an overview of growth, development, and nutrition mrs. catherine luksic bsn, rn

An Overview of Growth, Development, and An Overview of Growth, Development, and NutritionNutrition

Mrs. Catherine Luksic BSN, RNMrs. Catherine Luksic BSN, RN

Growth and DevelopmentDifferences between adult and child

The child is in a continuous process of growth and development

Growth spurts followed by plateaus

Not all parts mature at the same time

Key Terms in Child Key Terms in Child DevelopmentDevelopmentDevelopment

A progressive increase in the function of the body

GrowthAn increase in physical size, measured in feet or

meters and pounds or kilograms

MaturationThe total way in which a person grows and develops,

as dictated by inheritance

Stages of growth and developmentFetus: 9th gestational week to birthNeonate: birth to 4 weeksInfant: 4 weeks to 1 yearToddler: 1-3 yearsPreschool: 3-6 yearsSchool-age: 6-12 yearsAdolescent: 12-18 years

Directional PatternsFundamental to all

humansCephalocaudal

Proceeds from head to toe

Proximodistal From midline to

periphery

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Growth StandardsMeasured in

dimensionsHeightWeightVolumeTissue thickness

StandardizedCompare the

measurement of a child to others of the same age and sex

Growth ChartsChildren who are in

good health tend to follow a consistent pattern of growth

There are separate charts for boys and girls


Developmental ScreeningDevelopmental ScreeningDenver Developmental Screening TestAssesses the developmental status of children during

the first 6 years of life in four categories Personal-social Fine motor-adaptive Language Gross motor

Purpose is to identify children unable to perform at an age-appropriate level

Not an intelligence test

Influencing FactorsAll of the following factors are closely related and

dependent on one another in their effect on the growth and development of the childHeredityNationality and race Ordinal position within the familyGenderEnvironment

Types of FamiliesTypes of FamiliesNuclearExtendedSingle parentFoster parentDysfunctional

Dual careerBlended

Family ApgarFamily ApgarUsed to assess family function

Adaptation- shares resourcesPartnership- lines of communicationGrowth- G&DAffection- overt and covertResolve- time, money and space prevent & solve

problemsEnables the nurse to develop interventions that aid

the family to achieve a healthier adaptation to the child’s health needs

Homeless FamilyHas an impact on the growth and development

of a child.

Support system and financial resources often lacking

School or emergency department nurse

Community referrals

Personality DevelopmentPersonality is the result of interaction between

biological and environmental heritages

Maslow’s Hierarchy of NeedsMaslow’s Hierarchy of NeedsThe needs at the

bottom of the pyramid must be met before one can fulfill needs at the next higher level


The Growth and The Growth and Development of a Parent Development of a Parent (cont.)(cont.)

InfantChild’s task

Develop trust. Parent’s task

Learn “cues” presented by infant to determine individual needs.

Nursing interventionHelp parents assess and interpret needs of infant

(avoid feelings of helplessness or incompetence).Do not let grandparents take over parental tasks. Help parents cope with problems such as colic.


ToddlerChild’s task

AutonomyParent’s task

Try to accept the pattern of growth and development. Accept some loss of control but maintain some limits for safety.

Nursing interventionHelp parents cope with transient independence of

child (e.g., allow child to go on tricycle but don’t yell “Don’t fall”).


PreschoolChild’s task

Initiative

Parent’s taskLearn to separate from child.

Nursing interventionHelp parents show standards but “let go” so child

can develop some independence.


School-ageChild’s task

Industry

Parent’s task Accept importance of child’s peers and learn to accept some

rejection from child at times. Patience is needed to allow children to do for themselves, even

if it takes longer. Do not do the school project for the child. Provide chores for child appropriate to his age level.

Nursing intervention Be there to guide child, but do not constantly intrude. Help child get results from his or her own efforts at

performance.


AdolescenceChild’s task

Establishing identityAccepting pubertal changesDeveloping abstract reasoningDeciding on career Investigating lifestylesControlling feelings


Parent’s task Parents must learn to let

child live his or her own life and not expect total control over the child.

Expect, at times, to be discredited by teenager.

Expect differences in opinion and respect them. Guide but do not push.

Nursing intervention Help parents adjust to

changing role and relationship with adolescent.

Expose child to varied career fields and life experiences. Help child to understand emerging emotions and feelings brought about by puberty.

Erikson’s Stages of Erikson’s Stages of DevelopmentDevelopment

Tasks must be mastered at each stage to achieve optimum maturity

Each builds on the successful completion of the previous stage

Piaget’s Theory of Cognitive Piaget’s Theory of Cognitive DevelopmentDevelopmentIntellectual abilityIntellectual maturity is attained through four orderly

and distinct stages of development, all are interrelatedSensorimotor (birth to 2- reflexes)Preoperational (2 to 7 - ego)Concrete operations (7 to11- cause & effect)Formal operations(11to16-scientific process)

Kohlberg’s Theory of Moral Kohlberg’s Theory of Moral DevelopmentDevelopment Moral AbilityTheory is based upon Piaget’sThree levels

Preconventional - 4 to 7 -obedientConventional – 7 to 11 – conformity and loyal, obey

rulesPostconventional – 12 –older – moral values

Emphasis on the conscience of the individual within society

Family Nutrition

USDA dietary guidelinesIntended to help families make informed decisions

about what they eat

Infant Nutritional NeedsRequire more

CaloriesProteinMineralsVitaminsHigher fluid requirements

Fiber Needs of the Young ChildFiber Needs of the Young ChildThe American Academy of Pediatrics recommends

0.5 g of fiber/kg of body weight in childhood, gradually increasing to adult levels of 20 to 35 g/day by the end of adolescence

High-fiber foods can fill the small stomach capacity and provide few of the nutrients and calories needed by the active, growing child

Nutrition and HealthDigestive system of the newborn

Immature and functions minimally for the first 3 months of life

Saliva is minimal

Hydrochloric acid and rennin in the stomach and trypsin found in the intestines aid in the digestion of milk

The physiology of the digestive tract is the basis for introduction of various foods in the first year of life

Feeding the Healthy Child: Feeding the Healthy Child: InfantInfantSymptoms of

underfeeding RestlessnessCryingFailure to gain weight

Symptoms of overfeedingRegurgitationMild diarrheaToo rapid weight gain

High-fat diets causeDelayed gastric emptyingAbdominal distention

High carbohydratesAbdominal distentionFlatus Excessive weight gain

ConstipationToo much fat or proteinDeficiency in “bulk”

Nursing TipWhole milk should not be introduced before 1 year

of age

Low-fat milk should not be introduced before 2 years of age

Feeding the Healthy Child: Feeding the Healthy Child: ToddlerToddler

Can feed themselves by end of second yearImportant in order to develop a sense of independence

Parent should be present at mealtimes

Feeding the Healthy Child: Feeding the Healthy Child: PreschoolPreschoolLikes finger-foods

Regression common in this age group

More vulnerable to protein-calorie deficiencies

Feeding the Healthy Child: Feeding the Healthy Child: School-ageSchool-ageAttitude toward food unpredictable

Intake of protein, calcium, vitamin A, and ascorbic acid tends to be low

Intake of sweets decreases appetite and provides “empty” calories

Feeding the Healthy Child: Feeding the Healthy Child: AdolescentAdolescentGrow rapidly and expend large amounts of energy

Fad food drives a lot of food selections

Fatigue is common in this age group

Childhood ObesityOne-third of all children in the U.S. are overweight

30% to 40% of those are considered obese

Related to obesity in adulthood

Most often related to diet and inactivity

Basal metabolic index (BMI) percentile

Weight in pounds

Height in inches2

times 703

Feeding the Ill ChildMany hospitalized

children have poor appetites

Causes vary depending on illness/disease

Nurse should assessDoes child have any

teeth?Are there any lesions in

the mouth?Can child eat

independently or is assistance needed?

Dentition:

Eruption of teeth starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth".

Average age for teeth eruption:

• Lower central incisors • Upper central incisors • Upper lateral incisors • Lower lateral incisors • Lower first molars • Upper first molars • Lower cuspids • Upper cuspids • Lower 2nd molars • Upper 2nd molars

• Erupt at 6 months • Erupt at 7.5 months • Erupt at 9 months • Erupt at 11 months • Erupt at 12 months • Erupt at 14 months • Erupt at 16 months • Erupt at 18 months • Erupt at 20months • Erupt at 24 months.

Feeding the Ill Child (cont.)A tablespoonful of food for each year of age is a

good guide to follow when feeding a child

Sweet drinks and snacks should not be served just before meals

Infants who are placed on NPO status should be provided with a pacifier to meet their sucking needs

The Teeth (cont.)Important not to neglect baby teeth.(20)Deciduous teeth serve not only in the digestive process

but also in the development of the jawIf these teeth are lost too early, the permanent teeth can

come in poorly alignedDelayed or early eruption can be indicative of certain

endocrine disorders or other pathologic conditionsBottle Mouth occurs when sugars cling to infant’s teeth

and bacteria occursPermanent Teeth- develop before birth but do not erupt

until sixth year

Oral Care in Health and IllnessSticky foods have more potential to cause dental caries than do sugared drinks

Snack foods to avoidSugared gum, dried fruits,

sugared soft drinks, cake, and candy

Recommended snack foodsCheese, milk, sugarless

gum, raw vegetables

Brushing after each meal/snack

Eating a healthy, balanced diet enhances tooth development

Dental CariesOccurs when infant falls

asleep while breastfeeding or is put to bed with a bottle of milk or sweetened juice

Sugar pools in the oral cavity

Most often seen in children 18 months to 3 years of age


Education on Tooth HygieneStarts with first tooth

eruptionBrush before bedtimeFever is not associated

with teething; therefore, cause should be assessed

Replace toothbrush every 3 months or after a viral illness

Do not use a closed container for toothbrush storage

Avoid sharing toothbrushes

PlayPlay is the “work” of

childrenHospital playrooms are

used by children who do not have communicable illnesses (e.g., measles or a draining wound)

Art allows for creative expression

Computer games

Nursing interventions should focus on Encouraging optimal

play activities that are age-appropriate

Helping parents select age- and illness-appropriate toys An asthmatic child should

not be given a stuffed animal to play with

Medical Problems and Medical Problems and Dental HealthDental HealthHealth problem

AsthmaHemophiliaSeizure disordersBulimia

Effect on teethSucrose content of

medications can cause decay

Can cause oral bleeding, impaired healing

Causes decreased saliva; gingival overgrowth

Erosion of teeth from acid content during vomiting

an overview of growth, development, and nutrition mrs. catherine luksic bsn, rn

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