Childhood Development Milestones
Growth and Development Milestones
Growth and Development Milestones
August 2013
NRSG 206
Growth and Development Milestones
Infant (1-12 months)
Physical Growth: All major systems undergo progressive maturation. Growth is very rapid during the first year, especially the initial 6 months. Infants gain 5-7 oz. every week for the first 6 months. By the end of the first year the infant’s weight is about three times the birth weight. Height increases by 2.5 cm each month for the first 6 months. 6 months to year 1 growth comes in spurts rather than gradual patterns. Head growth is rapid. Head circumference increases approximately 1.5 cm each month, 6 months to 1 year by 0.5 cm. By the …show more content…
end of 1 year the cranial sutures close, the anterior fontanel close within the first 8 week and the posterior fontanel closing by 12 to 18 months.
Maturation of Systems: • Respiratory: rate slows from 35 at birth to 30 from months 1-11 • Immunologic: IgA is present in large amounts offering protection in the GI tract. Newborn receives significant amounts of maternal IgG starts synthesizing own at about 3 months, by 1 year has nearly 40% of adult levels. Significant amounts of IgM are produced at birth and adult levels are reached by 9 mos. IgA, IgD and IgE produced more gradually adult levels are not reached until early childhood. • Cardiovascular: heart rate slows from 100-180 (resting awake) at newborn to 80-150 after 3 mos. • Hematopoietic: significant changes occur during the 1st year fetal Hgb is present in large quantities for the first 5 mo., with adult Hgb steadily increasing through the 1st ½ of infancy. • Digestive: process is immature at birth. The majority of the digestive process does not begin functions until 3 mos. Digestion takes place in the duodenum where pancreatic enzymes and bile begin to break down protein and fat. The immaturity is evident in the appearance of the stool; solid foods are passed incompletely broken down. • Thermoregulation: during infancy becomes more efficient, the ability of the skin to contract and of muscles to shiver. • Renal: immature and predisposes the infant to dehydration. Complete maturity of the kidney occurs during the latter ½ of the 2nd year. • Sensory: Auditory acuity is at adult levels during infancy.
Visual acuity begins to improve, and binocular fixation is established. Binocularity, or the fixation of two ocular images into one cerebral picture, begins to develop by 6 weeks of age and should be well established by age 4 mos. Depth perception begins to develop by age 7 to 9 months by may exist earlier as an innate safety mechanism against accidental falling.
|Erikson |Kohlberg |Piaget |Freud |
|Psychosocial development – |Premorality or preconventional |Cognitive development – |Oral stage – mouth is pleasure |
|developing sense of trust |morality |sensorimotor phase |producer |
|Age |Gross motor |Fine motor |
|1 – 3 month |Can turn head from side to side |Hands predominately closed, grasp reflex …show more content…
strong|
| |Head lag @ 1mo able to hold head erect when |hand clenches on contact @ 1 mo |
| |sitting but still bobs forward @ 3 mos. With |Hands often open; grasp reflex fades @ 2 mos. |
| |only slight head lag. |Actively holds objects, grasp reflex absent, |
| | |hands kept loosely open, clutches own hand; |
| | |pulls at blankets and clothes |
|4 – 6 month |Almost no head lag, balances head, able to sit |Able to grasp objects, holds bottle, uses |
| |for increasing amounts of time, rolls from back|palmar grasp, plays with toys, tries to reach |
| |to abdomen |for object but over shoots. |
|7 – 9 month |Creeps on hands and knees, can pull self to |Uses thumb and finger in crude pincer grasp, |
| |standing position with something to hold on to |preference for dominant hand becomes evident. |
|10 - 12 month |Walks with one hand held, cruises well, may |Explores objects more thoroughly, has neater |
| |attempt to stand alone, may attempt to take |pincer grasp, can turn pages in a book(many at |
| |first step, can sit from standing position |a time) |
| |without help | |
Play: • 1-3months: Primarily narcissistic body parts are primarily objects of play and pleasure. • 4-6 months: Shows more discriminate interest in stimuli & begin to play alone with toy or stuffed animal. • 7-9 months: Laugh out loud, show a preference for certain toy. Become excited when food or a favorite object is brought to them. • 10-12 months: Play involves sensorimotor skills. Games like peek-a-boo and pat-a-cake. Play is much more selective choose who will interact.
Communication: • 1-3months: Cries to express displeasure, by 3 months squeals aloud to show pleasure. • 4-6 months: By 6 months begins to imitate sounds, babbling resembles on syllable utterance – ma, mu, da, di hi, vocalizes to toys mirror image, takes pleasure in hearing own sounds. • 7-9 months: Produces vowel sounds and “talks” when others are talking, combines syllables, such as dada, but does not ascribe meaning to them. Responds to simple commands. • 10-12 months: Says “dada, mama” with meaning, comprehends “bye-bye” May say one syllable words. Imitates definite speech sounds. Comprehends meanings of several words, recognizes objects by name, imitates animal sounds, and understands simple verbal commands.
Nutrition: • 1-3months: Human milk or formula • 4-6 months: Human milk is the most desirable for complete diet • 7-9 months: Progress to cereal • 10-12 months: Progress to baby food fruits and vegetables and other “soft” solid foods.
Health Promotion: • Wellness Examinations: 1 week for breast fed 2 weeks for formula fed, then 2, 4, 6, 9 and 12 months. • Immunizations: Hep B @ birth 2 and 6 mo., DPT @ 2,4, and 6 mo., Polio @ 2, 4, and 6 mo., Pneumococcal every 2, 4 and 6 mo., Influenza 6 months and then yearly, MMR not before 12 months, Varicella not be for 12 mo., • Dental Health: Cleaning begins when primary teeth erupt; fluoride at 6 months, tooth brushing is too harsh for the tender gingiva.
Injury Prevention: Parents should know the telephone # for poison control, If child is not breathing should call 911, constant vigilance, awareness and supervision is required. Small items that can fit through a toilet paper roll can pose a choking risk, the caregiver must physically remove child from danger.
Toddler (1-3 years)
Physical Growth: Growth rate slows down during this period. The birth rate is quadrupled by the age of 2 ½ and the height increases on average of 3 inches per year.
Maturation of Systems • Respiratory: Respiratory rate slows down and respirations continue to be abdominal. • Digestive: The stomach capacity increases and the gastric content increases and is capable of destroying many types of bacteria. • Immunologic: The production of antibodies is well established. There is an increase of colds and minor infections due to the lack of hand washing. • Bowel/Bladder: Sphincter control is achieved by 18-24 months and the bladder capacity increases to be able to hold urine for 2 hours or longer.
|Erikson |Kohlberg |Piaget |Freud |
|Toddlerhood is having a sense of |Right or wrong is determined by |This includes the 5th stage and the|Major conflict at this stage is |
|autonomy and overcoming doubt and |physical consequences |final stage of sensorimotor phase. |toilet training, the child learn to|
|shame | |The cognition process develops |control their bodily needs. |
| | |rapidly, toddlers will actively | |
| | |search for hidden objects. | |
|Age |Gross motor |Fine motor |
|15 - 18 month |Walk without help, seats self in a chair, runs |Builds a tower of 2-4 blocks, scribbles, turns |
| |clumsily, jumps in place with both feet |3-4 pages in a book at a time, manages a cup |
| | |and spoon |
|19 - 24 month |Goes up and down stairs alone, runs well, picks|Builds a tower of 6-7 blocks, turns pages of a |
| |up objects without falling |book one at a time |
|25 - 30 month |Jumps for chair or step, will stand on one foot|Will imitate vertical and horizontal lines, |
| |momentarily, |holds crayons with fingers instead of hand. |
|31 - 48 month |Pedal a tricycle, talk in simple sentences of |Draw a circle, complete simple puzzles, undo |
| |3-5 words, cut a straight line |Velcro on diapers |
Play: They parallel play with other children. Appropriate toys are locomotion toys such as push-pull, rocking horses, a small gym and slide. Finger paints, chalk and puzzles with large simple pieces help develop fine motor skills. Tactile play can provide opportunities for creativity such as clay, water toys and a sandbox.
Communication: By the age of 2 the child may have a vocabulary of about 300 words and can understand more than that. They may multiword sentences by stringing 2-3 words together. By the age of 3 they may talk in simple sentences.
Nutrition: As the growth rate slows there is a decrease in appetite.
Toddlers may become picky or fussy eaters. They can be influenced by factors of an overfilled plate, thus refusing it because of its size. Toddlers may have a favorite cup, plate or spoon and may refuse food because the food may be on a different plate.
Health Promotion: • Wellness Examinations: 12 months, 15-18 months, then yearly after age 2 • Immunizations: Between 12-18 months the following vaccines are given: Hep B (3rd shot in the series), DTaP, Hib, PCV, IPV, MMR, Varicella, and first of two Hep A injections. A yearly flu shot should also be given. • Dental Health: Brush and floss teeth, need regular dentist visits, need a fluoride supplement if it is not in the drinking water
Injury Prevention: Don’t allow the child to play on or near a curb or behind parked cars, supervise tricycle riding, turn pot handle toward the stove, move electrical appliances toward the back of the counter, cover electrical outlets with protective caps, place all potentially toxic agents in a locked cabinet, know the poison control number, place gates at the top and bottom of stairs, remove scatter rugs, keep large toys and bumper pad out of the crib or playpen, avoid fish with bones, hard candy, or chewing gum, keep Venetian blind cords out of reach of children, store dangerous tools and firearms in a locked
cabinet.
Preschooler (3-5 years)
Physical Growth: Physical growth at this age slows and stabilizes. The average weight gain remains about 5lb a year. The average height increases about 3 inches per year. These children will have large heads, with straight legs, and flat bellies. Preschoolers’ body systems mature and stabilize; which can adjust to moderate stress and change. Extremities of the preschooler grow rapidly which means the child becomes taller and leaner. More fine motor coordination is also seen. They can draw circles and squares instead of just scribbles.
|Erikson |Kohlberg |Piaget |Freud |
|A sense of initiative is the chief |Premortality or preconventional |Preschoolers have two ways al |Psychosexual development – Phalic |
|psychosocial task of the |mortality, stage 2 (4 to 7 years): |thinking: preconceptual thought - |or Oedipal/Electra stage – genitals|
|preschooler. |instrumental hedonism and concrete |(2 to 4 years) Preschoolers focus |become focus of curiosity, |
|Initiative vs. Guilt – Children |reciprocity. |on visual appearance. Misconception|Conscience develops |
|become competitive at this age. | |are: | |
|These children have a “can do” |The child conforms to rules out of |- Artificialismd - everything is | |
|attitude. They like to have goals |self-interest. |made by humans | |
|and they are very imaginative. |(ex: If you do something bad for |- Animism inanimate objects are | |
| |me, then it’s ok if I do something |alive | |
|A preschooler may take on something|bad to you.) |- Imminent justice - code that | |
|new even if he/she isn’t able to do| |determines law and order | |
|so. But then they feel guilty if |Concerned with satisfying own needs|Intuitive thought – (begins around | |
|they can’t accomplish that goal. | |4) aware of cause and effect | |
| | |relationships. | |
|Age |Gross motor |Fine motor |
|3 year |Child should be able to rides a tricycle, jumps|Child should be able to build a tower of 9-10 |
| |off of the bottom step, stands on one foot, go |cubes, and build bridges with three cubes. |
| |upstairs using alternate feet, perform broad |They should be able to place small pellets into|
| |jumps, and may try to dance but balance be |a bottle, draws circles or crosses, and can |
| |inadequate. |name what is drawn. |
|4 year |Childs ability to skip & hop on one foot, catch|Child should be able to use scissors to cut an |
| |reliably, throw overhead, and walk down stairs |outline, lace shoes (but not make a bow). The |
| |using alternate feet is intact. |can draw and copy a square, trace a cross and |
| | |diamond. They can also add three parts to a |
| | |stick figure. |
|5 year |Child is able to skip & hop on alternate feet, |They are able to tie shoelaces, use scissors |
| |catch throw well. Jump rope, skate with good |and pencil very well. Copying diamonds and |
| |balance and walk backwards should be achieved |triangles is achieved. Adds seven to nine |
| |also. They should be able to jump from height |parts to a stick figure. Prints a few letters, |
| |of 12 inches and land on toes. Balance on |numbers, or words like their name. |
| |alternate feet with eyes closed. | |
Play: During play the child has many changes at the preschool age. The child wants to please their parents. They engage in associative, imitative, imaginative, and dramatic play. Associative play is when they play the same game but are not working together with one another. Imitative play is when they copy actions. Copying the actions of their parents is one example of imitative play. Imaginative minds are apart of this age so monsters under the bed feel real to them. They are open to supernatural thoughts. Dramatic play is when they dress up and or use hand puppets to play. Helps with child to forget something they want to forget. Overall, this age of play is very active and their thoughts are expanding.
Communication: The Preschool age child uses language for mental symbolization. He/she might say something along the lines of “Do you like my horse” as he/she rides around the room on a pretend horse. Vocabulary increases dramatically between 2 and 5 so communication becomes enhanced verbally. They may become aggressive when they loose at this age. The may want to hurt or destroy property if they loose a game which communicates that they are dissatisfied. Stuttering or stammering may emerge if the child can’t master sensorimotor integration. Using words they are thinking faster than they can which causes them to end up in stuttering. Their language becomes more sophisticated and complex.
Nutrition: My pyramid for kids is important. It’s similar to toddlers. Quality is more important than quantity. The child should have about half the portion of an adult serving. Food becomes important for the strong taste they have for foods. They need to have about 90 calories per kilogram. According to that information if a child weighs 13 kg (28 lb) then that child would need 1170 calories for that day (average is 1800 calories).Proper nutrition, sleep, and dental care is important. 13 to 19 g/day of protein is recommended for preschoolers. Fatty acid consumption should be less than 10% total caloric intake. 500 mg of calcium is recommended as well. Fruit juices have been known to cause cavities. Having the practice of eating until the plate is clean is avoided as is may contribute to overeating.
Health Promotion: • Wellness Examinations: A SNELLEN screening is included in the exam. The wellness examination also checks to make sure the child can perform self care tasks like hand washing, getting dressed, toileting themselves. It also is used to see if the child lacks socialization skills. The child should be able to walk, run, climb, and jump at the preschool age. Health promotion is directed toward nutrition, adequate sleep, proper dental care, and injury prevention. • Immunizations: include DPT, polio, and MMR. • Ages 3 to 5 year olds should have 3 Hepatitis B, 4 Diptheria/Tetanus/Pertussis, 3 Polio, 1 Measles/Mump/Rubella, and 1 Varicella. • Dental Health: Deciduous teeth begin to be replaced with permanent teeth by age 5. The front teeth are first to go.
Injury Prevention: Improved gross and motor skills make them less prone to falls but they tend to be reckless and need education about safety on sidewalks, bicycling, running after balls because motor vehicle accidents are increased. Keep child’s stress level low. Monitor the amount so the amount doesn’t exceed their coping capabilities. Regression may occur if they are too frustration or traumatic event happens. If abuse is present then the incident needs to be investigated.
School-Age (6-12 years)
Physical Growth: These years are a time of gradual development. Growth in height and weight are at a much slower and steady pace. The average 6 yr old is approximately 45 inches tall and weighs 21 kg. The average 12 year old is about 59 inches tall and weighs approximately 40 kg. This is a difference of adding between 30 and 60 cm of growth in height and almost doubling their weight. Boys tend to be slightly taller and heavier than girls; however in the latter part of these years the girls may begin to surpass the boys. The body shape is becoming longer and leaner, lower center of gravity, baby teeth are starting to shed, decreased head circumference in relation to standing height and a decrease in waist circumference in relation to height. Muscular strength is increasing, as well as physical capabilities, posture and coordination.
Reflections of the body systems maturing include fewer upset stomachs, maintenance of glucose levels, and increased stomach and bladder capacity. Heart rate and respiratory rates decrease. Blood pressure increases from ages 6-12. Despite several infections that take place in the first couple years of school the immune system is becoming more competent in localizing infections. Bones are beginning to ossify and older children may begin showing signs of prepubescence. Generally puberty begins at age 10 in females and 12 for males.
|Erikson |Kohlberg |Piaget |Freud |
|Children are eager to learn and |School age children are beginning |Concrete operations, children are |Latency period, children are |
|experience a sense of |to develop a conscience and morals.|able to use thought processes to |experiencing relationships with |
|accomplishment |They begin to understand concepts |experience events and actions, |same sex peers. |
| |such as the “Golden Rule”. |allowing them to see things from | |
| | |another point of view. | |
Play: Play involves fantasy, increased physical skills, as well as intellectual ability. School age children will develop a sense of belonging with the development of clubs, groups, cliques and teams. These children see a need for rules, and games may have rules that are bizarre. Knowing these rules means belonging which is where they enjoyment is. Children derive a sense of pleasure and power from taunting and chanting things like, “Last one is a rotten egg!” Team play contributes to the social, intellectual, and skill growth, as well as teaching the children to modify and exchange personal goals for those of the group.
Nutrition: School-aged children continue to need healthy foods and nutritious snacks. They have a consistent but slow rate of growth and usually eat four to five times a day (including snacks). Many food habits, likes, and dislikes are established during this time. Family, friends, and the media (especially TV) influence their food choices and eating habits. School-aged children are often willing to eat a wider variety of foods than their younger siblings. Eating healthy after-school snacks are important, as these snacks may contribute up to one-third of the total calorie intake for the day. School-aged children have developed more advanced feeding skills, are better at feeding skills, and are able to help with meal preparation.
Health Promotion: • Wellness Examinations: Ideally programs would include a health appraisal, emergency care, safety education, communicable disease control, counseling, guidance, and health education tailored to meet the needs of individual students. • Immunizations: Tetanus, Diphtheria booster (Td) as well as an annual flu vaccination. • Dental Health: Proper oral hygiene is the most effective way to prevent dental caries. The secondary teeth begin to erupt at age 6. Correct brushing techniques should be established as well as habits. Inadequate dental care could lead to dental caries, malocclusion, and periodontal disease. Trauma is also common dental problem leading to loss of teeth.
Injury Prevention:
Automobile safety measures such as effective restraint systems, door locking mechanisms, and appropriate seating locations should be emphasized to reduce the prevalence and severity of injuries. The most common cause of death and severe injury in school age children is motor vehicle accidents. Most other injuries occur in or near home. Education is the most effective preventative measure. The use of helmets, appropriate padding, eye shields, and mouth guards are recommended for children riding bikes, skateboards, and playing sports, etc.
Adolescent (13-20 years)
Physical Growth:
|Female Puberty |Male Puberty |
|Breast changes, rapid increase in height and weight, appearance of |Enlargement of testicles, appearance of facial, pubic and axillary |
|pubic and axillary hair, menstruation |hair, rapid increase in height, changes in larynx and voice, nocturnal|
| |emissions |
|Erikson |Kohlberg |Piaget |Freud |
|Develop sense of Identity. Want to|Start of substituting their moral |Capacity for abstract thinking. Can|The id is the unconscious mind and |
|belong to a group. Establishes |values. Start to question their |understand abstract concepts and |driven by instincts. The ego is |
|difference between self and parent.|morality and relevance to society. |interpreting analogies and symbols.|the conscious mind and serves the |
|Becoming part of a group helps self|Move towards independence from |Beginning to understand |reality principle. The superego |
|identity. Others expectations can |parents and other authority |consequences and how they impact |functions as the moral arbitrator |
|influence identity formation. |figures. |their lives. Start to understand |and represents the ideal. |
|Forming sexual identity, influence | |how other people view them. | |
|from peer groups, culture, | | | |
|socioeconomic groups. Teens can | | | |
|emotions can swing swiftly either | | | |
|way. | | | |
Nutrition: Caloric and protein are very important at this stage of the child’s development due to the increased nutritional needs. Also supplements should be added due to the increase in need of Calcium, Zinc and Iron. Dietary teaching should include the need to eat breakfast and a balanced variety of healthy foods.
Health Promotion: • Wellness Examinations: Annually, what to assess. o Height and weight measurement o Age appropriate developmental screening o Vision screening o Hearing screening o Blood pressure (3 years and up) o Vital signs o Nutrition assessment o Immunizations o Lab procedures: urinalysis, sickle cell, tuberculin skin test, lead screening • Immunizations: DTaP btw 11-18 single dose, MCV4 (meningococcal) 11-12y/o, HPV for girls starting at 9, 1st dose, 2nd dose 2 months later, 3rd dose 6 months, 2nd MMR, exceptions pregnant teens, never got 1st dose, or documentation of 2 doses, influenza vac., Hep B 3 doses no specific age recommends, Varicella with no previous history, 13 y/o first dose, 2nd dose 4 weeks later. • Dental Health: corrective orthodontic appliances are usually first introduced, brushing and flossing are still important, fluoride use still recommended
Injury Prevention: Educate and reduce risk taking behaviors, education of motor vehicle operations, education of non automotive injury, ex: ATV’s, jet skis, snowmobiles, education of firearms, education of stretching exercises before game and practice, sports overuse injuries, football for boys and gymnastics and cheerleading for girls, education regarding eating disorders, suicide and depression. Educate on the use of drugs as this can lead to poisoning the body. Educate on the prevention of burns and use of sunscreen.
References
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2010). Maternal child nursing care. (4th ed.). Maryland Heights, MO: Elsevier.
Wissman, J. (2012 ed.). Adult medical-surgical nursing (RN edition 8.0). USA: Assessment Technologies Institute, LLC
Vaccinateindiana. (2013). Retrieved August 24, 2013, from www.vaccinateindiana.org/schoolrequirements
Growth and Development Milestones
August 2013
NRSG 206
Growth and Development Milestones
Infant (1-12 months)
Physical Growth: All major systems undergo progressive maturation. Growth is very rapid during the first year, especially the initial 6 months. Infants gain 5-7 oz. every week for the first 6 months. By the end of the first year the infant’s weight is about three times the birth weight. Height increases by 2.5 cm each month for the first 6 months. 6 months to year 1 growth comes in spurts rather than gradual patterns. Head growth is rapid. Head circumference increases approximately 1.5 cm each month, 6 months to 1 year by 0.5 cm. By the …show more content…
end of 1 year the cranial sutures close, the anterior fontanel close within the first 8 week and the posterior fontanel closing by 12 to 18 months.
Maturation of Systems: • Respiratory: rate slows from 35 at birth to 30 from months 1-11 • Immunologic: IgA is present in large amounts offering protection in the GI tract. Newborn receives significant amounts of maternal IgG starts synthesizing own at about 3 months, by 1 year has nearly 40% of adult levels. Significant amounts of IgM are produced at birth and adult levels are reached by 9 mos. IgA, IgD and IgE produced more gradually adult levels are not reached until early childhood. • Cardiovascular: heart rate slows from 100-180 (resting awake) at newborn to 80-150 after 3 mos. • Hematopoietic: significant changes occur during the 1st year fetal Hgb is present in large quantities for the first 5 mo., with adult Hgb steadily increasing through the 1st ½ of infancy. • Digestive: process is immature at birth. The majority of the digestive process does not begin functions until 3 mos. Digestion takes place in the duodenum where pancreatic enzymes and bile begin to break down protein and fat. The immaturity is evident in the appearance of the stool; solid foods are passed incompletely broken down. • Thermoregulation: during infancy becomes more efficient, the ability of the skin to contract and of muscles to shiver. • Renal: immature and predisposes the infant to dehydration. Complete maturity of the kidney occurs during the latter ½ of the 2nd year. • Sensory: Auditory acuity is at adult levels during infancy.
Visual acuity begins to improve, and binocular fixation is established. Binocularity, or the fixation of two ocular images into one cerebral picture, begins to develop by 6 weeks of age and should be well established by age 4 mos. Depth perception begins to develop by age 7 to 9 months by may exist earlier as an innate safety mechanism against accidental falling.
|Erikson |Kohlberg |Piaget |Freud |
|Psychosocial development – |Premorality or preconventional |Cognitive development – |Oral stage – mouth is pleasure |
|developing sense of trust |morality |sensorimotor phase |producer |
|Age |Gross motor |Fine motor |
|1 – 3 month |Can turn head from side to side |Hands predominately closed, grasp reflex …show more content…
strong|
| |Head lag @ 1mo able to hold head erect when |hand clenches on contact @ 1 mo |
| |sitting but still bobs forward @ 3 mos. With |Hands often open; grasp reflex fades @ 2 mos. |
| |only slight head lag. |Actively holds objects, grasp reflex absent, |
| | |hands kept loosely open, clutches own hand; |
| | |pulls at blankets and clothes |
|4 – 6 month |Almost no head lag, balances head, able to sit |Able to grasp objects, holds bottle, uses |
| |for increasing amounts of time, rolls from back|palmar grasp, plays with toys, tries to reach |
| |to abdomen |for object but over shoots. |
|7 – 9 month |Creeps on hands and knees, can pull self to |Uses thumb and finger in crude pincer grasp, |
| |standing position with something to hold on to |preference for dominant hand becomes evident. |
|10 - 12 month |Walks with one hand held, cruises well, may |Explores objects more thoroughly, has neater |
| |attempt to stand alone, may attempt to take |pincer grasp, can turn pages in a book(many at |
| |first step, can sit from standing position |a time) |
| |without help | |
Play: • 1-3months: Primarily narcissistic body parts are primarily objects of play and pleasure. • 4-6 months: Shows more discriminate interest in stimuli & begin to play alone with toy or stuffed animal. • 7-9 months: Laugh out loud, show a preference for certain toy. Become excited when food or a favorite object is brought to them. • 10-12 months: Play involves sensorimotor skills. Games like peek-a-boo and pat-a-cake. Play is much more selective choose who will interact.
Communication: • 1-3months: Cries to express displeasure, by 3 months squeals aloud to show pleasure. • 4-6 months: By 6 months begins to imitate sounds, babbling resembles on syllable utterance – ma, mu, da, di hi, vocalizes to toys mirror image, takes pleasure in hearing own sounds. • 7-9 months: Produces vowel sounds and “talks” when others are talking, combines syllables, such as dada, but does not ascribe meaning to them. Responds to simple commands. • 10-12 months: Says “dada, mama” with meaning, comprehends “bye-bye” May say one syllable words. Imitates definite speech sounds. Comprehends meanings of several words, recognizes objects by name, imitates animal sounds, and understands simple verbal commands.
Nutrition: • 1-3months: Human milk or formula • 4-6 months: Human milk is the most desirable for complete diet • 7-9 months: Progress to cereal • 10-12 months: Progress to baby food fruits and vegetables and other “soft” solid foods.
Health Promotion: • Wellness Examinations: 1 week for breast fed 2 weeks for formula fed, then 2, 4, 6, 9 and 12 months. • Immunizations: Hep B @ birth 2 and 6 mo., DPT @ 2,4, and 6 mo., Polio @ 2, 4, and 6 mo., Pneumococcal every 2, 4 and 6 mo., Influenza 6 months and then yearly, MMR not before 12 months, Varicella not be for 12 mo., • Dental Health: Cleaning begins when primary teeth erupt; fluoride at 6 months, tooth brushing is too harsh for the tender gingiva.
Injury Prevention: Parents should know the telephone # for poison control, If child is not breathing should call 911, constant vigilance, awareness and supervision is required. Small items that can fit through a toilet paper roll can pose a choking risk, the caregiver must physically remove child from danger.
Toddler (1-3 years)
Physical Growth: Growth rate slows down during this period. The birth rate is quadrupled by the age of 2 ½ and the height increases on average of 3 inches per year.
Maturation of Systems • Respiratory: Respiratory rate slows down and respirations continue to be abdominal. • Digestive: The stomach capacity increases and the gastric content increases and is capable of destroying many types of bacteria. • Immunologic: The production of antibodies is well established. There is an increase of colds and minor infections due to the lack of hand washing. • Bowel/Bladder: Sphincter control is achieved by 18-24 months and the bladder capacity increases to be able to hold urine for 2 hours or longer.
|Erikson |Kohlberg |Piaget |Freud |
|Toddlerhood is having a sense of |Right or wrong is determined by |This includes the 5th stage and the|Major conflict at this stage is |
|autonomy and overcoming doubt and |physical consequences |final stage of sensorimotor phase. |toilet training, the child learn to|
|shame | |The cognition process develops |control their bodily needs. |
| | |rapidly, toddlers will actively | |
| | |search for hidden objects. | |
|Age |Gross motor |Fine motor |
|15 - 18 month |Walk without help, seats self in a chair, runs |Builds a tower of 2-4 blocks, scribbles, turns |
| |clumsily, jumps in place with both feet |3-4 pages in a book at a time, manages a cup |
| | |and spoon |
|19 - 24 month |Goes up and down stairs alone, runs well, picks|Builds a tower of 6-7 blocks, turns pages of a |
| |up objects without falling |book one at a time |
|25 - 30 month |Jumps for chair or step, will stand on one foot|Will imitate vertical and horizontal lines, |
| |momentarily, |holds crayons with fingers instead of hand. |
|31 - 48 month |Pedal a tricycle, talk in simple sentences of |Draw a circle, complete simple puzzles, undo |
| |3-5 words, cut a straight line |Velcro on diapers |
Play: They parallel play with other children. Appropriate toys are locomotion toys such as push-pull, rocking horses, a small gym and slide. Finger paints, chalk and puzzles with large simple pieces help develop fine motor skills. Tactile play can provide opportunities for creativity such as clay, water toys and a sandbox.
Communication: By the age of 2 the child may have a vocabulary of about 300 words and can understand more than that. They may multiword sentences by stringing 2-3 words together. By the age of 3 they may talk in simple sentences.
Nutrition: As the growth rate slows there is a decrease in appetite.
Toddlers may become picky or fussy eaters. They can be influenced by factors of an overfilled plate, thus refusing it because of its size. Toddlers may have a favorite cup, plate or spoon and may refuse food because the food may be on a different plate.
Health Promotion: • Wellness Examinations: 12 months, 15-18 months, then yearly after age 2 • Immunizations: Between 12-18 months the following vaccines are given: Hep B (3rd shot in the series), DTaP, Hib, PCV, IPV, MMR, Varicella, and first of two Hep A injections. A yearly flu shot should also be given. • Dental Health: Brush and floss teeth, need regular dentist visits, need a fluoride supplement if it is not in the drinking water
Injury Prevention: Don’t allow the child to play on or near a curb or behind parked cars, supervise tricycle riding, turn pot handle toward the stove, move electrical appliances toward the back of the counter, cover electrical outlets with protective caps, place all potentially toxic agents in a locked cabinet, know the poison control number, place gates at the top and bottom of stairs, remove scatter rugs, keep large toys and bumper pad out of the crib or playpen, avoid fish with bones, hard candy, or chewing gum, keep Venetian blind cords out of reach of children, store dangerous tools and firearms in a locked
cabinet.
Preschooler (3-5 years)
Physical Growth: Physical growth at this age slows and stabilizes. The average weight gain remains about 5lb a year. The average height increases about 3 inches per year. These children will have large heads, with straight legs, and flat bellies. Preschoolers’ body systems mature and stabilize; which can adjust to moderate stress and change. Extremities of the preschooler grow rapidly which means the child becomes taller and leaner. More fine motor coordination is also seen. They can draw circles and squares instead of just scribbles.
|Erikson |Kohlberg |Piaget |Freud |
|A sense of initiative is the chief |Premortality or preconventional |Preschoolers have two ways al |Psychosexual development – Phalic |
|psychosocial task of the |mortality, stage 2 (4 to 7 years): |thinking: preconceptual thought - |or Oedipal/Electra stage – genitals|
|preschooler. |instrumental hedonism and concrete |(2 to 4 years) Preschoolers focus |become focus of curiosity, |
|Initiative vs. Guilt – Children |reciprocity. |on visual appearance. Misconception|Conscience develops |
|become competitive at this age. | |are: | |
|These children have a “can do” |The child conforms to rules out of |- Artificialismd - everything is | |
|attitude. They like to have goals |self-interest. |made by humans | |
|and they are very imaginative. |(ex: If you do something bad for |- Animism inanimate objects are | |
| |me, then it’s ok if I do something |alive | |
|A preschooler may take on something|bad to you.) |- Imminent justice - code that | |
|new even if he/she isn’t able to do| |determines law and order | |
|so. But then they feel guilty if |Concerned with satisfying own needs|Intuitive thought – (begins around | |
|they can’t accomplish that goal. | |4) aware of cause and effect | |
| | |relationships. | |
|Age |Gross motor |Fine motor |
|3 year |Child should be able to rides a tricycle, jumps|Child should be able to build a tower of 9-10 |
| |off of the bottom step, stands on one foot, go |cubes, and build bridges with three cubes. |
| |upstairs using alternate feet, perform broad |They should be able to place small pellets into|
| |jumps, and may try to dance but balance be |a bottle, draws circles or crosses, and can |
| |inadequate. |name what is drawn. |
|4 year |Childs ability to skip & hop on one foot, catch|Child should be able to use scissors to cut an |
| |reliably, throw overhead, and walk down stairs |outline, lace shoes (but not make a bow). The |
| |using alternate feet is intact. |can draw and copy a square, trace a cross and |
| | |diamond. They can also add three parts to a |
| | |stick figure. |
|5 year |Child is able to skip & hop on alternate feet, |They are able to tie shoelaces, use scissors |
| |catch throw well. Jump rope, skate with good |and pencil very well. Copying diamonds and |
| |balance and walk backwards should be achieved |triangles is achieved. Adds seven to nine |
| |also. They should be able to jump from height |parts to a stick figure. Prints a few letters, |
| |of 12 inches and land on toes. Balance on |numbers, or words like their name. |
| |alternate feet with eyes closed. | |
Play: During play the child has many changes at the preschool age. The child wants to please their parents. They engage in associative, imitative, imaginative, and dramatic play. Associative play is when they play the same game but are not working together with one another. Imitative play is when they copy actions. Copying the actions of their parents is one example of imitative play. Imaginative minds are apart of this age so monsters under the bed feel real to them. They are open to supernatural thoughts. Dramatic play is when they dress up and or use hand puppets to play. Helps with child to forget something they want to forget. Overall, this age of play is very active and their thoughts are expanding.
Communication: The Preschool age child uses language for mental symbolization. He/she might say something along the lines of “Do you like my horse” as he/she rides around the room on a pretend horse. Vocabulary increases dramatically between 2 and 5 so communication becomes enhanced verbally. They may become aggressive when they loose at this age. The may want to hurt or destroy property if they loose a game which communicates that they are dissatisfied. Stuttering or stammering may emerge if the child can’t master sensorimotor integration. Using words they are thinking faster than they can which causes them to end up in stuttering. Their language becomes more sophisticated and complex.
Nutrition: My pyramid for kids is important. It’s similar to toddlers. Quality is more important than quantity. The child should have about half the portion of an adult serving. Food becomes important for the strong taste they have for foods. They need to have about 90 calories per kilogram. According to that information if a child weighs 13 kg (28 lb) then that child would need 1170 calories for that day (average is 1800 calories).Proper nutrition, sleep, and dental care is important. 13 to 19 g/day of protein is recommended for preschoolers. Fatty acid consumption should be less than 10% total caloric intake. 500 mg of calcium is recommended as well. Fruit juices have been known to cause cavities. Having the practice of eating until the plate is clean is avoided as is may contribute to overeating.
Health Promotion: • Wellness Examinations: A SNELLEN screening is included in the exam. The wellness examination also checks to make sure the child can perform self care tasks like hand washing, getting dressed, toileting themselves. It also is used to see if the child lacks socialization skills. The child should be able to walk, run, climb, and jump at the preschool age. Health promotion is directed toward nutrition, adequate sleep, proper dental care, and injury prevention. • Immunizations: include DPT, polio, and MMR. • Ages 3 to 5 year olds should have 3 Hepatitis B, 4 Diptheria/Tetanus/Pertussis, 3 Polio, 1 Measles/Mump/Rubella, and 1 Varicella. • Dental Health: Deciduous teeth begin to be replaced with permanent teeth by age 5. The front teeth are first to go.
Injury Prevention: Improved gross and motor skills make them less prone to falls but they tend to be reckless and need education about safety on sidewalks, bicycling, running after balls because motor vehicle accidents are increased. Keep child’s stress level low. Monitor the amount so the amount doesn’t exceed their coping capabilities. Regression may occur if they are too frustration or traumatic event happens. If abuse is present then the incident needs to be investigated.
School-Age (6-12 years)
Physical Growth: These years are a time of gradual development. Growth in height and weight are at a much slower and steady pace. The average 6 yr old is approximately 45 inches tall and weighs 21 kg. The average 12 year old is about 59 inches tall and weighs approximately 40 kg. This is a difference of adding between 30 and 60 cm of growth in height and almost doubling their weight. Boys tend to be slightly taller and heavier than girls; however in the latter part of these years the girls may begin to surpass the boys. The body shape is becoming longer and leaner, lower center of gravity, baby teeth are starting to shed, decreased head circumference in relation to standing height and a decrease in waist circumference in relation to height. Muscular strength is increasing, as well as physical capabilities, posture and coordination.
Reflections of the body systems maturing include fewer upset stomachs, maintenance of glucose levels, and increased stomach and bladder capacity. Heart rate and respiratory rates decrease. Blood pressure increases from ages 6-12. Despite several infections that take place in the first couple years of school the immune system is becoming more competent in localizing infections. Bones are beginning to ossify and older children may begin showing signs of prepubescence. Generally puberty begins at age 10 in females and 12 for males.
|Erikson |Kohlberg |Piaget |Freud |
|Children are eager to learn and |School age children are beginning |Concrete operations, children are |Latency period, children are |
|experience a sense of |to develop a conscience and morals.|able to use thought processes to |experiencing relationships with |
|accomplishment |They begin to understand concepts |experience events and actions, |same sex peers. |
| |such as the “Golden Rule”. |allowing them to see things from | |
| | |another point of view. | |
Play: Play involves fantasy, increased physical skills, as well as intellectual ability. School age children will develop a sense of belonging with the development of clubs, groups, cliques and teams. These children see a need for rules, and games may have rules that are bizarre. Knowing these rules means belonging which is where they enjoyment is. Children derive a sense of pleasure and power from taunting and chanting things like, “Last one is a rotten egg!” Team play contributes to the social, intellectual, and skill growth, as well as teaching the children to modify and exchange personal goals for those of the group.
Nutrition: School-aged children continue to need healthy foods and nutritious snacks. They have a consistent but slow rate of growth and usually eat four to five times a day (including snacks). Many food habits, likes, and dislikes are established during this time. Family, friends, and the media (especially TV) influence their food choices and eating habits. School-aged children are often willing to eat a wider variety of foods than their younger siblings. Eating healthy after-school snacks are important, as these snacks may contribute up to one-third of the total calorie intake for the day. School-aged children have developed more advanced feeding skills, are better at feeding skills, and are able to help with meal preparation.
Health Promotion: • Wellness Examinations: Ideally programs would include a health appraisal, emergency care, safety education, communicable disease control, counseling, guidance, and health education tailored to meet the needs of individual students. • Immunizations: Tetanus, Diphtheria booster (Td) as well as an annual flu vaccination. • Dental Health: Proper oral hygiene is the most effective way to prevent dental caries. The secondary teeth begin to erupt at age 6. Correct brushing techniques should be established as well as habits. Inadequate dental care could lead to dental caries, malocclusion, and periodontal disease. Trauma is also common dental problem leading to loss of teeth.
Injury Prevention:
Automobile safety measures such as effective restraint systems, door locking mechanisms, and appropriate seating locations should be emphasized to reduce the prevalence and severity of injuries. The most common cause of death and severe injury in school age children is motor vehicle accidents. Most other injuries occur in or near home. Education is the most effective preventative measure. The use of helmets, appropriate padding, eye shields, and mouth guards are recommended for children riding bikes, skateboards, and playing sports, etc.
Adolescent (13-20 years)
Physical Growth:
|Female Puberty |Male Puberty |
|Breast changes, rapid increase in height and weight, appearance of |Enlargement of testicles, appearance of facial, pubic and axillary |
|pubic and axillary hair, menstruation |hair, rapid increase in height, changes in larynx and voice, nocturnal|
| |emissions |
|Erikson |Kohlberg |Piaget |Freud |
|Develop sense of Identity. Want to|Start of substituting their moral |Capacity for abstract thinking. Can|The id is the unconscious mind and |
|belong to a group. Establishes |values. Start to question their |understand abstract concepts and |driven by instincts. The ego is |
|difference between self and parent.|morality and relevance to society. |interpreting analogies and symbols.|the conscious mind and serves the |
|Becoming part of a group helps self|Move towards independence from |Beginning to understand |reality principle. The superego |
|identity. Others expectations can |parents and other authority |consequences and how they impact |functions as the moral arbitrator |
|influence identity formation. |figures. |their lives. Start to understand |and represents the ideal. |
|Forming sexual identity, influence | |how other people view them. | |
|from peer groups, culture, | | | |
|socioeconomic groups. Teens can | | | |
|emotions can swing swiftly either | | | |
|way. | | | |
Nutrition: Caloric and protein are very important at this stage of the child’s development due to the increased nutritional needs. Also supplements should be added due to the increase in need of Calcium, Zinc and Iron. Dietary teaching should include the need to eat breakfast and a balanced variety of healthy foods.
Health Promotion: • Wellness Examinations: Annually, what to assess. o Height and weight measurement o Age appropriate developmental screening o Vision screening o Hearing screening o Blood pressure (3 years and up) o Vital signs o Nutrition assessment o Immunizations o Lab procedures: urinalysis, sickle cell, tuberculin skin test, lead screening • Immunizations: DTaP btw 11-18 single dose, MCV4 (meningococcal) 11-12y/o, HPV for girls starting at 9, 1st dose, 2nd dose 2 months later, 3rd dose 6 months, 2nd MMR, exceptions pregnant teens, never got 1st dose, or documentation of 2 doses, influenza vac., Hep B 3 doses no specific age recommends, Varicella with no previous history, 13 y/o first dose, 2nd dose 4 weeks later. • Dental Health: corrective orthodontic appliances are usually first introduced, brushing and flossing are still important, fluoride use still recommended
Injury Prevention: Educate and reduce risk taking behaviors, education of motor vehicle operations, education of non automotive injury, ex: ATV’s, jet skis, snowmobiles, education of firearms, education of stretching exercises before game and practice, sports overuse injuries, football for boys and gymnastics and cheerleading for girls, education regarding eating disorders, suicide and depression. Educate on the use of drugs as this can lead to poisoning the body. Educate on the prevention of burns and use of sunscreen.
References
Perry, S. E., Hockenberry, M. J., Lowdermilk, D. L., & Wilson, D. (2010). Maternal child nursing care. (4th ed.). Maryland Heights, MO: Elsevier.
Wissman, J. (2012 ed.). Adult medical-surgical nursing (RN edition 8.0). USA: Assessment Technologies Institute, LLC
Vaccinateindiana. (2013). Retrieved August 24, 2013, from www.vaccinateindiana.org/schoolrequirements