PEDS - Health Promotion

8/19/2019 PEDS - Health Promotion

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Health Promotion in Pediatrics

Physical Development

- Infant (birth to 1 year old)o Posterior fontanel closes by 6 to 8 weeks of aeo !nterior fontanel closes by 1" to 18 months of aeo Dentition- si# to eiht teeth sho$ld er$pt by the end of the %rst year&

'irst teeth er$pt between the aes of 6 to 1 months eethin pain can be eased

1& *old teethin rins

"& +* teethin els,& !cetaminophen Ib$profeno .+ /+0 H!. , D!23o Ib$profen only in infants over the ae of 6 months

*lean the teeth $sin cool wash cloth Do not ive bottles to infants when they are fallin asleep

o 4ottle mo$th syndrome5 Dental *aries&

Infant Gross Motor Skills Fine Motor Skills1 month Head a 7rasp 0ee#2 months ifts head o9 mattress Holds hands in an open position3 months 0aises head and sho$lders o9 mattress .o loner has a rasp ree#&

:eeps hands loosely open4 months 0olls from back to side Places ob;ects in mo$th

5 months 0olls from front to back


2/14

- 3chool !e *hildren (6 to 1" years)o Permanent teeth er$ptiono Bis$al ac$ity ""o !$ditory ac$ity and sense of to$ch f$lly developo 0apid rowtho 'emales

4$ddin of breasts

!ppearance of p$bic hair +nset of menarche

o /ales nlarement of testicles

!ppearance of p$bic hair

3chool ae child 7ross /otor 3kills 'ine /otor 3kills*ontin$e to improve *ontin$e to improve

- !dolescent (1" to " years old)o !cne may appearo Increase in metabolism and rapid rowth alter sleepin habits5 sleep late and moreo 'emales

4$ddin of breast 7rowth of p$bic hair

+nsent of menstr$ationo /ales

Increase in siCe of testes and scrot$m

!ppearance of p$bic hair 7rowth of a#illary hair

*hane in voice

!dolescent 7ross /otor 3kills 'ine /otor 3kills*ontin$e to improve *ontin$e to improve

Physical development (weiht and heiht)

!7 =I7H HI7HI.'!.3 (birth to 1) - 1A to "1 per week the

%rst 6 months- Do$ble by 6 months- ripled by 1" months

- "&A cm per month the %rst 6

months- Increases by A by the ae

of 1" months +DD0 (1 to ,) - 3ho$ld weiht fo$r times their

birth weiht

- E&A cm per year

P03*H++ (, to 6) - 7ain " to , k per year - 6&A to F cm per year3*H++ !7 (6 to 1") - " to , k per year - A cm per year

!D+3*.* (1" to " years) - 4oys5 E to , k- 7irls5 E to "A k

- 7irls5 A to " cm- 4oys5 1 to , cm

*onitive Development


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!7 PI!7 !.7

- *an think loically abo$t abstract propositions and test

hypotheses systematically- 4ecomes concerned with the hypothetical> the f$t$re>

and ideoloical problems&1& !ble to think thro$h more than two cateories of variables

conc$rrently"& *apable of eval$atin the K$ality of their own thinkin,& !ble to maintain attention for loner periods of time@& Hihly imainative and idealisticA& Increasinly capable of $sin formal loic to make

- Develops ;aron with their

peer ro$ps


4/14

decisions6& hink beyond c$rrent circ$mstancesE& !ble to $nderstand how the actions of an individ$al

in$ence others

're$d

3!7 !7 *+7.+


5/14

activities&

7enital

stae

P$berty to

death

/at$rin

se#$al

interest

1& he enital stae is a time of

se#$al reawakenin"& he so$rce of pleas$re now

becomes someone o$tside the

family,& 're$d believed that $nresolved

conicts with parents re-

emere d$rin adolescence&

=hen these conicts have been

resolved the individ$al is

capable of developin a mat$re

love relationship and f$nction

independently as an ad$lt@& It is the p$berty period when

se#$al $res reawaken that

may lead to children e#plorin

their se#$alityPsychosocial Development

rikson

!es rikson .$rsin actionInfants ( birth to

1)

"r#st $s Mistr#st % &irth to 1'

1& !chievin this task is based on the K$ality fo

the careiver G infant relationship and the

care received"& he infant beins to learn delayed

rati%cation,& r$st is developed by meetin the needs5

comfort> feedin> stim$lation and

carin&needs@& /istr$st develops if needs are inadeK$ately

or inconsistently met> or if needs are over

met

oddler (1 to ,) A#tonom $s Shame ( )o#*t % 1 to 3'

*hildren learn to either be self-s$Jcient in

many activities> incl$din toiletin> feedin&

=alkin> and talkin +,-. to do$bt theirown abilities&


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Preschooler ( , to

6)

Initiati$e $s G#ilt %3 to 5'

1! Preschoolers become eneretic learners>

despite not havin all of the physical abilities

necessary to be s$ccessf$l at everythin2! 7$ilt may occ$r when preschoolers believe

they have misbehaved or when they are

$nable to accomplish a task3! 7$idin preschoolers to attempt activies

within their capabilities while settin limits is

appropriate3chool !e ( 6 to

1")

In/#str S inferiorit %5 to 12'

1& ! sense of ind$stry is achieved thro$h the

development of skills and knowlede that

allows the child to provide meaninf$l

contrib$tions to society"& ! sense of accomplishment is ained

thro$h the ability to cooperate and

compete with others,& *hildren sho$ld be challened with tasks

that need to be accomplished> and allowed

to work thro$h individ$al di9erences in

order to complete the task@& *reatin systems that reward s$ccessf$l

mastery of skills an tasks can create a sense

of inferiority in children $nable to completethe task or acK$ire the skills

A& *hildren sho$ld be ta$ht that not everyone

will master every skill!dolescence ( 1"

to ")

I/entit S role onf#sion % 12 to 18'

1& !dolescents develop a sense of personal

identity> and come to view themselves as

$niK$e individ$als"& 7ro$p identity- adolescents become part of a

peer ro$p that reatly in$ences behaviors

Psychosocial development (*ontin$ed)

!7 3+*I! 3' *+.*P /+0! 4+D2 I/!7 !*IBI3

I.'!.

(birth to

1)

1& !ttachment-

bein to bond

with parents&

3een within the

%rst month"& 3eparation-

infants %rst

distin$ish

themselves and

their primary

careiver as

separate

individ$als,& 3eparation

an#iety G @ to 8

months& Infants

will protest when

separated from

3eparation-

infants %rst

distin$ish

themselves

and their

primary

careiver as

separate

individ$als

1& /o$ths are

pleas$re

prod$cers (oral

phase"& Hands and feet

are ob;ects of

play,& 3milin ca$ses

others to react

1& 3hort attention"& solitary play,& rattles@& teethin toysA& playin pat a

cake6& playin with

ballsE& readin books8& mirrorsF& brihtly colored

toys1& playin with

blocks


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parents@& 3traner fear- 6

to 8 months& ess

likely to accept

straners +DD0

( 1 to ,)

1& separation

an#iety

1 separation

complete

"& 4eins

e#ploration

on own

1& *losely associated

with conitive

development"& ocentric G

$nable to see

thins from the

perspectives of

others,& P$nishment and

obedience beins

with a sense that

ood behavior is

rewarded and bad

behavior is

p$nished

1& !ppreciate

$sef$lness of

vario$s body

parts"& 7ender

identity by ,

years of ae

1& Parallel play-

toddlers observ

other children

then may

enae in

activities nearb"& 'illin emptyin

containers,& Playin with

blocks@& ookin at bookA& P$sh p$ll toys6& ossin ballsE& 'iner paints8& are piece

p$CClesF& hick crayons1& emper

tantr$ms5

fr$strated withrestrictions on

independence&11& oilet trainin

can bein when

toddlers have

the sensation o

needin to

$rinate or

defecate1"& Discipline sho$

be consistent

with well-de%ne

bo$ndaries thatare established

to develop

appropriate

social behavior&P03*H+

+0 ( ,

to 6)

1& Do not e#hibit

straner an#iety

and have less

separation

an#iety"& Proloned

separation>

d$rin

hospitaliCation>can provoke

an#iety- 'avorite toys

and

appropriate

play sho$ld

be $sed to

help ease

preschoolersM

fears,& Pretend play is

healthy and

allows

1 masterin

skills make

them feel ood

" reression

may occ$r

d$rin stress

1 arly

preschoolers

contin$e in the

ood-bad

orientation of the

toddler years&

!ctions are taken

based on whether

or not it willres$lt in a reward

p$nishment" +lder

preschoolers

primarily take

actions based on

satisfyin

personal needs>

yet are beinnin

to $nderstand the

concepts of

;$stice and

- 4ein to

reconiCe

di9erences in

appearances>

and identify

what is

considered

acceptable and

$nacceptable- 4y the ae of A

years>

preschoolers

bein

comparin

themselves

with peers- Poor

$nderstandin

of anatomy

makes intr$sive

e#periences>

s$ch as

- 3hifts to associative

play- Play is not hihly

oraniCed b$t

cooperation does

e#ist between

children- Playin ball- P$ttin p$CCles

toether- 0idin tricycles- Playin pretend and

dress $p activities- 0ole playin- Painin- 3imple sewin- 0eadin books- =adin pools- 3katin- *omp$ter prorams- lectronic ames


8/14

preschoolers to

determine the

di9erence

between reality

and fantasy

fairness in;ections or

c$ts>

frihtenin to

preschoolers1&"&,&@&A&

3*H++-

!7 (6 to

1"

- Peer ro$ps play an

important part in

social development- Peer press$re bein

to take e9ect- *l$bs and best

friends are pop$lar- 4$llyin- Prefer the company

of same ender

companions> b$t

bein developin

an interest in the

opposite se#

toward the end of

school ae years- /ost relationships

come from school

associations- *onformity becomes

evident

- Develop an

awareness

ofthemselves

in relation to

others&-

abilities> and

physical

characteristi

cs- *on%dence is

ained

thro$hestablishin

a positive

self-concept- Parents

contin$e to

in$ence

the school

ae childMs

self-ideals>

b$t by

middle

childhood

the opinionsof peers and

teachers

become

more

val$able

arly school ae

- Do not $nderstand the

reasonin behindr$les and

e#pectations for

behavior- 4elieve what they

think si worn and

what others tell

them is riht- ?$dement is $ided

by rewards and

p$nishment

ate 3chool ae years

- !ble to ;$de theintentions of an act

rather than ;$st its

conseK$ences-

stamps>

cards> coins

or st$9edanimals

- 0ide bicycle- 4$ilde

simple

models- ?oin

oraniCed

sports

F- 1" years of ae

- /ake crafts- 4$ild mode- *ollect

thins

enae in

hobbies- 3olve ;isaw

p$CCles- Play board

and card

ames- ?oin

oraniCed

competitive

sports!D+*

. (1"

to ")

- Peer relationships

develop& hese

relationships act as

s$pport system for

adolescents- 4est friend

relationships are

more stable and

loner lastin than

they were in

prevo$s years- Parent child

relationships

chane to allow

reater sense of

- Biew

themselves

in relation to

similarities

with peers

d$rin

yo$ner

adolescence- Biew

themselves

accordin to

their $niK$e

characteristi

cs as the

adolescent

- 3olve moral dilemma

$sin internaliCed

moral principles- N$estion relevance of

e#istin moral

val$es to society

and individ$als

- 4ase their own

normality on

comparison with

peers- he imae

established

d$rin

adolescence is

retained

thro$ho$t life

- .on-violent

ames- .on- violent

m$sic- 3ports- *arin for a pet- *areer trainin

prorams- 0eadin- 3ocial events

( oin to

movies> school

dances)


9/14

independence years

proress

Health promotion

!e Imm$niCation .$trition In;$ry preventionInfant

(birth to

year )

- 4irth G hepatitis 4

" months5 DtaP> rotavir$s

vaccine (0B)> inactivated

poliovir$s (IPB)> haemophil$

in$enCa type 4 (HI4)>

pne$mococcal vaccine(P*B)> Hep 4@ mos G DtaP> 0B> IPB> Hib>

P*B- 6 months 5 G DtaP> IPB (6 to

18 mos)> P*B> Hep 4 (6

to 1" mos)> rotaeK

(alternative form$lation

for 0B> reK$ires , doses

that m$st be completed

by ," weeks of ae)- 6 to 1" mos G seasonal

in$enCa vaccinationyearlyO can ive

trivalent inactivated

in$enCa vaccine (IB)

as I/

- 4reastfeedin provides

complete diet for infants d$rin

the %rst 6 months- Iron fortifed form$la is

acceptable alternative to breast

milk- *owMs milk is not recommended- 4ein vitamin D s$pplements

within the %rst few days of life- !lternative so$rce of $ids are

not needed d$rin the %rst @

months of life- !fter 6 months> 1 fr$it ;$ice

sho$ld be limited to @ to 6 oC

per day- 3olid foods are introd$ced

aro$nd @ to 6 months- 0eadiness incl$de interest in

solid foods> vol$ntary control of

the head and tr$nk- Iron forti%ed cereal is

introd$ced- .ew foods sho$ld be introd$ced

one at a time> over a @ to E day

period> to observe for sins of

allery or intolerance> which

may incl$de f$ssiness> rash>

vomitin> diarrhea> and

constipation- Beetables fr$its started

between 6 to 8 months of ae&

!fter both have been

introd$ced> meats may beadded

- *itr$s fr$its> meat> and es are

not started $ntil 6 months of

ae- 4reast milk form$la sho$ld be

decreased as intake of solid

foods increase> b$t breast milk

sho$ld remain the primary

so$rce of n$trition thro$h the

%rst year- 'oods that are cooked>

chopped> and $nseasoned are

appropriate by F months of ae

!spiration of forein ob;ects

- !void rapes> coin> candy- *lothin sho$ld be checked

for haCards (loose b$tton)

4odily harm

- 3harp ob;ects sho$ld be

kept o$t of reach- 3ho$ld not be left

$nattended with any

animals present

4$rns

- emperat$re of bath sho$ld

be checked- How water sho$ld be set

below @F *- Handle pots and pans

sho$ld be kept t$rned to

the back of stoves- lectrical o$tlets sho$ld be

covered

Drownin

- 3ho$ld not be left

$nattended in bath t$bs

'alls

- :ept at the lowest position

with the fails all the way $p- 0estrains sho$ld be $sed in

infants seats- Place safety ates on the

top and bottom of stairs

Poisonin

- #pos$re to lead paint

sho$ld be avoided- o#in sho$ld be kept o$t of

reach- n$mber of poison control

center sho$ld be kept near

the phone

/otor vehicle in;$ry

- infant only and convertible

infant toddler car seats- rear facin car seat $ntil the

ae of " years or the

recommended heiht- safest area for infants and


10/14

- 'iner foods incl$de5 ripe

banana> toast strips> raham

crackers> cheese c$bes>

noodles> peeled checks of

apples> pears> peaches- =eanin can be accomplished

when the infants are able to

drink for a c$p&- +ne meal may be replaced with

breast milk or form$la in a c$p

with handles- 4ed time feedins are the last

to be stopped

child is the back seat of a

car

s$9ocation

- plastic ba sho$ld be

avoided- balloons sho$ld be kept

away from infants- crib mattress sho$ld %t- pillows sho$ld be kept o$t

of reach- placed on their backs for

sleep

oddler (1

to ,

years)

1" to 1A mos G IPBO HibO

P*BO //0O varicella

1" to ", mos G Hep !> in "

doses> 6 mos apart

- ife time eatin habits- 4ein developin taste preference- 3ho$ld cons$me "@ to , oC of milk

per day& /ay switch from drinkin

whole milk to drinkin low fat milk

after " years of ae- ?$ice sho$ld be limited to @ to 6 oC

per day- rans fatty acid sho$ld be avoided- Diet sho$ld incl$de 1 c$p of fr$it- 'ood servin sho$ld be 1 tbsp for

each ear of ae- Prefer %ner foods beca$se of

increasin a$tonomy- 0e$lar meal times and n$trition

snack best meet n$trient needs- 'oods that are potential chokin

haCards ( n$ts> rapes> hot dos>

pean$t b$tter> raw carrots> to$h

meats> popcorn) sho$ld be

avoided- !d$lt s$pervision d$rin snack and

meal times- 3ho$ld not drink and play d$rin

activities or lyin down

/B!5 rear-facin car seats in the

back seat> preferably in the

middle> for the %rst year of life

$ntil they weih F&1 k> then

can sit in forward-facin car

seat $ntil @ years of ae andor

@lbs

!spiration of forein ob;ects5

small ob;ects> toys with small

partsO balloonsO clothin withloose b$ttons

4odily harm5 sharp ob;ect>

%rearms> animals> straners

4$rns5 same as infants

Drownin5 same as infants

close toilet lids> teach how to

swim

'alls5 same as infants keep

doors and windows closed

Poisonin5 same as infants

safety locks

3$9ocation5 same as infantsPreschool

er ( , to 6

years)

@ to 6 years old GDaPO

//0O varicellaO IPB

,6 to AF mos G seasonal

in$enCa vaccineO IBO or

live atten$ated in$enCa

vaccine (!IB) by nasal

spray

Bision screenin is done5

myopia and amblyopia are

two vision impairmentsthat can be detected

d$rin screenin of the

preschooler

*ons$me abo$t half th, amo$nt

of enery that ad$lts do (18

:cal)

'ood ;as contin$eO become

more willin to sample di9erent

foods by A years of ae

.eed 1, to 1F day of complete

protein in addition to adeK$at,

*a> 'e> folate and Bitamins ! Q *3at$rated fats sho$ld be less than

1 of preschoolerMs total caloric

intake> and total fat over several

days sho$ld be " to , of total

caloric intake

4odily harm

1& 'irm arm sho$ld be kept away"& Preschoolers sho$ld be ta$ht

straner safety,& =ear protective eK$ipment

4$rns

@& hermostat sho$ld be t$rned

down on hot water heatersA& 3$nscreen

Drownin

6& 3ho$ld not be left $nattended in

bath t$bs

E& 3$pervised when near pool8& a$ht to swim

/BI

F& =hen the forward facin car

seat is o$trown> the

preschooler transitions to a

booster seat1& 3afest area for children is the

back seat of the car11& =ear seat belt1"& Do not allow them to play near

c$rb or parked cars1,& each pedestrian safety r$les to

preschool ae children


11/14

1@& G stand back from c$rb while

waitin to cross the street1A& =ear liht colored clothin with

$orescent materials attached3chool

ae (6 to

1" years)

4y 6 years of ae> if not

iven between @-A years

of ae5 DaPO IPBO //0O

varicella

11-1" years old5 dapO

HPB " (for females) in ,doses and HPB@ (for

males)

In$enCa vaccine

3coliosis screenin sho$ld

be done

4y the end of school ae> children

sho$ld eat ad$lt portion of foo&

!void $sin food as reward

mphasiCe physical activity

each children to make healthy food

selections for meals and snacks

!void eatin fast food freK$ently

!void skippin meals

/odel healthy behavior

- 4odily harm

:eep away from %rearms

3ho$ld not be allowed to $se

trampolines

Identify safe play areas

3traner safety

=ear helmets and pads- 4$rns

'ire safety

=orkin smoke etector

3$nscreen

Preca$tion to take whle cookin

- /BI

*hildren $se approved car

restraint when they achieved

@MF

- Poisonins$bstance

ab$se*hemicals sho$ld be locked

each abo$t illeal dr$s and

alcohol!dolesce

nce (1"

to "

yearsR

If not ive at ae 11 G 1"

years of ae5 dapO /*B@O

P0B" series for females

and HPB@ series for males

In$enCa vaccine

3coliosis screenin

0apid rowth and hih metabolism

reK$ire increases in K$ality n$trients

- *a> fe> Cinc- 'olic acid- Bitamin 46> !> iron> calci$m>

and Cinc

4oth overeatin and $nder eatin

need to be checked

!void $sin food as reward

mphasiCe physical citivity

1& 4odily harm

:eep %rearms $nloaded and in a

locked cabinet or bo#

Proper $se of sportin eK$ipment

prior to $se

4e aware of chanes in mood

- Poor school performance- ack of interest in thins

that were of interest

- 3ocial isolation- Dist$rbance in sleep or

appetite- #pression of s$icidal

tho$hts"& 4$rns

each %re safety

!void tannin beds

!pply s$n 3creen

,& Drownin

each adolescents to swim

@& /BI5

DriverMs ed$cation

A& 3$bstance ab$se each to say no


12/14

3leep> dental> and se#$ality

!e 3leep Dental 3e#$alityInfants ( 1 month to 1 year) 1& .oct$rnal sleep pattern

is established by , to @

months of ae"& Infant sleeps 1@ to 1A

ho$rs daily and F to 11

ho$rs at niht aro$nd

the ae of @ months,& Infant sleeps thro$h

the niht and takes one

to two naps d$rin the

day by the ae of 1"

months oddler ( 1 to , years) 1& ypically 11 to 1" hr of

sleep per day> incl$din

one nap"& .aps often are

eliminated in older

toddlerhood,& 0esistance to bed time

1& 3ho$ld have an

established dental home

by the ae of 1 year"& 'lossin and br$shin

sho$ld be performed by

the ad$lt careiver> and

is the best method of


13/14

and e#pression of fears

are common in this ae

ro$p@& /aintainin a re$lar

bedtime and bedtime

ro$tines are helpf$l to

promote sleeS

removin plaK$e,& 4r$shin sho$ld occ$r

after meals and at bed

time& .othin to eat or

drink> e#cept water> is

iven to the child after

the bed time cleanin@& 'l$oride is

s$pplemented to

children livin in areas

witho$t adeK$ate levels

in drinkin waterA& arly childhood caries is

a form of tooth decay

that develops in the

toddlers> and is more

common in children who

are p$t to bed with a

bottle of ;$ice or milk6& *ons$mption of

carioenic foods sho$ld

be eliminated if

possible& If not> the

freK$ency of

cons$mption sho$ld be

limited&Pre 3chool (, to 6 years) 1& .eed abo$t 1" ho$rs of

sleep per day& 3ome

may still reK$ire a

daytime nap"& :eep consistent bed

time ro$tine,& and is

dependent on- !e- evel of activity- Health stat$s

"& F ho$rs of sleep is

needed each niht at

the ae of 1" years,& 0esistance to bed time

is sometimes

e#perienced aro$nd theae of 8 and F years>

and aain aro$nd the

ae of 11 years> b$t is

typically resolved by the

ae of 1"

- 4r$sh after meals

and snacks> and at

bedtime- 'loss daily- Have re$lar check

$ps- Have re$lar

$oride treatments

!dolescents (1" to " years) - 3leep habits chane

with p$berty d$e to

increased

metabolism and

rapid rowth- end to stay $p late>

sleep in later in the

- *orrective

appliances are most

common with this

ae ro$p- 4r$sh after meals

an snacks> and at

bedtime

- Provide adolescents

with acc$rate

information and

disc$ss what is

heard from peers- mphasiCe

abstinence and


14/14

mornin> sleep mre

than d$rin the

school ae years- D$rin the periods

of active rowth> the

ened for sleep

increases

- 'loss daily- Have re$lar check

$ps- Have re$lar

$oride treatments

practicin safe se#- Provide information

abo$t preventin

se#$ally transmitte

infections and

prenancy- Promote an

atmosphere where

adolescents are

comfortable askin

K$estions- !ssist adolescents

with problem solvin

and decision makin

skills

PEDS - Health Promotion

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