Age
Developmental
Changes
NEWBORN/INFANT
TODDLER
PRESCHOOL
SCHOOL-AGE
ADOLESCENT
0 to 1 year
1 to 3 years
3 to 6 years
6 to 12 years
11 to 20 years
Adjusted age= Premature age
minus (-) chronological age
*use this to determine outcome
STATE OF CONSCIOUSNESS
Deep Sleep- quiet w/o moving
Light Sleep-w/ movement, startle
Drowsiness-dozing
Quiet Alert-open eyes/calm
Active Alert-face/body active
Crying-disorganize movement
REFLEXES
Primitive: MRS BAGS
M- 4 mos B- 12 mos
R- 3 mos A- 4 mos
S- 2-5 mos G- Palmar- 4-6 mos
Plantar- 9 mos
S- 4-8 weeks
Protective: Right & Parachute
RESPIRATORY INFANT VS ADULT
•narrow passages, bronchi/ioles
•large tongue, funnel larynx
•fewer alveoli
PHYSICAL-1 YR.:
Cardio: ♥ x2, HR=100,
BP=100/50, risk of heat loss r/t
peripheral capillaries close to
skin, effective thermoregulation
*Eruption of teeth at 6-8 mos,
and stool becomes formed
IgG= from mom for 3-6 mos.
=40% (adult) by 12 mos.
IgM=after birth; adult level-9mos
PROBLEMS: SENSES/LANGUAGE
Weight gain= 3-5 lbs/yr
Height increase= 3 in/yr
Fontanels= close by 18 (anterior)
Head & body proportionate at 3 yr
Weight gain= 5 lbs/yr
Height increase= 2.5-3 in/yr
Loss of baby fat/muscle growth
Length of skull ⭡ slightly
Lower jaw=more pronounced
Upper jaw=widens
ORGAN SYSTEM
• Myelination of spinal
cord=controlled pee/poo=3y/o
• ⭡ # of alveoli
• Eustachian tubes=short/str8
• Cardiovascular: HR ⭣ , BP ⭡
• Murmur may be heard
• 20 deciduous teeth=present
• Urethra =short =UTI
• Bones ⭡ in length
SOCIAL SKILLS DEVELOPED
• Cooperation
• Sharing (things/feelings)
• Kindness/Generosity
• Affection display
• Conversations/feelings
expression
• Help other/Making friends
EMOTIONAL/SOCIAL
•Friendships= learns to
keep/make friend
•Fears=variety of fears,
parents to acknowledge
•Temperament
COGNITIVE:
Magical thinking=thoughts are
all-powerful
Imaginary friend=creative way
to sample activities/behaviors
Transduction=extrapolates
from 1 situation to another
Animism=attributes life-like
qualities to inanimate objects
LANGUAGE
• Symbolic thought
• Concept of death= no
understood
• Acquisition of language
=express thought/creativity
• Transition=telegraphic
speech (3y/o) to adult-like
sentences (5y/o)
Weight gain= 4-6 lbs
Height increase= 1 ft
Growth=average of 2 in/yr
Secondary sex characteristics
appear
ORGAN SYSTEM
Neuro: brain/skull grow slow,
facial proportions
Resp: RR⭡, diaphragmatic
Cardiovascular: BP ⭡, PR ⭣
GI: deciduous teeth to
permanent, fewer GI upset,
caloric need=lower
GU: bladder ⭡ (age in yr+ 2 oz)
Musculo: muscle still
immature, can easily injure
Immune: mature at 10 y/o,
fewer infections
LANGUAGE
• Vocab from 8k to 14k
words.
• Culture specific words used.
• Reading=improves language
• Complex grammar used
• Metalinguistic awareness
• Metaphors=begin to
understand
Sexual characteristics
Reproductive maturity
PUBERTY
• Girls earlier than boys
• Girls= 9-10 y/o =estrogen
=Peak height at 12 y/o
= fat deposits increase
• Boys=10-11 y/o =testoste.
=Peak height at 14 y/o
=Muscle mass increases
ORGAN SYSTEM
Neuro: myelin s. growth
=faster neural process
Resp: RV/VC=⭡
Cardio: ♥ size/strength ⭡,
SBP ⭡, HR ⭡
GI: full set permanent teeth,
see Table 27.2 (Ricci)
Coordination/balance/rhythm
= 2-wheel bike, jump rope,
dance, sports
Continued development
see Table 27.2 (Ricci)
Myelinations of the CNS=
refined fine motor skills
Continued development Use
of computer=increased fine
motor skills
If by:
4 mos=do not make sound/
=do not start to babble
=do not turn to find sounds
6 mos= do not squeal/laugh
=crosses eyes most of time
8 mos= do not babble
12 mos= do not use single word w/
meaning (i.e. dada/mama)
SOCIAL/EMOTIONAL
•Separation/Stranger Anxiety
•Temperament
•Cultural differences
Gross Motor
Skills
•cephalocaudal fashion
Fine Motor
Skills
• develops in proximodistal
fashion- maturation of
hands/finger use
ORGAN SYSTEM
Neurologic: Brain 90% at 2 y/o
Respiratory: ⭡ alveoli until 7 mos
Cardiovascular: HR ⭣ , BP ⭡
GI: stool passage ⭣
GU: bladder/kidney mature at 1624 mos
Musculo: sway back/pot belly
until 3 y/o
SENSES/LANGUAGE
•Receptive- understands what’s
being asked
•Echolalia-repetition of words
•Telegraphic- uses only important
words
•Uses all sense to explore
•Mature sense of smell
•Hearing at adult level
•Taste not completely developed
SOCIAL/EMOTIONAL
Separation- separates oneself
from parents
Individuation- forms sense of self
-learns to control one’s
environment= emotional lability
Egocentricism- focus on self
SLEEP:
18 mos= 13.5hr/day
24 mos=13hr/day
3 y/o= 12hr/day
=d/c day nap
30 mos=full set primary teeth
FYI: Typical toddler sleep thru the
night & take 1 daytime nap
TYPICAL BEHAVIORS
• Rely on security item
• Aware of gender differences
• May display aggressive behavior
• Show fear=loss of parents & of
strangers
•Separation anxiety=reoccur
•Resist invasive procedures
running, climbing, jumping,
pushing/pulling a toy/throwing
ball/ pedaling a tricycle
Progress: holding/pinching to the
ability to manage utensils, hold
crayon, string bead/use computer
SENSORY
• All senses=mature.
• 20/20 vision
• Ocular muscle control,
peripheral vision, color
discrimination= developed by
7 y/o
SOCIAL/EMOTIONAL ISSUES
• Temperament
• Self-esteem development
• Body image
• School-age fears
• Peer relationships
• Teacher/school influences
• Family influences
enlarge digestive organs
Musculo: ossification
=incomplete until late
adolescence in boys/occurs
earlier in girls, shoulder,
chest, hip ⭡
Integument: Skin= thick &
tough/ sebaceous
glands=more active/ sweat
gland=adult level
LANGUAGE
•Uses correct grammar/parts
of speech
•Uses slang
CHANGE IN RELATIONSHIPS
• Families/parents
experience changes &
conflict=required
adjustments
• Adolescent-family
relationship=essential for RN
when caring
• Peer groups= important
role in identity
SEXUALITY/INFLUENCE OF
DATING
•Interest in the opposite sex
r/t physical dev/body
changes/peer group
pressure/curiosity
Erikson’s
Theory
NEWBORN/INFANT
TODDLER
PRESCHOOL
SCHOOL-AGE
ADOLESCENT
Trust VS Mistrust
•Crisis of infancy
Autonomy VS Shame & Doubt
•exerts independence=sense of
control
•imitates adults
•negativism
•games= take turns at 3 y/o
Initiative VS Guilt
•Inquisitive/enthusiast learner
•Accomplishment=succeeding
in activities
•Pride in accomplishment
stimulates initiative
•Overextending=sense of guilt
• Superego (Conscious Dev.)
=completed/basis of moral dev.
Industry VS Inferiority
• Developing sense of selfworth
• Developing cognitive and
social skills
Identity VS Role Confusion
•task of developing their
own sense of identity by
revisiting each of the
previous stages of
development
Sensorimotor Stage
•experiments= see what happens
Preoperational stage
Progresses from a concrete
framework of thinking to an
abstract one in the formal
operational period
Nutritional Plan
• Lay foundation
• High in nutrient-rich foods
• Toddlers w/ vegan diet=
deficiencies in: vitamin D, Vitamin
B12, and iron.
Weaning: no later than 15 mos
Daily Req: 16-24b oz milk/day
No toothpaste: before 2 y/o
Developmental Concerns:
-Toilet teaching
-Negativism/Temper tantrums
-Thumb sucking & pacifiers
-Sibling rivalry/Aggression
Safety: home/car/injury
prevention
Teach: Strategies with Sib. Rivalry
•Keep the toddler’s routine=build
self esteem
• Spend individual time w/ toddler
daily
• Involve the toddler in caring sib.
Focus of Discipline for Tod
• Limit setting/Negotiation
• Techniques to learn prob. solvng
-time out= use 2.5-3 y/o. I min/age
Signs Tod is ready- Toilet
• Reg. BM/diaper not wet always
• Expresses need to poo/pee
• follows instruction/walk alone &
pull pants/follow caregiver to BR
• Toddler climbs on potty/toilet
Promoting G/D Thru Play
• Play = social medium
• 30 mins/day=structured physical
• unstructured 1-3 hrs/day
• Creative/physical play, not TV
• Engage in parallel play (w/
another child) instead of
cooperative play
• Egocentric=don’t like to share
• Short attn span=change toy freq.
• No to expensive toys.
Daily Requirements
• 500- to 800-mg calcium
• 10-mg iron
• 19-mg fiber
• Fat intake no < 20% &
No > 30% daily calories
• Saturated fats < 10%
• Diet=high nutrient-rich foods
• Limit=poor, high-calorie food
Risks of overweight/obesity
• Hypertension
• Hyperlipidemia
• Insulin resistance
Developmental Concerns:
• Lying
•Sex education, masturbation
Issues in Promoting G&D
• Building self-esteem
• Maintaining routine & ritual
• Setting limits
•Remaining consistent w/them
• Knowing signs of dev. delay
Concrete Operational (7-11)
• Sees info. in diff. dimension
• Sees other’s POV
• Anticipates consequences
• Stores memories of past
• Knows about conservation
Average-Weight (20 to 35 kg)
• 70 calories/kg/day (1,400 to
2,100 calories/day)
• 1,800 to 2,100 mL of water
per day
• 28-g protein
• 800-mg calcium
• Promote healthy eating
habits
Safety Issues
• Safety=pedestrian, bike/sport,
fire, water, abuse
Developmental Concerns
• TV/ video games/School
phobia/Latchkey/Stealing
Lying/Cheating/Bullying
Benefits of Physical Activity
• CV fitness, weight control
• Emotion tension release
• Dev. of leadership/follow skill
Vision Probs Freq ID
• Amblyopia (lazy eye)/Cross
eyed/Near/Farsightedness/
Astigmatism/Uncorrected eye
defects/Strabismus
Promote Appropriate
Discipline
• Logical consequences of
discipline/Rules by the family,
values, social rules of
conducts/Discipline=focus on
dev/Discipline with praise
Factors Det. Type of Discipline
• Developmental level of both
the child and the parents
• Severity of the misbehavior
• Established rules of fam
• Temperament of the child
• Response of child rewards
Promoting Sleep/Rest
• 12 hours sleep required
• Bedtime expectations/wakeup time
• Night terrors/sleepwalking
may occur, resolve by age 8-10
Safety Concerns
• Unintentional injuries/Safety
in Motor, Firearm, Water
Piaget’s
Theory
Nutrition
Concerns
Nursing
Implications
6 mos= milk + solid food
= solid food introduced Q
4-7 days to check food allergies.
4-6 mos= disappearance of
extrusion reflex
No to Breastfeeding if:
•galactocemic baby
•mom uses drug/contra med
•mom untreated active TB/HIV
•Safety= usecar seats/rear
facing/center
•Suffocation concerns (Crib)
Role of RN
• Promote early learning, safety,
proper nutrition, healthy sleep
and rest, healthy teeth and gums,
and appropriate discipline
techniques
Anticipatory Guidance
• Parents need tools to support
their infant’s development in a
safe fashion
• Parents can promote growth
and development of an infant
through solitary play
Hospitalization
• Explore the environment
• Engage in make-believe play
Nutritional Requirements
• ⭡ r/t growth/sex maturation
• ⭡calories, Zn, Ca, Fe for
growth
Nutritional Assessment
• Evaluation of foods eaten
• # of times-fast foods,
snacks, junk food/week
=guidance in food choices
Developmental Concerns
• Violence/Suicide
• Homicide
• Substance use
Areas to Encourage G&D
• Sports, physical fitness/
Participation in school activts
/Safety issues/Prop. nutrition
/Healthy sleep, rest/Personal
care/Healthy sexual life/Discip.
Risks of Being Involved in
Unhealthy Rom. Relationship
• Dating violence/Risky sexual
activity (STIs)/Premature preg.
Promote Proper Hygiene
• Encourage: frequent bathing
/shampoo of hair/deodorant
use/washing face 2-3x/day
• Discourage squeezing acne
/vigorous face scrub/ sun tan
• Teach care-piercings, tattoos
Caring for the Hospitalized
• Opportunities to maintain
independence /Allow to
participate in decisions /
Encourage socialization w/
friends thru phone/email/visits
Common Substances Abused
• Alcohol/prescribed meds/
Hallucinogens/Sedatives
/Analgesic/Anxiolytics/Steroids
/Inhalants/Stimulants/Opiates/
Club drugs: ecstasy, GHB/LSD