PEDS: Exam 1 Notes
CHAPTER 28
Growth: an increase in physical size, including the measurements of height, weight, and head
circumference.
*Obtain and record height and weight on a standard growth chart for children at all well-child
visits. Head circumference measurement is obtained for children ages 2 years and younger
Growth charts assist with tracking growth and development as the child ages. There are
combined ones and ones specific for boys and girls.
*The goal is to provide holistic nursing care. Identifying delays encourages prompt evaluation
and intervention.
Development: the progression toward maturity in mental, physical, and social markers.
*Obtain a developmental health history from caregivers and the child (if age-appropriate)
including nutritional intake, sleep, elimination, and a description of behaviors that reflect past
and current development
Cognitive development refers to the ability to learn or understand from experience, to acquire
and retain knowledge, to respond to a new situation, and to solve problems. It may be assessed
by intelligence tests and by observing a child’s ability to function in different environments.
The Role of the Nurse : Assessing for growth and development milestones is part of the nurse’s
role in the care of both well and ill children.
HEALTH PROMOTION AND ILLNESS PREVENTION: Determining a child’s
developmental stage is often the primary focus of a well-child assessment.
Home safety for an infant who is approaching the age for crawling is necessary to prevent injury
and the ingestion of harmful products. Caregivers should think about installing stairway gates
and locks on accessible cabinets where hazardous materials are stored.
Anticipatory guidance should be provided in a timely manner. Information given too early may
be forgotten by the time it is needed and if given too late, caregivers may have already addressed
the issue possibly inappropriately.
Factors Influencing Growth and Development
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Social determinants of health greatly influence whether a child achieves their growth
and development potential. Prenatal care, access to medical and dental care, adequate
nutrition, a safe environment, access to play areas, well-equipped childcare centers and
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schools, and access to developmentally appropriate play items can affect optimal growth
and development
GENETICS: basic genetic makeup of an individual is present. In addition to physical
characteristics such as eye color and height potential, a child may inherit a genetic
abnormality, which could result in disability or disease.
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SEX DIFFERENCES RELATED TO PHYSICAL GROWTH : females are born
weighing less (by an ounce or two) and measuring shorter (by an inch or two) than males.
Males tend to keep this height and weight comparison until prepuberty, at which time
females begin their puberty growth spurt (typically around 6 months to 1 year earlier than
males). By the end of puberty, usually around 14 to 16 years old, males tend to be taller
and weigh more than females. The difference in growth patterns is why specific growth
charts are utilized to monitor physical growth for males and females.
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TEMPERAMENT: the reaction pattern of an individual or an individual’s characteristic
manner of thinking, behaving, or reacting to environmental stimuli. Temperament is not
developed in stages. Understanding that not all children are alike helps parents/caregivers
understand why their children are different from one another, and from themselves.
Sibling Socialization and Relationship: Siblings and their position in the family have a role in
the socialization and development of self-esteem in each child.
 Jealousy, insecurity, and behavioral regression may occur in the older child with the birth
of a sibling.
 Parents should help siblings develop good relationships with each other, although there
will most likely be conflicts.
 It is important for parents to spend individual time with each child and connect with them
about an activity or interest they enjoy.
Physical Activity and Health: is essential for a healthy lifestyle and should begin in infancy and
continue through adolescence.
 Physical activity increases lean body mass, muscle and bone strength, and promotes
physical health.
 It fosters psychological well-being, can increase self-esteem and capacity for learning,
and help children and adolescents handle stress
 Health problems, such as obesity, which continues to increase in children, can be
addressed with a balance of physical activity and healthy eating.
 It is recommended that children and adolescents get 60 minutes or more of physical
activity a day
Nutrition: major influence on health, weight, and stature. Children may begin to show
inadequate physical growth as early as infancy due to poor nutrition.
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Nutrition plays a vital role in the body’s susceptibility to disease. Poor nutrition limits the
body’s ability to resist infection.
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Lack of calcium could leave a child prone to rickets, a disease that affects growth by
causing shortening or bowing of long bones.
Lack of vitamins can lead to visual impairments, poor healing, and poor bone growth.
Obesity is linked to a variety of comorbidities including type 2 diabetes and heart disease
Nutrition:
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Healthy eating habits are established in early childhood and persist throughout a lifetime.
Caregivers should model healthy eating patterns for their children.
Differences in recommended calorie intake for males and females start at age 9 years. They
range from 1,000 calories a day for a 2-year-old to 2,400 calories a day for an 18-year-old
male and 1,800 calories a day for an 18-year-old female
Eat a variety of foods.
Choices from all food groups:
 Dairy
 Protein
 fruits,
 vegetables
 grains
—should be included in meals every day.
Choose a diet low in saturated fat and trans fats.
 Fat intake does not need to be restricted for the first 2 years of life because fat is necessary
for myelination of spinal nerves.
 Thereafter, fat intake can be tailored to meet the guidelines of 30% of total intake (saturated
fat should be less than 7% of total intake) for both children and adults
Protein: major component of bones, skin, hair, and muscle and is responsible for a wide variety
of essential functions in the body, including growth.
Carbohydrate: a main energy source for the body, essential to the functioning of body systems.
Carbohydrates are important to infants and toddlers because their brain cells are actively growing.
Fat: second source of energy for the body. It can be an immediate energy source or can be stored
if not used, then released when energy is required. Some fat deposits also serve as insulating
material for subcutaneous tissues. In infants, fats are necessary to ensure myelination of nerve
fibers.
Vitamins: organic compounds essential for specific metabolic actions in cells.
fat-soluble vitamins (A, D, K, and E) are mainly supplied by fortified dairy products, cereals,
and plant or fish oils.
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Such vitamins are not absorbed from the gastrointestinal tract by themselves but only if
accompanied by fat molecules.
Once absorbed, they are used by cells for growth or are stored for later use.
Water-soluble vitamins (B complex and C) do not need fat for absorption.
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not stored well in the body, and should be taken daily to maintain effective levels.
are found primarily in fruits and vegetables.
Minerals: necessary for building new cells as well as for the regulation of body processes such as
fluid and electrolyte balance, nerve transmission, and muscle contractions.
Minerals are classified according to the amounts needed daily:
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macronutrient (a major mineral): more than 100 mg is needed daily
micronutrient (minor mineral): amount needed is less than 100 mgPromoting Adequate
Nutritional Intake in Vegetarian Diets
Promoting Adequate Nutritional Intake in Vegetarian Diets
Although a balanced vegetarian diet is sufficient during childhood, careful assessment and
education is necessary to ensure a child’s intake is adequate for growth
Five main types of vegetarian diets include:
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The lacto-ovo-vegetarian diet, which includes dairy products (“lacto”), eggs (“ovo”), and
plants (vegetables, fruits, and grains)
The ovovegetarian diet, which includes eggs but excludes dairy products
The lacto-v8egetarian diet, which includes dairy products but excludes eggs
The vegan diet, which excludes all animal products and consists of only vegetables, fruits,
and grains
The macrobiotic diet, which is a primarily vegetarian diet. Its main sources of protein are
grains, seeds, and nuts, but small quantities of egg, fish, and wild game can be added.
Protein: essential amino acids by cereal and legume combinations such as peanut butter
and wheat bread, corn and lima beans, pasta and beans, corn tortillas and beans, or
chickpeas and sesame seeds.
Complementary proteins do not have to be eaten at the same meal to be effective, as long
as varied plant proteins are consumed over the course of a day.
Calcium: milk and cheese supply the usual source of calcium for children. When dairy
products are not eaten, calcium must be obtained from other sources such as green leafy
vegetables or calcium-fortified tofu or soy flour.
Iron: Red meat, whole grains, fortified cereals, dark-green leafy vegetables, or dried fruits
are good sources of iron. Vitamin C enhances the duodenal absorption of iron found in
plants, so eating fruits and vegetables rich in vitamin C such as oranges or broccoli also
aids in iron absorption.
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Vitamins: B12, Riboflavin, vitamin D
Vitamin B12 is unique among vitamins because it is present only in animal products.
eggs and milk.
Children who totally omit animal sources need to have this vitamin supplemented daily.
Reliable supplements:B12 tablets or fortified foods such as commercial breakfast cereals,
soy beverages, and some brands of nutritional yeast.
Riboflavin is a B vitamin normally supplied by fortified milk.
When dairy products are not eaten, it can be supplied by soy milk, vegetables, or brewer’s
yeast, all of which contain all the B vitamins except vitamin B12.
Good sources of riboflavin in vegan diets are whole and enriched grains and cereals, nuts,
and dark-green leafy vegetables.
Vitamin D is necessary for calcium and phosphorus metabolism and is normally supplied
in fortified milk.
not present in plant foods and therefore must be supplemented in a vegan or ovovegetarian
diet by vitamin D drops or tablets.
Exposure to sunshine also supplies vitamin D but is generally an inadequate source.
Minerals: Zinc & Iodine:
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Zinc: primarily in animal foods but is also present in brewer’s yeast, nuts, and wheat germ;
therefore, zinc deficiency is not a problem with vegetarian diets.
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Iodine: supplied normally by seafood. In a vegan or vegetarian diet, it can be supplied by
seaweed and iodized table salt.
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Total Calories:
Plant foods have fewer total calories than meats.
Generous servings of nuts and legumes are recommended to take the place of meat
servings.
Theories of Child Development:
Theory: is a systematic statement of principles that provides a framework for explaining a
phenomenon
Developmental tasks are skills or growth responsibilities arising at a particular time in an
individual’s life, the achievement of which will provide a foundation for the accomplishment of
future tasks.
SEVEN AGE PERIODS
Erikson theory
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Infant – If care is inconsistent, inadequate, or rejecting, infants learn mistrust; they become
fearful and suspicious o people and then of the world
Toddler – arises from a toddler’s new motor and mental abilities. Take pride in the new
things they can accomplish but also want to do everything independently. They recognize
that they are separate individuals
Preschooler – learning how to do things such as drawing, building an object from a block,
or playing dress up, creativity, do not inhibit fantasy or play activity
School-aged – self confidence. Children learn how to do things well, offer encouragement
– not showing appreciation of their efforts may cause them to develop a sense of inferiority
Adolescent – must bring together everything they have learned about themselves as a
child/athlete/friend/worker/student… and integrate these different images into a whole that
makes sense. If they are not able to do so, they are left with role confusion or unsure of
what kind of person they are or want to become.
Late adolescent (young adult) – Ability to relate well with other people in preparation for
developing future relationships.
Piaget
Piaget’s four stages of cognitive development are as follows:
1.Sensorimotor—birth to 2 years: The child develops a sense of self as separate from the
environment and the concept of object permanence, that is, tangible objects do not cease to exist
just because they are out of sight. He or she begins to form mental images.
2.Preoperational—2 to 6 years: The child develops the ability to express self with language,
understands the meaning of symbolic gestures, and begins to classify objects.
3.Concrete operations—6 to 12 years: The child begins to apply logic to thinking, understands
spatiality and reversibility, and is increasingly social and able to apply rules; however, thinking is
still concrete.
4.Formal operations—12 to 15 years and beyond: The child learns to think and reason in
abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.
Infant
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Will search for a block hidden by a blanket, knowing the block still exists
Can recognize a parent remains the same person despite clothing
Can only play peek-a-boo when they have mastered permanence because only then do they
realize the person playing with them exists behind their hands
Learn they are a separate entity from objects
Mouthing and handling of objects by infants and the delight of watching a caregiver appear
is part of discovering permanence
Toddler
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Complete their understanding of object permanence
Begin to use symbols to represent objects
Start to draw conclusions only from obvious facts that they see
Preschooler
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Move to a substage of preoperational thought termed intuitive thinking. When children
look at an object, they are able to see only one of its characteristics (such as a banana is
yellow, but they are unable to see that it is also long)
Intuitive thinking contributes to the preschooler’s lack of conservation (the ability to
discern truth) or reversibility (ability to retrace steps)
School-aged
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Concrete operational thought begins because school-aged children can be seen using
practical solutions to everyday problems as well as begin to recognize cause and effect
relationships
Adolescent
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When this stage is reached, adolescents are capable of thinking in terms of possibility
(abstract thought) rather than being limited to thinking about what already is (concrete
thought)
Chapter 29
Growth and Development of an Infant
Infants grow rapidly both in size and in their ability to perform tasks during their first year.
A standard schedule for healthcare visits:
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2-week
2-month
4-month
6-month
9-month
12-month
they provide the opportunity to provide immunizations, obtain growth measurements, and perform
health assessments; they are important for caregivers because they provide an opportunity to ask
questions about their child’s growth pattern and developmental progress.
* They provide opportunities for healthcare providers to assess for potential problems when they
first appear.
Physical Growth:
Weight: infants double their birth weight by 4 to 6 months and triple it by 1 year.
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6 months, infants typically average a weight gain of 2 lb per month.
second 6 months, weight gain is approximately 1 lb per month.
The average 1-year-old male weighs 10 kg (22 lb);
the average 1-year-old female weighs 9.5 kg (21 lb).
An infant’s weight, however, is relevant only when plotted on a standard growth chart and
compared to that child’s own growth curve.
Length: during the first year by 50%, or grows from the average birth length of 20 in. to about 30
in. (50.8 to 76.2 cm).
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Length, like weight, is assessed best if it is plotted on a standard growth chart.
Infant growth is most apparent in the trunk during the early months.
During the second half of the first year, it becomes more apparent as lengthening of the
legs occurs.
At the end of the first year, the child’s legs may still appear disproportionately short,
however, and perhaps bowed.
Head Circumference: By the end of the first year, the brain already reaches two-thirds of its adult
size. Head circumference increases rapidly during the infant period to reflect this rapid brain
growth.
Body Proportion: changes during the first year from that of a newborn to a more typical infant
appearance. By the end of the infant period, the lower jaw is definitely prominent and remains that
way throughout life.
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The abdomen remains protuberant until the child has been walking well into the toddler
period.
Cervical, thoracic, and lumbar vertebral curves develop as infants hold up their head, sit,
and walk.
*Lengthening of the lower extremities during the last 6 months of infancy readies the child for
walking and often is the final growth that changes the appearance from “baby-like” to “toddlerlike.”
Body Systems
cardiovascular system: heart rate slows from 110 to 160 beats per minute to 100 to 120 beats per
minute by the end of the first year.
the heart is becoming more efficient is shown by a decreasing pulse rate and a slightly elevated
blood pressure (from an average of 80/40 to 100/60 mm Hg).
respiratory rate: of an infant slows from 30 to 60 breaths per minute to 20 to 30 breaths per
minute by the end of the first year.
lumens of the respiratory tract remain small and mucus production by the tract to clear invading
microorganisms is still inefficient, upper respiratory infections occur more often and tend to be
more severe than in adults
gastrointestinal tract is immature in its ability to digest food and mechanically move it along.
mature gradually during the infant year. Although the ability to digest protein is present and
effective at birth, the amount of amylase, which is necessary for the digestion of complex
carbohydrates, is deficient until approximately the third month. Lipase, necessary for the digestion
of saturated fat, is decreased in amount during the entire first year.
liver :remains immature, possibly causing an inadequate conjugation of drugs (if a drug should be
necessary for treatment of illness) and the inefficient formation of carbohydrate, protein, and
vitamins for storage.
Until age 3 or 4 months, an extrusion reflex (food placed on an infant’s tongue is thrust forward
and out of the mouth) prevents some infants from eating effectively if they are offered solid food
this early (not recommended).
Newborns can drink from a cup as long as a parent controls the fluid flow. An infant can
independently drink from a cup by age 8 or 10 months.
Teeth : The first baby tooth (typically, a central incisor) usually erupts at age 6 months and Fluoride
supplementation should be administered at 6 months of age.
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A new tooth monthly until all 20 deciduous (baby) teeth have erupted by age 2 to 3 years,
which are essential for allowing proper growth of dental arch.
Molars should erupt by around 13 months of age
Gross Motor Development
Four positions:
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ventral suspension: refers to an infant’s appearance when held in midair on a horizontal
plan and supported by a hand under the and the head hangs down with little effort at control.
Control increases with age.
o Children with cerebral palsy do not demonstrate the two listed reflexes
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Prone position – can move their heads out of a position, but cannot hold their head raised
for an extended time.
3 month can lift the head and shoulders off the table and look around, but pelvis is flat
4 month able to lift chest off of the bed and look around
most babies turn front to back first, then about 1 month later they can turn back to front
5 month can rest weight on their forearms and can completely turn over
9 months can creep/crawl
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Sitting: Infants have head lag when pulled up to a sitting position until about 1 month
2 month can hold their head steady when sitting up, although their head does tend to bob
forward and still show some head lag when pulled to a sitting position
5 month can straighten their back when held or propped in a sitting position
6 month can sit momentarily without support
7 month can sit alone but only when the hands are held forward for balance
8 month can sit securely without any additional support
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Standing: at 3 months infants try to support part of their weight on their feet
4 months able to support their weight on their legs, stepping reflex as faded
6 months can nearly support their full weight when in a standing position
7 moth bounces with enjoyment in a standing position
9 month can stand holding onto a low table
A child has until about 22 months of age to walk and still be within the expected time
frame.
These 4 are used to assess gross motor development
Fine Motor Development
1 month-old infants still have a strong grasp reflex, so they hold their hands in fists so tightly that
it is difficult to extend their fingers.
2-month-old infant will hold an object for a few minutes before dropping it. The hands are held
open, not closed in fists.
3 months, infants reach for attractive objects in front of them. Their grasp is unpracticed so they
usually miss them.
4 months, infants bring their hands together and pull at their clothes. They will shake a rattle
placed in their hand. Thumb opposition (ability to bring the thumb and fingers together) begins,
but the motion is a scooping or raking one, not a picking-up one, and is not very accurate.
5 month-old children can accept objects that are handed to them by grasping with the whole hand.
They can reach and pick up objects without the object being offered and often play with their toes
as objects. Fisting that persists beyond 5 months suggests a delay in motor development. Unilateral
fisting suggests hemiparesis or paralysis on that side.
6 months, grasping has advanced to a point where a child can hold objects in both hands. Infants
at this age will drop one toy when a second one is offered. They can hold a spoon and start to feed
themselves (with much spilling). The Moro, the palmar grasp, and the tonic neck reflexes have
completely faded. A Moro reflex that persists beyond this point should arouse suspicion of
neurologic disease.
7 month-old infants can transfer toys from one hand to the other. They hold a first object when a
second one is offered.
8 months, random reaching and ineffective grasping disappear as a result of advanced eye–hand
coordination.
10 months is the ability to bring the thumb and first finger together in a pincer grasp. This enables
children to pick up small objects such as crumbs or pieces of cereal from a high chair tray. They
use one finger to point to objects. They offer toys to people but then cannot release them.
12 months, infants can hold a crayon well enough to draw a semi-straight line. They enjoy putting
objects such as small blocks in containers and taking them out again. They can hold a cup and
spoon to feed themselves fairly well (if they have been allowed to practice) and can take off socks
and push their hands into sleeves (again, if they have been allowed to practice).
Language Development
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Begins with small, cooing sounds.
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By 2 months they can differentiate their cry (parents can tell the difference between hungry
cry and wet cry
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4 months – they become more talkative and start cooing babbling and gurgling more
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5 months – can make some simple vowel sounds
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6 months – the art of imitating
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9 months – usually speaks first words, such as da-da
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12 months – can generally say two words with meaning
PLAY
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1 month – can fix their eyes on an object, so mobiles are best and black and white or
brightly colored ones
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Hearing is a source of pleasure; a music box or a musical rattle
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3 month – can handle small blocks or small rattles
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4 month – play gym or floor mat to encourage exercise and rolling over
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5 month – can handle a variety of objects. Be sure they are small enough to hold, but large
enough that they cannot be swallowed
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6 month – old enough to play with bathtub toys with supervision
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8 month – sensitive to texture differences
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9 month – room to move around, toys that go inside one another (nesting toys), or stacking
toys
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10 months – peek a boo play, they can clap
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12 months – enjoyment with putting things in and taking things out of containers, pull toys
for walkers, listening to music
COGNITIVE DEVELOPMENT
Primary and Secondary Circular Reaction
third month of life, a child enters a cognitive stage identified by Piaget (1952) as primary circular
reaction.
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During this time, the infant explores objects by grasping them with the hands or by
mouthing them
Infants appear to be unaware of what actions they can cause or what actions occur
independently.
For example, if an infant’s hand should accidentally strike a mobile across the crib, the infant
appears to enjoy watching the brightly colored birds move in front of them but does not attempt to
hit the mobile again because they do not realize their hand caused the movement.
6 months of age, infants pass into a stage Piaget (1952) called secondary circular reaction.
Now when infants reach for a mobile above the crib, hit it, and watch it move, they realize it was
their hand that initiated the motion, and so they hit it again.
10 months, infants discover object permanence.
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Infants are ready for peek-a-boo once they have gained this concept.
They know their caregiver still exists even when hiding behind a hand or blanket and wait
excitedly for them to reappear.
Erikson’s Trust vs Mistrust – if this first step is not achieved, it can affect all future steps
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All children thrive on routine, such as the same story read repeatedly or the same
bedtime rituals
Promoting infant safety
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Unintentional injuries are a leading cause of death in children from 1 month to 24
months of age
Most unintentional injuries in infancy occur because caregivers either underestimate or
overestimate a child’s ability
Aspiration prevention: Avoid cylindrical objects, don’t prop up bottle for feeding, clothing
without buttons, if it fits inside a toilet paper roll then it can fit inside an infant’s mouth and be
aspirated
Fall prevention: Not left unattended on a raised surface
Car Safety: Rear facing car seats and never in the front seat of the car
Safety with siblings: Careful that older siblings do not give the infant toys that are not safe
Bathing and swimming safety: Infants should never be left unattended in a tub, even when
propped up out of the water or sitting in a bath ring
Childproofing: Move all potentially poisonous substances from bottom cabinets and store them
well out of the infant’s reach, Check play area for small objects, When walking begins, additional
childproofing measures are needed, such as access to open doors and stairs
PROMOTING NUTRITIONAL HEALTH OF AN INFANT
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Birth to 6 months – provide human milk (breastfeeding or expressed), may need vitamin D
supplements. Formula fed infants do not need vitamin D supplements because it is included
in the formula
If mother is a vegan, B12 supplements may be needed if the parent is deficient and is
breastfeeding
6 months to 1 year – continue to feed with human milk or formula. May need iron fortified
formula if not on human milk. Fluoride supplementation if not provided in the water
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Chewing movements begin around 7-9 months of age
Developmental Readiness for Beginning to Eat Solid Foods
Typically, between ages 4 and 6 months, infants develop the gross motor, fine motor, and oral skills
necessary to begin to eat complementary foods.
Signs that an infant is ready for complementary foods include:
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Being able to control the head and neck
Sitting up alone or with support
Bringing objects to the mouth
Trying to grasp small objects, such as toys or food
Swallowing food rather than pushing it back out onto the chin
Providing Safe Feeding
Infants aged 6 months to a year should be given age-appropriate and developmentally appropriate
foods to help prevent choking.
Foods such as hot dogs, candy, nuts and seeds, raw carrots, grapes, popcorn, and chunks of peanut
butter are some of the foods that can be a choking risk for young children.
Steps to decrease choking risks:
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Offering foods in the appropriate size, consistency, and shape that will allow an infant to
eat and swallow easily
Making sure the infant or young child is sitting up in a high chair or other safe, supervised
place; this is important to keep in mind as well when feeding infants in a hospital setting.
Ensuring an adult is supervising feeding during mealtimes
Not putting infant cereal or other solid foods in an infant’s bottle; this could increase the
risk of choking and will not make the infant sleep longer
Dietary Components to Limit
While encouraging infants to eat from each food group, some dietary components should be
limited. These include added sugars, foods high in sodium, honey and unpasteurized foods and
liquids, cow’s milk and fortified soy liquids, plant-based milk alternatives, and foods and liquids
containing caffeine
Added Sugar: Complementary foods need to be nutrient dense and not contain additional calories
from added sugars
Foods Higher in Sodium: Limit foods and fluids high in sodium, which is found in salty snacks,
commercial toddler foods, and processed meats.
Choose fresh or low-sodium frozen foods when available and low-sodium canned foods to
minimize sodium content (USDA, 2020).
Honey and Unpasteurized Foods and Liquids: Infants should not be given any foods containing
raw or cooked honey.
Honey can contain the Clostridium botulinum organism that could cause serious illness or death
among infants.
Infants and young children also should not be given any unpasteurized foods or liquid, such as
unpasteurized juices, milk, yogurt, or cheeses, as they could contain harmful bacteria.
Cow’s Milk and Fortified Soy Liquids: Infants should not consume cow’s milk or fortified soy
liquids to replace human milk or infant formula before age 12 months.
Cow’s milk does not have the correct amount of nutrients for infants, and its higher protein and
mineral content are hard for an infant’s kidneys and digestive system to process.
Plant-Based Milk Alternatives: These liquids should not be used to replace human milk or infant
formula in the first year of life. They come in different flavors and some forms have added sugars.
100% Fruit Juice and Sugar-Sweetened Drinks: Before age 12 months, 100% fruit or vegetable
juices should not be given to infants. Avoid foods and liquids with added sugars.
Caffeine: Concerns exist about potential negative health effects of caffeine for young children,
and no safe limits of caffeine have been established for this age group. Caffeine is a stimulant that
can occur naturally in foods and liquids or as an additive.
Baby-Bottle Tooth Decay Syndrome
Decay occurs because, while an infant sleeps, liquid from the propped bottle continuously soaks
the upper front teeth and lower back teeth (the lower front teeth are protected by the tongue). The
problem, called baby-bottle syndrome, is most serious when the bottle is filled with sugar water,
formula, milk, or fruit juice. The carbohydrate in these solutions ferments to organic acids that
demineralize the tooth enamel until it decays.
Obesity in Infants
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Obesity in infants is defined as a weight greater than the 90th to 95th percentile on a
standardized height/weight chart and height is in a lower percentile.
Obesity occurs when there is an abnormal increase in the number of fat cells because of
excessive calorie intake.
Preventing obesity in infants is important because this sets the pattern for obesity later in
childhood and into adulthood.
If a child becomes obese because of over ingesting milk, iron-deficiency anemia may also
be present because of the low iron content of both breast and commercial milk.
Overfeeding in infancy often occurs because parents/caregivers don’t have a clear
understanding of the caloric needs of the infant.
Chapter 30
Nursing Assessment of a Toddler’s Growth and Development
An assessment of a toddler begins with the child’s physical growth and skill development.
PHYSICAL GROWTH
Although toddlers are making great strides developmentally, their physical growth begins to slow.
Weight, height, head circumference, and BMI – plotted on a standard growth chart at each
healthcare visit. BMI screening is completed at 24 months to identify toddlers who are overweight
or underweight
Body contour – Tend to have a prominent ABD because the abdominal muscles are not yet strong.
The forward curve of the spine at the sacral area will correct itself naturally
Body Systems
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Respirations slow slightly
HR slows from 110 to 90
BP increases to about 99/64
The brain develops to about 90% of its adult size
Respiratory lumens progressively enlarge, and the incidence of respiratory infections
decreases
Stomach secretions become more acidic and the size of the stomach capacity increases
Control of urinary and anal sphincters becomes possible
Teeth – 8 new teeth, including molar
MILESTONES
Language Development: Toddlerhood is a critical time for language development. A 2-year-old
who does not talk in two-word simple sentences needs a careful assessment.
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A word that is used frequently by toddlers, and that is a manifestation of their developing
autonomy, is “no.”
Watching television promotes minimal learning in toddlers because the activity is passive,
and it is difficult to discern how language causes action
Encourage language development by naming objects during play and daily activities. This
helps children understand how words apply to people and objects.
Emotional During the toddler years, children change a great deal in their ability to understand the
world and how they relate to people.
Autonomy: The developmental task of the toddler years according to Erikson (1993) is the
development of a sense of autonomy versus shame or doubt .
Socialization:
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At 15 months, children are still enthusiastic about interacting with people, providing those
people are willing to follow them where they want to go.
By 18 months, toddlers imitate the things they see a caregiver doing, such as using a mobile
phone or wiping up spills, so they seek out caregivers to observe and imitate.
By 2 or more years of age, children become aware of gender differences and may point to
other children and identify them as “boy” or “girl” if this is what they heard from their
parents.
Play Behavior: children play beside other children, not with them. This side-by-side play (parallel
play) is a normal developmental sequence that occurs during the toddler period
Cognitive Development:
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Children enter the final stages of Piaget’s sensorimotor thought and the beginning of the
preoperative period around 12 months
During the fifth and sixth stages of the sensorimotor phase, toddlers are described as “little
scientists” because of their interest in discovering new results that different actions can
achieve.
At the end of the toddler period, children enter a second major period of cognitive
development termed preoperational thought. They are not able to change their thoughts to
fit a situation, so they learn to change the situation..
Health Promotion of a Toddler and Family
Toddlers visit healthcare facilities for health maintenance visits (recommended at 15, 18, 24, and
30 months of age) and immunizations.
These visits allow the nurse to give anticipatory guidance and provide an opportunity for growth
and development assessments.
PROMOTING TODDLER SAFETY
Accidents (unintentional injuries) are a major cause of death in infancy through late adolescence
in the United States .
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Poisonings most often occur from ingestion of cleaning products.
Aspiration or ingestion of small objects is also a major source of injury for toddlers.
Caregivers should keep their toddlers in rear-facing car seats until age 2 years, or until the
child reaches the maximum height and weight for their particular seat.
By the end of the toddler period, children can walk quickly but have limited judgment
about moving objects and safety hazards.
Lead Screening
All children between the ages of 6 months and 6 years who live in communities with
buildings built before 1950 in the United States and children who might have been
exposed to sources of lead in their home country should be tested for elevated lead levels.
Elevated lead levels are often caused by eating, chewing, or sucking on objects (e.g.,
windowsills, paint chips, furniture) with paint containing lead. Although federal law has
prohibited the use of lead in the manufacturing of both interior and exterior paints since
the mid-1970s, many older houses still contain paint that is lead-based.
Additional sources of lead poisoning can include:
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Toys manufactured in countries where restrictions on lead are lax
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Soil around the exterior of the house
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Dust or fumes created by home renovation
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Pottery made with lead glazes, jewelry made from lead or lead alloys
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Older lead-based water pipes
Lead dust brought home on the clothing of caregivers who work with lead products
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Lead is toxic to body tissue. Ingestion leads to serious damage to the brain and nervous
system, kidneys, and red blood cells.
Levels as low as 5 μg/dL can cause learning and behavioral problems.
High levels may result in seizures, cognitive challenges, coma, and death.
Beginning symptoms of lead poisoning include irritability, headache, fatigue, and
abdominal pain.
There may be no symptoms before damage occurs, making blood screening essential.
A positive result (over 5 μg/dL) must be confirmed by further testing.
The long-term effects of lead poisoning and therapy are discussed in.
Toddler Nutrition Requirements
Although a toddler’s daily food consumption may vary greatly, energy needs are
generally met when sufficient food is supplied in a positive environment
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Sedentary children aged 1 to 3 years should consume 1,000 kcal daily; active children in
this age group may need up to 1,400 kcal daily.
Calories are best supplied by a variety of foods provided three times a day.
Protein and carbohydrate needs are often those most easily met during the toddler period;
diets high in sugar should be avoided.
Fats should generally not be restricted for children under 2 years old; however, children over
2 years old should have a total fat intake between 30% and 35% of calories, with most fat
coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish,
nuts, and vegetable oils.
Trans-fats should be kept to a minimum.
Adequate calcium and phosphorus intake is important for bone mineralization
Vegetarian diets are adequate for toddlers – caregivers need to be well informed about the
needed vitamins and minerals
PROMOTING TODDLER DEVELOPMENT IN DAILY ACTIVITIES
A toddler’s new independence and developing abilities in self-care, such as dressing, eating, and,
to a limited extent, hygiene, present special challenges for parents.
Dressing: By the end of the toddler period, most children can put on their own socks and
underpants. Some may also be able to pull on pants or pullover shirts, though the sleeves of a
shirt often confuse toddlers.
Sleep: the amount of needed sleep gradually decreases as they grow older; may nap twice a day
and sleep 12 hours at night
Dental care: encourage healthy snacks to help prevent dental caries, urge caregivers to schedule
first dental visit by 12 months of age
PARENTAL CONCERNS ASSOCIATED WITH THE TODDLER PERIOD
Concerns in the toddler period usually arise because of a conflict over autonomy.
Toilet training is one of the biggest tasks of toddlerhood and can be explained to parents that
toilet training is an individualized task for each child.
Ritualistic behavior – The child who seems to need an excessive number of objects to clint to
may need more guidance
Ex: They want “their” spoon at mealtime or “their” blanket at bedtime.
Negativism: typically go through a period of extreme negativism with replies to every request as
a very definite “no.”
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easy for caregivers to believe their authority is being questioned when this happens.
baffled by the extreme change from happy, cooperative infant to uncooperative toddler.
not only a normal phenomenon of toddlerhood but also a positive stage in development.
indicates the toddler has learned that they are a separate individual with separate needs.
Separation Anxiety:. Toddlers who have separation anxiety have difficulty accepting being
separated from their primary caregiver to spend the day at a childcare center.
fear of being separated from parents begins at about 6 months of age and persists throughout the
preschool period
TEMPER TANTRUMS : Almost every toddler has a temper tantrum at one time or another.
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temper tantrums occur as a natural consequence of toddlers’ development.
They occur because toddlers are independent enough to know what they want, but they
do not have the vocabulary or the wisdom to express their feelings in a more socially
acceptable way.
For example, temper tantrums occur most often when children are tired
CONCERNS OF THE FAMILY WITH A TODDLER WHO HAS UNIQUE NEEDS
may be difficult for children with physical or mental disabilities to achieve a sense of autonomy
or independence because they may never be totally independent.
Autism Spectrum disorder
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Symptoms begin to appear slightly in infancy, but they are usually more
prominent during the toddler years, language delays, does not make eye
contact with others, difficulty interacting with playmates
Screening at 12 months, 18 months, and 24 months
Nutrition and the Physically Challenged or Chronically Ill Toddler
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All toddlers need experience in feeding themselves, but allowing a child with neurologic
deficits to do this can be difficult.
Accept that messiness will occur and suggest finger foods if possible.
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If a child is on a special diet, it may be difficult to prepare finger foods. If they are tube
fed, they receive no experience at all with finger foods.
For these children, caregivers should try to provide other, comparable experiences in
independence, such as letting them choose what toy to take to bed or what clothing to
wear.
CHAPTER 31
Preschool child
The preschool period traditionally includes the years 3, 4, and 5.
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Although physical growth slows considerably during this period, personality and cognitive
growth continue at a rapid rate.
children of this age want to do things for themselves—choose their own clothing and dress
themselves, feed themselves independently, wash their own hair, and so forth.
caregivers of a preschooler may find their child dressed in two different socks, going to
preschool with unwashed ears, or trying to eat soup with a fork.
ASSESSMENT
Assessment of a preschooler includes obtaining a health history and performing both
physical and developmental evaluations.
A detailed history is important for accurate evaluation.
Preschoolers may speak very little during a health assessment; they may even revert to
baby talk or infantile behaviors such as thumb-sucking if they find a health visit stressful.
Assess a child’s weight, height, and body mass index (BMI) according to standard growth
charts (available at ).
Assess a child for general appearance.
Preschoolers typically have six to 12 respiratory infections per year; therefore, many of
them will have one at the time of a health assessment.
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PHYSICAL GROWTH
A definite change in body contour occur: wide-legged gait, prominent lordosis, and
protuberant abdomen of the toddler change to slimmer, taller, and more childlike
proportions.
Contour changes are so definite that future body type—ectomorphic body build (slim body
build) or endomorphic body build (large body build)—becomes apparent. Handedness also
begins to be obvious.
Lymphatic tissue begins to increase in size, particularly the tonsils; levels of immune
globulin (Ig)G and IgA antibodies increase.
innocent heart murmurs may also be heard for the first time.
Pulse rate decreases to about 85 beats/min, and blood pressure holds at about 100/60 mm
Hg.
]
Weight, Height, Body Mass Index, and Head Circumference
Weight gain is slight during the preschool years; the average child gains only about 4.5 lb
(2 kg) a year.
Height gain is also minimal during this period: only 2 to 3.5 in (6 to 8 cm) a year on average.
Head circumference is not routinely measured at physical assessments on children over 2
years of age because it changes little after this time.
DEVELOPMENTAL MILESTONES
Language
• Typical vocabulary of about 900 words
• Egocentrism – one’s thoughts and needs are better or more important than those of
others
• Tend to imitate language, even language that is not appropriate or less-than-perfect
Play
 Preschoolers do not need many toys because, with an imagination more active than
it will be at any other time in life,
 They enjoy games that use imitation such as pretending they are a teacher,
firefighter, or store clerk.
 imaginary friends often exist until children formally begin school.
 Four- and 5-year-olds divide their time between active play and imitative play.
 Five-year-olds become interested in group games or reciting songs they have
learned in kindergarten or preschool.
EMOTIONAL DEVELOPMENT
Children change a great deal in their ability to understand their world and how they relate to other
people during the preschool years.
Initiative
 initiative versus guilt: Children with a well-developed sense of initiative like to explore
because they have discovered that learning new things is fun.
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If children are criticized or punished for attempts at initiative, they can develop a sense of
guilt for wanting to try new activities or to have new experiences.
****Those who leave the preschool period with a sense of guilt can carry it with them into school
situations. They may even have difficulty later in life making decisions about everything from
changing jobs to choosing an apartment because they cannot envision that they are capable of
solving the associated problems that will come with change.*****
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Support initiative by providing exposure to a wide variety of experiences and play
materials.
Trips to the zoo, family vacations, parks.
Emotional Development
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Imitation - Imitates the actions of people around the
Fantasy – Begin to differentiate differences between fantasy and reality
Socialization – Preschoolers who are exposed to other playmates have an easier time
learning to relate to people than those with rare interations with other children
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Cognitive development
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Piaget – still in preoperational, but start to move into intuitional thought
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Not aware of properties of conservation (can only see that the form has change,
doesn’t understand that the amount is the same)
Moral and Spiritual development – develop right from wrong (based on parents’ rules)
PROMOTING PRESCHOOLER SAFETY
As preschoolers broaden their horizons, safety issues must also widen.
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By age 4, children may project an attitude of independence and the ability to take
care of their own needs.
need supervision to be certain they do not injure themselves or other children during
active play and to ensure they do not wander too far from home.
Because they imitate adult roles so well, they may imitate taking medicine if they
see family members doing so.
Gun safety, including making sure any guns in the home are unloaded and locked,
is important education for caregivers.
A final area to consider is automobile safety. Preschoolers must be reminded
repeatedly to buckle their booster seat and not to walk in back of or in front of
automobiles.
Otherwise, a preschooler’s thought “I want to play across the street” can be so quick
and so intense that the child will run into the middle of the street before
remembering street safety rules.
\\
Motor Vehicle and Bicycle Safety
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Preschool is the appropriate age to promote bicycle safety because bicycles injuries
are a major cause of severe head injuries in this age.
To prevent such injuries, preschoolers need a safety helmet approved for children
their age and size.
Encourage caregivers who ride bicycles to demonstrate safe riding habits by
wearing helmets.
Seeing a caregiver routinely wearing a helmet may well be the most compelling
reason for a preschooler to wear one.
Nutritional Health
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Growth is slower, so appetites may vary
Encourage a wide variety and color for foods
May give vitamins (do not refer to them as candy)
Vegetarian/vegan diets- may need Calcium, vitamin B12, and vitamin D
supplements
ROMOTING THE DEVELOPMENT OF THE PRESCHOOLER IN DAILY
ACTIVITIES
mastered the basic skills needed for most self-care activities, including feeding,
dressing, washing (with supervision), and dental care (with supervision).
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Dressing
Many 3-year-olds and most 4-year-olds can dress themselves except for difficult
buttons, although conflict may occur over what the child will wear.
Preschoolers prefer bright colors or prints and so may select items that are appealing
in color rather than matching.
Sleep
On some occasions, even though they may be tired, children in this age group may
refuse to go to sleep because of fear of the dark and may wake at night terrified by
a bad dream.
This means that preschoolers may need a night-light turned on, although they did
not need one before.
A helpful suggestion is to avoid scary stories or screen time just prior to bedtime
and to be certain that when the light in their bedroom is dimmed, it has a soothing
atmosphere.
Exercise
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The preschool period is an active phase, so preschool play tends to be vigorous
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Active play helps relieve tension and should be allowed as long as it does not become
destructive
preschoolers love more structured games they were not ready for as toddlers.
Promoting these types of active games and reducing screen time can be steps toward
helping children develop motor skills as well as prevent childhood obesity .
Hygiene
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wash and dry their hands adequately if the faucet is regulated for them (so they do not scald
themselves with hot water).
When possible, parents should turn down the temperature of the water heater in their home
to under 120°F to help prevent scalds.
they should still not be left unsupervised at bath time in case they decide to add more hot
water or to practice swimming and are unable to get their head back above water.
****Preschoolers do not clean their fingernails or ears well either, so they may need
assistance with bathing. Using a nonirritating shampoo and hanging a mobile over the tub
so they have a reason to look up while their hair is rinsed helps make hair washing a fun
procedure****
Care of Teeth
If independent toothbrushing was not started as a daily practice during the toddler years, it should
be started during preschool.
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Electric or battery-operated toothbrushes are favorites of preschoolers and can be used
safely if the child is taught not to use it or any other electrical appliance near water.
preschoolers do well brushing their own teeth, caregivers should check that all tooth
surfaces have been cleaned.
Adults should also floss the child’s teeth because this is a skill beyond a preschooler’s
motor ability.
drink fluoridated water or receive a fluoride supplement
no later than 2 years of age for an evaluation of tooth formation because deciduous (baby)
A number of common health teeth must be preserved to protect the dental arch.
PARENTAL CONCERNS ASSOCIATED WITH THE PRESCHOOL PERIOD
Health problems and fears usually arise during the preschool years.
Common Health Problems of the Preschooler:
Even though the number of major illnesses is few in this age group, the number of minor illnesses,
such as common colds and ear infections, is high.
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live in homes in which adults smoke have a higher incidence of ear (otitis media) and
respiratory infections than other diseases
attend childcare or preschool programs also have an increased incidence of gastrointestinal
disturbances (vomiting and diarrhea) and upper respiratory infections from the exposure to
other children unless frequent hand washing is stressed.
demonstrate frequent whining or clingy behavior because of the frequency of repeated
respiratory or gastrointestinal infections.
Common fears of the preschooler
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Dark – can be heightened because of their vivid imagination. Night lights help
Mutilation – Do not know what body parts are essential, example: scraped skin can
grow back. Worried that if some blood is taken out of their bodies that all of their blood
will leak out
Separation or abandonment – They do not have an accurate sense of time and limited
sense of distance.
Behavior Variations
A combination of a keen imagination and immature reasoning results in a number of other common
behavior variations in preschoolers.
Telling Tall Tales
Stretching stories to make them seem more interesting is a phenomenon frequently encountered in
preschoolers.
EX. after a trip to the zoo, if you ask a preschooler, “What happened today?” a child perceives
you want something exciting to have happened, and so might answer, “A bear jumped out of the
cage and ate the kid next to me.”
Imaginary Friends
Imaginary friends are a normal, creative part of the preschool years and can be invented by children
who are surrounded by real playmates as well as by those who have few friends, caregivers may
find them disconcerting.
As long as a child has exposure to real playmates and imaginary playmates do not take center stage
in the child’s lives or prevent them from socializing with other children, they should not pose a
problem..
***Help preschoolers separate fact from fantasy about their imaginary friend by saying, “I know
your friend isn’t real, but if you want to pretend, I’ll set a place for them.” This response helps a
child understand what is real and what is fantasy without restricting imagination or creativity.***
Difficulty Sharing
Around 3 years of age, children begin to understand some things are theirs, some belong to others,
and some can belong to both.
EX: they can stand in line to wait for a drink, take turns using a shovel at a sandbox, and share a
box of crayons. Sharing does not come easily, however; children who are ill or under stress have
a greater difficulty sharing.
Ways to help them understand and practice:
***Caregivers may need to help a child learn property rights as part of learning to share, such as
“This is my private drawer and no one touches what is in it but me.” “That is your private box, and
no one touches the things in it but you.” “A shovel is ours and can be used by everyone playing in
the sand pile.****
Defining limits and exposing children to these three categories (i.e., mine, yours, and ours) helps
them determine which objects belong to which category.
Regression
stress that causes this may take many forms, it is usually the result of such things as a new baby in
the family, a new school experience, seeing frightening and graphic television news or
programming, stress in the home, or separation caused by hospitalization.
Will cause behaviors such as:
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thumb-sucking
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negativism
loss of bladder control
inability to separate from their parents.
CONCERNS OF THE FAMILY WITH A PRESCHOOLER WITH UNIQUE NEEDS
Preschoolers who are chronically ill may be limited in the foods they can eat (e.g., perhaps they
can eat only soft foods) or in their ability to help with food preparation may miss this
reinforcement.
If their appetite is diminished because of illness to the point where they take little or nothing orally,
it is still important that they continue to join the family at meals if possible.
In most households, this is a time for socialization, and preschoolers are open to the opportunity
for the learning that goes with this type of daily interaction.
Chapter 32
Nursing Care of a Family With a School-Aged Child
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The term “school age” refers to children between the ages of 6 and 12 years.
time of slow physical growth, the school-aged child’s cognitive growth and development
continue to proceed at rapid rates.
Assess children as individuals to understand the unique developmental needs of each child
based on what developmental status has been achieved, not on what stage one may think the
child should have reached .
The development of a school-aged child is much more subtle.
The child may demonstrate contradictory responses. (what the child enjoys on one occasion may
change over time)
Increasingly more influenced by the attitudes of their friends
School-aged period= initiation of independent decision making
Growth and Development of a School-Aged Child
PHYSICAL GROWTH
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The average annual weight aprox =3 to 5 lb
The increase in height is 1 to 2 in.
By 10 years of age, brain growth is complete, so fine motor coordination becomes refined, adult
vision level is achieved, and eruption of permanent teeth and growth of the jaw.
Sexual Maturation
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At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary
gland to begin production of gonadotropic hormones (activate changes in the testes and ovaries
to cause puberty.)
Secondary sex characteristics develop.
Puberty is rated using Tanner stages
Sexual maturation in females = between the ages of 12 and 18; in males=between 14 and 20
years.
Precocious puberty is an abnormal onset of puberty
Concerns of females
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Prepubertal females are usually taller by about 2 in.
explanation of menstruation and physical care should be provided, including proper hygiene and
activities. Sanitary napkins or tampons can be used for menstrual flow; with tampon use,
precautions are necessary to avoid toxic shock syndrome
Insufficient caloric intake, obesity, and emotional instability can influence menstrual regularity.
Concerns of malesAs production of seminal fluid increases, ejaculation during sleep may occur. This is termed
nocturnal emission
Transgender Children
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Transgender children identify with the gender that is not their sex assigned at birth.
Higher incidence of psychosocial disorders such as depression and anxiety
TEETHDeciduous teeth are lost and permanent teeth erupt during the school-aged period
DEVELOPMENTAL MILESTONES
Gross Motor Development
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They have enough coordination to walk a straight line
By 10 years of age, children are more interested in perfecting their athletic skills than they were
previously.
Fine Motor Development
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Six-year-olds can easily tie their shoelaces.
“Eraser year” because children are never quite content with what they have done.
Eight-year-olds are able to write script in addition to print.
Play
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Around 7 years of age, children also develop an interest in collecting items such as baseball
cards, dolls, rocks, or marbles.
Many 10-year-olds are interested in playing screen games.
During their 10th year, children become very interested in rules and fairness (they strictly
enforce rules)
LANGUAGE DEVELOPMENT
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Six-year-olds talk in full sentences, using language easily and with meaning. (define objects by
their use)
Most 7-year-olds can tell the time in hours.
By 12 years of age, children can carry on an adult conversation.
EMOTIONAL DEVELOPMENT
They can accomplish small tasks independently because they have gained a sense of autonomy.
-Developmental Task: Industry Versus Inferiority
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INDUSTRY= is learning how to do things well.
INFERIORITY= or become convinced they cannot do things they actually can do. Children can
have difficulty tackling new situations later in life.
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School-aged children need reassurance that they are doing things correctly, and this reassurance
is best if it comes immediately after a task is completed.
solving by saying, “Let’s talk about possible ways of doing it,” rather than offering a quick
solution.)
Home as a Setting to Learn Industry=Conformity is vital to children at this age.
Problem Solving= An important part of developing a sense of industry is learning how to solve
problems. (Encourage problem
Socialization
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Six-year-old children play in groups, but when they are tired or under stress, they usually prefer
one-to-one contact. Increasingly aware of family roles and responsibility
Promises must be kept because 7-year-olds view them as definite, firm commitments.
Insecure and often attempt many awkward and uncomfortable social experiences
COGNITIVE DEVELOPMENT
The age from 5 to 11 years is a transitional stage during which children undergo a shift from the
preoperational thought they used as preschoolers to concrete operational thought or the ability to
reason through any problem they can actually visualize
Children can use concrete operational thought because they learn several new concepts during school
age, such as:
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Decentering= the ability to project one’s self into other people’s situations and see the world
from another’s viewpoint
Accommodation=the ability to adapt thought processes to fit what is perceived.
Conservation= the ability to appreciate that a change in shape does not necessarily mean a
change in size. (a school-aged child will know that both glasses hold an equal amount.)
Class inclusion= the ability to understand that objects can belong to more than one classification.
MORAL AND SPIRITUAL DEVELOPMENT
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School-aged children begin to mature in terms of moral development as they enter a stage of
preconventional reasoning
They concentrate on “niceness” or “fairness”
School-aged children are rule oriented
Health Promotion for a School-Aged Child and FamilyPROMOTING SCHOOL-AGED SAFETY
School-aged children are ready for time on their own without direct adult supervision (They need good
education on safety practices).
PROMOTING NUTRITIONAL HEALTH OF A SCHOOL-AGED CHILD
Most school-aged children have good appetites, although meals may be influenced by the day’s
activity.
Establishing Healthy Eating Patterns
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School-aged children should be encouraged to eat a healthy breakfast to ensure the ability to
concentrate during the school day.
School-aged children can help prepare a nutritious lunch to take to school.
Nutritious after-school snacks are important in this age group. Poor eating habits developed in
the school-aged years may last through adulthood
Fostering Industry and Nutrition
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school-aged children usually enjoy helping to plan meals.
Eating meals while watching television or performing another activity is a risk factor for obesity
Recommended Dietary Intakes
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the recommended dietary intakes
Both females and males require more iron in prepuberty than they did between the ages of 7 and
10 years. Adequate calcium and fluoride intake remain important to ensuring good teeth and
bone growth.
A Vegetarian DietFoods highest in calcium are green leafy vegetables such as spinach and turnip greens, enriched bread,
and cereals. Soybeans, legumes, grains, and immature seeds such as green beans, lima beans, and corn
are relatively high in protein. Encourage outside activities for sun exposure to increase vitamin D.
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Dress=Although school-aged children can fully dress themselves, they are not skilled at taking
care of their clothes until late in the school-aged years
Sleep=Sleep needs vary among individual children. Younger school-aged children typically
require 10 to 12 hours of sleep each night, whereas older children require about 8 to 10 hours./
Night terrors may continue.
Exercise=School-aged children need daily exercise. (Increasing time spent in exercise need not
involve organized sports. It can come from neighborhood games, walking with parents or a dog,
or bicycle riding. A)
Hygiene=Children 6 or 7 years of age still need help regulating bath water temperature and
cleaning their ears and fingernails. By age 8 years, children are generally capable of bathing
themselves/Some children develop a fear of dentists; if a dentist visit was painful, they want to
avoid going at all. School-aged children have to be reminded to brush their teeth daily.
CONCERNS AND PROBLEMS OF THE SCHOOL-AGED PERIOD
Two of the more important disorders of the school-aged period are ADHD and ASDs because
these interfere so dramatically with school progress
-Problems Associated With Language Development
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The common speech problem for the preschool years is broken fluency; the most common
problem for a school-aged child is articulation. The child has difficulty pronouncing s, z, th, l, r,
and w or substitutes w for r (“westroom” instead of “restroom”) or r for l (“radies’ room” instead
of “ladies’ room”)
.Unless it persists, speech therapy for this normal developmental stage is not necessary.
-Common Fears and Anxieties of a School-Aged Child
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School-aged children are old enough to experience adult reactions to problems at home or
school.
School refusal is a fear of attending school. It is a type of “social phobia”
Bullying
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Bullying can be done face to face or through social media and/or texting.
Advise parents to monitor their child’s social media and texting interactions.
If bullying behavior is ingrained, therapy may be needed to correct the behavior. Stopping
bullying helps not only the victim but also the bully. Children who exhibit this type of aggressive
behavior in grade school may be more likely to have problems in adulthood
CONCERNS OF THE SCHOOL-AGED CHILD AND FAMILY WITH UNIQUE NEEDS
The Child of People With Alcohol Use Disorder
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A feeling of guilt that they are the cause of the parent’s drinking
Decreased ability to trust adults because the parent is unreliable
Poor nutrition and grades in school because the parent’s behavior is so erratic that no
regular schedule exists
The Child With a Long-Term Illness or Physical or Cognitive Challenge
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One of the biggest problems facing school-aged children with a long-term illness or physical or
cognitive challenges is time lost from school.
Children with physical or cognitive challenges should attend regular schools if possible.
It is important for children to develop a sense of industry or accomplishment