An Overview of Growth, Development, and Nutrition Mrs. Catherine Luksic BSN, RN.
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An Overview of Growth, Development, and An Overview of Growth, Development, and NutritionNutrition
Mrs. Catherine Luksic BSN, RNMrs. Catherine Luksic BSN, RN
Growth and DevelopmentDifferences between adult and child
The child is in a continuous process of growth and development
Growth spurts followed by plateaus
Not all parts mature at the same time
Key Terms in Child Key Terms in Child DevelopmentDevelopmentDevelopment
A progressive increase in the function of the body
GrowthAn increase in physical size, measured in feet or
meters and pounds or kilograms
MaturationThe total way in which a person grows and develops,
as dictated by inheritance
Stages of growth and developmentFetus: 9th gestational week to birthNeonate: birth to 4 weeksInfant: 4 weeks to 1 yearToddler: 1-3 yearsPreschool: 3-6 yearsSchool-age: 6-12 yearsAdolescent: 12-18 years
Directional PatternsFundamental to all
humansCephalocaudal
Proceeds from head to toe
Proximodistal From midline to
periphery
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
Growth StandardsMeasured in
dimensionsHeightWeightVolumeTissue thickness
StandardizedCompare the
measurement of a child to others of the same age and sex
Growth ChartsChildren who are in
good health tend to follow a consistent pattern of growth
There are separate charts for boys and girls
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
Developmental ScreeningDevelopmental ScreeningDenver Developmental Screening TestAssesses the developmental status of children during
the first 6 years of life in four categories Personal-social Fine motor-adaptive Language Gross motor
Purpose is to identify children unable to perform at an age-appropriate level
Not an intelligence test
Influencing FactorsAll of the following factors are closely related and
dependent on one another in their effect on the growth and development of the childHeredityNationality and race Ordinal position within the familyGenderEnvironment
Types of FamiliesTypes of FamiliesNuclearExtendedSingle parentFoster parentDysfunctional
Dual careerBlended
Family ApgarFamily ApgarUsed to assess family function
Adaptation- shares resourcesPartnership- lines of communicationGrowth- G&DAffection- overt and covertResolve- time, money and space prevent & solve
problemsEnables the nurse to develop interventions that aid
the family to achieve a healthier adaptation to the child’s health needs
Homeless FamilyHas an impact on the growth and development
of a child.
Support system and financial resources often lacking
School or emergency department nurse
Community referrals
Personality DevelopmentPersonality is the result of interaction between
biological and environmental heritages
Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of NeedsThe needs at the
bottom of the pyramid must be met before one can fulfill needs at the next higher level
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
InfantChild’s task
Develop trust. Parent’s task
Learn “cues” presented by infant to determine individual needs.
Nursing interventionHelp parents assess and interpret needs of infant
(avoid feelings of helplessness or incompetence).Do not let grandparents take over parental tasks. Help parents cope with problems such as colic.
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
ToddlerChild’s task
AutonomyParent’s task
Try to accept the pattern of growth and development. Accept some loss of control but maintain some limits for safety.
Nursing interventionHelp parents cope with transient independence of
child (e.g., allow child to go on tricycle but don’t yell “Don’t fall”).
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
PreschoolChild’s task
Initiative
Parent’s taskLearn to separate from child.
Nursing interventionHelp parents show standards but “let go” so child
can develop some independence.
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
School-ageChild’s task
Industry
Parent’s task Accept importance of child’s peers and learn to accept some
rejection from child at times. Patience is needed to allow children to do for themselves, even
if it takes longer. Do not do the school project for the child. Provide chores for child appropriate to his age level.
Nursing intervention Be there to guide child, but do not constantly intrude. Help child get results from his or her own efforts at
performance.
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
AdolescenceChild’s task
Establishing identityAccepting pubertal changesDeveloping abstract reasoningDeciding on career Investigating lifestylesControlling feelings
The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)
Parent’s task Parents must learn to let
child live his or her own life and not expect total control over the child.
Expect, at times, to be discredited by teenager.
Expect differences in opinion and respect them. Guide but do not push.
Nursing intervention Help parents adjust to
changing role and relationship with adolescent.
Expose child to varied career fields and life experiences. Help child to understand emerging emotions and feelings brought about by puberty.
Erikson’s Stages of Erikson’s Stages of DevelopmentDevelopment
Tasks must be mastered at each stage to achieve optimum maturity
Each builds on the successful completion of the previous stage
Piaget’s Theory of Cognitive Piaget’s Theory of Cognitive DevelopmentDevelopmentIntellectual abilityIntellectual maturity is attained through four orderly
and distinct stages of development, all are interrelatedSensorimotor (birth to 2- reflexes)Preoperational (2 to 7 - ego)Concrete operations (7 to11- cause & effect)Formal operations(11to16-scientific process)
Kohlberg’s Theory of Moral Kohlberg’s Theory of Moral DevelopmentDevelopment Moral AbilityTheory is based upon Piaget’sThree levels
Preconventional - 4 to 7 -obedientConventional – 7 to 11 – conformity and loyal, obey
rulesPostconventional – 12 –older – moral values
Emphasis on the conscience of the individual within society
Family Nutrition
USDA dietary guidelinesIntended to help families make informed decisions
about what they eat
Infant Nutritional NeedsRequire more
CaloriesProteinMineralsVitaminsHigher fluid requirements
Fiber Needs of the Young ChildFiber Needs of the Young ChildThe American Academy of Pediatrics recommends
0.5 g of fiber/kg of body weight in childhood, gradually increasing to adult levels of 20 to 35 g/day by the end of adolescence
High-fiber foods can fill the small stomach capacity and provide few of the nutrients and calories needed by the active, growing child
Nutrition and HealthDigestive system of the newborn
Immature and functions minimally for the first 3 months of life
Saliva is minimal
Hydrochloric acid and rennin in the stomach and trypsin found in the intestines aid in the digestion of milk
The physiology of the digestive tract is the basis for introduction of various foods in the first year of life
Feeding the Healthy Child: Feeding the Healthy Child: InfantInfantSymptoms of
underfeeding RestlessnessCryingFailure to gain weight
Symptoms of overfeedingRegurgitationMild diarrheaToo rapid weight gain
High-fat diets causeDelayed gastric emptyingAbdominal distention
High carbohydratesAbdominal distentionFlatus Excessive weight gain
ConstipationToo much fat or proteinDeficiency in “bulk”
Nursing TipWhole milk should not be introduced before 1 year
of age
Low-fat milk should not be introduced before 2 years of age
Feeding the Healthy Child: Feeding the Healthy Child: ToddlerToddler
Can feed themselves by end of second yearImportant in order to develop a sense of independence
Parent should be present at mealtimes
Feeding the Healthy Child: Feeding the Healthy Child: PreschoolPreschoolLikes finger-foods
Regression common in this age group
More vulnerable to protein-calorie deficiencies
Feeding the Healthy Child: Feeding the Healthy Child: School-ageSchool-ageAttitude toward food unpredictable
Intake of protein, calcium, vitamin A, and ascorbic acid tends to be low
Intake of sweets decreases appetite and provides “empty” calories
Feeding the Healthy Child: Feeding the Healthy Child: AdolescentAdolescentGrow rapidly and expend large amounts of energy
Fad food drives a lot of food selections
Fatigue is common in this age group
Childhood ObesityOne-third of all children in the U.S. are overweight
30% to 40% of those are considered obese
Related to obesity in adulthood
Most often related to diet and inactivity
Basal metabolic index (BMI) percentile
Weight in pounds
Height in inches2
times 703
Feeding the Ill ChildMany hospitalized
children have poor appetites
Causes vary depending on illness/disease
Nurse should assessDoes child have any
teeth?Are there any lesions in
the mouth?Can child eat
independently or is assistance needed?
Dentition:
Eruption of teeth starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth".
Average age for teeth eruption:
• Lower central incisors • Upper central incisors • Upper lateral incisors • Lower lateral incisors • Lower first molars • Upper first molars • Lower cuspids • Upper cuspids • Lower 2nd molars • Upper 2nd molars
• Erupt at 6 months • Erupt at 7.5 months • Erupt at 9 months • Erupt at 11 months • Erupt at 12 months • Erupt at 14 months • Erupt at 16 months • Erupt at 18 months • Erupt at 20months • Erupt at 24 months.
Feeding the Ill Child (cont.)A tablespoonful of food for each year of age is a
good guide to follow when feeding a child
Sweet drinks and snacks should not be served just before meals
Infants who are placed on NPO status should be provided with a pacifier to meet their sucking needs
The Teeth (cont.)Important not to neglect baby teeth.(20)Deciduous teeth serve not only in the digestive process
but also in the development of the jawIf these teeth are lost too early, the permanent teeth can
come in poorly alignedDelayed or early eruption can be indicative of certain
endocrine disorders or other pathologic conditionsBottle Mouth occurs when sugars cling to infant’s teeth
and bacteria occursPermanent Teeth- develop before birth but do not erupt
until sixth year
Oral Care in Health and IllnessSticky foods have more potential to cause dental caries than do sugared drinks
Snack foods to avoidSugared gum, dried fruits,
sugared soft drinks, cake, and candy
Recommended snack foodsCheese, milk, sugarless
gum, raw vegetables
Brushing after each meal/snack
Eating a healthy, balanced diet enhances tooth development
Dental CariesOccurs when infant falls
asleep while breastfeeding or is put to bed with a bottle of milk or sweetened juice
Sugar pools in the oral cavity
Most often seen in children 18 months to 3 years of age
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
Education on Tooth HygieneStarts with first tooth
eruptionBrush before bedtimeFever is not associated
with teething; therefore, cause should be assessed
Replace toothbrush every 3 months or after a viral illness
Do not use a closed container for toothbrush storage
Avoid sharing toothbrushes
PlayPlay is the “work” of
childrenHospital playrooms are
used by children who do not have communicable illnesses (e.g., measles or a draining wound)
Art allows for creative expression
Computer games
Nursing interventions should focus on Encouraging optimal
play activities that are age-appropriate
Helping parents select age- and illness-appropriate toys An asthmatic child should
not be given a stuffed animal to play with
Medical Problems and Medical Problems and Dental HealthDental HealthHealth problem
AsthmaHemophiliaSeizure disordersBulimia
Effect on teethSucrose content of
medications can cause decay
Can cause oral bleeding, impaired healing
Causes decreased saliva; gingival overgrowth
Erosion of teeth from acid content during vomiting
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