pedi 15
TRANSCRIPT
VNSG 1234 – PEDIATRICS
Chapter 15 – Overview of Growth, Development, and
Nutrition
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Growth Development, Maturation
• Directional patterns– Cephalocaudal – head to toe– Proximodistal – inner to outer
• Height – family trait, linear due to skeletal growth
• Weight – composed of high percentage of water– Birth weight doubles by 6 months– Birth weight triples by 12 months– After 1 yr – weight 4 - 6 lbs/yr until
puberty
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• Metabolic rate – higher in children than adults–Surface area higher in
children than adults
• Sleep patterns – may be altered by culture
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Growth standards– Allows child to be compared to
others and himself– Considerations
• Should follow predictable pattern (Denver II Screening) Developmental Screening
• Difference of 2+ percentiles from established pattern indicates need for further evaluation
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Influencing factors of uniqueness– Hereditary traits (eye and hair
color, physical resemblance)– Nationality and race– Gender– Environment– Ordinal position in the family
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Ordinal Position – Birth Order
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Families
• Traditional – two parents and their children
• Nuclear family – basic unit of American society
• 25% of households
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Nuclear Family
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Extended Families
• 3 generations• Addition of
grandparents, etc
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One Parent Families
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Blended FamilyMom with childrenremarries dad withchildren and then have their own children
Family success requires:
– problem-solving – communication – flexibility
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Homeless Families – modern day problem
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Personality DevelopmentCharacteristics that
determine the individual’s typical or recurrent pattern of behavior
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Personality Development:Maslow’s Hierarchy of Needs
Hierarchy of needs must be met to fulfill potential
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Freud• Infancy – orality• Early childhood – anality• Late childhood – phallic/oedipal (aware of sexuality)• School age – latency (focus on peers and groups)• Adolescence – genitality
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Erikson• Infancy – trust vs. mistrust• Early childhood – autonomy vs.
shame and doubt• Late childhood – initiative vs. guilt• School age – industry vs. inferiority• Adolescence – identity vs. role
confusion
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Piaget - Cognitive Development – Infancy – self-centered– Childhood
• Preoperational (2-7 yrs) – egocentric; thinks all see the world as the child does
– Preconceptual (2-4 yrs) – child not capable of reason
– Perceptual (4-7 yrs) – some reason but only able to concentrate on one thing at a time
– School age (7-11 yrs) – concrete operational• Reasoning is logical but limited to own
experience– Adolescence (11-16 yrs) – formal operational
• Develops abstract concepts and problem-solving
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Moral Development - Kohlberg • Preconventional (4-7 yrs) – children try to be
obedient for fear of punishment
• Conventional (7-11 yrs) – children show conformity & loyalty & focus on obeying rules
• Postconventional (12+yrs) – moral values are developed to solve complex problems with emphasis on individual conscience within the society
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Nutrition
• Child’s nutritional heritage – Factors influencing feeding children:
misinformation, income, folklore, fads, religion, culture, ethnicity• Hispanic diet – rice, beans, tortillas,
corn• American Indian – corn (maize), bread,
wild meat• Asian – rice, chicken, pork, vegetables• Italian – pasta, spices, cheeses
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Nutrition and Illness (diarrhea)– World Health Organization
distribute Pedialyte to third world countries
– Cereal solution – 1/2 c infant rice cereal, 2 c water, 1/4 tsp salt
– Other options - saltine crackers, half-strength apple juice
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Feeding the Healthy Child• Infant
– Milk substitutes available for therapeutic use
– Signs of Underfeeding• Restlessness, crying, failure to gain weight
– Signs of Overfeeding• Regurgitation, mild diarrhea, too rapid
weight gain– Introduce solid foods at 4 - 6 months
• Rice cereal first!– No whole milk prior to age 1 yr
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Toddler
– Feed self by 2 years leads to increased independence
– May begin to refuse foods
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Preschooler– Likes finger
foods & may dawdle while eating
– Snacks – dry cereal, graham crackers, fruit juices, ice cream
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School Age child
– Love sweets • Decreases appetite & provides empty
calories• High-fat & cholesterol diets may be
decreased by ↓ fried foods, ↓ fast foods, fruit instead of candy snacks
– Food attitudes unpredictable
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Adolescent
Good nutrition essential for appearance and fitness• Peer approval influences food fads &
skipped meals–Results in malnutrition
• Suspect anemia with fatigue, anorexia, irritability
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Characteristics of a healthy child• Steady weight & height gain• Alert • Shiny hair• No fatigue circles under eyes• Normal skin color• Erect posture• Healthy mucous membranes• Good appetite• Regular elimination• Sleep well
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Feeding the Ill Child• 1 tbsp of food per year of life
• Introduce one food at a time
• Do not transmit own preferences
• Do not serve sweets before meals
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Teeth and Oral Care
• Deciduous teeth– First appear about 7 months & all in by 2 ½ years
• By age 1, should have 4 upper & 2 lower teeth• Should see dentist by age 3
– AAPD advise dental visit by age 1– If lost early, permanent teeth are poorly aligned
• Permanent teeth– 32 teeth begin to erupt about age 6
• Wisdom teeth appear between 18-23 yrs
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Oral Care
• Limit frequency of sugar intake
• Sticky, retentive foods promote caries RaisinsCaramelsPeanut Butter
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• Safe snacks– Cheese, peanuts, milk, sugarless gum, raw
veggies• Fluorinated water is community prevention
of caries• Tooth brushing care
– Replace toothbrush q3 months or after viral/bacterial illness
– Do not store in closed container– Do not share toothbrushes
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Play• Business of childhood
– Can be therapeutic (“blowing” bubbles or balloons)– Art and coloring allows non-verbal
expression of feelings– Computer games assists in problem solving– Teach to select age- appropriate toys– Cooperative play – play with each other
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