pedi 15

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


• Metabolic rate – higher in children than adults–Surface area higher in

children than adults

• Sleep patterns – may be altered by culture


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


Influencing factors of uniqueness– Hereditary traits (eye and hair

color, physical resemblance)– Nationality and race– Gender– Environment– Ordinal position in the family


Ordinal Position – Birth Order


Families

• Traditional – two parents and their children

• Nuclear family – basic unit of American society

• 25% of households


Nuclear Family


Extended Families

• 3 generations• Addition of

grandparents, etc


One Parent Families


Blended FamilyMom with childrenremarries dad withchildren and then have their own children

Family success requires:

– problem-solving – communication – flexibility


Homeless Families – modern day problem


Personality DevelopmentCharacteristics that

determine the individual’s typical or recurrent pattern of behavior


Personality Development:Maslow’s Hierarchy of Needs

Hierarchy of needs must be met to fulfill potential


Freud• Infancy – orality• Early childhood – anality• Late childhood – phallic/oedipal (aware of sexuality)• School age – latency (focus on peers and groups)• Adolescence – genitality


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


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


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


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


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


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


Toddler

– Feed self by 2 years leads to increased independence

– May begin to refuse foods


Preschooler– Likes finger

foods & may dawdle while eating

– Snacks – dry cereal, graham crackers, fruit juices, ice cream


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


Adolescent

Good nutrition essential for appearance and fitness• Peer approval influences food fads &

skipped meals–Results in malnutrition

• Suspect anemia with fatigue, anorexia, irritability


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


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


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


Oral Care

• Limit frequency of sugar intake

• Sticky, retentive foods promote caries RaisinsCaramelsPeanut Butter


• 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

pedi 15

Health & Medicine

free powerpoint template

growth development

children family success

yrs child

skeletal growth weight

late childhood initiative

blended family mom

yrs formal operational