MATERNAL AND CHILD HEALTH NURSING III

PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

Growth and Development Document a 24-hr food recall, sleep, and a

description of school and play behaviors.
Routine screening including vision and hearing
should be scheduled.

v Psychosexual development (Freud) -

refers to developing instincts or sensual
pleasure
v Growth – increase in size (quantitative v Psychosocial development (Erikson) –
change), typically measured as height, weight, refers so stages of personality development
and head circumference.
v Moral development (Kohlberg) – refers
Growth in weight, for example, is measured in to the ability to know right from wrong and
pounds or kilograms; growth in height is to apply these to real-life situations.
measured in inches or centimeters.
v Cognitive development (Piaget) - refers
For assessment, measure height and weight on to the ability to learn or understand from
a standard growth chart for children at all experience, to acquire and retain
well-care visits. Measurement of head knowledge, to respond to a new situation,
circumference is included for children age 2 and to solve problems
years and younger.
Role of the Nurse
v Health Promotion and Illness Prevention
1. Determine Child’s Developmental Stage

v Development – progression toward maturity in

mental, physical, and social markers of normal
development. Indicates an increase in skill or
the ability to function (a qualitative change).

Development is measured by observing a

child's ability to perform specific tasks such Ø Primary focus of a well-child health
as how well a child picks up small objects, by interview and examination.
recording the parent's description of a
child's progress, or by using standardized For instance, during her child’s 24-month
tests such as the Ages & Stages Questionnaires. checkup, a mother might ask if it is normal
that her child cannot yet pedal a tricycle, a
Maturation is a synonym for development. question that cannot be answered without a
full understanding of average ranges of
Observe specific activities the child can motor coordination.
accomplish to establish whether developmental
milestones (major markers of normal Ø Periodic Anticipatory Guidance
development) are achieved.
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PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

you know how much that will

understand (e.g., anesthesia, some
body parts are necessary for life and
some are not, or stitches will not stay in
permanently).
Ø During the postsurgical period, you
need growth and development
knowledge to assess whether a child is
old enough to swallow pills, whether a
child will be able to accurately rate a
degree of pain on a standard scale,
Ø Discuss additional home safety with a
and how to approach a child who says
parent when a child is approaching the age “no” to every suggestion.
for crawling. Ø Physical growth is another important
Ø Installing a gate in front of a stairway
factor to consider because disease
and removing products or installing a affects children differently at various
lock on accessible cabinets where stages of growth.
hazardous materials are stored.
Ø Provide information to a parent of a 1-yr
A 12-year-old child who has fractured a
old that their child’s appetite will long bone, for example, has a
decrease significantly for the coming potentially more serious fracture than
year and is a normal developmental an 8-year-old child who fractures the
stage. identical bone.
Ø Likewise, the parent of a child approaching
puberty generally welcomes discussion on
how to prepare a child for this Principles of Growth and Development
challenging growth phase. Growing up is a complex phenomenon because of
the many interrelated facets involved. Children
Anticipatory guidance must be provided in do not merely grow taller and heavier as they get
a timely manner. Information given too older; maturing also involves growth in their
early is forgotten by the time it is needed. ability to perform skills, to think, to relate to
people, and to trust or have confidence in
themselves.
v Health Restoration and Maintenance
Patterns
Ø Neither physical growth nor aspects of
maturation occur haphazardly but in a
predictable pattern governed by several
principles.
Ø The pattern for general growth, such as
respiratory, digestive, renal,
musculoskeletal, and circulatory tissue,
proceeds fairly smoothly during childhood.
Certain body tissues, however, mature in
spurts.
Primary Focus: Determine Child’s Ø Neurologic tissue (spinal cord and brain)
Developmental Stage grows so rapidly during the first 2 years that
the brain reaches mature proportions by 2 to
Factors to Consider: 5 years of age.
Ø Lymphoid tissue (spleen, thymus, lymph
Ø Preparing a child for surgery, for nodes, and tonsillar tissue) also grows
example, would be ineffective unless rapidly during infancy and childhood to
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PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

provide young children early protection

against infection.

In 5-year-olds, for example, tonsillar tissue

has already reached its peak size (about
twice that of an adult). On assessment, the
back of the throat of young school-age
children appears to be “all tonsils.”

Ø The spleen is not usually palpable in adults,

the spleen is palpable 1 or 2 cm below the
left ribs in preschool children as another
example of this rapid immune tissue
growth.
Ø In contrast, reproductive organs (genital
tissue) show little growth until puberty

Principles of Growth and Development

 MATERNAL AND CHILD HEALTH NURSING III
PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

Major Factors Influencing G&D

1. Genetics
Temperament – influenced by genetics and
environment. a. Gender
b. Health
c. Intelligence

From the moment of conception when a

sperm and ovum fuse, the basic genetic
Ø Genetics - typical way a child reacts to makeup of an individual is cast. In
situations addition to physical characteristics such as
Ø Environmental - Whether a fetus enjoyed a eye color and height potential, inheritance
healthy uterine existence or whether the child (namana) determines characteristics such
was born into a family with sufficient funds to as learning style. A child may also inherit a
supply adequate health care. hether a child genetic abnormality, which could result in
receives good nutrition, beginning with being disability or illness at birth or later in life
breastfed, is yet another and so prevent optimal growth.

It is the intertwining of these or a combination a. Gender

of these factors that determines how each
child grows and matures. On average, girls are born lighter (by an
ounce or two) and shorter (by an inch or
two) than boys. Boys tend to keep this
height and weight advantage until
prepuberty, at which time girls surge ahead
as they begin their puberty growth spurt 6
months to 1 year earlier than boys. By the
end of puberty (age 14 to 16 years), boys
again tend to be taller and heavier than girls.

b. Health

A child who inherits a genetically

transmitted disease may not grow as rapidly
or develop as fully as a healthy child
depending on the type of illness and the
therapy or care available for the disease.
Before insulin was discovered in 1922, for
v GG HadId example, many children with type 1
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diabetes mellitus died in early childhood; Characteristics: Active children prefer to be in

those who lived were left physically motion and can have difficulty sitting for longer
challenged. Currently, with good health periods. Sedentary children prefer stationary
supervision and insulin therapy, the effects activities and may be slow moving.
of type 1 diabetes can be minimized so that
children with diabetes both grow and thrive.
Diabetes is still a major factor in the health
of children, however. As more and more
children become obese because of fast-food
diets and lack of an exercise program, type
2 diabetes now has begun to occur in
children as young as school age

c. Intelligence

Children with high intelligence do not

generally grow faster physically than other
children, but they do tend to advance faster They wiggle and squirm in their crib as early as
in skills. Occasionally, children of high 2 weeks of age. Parents put such children to
intelligence actually fall behind in physical sleep in one end of a crib and find them in the
skills because they spend their time with other end an hour later; such children will not
books or mental games rather than with stay seated in bathtubs and refuse to be
games that develop motor skills. confined in playpens. Other babies, by contrast,
Intelligence begins to make major move little, stay where they are placed, and
differences as children become adolescents appear to take in their environment in a quieter,
and begin to plan future careers. more docile way. Both patterns are normal;
they merely reflect the extremes of activity
level, one characteristic of temperament.
9 Reaction Factors by Chess and Thomas
2. Regularity/Rhythmicity - Have consistent
times for routine activities in your schedule, but
add some flexibility within routines. For snack,
instead of a group snack at one time, set out
snack foods for an extended period and let the
children eat at any point during the snack
period.

Definition: Natural patterns and schedules for

biophysiological functions (ex. Sleeping -
1. Activity - Allow children time for movement (sleeping and waking up the same time every
throughout the day and give children choices. day, elimination – pooping the same time ,
Let an active child step away from circle time eating – the same time).
if she has the wiggles. Have a place in your play
yard for children to sit and do table activities Range: Predictable vs. Variable
outside.
Characteristics: Children with regular patterns
Definition: Energy level and amount of will develop predictable schedules. Children
movement. with irregular patterns do not develop
schedules and may take longer to complete
Range: Energetic vs. Sedentary some developmental tasks, such as toilet
learning.
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PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

Some children approach the challenge in an

unruffled manner. They smile and “talk” to
Even as infants, such children tend to wake up strangers and accept a first feeding or a new
at the same time each morning, are hungry at food without spitting up or fussing. They
regular 4-hour periods, nap the same time every explore new toys without apprehension. Other
day, and have a bowel movement at the same children demonstrate withdrawal rather than
time every day. They are predictable and easy approach. They cry at the sight of strangers,
to care for because their parents learn early on new toys, and new foods; they fuss the first time
what to expect from them. On the other end of they are placed in a bathtub.
the scale are infants who rarely awaken at the
same time 2 days in a row. They may go a long 4. Adaptability - Let children know about
time without eating 1 day and the next day upcoming changes and discuss what will
appear hungry almost immediately after a happen. Be prepared to address children's
feeding. Such children are typically more reluctance and to give children extra time to
difficult to care for because it is difficult to make transitions.
anticipate a schedule for them. Parents must
constantly adapt their own routine to the child’s D: Ability to adjust to changes.
routine.
R: Accommodating vs. Resistant
3. Approach/Initial reaction - Prepare children
for meeting new people and trying new things. C: Highly adaptable children will accept
Join with or stay near hesitant children to lend changes in routines, activities, and the
a sense of security. environment. Children who are not adaptable
will resist changes and may become upset when
D: Reaction (initial) to new people and faced with changes.
situations (stimuli).

R: Open vs. Hesitant

C: Children who respond openly will go to new

people and explore new toys and environments.
Children who are hesitant will shy away from
new people and be uncomfortable in new
environments.

The first time such children are placed in a

bathtub, they might protest loudly, for example,
but by the third time, they sit splashing happily.
This is in contrast to infants who cry for months
whenever they are put into a bathtub or who
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cannot seem to accustom themselves to a new negative demeanor are harder to comfort or
bed, new car seat, or new caregiver. please and may tend to be disagreeable in
interactions.
5. Intensity/Intensity of Reaction - If a child is
boisterous, create spaces and activities that let
the child be boisterous. Set up the spaces and
activities to avoid interfering or overrunning
quieter activities and areas.

D: Emotional response to events.

R: Exuberant vs. Lethargic

C: Intense children are emotional in their

responses, positive and negative. Less intense A child who is always happy and laughing is
children may not show much emotion or seem said to have a positive mood quality.
detached. Obviously, this can make a major difference in
the parents’ enjoyment of a child; parents tend
to spend more time with a child with a positive
mood quality than with a child who seems
always unhappy and whining or has a negative
mood quality.

7. Distractibility - Limit distractions in the

environment by looking at where and when you
set up activities. Instead of doing manipulative
activities when school-agers come in from
school, do the activities later with the
They cry loudly, thrash their arms, and begin preschoolers during the school-age homework
temper tantrums when their diapers are wet, time.
when they are hungry, and when their parents
leave them. Other children, probably equally D: Ability to focus
frustrated or angry, rarely demonstrate such
overt symptoms or have a mild- or low- R: Attentive vs. Sidetracked
intensity reaction to stress.
C: Children who can focus are better able to
6. Mood/Mood Quality - Get to know what block out surrounding noise and activity.
children like. For children who tend to be Children who can't focus well can be easily
negative, use their likes to turn around or bothered by other noise and activity.
lighten their mood. If a child often complains
about cleaning up, and you know the child
loves dinosaurs, pretend to be dinosaurs while
cleaning up. Or hide a favorite dinosaur toy that
the child can hunt for while cleaning up.

D: Typical emotional outlook

R: Positive vs. Negative

Children who are easily distracted or who can
C: Children with a positive outlook are easier easily shift their attention to a new situation
to please and tend to be more even in their (distractibility) are easy to care for. If they are
interactions with others. Children with a crying over the loss of a toy, they can be
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PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN

appeased by the offer of a different one. If D: Reaction to sensory stimuli. (ex. texture,
children cannot be distracted this way, their touch, brightness, volume, taste, aroma)
parents may describe them as stubborn, willful,
or unwilling to compromise because they R: Unaffected vs. Irritated
persistently return to an activity or refuse to
adapt or change. C: Children with a high sensory threshold are
more comfortable with sensory experiences and
8. Persistence/attention span - Offer activities may not notice sensory stimuli. Children with a
that vary in length and complexity. For a more low sensory threshold are more likely to be
involved activity, try breaking it into two or bothered by sensory stimuli and may be
three activities, if possible. agitated by sensory experiences.

D: Ability to stay with an activity.

R: Immersed vs. Disinterested

C: Persistent children will stay with an activity

and can be attentive for extended periods.
Children with short attention spans will have
trouble staying with extended or multi-step
activities.

The threshold of response is the intensity level

of stimulation necessary to evoke a reaction.
Children with a high sensory threshold are
more comfortable withsensory experiences and
may not notice sensory stimuli. Children with a
low sensory threshold are more likely to be
bothered by sensory stimuli and may be
agitated by sensory experiences.

2. Environmental
Attention span is the ability to remain interested a. Socio-economic Status
in a project or activity for an average length of b. Parent-child Relationship
time. Like other aspects of temperament, this c. Health
can vary a great deal among children. Some d. Order in the family
play by themselves with one toy for an hour; e. Nutrition
others spend no more than 1 or 2 minutes with
each toy. The degree of persistence also varies.
Some infants keep trying to perform an activity
even when they fail time after time; others stop
trying after one unsuccessful attempt.

9. Sensory threshold - Be aware of the intensity

of sensory stimuli. Change the intensity by
looking for alternative materials or by adapting
materials. Use warm water in the water table or Although children cannot grow taller than
let a child wear gloves to finger paint. For their genetically programmed height
transition cues, use a rain stick instead of a bell potential allows, their adult height can be
or dim the lights instead of blinking the lights considerably less than their genetic
on and off.
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potential if their environment hinders their some cultures have different perspectives
growth. on education and value different ways of
contributing to society
For example, a child could receive
inadequate nutrition because of a family’s Children who are loved and are paid
low socioeconomic status, a parent could attention to by their parents thrive better
lack childcare skills or not give a child than those who are not (Feigelman, 2012).
enough attention or stimulation, or a child Luckily, for parents and children, either
could contact an infectious disease and be parent or even a nonparent may form this
left with a long-term disability. Illness can primary parent–child love relationship.
lower children’s appetites, thus interfering When assessing families, don’t just
with growth; others, such as certain examine how much time parents spend with
endocrine disorders, directly alter growth children; examine the quality of that time
rate. Having a parent who abuses alcohol or because it is the quality, not the quantity,
other substances can cause such that is most important. Loss of love from a
inconsistency in care that it can affect primary caregiver, as might occur with the
mental health death of a parent, or interruption of parental
contact through hospitalization,
Environmental influences, however, like imprisonment, or divorce can have such an
genetic ones, are not always detrimental. effect on a child that it interferes with a
For example, children with desire to eat, improve, and advance. It is
phenylketonuria, an inherited metabolic important to support parents’ active
disease that leads to poor growth and involvement in their child’s care so that a
cognitive challenge, can achieve normal parent–child relationship is strengthened
growth and development in spite of their and is valued in all healthcare and childcare
genetic makeup if their diet (a part of the settings.
environment) is properly regulated. The
following environmental influences are
those most likely to affect growth and
development.

A. Socioeconomic Status

Because health care and good nutrition both

cost money, children born into families of
low socioeconomic means may suffer from
a lack of both of these. Poor health
supervision can leave them without
immunization against measles or other
childhood illnesses and therefore
vulnerable to permanent neurologic
damage. Poor nutrition can also leave them
vulnerable to disease because antibody
formation depends on a good protein intake

B. Parent-child Relationship

What a parent expects a child to become as

an adult varies from culture to culture and
family to family but plays a role in how
much a child is guided to try to achieve in
life. Cultural norms also play a role because
MATERNAL AND CHILD HEALTH NURSING III
PEDIATRIC NURSING
TRANS BY: CAREY JAMILLE C. YADAN