GROWTH AND DEVELOPMENT By Kara Potter RN MSN

GROWTH AND DEVELOPMENT By: Kara Potter RN, MSN Revised and Presented by P. Braun RN, MSN

SLO’S • DIFFERENTIATE BETWEEN NORMAL AND ABNORMAL GROWTH AND DEVELOPMENT • EXAMINE THE USE OF PLAY THROUGHOUT THE DEVELOPMENTAL STAGES • ANALYZE SAFETY CONCERNS THROUGH THE DEVELOPMENTAL STAGES

FACTORS INFLUENCING DEVELOPMENT • GENETICS • NUTRITION • PRENATAL AND ENVIRONMENTAL FACTORS • FAMILY AND COMMUNITY • CULTURAL FACTORS

DEVELOPMENTAL STAGES • PRENATAL • INFANCY • NEONATAL-BIRTH TO 28 DAYS • INFANCY-1 TO 12 MONTHS • EARLY CHILDHOOD • TODDLER-1 TO 3 YEARS • PRESCHOOLER-3 TO 6 YEARS • MIDDLE CHILDHOOD • SCHOOL AGE-6 TO 12 YEARS • LATE CHILDHOOD • PREPUBERTAL-10 TO 13 YEARS • ADOLESCENCE -3 TO 18 YEARS

NEONATAL • NEWBORN HEAD ¼ OF BODY LENGTH • WEIGHT- GAINS 5 TO 7 OZ WEEKLY FOR FIRST 6 MONTHS • HEIGHT- GROWS 1 INCH MONTHLY FOR FIRST 6 MONTHS • HEAD CIRCUMFERENCE GREATER THAN CHEST • SEE CHARTS, PP 1675 -1681 IN WONG • REFLEXES- MORO, TONIC NECK, GAG, GRASP, ROOTING, BABINSKI

NEWBORN VISIT • 2 WEEKS OR 1 MONTH • ONLY FEED BREAST MILK OR FORMULA, Q 2 -3 HRS • UMBILICAL CORD FALLS OFF 7 -21 DAYS • SHOULD CRY WHEN NEEDS TO BE FED ETC. . • MORE FUSSY IN EVENING • TRUST VS MISTRUST • PIAGET- REFLEX STAGE

INFANT (1 TO 12 MO) • DOUBLE BIRTH WEIGHT IN 5 TO 6 MONTHS, TRIPLES BY 1 YEAR (USE GROWTH CHARTS) • HEIGHT INCREASES BY 50% IN A YEAR • HEAD GROWTH RAPID • HEAD CIRCUMFERENCE EXCEEDS CHEST • POSTERIOR FONTANEL CLOSES @ 2 TO 3 MONTHS • ANTERIOR FONTANEL CLOSES 12 TO 18 MONTHS • REFLEXES • PARACHUTE, LANDAU, LABYRINTH, BODY RIGHTING

INFANCY WELL CHILD CHECKS • 2 MONTHS • 4 MONTH • 6 MONTH • 9 MONTH

HEAD CONTROL

DEVELOPMENT OF SITTING

2 MONTH CHECK • HOLDS HEAD UP WHEN ON STOMACH • MINI PUSHUP 2 -4 MO • SMILES ON OWN • COOING • SIMPLE REFLEX ACTIVITY SUCH AS GRASPING, SUCKING • SHOULD TURN HEAD TO SOUND AT EAR LEVEL

4 MONTH • START TEETHING • INCREASED SALIVA • MATERNAL ANTIBODIES WEAR OFF START TO CATCH VIRUSES • SHOULD START TO BABBLE • REFLEXIVE BEHAVIORS OCCUR IN REPETITION SUCH AS OPENING AND CLOSING FINGERS REPETITIVELY

6 MONTHS • ROLLS OVER AND SITS WITHOUT SUPPORT 7 Months • TEETHING FIRST TOOTH AT ABOUT 4 -6 MONTHS • EXPLORATORY PLAY BANGING THINGS, DROPPING, PUTS THINGS IN MOUTH • GRABS THINGS, TRANSFERS HAND TO HAND • REPETITION OF CHANGE ACTIONS TO REPRODUCE INTERESTING CONSEQUENCES SUCH AS KICKING FEET TO MOVE A MOBILE SUSPENDED OVER THE CRIB.

6 MONTHS LANGUAGE • BABBLE WITH INFLECTION • RESPOND TO HIS OR HER OWN NAME • RESPOND TO SOUND BY MAKING SOUNDS • BABBLE CHAINS OF CONSONANTS (USUALLY SOUNDS FOR M, B, D) • USE HIS OR HER VOICE TO EXPRESS PLEASURE AND DISPLEASURE 6 month child vocalizing and responding https: //youtu. be/Y 02 R 7 yxv. ZFw

9 MONTHS • CHILD BECOMES MOBILE, IS STANDING PULLING UP. • POINTS AT OBJECTS • PINCER GRASP • SEPARATION ANXIETY • RESPONSES BECOME COORDINATED INTO MORE COMPLEX SEQUENCES. ACTIONS TAKE ON AN "INTENTIONAL" CHARACTER SUCH AS THE INFANT REACHES BEHIND A SCREEN TO OBTAIN A HIDDEN OBJECT. • SAFETY PROOF HOUSE! NO HANGING CORDS, ELECTRICAL SOCKETS ETC. . • HEALTH SCREENINGS: ANEMIA AND LEAD TESTS

INFANCY/ MOTOR DEVELOPMENT • • • HEAD CONTROL BY 4 MONTHS ROLL BACK TO SIDE 4 MONTHS ABDOMEN TO BACK 5 MONTHS BACK TO ABDOMEN 6 MONTHS SIT ALONE WITHOUT SUPPORT 8 MONTHS STAND HOLDING FURNITURE 9 MONTHS CRAWL 10 MONTHS CRUISES 10 -12 MONTHS WALKS HOLDING A HAND 12 MONTHS

DEVELOPMENT OF LOCOMOTION p. 421, Hockenberry, 10 th edition

INFANCY FINE MOTOR • DESIRE TO GRASP 3 MO • TWO HANDED VOLUNTARY GRASP BY 5 MO • HOLDS BOTTLE 6 MO • TRANSFERS OBJECTS HAND TO HAND 7 MO • PINCER GRASP 10 MO • REFINED PINCER 12 MO

CRUDE PINCER GRASP

NEAT PINCER GRASP

SENSORY DEVELOPMENT • HEARING AND TOUCH WELL DEVELOPED AT BIRTH • TURNS HEAD TO SOUND 2 MONTHS • SIGHT NOT FULLY DEVELOPED TILL 6 YEARS • SMILES 2 MONTHS • RESPONDS TO NAME 7 MONTHS • SHOULD HAVE 4 WORDS BY 1 YEAR • TEETH ERUPT 4 TO 6 MONTHS WITH INCREASED SALIVA

INFANT SAFETY • BACK TO BED! • CAR SEATS BACKWARD TILL 1 YEAR AND 20 LBS. IN 2017 WILL CHANGE TO 2 YEARS AND 40 POUNDS • SIDE-RAILS OF CRIB UP • NEVER LEAVE INFANT UNATTENDED ON TABLE, BED, BATH TUB • NO BOTTLES AT BED OR NAP TIME • INJURY PREVENTION • • ASPIRATION SUFFOCATION FALLS POISONING

PSYCHOSOCIAL DEVELOPMENT • ERIKSON’S PHASE I: DEVELOPING A SENSE OF TRUST • TRUST VS. MISTRUST • IMPORTANCE OF CAREGIVER-CHILD RELATIONSHIP • IMPORTANCE OF CONSISTENCY OF CARE

COGNITIVE DEVELOPMENT • PIAGET • SENSORIMOTOR PHASE • BIRTH TO 2 MONTH: REFLEX STAGE • 2 TO 4 MONTHS: PRIMARY CIRCULAR REACTIONS • 4 TO 8 MONTHS: SECONDARY CIRCULAR REACTIONS • 8 -12 MONTHS: COORDINATION OF SECONDARY REACTIONS • IMITATION • PLAY • OBJECT PERMANENCE (AFFECT) OBJECT PERMANENCE HTTPS: //YOUTU. BE/CSGWH 2 CWJNA (PG. 420, HOCKENBERRY, 10 TH EDITION)

TODDLER (12 MONTHS TO 3 YEARS) • WEIGHT GAIN SLOWS • HEIGHT AT 2 YEAR ½ OF FUTURE ADULT HEIGHT • HEAD CIRCUMFERENCE 90% OF ADULT SIZE BY 2 YEARS • ANTERIOR FONTANEL CLOSED BY 18 MONTHS

TODDLER CHECK 12 MO �NUTRITION- SWITCH CHILD FROM FORMULA TO WHOLE MILK! SHOULD USE CUP, ALL FOODS CUT U IN SMALL PIECES. WORRY ABOUT CHOKING, NO GRAPES, HOT DOGS! �SHOWS DEFINITE UNDERSTANDING OF SOME WORDS �HAS SOME SIMPLE WORDS MAMA, DADA �WALKS WITH ASSISTANCE (SOME WALK WITHOUT ASSISTANCE) �STANDS INDEPENDENTLY, CAN SEAT SELF ON

12 MONTHS LANGUAGE + COGNITIVE • TRY TO IMITATE WORDS • SAY A FEW WORDS, SUCH AS "DADA, " "MAMA, " "BABA" AND "UH-OH" • UNDERSTAND SIMPLE INSTRUCTIONS, SUCH AS "PLEASE DRINK YOUR MILK" • UNDERSTAND "NO" • DISCOVERY OF NEW WAYS TO PRODUCE THE SAME CONSEQUENCE OR OBTAIN THE SAME GOAL

TODDLER CHECK 15 -18 MO • FAMILY MEALS, BABY FEEDS SELF, USES CUP AND SPOON, BOTTLE TO BE REMOVED BETWEEN 12 TO 15 MONTHS! • WALKS, RUNS AWKWARDLY, • OBJECT PERMANENCE • VOCABULARY OF 3 -50 WORDS • CAN LINK WORDS TOGETHER

18 MONTHS LANGUAGE • POINT TO AN OBJECT OR PICTURE WHEN IT'S NAMED • RECOGNIZE NAMES OF FAMILIAR PEOPLE, OBJECTS AND BODY PARTS TODDLER POINTS TO BODY PARTSHTTPS: //YOUTU. BE/VQE 6 WGYJVEW • FOLLOW SIMPLE DIRECTIONS, SUCH AS "THROW ME THE BALL" • SAY UP TO 20 WORDS

TODDLER CHECK 24 MONTHS • • change from high fat to low fat (switch to skim milk) potty training begins (between 2 and 4 years) ask for common foods by name use simple phrases, such as "more milk" begin to use pronouns, such as "mine" begin to use prepositions, such as "in" and "under" ask one- to two-word questions, such as "go bye-bye? " respond to two-step verbal requests, such as "please put the book down and bring me your shoes" • say up to 50 to 100 words

TOILET TRAINING Which developmental stage is toilet training according to: Erikson? Piaget? Freud?

TODDLER • WALKS INDEPENDENTLY BY 15 MO • JUMPS IN PLACE BY 18 MO • STAIRS BY 24 MO • RUNS BY 24 MO

TODDLER FINE MOTOR • USES CUP WELL BY 15 MO. • BUILDS TOWER OF 2 CUBES BY 15 MO. • HOLDS CRAYON WITH FINGERS 24 TO 30 MO • COPIES CIRCLE BY 3 YEARS

TODDLER SENSORY �KNOWS NAME 12 MO REFERS TO SELF �FOLLOWS SIMPLE DIRECTIONS BY 2 YEARS �IDENTIFIES GEOMETRIC FORMS BY 18 MO �USES SHORT SENTENCES BY 18 MO TO 2 YEARS �REMEMBERS AND REPEATS 3 NUMBERS BY 3 YEARS � 300 WORD BY 2 YEARS �OBJECT PERMANENCE �RITUALISM

TODDLER SAFETY • CAR SEATS • SUPERVISE PLAY • CHILDPROOF HOME • SUFFOCATION • BURNS • FALLS • ASPIRATION/ POISONING

FORWARD-FACING CONVERTIBLE SEAT • EFFECTIVE JANUARY 1, 2017: • . CHILDREN UNDER 2 YEARS OF AGE SHALL RIDE IN A REARFACING CAR SEAT UNLESS THE CHILD WEIGHS 40 OR MORE POUNDS OR IS 40 OR MORE INCHES TALL. THE CHILD SHALL BE SECURED IN A MANNER THAT COMPLIES WITH THE HEIGHT AND WEIGHT LIMITS SPECIFIED BY THE MANUFACTURER OF THE CAR SEAT.

MATCHES ARE A POTENTIALLY DEADLY HAZARD

PLASTIC CAPS FOR ELECTRICAL SOCKETS

STORAGE OF CLEANING AGENTS

TODDLER PLAY • BEGINS MAKE BELIEVE PLAY • MAY USE IMITATION • PROVIDE BLOCKS, WHEEL TOYS, PUSH TOYS, SIMPLE PUZZLES, CRAYONS, DEVELOP MOTOR SKILLS • OFTEN ENJOY REPETITIVE STORIES AND SONGS WITH RHYTHM • OFTEN ENGAGE IN PARALLEL PLAY

PSYCHOSOCIAL DEVELOPMENT • ERIKSON: DEVELOPING AUTONOMY • “AUTONOMY” VS. “SHAME AND DOUBT” • “NEGATIVISM” • “RITUALIZATION” PROVIDES SENSE OF COMFORT • PSYCO-SEXUAL IS ANAL STAGE FROM 18 MO-3 YEARS

COGNITIVE DEVELOPMENT • PIAGET: SENSORIMOTOR CONTINUED: • TERTIARY CIRCULAR REACTIONS (12 -18 MONTHS) • INVENTION OF NEW MEANS THROUGH MENTAL COMBINATION (18 - 24 MONTHS) • BEGIN PREOPERATIONAL (2 -4 YRS) • INCREASED USE OF VERBAL REPRESENTATION BUT SPEECH IS EGOCENTRIC, BEGINNINGS OF SYMBOLIC RATHER THAN SIMPLE MOTOR PLAY. • AWARENESS OF CAUSAL RELATIONSHIPS BETWEEN TWO EVENTS • LEARN SPATIAL RELATIONSHIPS

PRESCHOOL 3 TO 6 YEARS • GROWTH SLOW AND STEADY 4 TO 5 LBS A YEAR • HEIGHT INCREASES 2 TO 3 INCHES A YEAR

PRESCHOOL CHECK @ 4 YEARS • NOW START WELL CHILD CHECKS EVERY YEAR • BEHAVIOR ISSUES OFTEN A CONCERN

PRESCHOOL LANGUAGE 3 -4 YRS • FOLLOWS 2 RELATED DIRECTIONS E. G. "CLOSE THE BOOK AND GIVE IT TO ME" • TELLS FIRST AND LAST NAME • UNDERSTANDS QUESTIONS ABOUT A PICTURE STORY E. G. "WHERE DID THE BUNNY GO? " • REASONS - ANSWERS "WHAT DO YOU DO WHEN YOU'RE HUNGRY? " • TELLS A SHORT STORY E. G. "TWO KIDS PLAYED BALL" • SENTENCES ARE USUALLY 3 AND 4 WORDS LONG • GIVES DIRECTIONS SUCH AS "FIX THIS FOR ME" • ASKS MANY QUESTIONS: "WHAT", "WHERE", "WHY"

PRESCHOOL LANGUAGE 4 -5 YEARS • FOLLOWS 3 RELATED DIRECTIONS SUCH AS "GET YOUR CRAYONS, MAKE A PICTURE AND GIVE IT TO THE BABY" • SPEAKS SOUNDS ACCURATELY EXCEPT PERHAPS FOR L, R, S, K, TH, CH, SH • MORE REASONING - ANSWERS QUESTIONS SUCH AS "WHAT DO YOU DO WHEN YOU ARE SLEEPY? " DESCRIBES OBJECTS AND EVENTS • CAN SHOW YOU "TOP", "BOTTOM", AND SEVERAL COLORS • CAN GIVE MEANINGS OF WORDS

PRESCHOOL MOTOR • SKIPS/HOPS ON ONE FOOT BY 4 YEARS • RIDES TRICYCLE BY 3 YEARS • CAN THROW/CATCH BALL BY 5 YEARS • BALANCES ALTERNATING FEET 5 YEARS

4 -YEAR-OLD HOPS ON ONE FOOT

PRESCHOOL SAFETY • TEACH: • TRAFFIC SAFETY • STRANGERS • FIRE PREVENTION/SAFETY • WATER SAFETY

PRESCHOOL PLAY • ENJOY IMAGINATIVE AND DRAMATIC PLAY • STARTS ROLE PLAY IDENTIFIES WITH SAME SEX • NEED TOYS TO DEVELOP MOTOR AND COORDINATION • MAY ENJOY SING ALONG SONGS

PRESCHOOLER PLAY • PRESCHOOLERS ENJOY IMAGINATIVE AND IMITATIVE PLAY

PRESCHOOLER PLAY • ENJOY A SENSE OF ACCOMPLISHMENT

PSYCHOSOCIAL DEVELOPMENT: ERIKSON • DEVELOPING A SENSE OF INITIATIVE • INITIATIVE VS. GUILT • DEVELOPMENT OF SUPEREGO (CONSCIENCE)

PSYCHOSEXUAL DEVELOPMENT: FREUD • OEDIPAL (PHALLIC) STAGE • OEDIPAL AND ELECTRA COMPLEXES

COGNITIVE DEVELOPMENT: PIAGET • PREOPERATIONAL PHASE—AGES 2 TO 7 • preconceptual phase: ages 2 to 4 • intuitive thought: ages 4 to 7 • speech becomes more social • the child has an intuitive grasp of logical concepts in some areas. • easy to believe in magic • reality not firm. • moral-ethical- the child is not able to show principles underlying best behavior. They use simple do's and don'ts imposed by authority.

SCHOOL AGE • “school age” generally defined as 6 to 12 years • physiologically begins with shedding of first deciduous teeth and ends at puberty with acquisition of final permanent teeth • gradual growth and development • progress with physical and emotional maturity

SHEDDING DECIDUOUS TEETH

SCHOOL AGE (6 -12 YRS) • Steady weight gain of about 5 lbs a year • Height increases by 1 to 2 inches a year • Motor Sensory • bone growth is faster than muscle/ligament = growing pain • Susceptible to green stick fracture • Movements become more graceful and coordinated • Vision 20/20 by 6 or 7 years

SAFETY • Teach proper use of sports equipment • Discourage risk-taking behaviors • Teach injury prevention • Bicycle safety, include helmet law • Firearms • Smoking • Introduce sex education

BICYCLE SAFETY

SCHOOL AGE PLAY • Can comprehend rules and rituals of games • Can play team games • Encourage athletic activities • Provide constructional toys (legos, puzzles etc. ) • Begin interest in video games due to increased hand eye coordination

SCHOOL-AGE CHILDREN ARE MOTIVATED TO COMPLETE TASKS

SCHOOL-AGE CHILDREN ARE OFTEN AVID COLLECTORS

ENGAGING IN ACTIVITIES WITH A “BEST FRIEND”

ACTIVITIES VARY BY INTEREST AND OPPORTUNITY

PSYCHOSOCIAL DEVELOPMENT • Relationships center around same-sex peers • Freud described it as “latency” period of psychosexual development

ERIKSON: DEVELOPING A SENSE OF INDUSTRY • Eager to develop skills and participate in meaningful and socially useful work • Acquire sense of personal and interpersonal competence • Growing sense of independence • Peer approval is strong motivator

PRIDE IN LEARNING NEW SKILLS

ERIKSON: INFERIORITY • Feelings may derive from self or social environment • May occur if incapable or unprepared to assume the responsibilities associated with developing a sense of accomplishment • All children feel some degree of inferiority regarding skill(s) they cannot master

PIAGET: COGNITIVE DEVELOPMENT • CONCRETE OPERATIONS • Use thought processes to experience events and actions • Develop understanding of relationships between things and ideas • Able to make judgments based on reason (“conceptual thinking”)

KOHLBERG: MORAL DEVELOPMENT • Development of conscience and moral standards • Age 6 to 7: reward and punishment guide choices • Older school age: able to judge an act by the intentions that prompted it • Rules and judgments become more founded on needs and desires of others

ADOLESCENT GROWTH (13 -18 YR) • Rapid period of growth • Attain final 20% of height rapid gain • Boys 4 in. /Year • Girls 3 in. /Year • Puberty • Appearance of acne on face and trunk • Development of secondary sex characteristics • Tanner stages

TANNER STAGES pp. 654 -657, Hockenberry, 10 th edition

SNACKING ON EMPTY CALORIES IS COMMON AMONG ADOLESCENTS

PIAGET: EMERGENCE OF FORMAL OPERATIONAL THOUGHT • Formal operational thinking: ages 11 to 14 • Abstract terms, possibilities, and hypotheses • Decision-making abilities increase • May not use formal operational thought and reasoned decision making all the time

ROMANTIC RELATIONSHIPS ARE IMPORTANT DURING ADOLESCENCE

THE PEER GROUP INFLUENCES ADOLESCENT DEVELOPMENT

INTIMACY • Intimate relationship begins to emerge in adolescence • Developmental course of intimacy • Self-focused • Role focused • Individual connected

PROMOTING OPTIMUM HEALTH DURING ADOLESCENCE • Empowering individuals, families, and communities • Power, authority, and opportunities to make healthy choices • Risk reduction in areas of mental health, substance use, sexual behavior, violence, unintentional injury, nutrition, physical activity and fitness, and oral health

ADOLECENT SAFETY • Accidents leading cause of death • Educate on drugs and alcohol • Screen for depression and suicide risk

REFERENCES • HOCKENBERRY, M. J. , WILSON, D. , (2015) WONG’S NURSING CARE OF INFANTS AND CHILDREN 10 TH EDITION. MOSBY, ST LOUIS MO • HOGAN, M. A. , WHITE, J. E. , FALKENSTEIN, K. , BRANCATO, V. , (2007) CHILD HEALTH NURSING REVIEWS & RATIONALES 2 ND EDITION. PRENTICE HALL, UPPER SADDLE RIVER, NJ.