LEARN
STEP #2 Make the connections to key topics.
108 Unit 3 | Growth and Development of the Child
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Developmental tasks are the sets of skills and competencies that are unique to each developmental stage. Certain tasks must be mastered for the child to progress to the next level. Develop- mental tasks for each stage are detailed in Table 7-1.
TABLE 71 Developmental Milestones
AGE
FINE MOTOR
GROSS MOTOR
Growth and Development
Birth to 1 month
Opens fingers slightly at rest
Arms and legs move together Holds chin up when lying on stomach Raises head and chest when lying on stomach Supports upper body with arms when lying on stomach Stretches legs out and kicks when lying on stomach or back Can roll from side to side Can sit unsupported by 7 or 8 months Supports whole weight on legs Pulls self up to stand Walks holding on to furniture May walk two or three steps independently Jumps Kicks ball Learning to pedal tricycle
SAFE AND EFFECTIVE NURSING CARE: Promoting Safety
2–3 months
Grasps toys, can open and close hands Eyes follow object to midline Blows bubbles
Childproofing Caregivers must be aware of growth and developmental mile- stones to prevent injury at different stages. In early childhood, care and consideration should be given to prevent falls, chok- ing, and aspiration of food or objects. Childproofing the home to prevent injuries is important.
Gastrointestinal Disorders
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Mary Grady, DNP, RN CNE, CHSE Jill Matthes, DNP, RN CHSE
CRITICAL COMPONENT Reflexes
6–8 months
Bangs objects on table Can transfer objects from hand to hand Start of pincer grasp
LEARNING OUTCOMES Upon completion of this chapter, the student will be able to: 1. Describe general principles of growth and development.
CONCEPTS
During a well-child visit, the mother is concerned her 4-month-old baby is acting startled for no reason. She says he makes jerky movements during sleep and sometimes when awake. How will you address the mother's concerns using the following information? Nurses need to know normal infant reflexes and recognize when they are not present. Reflexes that remain can be a sign of growth and developmental issues and delays (Beckett & Taylor, 2019). A few of the most common reflexes to watch for include: • Tonic neck/fencing reflex—disappears around 4 to 6 months • Moro/startle reflex—disappears around 4 to 6 months • Babinski's—disappears by 1 year of age
Caring Collaboration Communication Evidence-Based Practice Professionalism Growth and Development Self-Care Family Health Promotion
2. Discuss cognitive growth and development according to Jean Piaget. 3. Discuss psychosocial growth and development according to Eric Erikson. 4. Discuss psychosexual growth and development according to Sigmund Freud. 5. Discuss social-moral growth and development according to Lawrence Kohlberg. 6. Discuss the theory of nature versus nurture. 7. Apply principles of family-focused care in approaches toward the child. 8. Analyze factors that affect growth and development. 9. Understand nursing applications of growth and development theories.
1 year
Can hold crayon, may mark on paper Begins to use objects correctly
Gastrointestinal Disorders
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2–3 years
Learning to dress self Can draw simple shapes (e.g., a circle)
CLINICAL JUDGMENT Family-Centered Care
● Differentiation—simple to complex progression of achieve- ment of developmental milestones ● Example: The child learns to crawl before learning to walk. Variation at different ages is based on specific body structure and organ growth.
GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT
As part of family-centered care, nurses need to adapt their care and nursing interventions to the child's stage of growth and development. They will need to explain what is happening to a child in language and on a developmental level the family can understand. A child's caretaker should always be included in the child's care and interventions. Nurses need to remember that we are not caring for just a child, but for the entire family unit (Institute for Patient- and Family Centered-Care, n.d.).
4–5 years
Dresses independently Uses scissors Learning to tie shoes Brushes teeth
Goes up and down
Gastrointestinal Disorders
stairs independently
Growth and development are closely interrelated, interdepend- ent processes that are unique for each individual and influenced by factors such as genetics, environment, and nutrition. Growth, the increase in height and weight, and development, acquisition of skills and abilities, begin at conception and continue until end of life. Although highly individualized, growth and develop- ment follow an orderly pattern characterized by periods of rapid growth and plateaus (spurts and lulls): ● Cephalocaudal—starts at the head and moves downward ● Example: The child can control the head and neck before the arms and legs. ● Proximodistal—starts in the center and processes to the periphery ● Example: Movement and control of the trunk section of the body occurs before movement and control of the arms.
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Throws a ball overhand Hops on one foot
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CLINICAL JUDGMENT Failure to Thrive
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Source: Centers for Disease Control and Prevention (2021) .
Failure to grow and develop at an expected rate can mean that a child is failing to thrive. The diagnosis of failure to thrive (FTT) is given to children who fall below the fifth percentile ranges on height and weight charts. For infants, it usually presents first with an absence of weight gain or weight loss (Tagher & Knapp, 2020). Then a drop in height occurs followed by a drop in head circumference. FTT can have organic or nonorganic causes that contribute to developmental delays in the child.
PSYCHOINTELLECTUAL DEVELOPMENT
● Cognitive acts occur as the child adapts to the surrounding environment. ● The child’s experience with the environment naturally encour- ages growth and maturation. ● The child must accommodate new or complex problems by drawing on past experiences. ● There can be overlap between the child’s age and stage of development. Each stage does not start and end at exactly the same age for each child.
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The key theorist within cognitive development is Jean Piaget, a Swiss child psychologist (1896–1980). Piaget identified the following characteristics of cognitive development: ● Development is a sequential and orderly process, moving from stages that are relatively simple to more complex (Table 7-2).
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Pre-Assessment for Gastrointestinal Disorders
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