Chapter 015 lo

Chapter 15Chapter 15

An Overview of Growth, An Overview of Growth, Development, and NutritionDevelopment, and Nutrition

ObjectivesObjectives

• Explain the differences among growth, development, and maturation.

• Recognize and read a growth chart for children.

• List five factors that influence growth and development.

• Discuss the nursing implications of growth and development.

2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives Objectives (cont.)(cont.)

• Discuss the importance of family-centered care in pediatrics.

• Recognize the influence of the family and cultural practices on growth, development, nutrition, and health care.

• Describe three developmental theories and their impact on planning the nursing care of children.



• Discuss the nutritional needs of growing children.

• Differentiate between permanent and deciduous teeth, and list the times of their eruption.

• Understand the characteristics of play at various age levels.

• Describe the relationship of play to physical, cognitive, and emotional development.



• Understand the role of computers and computer games in play at various ages.

• Define therapeutic play.

• Understand the use of play as an assessment tool.


Growth and DevelopmentGrowth and Development

• Differences between adult and child– The child is in a continuous process of growth

and development– Growth spurts followed by plateaus– The growth is measurable, can be observed

and studied– Not all parts mature at the same time


The Impact of Growth and The Impact of Growth and Development on Nursing CareDevelopment on Nursing Care

• Developmental needs will have an impact on a child’s response to illness

• The nurse must know what is normal in order to recognize any deviations within a given age group and plan care accordingly– A child differs in anatomy and physiology as

compared to the adult; therefore, illnesses and their responses to them, including treatments, may be different


The Nursing Process Applied to The Nursing Process Applied to Growth and DevelopmentGrowth and Development

• Data collection– Height and weight, plot standard growth chart– Record developmental milestones achieved

related to age of child– Observe infant; interview parents

• Analysis/nursing diagnosis– Determine appropriate nursing diagnoses

related to parenting, coping skills, and unmet developmental needs


The Nursing Process Applied to The Nursing Process Applied to Growth and Development Growth and Development (cont.)(cont.)

• Planning– Offer guidance and teaching to family, school

personnel, and child to meet developmental needs

• Implementation– Interventions that foster growth and

development in the hospital setting can include encouraging age-appropriate self-care

– Anticipatory guidance may be given to parents so they understand changes in behavior, eating habits, and play for the growing child


The Nursing Process Applied to The Nursing Process Applied to Growth and Development Growth and Development (cont.)(cont.)

• Evaluation– Ongoing evaluation of growth and

development of the child and follow-up of teaching and guidance offered at prior clinic/home visits are essential


Key Terms in Child DevelopmentKey Terms in Child Development

• Development – A progressive increase in the function of the

body

• Growth– An increase in physical size, measured in feet

or meters and pounds or kilograms

• Maturation– The total way in which a person grows and

develops, as dictated by inheritance

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11

Directional PatternsDirectional Patterns

• Fundamental to all humans– Cephalocaudal

• Proceeds from head to toe

– Proximodistal• From midline to

periphery


Some Developmental Differences Some Developmental Differences Between Children and AdultsBetween Children and Adults

• Height• Weight• Body proportions• Metabolic rates• Respirations • Cardiovascular

system• Immunity

• Kidney function• Nervous system• Sleep patterns• Bone growth• Critical periods• Integration of skills


Growth StandardsGrowth Standards

• Measured in dimensions– Height– Weight– Volume– Tissue thickness

• Standardized– Compare the

measurement of a child to others of the same age and sex

– Compare the child’s present measurements with the former rate of growth and pattern of progress


Growth ChartsGrowth Charts

• Children who are in good health tend to follow a consistent pattern of growth

• At any age, there are wide individual differences in measured values

• There are separate charts for boys and girls


Developmental ScreeningDevelopmental Screening

• Denver Developmental Screening Test– Assesses 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 testElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16

Influencing FactorsInfluencing Factors

• All of the following factors are closely related and dependent on one another in their effect on the growth and development of the child– Heredity– Nationality and race – Ordinal position within the family– Gender– Environment


Types of FamiliesTypes of Families

• Nuclear

• Extended

• Single parent

• Foster parent

• Alternative

• Dual career

• Blended

• Polygamous

• Homosexual

• Cohabitation


Family ApgarFamily Apgar

• Used to assess family function– Adaptation– Partnership– Growth– Affection– Resolve

• Enables the nurse to develop interventions that aid the family to achieve a healthier adaptation to the child’s health needs


Family as Part of a CommunityFamily as Part of a Community

• Factors to consider– Housing– Access to public transportation– City services– Safety– Health care delivery system– Assessment of community is important in

creating discharge plans for family


Homeless FamilyHomeless Family

• Has an impact on the growth and development of a child

• Support system and financial resources often lacking

• School or emergency department nurse may be the only contact with health care or may be the first to identify the status of the family

• Community referrals for food, housing, education, and financial assistance are essential


Personality DevelopmentPersonality Development

• Personality is the result of interaction between biological and environmental heritages

• Unique organization of characteristics that determine the individual’s typical or recurrent pattern of behavior


Developmental TheoristsDevelopmental Theorists

• Erikson

• Freud

• Kohlberg

• Sullivan

• Piaget

• Maslow


Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of Needs

• The needs at the bottom of the pyramid must be met before one can fulfill needs at the next higher level


The Growth and Development of a The Growth and Development of a ParentParent

• First prenatal trimester– Child’s tasks

• Growth

– Parent’s task• Develop attitude toward newborn. Happy? Parent of

disabled child? Unwed mother? These factors and others affect the developing attitude of the mother.

– Nursing intervention • Develop positive attitude in both parents concerning

expected birth of child. Use referrals and agencies as needed.


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The Growth and Development of a The Growth and Development of a Parent Parent (cont.)(cont.)

• Second prenatal trimester – Child’s task

• Growth

– Parent’s task• Mother focuses on infant because of fetal movements

felt. Parents picture what infant will look like, what future he or she will have, and other ideas.

– Nursing intervention• Parents on child care and needs and providing

physical environment for expected infant. Information about newborn care should be given at this time.

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.


• Third prenatal trimester– Child’s task

• Growth– Parent’s task

• Mother feels large. Attention focuses on how fetus is going to get out.

– Nursing intervention• Detailed information should be presented at this

time concerning the birth processes, preparation for birth, breastfeeding, and care of sibling at home.



• Birth– Child’s task

• Adjust to external environment.

– Parent’s task• Elicit positive responses from child and respond by meeting child’s

need for food and closeness. If parents receive only negative responses (e.g., sleepy infant, crying infant, difficult feeder, congenital anomaly), parental development will be inhibited.

– Nursing intervention• Encourage early touch, feeding, and other practices. Explain

behavior and appearance of newborn to allay fears. Help parents to identify positive responses. (Use infant’s reflexes, such as grasp reflex, to identify a positive response by placing mother’s finger into infant’s hand.)



• Infant– Child’s task

• Develop trust. – Parent’s task

• Learn “cues” presented by infant to determine individual needs.

– Nursing intervention• Help 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.



• Toddler– Child’s task

• Autonomy

– Parent’s task• Try to accept the pattern of growth and development.

Accept some loss of control but maintain some limits for safety.

– Nursing intervention• Help parents cope with transient independence of

child (e.g., allow child to go on tricycle but don’t yell “Don’t fall” or anxiety will be radiated).



• Preschool– Child’s task

• Initiative

– Parent’s task• Learn to separate from child.

– Nursing intervention• Help parents show standards but “let go” so child

can develop some independence. A preschool experience may be helpful.


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• School-age– Child’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• Help parents understand that child is developing his or her own

limits and self-discipline. Be there to guide child, but do not constantly intrude. Help child get results from his or her own efforts at performance.



• Adolescence– Child’s task

• Establishing identity• Accepting pubertal changes• Developing abstract reasoning• Deciding on career• Investigating lifestyles• Controlling feelings



– 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 DevelopmentErikson’s Stages of Development

• Tasks must be mastered at each stage to achieve optimum maturity

• Each builds on the successful completion of the previous stage

• Parents must interact with their child to assist the child to master the various stages


Piaget’s Theory of Cognitive Piaget’s Theory of Cognitive DevelopmentDevelopment

• Intellectual ability• Intellectual maturity is

attained through four orderly and distinct stages of development, all are interrelated– Sensorimotor– Preoperational– Concrete operations– Formal operations

• Ages for each stage are approximate and each builds upon the others

• Consists of interactions and coping with the environment


Kohlberg’s Theory of Moral Kohlberg’s Theory of Moral DevelopmentDevelopment

• Sequential

• Theory is based upon Piaget’s

• Three levels– Preconventional– Conventional– Postconventional

• Each level contains two stages

• Emphasis on the conscience of the individual within society


Parent TeachingParent Teaching

• Experiences in dealing with challenges and disappointments prepare the child to function independently in adulthood

• Encourage child to deal with successes and failures, provide socially acceptable outlets, and intervene only if the frustrations become overwhelming

• Parent’s task is to provide the child with skills and tools appropriate for each age level to deal with current events


NutritionNutrition


Nutritional HeritageNutritional Heritage

• Some families do not consider food a priority

• A lack of adequate nutrition can lead to mental retardation

• The obese child may be subject to decreased motor skills and peer rejection

• The nurse identifies children at risk and assists the family in modifying eating habits to ensure adequate nutrition is provided for growth and development


Family NutritionFamily Nutrition

• USDA dietary guidelines– Intended to help families make informed

decisions about what they eat

• A well-balanced diet supplies all essential nutrients in the necessary amounts


FoodFood

• Provides heat and energy

• Builds and repairs tissues

• Regulates body processes

• Is given in a mixture of elements– Minerals– Compounds– Water


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Children’s Food PyramidChildren’s Food Pyramid


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Vegetarian Diet PyramidVegetarian Diet Pyramid


Infant Nutritional NeedsInfant Nutritional Needs

• Require more – Calories– Protein– Minerals– Vitamins– Higher fluid requirements


Fiber Needs of the Young ChildFiber Needs of the Young Child

• The 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



Nutrient Digestion

Nutritional Care PlanNutritional Care Plan

• Can be used in– Hospital– Home– Outpatient departments

• Provides information and stores it in one place


Nutrition and HealthNutrition and Health

• Digestive 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


Nutrition and Health PromotionNutrition and Health Promotion

• To help prevent some illnesses, it is not recommended to significantly restrict fat and cholesterol as they are needed for calories and the development of the central nervous system

• Nutritional needs may be changed due to the severity of illness– Total parenteral nutrition and enteral feedings

allow children who need nutritional support to be cared for at home


Feeding the Healthy Child: InfantFeeding the Healthy Child: Infant

• Symptoms of underfeeding – Restlessness– Crying– Failure to gain weight

• Symptoms of overfeeding– Regurgitation– Mild diarrhea– Too rapid weight gain

• High-fat diets cause– Delayed gastric emptying– Abdominal distention

• High carbohydrates– Abdominal distention– Flatus – Excessive weight gain

• Constipation– Too much fat or protein– Deficiency in “bulk”


Nursing TipNursing Tip

• Whole 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: ToddlerFeeding the Healthy Child: Toddler

• Can feed themselves by end of second year– Important in order to develop a sense of

independence

• Parent should be present at mealtimes

• Difficulties may arise from parental anxiety and/or a lack of time during meals


Feeding the Healthy Child: Feeding the Healthy Child: PreschoolPreschool

• Likes finger-foods

• Dawdling and regression common in this age group

• More vulnerable to protein-calorie deficiencies


Feeding the Healthy Child: Feeding the Healthy Child: School-ageSchool-age

• Attitude 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: AdolescentAdolescent

• Grow rapidly and expend large amounts of energy

• Important to involve adolescent in food selections that are nutritious and appetizing

• Fad food drives a lot of food selections

• Fatigue is common in this age group


Childhood ObesityChildhood Obesity

• One-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 × 705


Feeding the Ill ChildFeeding the Ill Child

• Many hospitalized children have poor appetites

• Causes vary depending on illness/disease

• May also refuse food as a means of manipulating parents

• Nurse should assess– Does child have any

teeth?– Are there any lesions

in the mouth?– Can child eat

independently or is assistance needed?


Feeding the Ill Child Feeding the Ill Child (cont.)(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


Food-Drug InteractionsFood-Drug Interactions

• Drug-drug: nurse needs to know the side effects of each drug prescribed and administered

• Drug-environment: involves interaction of the effects of a drug on the response of the patient to the environment (i.e., certain antibiotics cause pronounced photosensitivity)

• Drug-food: nurse needs to know if any foods are contraindicated when child is receiving certain drugs (i.e., Coumadin and foods containing high levels of vitamin K)


The TeethThe Teeth

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Permanent and deciduous teeth and age of eruption.


The Teeth The Teeth (cont.)(cont.)

• Important not to neglect baby teeth

• Deciduous teeth serve not only in the digestive process but also in the development of the jaw

• If these teeth are lost too early, the permanent teeth can come in poorly aligned

• Delayed or early eruption can be indicative of certain endocrine disorders or other pathologic conditions


Oral Care in Health and IllnessOral Care in Health and Illness

• Sticky foods have more potential to cause dental caries than do sugared drinks

• Snack foods to avoid– Sugared gum, dried fruits,

sugared soft drinks, cake, and candy

• Recommended snack foods– Cheese, milk, sugarless

gum, raw vegetables

• Brushing after each meal/snack

• Eating a healthy, balanced diet enhances tooth development


Dental CariesDental Caries

• Occurs 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


Education on Tooth HygieneEducation on Tooth Hygiene

• Starts with first tooth eruption

• Brush before bedtime– Protective bactericidal

effects of saliva decrease during sleep

• Fever is not associated with teething; therefore, cause should be assessed

• Replace toothbrush every 3 months or after a viral illness

• Avoid rinsing bristles in hot water

• Do not use a closed container for toothbrush storage

• Avoid sharing toothbrushes


PlayPlay

• Play is the “work” of children

• Hospital 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 Dental Medical Problems and Dental HealthHealth

• Health problem– Asthma– Hemophilia– Seizure disorders– Bulimia

• Effect on teeth– Sucrose 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


Question for ReviewQuestion for Review

• Why is introduction of solid foods to infants delayed until 4 to 6 months of age?


ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Critical Thinking Question

• Review Questions


Chapter 015 lo

Documents

growing childelsevier items

nursing intervention

health care

essentialelsevier items

derived items 2011

ageelsevier items

growth anddevelopment

ill child