Growth and Development Flashcards
1. Discuss the major concepts associated with growth and development, and describe their impact on pediatric nursing. 2. Identify the physical, psychosocial, and cognitive development tasks for the child from birth through adolescence. 3. Plan developmentally based nursing care strategies that promote anticipatory guidance and injury prevention. 4. Determine the child's nutrition and safety needs. 5. Identify behavioral reactions to illness and hospitalization in the child from birth through
1
Q
Which action would be most important in the psychosocial support of a 2-year-old who is having an invasive procedure?
a. Assuring her that it is not her fault.
b. Providing for parental presence.
c. Providing adequate pain control.
d. Performing the procedure quickly.
A
b
Toddlerhood is a marked time of heightened separation anxiety with a marked fear of strangers. For a child of this age, the most appropriate psychosocial support is to promote the presence of the primary caregiver.
2
Q
Which of the following would be most helpful when assessing a child’s bone age?
a. Growth percentile
b. Body mass index
c. Blood test
d. X-rays
A
d
Bone age is performed by taking an x-ray of the child’s hands and wrists for comparison against an atlas of standard x-rays categorized by age. This test is used to predict the remaining height growth given a certain bone age. Typically, a child’s bone age should match his or her chronological age.
3
Q
Which of the following assessments would be most concerning in a 3-month-old?
a. Closed posterior fontanel
b. Inability to roll over
c. Failure to track objects through visual fields
d. Failure to laugh
A
c
An infant develops the ability to track objects by 3 months, so the failure to do so is a concerning sign in a 3-month-old infant. The posterior fontanel closes by 2-3 months of age. Rolling over and laughing typically occurs at 4 months of age.
4
Q
Which of the following developmental milestones of the 5-month-old best reflects the principle of proximodistal growth and development?
a. Babbling
b. Raking objects
c. Rolling over
d. Eating solid foods
A
b
The principle of proximodistal growth and development states that children develop from the trunk to the tips of the extremities. Raking objects, which develops at 4 months, involves the use of hands to “rake” objects prior to the development of the more specific pincer grasp occurring by 9 months of age.
5
Q
The 5-year-old uses how many words in a sentence?
a. 3-4
b. 4-5
c. 5-6
d. 6-7
A
c
The 5-year-old typically uses 5-to-6 word sentences. A good rule-of-thumb to remember is that a typical preschool-age child will speak a sentence in the number of words equal to his age up to one more than his age.
6
Q
A nurse would expect a 4-month-old to:
a. Sit alone
b. Attempt to roll over
c. Begin to crawl
d. Grasp feet and pull them to mouth
A
b
The infant begins to roll over at 4 months, first from stomach to back then from back to stomach. Infants sit with support beginning at 5 months and eventually develop the ability to sit without support by 8 months. At 6 months, the infant pushes up from stomach onto hands and knees and rocks back and forth in that position until he eventually crawls by 9 months. Grasping feet and pulling them to the mouth occurs at 5 months of age.
7
Q
A 6-month-old infant is brought to the clinic. The mother reports that the infant weighed seven pounds at birth. What is the anticipated weight?
a. 10 pounds
b. 14 pounds
c. 18 pounds
d. 21 pounds
A
b
An infant doubles his birth weight minimally by 6 months of age and triples his birth weight by one year.
8
Q
A parent calls the clinic to express concern over her child’s eating habits. She says the child eats very little and consumes only a single type of food for weeks on end. The nurse knows this behavior is characteristic of:
a. toddlers
b. preschool-age children
c. school-age children
d. adolescents
A
b
Preschool-age children are known for their relatively small appetites and food jag-eating behaviors. Also, preschoolers have a relatively slow rate of growth and require fewer calories for growth.
9
Q
What is the best way to prepare 4-year-old Bryant for his admission to the hospital for same-day surgery?
a. Allow him to play with the medical equipment at the pre-operative visit and explain that he will be staying in the hospital for a few days.
b. Do not mention anything to Bryant until he arrives at the hospital for the operation.
c. Explain the details of the operation and what will happen.
d. Tell him that a hospital is a place where kids visit each other and eat ice cream.
A
a
It is developmentally appropriate to give the preschooler brief and understandable information. Allowing the child to handle equipment is an excellent way to orient the child to the hospital equipment and to involve him in the pre-operative teaching. It is important to always tell the truth to children while keeping in mind that concrete explanations without a lot of detail are most appropriate for preschoolers.
10
Q
When examining a 6-month-old who is quietly sitting on her mother’s lap, which of the following should the nurse do first?
a. assessment of the fontanel
b. palpation of pulses
c. auscultation of the chest
d. palpation of the abdoment
A
c
The 6-month-old is developing stranger anxiety and may cry during invasive procedures. It is best to perform assessments which require the child to be quiet first. Assessment of the fontanel and pulses can be performed next. Palpation of the abdomen would be performed last.
11
Q
Which developmental milestone would you expect to see the 9-month-old developing?
a. pincer grasp
b. walking
c. speaking intelligible words
d. sitting up without support
A
a
The normally developing 9-month-old is using the pincer grasp. Walking is a milestone for 12 to 16 months. The 9-month-old typically says ma-ma and da-da in correct context. Sitting up without support is achieved by 8 months.
12
Q
Which of the following developmental milestones would be most advanced for 6-month-old Harry?
a. reaching for objects
b. rolling over from back to front
c. laughing aloud
d. sitting up unsupported for short periods
A
d
Sitting up unassisted for short periods is the most advanced of the developmental milestones listed. Infants sit with support by 5 months and then sit unassisted by 8 months. Reaching for objects occurs between 4 and 6 months. Rolling over from front to back occurs first at 4 months followed by rolling from back to front between 5 and 6 months. Laughing aloud is a social milestone that occurs at 4 months.
13
Q
A baby’s length is twenty inches at birth. You approximate her height at 4 years of age to be:
a. 30 inches
b. 35 inches
c. 40 inches
d. 45 inches
A
c
Normal growth patterns predict that a baby’s birth length roughly doubles at four years of age.
14
Q
An 18-month-old is admitted for same day surgery. What does the nurse anticipate as his biggest fear?
a. pain
b. separation
c. death
d. body integrity
A
b
Separation anxiety is the greatest fear among toddlers. Fear of pain and invasion of the body integrity are issues of concern for older preschoolers and particularly school-age children. Gear of death is a more common concern for the adolescent who can think abstractly.
15
Q
You are evaluating a child who says “no,” is not toilet trained, has a closed anterior fontanel, and started to climb stairs a few months ago. How old is s/he?
a. 12 months
b. 18 months
c. 24 months
d. 36 months
A
c
The child is 24 months old. Saying “no” is typical of a toddler. The anterior fontanel closes between 12 and 18 months. Climbing stairs occurs at 21 months. Toilet training occurs at either 2 or 3 years of age.
16
Q
You are the nurse in an adolescent clinic caring for 14-year-old Lisa, who experienced menarche one year ago. Lisa is concerned that she is short and wants to know if she will grow taller. Based on your knowledge of growth and development, you know that:
a. In girls, menarche occurs early in puberty before the height spurt
b. In girls, menarche occurs late in puberty after the height spurt.
c. In girls, the peak height velocity is usually around 15 years.
d. It is impossible to predict how much more Lisa will grow.
A
b
The height spurt occurs earlier in puberty among girls as compared to boys. The average peak height velocity among girls is 12 years. There is limited growth potential after menarche with an average of 2.5 cm. Girls have a shorter period of time in which to grow and a lower rate of growth during the pubertal height spurt as compared to boys.
17
Q
When assessing the development of a 6-month-old, which of the following would be most concerning?
a. the child weighs twice as much as his birth weight.
b. the child does not look for hidden objects
c. the child does not understand the word “no.”
d. the child does not transfer objects from one hand to the other.
A
d
The infant can transfer objects from one hand to another at give months of age. Failure to achieve this fine motor skill is considered a developmental delay in a 6-month-old. The 6-month-old infant should weigh at least twice her birth weight. Looking for hidden objects is an example of the understanding of object permanence, a phenomenon that occurs between 8 and 12 months. The infant understands the word “no” by approximately 9 months.
18
Q
In which of the following age groups does the child experience the fastest rate of growth in the limbs?
a. infancy
b. preschool
c. school-age
d. adolescent
A
c
The limbs experience the fastest rate of growth during the school-age years. The head experiences the fastest rate of growth during infancy. The trunk grows the fastest during the toddler and preschool years. The gonads and associated tissues experience the fastest rate of growth during the adolescent years.
19
Q
A teenager has come into the clinic requesting birth control. She says she does not want to tell her parents. Which of the following is the best response:
a. we can give you birth control and not tell your parents
b. we are not permitted to give you birth control without parental consent
c. is there someone else i can talk to about this?
d. you will need to become emancipated before we can give you birth control without parental consent
A
a
In most states, parental consent is not required for birth control or treatment for a sexually transmitted infection.
20
Q
The nurse is teaching a parenting class when a mother asks when a child develops a conscience. Basing her response on Erikson’s theory of development, the nurse knows that this usually occurs during which of the following stages?
a. by the end of the first year of life.
b. by the end of the toddler stage.
c. during the preschool stage.
d. during the school age years.
A
c
Children usually recognize an “inner voice” during the preschool years.
21
Q
The nurse is caring for a child who is very outgoing and likes to talk about his friends. He asks to play board games and is very concerned about the rules of the game. When the nurse wins the game, he throws the game and says, “You cheated!” How old is this child likely to be?
a. 2
b. 4
c. 7
d. 13
A
c
School are children are very competitive and enjoy games. They often focus on rules, but do not like to lose.
22
Q
You note that Joshua’s head circumference is now smaller than his chest circumference. His age is most likely?
a. 3 months
b. 9 months
c. 15 months
d. 30 months
A
d
The chest circumference is greater than the head circumference after the age of 24 months. The head circumference is greater than the chest circumference from birth to 6 months. The head circumference is equal to the chest circumference between the ages of 6 and 24 months.
23
Q
Jessica’s physical reveals that her BMI is at the 90th percentile. You correctly explain to her mother:
a. “A BMI in the 90th percentile indicates that Jessica is overweight, would you like to talk to a dietician?”
b. “Jessica is very healthy and is taller than most children her age.”
c. “A BMI in the 90th percentile indicates a risk of becoming overweight, we can discuss ways to reduce this risk.”
d. “A BMI in the 90th percentile indicates that Jessica is underweight, let’s talk about her dietary intake.”
A
a
A BMI between 85% and 95% (25 - 29.9) indicates that the child is overweight. A child is considered obese when the BMI is equal to or greater than 95% (≥30). A child is considered underweight when the BMI is less than 5% (<18.5).
24
Q
A group of children are playing in the playroom. The children are tested on the concept of conservation. One child has just mastered this concept. How old is this child most likely to be?
a. 4 years
b. 6 years
c. 8 years
d. 12 years
A
c
An 8-year-old child is in the concrete operational phase of cognitive development and would understand the concept of conservation. Conservation is not typically understood prior to the age of 8. A 12-year-old child is in the formal operational phase of cognitive development and is likely to have mastered the concept of conservation years earlier.
25
The nurse is playing with an infant who has just had a PICC line placed. When the nurse hides a toy rattle under a blanket, the infant actively looks for it while lifting up the blanket. How old is this infant most likely to be?
a. 2 months
b. 4 months
c. 6 months
d. 8 months
d
Object permanence is a concept that usually develops between 8 and 9 months.
26
Six-year-old Josie is being seen in the emergency room after falling off her bike. The nurse is preparing to assist with suturing her scalp lacerations, when Josie cries out, "I'm sorry I didn't wear my helmet, I promise I'll be good next time, please don't hurt me!" Which of the following is the nurse's best response?
a. "Helmets are very important and protect your head, please make sure that you wear it in the future."
b. "We need to fix your head; you are doing such a good job of trying to stay still."
c. " You're right, you probably wouldn't be here if you had been wearing a helmet."
d. "This won't take very long. You're actually very lucky, it could have been a lot worse."
b
The nurse is to encourage the child to help her cope with a stressful procedure. Although education should be provided, it is inappropriate to do so during a painful procedure. It is important to dispel feelings of guilt as she is experiencing magical thinking and likely thinks that the sutures are a form of punishment.
27
Julianne is a 4-year-old newly diagnosed with diabetes who is frightened of finger sticks. The nurse's best response is:
a. Allow Julianne to hold her favorite stuffed animal during finger sticks.
b. Encourage Julianne's mother to coach her during finger sticks.
c. Encourage Julianne to count backward from 10 during finger sticks.
d. Encourage Julianne to play with the equipment and 'practice' on her dolls.
d
Play therapy uses the therapeutic powers of play to help children resolve various challenges. Although a 4-year-old child will likely find comfort in a favorite animal, she is more likely to learn to cope through play therapy.
28
Mrs. Garcia brings 5-year-old Jeffery to a local museum where children are encouraged to interact with the attractions. She praises and helps him explore the museum. This is known as what kind of play?
a. Mutual play
b. Imaginative play
c. Solitary play
d. Parallel play
a
Mutual play occurs when a parent offers praise and support while encouraging a child to explore their environment. Imaginative play occurs when children pretend. Solitary play occurs when children play without regard for what others around them are doing. Parallel play occurs when children play side-by-side.
29
The nurse is watching a group of toddlers in the playroom. Which of the following type of play is typical of older toddlers?
a. Solitary
b. Parallel
c. Team play
d. Mutual play
b
Parallel play with children play side by side, is associated with toddler years. Solitary play is associated with infancy and early toddler years. Team play is associated with school-age children. Mutual play is associated with children from infancy though school-age. It is not seen in groups but occurs between caregiver and child.
30
The nurse is caring for an infant who raises her chest when lying on her stomach, is beginning to babble, and follows an object 180 degrees with her eyes. How old is this infant most likely to be?
a. 4 weeks
b. 3 months
c. 4 months
d. 5 months
b
The described skills are appropriate for a 3-month-old child.
31
Which of the following is a cause for concern in a 6-month-old child?
a. The infant does not sit without support.
b. The infant does not clap his hands.
c. The infant does not grasp and hold objects.
d. The infant does not have a pincer grasp.
c
The infant should grasp and hold objects by 3 months, sit without support at 8 months, demonstrate pincer grasp at 9 months, and clap hands between 10 and 12 months.
32
Four-month-old Jessie is being evaluated in the developmental clinic. Which of the following would be most concerning?
a. He doesn't hold objects in his hands.
b. He doesn't rake objects with his hands.
c. He doesn't transfer objects from hand to hand.
d. He doesn't clap his hands.
a
A 3-month-old infant should grasp and hold objects in his hands. A 4-month-old infant should be developing the skill of raking objects with his hands and transferring objects from hand to hand. An infant develops the skill of clapping his hands between 10 and 12 months.
33
The nurse is caring for Marissa and notes that she pushes up from her stomach onto her knees and rocks back and forth. Which of the following most likely represents Marissa's age?
a. 4 weeks
b. 3 months
c. 6 months
d. 8 months
c
Pushing up to the knees from the stomach and rocking back and forth is appropriate for a 6-month-old to be doing.
34
Evan, who measured 20 inches at birth, now measures 30 inches. Which of the following most likely represents Evan's current age?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
b
An infant's length usually increases by 50% by 12 months of age. From 1 to 2 years, a toddler grows 5 inches on average. Beginning from 2 to 3 years, the child grows an average of 2.5 inches annually until the adolescent growth spurt.
35
Two-year-old Maria's mother needs to briefly leave the hospital to pick up Maria's sister, Christie, from preschool. She is worried about how Maria will react. The nurse's best suggestion is:
a. "Tell Maria that you need to get Christie and you will be back when lunch is over, and Dora the Explorer comes on TV."
b. " Tell Maria that you need to leave to get Christie and if she doesn't cry you will bring her a surprise."
c. "Wait until Maria starts her nap and quietly sneak out. You'll be back before she wakes up."
d. "I'll distract Maria while you leave, we'll bring her a special toy to keep her entertained."
a
Two-year-old children understand time in terms of routine. A toddler would comprehend that her mother is returning after lunch and at the start of a favorite show. Although toddlers enjoy rewards, it is inappropriate to discourage her from expressing her feelings. Anxiety would be increased if the child was to wake up during the time when her parent was absent.
36
Sammy enjoys copying shapes and can identify most colors. He draws a picture of the nurse with just two body parts. Sammy is most likely how old?
a. 2 years old
b. 3 years old
c. 4 years old
d. 5 years old
c
Most 4-year-olds can identify most colors and copy shapes.
37
The nurse asks a child if it is ever OK to tell a fib. The child responds, "I think that telling a lie to get out of trouble is wrong, but telling your mom you like her hair cut when it's really ugly is OK." What age is this child likely to be?
a. 7 years old
b. 8 years old
c. 9 years old
d. 10 years old
d
Most 10-year-old children can recognize shades of gray and see beyond the firm concept of right and wrong. Children ages 7 to 9 years have a rigid concept of right and wrong.
38
Which of the following is the first sign of puberty in males?
a. Testicular enlargement
b. Pubic hair development
c. Growth spurt
d. There is no specific order of events as puberty follows an individual development pattern.
a
The following is the progression of pubertal milestones among boys. Testicular enlargement is the first sign of puberty and occurs on average at 11 years of age. Pubic hair is the second sign of pubertal development and occurs on average at 12 years of age. The height spurt is the last sign of puberty and occurs on average at 13-14 years of age. The average age of height spurt in boys occurs 2 years later than girls (on average) because boys enter puberty 1 year later and boys' height spurt is a late pubertal event.
39
The nurse should begin lead screening when the child reaches what age?
a. 6 months
b. 12 months
c. 18 months
d. 24 months
a
Lead screening should begin at 6 months using a standard lead screening questionnaire and should continue at regularly scheduled primary care visits.
40
All interventions are based on the following principles:
**All interventions are family-centered, treating the child and family as a unit.
2. The goal is to help the child and family unit attain, maintain, or regain optimal health.
3. Nursing interventions are guided by both the child's chronologic age and level of development (physical and mental).
4. Health and development are affected by environment and heredity.**
41
**Cephalocaudally**
**From head to toe**
42
**Proximodistally**
**From the trunk to the tips of the extremities**
43
Growth pattern in infancy
| (birth to 12-15 months)
a period of rapid growth in which the head grows faster than other tissues.
44
Growth pattern in toddler-preschool age
| (12-15 months to 5 years)
a period of slow growth in which the trunk grows more quickly.
45
Growth pattern in school age
| (6-12 years)
a period of slow growth in which the limbs grow the fastest.
46
Growth pattern in adolescence
| (13 to 18-20 years)
a period of rapid growth for the trunk, including the gonads and associated tissues.
47
# Erikson's Psychosocial Development
Infancy
| (0 to 12-15 months)
**Trust vs mistrust**
Trust is essential for development of a healthy personality and is fostered by consistent and loving care from a consistent, caring figure.
Consistency allows the infant to predict responses.
Mistrust is promoted when trust-promoting experiences are not present and when basic needs are inconsistently or inadequately met.
Assure parents that they cannot spoil an infant.
48
What is the age of a child in the Trust vs Mistrust psychosocial development stage?
0 to 12-15 months
49
# Erikson's Psychosocial Development
Toddlerhood
| (1-3 years)
**Autonomy vs shame and doubt**
Autonomy is fostered through the freedom and encouragement to master new things and become independent related to themselves and the environment.
Shame and doubt are promoted when overdependency is fostered where independence is possible; the child is made to feel self-conscious, or their independent decisions have negative consequences.
50
What is the age of a child in the Autonomy vs Shame and Doubt psychosocial development stage?
1-3 years
51
# Erikson's Psychosocial Development
Early Childhood
| (3-5 years)
**Initiative vs guilt**
The conscience develops here when a child recognizes the guidence of not only outsiders but also an "inner voice."
The focus is maintaining a sense of initiative without impinging on the rights and privileges of others or developing an overwhelming sense of guilt.
52
What is the age of a child in the Initiative vs guilt psychosocial development stage?
3-5 years
53
# Erikson's Psychosocial Development
Middle Childhood
| (6-12 years)
**Industry vs inferiority**
The focus here is on achievement. Competition and cooperation with others is an important component of this stage.; learning rules is also important. This stage is marked by social relatioships.
Inferiority or inadequacy occurs when a child is unable to meet others' expectations or if he/she feels that external standards are too hight.
54
What is the age of a child in the Industry vs Inferiority psychosocial development stage?
6-12 years
55
# Erikson's Psychosocial Development
Adolescence
| (13-20 years)
**Identity vs role confusion**
The child's body is rapidly changing. They become concerned with others' opinions as compared with their own self-concept. Identification of roles and integration of own values with society are key issues. An important milestone includes decision-making regarding a future occupation.
Inability to resolve these conflicts results in role confusion.
56
What is the age of a child in the Identity vs Role Confusion psychosocial development stage?
13-20 years
57
# Piaget Cognative Development
Sensorimotor
| Birth to 2 years
Intellectual development occurs through the child's interaction with the environment. Progression is from reflexive behavior to simple, repetitive behavior to imitative behavior. A sense of time and space develops with routines, and a sense of cause and effect develops. Object permanence is eventually recognized here, and language development begins to occur.
58
# Piaget Cognative Development
Preoperational
| 2 to 7 years (preconceptual = 2-4 years; intuitive = 4-7 years)
**Egocentrism** is the primary element of cognitive development. The child is unable to see things from any perspective other than their own. **Thinking is magical, concrete, and dominated by perception; it is done in a non-logical and nonreversible manner.** Reasoning becomes intuitive and transductive (infers particulars from particulars, rather than inductive or deductive).
Uses symbols, language, and imitation to learn.
59
# Piaget Cognative Development
Concerete operations
| 7-11 years
Thought becomes more logical. **Thinking is in terms of the world as concrete and tangible.** The child develops a sense of conservation and reversibility. Reasoning is inductive; the child masters facts and collects and sorts objects. The child is able to consider others' points of view.
60
# Piaget Cognative Development
Formal operations
| 11-15 years
Adaptability and flexibility are developed here. Abstract thought develops. New ideas can be created and situations can be analyzed.
61
# Growth principles
Weight
1. **Average newborn: 7 lbs**
a. Maternal nutrition and genetics primarily influence birth weight.
2. **5 months: double birth weight**
3. **1 year: tripple birth weight**
a. Weight after 1 year is largely a result of environmental influcences, such as diet and physical activity level; it is also influenced by one's health.
**BMI**
* ≥95% - Obese (30kg/m² or more)
* 85% - 95% - Overweight (25-29.9kg/m²)
* <5% - Underweight (<18.5kg/m²)
**Weigh children >2 years of age on a standing scale wearing a gown or light clothing.**
62
# Growth principles
Height
1. **Average newborn: 20 in.**
2. **Growth in first year: 10 in.**
3. Growth in second year: 5 in.
4. Growth each year from age 2 to puberty: 2.5 in.
**Birth length doubles at 4 years of age**
Linear growth measurement at age 2 years is roughtly half of the child's adult height.
Children 24 months to 36 months can be measured laying down (length chart) or standing (height chart). They will either appear longer or shorter compared to others due to exaggerated lumbar lordosis in toddlers that straightens when they lie down.
63
# Vital Signs
Temperature
1. Oral thermometers are not used until after age 4 to 5 years.
2. Rectal temperature is approximately 1°C higher and axillary temperature is approximately 1°C lower than oral temperature, but these values vary.
3. A temperature below 38°C (100.4°F ) is not a fever; some use 101°F as the cutoff for fever management, unless the child appears unwell.
4. If tympanic temperature measurement is used, position ear so that theinfrared sensor focuses on the eardrum; this may require the ear to be pulled up and back if over 3 years and down and back if under 3 years.
5. Avoid rectal temperatures in neutropenic patients and after rectal surgery.
64
# Vital Signs
Respirations
**1. Respiratory rate decreases with age.
2. Infants are diaphragmatic breathers; their breathing may be irregular so count for a full minute.
3. Infants are obligate nose breathers.
4. Newborn rate = 35/min (range = 32-60/min); 2 years = 25/min; 10 years = 19/min**
65
# Vital Signs
Pulse
1. Newborn rate = 110-160 beats/min at rest awake
2. 2 years = 70-110 beats/min
3. 10 years = 55-90 beats/min
66
# Vital Signs
Blood Pressure
1. Newborn mean BP = 65/41 mmHg
2. 2 years = 102/58 mmHg
3. 12 years = 119/76 mmHg
67
**Bone Age**
1. **The tarsals and carpals are X-rayed to determine the degree of ossification.**
2. The measure is used for the child who is shorter or taller than chronologic age suggests.
68
# Developmental Assessment
Wechsler Intelligence Scale for Children-V (WISC)/
Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPS-IV)
1. WPPSI is for ages 4.5 to 6 years; WISC is for those 6 to 16 years.
2. These scales result in a full-scale Intelligence Quotient (IQ), a Verbal IQ index, and a Performance IQ index.
3. Helpful for those with intellectual disability, learning disabilities, and ADHD.
69
# Developmental Assessment
Bayley Scales of Infant and Toddler Development-4
1. Measure the cognitive, language, motor, social-emotional, and adaptive behavior domains.
2. Often used to determine development in follow-up assessments of premature infants up to 42 months.
70
Developmental Assessment of Young Children (DAYC-2)
1. Developmental assessment for children 5-11 with possible delays in cognition, communication, social-emotional development, physical development, and adaptive behavior.
71
Developmental Milestones: Infant (0-12 months)
0 to 3 months
1. **The posterior fontanel closes at approximately 2 months**
2. **Vision is poor. Black and white are the colors best seen by the neonate. The neonate begins to focus on nearby faces. By 3 months, the infant develops binocular vision; the eyes can follow an object 180°.**
4 to 6 months
1. **Birth weight doubles at 5 months.**
2. Sleeps through the night with one or two naps a day.
3. Explores own feet.
4. Begins teething (lower central incisors appear first); may increase drooling and irritability.
5. Develops color vision and improved disetance vision.
6. Develops improvement in the ability to track objects with the eyes (failure to track objects or respond to sound signifies a need for additional assessments of hearing and vision).
7 to 9 months
1. Environmental safety due to motor development.
10 to 12 months
1. Environmental safety due to motor development.
2. **Birth weight triples by 12 months.**
3. **Length increases by 50% from birth.**
72
Psychosocial development: 0 to 3 months
1. The infant's intstinctual smile develops at 2 months and social smile at 3 months.
a. **The social smile is the infant's first social response. It initiates social relationships, indicates memory traces, and signals the beginning of thought processes.**
2. The infant recognizes the parent's voice.
3. The neonate is stimulated by being held or rocked, listening to music, or watching a black and white mobile.
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Psychosocial development: 4 to 6 months
1. At 4 months the infant laughs in response to the environment.
2. The infant cries when the parent leaves; this is a normal sign of attachment.
3. **The infant discerns one face from another and exhibits stranger anxiety (is wary of strangers and clings to or clutches parents).**
4. The infant begins comforting habits such as thumb sucking, rubbing an ear, or holding a blanket or stuffed toy.
a. All of these habits symbolize parents and security.
b. Thumb sucking in infancy does not result in malocclusion of permanent teeth.
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Psychosocial development: 7 to 9 months
1. The infant likes to look in the mirror.
2. The infant enjoys playing simple games like peek-a-boo, playing with toys that make noise, or listening to music.
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Psychosocial development: 10 to 12 months
1. The infant may exhibit marked stranger anxiety.
2. The infant will test the caregiver's reaction by throwing the bottle or cup off the high chair to test the caregiver's response (e.g., picking it up).
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Cognitive development: 0 to 3 months
1. **Notices own hands**
2. Observes people's faces and watches mobiles
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Cognitive development: 4 to 6 months
1. The infant smiles and laughs in response to pleasant environmental stimuli
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Cognitive development: 7 to 9 months
1. The **infant develops object permanence**
2. Stranger anxiety - aware of faces other than significant others
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Cognitive development: 10 to 12 months
1. Finds hidden object easily
2. Points to or looks at correct image when named
3. Uses simple gestures such as shakes head for "no"
4. Responds to simple verbal requests (e.g., "bring mama the ball.")
5. The infant learns through increased exploration of the environment. Sensorimotor experiences should be positive ones.
80
Language/communication: 0 to 3 months
1. Begins to babble
2. **turns head toward sound**
3. Cries to indicate need. *Respond to those needs in a consistent manner to promote trust.*
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Language/communication: 4 to 6 months
1. Responds to own name
2. Continuous babbling occurs
3. Babbles in response to sounds as in a conversation by age 6 months
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Language/communication: 7 to 9 months
1. The infant can say all vowels and most consonants but speaks no intelligible words.
2. The infant understands the word "no" at 9 months. Use of this word shoud be limited. The physical environment should be safe and secure so use of the word is exception rather than routine.
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Language/communication: 10 to 12 months
1. The infants says "mama" and "dada."
2. **The infant can say about five words but understands more.**
3. The infant repeats sounds and gstures.
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Motor skills: 0 to 3 months
1. All motor behavior is reflex at birth; all extremities are flexed at birth. Reflexes reach a peak at 4 to 8 weeks, especially the sucking reflex.
**2. Rooting - stroke cheek and face turns towards stroked cheek and begins to suck
3. Moro - startle reflex - with loud noise or sudden movement, limbs extend, fingers spread
4. Tonic neck/fencing - when supine with head turned to one side, arm and leg on that side will flex and arm and leg on opposite side of body will extend
5. Babinski - stroke outer sole of foot from heel to ball of foot and toes will hyperextend
6. Parachute - emerges at 5-6 months and is retained - arms extend (as if to break one's fall) when rotated quickly to airplane position**
7. When prone, the neonate can lift the head slightly off the bed but not off a pillow.
8. **At age 3 months, most primitive reflexes begin to disappear except for the protective and postural reflexes (the blink, cough, swallow, and gag reflexes), which remain for life. Babinski is the last reflex to disappear; if present after 2 years, may indicate a CNS abnormality
9. When held, the infant begins to hold up own head**
10. Infant begins to put hand to mouth.
11. Infant reaches out voluntarily but is uncoordinated.
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Moro Reflex
**1. startle reflex - with loud noise or sudden movement, limbs extend, fingers spread
2. present at birth to 3 months.**
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Babinski Reflex
**1. stroke outer sole of foot from heel to ball of foot and toes will hyperextend
2. present at birth to 3 months.**
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Motor skills: 4 to 6 months
1. **The infant first rolls over from stomach to back, then from back to front.**
2. The infant reaches for objects and voluntarily grasps them
3. **The infant transfers objects from one hand to another**
4. **The infant rakes objects with hands**
5. When prone, the infant uses arms to push the chest up while resting the lower body on the knees. The infant rocks nack and forth in this position and may begin to crawl on belly backwards now *or in the next developmental stage.*
6. **The infant sits with support.** May begin to sit without support.
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Motor skills: 7 to 9 months
1. **The infant sits alone without assistance.**
2. **The infant creeps forward on hands and knees with the belly off the floor (crawls).**
3. The infant stands while holding onto an object for support, such as a parent's hand or table.
4. **The infant develops a pincer grasp and places everything in the mouth.**
5. The infant self-feeds crackers, Cherrios, and a bottle. The infant who is emotionally ready can be weaned to a cup.
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Motor skills: 10 to 12 months
1. **The infant cruises at 10 months (sidesteps while holding on).**
2. **The infant walks with support at 11 months.**
3. **The infant takes first steps at 12 months, with variability up to 15 to 16 months.**
4. **The infant claps hands, waves bye-bye, and enjoys rhythm games.**
5. The infant explores everything by feeling, pushing, turning, pulling, biting, smelling, and testing for sound; enjoys cloth books and toys to build with and knock over.
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Neonatal Abstinence Syndrome (NAS)/
Neonatal Opioid Withdrawal Syndrome (NOWS)
1. Baby exposed to opiates in utero and has withdrawal within the first few days following delivery and lasts from 6 days to 8 weeks.
2. Symptoms include: high-pitched non-stop crying, hypertonicity with tremors, jitteriness, irritability, tachypnea, yawning, poor feeding, temperature instability, seizures, disturbed sleep patterns, nasal stuffiness.
3. Assess usig the Finnegan Neonatal Scoring System, the NICU Network Neurobehavioral Scale (NNNS) or eat, sleep, and console model (ESC)
4. Treatment includes decreased external stimuli (lighting and noise), swaddle, avoid unnecessary handling, feed with hypercarloric formula. May administer morphine, methadone, or buprenorphine.
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Developmental Milestones: Toddler (ages 1 to 3)
| Overview
Overview
1. This is a period of slow growth, with a weight gain of 4 to 9 lbs over 2 years.
2. Vision is still not mature.
3. Toddler requires 10 hours of sleep a night plus one daytime nap.
4. **Anterior fontanel closes by 18 months.**
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Developmental Milestones: Toddler (ages 1 to 3)
| Psychosocial Development
Psychosocial Development
1. Todder is egocentric.
2. **Separation anxiety; often increases in intensity through the middle of toddlerhood.**
3. The toddler sees bedtime as desertion. Sleep issues are common problems often resulting from separation anxiety. **Transitional objects such as special blankets and stuffed animals may ease the transition to sleep and being alone.** (Transitional objects provide security. As long as they do not interfere with daily functioning and social interactions, they are not detrimental to mental health.)
4. The toddler develops a fear of the dark.
5. Separation anxiety demonstrates closeness between the toddler and parent; they scream and cry when the parent leaves, then sulk and engage in comfort measures.
6. **The parent who is leaving should say so and should promise to return.
a. The parent should leave a personal item with the toddler.
b. Prepare the parent for the toddler's reaction and explain that this process promotes trust.**
7. To promote autonomy, let the toddler perform developmentally appropriate tasks independently and praise success. Examples; cleaning up, self-feeding, self-dressing.
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Developmental Milestones: Toddler (ages 1 to 3)
| Cognitive Development
Cognitive Development
1. The toddler engages in ritualistic behavior to master skills and decrease anxiety.
2. **The toddler exhibits magical thinking (believes that thoughts affect actions.**
3. The toddler uses symbols (understands gestures such as waving bye).
4. Memory and learning are enhanced by experience.
5. The toddler shows curiosity about everything and is not intentionally destructive; can lead to aspiration or ingestion of dangerous items.
6. Older toddlers use play to express feelings.
7. The toddler lacks the concept of sharing and does not understand the value of items.
8. The toddler recognizes self in mirror.
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Developmental Milestones: Toddler (ages 1 to 3)
| Language/communication
Language/communication
1. **By 12 months, the toddler uses 5 words.**
2. **By 18 months, the toddler uses up to 50 words but can point to objects when asked.**
3. **By age 2, the toddler uses 400 words in two- to three-word phrases and comprehends many more words.**
4. At age 3, the toddler is a chatterbox.
5. The amount the toddler speaks is influenced by the amount spoken in the home.
6. The ability to understand speech is more important than vocalization.
*The toddler should talk by age 3; if not, seek further evaluation and assess the toddler's hearing.*
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Developmental Milestones: Toddler (ages 1 to 3)
| Motor skills
Motor skills
1. The toddler uses arms to balance.
2. The toddler plants feet wide apart and walks by age 15 months; if not, seek further evaluation.
a. Feet are flat, with no arches.
b. **Provide push-pull toys to encourage walking.**
3. **The toddler climbs stairs at age 21 months.**
4. The toddler runs and jumps by age 2 years.
5. **The toddler rides a tricycle by age 3 years.**
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Developmental Milestones: Toddler (ages 1 to 3)
| Developmental approaches to care
Developmental approaches to care
1. Care
a. **Avoid separation from parents; keep parents in child's line of vision.**
b. **Toddlers are slow to warm up because of stranger anxiety. Allow time for the toddler to become aquainted with you. Talk in a friendly voice.**
c. Be flexible and realistic. Focus on the important components of your assessment.
d. The toddler understands limits and responds to consistency and limit setting.
e. The toddler responds will to positive reinforcement.
2. Play
a. The toddler engages in solitary play. Toddlers often play side by side, but not together (parallel play).
b. The toddler uses transitional objects for comfort and security.
c. Promote verbal and physical stimulation.
3. Teaching
a. The focus of teaching is the parent. Involve the child when possible.
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Developmental Milestones: Toddler (ages 1 to 3)
| Reactions to illness and hospitalization
Reactions to illness and hospitalization
1. The toddler may become unusally compliant or aggressive.
2. **The toddler may regress, losing milestones previously achieved.**
3. The toddler with a chronic condition may have difficulty achieving autonomy because of increased dependency on caregivers.
4. Provide nursing interventions:
a. **Choices where possible**
b. Independence when possible
c. Positive senorimotor activities
5. **Promote parental/caregiver presence and involvement.**
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Developmental Milestones: Toddler (ages 1 to 3)
| Diet and nutrition
Diet and nutrition
1. **The toddler eats less than during infancy because of decreased growth rates.**
2. Encourage three nutritious meals and two healthy snacks per day.
3. **Portion size is 1 teaspoon per year of age for each serving** (e.g., veggie, fruit, starch, meat).
4. Encourage socialization at mealtimes.
5. Discourage battles over food; toddlers will eat when they are hungry.
6. Limit mealtime to 10 to 15 minutes; toddlers cannot sit still or focus for longer.
7. Toddlers may have difficulty sitting the full length of an adult/family meal.
8. Avoid foods high in sugar.
9. **The toddler feeds himself; provide finger foods to promote autonomy.**
10. At **12 months, formula can be changed to whole milk. Milk intake should be limited to 24 oz/day to assure intake of other nutritious foods. Breastfeeding can continue past 12 months but whole milk should be the prepared drink of choice. **
*The fat content in whole milk is necessary for children up to 2 years of age to promote myelinization of the brain.*
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Developmental Milestones: Toddler (ages 1 to 3)
| Dentition
Dentition
1. The toddler should brush teeth twice daily with toothpaste designed for infants/toddlers (size of a grain of rice)
2. **The toddler will have 20 deciduous teeth by 3 years of age.**
3. **All toddlers should be evaluated every 6 months by a dental practitioner, starting at 12 months of age.**
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Developmental Milestones: Toddler (ages 1 to 3)
| Discipline
Discipline
1. Positive reinforecement should be used for good behavior with distraction and ignoring unwanted behavior.
2. **Time out is an appropriate discipline strategy; 1 minute of time out per 1 year of age.**
3. The toddler uses "no" excessively and to show assertiveness; the toddler is curious as to how the parents will respond to "no."
4. The toddler becomes frusterated, wants immediate gratificaiton, and acts out of anger; the toddler may lose control; temper tantrums are common.
5. **To prevent tantrums, the parents should keep routines simple and consistent, set reasonable limits and give raitonales, avoid head-on clashes, and provide choices.**
6. **During a tantrum, provide a safe environment for the toddler, identify the tantrum's cause and help the toddler regain control.**
a. Do not reson, threaten, promise, hit, or give in.
b. Do not tell the toddler to wait.
c. **Respond consistenly**; follow through on discipline free of anger.
7. Overcriticizing and restrictting the toddler may dampen enthusiasm and increase feelings of shame and doubt.
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Developmental Milestones: Toddler (ages 1 to 3)
| Toilet training
Toilet training
1. Depends on emotional readiness.
a. The toddler acts to please others, trusts enough to give up body products, and begins autonomous behavior.
b. The parents must be committed to establishing a toilet pattern and must communicate well with the toddler, offering praise for success but no punishment for failure.
2. **Training also depends on the toddler's physical readiness.**
a. The toddler's kidneys should reach adult functioning by age 2 with mature bladder sphincter control.
b. The toddler feels the discomfort of wet or messy pants, identifies elimination as the cause of this discomfort, and recognizes the sensation before excretion.
c. The toddler removes own clothes, walks unaided, stoops and sits, talks, and imitates others.
3. **Toilet sitting begins when the child appears ready**
a. Provide a pleasant mood during this time.
b. The toddler should use a potty seat or chair.
c. The toddler may fear being sucked into the toilet.
d. The toddler is curious about excretion products.
e. Do not refer to bowel movements as dirty or yucky.
1. Excrement is the toddler's first creation.
2. Provide alternative toys such as clay and water.
f. Teach the toddler hand washing and front-to-back wiping.
1. When toilet training begins, sit on toilet every 2 hours.
g. With increased stress, the toddler may regress; toileting may have to be retaught.
h. Introduce underpants as a badge of success and maturity.
i. The toddler should achieve day dryness by 3 years and night dryness by 5 years.
j. If the toddler isn't trained by age 5 years, seek further evaluation.
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Developmental Milestones: Preschool (ages 3 to 5)
| Overview
1. Slow growth continues during this period.
2. Birth length doubles by age 4.
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Developmental Milestones: Preschool (ages 3 to 5)
| Psychosocial development
Psychosocial development
1. **The child is in Erikson's period of initiative vs guilt; the preschooler aims to accomplish and achieve.**
2. Egocentricity decreases, and awareness of others' needs increases.
a. The child begins sharing and taking turns but continues having difficulty with these concepts.
b. The child attempts to please others.
3. The child begins to develop a conscience.
a. The preschooler tries to avoid getting in trouble.
4. The child begins to function socially.
a. The child learns rules.
b. Nursery school enhances the child's social development.
5. The child may exhibit sibling rivalry (reinforce the fact that each child is special).
6. The child develops fears of such things as the dark, animal noises, and new experiences.
7. **Engages in imaginative play (pretend) and dramatic play (dress-up).**
8. **The child may develop an imaginary playmate to help deal with fears and loneliness; this is prevalent and normal in bright, creative children.**
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Developmental Milestones: Preschool (ages 3 to 5)
| Cognitive development
Cognitive development
1. The child has limited perspective and ofcuses on one idea at a time.
2. The child becomes aware of racial and sexual differences.
a. Boys may begin to masturbate.
b. Begin devlopmentally appropriate teaching regarding sexuality.
3. The child develops a body image.
a. The parents should promote awareness of positive aspects of both sexes.
b. The parents should use appropriate names for body parts.
c. The child can draw a person.
4. **The child begins to have a concept of causality but still exhibits magical thinking.**
5. **The child begins to have a concept of time.**
a. The parent can explain time by referring to events.
b. The child begins to have a concept of "today" and "tomorrow".
6. The child begins to have a concept of numbers, letters, and colors.
a. The child may count but may not understand what the numbers mean.
b. The child may recognize some letters of the alphabet.
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Developmental Milestones: Preschool (ages 3 to 5)
| Language/Communication
Language/Communication
1. **The 3-year-old uses three- to four-word sentences but difficulty with pronouns.**
2. The 4-year-old uses four-to five-word sentences, names colors, and counts.
3. The 5-year-old uses sentences of more than five words and tells long stories.
4. **Preschoolers are concrete thinkers. Communication and explanations should provide concrete ideas and examples; preschoolers are often scared by health care lingo.**
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Developmental Milestones: Preschool (ages 3 to 5)
| Physical development/Motor skills
1. The child dresses and undresses self (may not be able to tie shoes until age 5).
2. **At age 3 years, the child builds a tower of more than six blocks, walks up and down stairs.**
3. At age 4 years, the child hops and stands on one foot for up to 5 seconds, draws a person with two to four body parts, throws overhand, and catches a ball.
4. At 5 years, the child runs, jumps, skips, hops and does sumersaults.
5. Child develops hand dominance.
6. Vision acuity is tested to assure binocular vision; color vision is tested once, preferably prior to school entry.
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Developmental Milestones: Preschool (ages 3 to 5)
| Developmental approaches to care
Care
1. Respect the child's privacy and modesty.
2. Promote cooperation.
3. Provide explanations.
Play
1. The child begins group play in activities wit few or no rules.
2. Play can be used as a teaching tool and to build rapport.
3. Engage the child in their favorite activities.
a. **Examples of appropriate toys include dolls, sandbox, water, blocks, crayons, clay, and finger paint.**
Teaching
1. The parent is the primary focus of teaching.
2. Involve the preschooler in teaching through the use of short, simple explanations.
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Developmental Milestones: Preschool (ages 3 to 5)
| Reactions to illness and hospitalization
1. Observe for maladaptive responses to illness and hospitalization.
a. The child shows anxiety about health care treatments and life events.
The child shows fear concerning body integrity.
2. Provide for developmentally supportive nursing interventions.
a. Allow the child to handle and play with medical equipment to increase comfort level (e.g., stethoscope, BP cuff).
b. Use doll play to help the child prepare for or adjust to treatment.
3. Provide adhesive bandages for cuts, because the child fears losing blood and they cover hols to maintain body integrity.
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Developmental Milestones: Preschool (ages 3 to 5)
| Diet and nutrition
1. Encourage three nutritious meals plus two healthy snacks per day.
2. Food jags and strong food preferences are common.
a. Encourage parents to offer a variety of foods.
b. Avoid battles over foods.
c. Children often do not like food mixed together; keep foods separate.
3. Portion size is 1 tablespoon per year of age for each serving (e.g., veggies, fruit, starch, meat).
4. Children establish eating behaviors (washing hands before meals, table manners, eating while seated).
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Developmental Milestones: Preschool (ages 3 to 5)
| Dentition
1. Brush teeth twice daily and introduce dental flossing daily.
2. Child should have a dental visit every 6 months.
3. **Should have 20 deciduous teeth.**
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Developmental Milestones: Preschool (ages 3 to 5)
| Parenting issues
Bedwetting (enuresis)
1. Bedwetting is a common concern in this age group.
a. **Nighttime dryness is generally achieved by age 5.**
2. Limit fluids after dinner time.
3. Encourage toilet time prior to sleep.
*Bedwetting that is a new occurrence in a previously toilet-trained child should be discussed with the child's pimary care provider. Bedwetting can be a sign of a UTI as well as other disease conditions and psychosocial problems.*
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Developmental Milestones: Preschool (ages 3 to 5)
| Behavior/Discipline
1. Child **wants to please adults**; catch the child "doing good" and give praise.
2. **Disciplinary actions, if needed, should be consistent; "time out" is an effective disciplinary action; one minute per year of age is appropriate. Because the child has poor concept of time, make sure the child is told when the time out is over.**
3. Do not compare one child to another in terms of abilities or psychosocial traits.
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Developmental Milestones: Preschool (ages 3 to 5)
| Readiness for kindergarten
The following attribute may indicate readiness:
1. The child picks up after self.
2. The child gets along without either parent or short periods.
3. The child is less afraid.
4. The child follows directions.
5. The child speaks in correct, complete sentences.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Overview
School shapes the child's cognitive and social development.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Psychosocial development
1. **The school-age child is in Erikson's stage of industry vs infertiority; school is seen as the "job" of the school-age child.**
2. **The teacher, perhaps the first important adult in the child's life besides the parents, may be a major influence.**
3. The child plays with peers.
a. The child develops a first true friendship.
b. The child develops a sense of belonging, cooperation, and compromise.
4. The child begins to participate in group activities, including team sports (**cooperative play**).
a. encourages competition through fair play and relieve the child of having to make decisions.
b. Play involves group goals with interaction and cooperation.
5. **The child develops a sense of morality in which the child conforms to social norms and customs.**
a. **The early school-age child sees actions as either right or wrong.**
b. **After age 9, the child understands intent and differing points of view.**
c. **The child plays by the rule but often cheats, which is developmentally appropriate as moral development progresses.**
6. The child compares own body to others and may become modest.
7. The child participates in family activities, becomes aware of social roles, engages in fantasy play and daydreaming.
8. The child may exhibit fear of death and school phobias; these fears may cause psychosomatic illness.
9. The child likes to accomplish tasks.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Cognitive development
1. **The child enters Piaget's cognitive level of concrete operations.**
a. **The child develops a sense of time and space, cause and effect, nesting (building blocks, puzzle pieces), reversibility, conversation (permanence of mass and volume), and numbers.**
2. The child understands the relationship of parts to the whole (fractions).
3. The child learns to classify objects in more than one way.
4. The child becomes interested in board games, cards, and collections.
5. The child learns to read and spell.
6. **School participation and school achievement are essential components of child's focus.**
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What is nesting?
building blocks, puzzle pieces
118
What is conversation?
permanence of mass and volume
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Developmental Milestones: School-age Child (ages 6 to 12)
| Physical Development/motor skills
1. Slow growth continues during this period; height increases about 2.5 in. a year and weight doubles between ages 6 and 12.
2. Both sexes are about the same size until approximately age 9, when some females begin puberty and grow faster. (Precocious puberty is when breast development begins before age 7 in White females and before age 6 in African American females and before age 9 in males.)
3. Bones grow faster than muscles and ligaments; therefore, the child is limber and prone to bone fractures.
4. Large and small muscle groups are refined.
5. Lymphoid tissue hypertrophies to maximum size.
6. **Vision matures by approximately age 7.**
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Developmental Milestones: School-age Child (ages 6 to 12)
| Communication
Language development is perfected.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Developmental approaches to care
Care
1. **Explain procedures, equipment, and care.**
2. Provide time for interviewing the child separately from the parent.
Play
1. Inquire about favorite activities.
2. **Promote peer contact where possible.**
Teaching
1. Parents and schools shre the responsibility for health teaching, with parents being the primary providers of information and values.
2. Provide explanations and answer questions in an age-appropriate manner.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Reactions to illness and hospitalization
1. Observe for maladaptive responses to illness and hospitalization.
a. The child exhibits signs of isolation because of school abenteeism, lack of peer contact, and increased dependence on caregivers.
b. **Promote communication with classmates/friends.**
2. Provide for developmentally supportive nursing interventions.
a. Promote school attendance.
b. Educate the child about their illness and reinforece that illness is not their fault.
c. Collaborate with the school nurse and teachers regarding the child's abilities and needs.
d. Encourage participation in activities and care as much as possible.
*Accidents are major cause of death and disability among school-age children.
School-age children are open to role play. This provides a real-life way of practicing one's response.*
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Developmental Milestones: School-age Child (ages 6 to 12)
| Diet and nutrition
1. The school-age period is one inwhich the child is greatly influenced by peers and the media regarding diet and nutrition.
2. This is a time when healthy diet and activity habits are established.
a. Encourage three nutritious meals and two healthy snacks per day
b. Discuss healthy lifestyle choises regarding food choices and physical activity; limit screen time.
3. **Overweight puts children at risk for type 2 diabetes, hypertension and hyperlipidemia. **
a. **Monitor BMI with yearly growth chart documentation and assessment.**
b. **Refer to nutrition consultation and medical evaluation for BMI>85% (>25).**
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# Developmental Milestones: School-age Child (ages 6 to 12)
Developmental Milestones: School-age Child (ages 6 to 12)
| Dentition
1. The first primary tooth is displaced by a permanent tooth at age 6 to 7, and permanent teeth replace primary teeth at a rate of 4 per year until age 12; by age 1, all permanent teeth are present except the final molars; the jaw grows to accommodate the permanent teeth.
2. Dental visits are every 6 months.
3. Brush teeth twice daily with a fluoride toothpaste, and floss daily.
4. This is a prime time for the development of dental caries; nutrition and dental education should be reinforced in the home and in the school.
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Developmental Milestones: School-age Child (ages 6 to 12)
| Parenting issues
Communication: The school-age child develops increased independence from parents with wider influences of peers and teachers.
1. Encourage independence while increasing personal responsibilities.
2. Use active listening.
3. Become involved in the child's activities outside of school.
Behavior/Discipline
1. Use praise and support.
2. Discuss consequences of actions.
3. Discuss conflict resolution among peer group.
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Developmental Milestones: Adolescent (ages 13 to 18)
| Psychosocial development
1. **Adolescents experience Erikson's psychosocial stage of identity vs role confusion. This is also a time in which the adolescent struggles to confront issues of morality, sexuality, and future occupation.**
2. Adolescence ends when the youth is physically and financially independent of parents.
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Developmental Milestones: Adolescent (ages 13 to 18)
| Cognitive development
1. The adolescent **develops abstract thinking** and an increased ability to analyze, synthesize, and use logic.
2. The adolescent reaches Piaget's cognitive level of an adult; however, brain maturity continues through early adulthood.
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Developmental Milestones: Adolescent (ages 13 to 18)
| Development of secondary sex characteristics (often during school-age)
Female
1. **Breast development (thelarche), the first sign of puberty (as per the Tanner assessment), begins on average at age 9.7 with the bud stage (range = 7-13 years). **
a. **Breast development takes approdimately 3 years to complete.**
b. **Breast development ends by approximately age 17.**
2. Pubic hair appears on average at age 11 and continues with the progression of puberty and for several years after puberty.
3. **The onset of menses occurs between ages 8 and 16 (12.5); menses initially may be irregular. **
4. The growth spurt begins early in puberty, shortly after breast budding, before menarche. Females grow up to 3 in. (8 cm)/year, stopping growth around age 16. Compared with males, females have a shorter period of time in which to grow and a lower rate of growth during the pubertal growth spurt.
Male
1. **Testicular enlargement signals the start of puberty (as per the Tanner assessment), beginning approximately at 11 years, with a range of 10 to 15 years.**
2. Pubic hair growth begins on average at 12 years and contiues to grow and increase until approximately age 20.
3. **The male's heigh spurt begins 2 years later than the female's.**
a. The male can grow up to 3.5 in. (9cm)/year, with growth ending around age 20.
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Developmental Milestones: Adolescent (ages 13 to 18)
| High-risk behaviors
1. **Motor vehicle accidents are the primary cause of morality and morbidity; car safety information is essential at this age, especially related to distracted driving (e.g., texting).**
2. **Suicide is the third leading cause of death among middle and late adolescents (homicide is second).**
3. Approximately half of all adolescents have had sexual intercourse by high-school graduation.
a. **Half of sexually transmitted infections occur in youth age 15-24.**
1. **Should be tested within 1 year of onset of sexual activity; chlamydia most common STI.**
2. **Should be tested for HIV and other STIs as well as pregnancy.**
3. **Should receive HPV vaccine by their teen years (between ages 9 and 26).**
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Developmental Milestones: Adolescent (ages 13 to 18)
| Communication strategies
1. Use active listening techniques.
2. Use open-ended questions in patient interview rather than yes/no questions.
3. Remain nonjudmental; focus on obtaining health-related information and identifying risk factors to guide teaching and care.
4. Do not promise to keep information confidential if it inolves potential danger to the youth by himself/herself or others, or danger to others.
5. Questions related to reproductive choices (pregnancy, birth control, treatment of STIs) does NOT have to be shared with the parent if the child requests confidentiality.
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**HEEADSSS assessment**
**To assess Adolescent Risk Profile**; ask about:
1. Home Environment
2. Education & Employment
3. Peer-related Activities
4. Drugs
5. Sexuality
6. Suicide/depression
7. Safety from injury and violence.
**Assess for access to firearms**
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Developmental Milestones: Adolescent (ages 13 to 18)
| Dentition
Final molars (wisdom teeth) may erupt.
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Developmental Milestones: Adolescent (ages 13 to 18)
| Parenting issues
Communication
1. Limit setting is successful when it is understood and not arbitrary.
2. Give freedom and choices where possible.
Discipline
1. Focus on encouraging the adolescent to make decisions and understand consequences.
2. Save battles for the imiportant things.
