Chapter 15 An Overview of Growth, Development, and Nutrition Mrs. Briane Flaherty RN, BSN.

Chapter 15

An Overview of Growth, Development, and Nutrition

Mrs. Briane Flaherty RN, BSN

Growth and Development• Differences 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 Development• Development

– A progressive increase in the function of the body

• Growth– An increase in physical size, measured in feet or meters and

pounds or kilograms

• Maturation– The total way in which a person grows and develops, as dictated

by inheritance

Stages of growth and development

• Fetus: 9th gestational week to birth• Neonate: birth to 4 weeks• Infant: 4 weeks to 1 year• Toddler: 1-3 years• Preschool: 3-6 years• School-age: 6-12 years• Adolescent: 12-18 years

Directional Patterns• Fundamental to all humans

– Cephalocaudal• Proceeds from head

to toe– Proximodistal

• From midline to periphery

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Growth Standards• Measured in

dimensions– Length/Height– Weight– Volume– Tissue thickness

• Standardized– Compare the

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

Growth Charts• Children who are in good

health tend to follow a consistent pattern of growth

• There are separate charts for boys and girls


Developmental ScreeningDenver Developmental Screening Test

Assesses the developmental status of children during the first 6 years of life in four categories

Personal-socialFine motor-adaptiveLanguageGross motor

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

Not an intelligence test

Influencing Factors• All of the following factors are closely related and dependent on one

another in their effect on the growth and development of the child– Heredity– Nationality and race – Ordinal position within the family– Gender– Environment

Types of Families

• Nuclear• Extended• Single parent• Foster parent• Dysfunctional

• Dual career• Blended

Family Apgar• Used to assess family function

– Adaptation- shares resources– Partnership- lines of communication– Growth- G&D– Affection- overt and covert– Resolve- time, money and space prevent & solve problems

• Enables 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 Development• Personality is the result of interaction between biological and

environmental heritages

Maslow’s Hierarchy of Needs

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


The Growth and Development of a Parent (cont.)

• Infant– Child’s task

• Develop trust. – Parent’s task

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

– Nursing intervention• Help 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

Autonomy

Parent’s taskTry 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”).


• Preschool– Child’s task

• Initiative

– Parent’s task• Learn to separate from child.

– Nursing intervention• Help parents show standards but “let go” so child

can develop some independence.


• School-age– Child’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.


• Adolescence– Child’s task

• Establishing identity• Accepting pubertal changes• Developing abstract reasoning• Deciding on career• Investigating lifestyles• Controlling 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 Development

• 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 Development

• Intellectual ability• Intellectual maturity is attained through four orderly and distinct

stages of development, all are interrelated– Sensorimotor (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 Development

• Moral Ability• Theory is based upon Piaget’s• Three levels

– Preconventional - 4 to 7 -obedient– Conventional – 7 to 11 – conformity and loyal, obey rules– Postconventional – 12 –older – moral values

• Emphasis on the conscience of the individual within society

Family Nutrition

• USDA dietary guidelines– Intended to help families make informed decisions about what

they eat

Infant Nutritional Needs• Require more

– Calories– Protein– Minerals– Vitamins– Higher fluid requirements

Fiber Needs of the Young Child

• The 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: InfantSymptoms 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 Tip• Whole 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: Toddler

• Can feed themselves by end of second year– Important in order to develop a sense of independence

• Parent should be present at mealtimes

Feeding the Healthy Child: Preschool

• Likes finger-foods

• Regression common in this age group

• More vulnerable to protein-calorie deficiencies

Feeding the Healthy Child: School-age

• Attitude 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: Adolescent

• Grow rapidly and expend large amounts of energy

• Fad food drives a lot of food selections

• Fatigue is common in this age group

Childhood Obesity• One-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 Child• Many hospitalized

children have poor appetites

• Causes vary depending on illness/disease

• Nurse should assess– Does child have any

teeth?– Are there any lesions

in the mouth?– Can child eat

independently or is assistance needed?

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

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

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 jaw• If these teeth are lost too early, the permanent teeth can come in

poorly aligned• Delayed or early eruption can be indicative of certain endocrine

disorders or other pathologic conditions• Bottle Mouth occurs when sugars cling to infant’s teeth and

bacteria occurs• Permanent Teeth- develop before birth but do not erupt until sixth

year

Oral Care in Health and Illness

• Sticky foods have more potential to cause dental caries than do sugared drinks

• Snack foods to avoid– Sugared gum, dried fruits,

sugared soft drinks, cake, and candy

• Recommended snack foods– Cheese, milk, sugarless

gum, raw vegetables

• Brushing after each meal/snack

• Eating a healthy, balanced diet enhances tooth development

Dental Caries

Occurs 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 Hygiene• Starts with first tooth

eruption• Brush before bedtime• Fever 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

Medical Problems and Dental Health

• Health problem– Asthma– Hemophilia– Seizure disorders– Bulimia

• Effect on teeth– Sucrose 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

Play• Play is the “work” of children• Hospital 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

Chapter 15 An Overview of Growth, Development, and Nutrition Mrs. Briane Flaherty RN, BSN.

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Transcript of Chapter 15 An Overview of Growth, Development, and Nutrition Mrs. Briane Flaherty RN, BSN.