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- 1. PEDIATRIC NURSING (CHILD HEALTH NURSING) BASIC CONCEPT OF GROWTH AND DEVELOPMENT PREPARED BY MR. VIPIN JAIN PROFESSOR & HEAD OF DEPARTMENT PEDIATRIC NURSING, CIN
- 7. The term pediatrics is derived from Greek words, ‘pedia’ means child , ‘iatrike’ means treatment and ‘ics’ means branch of science. Thus it means pediatrics is the branch of medical science which deals with the care and treatment of children from conception to adolescence in health and illness. It is also concerned with preventive, promotive, curative and rehabilitative care of children. In India about 35% of total population are children below 15 years age. Children are vulnerable to diseases , death and disability. They need appropriate care for survival and healthy development.
- 8. Concept of pediatric nursing: “Today's Children's are the future of tomorrow”. Pediatric nursing concerned with preventive, promotive, curative and rehabilitative care of children. It belongs with all round development of body, mind, and spirit of the individual. CHN concerned with: i. wellbeing of children towards max.functioning. ii. Implement of scientific principles and theory related to nursing practice. iii. Provie care to mother, child and family. iv. Using team approach to solve problems V. focusing on ethical, moral and legal problems regarding child care.
- 9. Goals of pediatric nursing: @ to provide skillful, intelligent and need based care of children specially in sick child(LBW). @ To promote G&D of children for healthy nation @ to elevate the standard of child health. @ to prevent the diseases at primary and secondary level. @ provide good post natal care to mother & baby. Qualities of pediatric nurse: @ be loving and liking for children. @ ability to understand child’s GD & behavior. @ have good observation, judgment and communication skills. @ be friendly, honest, gentle, responsible, and trustworthy.
- 10. Role of pediatric nurse: nurse is both caring and curing. caring is must in wellness and illness. The role of pediatric nurse is expanded and vary according to time. 1. Primary care giver 2.Health educator 3. Nurse counselor 4.Social worker 5.Team coordinator and collaborator 6.Manager 7.Child care advocate 8.Recreationist 9.Nurse consultant 10.Researcher
- 11. Child growth and development Growth and Development occurs in the following order Infancy Early Childhood Middle Childhood Adolescent Stages of Growth and Development infancy •Neonate : Birth to 1 month •Infancy : 1 month to 1 year Early Childhood •Toddler:1-3 years •Preschool:3-6 years
- 12. Middle Childhood •School age : 6 to 12 years Late Childhood •Adolescent : 13 years to approximately 18 years Growth and development are similar words but different from each other though it is not possible to separate them totally. It is a whole process which includes growth of the body as well as growth of various aspects of child's personality, e.g., the physical, emotional, social and cognitive development. Development is a progressive change the child undergoes which increases the physical, social, mental and emotional capacities of the child.
- 13. Growth 1. Growth is quantitative. 2. Growth comprises of height, weight, size and shape of body organs like brain, etc. 3. It is due to cell division. 4. Growth is for limited period. 5. Growth can be measured. 6. Growth tells about one aspect of personality but in limited scope.
- 14. Development 1. Development is quantitative as well as qualitative. 2. In this with the physical changes cognitive, social and emotional change are also included. 3. It happen due to motor and adjust mental processes and their interplay. 4. Development takes place till death. 5. It can be observed by matured behavior. 6. Development deals with all the aspect of personality and has a vast scope.
- 15. Principles of Growth and Development 1.Growth is an orderly process, occurring in systematic fashion. 2.Rates and patterns of growth are specific to certain parts of the body. 3.Wide individual differences exist in growth rates. 4.Growth and development are influences by multiple factors. 5.Development proceeds from the simple to the complex and from the general to the specific. .
- 16. 6. The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal. 7.There are critical periods for growth and development. 8.Rates in development vary. 9.Development continues throughout the individual's life span.
- 17. Aspects/dimensions of growth & development- SMILE- 1. Social development 2.Spiritual development 3.Motor development(fine/gross motor) 4.Moral development 5.Intellectual development 6.Language development 7.Emotional development
- 18. FACTORS AFFECTING GROWTH AND DEVELOPMENT (i) Heredity - It is the process by which the features and characteristics are passed from parents to the child before the child is born. Thus features like the colour of the skin and eyes, the height, body build, intellect and talents, etc., are all fixed and no one can change them beyond a limit. (ii) Prenatal environment - This is the environment of the foetus in the womb. If the mother gets poor nutrition, is emotionally upset or smokes, drinks, or takes some medicine or suffers from certain diseases, the growth of the child can be adversely affected. (iii) Nutrition - Proper nutrition is essential for the healthy development of the child. A malnourished child’s growth may be retarded or slow.
- 19. (iv)Intelligence - Higher intelligence is associated with faster development while lower intelligence is associated with retardation in various aspects of development. (v) Emotional climate of home - If there is a lot of discord/fights at home or the child is not given enough love and attention or there is physical/ mental abuse of the child, then the child’s development is adversely affected. (vi) Health of the child - If the child frequently falls sick, suffers from some disorder, is disabled or has disturbed endocrine functioning, the development is likely to suffer.
- 20. (vii) Level of stimulation - The amount of stimulation the environment provides to the child i.e., the opportunities for exploration of environment, opportunities of interaction with other people, etc., all influnence the rate of development. (viii) Socio-economic status - It also influences the development by deciding the kind of nutrition, stimulation, facilities, opportunities, genetic endowment the child gets.
- 21. (ix) Sex - All children follow the same sequence of development. However, certain skills are faster in girls than in boys and some other skills are faster in boys than girls. For example, language acquisition is faster in girls and skills like jumping catching, throwing are faster in boys. Sex is also a factor that decides the potential of a child in physical development - boys grow up to be taller, heavier and more muscular than girls.
- 22. Rights of children's- 1) The right to love and affection from parents. 2)Right to free education 3)Right to name & nationality. 4)The right to get adequate nutrition and medicine. 5)Right to opportunity for play and recreation 6)Right to get special care if baby is handicapped. 7) right to get relieve first in disaster. 8)Right to be part of society and develop own abilities. 9)Right to be brought up in a spirit of peace and brotherhood. 10)Right to enjoy these rights regardless of race, colour,sex,religion,nation etc.
- 23. Areas of development- Social development-
- 27. Growth Patterns The child’s pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal. Why developmental assessment? Early detection of deviation in child’s pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive
- 28. Gross Motor Skills The acquisition of gross motor skill precedes the development of fine motor skills. Both processes occur in a cephalocaudal fashion Head control preceding arm and hand control Followed by leg and foot control. Gross Motor Development Newborn: barely able to lift head 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms Head Control Sitting up 2months old: needs assistance 6 months old: can sit alone in the tripod position 8 months old: can sit without support and engage in play
- 29. Sitting Up Age 2 months Age 8 months
- 30. Ambulation 9 month old: crawl 1 year: stand independently from a crawl position 13 month old: walk and toddle quickly 15 month old: can run Fine Motor - Infant Newborn has very little control. Objects will be involuntarily grasped and dropped without notice. 6 month old: palmar grasp – uses entire hand to pick up an object 9 month old: pincer grasp – can grasp small objects using thumb and forefinger
- 31. Nine to 12-months 13 month old Ambulation
- 32. Speech Milestones 1-2 months: coos 2-6 months: laughs and squeals 8-9 months babbles: mama/dada as sounds 10-12 months: "mama/dada specific 18-20 months: 20 to 30 words – 50% understood by strangers 22-24 months: two word sentences, >50 words, 75% understood by strangers 30-36 months: almost all speech understood by strangers
- 33. Hearing BAER hearing test done at birth Ability to hear correlates with ability enunciate words properly Always ask about history of otitis media – ear infection, placement of PET – tubes in ear Early referral to MD to assess for possible fluid in ears (effusion) Repeat hearing screening test Speech therapist as needed Red Flags in infant development Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years.
- 34. 6-month-old 12-month-old Fine Motor Development
- 35. Fine Motor – Older Toddler 3 year old: copy a circle and a cross – build using small blocks 4 year old: use scissors, color within the borders 5 year old: write some letters and draw a person with body parts Toddlers(Issues in parenting – toddlers) Stranger anxiety ( crying when baby sees someone she doesnt know and they are trying to carry her) – should dissipate by age 2 ½ to 3 years Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training
- 36. Pre-School Fine motor and cognitive abilities Buttoning clothing Holding a crayon / pencil Building with small blocks Using scissors Playing a board game Have child draw picture of himself Pre-school tasks Red flags: preschool Inability to perform self-care tasks, hand washing simple dressing, daytime toileting Lack of socialization Unable to play with other children Able to follow directions during exam Performance evaluation of pre-school teacher for kindergarten readiness
- 37. School-Age School Years: fine motor Writing skills improve Fine motor is refined Fine motor with more focus Building: models – legos, Sewing Musical instrument Painting,Typing skills Technology: computers School performance Ask about favorite subject How they are doing in school Do they like school By parent report: any learning difficulties, attention problems, homework Parental expectations
- 38. Red flags: school age School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse School Age: gross motor 8 to 10 years: team sports Age ten: match sport to the physical and emotional development School Age: cognitive Greater ability to concentrate and participate in self-initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games.
- 39. 13 to 18 Year Old Adolescent As teenagers gain independence they begin to challenge values Critical of adult authority Relies on peer relationship Mood swings especially in early adolescents Adolescent behavioral problems Anorexia Attention deficit Anger issues Suicide
- 40. Adolescent Teaching Relationships Sexuality – STD’s / AIDS Substance use and abuse Gang activity Driving Access to weapons