Ch 4-7 toddler-adolescence

Communication Skills in the Preschool Child (5 years)

- can explain how to use something - talks about past, future, and imaginary events - can answer Qs that use "why" and "when" - vocab ~2,100 words

Signs of Developmental Delay (5 years)

- doesn't show a variety of emotions - extremes of behavior (fear, anger, aggression) - unusually withdrawn or inactive - cannot complete self-care activities (toileting, dressing teeth, brushing)

Signs of Developmental Delay (3 years)

- falls down often or had trouble with stairs - drools or unclear speech - can't work simple toys - doesn't make eye contact

Communication Skills in the Preschool Child (3 years)

- speaks in complete sentences - follows instructions with 2 or 3 steps - can name most familiar things - vocab ~900 words

Neurologic system (toddler)

-Brain reaches about 90% of size by age 2 -Increased myelination improves coordination, balance, and sphincter control

gross motor skills (toddlers)

-Initial walking with "toddler" gait -Later includes running, climbing, jumping, pushing or pulling a toy, throwing a ball, and pedaling a tricycle

Promoting Optimum Health during the School Years

-Likes and dislikes established at an early age continue in middle childhood, although preferences for single foods subside, and children develop a taste for a variety of foods

Discipline should focus on

-Limit setting -Negotiation -Techniques to assist the toddler to learn problem solving

Causes of Amblyopia:

-Uncorrected refractive errors or other eye defects in one eye (near-sighted, far-sighted or astigmatism) -Malalignment of the eye muscles (strabismus) -Deprivation due to cataract formation in one eye (rare)

Organ System Maturation School-Age Child: GU system

-bladder capacity increases (age in years + 2 = ounces); prepubescence occurs

Organ System Maturation School-Age Child: CV system

-blood pressure increases and pulse rate decreases.

Organ System Maturation School-Age Child: Neurologic system

-brain and skull grow very slowly; cognitive processes mature

Organ System Maturation School-Age Child: GI system

-deciduous teeth replaced by permanent teeth; fewer gastrointestinal upsets; stomach capacity increases; caloric needs are lower but appetite may increase

Organ System Maturation School-Age Child: Musculoskeletal system

-greater coordination and strength; muscle still immature and can easily be injured

postpubescence

1 to 2 years after puberty -> skeletal growth is complete and reproductive functions become established

the preschool child needs about _______

12 hours of sleep each day.

Sleep Requirements for the Toddler (3 years old)

12 hours/day

toddlerhood age range

12 to 36 month

Sleep Requirements for the Toddler (24 months)

13 hours/day

Sleep Requirements for the Toddler (18 months)

13.5 hours/day

It is now recommended that all infants and toddlers ride in rear-facing car safety seats until they reach the age of _____ or height recommended by the car seat manufacturer.

2 years

The vocabulary of a preschooler increases to about __________ and the child speaks in full sentences with appropriate use of tense and prepositions.

2,100 words,

preschooler age range

3 years to 6 years

All primary teeth are erupted by _____________ of age and may be kept healthy with appropriate tooth brushing and fluoride supplementation

30 months

_________ of all adolescent deaths in the United States are the result of motor vehicle accidents

40%

middle childhood/ school age years age range

6-12 years of age

Puberty begins in girls around _______ years old and in boys around _______ years old

9 to 10; 10 to 11

The toddler progresses from limited expressive language capabilities to a vocabulary of _____ words by age 3 years.

900

respiratory system (toddler)

Alveoli increase in number until age 7; trachea and airways small compared to adult; tonsils and adenoids are large relative to size of oral cavity

GU system (toddler)

Bladder and kidney reach adult function by 16 to 24 months; bladder capacity increases; urethra remains relatively short

Musculoskeletal system

Bones increase in length; muscle matures; swayback and pot belly appear due to weak muscles until 3 years old; bowlegged appearance

dramatic play

Children's creation of scenes when they play "pretend"

Coping with Concerns Related to Normal Growth and Development (school-age child)

Daily relationships with age mates provide the most important social interactions for school-age children. For the first time, children are able to join in group activities with unrestrained enthusiasm and steady participation. Previously, interactions were limited to short periods under considerable adult supervision.

Prepubescence

Defined as 2 years preceding puberty Typically occurs during preadolescence Varying ages from 9 to 12 (girls about 2 years earlier than boys) Average age of puberty is 12 in girls and 14 in boys

Emotional and Social Development of the Toddler

Emotional development in the toddler years is focused on separation and individuation, which leads to egocentrism

Is the following statement true or false? The school nurse conducting a vision screening program identifies a child with amblyopia. Both eyes were noted to have visual acuity less than expected for the child's age.

False. Amblyopia, or lazy eye, occurs when one eye is more nearsighted, farsighted, or astigmatic than the other eye causing an imbalance in vision. Rationale: Malalignment of both eyes is referred to as strabismus.

Tell whether the following statement is true or false. The nurse is counseling parents of a 5 year old who are concerned that their child is masturbating. The recommended intervention for this situation is to advise parents to discourage their child from this practice using firm discipline.

False. The recommended intervention for a 5-year-old child who is masturbating is to treat it in a matter-of-fact way, making sure the child knows nudity and masturbation is not acceptable in public. Rationale: If parents overreact to this behavior, it may occur more frequently. The child should also be taught that no other person can touch his or her private parts.

Is the following statement true or false? A colorful simple board game that requires multiple players to cooperate with each other for a common goal would be the best type of toy for toddlers.

False. Toddlers tend to engage in parallel, solitary play and are not likely to cooperate in a group game situation because of their basic egocentric nature. Rationale: The best toys for toddlers are familiar household items, child-size household items, blocks, cars, plastic figures, stuffed animals, dolls, doll beds, and carriages. Manipulative toys with knobs and buttons that make things happen, shapes to insert into matching holes, puzzles, chalk, buckets and shovels, and floating toys are also recommended. Appropriate gross motor toys include gyms, tricycles, pull toys, and wagons.

Cardiovascular system (toddler)

Heart rate decreases; blood pressure increases

Building Healthy Eating Habits (Toddlers)

Preschoolers are often erratic eaters! •Small portions on smaller sized plates and bowls with appropriately sized utensils are best •Encourage child to serve self •Allow child to decide when to stop eating (don't force food) •Snacks should be high quality (lean proteins, whole grain, fruits, veggies, dairy) •Family meal times allow parents to model appropriate behaviors at meals and facilitate communication

fine motor skills (toddlers)

Progress from holding and pinching to the ability to manage utensils, hold a crayon, string a bead, work a puzzle, and use a touch screen

GI system (Toddler)

Stomach increases in size; small intestine grows in length; less frequent stools; stool color may be variable based on diet; bowel control typically achieved by end of toddler period

Growth and development in toddlerhood

Toddler development may be promoted through active gross motor play, books, music, and block building •Play is the major socializing medium at this age •Typically need 30 minutes of structured physical activity and 1 to 3 hours of unstructured physical activity per day •Toddlers engage in parallel play (playing alongside another child) instead of cooperative play •Toddlers are egocentric and do not like to share •Short attention span of toddlers will make them change toys frequently •Toys that engage multiple senses with creative play need not be expensive!

Is the following statement true or false? Suicide is the third leading cause of death in adolescents 15 to 19 years of age.

True. Suicide is the third leading cause of death in adolescents 15 to 19 years of age. Rationale: In a nationwide CDC study, 15% of adolescents surveyed reported that they had seriously considered suicide within the past 12 months, with 11% creating a plan and 7% attempting to take their own life (Centers for Disease Control and Prevention, 2008d).

Is the following statement true or false? The nurse caring for an adolescent should educate the parents about the importance of monitoring their adolescent's interaction with peer groups

True. The nurse caring for an adolescent should educate the parents about the importance of monitoring their adolescent's interaction with peer groups. Rationale: Adolescents who do not have parental or adult supervision and opportunities for conversation with adults may be more susceptible to peer influences and at higher risk for poor peer selections.

Is the following statement true or false? The nurse should recommend that parents of a 3 to 5 year old receive 500 to 800 mg calcium and 10 mg iron daily.

True. The preschool child needs 500 to 800 mg calcium and 10 mg iron daily. Rationale: Preschool children need 500 to 800 mg calcium and 10 mg iron daily. Parents should be aware that drinking excess amounts of milk may lead to iron deficiency as the calcium in milk blocks iron absorption.

The nurse is assessing a 3 year old for gross motor skill development. Which of the following would the nurse expect this preschooler to have accomplished? a. bend over without falling b. standing on one foot for 10 seconds c. skipping d. swimming

a. bend over without falling. The 3 year old should be able to bend over without falling. Rationale: At age 4, the preschooler hops on one foot and stands on one foot up to 5 seconds. At 5 years old the preschooler stands on one foot for 10 seconds, may skip, and may learn to skate and swim.

Tanner Staging - male

age span for stages 2-5 = 11-14 years 1 pre-puberty, no changes 2 scrotum and testes enlarge, fine sparse hair (penis doesn't grow) 3 hair is darker and coarser, penis growth (mostly length) 4 everything grows, penis inc width, hair is adult like but not on thighs 5 adult size and hair

Negativism (toddler)

always saying "no" is a normal part of healthy development and is occurring as a result of the toddler's attempt to assert his or her independence.

Vision Problems Frequently Identified in School-Age Children

amblyopia strabismus

food high in fiber

applesauce, carrots, corn, green beans, mangos, pears

food high in vitamin A

apricots, cantaloupe, carrots, mangos, spinach and dark greens, sweet potatoes

toddler play

associate play imitative play imaginative play dramatic play

Tanner Staging - female

average age span = 8-13 years 1 prepuberty-no changes 2 breast buds, fine to coarse sparse hair 3 breast enlargment, areola flat, pubic hair is coarser, covers pubic bone 4 projection of areaolar mound, hair covers pubic mound, not to thighs 5 areola returns flat (not all), hair triangluar and onto thighs

food high in folate

avocados, broccoli, green peas, oranges, spinach and darks, strawberries

The nurse obtains a nutrition history for a school-age child. The parent indicates the child's favorite beverage is apple juice and consumes three large glasses per day. The mother asks if this is a good thing. Which of the following would be the best response for the nurse to reply to the mother? 1) Apple juice is very healthy. Keep up the good work! 2) Apple juice has quite a bit of sugar and no fiber. Could you substitute an apple for one of those servings? 3) As long as your child drinks plenty of fluids, she will be fine.

b. An 8-ounce serving of apple juice has about 24 g of sugar—the equivalent of 3 teaspoons of sugar, with none of the fruit fiber that would be available in a whole apple. Rationale: Children need both fruit and fiber daily as part of a healthy diet. Apple juice, while made from apples, concentrates the sugar and takes out the fiber. Water and milk are good alternatives for beverages.

The nurse is assessing a 5-year-old child for signs of developmental delay. Which of the following would alert the nurse to a potential problem? a. the child can build a tower of six blocks b. the child does not play with other children c. the child engages in fantasy play d. the child separates from parent easily

b. the child does not play with other children. This is a sign of a potential developmental delay. Rationale: Signs of developmental delay in preschool-age children include not playing with other children, not being able to build a block tower of six to eight blocks, not engaging in fantasy play, and not separating from the parent without major protest.

food high in vitamin C

broccoli, cantaloupe, green peas, oranges, potaoes, strawberries, tomatoes

gross motor skill by 2 years

climbs stairs; push toys with wheels

gross motor skill development by 3 years

climbs well pedals tricycle climbs stairs with alternate feet bends over without falling

Toddler and Teasing

common and can have a long-lasting effect -Increasing awareness of differences, especially when accompanied by unkind comments and taunts from others, may make a child feel inferior and undesirable

telegraphic speech

common in the 3-year-old. In telegraphic speech the nouns and verbs are present and are verbalized in the appropriate order.

strabismus

crossed eyes

The nurse is planning a diet for a toddler that is rich in vitamin A. Which of the following foods might the nurse include? a. avocados b. corn c. strawberries d. carrots

d. carrots. Carrots are rich in vitamin A. Rationale: Avocados are rich in folate, corn is rich in fiber, and strawberries are rich in vitamin C. Other foods rich in vitamin A include apricots, cantaloupe, spinach, mangos, dark greens, and sweet potatoes.

fine motor skill development by 5 years

dresses/undresses self prints some letters feeds self well with utensils

Sensory Development of the Toddler

explore environment with all five senses (including taste) Visual acuity continues to improve (at least 20/50) Hearing likely to be at adult levels Although not fully developed, toddlers may express preferences for certain smells Taste discrimination is not completely developed, but toddlers may exhibit preferences for certain flavors of foods -This lack of complete taste discrimination places toddlers at risk of accidental ingestion. May prefer certain textures (soft vs. scratchy clothes)

Physical Changes Related to Puberty: Late (17-20 years)

female: Adult-like pubic hair and breasts male: Adult-like pubic hair, scrotum, testes and penis; breast tissue disappears, facial hair more coarse and widespread

Physical Changes Related to Puberty: Middle (14-16 years)

female: coarser pubic hair; broader distribution of pubic hair beyond mons; areola more prominent males: Coarser pubic hair; growth in scrotum, testes; penis widens, glans penis develops; may see breast development, soft facial hair

Physical Changes Related to Puberty: Early (10-13 years)

female: soft pubic hair begins on mons; breast buds appear; menses begin; increased pigmentation on genitalia males: pubic hair begins and spreads laterally, scrotum and testes enlarge; scrotum begins to darken

Middle childhood is the ideal time for _________

formal sex education

Organ System Maturation (Adolescent): GI system

full set of permanent teeth; liver, spleen, kidneys, and digestive tract enlarge

associative play

group play in similar or identical activities but without rigid organization or rules

Organ System Maturation (Adolescent): Neurologic system

growth of myelin sheath enables faster neural processing; cognitive growth increases

Organ System Maturation (Adolescent): Respiratory system

increase in diameter and length of the lungs; respiratory volume and vital capacity increase

Regressive behaviors (e.g., baby talk)

is children's way of expressing stress. should be ignored, while praising the child for developmentally appropriate behaviors

amblyopia

lazy eye; when one eye can focus better than the other

Organ System Maturation (Adolescent): Musculoskeletal system

linear growth is not complete until late adolescence in boys and occurs earlier in girls; growth plates (which promote linear growth) begin to close at puberty. Adult height is attained when growth plates have closed in late adolescence

fine motor skills by 12-15 months

manage utensils, hold a crayon, string a bead, and use a computer

Organ System Maturation School-Age Child: Immune system

matures to adult level around 10 years old; fewer infections experienced

Temper tantrums (Toddlers)

nearly universal during toddlerhood as independence is established and more complex tasks are attempted that may overwhelm the child emotionally

overweight vs obesity

overweight = BMI 85th-95th percentile for age and sex obesity = BMI >95th percentile

injury prevention toddler

proper storage of medications and other potentially poisonous substances and appropriate supervision.

echolalia

repetition of words and phrases without understanding normally occurs in toddlers younger than 30 months of age. "Why" and "what" questions dominate the older toddler's language.

Organ System Maturation School-Age Child: Respiratory system

respiratory rates decrease; respirations are diaphragmatic in nature

gross motor skill by 18 months

runs

Organ System Maturation (Adolescent): CV system

size and strength of heart increases; systolic blood pressure increases and heart rate decreases

Organ System Maturation (Adolescent): Integumentary system

skin is thick and tough; sebaceous glands are more active; sweat glands function at adult level

gross motor skill development by 5 years

stands on one foot >10 sec swings and climbs well may skip

fine motor skills by 18 months

throw a ball

fine motor skill development by 3 years

undresses self copies circle builds a tower of 9 blocks screws/unscrews lids, nuts, and bolts

stuttering

usually has its onset at between 2 and 4 years of age. occurs more often in boys than in girls. About 75% of all cases of stuttering resolve within 1 to 2 years after they start.

gross motor skill by 12 months

walking independently

Promoting Sleep and Rest (School-Age Child)

•12 hours of sleep required •Children may need help in winding down to promote sleep •Night terrors and sleepwalking may occur but should resolve by age 8 to 10 years •May resist going to bed at age 8 to 11 years •Children of 12 years and older are generally less resistant to bedtimes

Issues Involved in Promoting Growth and Development of the Preschooler

•Building self-esteem •Maintaining routine and rituals •Setting limits and remaining consistent with them •Early recognition of signs of developmental delay -when a child is identified with a potential sign of a developmental delay, he or she should be referred for further developmental evaluation •Supporting development of self-care activities (e.g., dressing, toileting) •Developing social skills within both the family and the larger society •*Nurses can provide direction and guidance to parents of this age group

Developmental Concerns (School-Age Child)

•Bullying •Television and video games (setting limits on both the content and amount of time) •School refusal (school phobia) •Latchkey children and safety •Stealing, lying, cheating, bullying (whether as the perpetrator or the victim) •Fitting in with peer groups •Tobacco and alcohol education

Developmental Concerns for the Adolescent

•Changes in body image •Peer groups •Violence •Suicide •Homicide •Substance use •*There are confidentiality laws relating to teens for sexual health and mental health issues

Social Skills Developed by the Preschooler (by the time they enter kindergarten)

•Cooperation •Sharing (of things and feelings) •Kindness •Generosity •Affection display •Conversation •Expression of feelings •Helping others •Making friends •*Encourage parents to allow preschoolers to do simple things for themselves

Development of Gross and Fine Motor Skills (School-Age Child)

•Coordination, balance, and rhythm improve, facilitating the opportunity to ride a two-wheel bike, jump rope, dance, and participate in a variety of other sports •Myelinization of the central nervous system is reflected by refinement of fine motor skills in the school-age child •Hand usage improves •Eye-hand coordination and balance improve •Can write, print words, sew, or build models •Takes pride in activities requiring dexterity and fine motor skills, such as playing musical instruments

Factors Determining Type and Amount of Discipline

•Developmental level of both the child and the parents •Severity of the misbehavior •Established rules of the family •Temperament of the child •Response of the child to rewards

Signs of Vision Problems in School-Age Children

•Eye rubbing, squinting •Avoiding reading •Frequent headaches •Holding reading materials close •Problems with depth perception or hand-eye coordination •One role of the school nurse is to conduct vision screening programs to identify problems with vision and make appropriate referrals when necessary *Sports-related eye injuries and eye protection are important in this age group

Emotional and Social Development of the Preschooler

•Friendships -Preschoolers learn how to make and keep a friend •Temperament -Influenced by parent's expectation of child's behavior -Determines child's task orientation, social flexibility, and reactivity •Fears -Preschoolers exhibit a variety of fears -Parents should acknowledge child's fears -Nightmares versus "night terrors"

Physiologic Growth of the School-Age Child

•Grows an average of 2.5 inches per year •Increases weight by average of 7 pounds per year •Early on, boys and girls are similar in height and weight •Later, girls may develop faster than boys in height and weight; boys will "catch-up" later •Secondary sexual characteristics begin to appear •Expectations of behavior should be consistent with age, not appearances •Primary teeth are lost and replaced by permanent teeth

Language and Communication Skills (School-Age Child)

•Hearing deficits that are severe are usually diagnosed in infancy, but the less severe may not be diagnosed until the child enters school and has difficulty learning or with speech •Vocabulary expands to 8,000 to 14,000 words •Culturally specific words are used •Reading efficiency improves language skills •More complex grammatical forms are used •Development of metalinguistic awareness occurs Metaphors are beginning to be understood

physical growth of the toddler

•Height and weight increase steadily in spurts at a slower rate than the infant -Generally reach half adult height by age 2 -Average weight gain is 3 to 5 lb per year -Height increases by an average of 3 in per year -Adult height is about twice the child's height at 2 years of age •Anterior fontanelle closes by 18 months •Head size more proportional to body by age 3

Consequences of childhood obesity include:

•Hypertension •Hyperlipidemia •Insulin resistance

Toddlers Developing a Self-Concept

•Importance of significant adults in shaping a child's self-concept •Positive self-concept leads to feelings of self-respect, self-confidence, and happiness

Social Development School-Age

•Importance of the peer group -Peer-group identification is an important factor in gaining independence from parents -Children frequently have 'best friends' -Role of peer group is to provide security as they gain independence from parents

Speech Development of the Toddler

•Language development occurs rapidly during the toddler years in a dynamic and complex process •Receptive language •Expressive language •Receptive far more advanced early on than expressive language development •Common language occurrences-Echolalia and telegraphic speech

Developmental Issues for Preschoolers

•Lying •Sex education •Masturbation

Common Findings in the Cognitive Development of the Preschooler

•Magical thinking-Believes thoughts are all-powerful •Transduction-Extrapolates from one situation to another •Animism-Attributes life-like qualities to inanimate objects •Imaginary friend-Creative way to sample activities and behaviors and practice conversation skills

Typical Behaviors of the Toddler

•May rely on a security item •Becomes aware of gender differences •May display aggressive behaviors •Consider the role of temperament in developing behaviors •May show fear of loss of parents and of strangers •Becomes more self-aware; does not have clear body boundaries -Separation anxiety may reoccur -May resist invasive procedures

Injury Prevention

•Most common cause of severe injury and death in school-age children is motor vehicle crashes, pedestrian and passenger •Bicycle injuries -> benefits of bike helmets •Recommend a helmet approved by the U.S. Consumer Product Safety Commission and replace the helmet at least every 5 years •Appropriate safety equipment for all sports •Water safety

Maturation of the Organ System (Preschooler)

•Myelination of the spinal cord allows for bowel and bladder control to be complete •Small intestine grows in length •Respiratory structures continue to grow in size; number of alveoli increase •Eustachian tubes remain short and straight •Heart rate decreases; blood pressure increases slightly; innocent heart murmur may be heard •20 deciduous teeth should be present •Urethra remains short in children, making them susceptible to urinary tract infections •Bones increase in length and muscles strengthen and mature

Physiologic Changes in Adolescence

•Physical development, hormonal changes, and sexual maturation occur during puberty •Secretion of estrogen in girls and testosterone in boys stimulates physical sexual changes -Thelarche -> breast bud development -Menarche -> menses commences -Nocturnal emissions -> wet dreams •Peak height velocity occurs at about 12 years of age in girls and 14 years of age in boys •Muscle mass increase in boys and fat deposits increase in girls •Voice deepens (most dramatic in males) •Limbs elongate disproportionately (may look "leggy") •Growth plates at the end of long bones begin to close •Apocrine glands (sweat glands) activate in axilla and genital areas •Skin changes related to increased sebaceous gland secretions may lead to skin eruptions (acne) •Increase in body hair •Hips widen in females, shoulders widen in males

Dentition and Nutrition (toddlers)

•Physiologic anorexia -> Because they are not growing as fast, they need less calories and they seem to have a poor appetite •Food jags -> when a child will only eat 1 food item, or a very small group of food items, meal after meal

Focus of Nursing Care Plan to Promote Growth and Development of Preschooler

•Promoting growth through play •Promoting early learning •Promoting language development •Promoting social skills for preschool/kindergarten •Promoting safety •Promoting nutrition •Promoting healthy sleep and rest •Promoting appropriate discipline (e.g., timeout)

Safety Issues for the School-Age Child

•Promotion of safe habits during the school-age years is important for parents and nurses •Increasing independence of the school-age child comes with increased self-confidence and decreased fears, which may contribute to accidents and injuries •Car safety, Pedestrian safety •Bicycle and sport safety •Fire safety •Water safety •Abuse in children

Caring for the Hospitalized Adolescent

•Provide opportunities for adolescent to maintain independence •Encourage adolescent to participate in decisions •Encourage socialization with friends through phone, e-mail, and visits when possible •Identify any knowledge self-care deficits and provide resources

Promoting Safety for the Toddler

•Safety is of prime concern throughout the toddler period •Increasing mobility requires increased vigilance -toddlers require direct observation and cannot be trusted to be left alone •Provide a childproof environment •Use a safe car seat in back seat of the car •Provide a safe home environment -Avoid exposure to tobacco smoke -Prevent injury; water safety -Prevent poisoning

Teaching Strategies to Minimize Issues with Sibling Rivalry

•Sibling rivalry •Attempt to keep the toddler's routine as close to normal as possible •Minimize other changes in the household, if possible •Spend individual time with the toddler on a daily basis •Involve the toddler in the care of the baby

Emotional and Social Developmental Issues (School-Age Child)

•Temperament •Self-esteem development •Body image- is what children think about their bodies •School-age fears •Peer relationships •Teacher and school influences •Family influences

Language development (toddler)

•The acquisition of language skills in the toddler period is enhanced in the preschool period, allowing the preschooler to progress further with symbolic thought •The acquisition of language in the preschool child allows the child to express thoughts and creativity •The preschooler transitions in this period from the use of telegraphic speech at age 3 years to the adult-like structure of sentences at age 5 years •Dysfluency or hesitancy in speech is a normal finding in the preschool period and occurs as a result of the fast pace with which the preschooler is gaining language skills and vocabulary

Physical Growth Developments of the Preschooler

•The preschooler is slender and agile, with an upright behavior, is more graceful than the toddler, and can run more smoothly •Average growth of 2.5 to 3 inch per year •Average weight gain around 5 lb per year •Loss of baby fat and growth of muscle •Length of skull increases slightly; lower jaw more pronounced; upper jaw widens •Expect the child to remain on the same or similar growth curve on the growth chart as from previous visits (large changes in percentiles require additional assessments)

Risks of Being Involved in an Unhealthy Romantic Relationship

•They need to know the signs of an unhealthy relationship and how to seek help if needed •Risks of being involved in an unhealthy romantic relationship -Imbalance of power in the relationship to the detriment of one of the partners -Unsafe sexual activity (STIs) -Unwanted pregnancy -Dating violence

Promoting Optimum Growth and Development in the School Age Child

•This period begins with entrance into the school environment, which has a significant impact on development and relationships •Gradual growth and development -Their bodies take on a slimmer look with longer legs, varying body proportions, and a lower center of gravity •Progress with physical and emotional maturity •School-age children are more graceful than they were as preschoolers, and they are steadier on their feet

Common Developmental Concerns of the Toddler

•Toilet teaching •Negativism •Temper tantrums •Thumb sucking and pacifiers •Sibling rivalry •Aggression and regression •Weaning to cup

Signs a Toddler is Ready for Toilet Teaching

•Toilet teaching can be achieved after myelination of the spinal cord is complete, usually around 2 years of age •Has regular bowel movements (usually after 2 years of age) •Expresses knowledge of need to defecate or urinate •Diaper is not always wet •Willing to follow instructions •Walks well alone and can pull down pants •Follows caregiver to bathroom •Climbs onto potty chair or toilet

Safety Concerns for Adolescents

•Unintentional injuries -injuries are the leading causes of death in adolescents (U.S. Department of Health and Human Services, 2008) •Motor vehicle safety (as a driver and as a passenger) -Motor vehicle accidents are the number one cause of death in adolescents •Avoiding substance abuse •Internet safety •Firearm safety •Water safety

Promoting Self-Feeding in Toddlers

•Use a child-sized spoon and fork with dull tines •Ensure the portion size, type, and texture of the food is appropriate for the toddler considering dentition •Seat the toddler in a high chair or at a comfortable height in a secure chair •Include the toddler in family mealtimes; praise attempts at self-feeding •Never leave the toddler unattended while eating •Minimize distractions during mealtime

adolescent age range

•begin with the gradual appearance of secondary sex characteristics usually by 11 or 12 years of age (onset of puberty) and to end with cessation of body growth at 18 to 20 years

Factors Contributing to Adolescent Violence

●Low self-esteem ●History of victimization ●Peer or gang pressure ●Poor family functioning ●Limited parental supervision/parents working extended hours outside of the home ●Access to guns and cars ●Drug or alcohol use ●Less than optimal housing situation ●Lower socioeconomic class ●Racism ●Incarceration