first year peds
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| Morbidity | GI and Respiratory most common
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| Hospitalized Child’s Reaction infant | Infant Separation anxiety
Angry/upset then withdrawn
Feel abandoned by paren
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| Hospitalized Child’s Reaction todler | protest loudly, cry to sleep, anger to despair, denial of importance of parent
Fear of injury/pain
Loss of control ERIKSON: TODDLERS task of autonomy, activity limits and decreased choices leave child to feel powerless Miss rituals/routines May regress
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| Hospitalized Child’s Reaction preschooler | Preschooler Separation anxiety relieves tension through magical thinking, imaginary friends sign of high intelect
Fear mutilation
Act uncooperatively
Ask for parentsMiss rituals
May regress
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| Hospitalized Child’s Reaction school aged | School age Separation anxiety
Fear disability and death
Loss of control may have altered vitals in emotional response
Fear pain/bodily harm
Miss friends
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| Hospitalized Child’s Reaction adolesent | Adolescent Does not want to appear different
Loss of control
Miss friends
All ages Fear of unknown
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| Family’s Reaction to childs hospitalization | Guilty, helpless, and anxious involve parent in care and encourage them
• Blame themselves
• Fear of unknown
• Financial pressure
• Siblings : Angry, resentful, jealous, & guilty involve sibling in care
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| Safety | Supervised
• Siderails
• Medications
• Toys
• Equipment
• Restraints therapeutic holding: parent holds child for injection
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| Medical Asepsis | • Prevent spread of infection
• Disinfect contaminated objects
• Use disposable items
• Utilize universal precautions
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| the child in pain | Identify words used for pain. Monitor VS eval pain and vitals 15-30 min after admin
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| Non-pharmacological Pain Management | Distraction
_ Relaxation
_ Heat/ cold
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| Pharmacological Pain Management | NONopioids=mild to moderate
opoioids=moderate to severe(consider the effects)
oral opioids= oxycodone codine
morphine is given IV
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| pain scale | (infants and verry young children)FLACC=face legs activity cry and consolability.
FACES(preschool and schoolage)
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| Height & Weight head circumference | •Weigh infant naked
• Measure infant supine
Above eyebrows/ ears to occipital prominence
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| vitals special considerations RR,HR are higher, BP lower | count (abdominal) rise and fall. in community bp is measured at 3yo. unless renal or heart pt. done on admission. proper size 40%with and 80-100% (bladder length)circumference of arm
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| vitals special considerations cont. | Oral Not after oral surgery
Not with seizures
Rectal Lubricate
Insert 1”
Not for newborns
Last VS
Axillary Hold arm close to body
Tympanic Direct toward eardrum
Rapid & easy
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| stages of growth and development | NB= birth to 4weeks, infant=one month to one year, toddler 1-3y, 3-6,6-12,12-21
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| Ht, Wt, & Proportion | rapid growth periods: fetal head, infancy trunk, child limbs adolescence genitals
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| Metabolic Rate | higher =more waste producedRENAL, insensible losses FLUID,greater BSA INTEGUMENT
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| Bone Growth | best indicator of biologic age
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| Critical Periods | first 3 months after conception
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| Integration of Skills | Integration of Skills child will focus on one skill while mastering others already learne
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| hight | NB 20inc,liner growth is skeletal.family trait, nutrition and health play a role
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| weight | infant 7lbs, uterine environment plays a role, doubles by 6months, triples by first year
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| Metabolic Rate | Metabolic Rate higher =more waste producedRENAL, insensible losses FLUID,greater BSA INTEGUMENT
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| Bone Growth | best indicator of biologic age, osteoblastic rate high end, calcium stored in ends of long bones
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| Critical Periods | first 3 months after conception
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| Integration of Skills | child will focus on one skill while mastering others already learned
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| Directional Patterns | Cephalocaudal head to toe
• Proximodistal inner to outer
• General to specific
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| nutrition | MAY be the single most important factor on growth and development
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| mazlows hierarchy of needs | self actualization, esteem, Love(belonging), safty(protection,), activity, physiological needs
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| Erikson PSYCHOSOCIAL DEVELOPMENT | TRUST/MISTRUST
ATONOMY/SHAME DOUBT
IDENTITY/ROLE DEFUSION
INDUSTRY/INFERIORITY
INITATIVE/GUILT
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| TRUST/MISTRUST | Infancy:TRUST feeding in a timely and loving manor
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| ATONOMY/SHAME DOUBT | Toddler INDEPENDENCE maintain daily routine allow to dress and feed self
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| INITATIVE/GUILT | Preschooler; CURIOSITY should be encouraged by exploration and questions
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| INDUSTRY/INFERIORITY | School aged: SELF WORTH AND VALUE use activities to express
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| IDENTITY/ROLE DEFUSION | Adolescence DEFINE, INDEPENDENCE promote responsibility and support choices
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| Kohlberg MORAL DEVELOPMENT | PRECONVENTIONAL PRESCHOOL
CONVENTIONAL SCHOOL
PRINCIPLED MORAL ADOLESCENCE
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| PRECONVENTIONAL PRESCHOOL(4-7 years old) | or premoral, rules are absolute breaking rules result in punishment(4-7 years old)
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| CONVENTIONAL SCHOOL age (7-11) | CONVENTIONAL rules are created for all adhearing to rules is the right thing to do
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| PRINCIPLED MORAL(12-death) | right and wrong based on own perceptions of the world
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| Piaget COGNITIVE DEVELOPMENT | SENSORIMOTOR
PREOPERATIONAL
PRECONCEPTUAL
PERCEPTUAL
CONCREAT OPERATION
FORMAL OPERATION
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| SENSORIMOTOR (birth -2years) | learns by reflexes, and senses
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| PREOPERATIONAL(2-7) | egocentric every one sees world as he or she does
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| PRECONCEPTUAL (2-4) | general concepts still dumb as hell
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| PERCEPTUAL (4-7) | capable of some reasoning but focus on one aspect of subject at a time(centering)
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| CONCREAT OPERATION (7-11) | reasoning is logical but limited to own experience (cause and effect)
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| FORMAL OPERATION (11-16) | develops abstract concepts. oriented to problem solving
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| Erickson examples toddlers | toddlers ability to do simple daily routines(independence)feed and dress themselfs,
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| Erikson examples preschoolers | cruiosity about enviroment encouraged by exploration and questions, let them play iwth medical equipment if safe. limit with choices. this promotes self satisfaction and broadens their experiences
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| Erikson examples school age | activities provide self worth. school edu, hobbies and interaction with peers can assist with a feeling of accomplishment
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| Erikson examples Adolescents | take responsibility for actions and promote their choices can enhance their identity
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| Infant Growth Characteristics | Rapid growth and development
• Individual patterns
_ Continuous growth
_ Slow and rapid periods
• Brain growth most critical
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| Fontanels close | 2mo posterior 2years anterior closes
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| Reflexes disappear | grasp 2mo, primitive 3mo, rooting moro 4mo
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| Sit up | with support 5 mo, pulls self to sit at 6mo,sits alone steady 8 mo
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| Turn over | 4 mo, completely at 6mo
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| Crawl | 7mo
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| Walk 11-12mo | Walk 11-12mo
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| Tooth develop | signs at 5mo, two incisors at 6-10mo
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| Eating | 7mo involvement with feeds, 9mo spoon independent and pincer grasp
4-6mo=cereal, pureed veg fruit one at a time7-8mo,cup juice and finger foods at 9mo,allergenic types after one year old and observe for reactions one new per week.
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| Talking | 9mo rare, 10mo aprox 3 words
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| Stranger fear | 11 mo
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| Pincer grasp | 8 mo- 1year
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| Infant Needs | Love and security
• Trust vs Mistrust erikson
• Sensory stimulation
• Play - solitary
• Safety
• Nutrition
• Dental health
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| APGAR initial and in 5 min | 8-10 good score,4-7 require special care and obs, 0-3 requires resuscitation
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| icterus neonatorum | physiologic jaundice, caused by the destruction of RBCs
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| kinicterus | bilirubin encephalopahty, if jaundice is sever and unchecked can result in brain damage, and death, may also result from cold stress (metabolic jaundice)
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| infant G/D feeding | extrusion reflex(spit out food)disapears around 3-4 mo. cearial 4mo, can handle more complex food 6mo, at 12 mo stomach is 200ml. 2years has mastered spoon.4-6mo solids.cerial4-fruits&veg7-meats8-juice9-alergenic1year
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| teeth | 20 in 2.5, begining at 6mo, no bottels to bed, discurage nite time feedings after one year of age
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| colic | pyroximal abdominal pain usualy goes away by 3months. treatment: prone over a (warm!)hot water bottle*, pacifier, walks car rides, burping, WILL OUTGROW THIS
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| The Toddler | SLOWER GROWTH.control of head hands and feet Curiosity Ritualistic, gross motor quickly develops
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| Toddler GROSS MOTOR | 15mo walks,runs 18-24mo,jumps 30mo. stairs 18-24,throws ball 18m, kicks ball 24m,
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| Toddler physcial | Proportions change arms and legs get longer
_ Arms & legs lengthen bone growth important epiphyseal areas
_ Muscle growth size and strength of muscle fibers increase
• Total of 20 teeth 30mo 2.5---3years
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| Autonomy vs Shame/Doubt (Erikson) | encourage independence, don’t do everything for them, sense of security is gained from independence, but help and limit choice. Independence importance of toileting eating sleeping, tolerates brief independence likes to know where parents are
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| Anal phase (Freud) _ Toilet training mylination of spine is complete by 2years allowing control of sphincters | indication of readiness is waking up dry after substantial nap or sleep 18-24 Mo, sit on potty for 5-10 min MAX, set routine after nap, before meals before bed every day, can sit on toilet reverse style,
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| Toddler vocalization | 15mo, 4-6words,18m 10+ body parts, 24m 300words first name toileting food drink, wont shut up.30m first and last name,pronouns plurals and one color.
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| Toddler - Common Behavior • Temper tantrums | ignore unless hurting self or others and divert to other activity asserting independice
• Negativism
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| Toddler - Fears | • Separation anxiety greatest fear separation from parents (never sneek out)mastering separation is a developmental process
_ Protest-Despair-Denial
• Abandonment
• Strangers
• Loud noises
• Sleep
• Large animals
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| Toddler - Learning | Explore & experiment
• Imitation
• Repetition
• Parallel Play
• Poor sharing
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| Toddler - Communication | Delayed speech may not indicate mental slowness, direct further questions to pediatrician
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| Toddler - Communication cont. | DDST denver developmental screening test, personal social fine motor adaptive language and gross motor is nither a neuro or intellectual test. Low score merely indicates further eval
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| Communication | _ Keep simple
_ Eye level
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| toddler management | help them establish limits for them self and and find socially acceptable outlets for their behavior
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| DDST | Denver developmental test not intellect or neurological. used up to 6years old. does not diagnose anything just indicts need for further testing
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| the "I message" | example I feel angry when u hit your sister, saying your a bad boy demoralizes the child and invokes guilt.
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| play of the todler | not shairing "MINE!" parallel play at first, then as verbage and hand skills pick up, associative play, and may or may not begin cooperative play
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| The Preschool Child | Age 3-6 yr 90% of brain growth achieved.Initiative vs Guilt conflict arises when initiative is punished or criticized
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| Development of Preschool Child | • Egocentrism only sees his or her point of view
• Animism objects have life
• Artificialism everything is created by human beings sky painted ect
• Symbolism pretending that a box is a fort
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| Development of Preschool Child cont. | Preconceptual 2-4 years
_ Intuitive thought 4-7years
• Magical thinking believes that he can wish things dead. Centering focus is on single aspect ignores everything else
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| Fears of Preschool Child | Bodily harm/ pain poor body boundaries fear insides may spill out band aids are useful with magical thinking, may wonder if sister lost her dong in an accident.
• Animals
• Dark
• Strangers
• Ghosts
• Night terrors
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| Fears of Preschool Child | more fears than toddlers or older children may be sign of increasing intellect (protective mechanism) Fears fade at 5
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| Play of Preschool Child | • Associative play:playground no rules,in a group
• May revert to parallel:play is independent, but near other children Toddlers
• Imaginary playmates
• Dress up
• Imitation
Imaginary playmates
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| the 3 year old | delight to parents, helpful, simple household chores.fetching things on command.
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| the 4 year old | is a stormy age bulling, show off, profanity
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| the five year old | responsible, doing what is expected of them, like to finish wwhat they started, games with rules.encourage motor skills tricycles, hammering nails,let em learn not to smash their fingers dont be over bearing and sheltering. as long as it wont kill them
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| limit TV | one to two hours a day
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| Language delay | now is the time to spot delays and be real concerned that your child is experiencing detrimental trouble, ARTICULATION, STUTTERING(repeating ), STAMMERING(pausing), SEEK SPEECH THERAPY
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| The School Age Child | Ages 6 to 12 yrs
• Fact over fantasy
• Same sex friends
• Permanent teeth age 6 molar first perm teeth
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| Growth of School Age Child | Muscle coordination, fine motor skills
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| Development - School Age | Piaget - Concrete thinking from inductive to deductive reasoning, conservation and reversibility,
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| conservation | recognize equal quantities regardless shape
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| reversibility | count backwards and subtract
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| Industry vs Inferiority | child is a worker and a producer wants to accomplish tasks. give praise and have patients, don't hold standards too high
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| Achievement | leads to self esteem, failure has negative effects(learns if he or she is leader or follower)
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| Development – School Age | _ Conscience develops learning right and wrong on the scale of the greater good)
• Freud
_ Latency
_ Identify with same sex parent
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| Fears of School Age Child | Body mutilation fear that body will not return to normal after illness
• Changes in body image
• Death
• Failure
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| Play of School Age Child | Peers (same sex) risk for gang initiation, violence drugs, and sex.
• Group activities
• Collecting
• Ordering
• Rule oriented
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| Language of School Age | 3000+ word vocabulary
• Complex sentences
• Grammar
• Express thoughts
• Reading
• Print _Script
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| Erikson - Industry vs Inferiority | child is a worker and a producer wants to accomplish tasksAchievement leads to self esteem, failure has negative effects(learns if he or she is leader or follower)
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| Kohlberg | Conscience develops learning right and wrong on the scale of the greater good)
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| Growth of Adolescents | Puberty
_ Girls 2 years > boys
_ Boys growth overall
•Weight 50%
• Refine fine motor skills
• Gross motor adult
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| Development of Adolescent | Piaget - Formal Operations ability to think in abstract or multiview points making inferences
• Erikson - Identity vs. Role confusion tries out various rols, begins to think about what role they want
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| Development of Adolescent | Kohlberg Post-conventional consider others viewpoints social responsibility is recognized
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| Nutrition | girls at risk for bulimia nervosa, boys may start body building, protein supplements may be harmful, renal fxn,
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