Toddler Growth and Development

Growth and Development
Robin Harmon 10/11/2009

Adolescent
Physical Development:
Height/Weight:
Age Physical Growth
12 to 18 Variation in age of growth spurt, girls gain 15 to 55 pounds and grow 2 to 8 inches; boys gain approximately 15 to 65 pounds and grow 4.5 to 12 inches

Normal Adolescent Physical Growth Patterns:
Age Height Females Height Males Weight Females Weight Males
12 55-64 in 54-63.5 in 68 -136 lb 66- 130 lb
14 59-67.5 in 59-69.5 in 84 - 160 lb 84 - 160 lb
16 60-68 in 63- 73 in 94 - 172 lb 104 - 186 lb
18 60 - 68.5 in 65 - 74 in 100 - 178 lb 116 - 202 lb
Adolescence is the second fastest growth period. It is the first stage in which patterns differ gender. Both height and weight increase earlier in females than in males, but gains in both measurement are ultimately greater in males than in females. As mentioned females usually start to mature earlier than males. At puberty, increases in four primary sex hormones cause physical changes in girls. These hormones are follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and progesterone. There is an increase in the rate of skeletal growth, a widening of the pelvis, and a change in fat distribution. Breast tissue begins to develop, and coarse hair forms under the arms and over the mons pubis. At about 13 years females experience menarche, the beginning of the menstrual cycle. Menarche can begin as early as age 8 and as late as age 16. A few months later ovulation begins. These changes take several years to complete. The female usually reaches full physical maturation by age 16, but it might be as late as 18 years of age. Sexual maturity can be documented in stages (called Tanner's stages).
Male development usually begins 2 years later than female development. Changes in hormones guide physical changes in males as in females. FSH and LH trigger the increase of testosterone. There is a rapid growth with an increase in height, lengthening of the jaw, and a doubling of muscle mass. The penis and testicles mature, and coarse hair forms on the face, axillae, and pubis. The voice deepens. Ejaculation signals the beginning of spermatogenesis. Although these changes are usually apparent by age 16 the male may not reasch his adult hight until 19 to 21 years of age.

Vital Signs:
Temperature (oral): 98.6 Fahrenheit
Pulse: 70 (50 to 90)
Respirations: 18 (15 to 20)
Blood Pressure: 120/80 mmHg

Motor Development:
Fine Motor Skills: Skills are well developed
Gross Motor Skills: New sports activities attempted and muscle development continues. Some lack of coordination common during growth spurts
Psychosocial Development:

Erickson's Stages of Development:
The 5th stage is adolescence. This stage, ages 12 to 20 years of age , is the time of identity versus role confusion. Teenagers are developing their sexual identity becoming more independent and beginning the process of separation from their parents. Teenagers have a strong desire to make their own decisions and "live their own life", but at the same time they have a real need to know the boundaries or rules. Teenagers are examining the world and trying to decide where they fit, what their life's work will be, and how they can accomplish their goals. They are beginning to use peers for support instead of relying on parents for help in making decisions. With positive reinforcement of their progress, they can develop a strong identity. However with continual negative feedback, coupled with feelings of inferiority and guilt, they become confused, ambivalent, and withdrawn. If the parents do not allow them to separate from their influence, develop peer relationships, and make their own decisions, they will remain dependent because they have not developed a clear identity.
Cognitive Development/Communication:
Although emotional and physical maturity is usually reached sooner in females, cognitive development progresses equally. The adolescent moves from the concrete operations level to the abstract comprehension (formal operations) level of cognitive development. Cognitive milestones include the following:
*Ability to examine hypothetical situations and apply the concepts to current issues.
*Ability to examine philosophical ideas and compare real world situations to the ideal.
*Ability to pan for the "what if"
*Development of adult profiency with language (although adolescents frequently use slang to "fit in" with their peer groups)
In the early years 13 to 14 years of age, adolescents may be self-centered but they gradually mature and develop a strong identity. This is a difficult transition, however. A changing boby and an increase in hormones bring about confusion and doubt. Adolescents want to feel attractive, but they may feel ugly because of skin changes, the awkwardness of a rapidly changing body, and mood changes. Hormonal changes and a physiologic drive to reproduce put many pressures on development of sexuality. Peers are most important at this time and can have a positive or negative influence on behavior. Stron peer pressure and feelings of immortality ("it won't happern to me") can lead to unwise choices and risk taking behaviors. Parents often look for guidance at this period in their children's lives. The simple rules of family are giving way to larger societal influnences. Educational, religious, and health care professionals can offer valuable information to help parents provide guidelines for their teens.

Health Screening:
*Health examinations as recommended by the physician
*Screening for tuberculosis
*Periodic vision and hearing screenings
*Regular dental assessments
*Obtaining and providing accurate information about sexual issues
15 years: Height and Weight, Review developmental milestones, and sexual activity. The physical examination now should include self-care of skin-examination, breast self-examination, testicular self-examination, and frequency of pelvic examinations. It is particularly important to include counseling on substance use, unwanted pregnancy, and STD risk reduction.

Health Promotion:
Immunizations: as recommended, such as adult tetanus-diphteria (Td) vaccine and hepatitis B vaccine.
Range of Recommended ages
Hepatitis A9, Influenza, PPV, MCV4
Catch- Up Immunization
Hepatitis B1, Tdap, MMR, Varicella, MCV4

Nutrition: 2,200 to 2,800 kcal/day
Meeting the nutritional needs of the adolescent is a challenge. The rapid growth spurt and increased muscle mass result in a need for 2,000 to 3,000 calories daily. Teens active in sports require even higher calorie intake. Requirements for iron, calcium, zinc, and vitamins all increase. To meet these requirements, 3 meals per day, with nutritious snacks between meals are needed. Calcium intake has been found to be particularly important during adolescence, and adequate intake has been linked with the prevention of osteoporosis. The deposition of calcium is 5 times greater prior to menarche than that of adult women. Adequate calcium and vitamin D during early adolescence is effective in enhancing bone mineral composition. Adolescents diets should contain protein, milk, fresh fruits, and vegetables daily. However, many adolescents choose high calorie, high fat, convenience foods. The adolescent should be taught to make healthy food choices. Nutritional teaching and counseling are most effective when conducted in a group setting with teenager's peers.
*Importance of healthy snacks and appropriate patterns of food intake and exercise.
*Factors that may lead to nutritional problems (e.g., obesity, anorexia, nervosa, bulimia)
*Balancing sedentary activities with regular exercise

Elimination:
School age & adolescents = 0.5-1 ml/Kg/hour

Hyigene:
Children are at high risk for contacting communicable diseases. This risk can be lowered through careful attention to matters of hyigene. Hand washing is an important measure for the nurse to teach parents. Children need to understand the importance of washing their hands vigoursly before and after meals and after toileting. Germs are also spread among children by sharing toys and snacks. Children in church nurserier, day care centers, and schools should be monitored for hand to mouth activities and encouraged to wash their hands frequently.
The child who is ill can spread germs to other children by coughing, sneezing, and indiscriminately disposing used tissues. The nurse can teach the parent and children the importance of covering their mouth when coughing or sneezing. School officials are now encouraging children to sneeze and cough into their elbows rather than their hands. This will prevent germs from getting onto the child's hands, where they can more easily passed to others. Children should be taught to dispose of used tissues in trash receptacles and avoid leaving them where others may come in contact with them.

Rest/Sleep:
Studies of normal sleep and sleep patterns in adolescents have identified important issues regarding the basic developmental physiology of sleep and circadian rhythms in adolescence. The role of pubertal/hormonal influences on circadian sleep-wake cycles and melatonin secretion has been recognized, and the effects include development of a relative phase delay (later sleep onset and wake times) in early puberty and the development of a physiologically based decrease in daytime alertness levels in mid- to late- puberty. The genotypic expression in adolescence of delayed circadian phase preference has also been explored as an important factor determining the timing of sleep/wake cycles.

- Studies of homeostatic regulation of sleep and wakefulness have demonstrated that sleep needs in adolescence do not decline significantly, and that optimal sleep amounts remain about 9 hours into late adolescence. However, epidemiological research on "normal" sleep patterns and amounts suggests that adolescents only average 7 to 7 1/2 hours of sleep per night, resulting in the accumulation of a considerable sleep debt over time. These data suggest that chronic partial sleep deprivation is a serious problem in this age group and that particular subgroups may be at relatively higher risk.

- Environmental and social factors also impact significantly upon delayed sleep onset in adolescents. For example, many adolescents have highly irregular sleep/wake patterns from weekday to weekend. Another important factor potentially contributing to insufficient sleep is the early start time of many middle and high schools in the United States.

Activity/Play:
The adolescent is rapidly making the transition from childhood play to adult play. As a result team sports, extracurricular activities, and attending movies and concerts often occupy the adolescent 's free time. The adolescent begins to try out more risky adult activities, including car racing, motorcycle riding, and jet boating. Being with friends and peer groups soon becomes more important than spending time with parents. Teens look to each other for approval. By late adolescence, male-female relationships are developing, and sexual encounters might be part of the "play" Unfortunately other activities such as use of alcohol and illegal drugs might become part of the adolescent's recreational time. Nurses should help parents and teens prepare for the responsibilities and consequences of adult play.
*Encouraging adolescent to establish relationships that promote discussion of feelings, concerns, and fears.
*Parents' encouraging adolescent peer group activities that promote appropriate moral and spiritual values
*Parents' acting as role models for appropriate social interactions
* Parents' providing a comfortable home environment for appropriate adolescent peer group activities

Dental Health:
During adolescence, individuals are at increased risk for caries. This risk is due to immature enamel, a diet high in refined carbohydrates and acid-containing beverages, and poorly established oral habits. The nurse should assess for and encourage regular dental check ups, brushing and flossing.
The adolescent may pierce his or her tongue, lip, cheek, or uvula. These piercings have been found to compromise oral and overall health. If they are done in nonasptic conditions, disease transmission may occur. Such diseases include hepatis, tuberculosis, tetanus, and other bacterial or viral infections. The nurse should assess a client's oral cavity for the presence of these piercings and include the risks and hazards in health promotion teaching.

Safety and Injury Prevention:
Driving:
•Create driving rules – Parents should be able to experience first hand what kinds of abilities their teens have while on the road. A learner’s permit requires that the teen spend a set number of hours in driver’s training, but as a parent you may know that that amount of time is not sufficient for you to feel comfortable enough to let your teen get his license and be on the road alone. There is nothing wrong with creating your own family rules of the road and holding off on allowing your teen to get his license until you feel like he is ready. New teenage drivers whose parents put restrictions on them in their first six months behind the wheel are less likely to report that they engage in risky driving behavior, even after the restrictions have been lifted. Of course no parent will ever be fully prepared to send their son or daughter out on the road, but you can feel more comfortable about it if you are the one who gets to decide when he or she is ready to start driving.
•Use statistics and real-life stories – Teenagers are infamous for their abilities to know everything and especially to be smarter than their parents. Hopefully, you sensed the satire in that comment yet those with teens understand better than anyone the challenges that exist when teaching teens. Sometimes the council of others or facts from reputable sources are what is needed to get the point through to teens about the importance of safe driving. Using statistics such as that the number one cause of death among teenagers is a car accident or that 41% of teenage fatalities are due to car accidents may be a powerful tool for you to use in getting your child’s attention.
•Take a course – Many times parents simply do not know what exactly they should be teaching their children when it comes to driver’s education. There are so many things that are important to know that often times the simple topics of driving safety are over looked. If you feel like you need some more structured guidance when it comes to teaching your teen safe driving, consider having your teen take a course offered by your car insurance company. Many of the national car insurance companies will offer courses as well as programs designed specifically for providing an incentive to teens if they drive safely. Of course parents are encouraged to participate in these courses as well as to play an active role in the contractual agreements that their teens will make.

Poisoning:
*Keep toxic products in locked areas.
*Keep prescribed and over the counter medicines in locked cabinets.
*Keep the local Poison Control Center phone number by the phone.
Adolescent Sexuality and Teenage pregnancy and STI's:
More than 50% of adolescent girls and 75% of adolescent boys report engaging in sexual intercoarse before the age of 18. This high risk behavior not only increases the incidence of teenage pregnancy, it also exposes the teens to STD's. Decreasing the incidence of adolescent pregnancy and STI's is an objective of the U.S. Department of Health and Human Services and of many school systems.
Peer pressure can lead the adolescent to experiment in high risk activities. The combination of peer pressure, feelings of invincibility, and elevated sex hormones and sex drive may lead adolescent's to engage in premartial sexual intercoarse.Some begin to develop a monogamous relationship, at least for a while. Other teens fail to develop a close relationship with one person and move from partner to partner in a short period of time or have multiple partners at one time. Nearly half of high school seniors report having had sexual intercoarse. As mentioned frequent sexual contact with multiple partners increase the exposure to STI's and the likehood of pregnancy. Teens in lower socioeconomic levels engage in sexual rrelationships at nearly the same rate as other teens. However they have a disproportionate number of teen pregnancies. The lower socioeconomic level adolescent may not have the same access to birth control measures as their counterparts in higher socioeconomic levels. They may not feel that higher education and career development are realistic goals. Instead they may transition into adulthood by engaging in sexual intercourse and becoming parents. In contrast teens in higher socioeconomic levels often have ready access to various forms of contraception. They may have been rasied with the expectation that they will go on to college or a career before parenting. These teens may be more likely to use contraceptive methods or to terminate pregnancy if it occurs.