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8-1

Objectives
8-2

Lifespan
• Lifespan
– The period during which something is functional
• In humans, lifespan is the period from birth to death.
8-3

Human Development
• Human development is the process of growing to maturity
– Infancy – birth to 12 months
– Toddler – 12 to 36 months
– Preschooler – 4 to 5 years
– School-age – 6 to 12 years
– Adolescence – 13 to 18 years
– Early adulthood – 20 to 40 years
– Middle adulthood – 41 to 60 years
– Late adulthood – 61 years and older
8-4

• Physiologic
• Cognitive
• Psychosocial
Milestones
8-5

8-6

Physiologic Changes
• Birth – usually weighs about 7 pounds
– Doubles birth weight by 3 to 4 months
– Triples birth weight by end of first year
• Length
– Usually about 19 to 20 inches long at birth
– Reaches about 29 to 30 inches at 12 months
8-7

Physiologic Changes
• Top-heavy appearance
– Chest circumference less than head circumference
– About 9 to 10 months, circumference of head and chest are about the same
– After 1 year of age, chest larger
8-8

Physiologic Changes
• Head may be misshapen during vaginal delivery
• Fontanels (soft spots) present on top and back of the head
– “Gaps” in the bones of the head
– Allow flexibility during delivery and growth of the brain
8-9

Physiologic Changes
• Reflexes
– Feeding reflexes
• Rooting
• Sucking
– Moro reflex
– Palmar grasp reflex
8-10

Physiologic Changes
• Senses
– At birth, the most developed of the senses is hearing.
– Sight is the least developed sense.
8-11

Physiologic Changes
• Heart rate
– Between 100 and 160 beats per minute during first 30 minutes of life
• Slows to about 120 beats per minute
– Heart rate is usually between 80 and 140 beats per minute during first year.
8-12

Physiologic Changes
• Respiratory rate
– Usually between 40 and 60 breaths per minute
– Drops to about 30 to 40 breaths per minute after first few minutes of life, and slowing to 20 to 30 breaths per minute by one year.
8-13

Physiologic Changes
• Respiratory anatomy
– In general, all structures are smaller.
– More easily blocked than in adults
– Nasal passages
• Soft and narrow
• Have little supporting cartilage
8-14

Physiologic Changes
• Tongue takes up proportionally more space in the mouth of a child than in an adult
• Tracheal rings are softer and more flexible
• Chest wall is softer and more elastic
• Fewer and smaller alveoli
• Depend more heavily on the diaphragm for breathing
8-15

Physiologic Changes
• Nervous system
– Significant growth during first year
– Neurons (nerve cells) grow and form increasingly dense connections
• Enables faster and more efficient message transmission
8-16

Physiologic Changes
• Skin
– Susceptible to changes in temperature
– Large body surface area
– Skin is thin with few fat deposits
– Poorly developed temperature-regulating mechanisms
8-17

Cognitive Changes
• 2 to 6 months
– Increasingly aware of surroundings
– Begins to explore own body
– Should make eye contact by 6 months
• Between 6 and 12 months
– Begins looking for things not in sight
• By 12 months
– Speaks first understandable words
8-18

Psychosocial Changes
• Crying
– Pre-cry signals
– Basic cry
– Angry cry
– Pain cry
8-19

Implications for Healthcare Professionals
• Young infants are unafraid of strangers and have no modesty.
• Older infants have separation anxiety.
• If possible, assess the baby on the caregiver’s lap.
• Handle the infant gently but firmly
• Support the head and neck if the baby is not on a solid surface
• Keep the infant warm
8-20

(1-3 Years of Age)
8-21

Physiologic Changes
• Looks chubby
– Relatively short legs
– Large head
•
• Heart rate
– Between 80 and 130 beats per minute
• Respiratory rate
– About 20 to 30 breaths per minute
8-22

Physiologic Changes
• Body systems continue to grow
– Respiratory system
• Terminal airways continue to branch
• Alveoli increase in number
– Musculoskeletal system
• Muscle mass increases
• Bone thickness increases
– Nervous system
• Effortless walking
• Fine motor skills are developing
8-23

Physiologic Changes
• Always on the move
• Prone to injury
8-24

Physiologic Changes
• Immune system
– More susceptible to minor respiratory and gastrointestinal infections
8-25

Physiologic Changes
• Digestive and urinary systems
– Stomach capacity increases
– Voluntary control of elimination
• Toilet training
• Average age for completion is about 28 months
8-26

Cognitive Changes
• 12 to 18 months
– Imitates older children and parents
– Knows major body parts
– Knows 4 to 6 words
• 18 to 24 months
– Begins to understand cause and effect
– Can identify objects
– Talks in short sentences
• 24 months
– Knows about 100 words
8-27

Psychosocial Changes
• Strong separation anxiety
• Temper tantrums
• Can answer simple questions and follow simple directions
– However, you cannot reason with a toddler .
8-28

Psychosocial Changes
• Comfort object
– Blanket
– Stuffed animal
– Toy
• Afraid of:
– Being left alone
– Monsters
– Interruptions in their usual routine
– Getting hurt (such as a fall or cut)
8-29

Implications for Healthcare Professionals
• Favorite words: no and mine
• Distrustful of strangers
• May scream, cry, or kick when touched
• Do not like having clothing removed
• Do not like anything on their faces
8-30

Implications for Healthcare Professionals
• Approach the child slowly
• Address him by name
• Talk to him at eye level
• Use simple words and short phrases
• Use a calm, reassuring tone of voice
• Assess the child’s head last
• Respect the child’s modesty
• Praise for the child for cooperative behavior
8-31

(4-5 Years of Age)
8-32

Physiologic Changes
• Taller and thinner than a toddler
• Heart rate
– Between 80 and 120 beats per minute
• Respiratory rate
– About 20 to 30 breaths per minute
• Hops, swings, climbs…
• Dresses self
• Brushes own teeth
8-33

Cognitive Changes
• Has a better understanding of time
• Can count ten or more objects
• Increased attention span
• Vocabulary of about 1500 words
• Sentences now consist of 6 to 8 words
• Can correctly name at least four colors
• Can say his name and address
• Understands a 3-part request
8-34

Psychosocial Changes
• Likes to sing, dance, and act
• Wants to be like his friends
• Certain that he knows everything
• May be rude when you ask him to do something he does not want to do
• Able to play more independently
• May be able to spend more time apart from caregiver
• Explores his body
• Finds playing “doctor” an interesting activity
8-35

Implications for Healthcare Professionals
• Afraid of adults who look or act mean
• Approach slowly
• Talk to the child at eye level
8-36

Implications for Healthcare Professionals
• Preschoolers are curious and like to "help.”
• Encourage the child to participate
• Preschoolers are highly imaginative
– Choose your words carefully
– Avoid baby talk
– Avoid frightening or misleading terms
– Dress and bandage wounds promptly
8-37

– Foods
– Games
– Cartoon characters
– Movies
– Computer game
Distractions
– Visually locate an item in the area
– Sing a song
– Tell you about school
8-38

(6-12 Years of Age)
8-39

Physiologic Changes
• Heart rate usually 70 to 110 beats per minute
• Respiratory rate 20 to 30 breaths per minute
• Systolic blood pressure 80 to 120 mmHg
• Growth in height and weight continues
• Growth spurts begins before onset of puberty
• Fine motor skills continue to develop
• Baby teeth are lost and permanent teeth come in
8-40

Cognitive Changes
• Thinks logically
• Able to see things from another’s point of view
• Ability to read is acquired
8-41

Psychosocial Changes
• Important to a school-age child:
– School
– School-related activities
– Popularity
– Peer groups
• More interaction with adults and children
• Begins comparing himself with others
• Develops self-esteem
• Takes pride in learning new skills
8-42

Psychosocial Changes
• Body image is important
• Children with a chronic illness or disability are very self-conscious.
• Physical differences often result in taunts from other children
– Can have lasting effects
8-43

Psychosocial Changes
• Begins to understand that death is permanent
• May feel responsible and guilty for a loved one’s death
• Grief reaction varies
8-44

Implications for Healthcare Professionals
• Usually cooperative
• Very modest
• May view illness or injury as punishment
• Talk directly to the child about what happened
• Explain procedures
• Be honest
8-45

(13-18 Years of Age)
8-46

Physiologic Changes
• Size and strength of the heart increases
• Blood volume increases
• Systolic blood pressure increases
• Heart rate decreases
– Heart rate is usually 55 to 105 beats per minute
– Respiratory rate is 12 to 20 breaths per minute
– Systolic blood pressure is100 to 120 mmHg
8-47

Physiologic Changes
• Muscle size and strength increase
• Bone growth is nearly complete
• Rapid 2 to 3 year growth spurt
• Physical maturity
– Girls
• Begins at age 10 and ends about age 16
– Boys
• Begins at age 12 and ends about age 18
8-48

Physiologic Changes
• Primary sexual development
– Ovaries, uterus, breasts, and penis
• Secondary sexual development
– Voice changes
– Development of facial and genital hair
8-49

Physiologic Changes
• Menarche
– Onset of menstruation during puberty
– Average age of menarche is 12.5 years
• Menstruation
– Periodic discharge of blood and tissue from the uterus
– Occurs about every 28 days
• Increased risk of teen pregnancy and sexually transmitted infection
8-50

Cognitive Changes
• Ability to reason
• Think beyond the present
• Concerned about the opinions of others
• Develop morals
– Question adults who say one thing but do another
8-51

Psychosocial Changes
• Wants to be treated like an adult
• Conflicts between an adolescent and parents are common
8-52

Psychosocial Changes
• Self-consciousness increases
• Peer pressure increases
• Interest in the opposite sex increases
• Anti-social behavior peaks around eighth or ninth grade.
• Hormone surges cause wide mood swings.
8-53

Psychosocial Changes
• Peer groups are important
• School is typically the focus of social life
• Body image is of great concern
– Compare themselves with their peers and determine if they are “normal” based on what they observe
8-54

Psychosocial Changes
• Eating disorders common
• Experimentation with tobacco, alcohol, and illicit drugs
• Depression and suicide are more common in adolescents than any other age group.
8-55

Psychosocial Changes
• Between 15 and 17 years of age:
– Cautiously establishes relationships
– Usually knows if he or she is homosexual or heterosexual
• Around the age of 18:
– Begin to understand who they are
– Develop an attachment to another person
– Stable relationships form
8-56

Implications for Healthcare Professionals
• Inconsistent, unpredictable
• Expect to be treated as adults
• Obtain the history from the patient instead of a caregiver
• Expect many questions
• Do not bargain in order to do what you need to do
8-57

Implications for Healthcare Professionals
• Try to have an adult of the same gender as the child present during the exam
• Do not tease or embarrass an adolescent patient, particularly in front of peers
8-58

(20 to 40 Years of Age)
8-59

Physiologic Changes
• Peak physical condition
– Heart rate averages 70 beats per minute
– Respiratory rate averages 16 to 20 breaths per minute
– Systolic blood pressure averages 120/80 mmHg
• Accidents are a leading cause of death in this age group
8-60

Cognitive Changes
• Young adults recognize that, in some situations, there is no single correct solution.
– In fact, the solution may vary from situation to situation.
8-61

Psychosocial Changes
• Becomes independent of parents
• Completes education
• Establishes a career
– High levels of job stress
• Establishes an intimate relationship
• Decides whether to have children
• Friendships are important
8-62

Psychosocial Changes
• Demonstrate reckless behavior less often than adolescent
• More likely to use abuse alcohol and illicit drugs and have serious emotional difficulties than older adults
• Eating disorders are more common in this age group than at other ages.
8-63

Implications for Healthcare Professionals
• Approach in a respectful, friendly manner.
• Obtain a history from the patient.
• Explain what you are planning to do and why it needs to be done.
• Allow time for questions.
• Provide clear and honest explanations.
8-64

(41 to 60 Years of Age)
8-65

Physiologic Changes
• Heart rate averages 70 beats per minute
• Respiratory rate averages 16 to 20 breaths per minute
• Systolic blood pressure averages 120/80 mmHg
• In the early 40s, the body is still functioning as effectively as it did in 20s
8-66

Physiologic Changes
• Near vision declines by the late forties
• Taste sensations diminish
• Ability to hear high frequency sounds decreases, particularly in men
• Metabolism slows, making weight control more difficult
8-67

Physiologic Changes
• Cardiovascular health becomes a concern
– Blood vessels lose elasticity and become thicker.
– Cholesterol levels increase
– Cardiac output decreases
8-68

Physiologic Changes
• Hormonal changes occur in both women and men.
– In women, menopause occurs in the late
40s or early 50s.
– In men, testosterone levels gradually decline and sperm production decreases.
• Hair begins to thin and turn gray
• Skin’s elasticity and moisture decrease
– Wrinkling occurs
• Cancer often strikes in this age group.
8-69

Cognitive Changes
• Memory, perception, learning, problem solving, and creativity change very little.
• Reaction time may diminish toward the later part of middle adulthood.
• Experience and expertise allows them to surpass younger workers in problem solving ability.
8-70

Psychosocial Changes
• Approach problems more as challenges than threats
• Typically the center of the family, between aging parents, adult children, and grandchildren
• Some may be burdened by financial commitments for them.
8-71

Psychosocial Changes
• Empty nest syndrome
– A feeling of sadness and loneliness when one or more of the children leaves home
8-72

Implications for Healthcare Professionals
• Talk to the patient in a respectful, friendly manner.
• Obtain a history from the patient.
• Listen carefully to the patient’s answers.
• Explain what you are planning to do and why it needs to be done.
• Allow time for the patient to ask questions.
• Provide clear and honest explanations.
8-73

(61 Years of Age and Older)
8-74

Physiologic Changes
• Maximum life expectancy
– Oldest age to which any person lives
• Average life expectancy
– The age at which half of the people born in a particular year will have died
8-75

Physiologic Changes
• Cardiovascular system changes
– Thickening of the blood vessels
– Decreased vessel elasticity
– Increased peripheral vascular resistance
– Marked increase in systolic blood pressure
– Heart’s valves become hard and thick
– Heart is less responsive to exercise
– Rapid heart rates are not well tolerated
8-76

Physiologic Changes
• Respiratory system changes
– Diminished elasticity of the diaphragm
– Weakening of the chest wall muscles
– Coughing is often ineffective
– Decreased number of alveoli that participate in gas exchange
– Activity of cilia in the lungs is decreased
8-77

Physiologic Changes
• Sensory changes
– Loss of taste buds
– Hearing loss
– Diminished sense of smell
– Diminished vision
– Diminished perception of pain
– Diminished reaction time.
8-78

Physiologic Changes
• Older adults have
– Less subcutaneous tissue
– Inefficient blood vessel constriction
– Diminished shivering and sweating
– Diminished perception of temperature
– Diminished thirst perception
– Increase the likelihood of a heat- or coldrelated emergency
8-79

Physiologic Changes
• Musculoskeletal system changes
– Loss of muscle strength
– Decrease in the number of muscle cells
– Loss of bone mass
– Falls are common in older adults
8-80

Physiologic Changes
• Urinary system changes
– Reduced blood flow to the kidneys
• Thickening of the blood vessels
• Narrowing of the renal arteries
– Bladder holds less urine
• Increased urinary frequency
8-81

Physiologic Changes
• Gastrointestinal (GI) system changes
– Some older adults have no teeth and depend on dentures.
– Saliva declines with age.
– Delayed gastric emptying.
– GI secretions are decreased.
– Less efficient break down of protein.
– Less efficient break down of fats.
– Vitamin and mineral deficiencies.
8-82

Physiologic Changes
• Nervous system changes
– Loss of nerve cells
– Can learn new material, but may have difficulty retrieving information
– Balance and coordination are decreased
– Sleep disorders common
8-83

Cognitive Changes
• Short-term memory is relatively unaffected
• Age-related changes in memory most often occur in recent memory
• Long-term memory is essentially unaffected by the aging process
8-84

Psychosocial Changes
• Making personal choices to find the meaning of life
• Evaluating one’s self-worth
• Adjusting to retirement
• Adjusting to reduced income
• Establishing satisfactory living arrangements
• Adjusting to the death of a spouse or companion
• Maintaining contact with friends and family
• Meeting social and civic obligations
8-85

Implications for Healthcare Professionals
• Elderspeak should be avoided:
– Speaking louder and more slowly
– Using a patronizing tone
– High pitch
– Increased volume
– Increased repetition
– Simpler vocabulary and grammar than normal adult speech
– Making statements that sound like questions
– Exaggerating words
8-86

Implications for Healthcare Professionals
• Elderspeak does not communicate appropriate respect.
– Implies that the patient is dependent and incompetent
• An older adult will better understand you if you repeat and reword what you are saying.
8-87

Questions?
8-88