex fades §Bring hands to mouth §Reaches for objects with both arms, starting at sides and closing in front of body; often contacts object with closed fists GROSS MOTOR SKILLS §Keeps head in mid-position while on her back, and moves her arm and leg on one side in unison, then the arm and leg of the other side §Raises head and chest when on tummy §Holds head up with more control §Sits with support on a lap PHYSOCIAL DEVELOPMENT §Shows appropriate facial expressions in response to such emotions as anger, fear, joy §Reflects feelings of happiness with chortles or squeals; frustration with whimpers; and hunger with smacking lips §Begins to show sadness §Responds to familiar people; may stop or start crying according to who holds him. §Can distinguish and express discomfort INTELLECTUAL DEVELOPMENT §Distinguishes speech from sounds you make §Focuses on high contrast patterns and faces §Recognizes a few objects (e.g., bottle or rattle) §Holds onto objects briefly as his voluntary grasp replaces reflex grasp §Looks at his hands and feet as objects for examination §Begins to sense that hands and feet are extensions of himself with limits and opportunities §Associates people with behavior, for example, mother and feeding

health promotion in infancy

Malnutrition: continues to be a major problem in children under the age of 5 Food allergies or hypersensitivity: reaction involving immunologic mechanisms (IgE), common in infancy (egg, wheat, cow's milk), usually outgrow allergies §SIDS §Sudden death of an infant under 1 year of age that remains unexplained after a complete postmortem examination. §Leading cause of death in children between the ages of 1 month and 1 year §Cause? §Children at risk for SIDS. §One or more ALTE's requiring resuscitation or vigorous stimulation §Preterm infants who are having apnea at D/C §Siblings of two or more SIDS victims §Certain types of diseases §Home monitoring and respiratory stimulants are recommended for the at risk children

feeding in infancy

TEETHING - Age of tooth eruption varies but the order is fairly regular - 1st primary teeth are the lower central incisors at about 6 followed by the upper central incisors . §The 1st 6 months §Human milk is the most desirable §Acceptable alternatives is commercial iron fortified formula §Whole milk, low fat milk or imitation mild SHOULD NOT be fed to the infant under age 1 §Total amount of formula ingest should not exceed 32 ounces a day §The addition of solid foods should not occur before 4-6 months of age §2nd 6 months §Formula or breast milk continued; addition of solids §Rice infant cereal is generally introduced first §After 6 months, cereal can be mixed with fruit juices §Fruit juices can be substituted for one feeding a day §Add strained fruit, vegetables, & meat(one at a time & in small amount §8-9 months can eat junior foods & finger foods §1 year can eat well cooked table foods §Wean to cup 9-12 months; NO infant feeders; do not put cereal in bottle

body image: how does this effect how we plan care with toddlers

§Body Image §Know body parts §Recognition of sexual differences §Refer to self by name and use pronouns §Have UNCLEAR body boundaries §Avoid negative labels Development of Sexuality -Explore bodies and find touching body parts pleasurable -Parental reactions will influence the child's attitude and should be accepting rather than critical Social Development -Some ability to withstand delayed gratification and tolerate moderate frustration -Transitional objects provide security Language Development: -Increase in number of words; increase ability to understand -Speaking in 2 word sentences Personal Social Behavior - Can remove cloths, put on cloths and shoes; no regard for right or left Play: Parallel- 2 toddlers play with similar objects side by side, occasionally trading toys and words.

how to teach to cope with stranger fear

§Coping with Stranger Fear §Infants need opportunities to experience strangers safely §Stranger Anxiety: peaks at 8 months; by 11-12 months infants are able to anticipate the departure & begin protesting before the caregiver leaves §The best approach for the stranger is to talk to the parent first, talk softly, meet the child at eye level, maintain safe distance and avoid sudden intrusive gestures

Erikson's stage: trust vs mistrust

§Developing a Sense of Trust in self, others & world, §Trust=feeding, comfort, stimulation & caring needs will be met - basic needs are met (fed, sleep, dry) §Crucial element is quality of relationship §Failure to learn delayed gratification leads to mistrust §Consistency of care is essential §Food intake is the most important social activity for infant §Tactile stimulation is very important for the infant §Biting is a mechanism of control (reflect their feelings since they cannot verbalize them) first child develops first b/c everyone is paying attention to them (speech, walking faster) second child more likely to have developmental issues b/c no one is paying attention to them if dont develop trust: stay in this stage

Erikson stage for toddlers: autotomy vs doubt and shame

§ERIKSON- Developing a sense of AUTONOMY while overcoming a sense of DOUBT AND SHAME §Several characteristics of this stage; holding on and letting go; negativism; ritualism §Development of the ego is evident when the child is able to tolerate delayed gratification

injury prevention in toddlers

§INJURIES are the leading cause of death in children over the age of 1 and it is r/t their unawareness of danger and increased locomotion §MVA's §Most occur because a restraint device was not utilized or utilized correctly §Pedestrian injuries §Drowning §Burns §Poisoning §Falls §Aspiration & Suffocation §Bodily Damage

what impacts growth and development

§Influences on development: family and parenting-both nature and nurture are important in determining individual patterns of development

health promotion-toddlers

§PROMOTING OPTIMUM HEALTH DURING TODDLERHOOD §Nutrition- §Physiologic anorexia - decreased nutritional need with a decreased appetite §Eating habits established in the first 2-3 years tend to have a lasting effect on subsequent years §Serving sizes need to be appropriate §Food Jags are common §Ritualism is often a big parent of mealtime §Mealtime should be enjoyable §Grazing is ok SLEEP & ACTIVITY About 12 hours a day with 1 nap Sleep problems are common DENTAL HEALTH: prevention of early childhood caries §First dental visit between 1-2 years §Brushing and flossing are important §Fluoride §Low Calorie diet §Nursing Caries/Bottle Mouth

growth and development definition

§Principals of G&D: growth refers to an increase in physical size, development refers to an increase in capability or function. Cephalocaudal development-development that proceeds from the head downward through the body and toward the feet.(example-an infants head is much larger proportionately that the trunk or extremities, infants learn to hold up their heads before sitting Proximodistal development-development that proceeds from the center of the body outward to the extremities.(example-infants are first able to control the trunk, then the arms; only later fine motor of fingers)

stages of separation anxiety

§Protest §Screaming, crying, clinging §Resists attempts to comfort §Despair §Sad, withdrawn, quiet §Cries when parents return §Denial §Protest subsides, shows interest in setting §Appears happy and content

How do Toddlers and Preschoolers view Hospitalization

§Sees illness as punishment §Has incorrect cause-and-effect perceptions §Begins to understand concept of germs §Knows outside body-part names §Has vague knowledge of internal organs

Piaget's stage: Sensorimotor

§Sensorimotor Phase, The infant progresses from reflex behavior to simple repetitive acts to imitative activity §3 CRUCIAL events take place during this stage: §Separation-learn to separate self from environment §Object permanence-Object that leaves one sight still exist (8-12 months of age) - just bc something is out of sight doesn't mean its gone - take a object and move it- see if they search for it §Ability to use symbols or mental representation-can think of an object or situation without actually experiencing it

piagets stage for toddlers: preoperational and preconceptual phase

§Sensorimotor and Preconceptual Phase §Period from 12 to 24 months is a continuation of the final two stages of the sensorimotor phases §Differentiation of oneself from objects is evidenced by the child's increasing ability to tolerate longer periods of separation §Awareness of causal relationship §Appearance of an object denotes its function (symbolic) §Aware of spatial relationships §Object permanence has advanced §Domestic mimicry and sex role behaviors become increasingly common §Some sense of time develops; have a limited ability to wait - the world is denominated on how it looks not how it is - think about things symbolically - animism (pretend play) - egocentric (thinks people see things as they do) PRECONCEPTUAL PHASE §At 2 years of age, enter this stage and last until 4 §Thinking is primarily on the basis of their perception of an event ( way thing appear not logical reasoning) §Problem solving is based on what they see or hear directly rather than what they recall about objects or events

toddlers

§Sensory Changes §Visual acuity is achieved at 20/40 §Persistent strabismus requires evaluation §Depth perception continues to develop §All senses are utilized to explore the environment §Maturation of Systems §Most of physiologic systems are relatively mature by the end of toddlerhood §RR and HR slow; B/P increase; temp regulation is more mature; able to conserve fluids under stress decreasing the risk of dehydration §Myellnation of spinal cord is complete thus control of anal and urethral spincter is gradually achieved (18 to 24 months) Fine Motor Increasing dexterity Gross motor- - Walk up and down stairs at 2-3 years -By 3-4 years can jump using both feet, stand on one foot for a second and take a few steps on tiptoes Psychosocial Development -Differentiation of self from others -Toleration of separation from parents -Ability to withstand delayed gratification -Control over bodily functions Acquisition of socially acceptable behavior Verbal means of communication Ability to interact with others in a less egocentric manner

concerns during infancy

§Separation Anxiety and Stranger Fear §Spoiled Child Syndrome (limits, boundaries, structure, sleep schedule) §Limit Setting and Discipline §Thumb Sucking and Use of Pacifier- peaks 18-20 months, most prevalent when child tired/hungry §Sucking is the infants chief pleasure §Problems arise when parents are concerned about sucking & attempt to restrain this natural tendency - want to take away before peak sucking: longer they have it the more they become dependent §Investigate the parents feelings & base guidance on this information §Malocclusion may occur if thumb sucking persist past 4 years

who needs a sibling

§Sibling Rivalry §The arrival of a new infant is a crisis for the toddler §Talk about what will change in the household; use a doll §Avoid additional stressors for the toddler at this time §Encourage visitors to involve toddler in visits §Overt jealousy or verbal expressions may be expressed from the toddler §Temper Tantrums §Assertion of independence by violently objecting to discipline §Best approach is to IGNORE it §REGRESSION §Retreat from one's present pattern of functioning to past levels §Usually occurs as a coping mechanism §Additional stressors can hinder their ability to master present developmental tasks §Best approach is to IGNORE it & PRAISE existing patterns of appropriate behavior

How to help with the stress of being in the hospital

§Stress Reduction: The 4 Rs §Recreation: toys, games, activities, physical activity §Rest: calm, quiet; bedtime rituals §Relationships: family members, siblings, peers, support groups §Routines: follow normal routine, provide transition objects, provide consistent caregivers

major milestone

§TOILET TRAINING §Assess toilet training readiness §Physical §Mental §Psychological §Parental §Bowel training is usually first then bladder §Night time training may not be completed until 4 or 5 year §Potty chairs; practice sessions should be limited to 5 to 10 minutes §Praise child for efforts; allow to watch others; do not force or spank for accidents §Day time accidents are common during periods of intense activity

who are toddlers

§Toddlerhood from 12 months to 36 months: §Intense exploration of the environment as the toddler attempts to control the environment and others by temper tantrums, negativism and obstinacy. §It is a very important time for intellectual growth and developmental achievements §Biologic developments §Growth slows-weight is about 4 to 6 lbs/yr §Height increases 3"/yr and occurs mainly in elongation of the legs; average height of a 2 year old is 34"; In general adult height is 2x height at 2 years of age. §Head circumference is equal to chest circumference; total increase in head circumference in 2nd year is about 1"; ant fontanel closed

infancy

• Digestion - Stomach continues to grow throughout infancy to accommodate a greater volume of food (big issue is overfeed) -- how much, how often, any changes in formula since birth - Breast fed infants have twice as many stools - Not uncommon to see undigested particles in stool as diet is progressed (let parent know) - Tooth eruption usually occurs in a fairly orderly sequence beginning at about 6-7 months of age --- painful (systemic effects: fever, dehydration) • Thermoregulation - Becomes more efficient as ability of skin to contract and muscles to shiver in response to cold increases; accumulation of adipose tissue during first 6 months serves as insulation against heat loss. • Body weight - 75% on infant's body wt. is water at birth, there is an excess of extracellular fluid; as body water decreases so does ECF. The excess of ECF predisposes the infant to more rapid loss of total body fluid - Renal- immaturity predisposes to dehydration; complete maturity during later half of 2nd year - Auditory- at adult levels during infancy • Visual- binocularity begins by age 6 weeks; well established by 4 months. Depth perception develops by 7-9 months

overview of fine/gross motor skills - infant

• Fine Motor- Grasping begins 2-3 months initially as a reflex & gradually becomes voluntary - 1 month hands mostly closed - 2-4 months holds rattle when placed in hand, readily brings objects from hand to mouth, looks at and plays with own fingers - 4-6 months voluntarily grasps object, holds bottle, grasps with whole hand - 6-8 months transfers object from hand to hand, beginning pincer grasp - 8-10 months crude pincer grasp, picks up small objects - 10-12 months can pick up finger food, may hold crayon or pencil and mark on paper, places object into containers through holes KNOW!!!!!! • Gross Motor - Head Control • Full term newborn: momentarily hold head midline • Because of the poor head control at this age when infant is placed prone on a pillow or soft surface increase risk for suffocation • 2-4 months Moro reflex fading, can turn from side to back and then return, decrease in head lag when pulled to sitting position; sits with head held in midline with some bobbing, when prone holds head and supports weight on forearms • 4-6 months head held steady when sitting, no head lag, turns from abd to back by 4 months and then back to abd by 6 months • 6-8 months sits alone steadily without support by 8 months, likes to bounce on legs when held in standing position • 8-10 months- crawls or pulls whole body along floor by arms, creeps by using hands and knees to keep trunk off floor, pulls self to standing and sitting by 10 months, recovers balance when sitting • 10-12 months stands alone, walks holding onto furniture, sits down from standing KNOW !!!!!!

health promotion of infant & family

• First 6 months of life growth is very rapid, birth wt doubles by 5 months of age and triples by the end of first year. • Breast fed infants tend to gain less wt. After 4-6 months than bottle fed infants • Height-1" a month for first 6 months; increase about 1 foot during first year primarily in the trunk • Head-grows rapidly first 6 months; closure of sutures with the posterior fontanel fusing by 6-8 weeks; anterior fontanel closes 12-18 months • Maturation of systems - Fetal Hemoglobin (HgF) is the primary hemoglobin for the first 2-3 months - Physiologic anemia is common 2-3 months of life -- can give hydroxyurea (SSD)

language development

• Language Development - Crying is the first means of verbal communication - Parents need to know that periods of unexplained fussiness are NORMAL!! - 3-6 months vocalizes during play and with familiar people, laughs, cries less, squeals and makes pleasurable sounds, babbles (mamamamama) - 6-9 months increases vowel and consonant sounds, links syllables together, uses speechlike rhythm when vocalizing with others - 9-12 months understands no, says dada and mama to identify parents, learns one or two other words, receptive speech surpasses expressive speech - 1 year can say 3-5 words with meaning