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Chapter 17
The Pediatric Client
17-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Fundamental Concepts of Growth and Development
Growth refers to the quantitative changes in physical size of the body and its parts.
Development refers to behavioral changes and increasing competency in functional abilities and skills.
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Maturation describes the increasing complexity of a person’s capabilities.
Maturation involves biological growth, functional changes, and learning that come with age.
Fundamental Concepts of Growth and Development
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Principles of Growth and Development
Occurs in a cephalocaudal direction and proximodistal manner
Occurs from simple to complex and from the general to the specific
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All individuals go through the same developmental processes.
Growth and development do not proceed at a consistent rate.
The pattern of growth and development is continuous, orderly, and predictable.
Principles of Growth and Development
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Every person proceeds through stages of growth and development at an individual rate.
Every stage of development has specific characteristics.
Each stage of development has certain tasks to be achieved or acquired during that specific time.
Principles of Growth and Development
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Principles of Growth and Development
Some stages of growth and development are more critical than others.
A critical period can be a time of the most rapid growth or development in a particular stage of the life cycle.
Growth and development may temporarily be stalled or regress during critical periods “touch points.”
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Factors Influencing Growth and Development
Heredity Health Status Life Experiences Cultural Expectations
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Factors Influencing Growth and Development
Heredity• The genetic composition of an individual
determines physical characteristics.• Determines to a great extent the rate of
physical and mental development.
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Factors Influencing Growth and Development
Health Status• Illness or disability can interfere with the
achievement of developmental milestones.
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Factors Influencing Growth and Development
Life Experiences• A child’s experiences can influence the rate
of growth and development.
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Factors Influencing Growth and Development
Cultural Expectations• The age at which an individual masters a
particular task is determined in part by culture.
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Theoretical Perspectives of Human Development
Physiological growth of an individual is influenced primarily by interaction of genetic predisposition, the central nervous system, the endocrine system, and maturation.
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Theoretical Perspectives of Human Development
Psychosocial Dimension• Consists of subjective feelings and
interpersonal relationships.
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Theoretical Perspectives of Human Development
Self-concept is a view of one’s self, and is likely the most important key to a person’s success and happiness. • Body Image• Self-Esteem • Ideal Self
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Characteristics of an Individual with a Positive Self-Concept
Self-confidence Willingness to take risks Ability to receive criticism without
defensiveness Ability to adapt effectively to stressors Innovative problem-solving skills
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Psychosocial Dimension
Intrapsychic (psychodynamic) Theory• Focuses on an individual’s unconscious
processes, which are feelings, needs, conflicts, and drives.
• Sigmund Freud and Erik Erikson are two major intrapsychic theorists.
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Sigmund Freud
Viewed the personality as a three-part structure: the id, the ego, and the superego.
Believed that personality development was completed in the final stages of adolescence.
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Erik Erikson
Expanded Freud’s concept of developmental stages to a lifelong process.
Certain psychosocial tasks must be mastered in each of eight developmental stages.
Each stage poses a conflict that can have favorable or unfavorable outcomes.
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Psychosocial Dimension
Self-fulfilling cycle in positive self-concept
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Psychosocial Dimension
Interpersonal Theory (Harry Stack Sullivan)• Relationships with others influence how
one’s personality develops.• Approval and disapproval from significant
others shape the formation of one’s personality.
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Cognitive Dimension• Perception, memory, and judgment• Develops throughout the life span
Theoretical Perspectives of Human Development
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Cognitive Dimension
Jean Piaget• Observations of children learning to think by
playing
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Jean Piaget
Intellectual development is characterized by four phases as the child interprets and uses the environment. • Sensorimotor• Preoperative• Concrete Operations• Formal Operations
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Jean Piaget
The individual learns by interacting with others and the environment through:• Assimilation• Accommodation• Adaptation
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Moral Dimension• A person’s value system that helps in
differentiating right and wrong.• Moral maturity is the ability to independently
decide for one’s self what is “right.”
Theoretical Perspectives of Human Development
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Moral Dimension
Lawrence Kohlberg• Framework for understanding how
individuals, over time, develop a moral code to guide their behavior and make moral judgments
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Spiritual Dimension• Relationships with one’s self, with others,
and with a higher power or divine source• Characterized by a sense of personal
meaning
Theoretical Perspectives of Human Development
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Holistic Framework for Nursing
Respect for the diversity of persons, their values, and beliefs
Understanding human responses to health problems and their effects on development
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Holistic Framework for Nursing
Planning involvement of children and their families in assuming responsibility for self-care
Tailoring communication skills to the client’s age and development
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Stages of the Life Cycle
Nursing implications for each stage of the life cycle include assessment, wellness promotion, and safety considerations.
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Stages of the Life Cycle
The prenatal period begins with conception and ends with birth.• Germinal Stage • Embryonic Stage• Fetal Stage
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Prenatal Period
Nursing Implications • Early prenatal care is essential for a positive
pregnancy outcome.- Physical examinations and screenings
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Wellness Promotion during the Prenatal Period
The uterus is the primary environment affecting prenatal growth and development.• Physiological assessment• Teaching nutritional guidelines• Teaching relaxation techniques to promote a
supportive environment
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Safety Considerations during the Prenatal Period
A teratogenic substance is any substance that can cross the placental barrier and impair normal growth and development.
- Medicines- Illegal drugs- Nicotine- Alcohol
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Prenatal Safety Considerations
Nicotine crosses the placental barrier, and interferes with oxygen transport to the fetus.• Increased risk of premature birth, retarded
growth, learning difficulties, and fetal death
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Prenatal Safety Considerations
Alcohol consumption is most dangerous during the first 3 months of pregnancy.
Fetal alcohol syndrome is considered to be the leading cause of mental retardation among infants.
The effects of alcohol on the fetus are permanent.
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Neonate• First 28 days of life following birth.• Major physiological adjustments to
extrauterine life.• The major psychological task of neonates is
to adjust to the parental figures.• Bonding is the formation of attachment
between parent and child.
Stages of the Life Cycle
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Neonate
Nursing Implications• Complete and thorough physical
assessment includes evaluation of neonate’s reflexes, respiratory and cardiac functioning.
• The Apgar assessment tool is performed at 1 minute and again at 5 minutes.
• Parents are encouraged to cuddle the newborn and establish eye contact.
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Neonate
Bonding between a parent and neonate; consider the factors that may have an impact on the early attachment between this father and daughter.
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Wellness Promotion during the Neonate Period
Teaching basic newborn needs (to be held, rocked, and talked to).
Teaching hygienic practices. Monitoring nutritional status. Conducting screening tests. Promoting early parent-neonate
interaction.
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Safety Considerations during the Neonate Period
Accidents are the primary cause of neonatal mortality.• Teaching parents about infant seats
Maintenance of skin integrity
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Infant • From the first month to the first year of life• Continued adaptation with rapid physiologic
growth and psychosocial development
Stages of the Life Cycle
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Nursing Implications during theInfant Period
Safety, prevention of infection, and teaching parents about incorporating the child into the family
Provision of support, reassurance, and information to the parents
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Wellness Promotion for the Infant
Breast feeding/formulas Introduction of solid foods Immunization Promotion of sleep Growth and development concepts
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Wellness Promotion for the Infant
Teaching parents preventive measures regarding respiratory infections and parasitic diseases
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Safety Considerations for the Infant
Consistent and proper use of infant car seats is one of the most effective safety measures parents can take.
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Toddler • Begins at 12 to 18 months of age, when a
child begins to walk alone; ends at approximately age 3.
• Child becomes more independent.• The toddler’s frequent use of the word “no”
is an expression of developing autonomy.
Stages of the Life Cycle
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Nursing Implications during theToddler Stage
Toddlers need to have regular health examinations and immunizations.
Play is an effective tool for building rapport with toddlers.
Parents are encouraged to actively participate during examination and immunizations.
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Wellness Promotion for the Toddler
Nutritional needs change as growth rate slows and caloric needs decrease from infancy.
Expect sporadic eating patterns. Establish a mealtime routine. Avoid power struggles during meals.
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Toddlers, with their increased mobility and curiosity, are especially prone to accidental poisonings.
Use age-appropriate toys and child-proof the home and surrounding environment.
Safety Considerations for the Toddler
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Preschooler • Ages 3 to 6 years.• Physical growth slows and psychosocial and
cognitive development accelerate.• The child’s world begins to expand.• The child is better able to communicate.
Stages of the Life Cycle
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Preschooler
Nursing Implications• Play is the mechanism used to learn about
the environment and develop relationships.• Play is a tool used by nurses with
preschoolers to help reduce fear and anxiety.
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Wellness Promotion for the Preschooler
Optimum time to promote lifelong health-promoting lifestyles.
It is important for nurse to communicate at the child’s level of comprehension.
Immunization is a major wellness intervention.
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Safety Considerations for the Preschooler
Eagerness to explore the environment and cognitive immaturity lead to risk of an accident.
Common accidents are burns, falls, drowning, animal bites, and ingestion of poisonous substances.
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Safety Considerations for the Preschooler
Role modeling by adults is the best method of developing safety habits in the preschooler. These habits will tend to be lifelong.
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School-Age Child • Ages 6 to 12 years.• The child’s world expands greatly.• Play time becomes more structured and less
spontaneous.
Stages of the Life Cycle
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School-Age Child
Involvement in academics, sports, and social activities stimulates the development of creativity and provides outlets for its expression.
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School-Age Child
Nursing Implications• Common health problems may affect growth
and development.• Hospitalized children and children with
illnesses who require home care have very special needs.
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Wellness Promotion and the School-Age Child
Promote healthy lifestyles with children in schools.
Parent Education• Proper nutrition• Immunizations• Dental care• Safety precautions• Adequate rest/sleep.
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Safety Considerations and theSchool-Age Child
Many accidents occur during play. Common injuries are related to use of
skates, skateboards, in-line skates, and bicycles.
Children must also be taught to use caution with strangers.
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Preadolescent• Ages 10 to 12 years.• Begins to experience hormonal changes that
will result in the onset of puberty.• Girls generally experience preadolescence
at a younger age than boys.
Stages of the Life Cycle
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Nursing Implications• Sensitivity and a nonjudgmental approach• Attending to the child’s language• Encouraging the child to ask questions
about any health-related concerns
Preadolescent
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Wellness Promotion for thePreadolescent
Information about nutrition, rest, and activity, and the physiological changes that are occurring• Growth spurt• Sexual and psychosocial changes
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Safety Considerations for thePreadolescent
Risk for sports and play injuries Risk for violence, both in and away from
the home Education about violence, substance
abuse, sex education, and development of healthy lifestyle
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Adolescent • Onset of puberty to ages 18 to 20• Major transition from child to adult
Stages of the Life Cycle
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Adolescent
Establishing a sense of personal identity uses a great amount of the adolescent’s psychic energy.
Emphasis on physical attractiveness sometimes results in eating disorders.
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Nursing Implications• The nurse must honor the adolescent’s
choice to withhold sensitive information from parents.
• Adolescents should be treated in a respectful, dignified manner.
• A nonjudgmental attitude is essential to the establishment of rapport with adolescents.
Adolescent
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Adolescent
Wellness Promotion• Hygiene• Nutrition• Sex education• Developmental changes• Substance abuse prevention
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Safety Considerations for the Adolescent
Risk for Accidents• Testing limits• Impulsive behavior• Sense of being invulnerable• Rebelling against adult advice
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Adolescent Safety Considerations
The stressors of adolescence cause many health problems in adolescents.
Stressors affect sexual behavior, risk for suicide, and substance abuse.
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Adolescent Safety Considerations
Sexual Behaviors• Teenage pregnancy• Sexually transmitted diseases
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Adolescent Safety Considerations
High Risk of Suicide• Often, suicide is perceived by the adolescent
as the only alternative to an overwhelming situation.
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Adolescent Safety Considerations
Substance Abuse• Using alcohol or other drugs is a common
maladaptive attempt to cope with stressors.
