Infants and Toddlers Information on normal growth & development necessary for:

proper assessment & diagnosis anticipatory guidance and teaching of parents

Research on nursing cares effects on family outcomes

Infants - Physical Development

Principles
Cephalocaudal Proxomodistal Simple to Complex

Growth
Weight & Height
Doubles 5 months, triples 1 year

Proportions

Body Proportions, Fetal Period Through Adulthood

2 months (fetal)

5 months (fetal)

Newborn

2 years

6 years

12 years 25 years

New research on the brain New brain research on first two years of life
Brain development leads to increasingly complex experience AND increasing complexity of experience lead to brain development

Practice, Stimulation, Enrichment Problems of over- and under-stimulation

The Process of Myelinization

An x o M ln yi e Set ha h N rn eo u

N rn eo u

An x o Nc u ul s e M ln yi e Set ha h

Percentages of Adult Weight

Brain

Body

At Birth
2 Years 4 Years

25%
75% 90%

5%
20% 20%

Physical Development, cont. Fine motor skills - hand control Large motor skills - Locomotion
creeping, crawling, cruising milestones - head lag at 6 months cultural differences

Gender differences Safety Table 10-11 (p. 371-372) Should babies go to exercise class?

Milestones of Motor Development

Cognitive Development in Infancy Sensorimotor Stage (0 - 2 years)

reflexes purposeful activity linked to ability object permanence separation anxiety, stranger fear (6 11 months)

 Language Development
motherese importance of conversation

Comprehension precedes vocalizations 200 word vocabulary (2 years) Characteristics of language in infancy
Overextensions Underextensions

Toys That Support Cognitive Development in Infancy Birth - 2 Months Mobile in crib Rattle Music box 6 - 12 Months Squeeze toys Nested plastic cups Boxes with lids Soft ball Stuffed animals Pots and pans Picture books (especially cloth or cardboard) 12 - 24 Months Dolls, especially large ones Toy telephone Puzzles (5 - 10 pieces) Vehicles (cars, boats, train) Sandbox, shovel, and pail Water toys (cups, funnel, etc.) Picture books with simple words

Infancy - Psychosocial Development

Erikson
Trust (year 1) Autonomy (year 2)

Transactional Models
Reciprocal socialization, matching cues

Temperament
easy difficult slow to warm up

 Attachment What affects attachment?

maternal factors: abuse & neglect, depression, schizophrenia child factors: temperament? prematurity?

Father-infant attachment
different interaction patterns: play vs. stress

Toddlers and Parents

Developmental Course of Infant Emotions Self -concept (e.g. Terrible Two's)

Sense of standards Self-description Self-recognition (self-awareness)

Individuation - Autonomy

Toddlers, cont.

Parenting principles
choices Rituals, transitional objects separation distress substitution/distraction

Day care - 2 issues

Age Quality

Nursing care of infants/toddler: Well Child visits

Parents will ask about the Big FIVE
Eating Sleeping Elimination Behavior Development

Ask about Parent/child Interaction Observation Ask questions

Tell me about your baby Give me three words to describe your baby

How is life with baby?

Question
When a nurse is meeting a toddler for the first time, which of the following approaches would be likely to ensure a friendly response?
Call her by name as you greet her? Introduce yourself by first name, then ask her name Talk softly and kneel in front or beside her State clearly that you are her nurse

Nutrition
Breast-feeding - 6 mos. To 1 year If formula,
bottled water if lead problems Whole milk until 1 year (I.e. No low fat) Bottle mouth, caries

Introduce new foods one at a time - allergies 1 tbsp/year of age = serving

Nutrition: Rules of thumb

A well nourished child is troublesome, demanding, energetic. You are responsible for what your child is offered to eat, where and when it is presented, HE/SHE is responsible for how much of it she eats. Chances are your child will refuse food in direct proportion to your effort to provide it.

Elimination & Toilet Training

What is the most important question you ask the parent? Toilet training
Not before 18th month of life (boys later) 2-3 years bladder reflex control achieved 3 years have regular voiding habits 4 years independent bathroom activity 5 years Nighttime control expected

Discipline
The question
How do you handle discipline in your home?

Immunizations
Types Schedule How to give Atraumatic care p. 365

Morbidity and Mortality First two years

Accidents leading cause of death
MVA is leading cause of accidental death poisoning

Congenital anomalies nutritional deficiencies

iron deficiency anemia B12 deficiency (vegans) - neurological probs.

malignancies infections

Early childhood - Physical Development (3 - 6 years)

Physical growth
growth slows 2 - 2 1/2 inches/year 5- 7 lbs/year shape changes
boys gain more muscle, girls gain more fat

Motor development - high activity level

Cognitive development the "Why?" years

Piaget's Preoperational stage
Examples of symbolic thought
deferred imitation symbolic play - pretend, "make-believe" language

Key features
Centering (conservation tasks) Egocentrism (3 mountains task) Appearance-reality distinction proximity (e.g., theories of illness) animism

Early Childhood - Psychosocial Development

Erikson - Initiative vs Guilt

Self - regulation/self -control

Aggression Modeling - parental behavior, adult behavior, TV

Parental Concerns
Discipline
Timing Consistency Relationship Short explanations

Nutrition
decreased caloric need decreased appetite, snacking

 Sleep
afternoon "rest, sleep through the night bedtime problems transitional objects fears, nightmares, night terrors, sleepwalking Should infants/young children sleep in the parents bed?

Safety
Streets Water curiosity

 Day care/Preschool
effects on social development types early childhood education intervention programs, e.g., Head Start health problems
more URI more GI Hepatitis B

Health Problems in Early Childhood

Leading cause of death
first = accidents
motor vehicle accidents no seat belts = 11X higher fatalities

Second = cancer & heart disease (congenital)

Illness
most common =Respiratory infections Local and national problem = Immunizations, lead poisoning

Physical Impact of Poverty on Growth

150 135 120 105

Percentage

90 75 60 45 30 15 0 France United States

Daily calories as % daily requirement Children stunted age 0-5 Children age 0-5 underweight

Japan

India

United Kingdom

Honduras

Jamaica

Countries Arranged by Rank for Calories per Day

Viet Nam

Ethiopia

Canada

Brazil

Mexico

China

TYPES OF CHILD ABUSE

PHYSICAL ABUSE SEXUAL ABUSE PHYSICAL NEGLECT EMOTIONAL NEGLECT

Painful, physically damaging assault Sexual molestation or exploitation Insufficient provision of food, shelter, clothing, medical care

Failure to provide basic nurturance and emotional support required for normal development
Actions that damage a child's emotional, social, or intellectual functioning

PSYCHOLOGICAL ABUSE

3 major risk factors: 1. parental characteristics abused as child (?) - most were not *unrealistic expectations of child or inadequate knowledge of child growth and development

2. Child characteristics
3. environment families socially isolated high levels family stress or chronic stress

Most Common Injuries in child abuse Burns (scalds)

accidents typically front of body (chest) suspicious - back, buttocks, extremities immersion, imprint burns

Bruises
accidents - bony surfaces suspicious - cheeks, abdomen, back, buttocks, inner thighs r/o bleeding disorders

 Fractures - consistent with gross motor abilities?

Abdominal - may not be external signs but internal rupture of organ, blood vessel head injury - leading cause of death from child abuse

Sexual Abuse need expert clinicians to diagnose. Few definitive signs.

Depression, anxiety, hypersexuality ( sexual actingout behaviors possible but not definitive)

Parent's reactions
denial, blame or punish child

 Nursing care protect child - mandatory reporting support child support family & parenting*