Life Span Development

Editor's Notes

• #2: Chapter 10: Life Span Development Comprehensive Lecture
• #3: National EMS Education Standard Competencies Life Span Development Integrates comprehensive knowledge of life span development.
• #4: Lecture Outline I. Introduction A. Humans evolve as people over their life spans. 1. Paramedics must be aware of the changes that humans undergo at each stage of life. Changes will be: a. Obvious and subtle b. Physical and mental 2. These changes may affect the approach to patient care.
• #5: Lecture Outline II. Infants A. An infant is a person ages 1 month to 1 year. 1. Babies younger than 1 month are called newborns or neonates, depending on their age. 2. Infants both grow and develop. a. Growth: Defined as an increase in size b. Development: Represents increased function or mastery of skills
• #6: Lecture Outline B. Physical changes 1. Vital signs a. The younger a person, the faster their pulse rate and respirations. b. In children, blood pressure often corresponds with the patient’s weight, typically increasing with age. 2. Weight a. A full-term newborn usually weighs around 7.5 pounds (3.4 kg) at birth. b. Due to fluid loss, infants lose 5% to 10% of their birth weight in the first week. c. Infants begin gaining weight again during the second week of life. i. Grow at a rate of 1 ounce (30 g) per day ii. Their weight doubles by 6 months and triples by age 1 year. 3. Cardiovascular system a. Prior to birth, fetal circulation occurs through the placenta. b. Postbirth, infants experience physiologic changes to enable independent circulation through their own vasculature.
• #7: Lecture Outline 4. Pulmonary system a. A newborn’s first forceful breath results from chemical, mechanical, thermal, and sensory triggers. b. Young infants are nose breathers for the first several months of their lives; those under 6 months are prone to nasal congestion. i. Can cause viral upper respiratory infections ii. Check to ensure nasal passages are clear if called for a choking infant.
• #8: Lecture Outline c. When compared to an adult, infants have the following characteristics: i. Less rigid rib cages ii. Diaphragm is the newborn’s major respiratory muscle. iii. Intercostal muscles are not well developed. iv. Immature accessory muscles, which may cause fatigue v. Proportionally larger tongue and proportionally shorter, narrower airway, which may cause occlusion more easily than an adult vi. Fewer alveoli, which decreases surface area for gas exchange vii. Fragile lungs are easily damaged by excessive force or volume when providing bag-mask ventilations. (a) Barotrauma is trauma from pressure. (b) It is imperative to use the correct size bag-mask device for the patient.
• #9: Lecture Outline 5. Renal system a. Newborns and infants can become easily dehydrated. b. The inability of newborn’s kidneys to concentrate urine and excrete water may cause dehydration. c. The high percentage of water in infant urine may cause electrolyte imbalances. 6. Immune system a. Infants have a passive immunity acquired from their mothers that continues during the first year of life. i. Breastfed infants receive additional antibodies via milk. 7. Nervous system a. An infant’s nervous system continues to evolve following birth. i. Newborns cannot localize and isolate a particular response to sensation. ii. An infant’s brainstem and spinal are present and functioning, but memory and fine motor coordination are not yet fully developed. iii. An infant’s ability to control body temperature is limited. iv. Motor and sensory development are most developed in the cranial nerves, which control blinking, sucking, and gag reflexes. b. Infants are born with the following four reflexes: i. Moro reflex (startle reflex): When an infant is startled, he or she opens the arms wide and spreads the fingers, seeming to grab at things. ii. Palmar grasp: Infant grasps an object that is placed in the hand. iii. Rooting reflex: When touched on one cheek, infant turns the head toward that touch. iv. Sucking reflex: Infant starts to suck when the lips are touched. c. Many of these reflexes are tested when feeding.
• #10: Lecture Outline d. Fontanelles i. Allow the head to be molded (for example, when passing through birth canal) ii. Three or four bones of the skull iii. Eventually bind together and form suture joints by age 2 years iv. A sunken anterior fontanelle may indicate dehydration. e. Sleep pattern is developed through a combination of central nervous system development and parental efforts. i. Most infants develop the ability to sleep for 5 hours by age 3 months. ii. Some do not develop this until age 1 year. iii. A concern related to infant sleep is sudden infant death syndrome (SIDS).
• #11: Lecture Outline 8. Musculoskeletal system a. Growth plates (often called epiphyseal plates) are located on either end of an infant’s long bones, and are the centers where longitudinal bone growth occurs. b. Growth charts i. Track the growth of infants and children. ii. Provide percentiles comparing child’s growth to growth expected for an average child of that age. 9. Teeth a. Teething generally begins between ages 4 to 7 months. i. Some children have teeth erupt as early as 1 month. ii. Some may wait as long as 1 year. b. Teeth erupt in a predetermined order. c. Most children have all of their teeth by age 3. d. Permanent teeth start to come in around age 6.
• #12: Lecture Outline C. Psychosocial changes 1. An infant’s psychosocial development begins at birth. a. Evolves as infant interacts with and reacts to the environment
• #13: Lecture Outline 2. Infants typically have their own timetable for becoming attached to their family. 3. Bonding: Formation of a close, personal relationship a. Usually based on a secure attachment, which occurs when an infant understands that parents or caregivers will be responsive to his or her needs i. Encourages an infant to explore b. Anxious avoidant attachment i. Observed in infants who are repeatedly rejected ii. These children become isolated. 4. Most infants use crying as the primary method of communicating distress. a. Infants will cry to express anything. b. Parents can usually tell what an infant needs by the tone of an infant’s cry. c. Infants use a less common alarming distress cry when something unexpected (situational crisis) occurs. i. Example: Separation anxiety is a normal reaction to the idea or reality of being separated from a parent. (a) Peaks at 10 to 18 months and involves clingy behavior and fear of the unfamiliar
• #14: Lecture Outline 5. For infants, a reaction to a situational crisis follows three phases: a. Protest phase i. Can start immediately ii. Usually lasts about a week iii. Includes loud crying, irritability, restlessness, and rejection of other caregivers’ efforts b. Despair phase i. Involves monotonous wailing because the infant believes the situation is not going to change c. Withdrawal i. Occurs when the infant becomes almost apathetic and appears bored by his or her surroundings 6. Developing infants need a predictable environment to feel secure. a. If an infant’s environment is too unpredictable, he or she may withdraw. b. Trust and mistrust i. Stage of development from birth to about 18 months ii. Infant gains trust when caregivers provide a planned, organized, and stable environment. iii. The infant develops behavioral problems if he or she believes caregivers will not provide an organized environment. c. Infants respond well to scaffolding. i. Instructional technique in which a person builds on what has already been learned
• #15: Lecture Outline 7. Temperament a. Easy children have normal body function, have low-intensity reactions, and adjust readily to their surroundings. b. Difficult children have intense reactions and do not acclimate well to new surroundings. c. Slow to warm up children have low-intensity reactions, but usually exhibit a negative mood. 8. You should adjust your approach to an infant based on the patient’s developmental age. a. Allow caregivers to hold infant, and allow the infant to hold a toy. b. Allow caregivers to hold the infant during physical assessment except: i. In cases of respiratory failure ii. When there is need for spinal immobilization iii. When the infant has a reduced level of consciousness c. Distract the child. d. Save the hardest part of the assessment or treatment for last.
• #16: Lecture Outline III. Toddlers and Preschoolers A. Physical changes 1. A toddler is a child ages 1 to 2 years; a preschooler is a child ages 3 to 5 years. 2. As compared to infants, vital signs in this age group are as follows: a. Pulse rate and respiratory rate are slower than infants. b. Systolic blood pressure is higher than infants (approximately 100 mm Hg). c. Weight gain levels off.
• #17: Lecture Outline 3. A toddler’s cardiovascular system is similar to an adult’s. Note the following considerations: a. This age group is developing more lung tissue (bronchioles, alveoli). b. They still lack well-developed lung musculature, preventing sustained, long-term deep or rapid respirations. 4. Toddlers lose their passive immunity and begin to develop colds. a. Exposure to others helps them acquire their own immunity.
• #18: Lecture Outline 5. Toddlers/preschoolers experience numerous types of neuromuscular growth, including: a. The development of gross motor skills, such as grabbing an object with the full palm b. The development of fine motor skills, such as picking up a crayon c. A preschooler’s brain weighs 90% of its final adult weight. d. Muscle mass and bone density increase and become more like those of an adult.
• #19: Lecture Outline 6. Renal system changes include bladder control. a. Physiologically, toddlers develop bowel control prior to bladder control. b. The average age for toilet training is 18 months. c. Psychologically, the child may not be ready until 18 to 30 months. 7. Baby teeth will emerge through the teething process, and may include pain and fever. 8. Sensory development makes tickling fun.
• #20: Lecture Outline B. Psychosocial changes 1. Separation anxiety peaks between ages 10 to 18 months. 2. Language acquisition occurs in phases, beginning with: a. The ability to speak one or two words at age 1 year b. Basic language mastery at 36 months of age c. From ages 2 to 5, the number of words in a spoken sentence typically equals the child’s age; at age 3, a toddler speaks in three-word sentences. 3. Most children master basic language by age 3 or 4 years, understanding and using complete sentences. 4. Toddlers begin interacting with peers, which results in: a. Learning about control, obedience, and competitiveness through game playing b. Modeling their behavior on that of friends, TV or Internet characters, or others in their environment c. Recognizing sexual differences by observing their role models and siblings
• #21: Lecture Outline 5. Paramedics should consider the following when caring for toddler/preschool patients: a. Always include a parent/caregiver in the treatment. b. Position yourself at the child’s eye level. c. Explain what you plan to do ahead of time, giving the child choices whenever possible. d. Save the hardest part of the assessment for last. e. Do not reason with a child about why a procedure must be done; explain it, then do it.
• #22: Lecture Outline C. Other factors also affect the psychosocial development of toddlers and preschoolers. 1. Three approaches to parenting affect a child’s development. a. An authoritarian style expects complete obedience, disregards a child’s personal freedom, and may lead to a child having self-esteem issues. b. An authoritative style sets and enforces rules, balancing parental authority with a child’s personal freedom, allowing children to develop into independent, well-socialized, easygoing adults. c. A permissive style does not impose many rules, if any, on the child and tolerates all behaviors, including socially unacceptable ones; may be subdivided into: i. Indifferent parents (do not care) ii. Indulgent parents (excessively lenient, giving the impression of “spoiled” children) 2. Although not uncommon in the United States, divorce has a profound effect on a child’s self-esteem and sense of well-being. a. Children question if the divorce was their fault and experience pain from the changing environment. b. Most children adapt easily if both parents maintain their children as their priority.
• #23: Lecture Outline IV. School-Age Children A. Physical changes 1. School-age children are age 6 to 12 years. 2. The following physical changes affect patients in this age group: a. Vital signs and physical body approach those of an adult. b. Children at this age grow approximately 5.5 to 7.7 pounds (2.5 to 3.5 kg) and 2 inches (5 cm) each year. c. Brain function develops in both hemispheres. d. Permanent teeth arrive. e. Puberty may begin at age 10 or younger.
• #24: Lecture Outline B. Psychosocial changes 1. Children develop three stages of reasoning: a. Preconventional reasoning involves acting to avoid punishment and get what they want. b. Conventional reasoning involves acting to obtain approval from peers and society. c. Postconventional reasoning involves making decisions guided by conscience. 2. Children develop self-concept and self-esteem. a. Self-concept: A person’s perception of himself or herself b. Self-esteem: How a person feels about himself or herself, and how a person feels about how he or she fits in with peers
• #25: Lecture Outline 3. Paramedics should use the same techniques employed for preschoolers. a. Note that gaining (or losing) trust is the biggest issue with this age group. i. Be direct, assertive, and open.
• #26: Lecture Outline V. Adolescents (Teenagers) A. Physical changes 1. Adolescents are people ages 13 through 18 years. 2. Vital signs level off to within adult ranges: a. Systolic blood pressure is between 110 and 131 mm Hg. b. Pulse rate is between 60 and 100 beats/min. c. Respirations are in the range of 12 to 20 breaths/min. 3. This age group undergoes a rapid, 2- to 3-year growth spurt as muscle and bone grows and blood chemistry changes. a. Begins with the hands and feet, then moves to the extremity long bones, and finally finishes at the torso b. Although boys generally experience rapid growth later than girls, they end up taller and physically stronger. c. Muscle mass and bone density are nearly at adult levels.
• #27: Lecture Outline 4. Patients in this age group undergo reproductive system changes. a. Secondary sexual characteristics develop in both males and females, including: i. Enlargement of external sex organs ii. Pubic and axillary hair iii. Change in range and depth of voice b. In girls, breasts and thighs increase in size, and they begin menstruation, although the first period (menarche) may occur in some school-age girls. c. Both sexes secrete hormones associated with reproduction. i. Females release follicle-stimulating hormone and luteinizing hormone, to increase estrogen and progesterone production. ii. Males release gonadotropin to produce testosterone. iii. Acne may result from hormone secretion. d. Midadolescents of both sexes are physically capable of reproduction.
• #28: Lecture Outline B. Psychosocial changes 1. Conflict often marks the relationship between teenagers and their families. a. Privacy becomes more important. b. Self-consciousness increases as teenagers struggle to fit in. i. Adolescents may struggle to create their own identity. c. Rebelliousness may increase as a part of finding an identity. d. Peer pressure is a major factor. e. Self-destructive behaviors may begin, including: i. Antisocial behavior ii. Eating disorders iii. Smoking iv. Drinking v. Experimenting with drugs 2. Some teens show more interest in sexual relations. 3. Teens begin to develop their own code of personal ethics, based on their parents and the influence of his or her environment. 4. Patients in this age group are at greater risk than other age groups for depression and suicide.
• #29: Lecture Outline 5. Paramedics should provide discretion, respect, and privacy to this age group. a. Speak to a patient in an area that is separate from parents/caregivers, if possible.
• #30: Lecture Outline VI. Early Adults A. Physical changes 1. Early adults are people ages 19 to 40 years. 2. Vital signs do not vary greatly throughout adulthood. a. Pulse rate will stay around 70 beats/min. b. Respiratory rate will stay in the range of 12 to 20 breaths/min. c. Blood pressure will be approximately 120/80 mm Hg. 3. The human body functions at its optimal level between the ages of 19 to 25 years; the following physical changes occur after this age: a. The spinal disks settle, causing “shrinking.” b. Fatty tissue increases and leads to weight gain. c. Muscle strength decreases. d. Reflexes become slower.
• #31: Lecture Outline B. Psychosocial changes 1. Work, family, and stress define this age group. a. Early adults do everything they can to “settle down.” b. This age group tends to seek and find romantic love and have babies. c. This is considered one of the most stable periods of life, with fewer psychological problems related to well-being.
• #32: Lecture Outline VII. Middle Adults A. Physical changes 1. Middle adults are people ages 41 to 60 years. 2. Despite the body’s high level of functioning, patients in this group are vulnerable to the following physical changes: a. Vision and hearing loss b. Cardiovascular disease c. Weight gain due to lower metabolism 3. Cancer rates increase. 4. Women begin menopause in 40s and 50s, causing possible bone density loss (fractures) and cardiac conditions.
• #33: Lecture Outline B. Psychosocial changes 1. People in this age group focus on meeting their life’s goals. a. Some must adjust to living without their grown-up children (empty nest syndrome). b. Some have financial worries as they face retirement planning and meeting daily needs. c. People now see crisis as a challenge to be overcome, rather than a threat.
• #34: Lecture Outline VIII. Late Adults A. Physical changes 1. People in this group are ages 61 and older. a. Life expectancy, or the average amount of years a person can be expected to live, is now approximately 78 years; the maximum is 115 years. 2. Vital signs depend on the person’s overall health status, medical conditions, and medications.
• #35: Lecture Outline 3. Cardiovascular system a. Atherosclerosis is caused by the buildup of cholesterol and calcium (plaque) within the walls of blood vessels. i. Leads to a partial or complete blockage of blood flow within the vessel ii. Can contribute to the development of an aneurysm (a) An aneurysm is a weakening or bulging of a blood vessel wall that may rupture. iii. Many people older than 65 have atherosclerotic disease. b. In general, people in this age group have hearts that are less able to deal with exercise or disease as a result of the following: i. Decreased pulse rate ii. Declining cardiac output iii. Inability to elevate cardiac output to match the body’s demands
• #36: Lecture Outline c. Overall, the vascular system becomes “stiff,” resulting in the following changes: i. Increased diastolic blood pressure ii. Decreased cardiac output related to the thickening and stiffening of the left ventricle iii. Impeded blood flow into and out of the heart and heart murmur related to stiffening of heart valves iv. Reduced elasticity of the peripheral vessels of up to 70% related to decreased amounts of elastin and collagen v. Reduced ability to compensate for blood pressure changes d. Fatty tissue begins to replace bone marrow, resulting in the production of fewer blood cells. i. This hinders body’s ability to heal after trauma. ii. It also decreases functional blood volume.
• #37: Lecture Outline 4. Respiratory system a. The following structural changes make breathing more difficult for patients in this age group: i. The size of the airway increases, while surface area of alveoli decreases. ii. Lungs become less elastic, forcing people to use intercostal muscles to breathe. iii. The calcification of the ribs to the sternum makes chest more rigid; this can also lead to fracture. iv. Muscle strength of intercostal muscles and diaphragm decreases.
• #38: Lecture Outline b. Changes in the mouth and nose leave the upper airway less protected and the chances of aspiration and obstruction more likely. i. It is more difficult to clear secretions. ii. Cough and gag reflexes decline. iii. Decline in cilia in airways makes structures less responsive to smoke, dust, and so on.
• #39: Lecture Outline c. Weakening of the smooth muscles in the upper airway may lead to collapse and inspiratory wheezing and low flow rates.
• #40: Lecture Outline d. In older adults, the vital capacity is significantly decreased because of: i. Loss of respiratory muscle mass ii. Increased stiffness of the thoracic cage iii. Decreased surface area available for air exchange e. While vital capacity decreases, residual volume increases and causes stagnant air to hamper gas exchange in the alveoli; this may cause: i. Hypercarbia, or increased carbon dioxide in the bloodstream ii. Acidosis
• #41: Lecture Outline 5. Endocrine system a. Reduced physical activity and declining endocrine system lead to weight gain. i. Body cannot produce the additional insulin needed to control blood glucose, leading to diabetes mellitus. ii. Higher blood glucose levels may cause mental status changes. b. Changes in the reproductive system occur for both men and women: i. Males still produce sperm, but lose penis rigidity. ii. Females experience atrophy of uterus and vagina related to menopausal decrease in hormone production. iii. Both sexes may experience less sexual desire.
• #42: Lecture Outline 6. Renal system a. Structural and functional changes occur in the kidneys: i. Filtration function declines significantly between the ages of 20 to 90 years. ii. Kidney mass also decreases over the same span of time. iii. Number of nephrons (capillaries that filter waste) declines between the ages of 30 and 80 years. (a) More abnormal glomeruli are present in the nephrons. b. Aging kidneys respond less efficiently to hemodynamic stress and to fluid and electrolyte imbalances, which means: i. Body has decreased ability to eliminate wastes ii. Body has decreased ability to conserve fluids when needed
• #43: Lecture Outline 7. Gastrointestinal system a. Functional changes may inhibit nutritional intake and utilization, resulting in vitamin and mineral deficiencies. i. Decreased sensation of taste buds ii. Weaker teeth make chewing harder. iii. Decreased saliva production makes processing complex carbohydrates more difficult. iv. Slower gastric motility may lead to constipation, or a feeling of no hunger. v. Gastric acid secretion diminishes. vi. Decreased blood flow (by up to 50%) to mesentery membranes decreases ability to extract nutrients from digested food. b. Other changes that affect patients in this age group include: i. Increased chance of gallstones ii. Loss of anal sphincter elasticity, which may cause fecal incontinence (a) This is of great concern to many patients and requires understanding by paramedic. (b) Always ask about bowel habits during interview.
• #44: Lecture Outline 8. Nervous system a. Central nervous system changes may include: i. Brain weight loss of between 10% to 20% by age 80 years ii. Loss of between 5% to 50% of neurons, with shrinkage of existing neurons iii. Loss of as much as 20% of frontal lobe synapses iv. Slower motor and sensory neural networks b. Note that the brain’s metabolic rate remains the same as does oxygen consumption. c. The sleep patterns of an older adult will change, and may become biphasic (two-phased).
• #45: Lecture Outline d. These brain changes make the brain more at risk for injury due to trauma due to: i. Additional room between the brain and outermost layer of meninges due to brain shrinkage allows the brain to move when stressed. ii. Bridging veins can tear if brain moves, causing bleeding and an undetected subdural hematoma.
• #46: Lecture Outline e. Peripheral nervous system changes may include the following: i. Overall diminished sensation ii. Diminished proprioception may increase likelihood of falls and trauma. iii. Deteriorated nerve endings cause loss of skin sensitivity to heat, cold, sharpness, and wetness, leading to injury.
• #47: Lecture Outline 9. Sensory changes a. While the senses are affected by aging, many patients in this age group see and hear well. b. General eye and vision changes may include the following: i. Restricted pupillary reaction as pupils become smaller and sluggish in response to light; visual acuity also diminishes. ii. Restricted ocular movements iii. Increased visual distortions iv. Decreased ability to focus at close range related to lens thickening v. Narrower peripheral fields of vision, with greater sensitivity to glare
• #48: Lecture Outline c. Hearing loss related to structural changes is four times more common than the loss of vision in this population. i. Loss of high-frequency hearing ii. Deafness d. Eating becomes less pleasurable due to the loss of both taste bud sensation and olfactory perception.
• #49: Lecture Outline B. Psychosocial changes 1. Paramedics should value the chance to learn from the wisdom of late adults. a. 5 years before death, most retain a high level of brain function. b. The terminal drop hypothesis theorizes that a person’s mental function begins to decline 5 years before death. 2. General statistics related to this population include the following: a. Many live at home.
• #50: Lecture Outline b. Most are active, healthy, and independent, although they may receive some assistance or support from family, friends, or home health care providers. c. The number of assisted-living facilities is increasing; they allow residents to live with people in their own age group, while enjoying the privacy of their own apartment and the security of nursing care, maintenance, and food preparation. d. Many have financial concerns related to paying for health care and basic necessities. i. Many single women in the United States age 60 or older live at or below the poverty level. 3. Late adults must come to terms with their own mortality, which may prove difficult as family members and friends die. 4. Many older people are happy and actively participating in life.