Growth and developmental assessment of the child

Principles of growth & development Principles of growth & development P25P25Major theories of development Major theories of development ＆＆ nursing applicatnursing application ion P26~P36 P26~P36Influences on developmentInfluences on development P36P36各年齡層兒童的生長與發展 各年齡層兒童的生長與發展 P39~P66P39~P66評估評估

Principles of growth & development P25

The exact age at which skill emerge differs, but thThe exact age at which skill emerge differs, but the sequence or order of skill performance is unifore sequence or order of skill performance is uniform among children. m among children. 第第 22 段第段第 22 行行

Cephalocaudal developmentCephalocaudal development Proximodistal developmentProximodistal development Physical size, motor skills, cognitive ability, languPhysical size, motor skills, cognitive ability, langu

age, sensory ability, and psychosocial patterns. age, sensory ability, and psychosocial patterns. These assessments can guide the nurse in planniThese assessments can guide the nurse in planni

ng interventionsfor the child and family.ng interventionsfor the child and family.

Major theories of development ＆ nursing application P26~P36

Simon FreudSimon Freud－－psychosexualpsychosexual

Erik EriksonErik Erikson －－ psychosocialpsychosocial Jean PiagetJean Piaget －－ cognitive developmentcognitive development Chess Chess ＆＆ Thomas Thomas －－ Temperament theorTemperament theor

yy

心理社會發展心理社會發展 Simon FreudSimon Freud

PsychosexualPsychosexual id id 、、 ego ego (defense mechanism (defense mechanism P27P27)) 、、 superegosuperego oraloral 、、 analanal 、、 phallicphallic 、、 latencylatency 、、 genital genital P27P27

Erik EriksonErik Erikson PsychosocialPsychosocial

Trust v.s. mistrust (birth to 1 year)Trust v.s. mistrust (birth to 1 year)Autonomy v.s. shame and doubt (|1 to 3 years)Autonomy v.s. shame and doubt (|1 to 3 years) Initiative v.s. guilt (3 to 6 years)Initiative v.s. guilt (3 to 6 years) Industry v.s. inferiority (6 to 12 years)Industry v.s. inferiority (6 to 12 years) Identity v.s. role confusion (12 to 18 years)Identity v.s. role confusion (12 to 18 years)

Two possible outcomes Two possible outcomes P27P27 倒數第四行最後倒數第四行最後• HealthyHealthy ＆＆ moves on to future stagesmoves on to future stages• Unhealthy outcomeUnhealthy outcome ＆＆ will influence future sowill influence future so

cial relationships.cial relationships.

心理社會發展 心理社會發展 P27, 29, 30P27, 29, 30

Jean Piaget P30~32

Cognitive developmentCognitive development Accommodation( 適應 ) Assimilation( 同化 )&change

Sensorimotor (birth to 2 years) Preoperational (2 to 7 year) Concrete operation (7 to 11 years) Formal operation (11 years to adulthood)

Chess ＆ Thomas P34~36

Temperament theory Temperament theory 先天就決定的對內在或外在刺激的反應模式先天就決定的對內在或外在刺激的反應模式

Nine parameters of response to daily events (TablNine parameters of response to daily events (Table 2-5) e 2-5) P35P35

Three major personality types (Table 2-6) Three major personality types (Table 2-6) P35P35

Nursing ApplicationNursing Application

Influences on development P36

GeneticsGenetics Prenatal influencesPrenatal influences Cultural influencesCultural influences Others influencesOthers influences

NutritionNutrition 、、 Family structureFamily structure 、、 SchoolSchool 、、StressStress 、、 Socioeconomic Socioeconomic influencesinfluences 、、 CommunityCommunity 、、 MediaMedia

各年齡層兒童的生長與發展 Physical growth and developmentPhysical growth and development Cognitive developmentCognitive development Injury prevention Injury prevention Personality and TemperamentPersonality and Temperament Play and communicationPlay and communication SexualitySexuality

P39

Infant Physical growth and development Physical growth and development P40-42P40-42

The first year of life is one of rapid change for the infant. The first year of life is one of rapid change for the infant. P40P40 第第 11段段

The birth weight usually doubles by about 5 months and triples by The birth weight usually doubles by about 5 months and triples by the end of the first year(Figure 2-7*).the end of the first year(Figure 2-7*).

Height increases by approximately l foot during this year.Height increases by approximately l foot during this year. Teeth begin to erupt at about 6 months, and by the end of the first Teeth begin to erupt at about 6 months, and by the end of the first

year the infant has six to eight deciduous teeth (see Chapter 4). year the infant has six to eight deciduous teeth (see Chapter 4). Kidney and liver maturation helps infant excrete drugs or other toxKidney and liver maturation helps infant excrete drugs or other tox

ic substances. ic substances. P40P40 第第 22 段段 Maturation of the nervous system is demonstrated by increased conMaturation of the nervous system is demonstrated by increased con

trol over body movements, enabling the infant to sit, stand, and watrol over body movements, enabling the infant to sit, stand, and walk. lk.

Sensory function also increases as the infant begins to discriminate Sensory function also increases as the infant begins to discriminate visual images, sounds, and tastes. visual images, sounds, and tastes.

參考參考 Table 2-11Table 2-11

Infant Cognitive development Cognitive development P42-43P42-43

The newborn's eyes widen an response to sound. The newborn's eyes widen an response to sound. Turns to the sound and recognizes its significance.Turns to the sound and recognizes its significance. The 2-month-old cries and coosThe 2-month-old cries and coos 1/y says few words and understands many more.1/y says few words and understands many more. The 6-week-old grasps a rattle .The 6-week-old grasps a rattle . The l-year-old reaches for toys and self-feeds.The l-year-old reaches for toys and self-feeds.

The infant receives stimulation through sight, sound, and The infant receives stimulation through sight, sound, and feeling, which the maturing brain interprets. This input feeling, which the maturing brain interprets. This input from the environment interacts with internal cognitive from the environment interacts with internal cognitive abilities to enhance cognitive functioning.abilities to enhance cognitive functioning.

Infant

Injury prevention Injury prevention P44P44

Major cause of death in childhood.Major cause of death in childhood. Increasing mobility Increasing mobility

Infant Personality and Temperament Personality and Temperament P45P45

They may display varying degrees of regularity in They may display varying degrees of regularity in activities of eating and sleeping, and manifest a capacity activities of eating and sleeping, and manifest a capacity for concentrating on tasks for different amounts of for concentrating on tasks for different amounts of timetime . .

The parents can appreciate more fully the uniqueness of The parents can appreciate more fully the uniqueness of their infant and design experiences to meet the infant's their infant and design experiences to meet the infant's needs. Parents can learn to modify the environment to needs. Parents can learn to modify the environment to promote adaptation.promote adaptation.

Although the infant's temperament is unchanged, the Although the infant's temperament is unchanged, the

ability to fit with the environment is enhanced.ability to fit with the environment is enhanced.

Toddler First adolescence. First adolescence. Displaying independence and negativism .Displaying independence and negativism .

Physical growth and development Physical growth and development P47P47 Growth slowsGrowth slows By age 2 years, the birth weight has usually quadrupled and By age 2 years, the birth weight has usually quadrupled and

the child is about one half of the adult height. the child is about one half of the adult height. Body proportions begin to change, with legs longer and heaBody proportions begin to change, with legs longer and hea

d smaller in proportion to body size than during infancy (sed smaller in proportion to body size than during infancy (see Figure 2-7). e Figure 2-7).

The toddler has a pot-bellied appearance and stands with feThe toddler has a pot-bellied appearance and stands with feet apart to provide a wide base of support. et apart to provide a wide base of support.

By approximately 33 months, eruption of deciduous teeth iBy approximately 33 months, eruption of deciduous teeth is complete, with 20 teeth present.s complete, with 20 teeth present.

粗及精細動作發展圖粗及精細動作發展圖 P48, P49Table 2-16 Toilet Training P48, P49Table 2-16 Toilet Training

Toddler P47

Cognitive developmentCognitive development Preoperational stagePreoperational stage Object permanence is well developed.Object permanence is well developed. About 2 years of age, increasing use of words .About 2 years of age, increasing use of words . Rudimentary problem solving, creative Rudimentary problem solving, creative

thought, and an understanding of cause-and-thought, and an understanding of cause-and-effect relationships are now possible. effect relationships are now possible.

Toddler Injury prevention Injury prevention P49P49

Family want to know Family want to know P50P50 Table 2-18 Injury Prevention in ToddlerhoodTable 2-18 Injury Prevention in Toddlerhood P51 P51

乘坐對象 乘 坐 標 準 安 全 椅

放 置 位 置

使用安全椅

種 類

一 一歲以下或 體重未到達 10公斤嬰兒

汽 車 後 座 嬰兒用安全椅或臥床

二 一至四歲以下或體重在 10-18公斤幼童

汽 車 後 座 兒童用座椅

三

四歲至十二歲以下 或體重在 18-36公斤兒童

汽 車 後 座 使用安全帶

每個安全椅以乘坐一位兒童為限，以維護兒童乘車安全。

九十三年六月一日起，兒童未依規定乘坐安全椅，處駕駛人新臺幣五百元罰鍰。

Toddler

Personality and Temperament Personality and Temperament P50P50

The toddler retains most of the temperamental The toddler retains most of the temperamental characteristics identified during infancy, but may characteristics identified during infancy, but may demonstrate some changes. demonstrate some changes.

Increasing independence characteristic of this Increasing independence characteristic of this age is shown by the toddler's use of the word age is shown by the toddler's use of the word nono..

Preschool child

A time of new initiative and independence. A time of new initiative and independence. Most children are in a child care center or Most children are in a child care center or

school for part of the day and learn a great deal school for part of the day and learn a great deal from this social contact.from this social contact.

Language skills are well developed, and the Language skills are well developed, and the child is able to understand and speak clearly. child is able to understand and speak clearly.

The world of busy preschoolers.The world of busy preschoolers.

P52

Preschool child

Physical growth and developmentPhysical growth and development Grow slowly and steadily, with most growth Grow slowly and steadily, with most growth

taking place in long bones of the arms and legs.. taking place in long bones of the arms and legs.. Runs with ease, holds a bat, and throws balls of Runs with ease, holds a bat, and throws balls of

various types.various types. Writing ability increases, enjoys drawing and Writing ability increases, enjoys drawing and

learning to write a few letters.learning to write a few letters. Begin to brush their own teeth, and schedule the Begin to brush their own teeth, and schedule the

first dental visit so the child can become first dental visit so the child can become accustomed to the routine of periodic dental care.accustomed to the routine of periodic dental care.

Table 2-20.Table 2-20.

P52-54P52-54

Preschool child

Cognitive developmentCognitive development Preoperational thought. Preoperational thought. Symbols or words Symbols or words Still has some limitations in thought (Table 2-22).Still has some limitations in thought (Table 2-22).

P54

Preschool child

Injury preventionInjury prevention Increasing independence. Increasing independence. At high risk of injury from fire, drowning, At high risk of injury from fire, drowning,

and motor vehicle and pedestrian accidentsand motor vehicle and pedestrian accidents..

P55

Preschool child

Personality and TemperamentPersonality and Temperament Characteristics of personality tend to persist over Characteristics of personality tend to persist over

time. time. The preschooler may need assistance as these The preschooler may need assistance as these

characteristics are expressed in the new situations characteristics are expressed in the new situations of preschool or nursery schoolof preschool or nursery school

To identify the child's personality or temperament To identify the child's personality or temperament characteristics and to find the best environment for characteristics and to find the best environment for growth..growth..

P55

School-age child Physical growth and development Physical growth and development P58P58

Long bones continue to grow, leg length increases. Long bones continue to grow, leg length increases. Fat gives way to muscle, and the child appears leaner. Fat gives way to muscle, and the child appears leaner. toothtooth

the first deciduous tooth is lost at 6 years and permanent teeth begin the first deciduous tooth is lost at 6 years and permanent teeth begin to erupt. to erupt.

Closely monitored to ensure that brushing and flossing are adequate.Closely monitored to ensure that brushing and flossing are adequate. Loose teeth are identified before surgery or other events that may Loose teeth are identified before surgery or other events that may

lead to loss of a tooth. lead to loss of a tooth. Body organs and the immune system mature.Body organs and the immune system mature. Medications are less likely to cause serious side effects. Medications are less likely to cause serious side effects. The urinary system can adjust to changes in fluid status. The urinary system can adjust to changes in fluid status. Rapid increases in size commonly occur during school age.Rapid increases in size commonly occur during school age. Physical skills are also refined . (Table 2-25).Physical skills are also refined . (Table 2-25).

School-age child

Cognitive developmentCognitive development CConcrete operational thought at about 7 years. oncrete operational thought at about 7 years. Consider alternative solutions and solve problems. Consider alternative solutions and solve problems. Rely on concrete experiences and materials to form Rely on concrete experiences and materials to form

their thought content.their thought content. Learns the concept of conservation.Learns the concept of conservation.

P59P59

School-age child

Injury preventionInjury prevention

Play in unsupervised settings for longer periodsPlay in unsupervised settings for longer periods . .

P61P61

School-age child

Personality and TemperamentPersonality and Temperament The enduring aspects of temperament The enduring aspects of temperament

continue to be manifested during the continue to be manifested during the school years. school years.

Creative efforts and alternative methods Creative efforts and alternative methods of learning should be valued. of learning should be valued.

Encourage parents to see their children as Encourage parents to see their children as individuals who may not all learn in the individuals who may not all learn in the

same waysame way. .

P62P62

School-age child SexualitySexuality

Although children become aware of Although children become aware of sexual differences between genders during sexual differences between genders during preschool years, they deal much more preschool years, they deal much more consciously with sexuality during school consciously with sexuality during school age. age.

Need information about their bodily Need information about their bodily changes .changes .

Become interested in sexual issues .Become interested in sexual issues .

P62P62

Adolescent child

A period of identity formationA period of identity formation.. Physical growth and developmentPhysical growth and development

The physical changes ending in puberty, or sexual The physical changes ending in puberty, or sexual maturity, begin near the end of the school-age period. maturity, begin near the end of the school-age period.

The prepubescent period : growth spurt. The prepubescent period : growth spurt. The increase in height and weight is generally remarkable. The increase in height and weight is generally remarkable. Girls :breast sizeGirls :breast size , pubic hair & menstruation occurs. , pubic hair & menstruation occurs. Boys: penis and testes size Boys: penis and testes size , pubic hair, deepening of the , pubic hair, deepening of the

voice and growth of facial hair occur later. voice and growth of facial hair occur later. Take adult doses of medications. Take adult doses of medications. Table 2-28Table 2-28

P62P62

Adolescent child Cognitive development Cognitive development P63P63

Formal operational thought.Formal operational thought. The ability to reason abstractly. The ability to reason abstractly. The ability to think and act independently leads The ability to think and act independently leads

many adolescents to rebel against parental many adolescents to rebel against parental authority. Through these actions, adolescents authority. Through these actions, adolescents

seek to establish their own identity and values.seek to establish their own identity and values.

Adolescent child Injury preventionInjury prevention

They often believe they are immune from harm. This eThey often believe they are immune from harm. This encourages adolescents to put themselves at high risk froncourages adolescents to put themselves at high risk from dangerous behaviorsm dangerous behaviors . . P63 倒數第 3 行

Motor vehicle crashes, suicides, and homicides cause 7Motor vehicle crashes, suicides, and homicides cause 75% of adolescent deaths5% of adolescent deaths . . P63 此段第 1 行

Suicide among adolescents has increased by 300% oSuicide among adolescents has increased by 300% over the past four decades and is the second leading cver the past four decades and is the second leading cause of death from l5 to l9 years(MMWR, 1995; Haause of death from l5 to l9 years(MMWR, 1995; Hayden & Leuer, 2000) . yden & Leuer, 2000) . P64 第 2 行

The high rate of stress experienced, harmful substanThe high rate of stress experienced, harmful substances and firearms promotes death by suicide. ces and firearms promotes death by suicide. P64 倒數第 4 行

Violence is an increasingly important factor in adoleViolence is an increasingly important factor in adolescent injury. scent injury. P65 P65 第第 22 段第段第 11 行行

P63-65

Adolescent child Personality and TemperamentPersonality and Temperament

Characteristics of temperament manifested Characteristics of temperament manifested during childhood usually remain stable in thduring childhood usually remain stable in the teenage years. e teenage years.

It is also common for an adolescent who waIt is also common for an adolescent who was an easy child to become more difficult becs an easy child to become more difficult because of the psychologic changes of adolesceause of the psychologic changes of adolescence and the need to assert independence. nce and the need to assert independence.

P65

Adolescent child

SexualitySexuality Achieves sexual maturityAchieves sexual maturity

Interactions with members of the opposite sex.Interactions with members of the opposite sex. The forces of society and familyThe forces of society and family

Identity formationIdentity formation. .

P66

評估 兒童完整健康史兒童完整健康史 身體檢查與評估身體檢查與評估 身心發展評估工具身心發展評估工具

兒童完整健康史 個人：病史、營養史、發展史個人：病史、營養史、發展史 家庭評估：家族史、家庭內家庭評估：家族史、家庭內 // 外在結構、家外在結構、家

庭互動庭互動 營養評估：體重及生長發育的情形、血比容營養評估：體重及生長發育的情形、血比容

及血紅素、皮膚及皮下脂肪、排泄睡眠精及血紅素、皮膚及皮下脂肪、排泄睡眠精力）（飲食習慣、進食的量與質、對食物的力）（飲食習慣、進食的量與質、對食物的喜好以及吸收的狀況喜好以及吸收的狀況 熱量需要量熱量需要量 奶量的計算奶量的計算 副食品添加（嬰幼兒每天飲食建議量）副食品添加（嬰幼兒每天飲食建議量） Physiologic anorexiaPhysiologic anorexia

熱量需要量 0-6M 115 Cal/Kg0-6M 115 Cal/Kg 6-12 105 Cal/Kg 6-12 105 Cal/Kg

<1y/o 110-120 Cal/Kg<1y/o 110-120 Cal/Kg 1y/o1y/o 左右 左右 1300 Cal/day1300 Cal/day > 1y/o > 1y/o 每增每增 11 歲增加歲增加 100 Cal100 Cal

奶量的計算 全奶 全奶 14%14%

30 ml = 20Cal30 ml = 20Cal

嬰幼兒每天飲食建議量 1~31~3 個月大個月大

牛奶占牛奶占 100100 ％％ 44 ～～ 66 個月大個月大

牛奶占牛奶占 8080 ～～ 9090 ％％ 副食品：果汁、青菜湯、麥糊或米糊副食品：果汁、青菜湯、麥糊或米糊

77 ～～ 12 12 個月大個月大 牛奶占牛奶占 5050 ％～％～ 70 70 ％％ 副食品：稀飯、麵條、蛋副食品：稀飯、麵條、蛋

11 ～～ 22 歲歲 牛奶占牛奶占 3030 ％％

身體檢查與評估 技巧技巧 ---- 視、聽、叩、觸診視、聽、叩、觸診

生長測量生長測量身高、體重、頭圍之生長曲線圖、身高、體重、頭圍之生長曲線圖、成長曲線圖成長曲線圖

生理測量生理測量體溫、脈搏、呼吸、血壓 體溫、脈搏、呼吸、血壓

器官或系統的檢查與評估 器官或系統的檢查與評估

兒童生長可能有問題的情況

身高與體重的百分位相距太大身高與體重的百分位相距太大 無法達到預期的生長速度無法達到預期的生長速度 (( 尤其是嬰幼兒及青尤其是嬰幼兒及青

少年期少年期 )) 成長突然增快或遞減成長突然增快或遞減

身心發展評估工具 DDSTDDST （（ Denver Developmental Screening TesDenver Developmental Screening Tes

tt ）） 社會適應、精細動作、粗動作、語言發展社會適應、精細動作、粗動作、語言發展

BSIDBSID （（ Bayley Scales of infant DevelopmentBayley Scales of infant Development ）） 心智、動作、行為量表心智、動作、行為量表

PDMAPDMA （（ Peabody Developmental Motor Scales Peabody Developmental Motor Scales and Activity Cardsand Activity Cards ））

氣質評估量表氣質評估量表 活動量、規律性、注意力分散度、趨避性、堅持活動量、規律性、注意力分散度、趨避性、堅持

性、反映閥、適應性、反應強度以及情緒本質。性、反映閥、適應性、反應強度以及情緒本質。

P197 Table 6-2, P198 Table 6-3

氣質量表

嬰兒氣質評估量表嬰兒氣質評估量表學步期幼兒氣質量表學步期幼兒氣質量表兒童氣質量表兒童氣質量表青少年氣質量表青少年氣質量表

徐澄清， “小時了了”