Discussion: Growth and Developmental Patterns

Compare and contrast the growth and developmental patterns of two toddlers of different ages using Gordon’s functional health patterns. Describe and apply the components of Gordon’s functional health patterns as it applies to toddlers.

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Instructions:

Post your discussion to the Moodle Discussion Forum. Word limit 500 words. Support your answers with the literature and provide citations and references in APA format. Reply to at least two other student posts with a reflection of their response. Discussion: Growth and Developmental Patterns

Chapter_0172.ppt
Chapter 17

Infant

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Human development begins when a sperm penetrates a mature ovum

Infant depends completely on others, primarily the parents, to meet all needs

Developmental landmarks

To guide parents, nurse must know what behaviors to expect at certain age levels

Physical growth landmarks

Developmental tasks

Biology and Genetics

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Developmental Tasks

Physiological equilibrium

Task of survival: basic physiological functions

Oral stage of development

Stimulation and environmental interaction

Essential for infant development

Progressive connections of dendrites

Increases vascularization of brain structures

Increases myelination of brain/nerves

Infant should have auditory/visual stimuli

Radios, spoken voice, mobiles

Sense of touch important as well

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Concepts of Infant Development

Psychosocial development: Erikson

Trust vs mistrust

Trust influences future relationships

Infant needs maximum gratification/minimum frustration

Cognitive development: Piaget

Sensorimotor period

Mastering simple coordination activities through senses and motor activity

Reflexes

Responses following stimulation

Rooting and sucking reflex: assists survival

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Measuring Growth and Development

Denver Developmental Screening Test II

Screening tool birth to age 6

Screen at 3-4 months, 10 months, 3 years

Areas of development

Personal-social

Fine motor–adaptive

Language

Gross motor

CDC growth charts

Height, weight, head circumference

Plotted on standardized grid

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Gender and Race

Gender

Male: larger, more muscle mass, more motor activity

Female

More physically mature at birth

Less vulnerable to stress, greater response to tactile stimulation/pain

Impact on parental relationships/expectations

Race

Physical variations among people of different races

Diversity challenges in health assessment, nursing care

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Genetics

Maternal age

Down’s syndrome: >35 years old

Ethnic background

Eastern European Jews: Tay-Sachs

Blacks: sickle cell

Family history

Examples: Huntington’s chorea, hemophilia, mental retardation

Genetic counseling: informed decision re birth defects

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Genetics (Cont.)

Maternal reproductive history

Spontaneous abortions, stillbirths, previous children with genetic conditions

Maternal disease

Examples: Diabetes mellitus, seizure disorder, phenylketonuria

Nurse’s role

Case finding, referral, family education during genetic counseling process

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Gordon’s Functional Health Patterns

Health perception–health management pattern

Nutritional-metabolic pattern

Elimination pattern

Activity-exercise pattern

Sleep-rest pattern

Cognitive-perceptual pattern

Self-perception–self-concept pattern

Roles-relationships pattern

Sexuality-reproductive pattern

Coping–stress tolerance pattern

Values-beliefs pattern

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Health Perception—Health Management Pattern

Health promotion through parents

Promote competence in parents’ ability to act to enhance infant’s health

Identify problems

Family’s perception of good/bad health practices

Consequences of unhealthy practices

Help parents recognize infant susceptibility

Teach characteristics that influence health

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Nutritional-Metabolic Pattern
Essential Infant Nutrients

Water—supplied by breast milk

125-150 mL/kg/day first 6 months

125-135 mL/kg/day second 6 months

Protein: not to exceed 20%—kidney is immature

2.2 g/kg/day first 6 months

2 g/kg/day second 6 months

Fat: 3.8-6 g/kcal: breast milk is 50% fat

CHO—37% of calories in breast milk

Vitamins and minerals

Vitamin D supplementation (if breastfed)

Iron fortification by 6 months. Discussion: Growth and Developmental Patterns

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Nutritional-Metabolic Pattern

Food additives

May be present in commercial baby food

Homemade baby food

Avoid salt/sugar/additives

Nutrition problems

Under nutrition: inadequate calories or nutrients

Overnutrition: more calories and nutrients than needed

Baby food

If home prepared must cook without salt or sugar then blenderize food—economical option

Commercial food is safe, nutritious and high quality

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Nutritional-Metabolic Pattern (Cont.)

Breastfeeding: the perfect food

Exclusive: preferred method first 6 months

Continued: first year and beyond

Nurse’s role in encouraging breastfeeding

Introduction of solid foods

4-6 months: infant physiologically and developmentally ready

Recommendation: wait until 6 months to lower risk of food allergies

Sequence of solids: cereal, fruits, vegetables, meats

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Nutritional-Metabolic Pattern (Cont.)

Weaning: introducing infant to cup

Gradual process: usually 5-6 months

Developmental milestones

Infant extrusion reflex needs to be absent

Infant can sit only slightly supported

Able to turn head away to indicate food refusal

Avoid propping baby bottles

Danger of aspiration

Baby bottle syndrome—tooth decay

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Elimination Pattern

Bowel elimination

Develops pattern by second week of life

Breastfed stool

Softer consistency, clean smell, initially several stools daily; progresses to once daily or over several days

Bottlefed stool

Harder consistency, smellier

Similar to infant on solid food

Defecation involuntary

Delay toilet training until at least 18 months old

Urinary elimination

6-12 times/day first few months

Irregularly after first few months

Voiding involuntary. Discussion: Growth and Developmental Patterns

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Activity-Exercise Pattern

Activity through play

Exercise of senses (visual)

Solitary and repetitious

Promoting play is important!

Activity through stimulation

Parental stimulation important to development

Singing/music, rocking

Mirrors, face-to-face interaction

“Tummy time” needed to prevent flattening of head from sleeping supine

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Sleep-Rest Pattern

Sleep needs correlate to rate of growth

80% at birth

12 hours daily at 12 months

Promote infant’s sleep patterns

Sensitivity to sleep cycles, develop rituals

Not firm “schedule”

Sleep problems are highly prevalent

Bedtime rituals helpful

Brief arousals at night are normal for infants

Quiet room separate from parents is recommended

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Sleep – Rest Pattern
Sudden Infant Death Syndrome

Third leading cause of death in United States/Canada

Unknown cause

Risk factors

Prone sleeping, exposure to tobacco smoke, soft sleeping surfaces, hyperthermia, bed sharing, lack of breastfeeding, SIDS sibling, preterm, near-SIDS

Recommendations

Avoid risk factors

Supine sleep position, offer pacifier

Nurse’s role in family coping/grief

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Cognitive-Perceptual Pattern

Vision

Initial: eye muscles weak, vision unfocused, without meaning

Eye movements coordinate by 3 months

Eye movements mature by 6 months

Hearing

Acute ability; sound discrimination is an important developmental task

Smell

Fully developed; can differentiate odor of mother’s milk from others at 2 weeks. Discussion: Growth and Developmental Patterns

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Cognitive-Perceptual Pattern (Cont.)

Taste

Present at birth; salivation at 3 months of age

Touch and motion

Tactile sensation well developed

Touch relieves infant tensions and speeds neuromuscular development

Language development

Sensory stimulation important

Cooing by 2 months; babbling at 6 months, single words by 12 months

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Self-Perception–Self-Concept Pattern

Separating “me” from “non-me”

Developed through feedback

Effect of crying/smiling on others

Ability to use body to influence others

Messages infant receives from body

Differentiates “self” in mirror images

4 months of age

Develops body image as he or she experiences the environment through senses

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Roles-Relationships Pattern

Attachment and bonding

Establishment of maternal-infant bond

Influenced by previous life experiences

Theories of attachment

Freudian psychoanalytic theory

Social learning theory

Difficulties with attachment

Increased risk: child abuse, failure-to-thrive, behavior problems

Paternal attachment/bonding: engrossment

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Roles-Relationships Pattern
Child Abuse

Active or passive abuse at hands of parents or caregivers

Most common under age 3

Parenting not instinctive; response to inadequate parental coping

Women abuse more frequently

Men more severely; sexual abuse

Intergenerational cycle of behavior

Profound long-term effect on child

Community goals—ID and prevention

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Roles-Relationships Pattern
Child Abuse (Cont.)

Prevention of child abuse: identification and intervention in families “at risk”

Identification of abuse when it occurs

Protection of abused/at-risk children

Scope of child abuse is extensive

650,000 infants and children annually

1,500 children die from abuse or neglect

Abuse occurs in every race, creed, or socioeconomic status. Discussion: Growth and Developmental Patterns

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Sexuality-Reproductive Pattern

Sexual identity begins at birth

Caretaker’s behavior secondary to gender

Infant’s sexuality

Gives direction to own responses through life

Infant characteristics

Great oral sensitivity

Enjoy skin-to-skin contact

Explores own body for pleasure in infancy

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Coping–Stress Tolerance Pattern

Developmental crisis

Necessary part of growth/development

Learning new skills

Situational crisis—not anticipated as part of normal growth/development

Separation from significant other

Protest: infant cries loudly; screams for mother

Despair: stops crying; withdrawn, apathetic

Withdrawal: ignores mother on her return

Infant: little initial coping ability

Gradually learned over time

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Values-Beliefs Pattern

Parents’ values/beliefs influence care/development of infant

Nursing interventions

Works within parental framework

Examines own attitudes in working with families

Influencing behavior

Modeling behavior

Serving as consultant (listening)

Expressing values/attitudes;

Remaining open to other approaches

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Physical Agents

Leading cause of death

Falls

Most common after 4 months (rolling over)

Do not leave unattended on raised surface

Burns

Deaths from smoke/toxic gasses

Swallowing/choking on foreign objects

Potential: any small object in mouth

Childproof environment

Infant CPR: parents and caregivers

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Biological Agents
AIDS

Acquired immunodeficiency syndrome (AIDS)

Transmission: pregnancy, delivery, breastfeeding

Symptoms usually during first year: infections, developmental delays, failure to thrive

WHO and UNAIDS recommendation

Male circumcision to reduce risk of heterosexually acquired HIV infection in men

Nursing role

Education of disease process, transmission

Prevention of AIDS transmission

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Biological Agents
Immunization

ICDC and AAP recommended schedule

Routine immunizations at birth; 1, 2, 4, 6 months; 12 months

Active immunization

Live, killed, or attenuated organism

Stimulates immune system to build immunity

Diphtheria; tetanus; acellular pertussis; inactivated polio; measles, mumps, and rubella

Passive immunization

Naturally occurs in newborns from maternal antibodies

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Chemical Agents

Drugs

Aspirin, acetaminophen, vitamins

Childproof packaging: not absolute

Prevention

Eliminate hazards from exploring infants

Supervise infants

Poison prevention

Plants—keep out of reach

Cleaners, household supplies

Lock

Safe storage

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Chemical Agents (Cont.)

Toxins: infants are vulnerable

Oral habits, unique diet

Longer life span—potential for damage

Pesticide exposure: food esp produce

Lead—disproportional exposure to infant

Breathe in more air, closer to ground

More mouth-breathing

Oral habits, greater GI absorption

Indoor air pollutants: smoke, carbon monoxide

Water pollution

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Motor Vehicles

Injuries

Improper restraint

Infant on adult lap

Distracting, potential for becoming projectile

Car seats

Rear-facing safety seat for infants to 20 lb

Shield-type of “infant-only” seat to 30 lb

Heat stroke

If left unattended in motor vehicle

Dangerous temperatures occur in 15-30 minutes

Nursing implications

Teach safety; support public awareness

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Radiation and Cancer

Radiation exposure

Natural background radiation (cosmic waves, soil, water, air)

Human made radiation (microwaves, electronic devices)

Infant vulnerability: rapidly growing and immature cells

Cancer

Leading cause of death from disease

Nurse’s role: risk-factor identification, screening, assessment, community education

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Determinants of Health
Day Care Community and Work

Growing need for day care

Center-based facility while parents at work

Separation traumatic for both child and parent

Ideal: mother/infant together 4-6 months before being placed in day care (enhances attachment)

Nurse’s role includes:

Counseling parents on types/screening day care

Helping parents understand separation and expected behaviors

Assisting parents to deal with separation behaviors

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Social Factors and Environment

Culture and ethnicity: from infant’s worldview

Power structure in the cultural group

Breastfeeding decisions

Traditional/folk beliefs

Language

Medium for understanding/working together

Strategies for removing communication barriers

Religion: impacts health

Decisions on treatment

Evaluation of health services

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Levels of Policy Making and Health
Legislation

National goal: improve infant health

Strategies to decrease infant mortality

Family planning services

Pregnancy/infant services

Educational efforts on prenatal care

Immunization efforts

Nursing’s role

Participate in development of health care policy

Coordination of community resources

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Economics and Nursing Role

Poverty impacts infants

Infant mortality rates higher

Higher disease rates

Delayed language development

Nursing interventions

Assess family situation, infant status

Identify community resources

Family advocate in health care system

Participate in legislative process

Health planning council, concerned citizens group

Advisory capacity to local or state legislator

Well child visits—promote and maintain health

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Primary role is to provide the family with education (infancy is critical development period)

Additional roles: support and advocacy

Focusing on the nutritional needs of the infant during the first 18 months of life

Guidance to parents

Encouraging sound practices in the home to foster optimal conditions for normal growth and development. Discussion: Growth and Developmental Patterns

Nursing Application

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Chapter_018-4.ppt

Chapter 18

Toddler

Biology and Genetics

12-18 months → 3 years of age
Overview of developmental/physical changes
2-4 inches height/year; 4-6 lb weight/year
Continue to measure head circumference
May measure length (recumbent) or height (standing)

Physical Characteristics
by System

Kidneys	Specific gravity similar to adults 500-600 mL urine at 2 years old Begin voluntary control
Gastrointestinal	Functional maturity Needs more frequent meals/snacks Control of internal/external anal sphincters
Respiratory	Lung capacity increases Respiratory rate decreases Smaller upper tract diameter (airway obstruction potential)

Physical Characteristics
by System (Cont.)

EENT	Similar to infant Continued risk for otitis media
Endocrine	Become functional (exception: reproductive)
Circulatory	Blood pressure increases Heart rate decreases More effective thermoregulation
Immunity	Active immunity/immunizations by 18 months Exposure to new/different organisms— begin to build immunity

Physical Characteristics
by System (Cont.)

Teeth	All 20 primary teeth erupt by end of toddlerhood At risk of choking because of immature swallowing pattern
Musculoskeletal	Increased size/strength of muscle fibers Myelination of corticospinal tract sufficient for most movement Voluntary motor movements often with involuntary movement on other side of body Does not show hand dominance

Gordon’s Functional Health Patterns

Health perception–health management pattern
Nutritional-metabolic pattern
Elimination pattern
Activity-exercise pattern
Sleep-rest pattern
Cognitive-perceptual pattern
Self-perception–self-concept pattern
Roles-relationships pattern
Sexuality-reproductive pattern
Coping–stress tolerance pattern
Values-beliefs pattern. Discussion: Growth and Developmental Patterns

Health Perception–
Health Management Pattern

Little understanding of health
Depend on caregivers for health management
Health behaviors (e.g., brushing teeth) part of taught rituals
Identify with behavior modeled by caregivers
Nutrition
Exercise

Nutritional-Metabolic Pattern
Nutrition Principles

Ensure adequate iron intake
Moderate amount of milk (low in Fe)
Prevent dental caries: bedtime bottle only water
Juice overconsumption
Appetite decreased—assess intake over several days
Mealtime
Opportunity to offer healthy, age-appropriate choices
Avoid overattention/punishment re food behavior

Elimination Pattern
Toilet Training

Major parental concern
Emotional/physical readiness—usually 18 months of age or older
Nurse provides anticipatory guidance to parents on:
Developmental readiness of child
Parental attitudes and process of toilet training

Activity-Exercise Pattern

Always busy and exploring
Most waking hours at play
Exploring, imitating, creating rituals
Risk for injury
Parallel play: side-by-side, but independent play
Anticipatory guidance
Appropriate toys, opportunities for learning and social encounters, limit TV time

Sleep-Rest Pattern

Need: 12 hours a day; one to two naps
Schedules are helpful to avoid overfatigue
Rituals help develop a sense of security
Night terrors
Normal, less frequent as child develops
Not fully awake
Instruct parent to speak soothingly, do not try to wake child

Cognitive-Perceptual Pattern

Sensorimotor—preoperational
Egocentrism—world as relates to them
Object permanence
Play imperative—learn by repetition
Hearing—critical for language/speech
Hearing loss assessed at birth, can be tested during toddler, preschool years
Otitis media: leading cause of hearing loss in toddlers

Cognitive-Perceptual Pattern (Cont.)

Vision
Amblyopia—diminished or loss of vision in one eye

Brain favors normal eye

Strabismus—deviation in line of vision

Management focused on making child use eye with reduced vision (lazy eye)

Be alert to “red flags” of vision problems (next slide)
Taste and smell
Begin learning conditioned association between smell/taste; develop food aversions

Red Flags of Vision Problems

Rubs eyes excessively
Shuts one eye, tilts head, sideways gaze
Difficulty with close vision
Blinks, frowns, squints on viewing objects
Holds book close to eyes
Red, encrusted or swollen eyelids
Inflamed or watery eyes
Recurrent styes

Self-Perception–Self-Concept Pattern

Erikson: autonomy vs doubt/shame
Relinquish dependence on others
Need to explore world
Physically
Relationships—“NO” and temper tantrums
Guidance to parents
Safe environment
Promoting autonomy
Preventing and dealing with temper tantrums

Roles-Relationship Pattern

Roles understood as they relate to child
Sibling rivalry: ongoing negotiation of roles and relationships
Imitate others
Prefer others’ possessions
Child abuse—nurse’s role
Need to be aware of potential; s/s abuse
Report when child abuse suspected

Sexuality-Reproductive Pattern

Genital exploratory behavior and masturbation
Normal developmental process
Opportunity to learn about body
Parents reaction is variable
Nurse includes this subject when teaching about toilet training
Recommend using correct anatomical terms

Coping–Stress Tolerance Pattern
Temperament

Individual style of emotional or behavioral response across situations
Foundation for coping
Influenced by environmental characteristics
Influences psychosocial adjustments
Nurse can assist parents in recognizing temperament and developing management strategies

Values-Belief Pattern

Healthy behaviors reflect positive values/beliefs
Toddler’s environment
Teach right/wrong
Contribute to security, belonging, autonomy
Values/beliefs
Interactions with parents
Religious rituals/beliefs
Development facilitated by consistent behavioral expectations, reinforcing acceptable behavior

Environmental Processes: Physical Agents

High risk for accidental injury
Structural hazards
“Baby-proof” the environment
Inspect for hazards in unfamiliar environments
Appropriate supervision
Toys
Inspect toys
Risk of small removable parts, batteries, toxic paint, sharp edges

Environmental Processes: Physical Agents (Cont.)

Sports
Improper storage of guns, heavy equipment
Wear bike helmets
Drowning: highest risk ages 1-3
Can drown in water if covers nose/mouth
Danger: pools, tubs, toilets, pails of water
Burns
Hot liquids, electrical cords, fireplaces
Lower water heater to 120-125°F

Motor Vehicle–Related Injury

One of leading causes of death 1-4 years
Child safety seats
Correct seat for weight of child
Proper installation of safety seat
Rear seat position preferred
Pedestrian accident potential at home
Killed/injured in driveway by backing vehicle

Biological Agents and Poisoning

Biological agents
Potential of bioterrorism: talk about fears, appropriate precautions/response
Poisoning—greatest risk ages 1-2
Toddlers use mouth as way to explore environment
Medications, household products, plants, cigarettes, alcohol, cosmetics
Suspected poisoning—contact Poison Control Center
Lead—teach primary prevention, screening (secondary prevention)

Determinants of Health:
Social Factors and Environment

Day care—HHS four-step approach
Interview potential provider and observe setting
Check references
Make decision based on specific criteria
Get and stay involved
Culture and ethnicity
Toddlers shaped by family values/beliefs
Knowledge, respect, negotiation across cultures needed for high-quality health outcomes

Levels of Policy Making and Health

Legislation
Safety and injury prevention
Abuse and neglect protection
Assistance for handicapped children 0-3 years
Economics
Toddler mortality/morbidity rates increase in poverty
Medicaid, uninsured, SCHIP program

Health Services/Delivery System
Health Care Delivery System

Adequacy of system significantly affects health of toddler
Routine assessment needed
Growth/development
Immunizations
Discussion of developmental concerns
Anticipatory guidance

Provide education focused on the physical and developmental changes for toddler
Teach health-promotion activities to toddlers
Engage in screening activities
Promote routine health examinations and childhood immunization schedule
Educate parents about resources available in the community—many free or low cost

Nursing Application
Nursing Involvement with the Family