CCN3147Child and Adolescent Health - L1

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Student will be able to:

Identify and describe eight principles of human development

Compare and contrast the major theories of human development

Assess physiological growth and developmental milestones of different developmental stages

Discuss health promotion and maintenance activities for different developmental stages

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Outline of the lecture

Principles and themes of growth and development Theories of human development Growth and development of

– Newborn– Infant– Toddler– Preschooler– School-Aged Child– Adolecent

Stages of growth and development

• First 28 days or 4 weeks of lifeNewborn

• Between 1 month and 1 year of ageInfant

• 12-36 months of ageToddler

• Ages 3 to 6 yearsPreschooler

• Ages 6 to 12 yearsSchool-Age Child

• Ages 12 to 19 years, or laterAdolescent

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Theoretical Approaches to the Growth and Development of Children

(Potts & Mandleco)

Growth, Maturation and Development

• Physiological increase in size through cell multiplication and differentiationGrowth

• Changes due to genetic inheritance• These changes allow children to function at

increasingly higher and more sophisticated level as they get older

Maturation

• The predictable physiological, psychosocial and cognitive changes occurring over one’s lifespan

Development

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Principles of Growth and DevelopmentDevelopment is orderly and sequential

Development is directional: Cephalocaudal & Proximodistal

Development is unique for each child

Development is interrelated

Development becomes increasingly differentiated

Development becomes increasingly integrated and complex

Children are competent

New skills predominate

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Principles of Growth and DevelopmentStages, Age Ranges, and Characteristics of Human Development Related to Pediatric Nursing

STAGE AGE CHARACTERISTICS

Infant Birth to 1 year • Period of rapid growth and change• Attachments to family members/ caregivers, trust develops

Toddler 1 to 3 years • Motor ability coordination, sensory skills developing• Basic feelings, emotions, a sense of self• Being independent become important

Preschooler 3 to 6 years • Continued physiological, psychological and cognitive growth• Better able to care for themselves• Interested in playing with other children

School Age 6 to 12 years • Interested in achievement• Ability to read, write, and complete academic work advances• Understanding of the world broadens

Adolescent 12 to 19 years, or later

• Transition period between childhood and adulthood• Physiological maturation occurs• Formal operational thought begins• Preparation for becoming an adult takes place

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Themes of Human Development

Nature Vs Nuture

Continuity Vs Discontinuity

Passivity Vs Activity

Critical Vs Sensitive Period

Universality Vs Context Specificity

Assumptions about Human Nature – original sin/ innate purity/ tabula rasa

Behavioral Consistency

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Theories of Human Development

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Growth and Development of the Newborn

(Potts & Mandleco)

Extrauterine Transition-Fetal Circulation-

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Extrauterine Transition- Transition to Extrauterine Life

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Physiological DevelopmentNewborn

General appearance– Head: ¼ of the total body size– Extremities may appear short

• Should be able to touch the upper thighs when extended

– Molding– Caput succedaneum

• The swelling of the soft tissues of the scalp • Usually resolves within a few days• Cephalohematoma?

– Puffy eyelids– Acrocyanosis

• Bluish discoloration of the hands and feet

– Fontanels 1-13

Physiological DevelopmentNewborn (continued)

Molding. (A) Movement of Cranial Bones During Labor. (B) Cranial bones return to their proper placement in 2 to 3 days.

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Physiological DevelopmentNewborn (continued)

(A)Caput Succedaneum (B) Cephalhematoma

• Blood between skull bone and the periosteum

• Because of the rupture of blood vessels secondary to the head trauma from the birth process

• A cephalohematoma develops 24-48 hours after birth

• It will not cross suture lines• It may take 2 to 3 weeks to resolve• Providing reassurance to caregivers• Explain it will change over the next

several weeks to take on the appearance of a “normal” baby 1-15

Physiological DevelopmentNewborn (continued)

Placement of sutures and fontanels.

Fontanels• “soft spot”• At the junctions of suture lines of

the skull bones• Allowing adaptation to the pelvis

shape during delivery and growth of brain over the coming year

• Posterior fontanel – closes by 3 months of age

• Anterior fontanel – 8 to 18 months of age

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Physiological DevelopmentNewborn (continued)

This newborn has acrocyanosis and also demonstrates flexion of the arms and legs.

Acrocyanosis• Bluish

discolouration of the hands and feet

• Caused by the instability of the peripheral circulation system

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Physiological DevelopmentNewborn (continued)

Initial assessmento Apgar scoring system

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Apgar scoring system• Assess the newborn’s immediate adjustment to extrauterine life• Evaluation of 5 categories are made 1 and 5 minutes after birth

and are repeated every 5 minutes until the infant’s condition stabilizes• 0-3 represent severe distress

• Scores of 4-6 signify moderate difficulty

• Scores of 7-10 indicate absence of difficulty in adjusting to extrauterine

life (Hockenberry & Wilson, 2013)

• The Apgar score is affected by the degree of physiologic immaturity, infection, congenital malformations, maternal sedation or anlgesia, and neuromuscular disorders

• It is not a tool, but to interpret past events, determine need for newborn resuscitation, or predict future events linked to the infant’s eventual neurologic or physical status

• Considerable controversy of its misuse as an indicator for the presence or absence of perinatal asphyxia. 1-19

Physiological DevelopmentNewborn (continued)

Neurological system

oBallard Assessment Scale for Gestational AgeoNeonatal Reflexes

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Ballard Assessment Scale• Initial neurological

examination• In determining the

gestational age of newborn assists in developing appropriate care and may influence the newborn’s optimal neurological development and functioning

• Should be complete within the first 12 hours of life

• Refer to slides of high risk newborn

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Neonatal Primitive Reflexes

Reflex Stimuli Response

Babinski Lateral aspect of the sole is stroked from el upward and across the ball of foot

• Hypertension of the toes

Palmar grasp Palms of hand are touched near base of digits • Flexion of hands • Object is grasped

Plantar grasp Place the finger at the base of the newborn’s toes • Toes will curl downward

Dance or step Newborn is held upright, one foot is allowed to touch a flat surface

• Alternate stepping movements

Moro Sudden changes in position • Arms extend, head moves back• Fingers spread apart with thumb and forefinger

forming a ‘c’• Arms being bought back to center with hands

clenched• Spine and lower extremities extended

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Other Neonatal ReflexesReflex(Disappears) Stimuli Response

Tonic neck(3-4 months)

Head turn to one side when supine

• Arm and leg extended on the side head is turned toward• Arm and leg flexed on opposite side

Survival reflexes: rooting, sucking, blinking or corneal, pupillary, sneeze and gag reflexes

Rooting(app. 4 months)

Stroke or touch cheek • Head turn towards stimuli

Sucking(7 months)

Object touching lips or placed in mouth

• Sucking

Physiological DevelopmentNewborn (continued)

Intrauterine growth curves• Classify infants according to birth weight and gestational age

LGA: Large for gestational age– Falls above the 90th percentile

AGA: Average for gestational age– Falls between 10th and 90th percentile

SGA: Small for gestational age– Falls below 10th percentile

• It provides a more satisfactory method for:• predicting mortality risks• providing guidelines for management of the neonate than estimating gestational

age or birth weight alone• The lower the birth weight and gestational age, the higher the morbidity and

mortality1-23

Physiological DevelopmentNewborn (continued)

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Cardiorespiratory systemo Respiratory

• Rate: 30–60 breaths per minute• Abdominal, shallow, irregular

o Heart• Rate: 180 beats per minute up to 4 hours after birth• Rate: 100–150 beats per minute after 4 hours

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Gastrointestinal systemo Stomach capacity

Approximately 60 mL

o Emptying time 21/2 to 3 hours, increase to 3 to 6 hours during infancy

o Gastroesophageal reflux Diminished lower esophageal sphincter function Inappropriate relaxation in conjunction with the delayed gastric emptying

Physiological DevelopmentNewborn (continued))

Gastrointestinal systemoImmature liver

Reduce bile salt secretion, less capable of absorbing fat

Jaundice: ↑unconjugated bilirubin• Transcutaneous bilirubinT• Total serum bilirubin• Kernicterus – chronic and permanent sequelae of

bilirubin toxicity• Phototherapy care

o Stools Meconium – first bowel movement, black and

tarry Breastfed – yellow to golden, pastry, sour-milk

odor Formula-fed- pale to light yellow, firmer, strong

odor

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Genitourinary system

o Kidneys•15mL/kg/day, 2-6 voiding per day

o Male genitalia•Prior 36 weeks, the testes remain in inguinal canal•Term newborn- pendulous scrotum•Hydrocele•Circumcision

o Female genitalia•Prior 36 weeks, clitoris is prominent with labia majora small and widely separated

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Musculoskeletal systemo Head lag

• The newborn cannot support the full weight of head

Integumentary systemo Mongolian spot

• An irregularly dark pigmented area on the posterior lumbar region

Psychosexual DevelopmentNewborn (continued)

Cognitive developmento Habituation: Ability to decrease responses to

disturbing stimuli Psychosocial developmento Erikson: Trust versus mistrusto Newborns are often given to their mothers to

hold soon after birth so attachment can begin early

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Health Promotion and Maintenance Newborn

Vitamin Ko Prevent hemorrhagic diseaseo Term newborn: 1 mg IMo Preterm newborn: 0.5 mg IM

Immunizations Hearing screening

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Immunizations Programme in Hong Kong1-30

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Automated Oto- Acoustic Emission (AOAE) Screening Recordhttp://www.hkjpaed.org/pdf/2008;13;275-278.pdfhttp://www.fhs.gov.hk/english/health_info/child/15655.pdf• launched in MCHCs in 2003 to

replace the Distraction Test (DT) which has been in place since 1978

• However, since the implementation of the universal newborn screening in all public hospitals in February 2007, the MCHCs perform only about 30% of all infant hearing screening

• In a quiet room, a small soft-tipped earpiece cover baby’s ears and ear will be tested one by one for the respond to the sound with an automated machine for the echo produced by the cochlea

• Will not cause harm or pain

Anticipatory GuidanceNewborn Nutrition

Nutrition Breast milk Vs Formula milk (see next slide) Water comprises up to 75% of a term

newborn’s weight Daily requirement of water: 80-150mL/kg/day Daily requirement of caloric intake: 100-

115kcal/kg/day

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Anticipatory GuidanceNewborn Nutrition

(continued)

Newborn Feeding (Gregory, 2005; Newburg, 2005)

• The most ideal form of nutrition of the newborn is breastfeeding• Nutritional advantages• Multiple potential protective mechanisms

Reduction of sudden infant death syndromeReduction in childhood obesity, Crohn’s disease, otitis media and

asthma• A successful start with breastfeeding may be the determining factor as

to whether the mother continues to breastfeed

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Family teaching - breastfeeding

• Breasts may be firm but feel softer after nursing• Nurse at least 10-15 minutes on each side• To prevent nipple tenderness, hold infant correctly• Release the suction before the newborn is removed from the breast by placing a finger in the side of

the mouth and between the jaws• After nursing, express a little breast milk, massage into the nipple and areola, and allow to air dry• Do not use soap or alcohol on breasts or nipples. Clean with water during showering or bathing• Baby’s urine should be light yellow with soft yellow stools• Burp baby between breasts and at the end of feeding

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Family teaching- bottle feeding

• Formula should be iron- fortified• All the newborn’s nutrition needs are met by formula. Cereal juice or other baby foods are not

necessary• Three forms: ready to feed, concentrated liquid and powdered• Be sure formular is diluted correctly• If the newborn drinks part of bottle, it can be left at room temperature, but it must be used within 1

hour• Do not heat bottles in a microwave. This lead to uneven heating and can cause severe burns to the

newborn’s mouth and throat• Most babies are satified in about 20 minutes. Feeding should not last longer than 30 minutes• Burp after half of the feeding and again at the end of the feeding• Never prop the bottle or leave the newborn unattended• Avoid “nursing bottle syndrome”

∙ Dental carie ∙ Otitis media

Newborn is more vulnerable to underheating and overheating– Large body surface area– Poor thermal insulation– Limited shivering response– Increased metabolic rate

Heat exchange– Convection – taking a bath– Conduction – infant’s body touching the cold scale– Radiation – next to cold window– Evaporation – not dry thoroughly after bathing

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Brown fat– The primary form of heat production – brown adipose tissue metabolism– Subscapular, axillary. Adrenal and mediastinal regions– Brown fat cells differ from other adipose tissue because of

• fat vacuoles• numbers of mitochondria• glycogen stores• Enhance responsiveness to the thermal stimuli

Anticipatory Guidance - Thermoregulation

Family teaching- keeping the newborn warm

• Explain how the newborn loses heatConvection, conduction, radiation and evaporation

• Provide information on how to reduce heat exchangeReduce the area exposed during a bathLimit exposure to drafts created by doors, ventilation systems and

traffic flow around the newborn’s bedWarm solid surfaces between the newborn by placing a blanket on

the scalePlace the newborn’s crib on an inside wall in the room, away from

the windowBlock sunlight on the newborn in the car to prevent overheatingCheck the water temperature for bathing before the newborn is

placed in the tub to avoid burn

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The newborn will sleep between 16 and 19 hours a day Sleep cycle averaging 45-50 minutes Two sleep states: light and deep Light sleep: rapid eye movements occur during 10-second intervals Please read Poster - Sudden infant death syndrome (SIDS)

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Family teaching- sleeping

• Do not position newborn prone• Position newborn supine• Avoid soft bedding or pillows, comforters, sheepskin or water

beds• Explain that over swaddling or increased room temperature, in

combination with the prone position, may increase the likelihood of SIDS (Sudden Infant Death Syndrome).

Anticipatory Guidance - Sleep

The High-Risk Newborn Large for gestational age (LGA)

– Maternal factors: • A high maternal weight gain• Multiparity• History of large infant• Maternal disease – diabetes

– Infant:• Genetic predisposition• Genetic abberations – Beckwith

Wiedemann Syndrome– Increase potential for neonatal morbidity –

birth trauma• Caput succedaneum or

cephalohematoma• Bruising or laceration secondary to a

forceps delivery• Broken clavicle

– Hypoglycemia – transient hyperinsulinemia in response to maternal hyperglycemia

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Small for gestational age (SGA)– Low Birth Weight (LBW) – 2500 to 1501g– Very Low Birth Weight (VLBW) – less

than 1500 grams– Extremely Low Birth Weight (ELBW) –

Less than 1000 grams– Maternal:

• Low socioeconomic status• Hypertension, cardiac or renal disease• Cigarette smoking• Placental insufficiencies• Uterine anomalies

– Fetal:• Intrauterine growth restriction• Congenital malformation• Congenital infection• Inborn errors of metabolism

The High-Risk Newborn (continued)

The Preterm Infant

• Is born earlier than 37 weeks gestation• Classified by weight as well as

gestational age: Low Birth Weight (LBW) Very Low Birth Weight (VLBW) Extremely Low Birth Weight

(ELBW) Extremely preterm infant <27

weeks’ gestation Very preterm infant <32 weeks Moderately preterm infant <32-36

weeks’ gestation

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Premature infant and associated problems.

Summary of Newborn Physical AssessmentArea Assessed Normal Findings

Head • Anterior fontanel diamond- shaped, soft and flat• Posterior fontanel triangle- shaped• Head circumference 33-35 cm

Face and Eyes • Symmetrical facial features and movement• Eyes symmetical

Thorax • Symmetrical movement• Circumference equal to or less than head circumference• Nipples symmetrical• Breath sounds clear and equal bilaterally• Heart with regular rate and rhythm, S2 split

Adbomen • Soft, nondistended• Umbilical cord with two arteries and one vein• Bowel sounds present

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Genitalia • Male• Meatal opening in the centre of glans• Strong, arching urinary stream• Penile erect when voiding or with stimulation• Scrotum with rugae and pink or dark brown in color• Both testes descended

• Female• White or pink vaginal discharge• Edematous clitoris and labia majora• Increased pigmentation

Anus and Rectum • Patent anus • Meconium passage by 24 hours

Extremities • Flexion position• Symmetrical and equal movement• Full range of motion• Hands reach upper thighs when upper extremities are extended

Spine • Straight• Moves head from side to side when prone• Can lift head when prone

Growth and Development of the InfantL1

Home StudyStudent please refer to both NOTES & BOOKS for reference!

Physiological DevelopmentInfant

Weight and height– Weight: first 6 month, gain 1.5lb per month

• Tripled birth weight by 12 months of age

– Height: first 6 month, increases 1 inch per month• 50% increase in height from the birth length by 12 months of age

Head growth– By the age of 12 months, the infant’s brain will be 2/3 the size of an

adults

Chest growth– At birth, 1 inch less than head circumference– By 1 to 2 years of age, head circumference = chest circumference– Lower edge of scapulas and brought around over the nipple line

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Physiological DevelopmentMotor Development of Infant

Motor development– Disappearance of primitive reflexes– Able to willing grasp an object instead of the

involuntary grasp reflex• Pronation before supination• The ability to grasp precedes the ability to release

– Gross motor: Ability to use large muscle groups to maintain balance

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Physiological DevelopmentMotor Development of Infant

(continued) Motor development - Gross motor

– for postural control• Head control when standing and sitting, no head lag when 4-6

months– for locomotion (the ability to move from place to place without

assistance)• 6 months can be held in standing position with bearing weight

on legs• 8 months can bear weight• 8 to 10 months:

– First crawling (pulling self forward with abdomen touching the floor)

– Then creeping (moving on hands and knees with abdomen off the floor)

• 10 to 12 months– Deliberate steps while holding on something (cruising)– Attempts to walk alone 1-44

Physiological DevelopmentMotor Development of Infant (continued)

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Fine Motor Skill: Ability to coordinate hand-to-eye movement in an orderly and progressive manner

Age in Month Examples of Fine Motor Skills

2-3 months Holds hands openRegards own hands and fingersPlace hands in mouth

4-5 months Place object in mouthUse hold hand to grasp object

6-7 months Holds and bangs objects togetherActively drops objectsTransfers object between hands

8-9 months Pincer grasp beginningReleases object at willDominant hand preference emerging

10-12 months True pincer graspSelf- feed finger foodPlace small object in a containerHold and mark with a crayonTurn multiple pages in a book

Psychosexual DevelopmentInfant

Freudo Infant in oral stageo Oral stimulation or sucking o Feeding or nutritive sucking becomes the

most important source of pleasure and satisfaction

o Non-nutritive sucking, such as toys, fingers, or a pacifier in the mouth

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Psychosocial DevelopmentInfant

Erikson - Trust versus mistrust– Basic needs of feeding, clothing and comforting are met– The quality of the caregiver- infant interaction– Nurturing behaviors such as talking, playing, smiling dressing and

comforting– Alternative child care situation (child care setting, baby sitters, child

care workers), it is critical to ensure the trust development also can be developed:

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Inform the child care provider about: Inquire the child care provider about:• Usual home routines• Sleep patterns• Eating habits• Cues given when frustrated• Response to comforting methods• Favorite toys, games, songs and music

• The child care provider’s experience• How the child care provider comforts a

fussy infant• Whether there are other children in

their care• The number of children in their care

Cognitive Development - Infant Piaget’s sensorimotor stage has four substages

1.Reflexes– First to 1 month– Rooting, sucking or crying– Cause-and effect expeirence

2. Primary circular reactions– 1 to 4 months– voluntary actions– An active observer of the world– Hand-eye coordination – look and grasp the object– Object permanence has not yet developed

3. Secondary circular reactions– 4 to 8 months– Actions are more intentional, repetitive actions and the effect– Beginning of object permanence– Search for an object out of the visual field– Stranger anxiety

4. Coordination of secondary schema– Able to put several events to accomplish an end result– Putting the matching shape in a box– Understand simple words and commands (no-no, bye-bye, cracker)– Object permanence is apparent

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Temperament CharacteristicsInfant

Characteristics Description

Activity Amount of motor activity and proportion of active to inactive periods

Intensity Amount of emotional energy released with responses

Sensitivity Amount of sensory stimuli required to produce response

Approach/ withdrawal Nature of initial response to new stimuli

Adaptability Ease of accepting new situation after initial response

Frustration tolerance Length of time activity is pursued

Mood Amount of pleasant versus unpleasant behavior child exhibits

Distractibility Effectiveness of extraneous stimuli in altering direction of ongoing behavior

Regularity Predictability of physiological functions such as hunger, sleep and elimination 1-49

Health Promotion - Infant feedingKey points related to feeding behaviors

4-6 months Readiness for solids

6-8 months Sits alone with steady head during feeding

8-10 months Readiness for finger foods• Avoid nuts, popcorn, whole kernel corn, chunks of meat, sticky, stringy and

chewy food, small hard and round candyGrasp spoon but cannot use it effectively

10-12 months Increasing determination to feed selfNeat pincer graspHolds cup but frequently spills

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**Being safe with pacifier**

• Look for one-piece construction• The mouth guard should be wider than the infant’s mouth• Ventilation holes should be present on mouth guard• Keep the pacifier clean• Never put a pacifier on a string• Do not leave a pacifier in a sleeping infant’s mouth• Mothers should not use their mouths to clean the pacifier

Health Promotion - Infant (continued) Communication

– 2 months- social smile– Receptive language

• The ability to understand words– Expressive language

• By the end of first year– the infant can say several words ‘dada’ ‘mama’– Understand simple command ‘where is your nose?’

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Colic– Recurrent episodes of unexplained crying and inability to be consoled– ‘Rule of 3’ (Cohen- Silver & Ratnapalan, 2009)

• Crying at the first 3 months of lift• Lasts longer than 3 hours per day• Occur more than 3 days in any 1 week• Continues for at least three weeks

Colic management– The way of holding infant as shown in the pictures– Feed the infant slowly, burp frequently– When breastfeeding, avoid gas formation food e.g. cabbage– Swaddle the baby to decrease self-stimulation by jerky or sudden movements– Take the infant for a car ride– Use a swing for at least 20 minutes

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– Walk or rock the infant while applying gentle pressure to the infant’s abdomen– Gently message the back of the infant while lying down– Supply background or ‘white noise’ Ihair dryer, vaccum cleaner, fan) or play

mothers’ heartbeat or some soft music– Place the infant in a quiet darkened room to reduce environmental stimulation– Let the infant cry it out in the crib when other measures do not work.

Sometimes only fatigue will make the infant fall asleep– Place warm towel or washcloth on infant’s adbomen– Do not shake the infant if frustrated with the crying and irritability

Growth and Development of the Toddler and Preschooler - L1

Home StudyStudent please refer to both NOTES & BOOKS for reference!

MSLCB Developmental Milestones(Duderstadt,K. G. 2006, ch. 3)

M: Gross and fine motor skill

S: Social skill

L: Receptive and expressive language

C: Cognitive achievements

B: Book use

18 Months

M Walks ups steps, walk backward; uses spoon, cup;scribbles

L Uses three to six words, not echolalia (repetition of another person’s words)Indicate desired objects with index fingerFollow simple directionsPoints to at least one body part

C Works wind-up toys, on-off buttons (Cause/effect)

B Points to pictures in book; may name objects

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2 Years

M Goes up/ down stairs one step at a timeKicks ballStacks five or six blocksMakes circular stroke with crayon

S Interested in other children, but much play is parallel

L Says two-word phrases, says at least 20 words, can follow two-step command

C Exhibits imitative play

B May carry book around house, ‘read’ to dolls

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3 Years

M Broad jumps, rides tricycle

S Dresses self mostly, with supervision; achieve toilet training

L 3-4 words sentences; know preposition; Speech at least 50% intelligible, know name, age and gender

C Early imaginative behavior

B Child wants same story repeatedly; Explains story when asked ‘what’ questions

4 Years

M Balances on 1 foot for 4-5 seconds, rides bike with training wheels , throws overhand; dresses with little help

S Understand taking turns; uses words; not hitting; establish friendships

L Speech entirely intelligible, mostly correct grammar, asks questions

C Draws a person with 3 or more parts, knows at least 2-3 colors

B Turns pages one at a time, retells familiar story, pretends to read and write

5 Years

M Balances on 1 foot for 5-10 seconds, dresses self; may be able to skipCopies square, triangle; draws six-part person

S Play well with group of children; vulnerable in social relationships

L Has fluent use of language with correct use of me, I, past tense, plurals

C Can answer correctly: ‘If I cut an apple in half, hoe many pieces will I have?’,‘What do you do to make water boil?’

B Explains ‘What will happen next?’ in stories; Retain interest in 10- to20- minute-long stories

Toddler - Negativism Negativism is an expression of the toddler’s constant search for

autonomy Toddler seems to delight in doing the opposite of what is asked and

responding “no” to all requests Caregivers are frequently frustrated Typically passes by about 30 months of age

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How to handle “No!”– Reduce the opportunity to say “no.” – Do not give the child an option if one doesn’t really exist– Avoid complex requests or over stimulating situation when the toddler is tired or

hungry– Do not draw attention to the negative behaviors– Do not threaten the child, especially as a reaction of frustration or anger– State disciplinary guidelines briefly, in simple terms– Be sure the child understand the consequence– The toddler may not remmber both terms and the consequence with a lengthy

explanation

Growth and Development of the School-Age Child

L1Home Study

Student please refer to FACTSHEET, NOTES & BOOKS for reference!

Physiological DevelopmentSchool-aged Child

Musculoskeletalo Weight and height increases

o Boys: 45 pounds and 46 inches tall

o Girls: 43 pounds and 45 inches tall

o Basic gross motor skills

Cardiorespiratoryo Increased efficiencyo Decrease in pulse rate: 90-95 bpmo Decrease in heart rate

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Immune systemo Antibodies are produced by the

lymphatic system and reach their peak by age 7 years

Sexual developmento The last year of the school-age

period are called prepubescence (two years before puberty)

o The physiological signs of prepubescence appear between

o Female: 8 to 13 years of age (breast tissue development)

o Male: 10 to 14 years of age

Psychosexual DevelopmentSchool-aged Child

Freud: Latency– Calm period in the development of sexuality– Learn about sex-role behavior

Sexual developmento Pubertyo MenarcheoFemale have the first period

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Psychosocial DevelopmentSchool-aged Child

Peers Erikson: Industry versus inferiority Self-concept and self-esteem

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Cognitive DevelopmentSchool-aged Child

Piaget: Concrete operations– From egocentric to more open and flexible thought– Imagine the world without having to experience it – Abstract thought not yet developed

• Classification – group items a/c to common characteristics

• Conservation – acknowledge that a change in shape does not mean a change in amount

• Reversibility– Recognize action can move in reverse order– Toys resembling

Language and reading– Knows grammatical rules– Vocabulary 10000 words and exceeds 40000 words at the end of school-age

year– Use of metaphors by 11 years of age– A tool for socialization– Encourage reading

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Moral DevelopmentSchool-aged Child

Kohlberg stage: Conventional level– “be good”– Ages 6-10, avoid disapproval of others, maintain

positive relationship– Age 11 and 12 years, doing the “right” thing– Showing respect to the authority figures– Rigid behaviors in an effort to obey the laws– Understand the need to treat others as they would like

to be treated1-62

Health Promotion - School-aged (continued) Dental health

o Care of teetho Malocclusiono Braces

Safety and injury preventiono Contributing factors

o Unintentional injurieso Physical challenging activitieso Motor vehicle accidents

o Safety rules for school-age children

Health screening School

o Physical developmento Intellectual developmento Social development

Homework1-63

Playo Physical capabilitieso Concept of cooperationo “ Hey Mom, can I join Facebook?”

Stress: Signs and symptomso Frequent fatigueo Irritabilityo Change in sleep or eating patternso Complaints of headache or

stomachacheo Substance abuseo Drop in academic performance

Latchkey children (not applicable in Hong Kong)

o Home alone without adult supervisiono Tips for latchkey children

- Do not open the door to anyone you do not know

- Do not tell a telephone caller you are home without a caregiver

- Make a list of emergency phone numbers

- Create an after-school routine such as homework,

household chores or caring of pets

- No access allowed to adult cable TV or internet sites

Honesty– Role model– Be understanding– Discuss the consequence– Reinforce the benefits of being honest

Limit setting and discipline Sexuality

– Provide education- appropriate anatomical terms– Honest and open discussion

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Growth and Development of the AdolescentL1

Home StudyStudent please refer to FACTSHEET, NOTES & BOOKS for reference!

Adolescence The time of life that begins with puberty and ends

when the individual is physically and psychologically mature and able to assume adult responsibilities

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Ten Developmental Tasks for Adolescents Adjust to sexually maturing bodies and feeling Develop and apply a more abstract thinking skills Develop and apply a more complex level of perspective taking Develop and apply new coping skills in areas such as decision making, problem solving

and conflict resolution Identify meaningful moral standard, value and belief systems Understand and express more complex emotional experiences Form friendships that are mutually closed and supportive Establish key aspects of identity Meet the demands of increasing mature roles and responsibilities Renegotiate relationships with adults in parenting roles

Physiological Development - Adolescent Puberty

o State of physical development when secondary sex characteristics begin to appear, sexual organs mature, reproduction first becomes possible, and the adolescent growth spurt starts

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Musculoskeletal systemo Adolescent growth spurto Female peak height velocity (PHV): 11 years old or 6–12 months before

menarcheo Male peak height velocity: About 13 years oldo Weight increases follow the same growth curve as height

Genitourinary systemo Follicle-stimulating hormone (FSH)o Luteinizing hormone (LH)o Tanner stages

• Females: Describes breast and pubic hair development

• Males: Describes testes, penis, scrotum, and pubic hair development

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Hormonal interaction between hypothalamus, pituitary, and gonads. GnRH, Gonadotropin-releasing hormone; FSH, follicle-stimulating hormone; LH, luteinizing

hormone.

Physiological DevelopmentAdolescent (continued)

Approximate timing of developmental changes in girls 1-69

Physiological DevelopmentAdolescent (continued)

Development of breasts in girls. Average age span is 6 to 13 years. Stage 1 (prepubertal—elevation of papilla only) is not shown.

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Physiological DevelopmentAdolescent (continued)

Growth in pubic hair in girls. Average age span for stages 2 through 5 is 11 to 14 years1-71

Physiological DevelopmentAdolescent (continued)

Approximate timing of developmental changes in boys1-72

Physiological DevelopmentAdolescent (continued)

Developmental stages of secondary sexual characteristics and genital development in boys. Average age span is 12 to 16 years.

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Physiological Development - Adolescent (continued)

Linear growth in centimeters per year

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Adolescent issues/concerns in Hong Kong Stress coping from school achievement and interpersonal relationship Increasing suicidal rate Eating disorder Peer group and juvenile crime Immigrants from mainland China Substance use and misuse Increasing morbidity rate Any other problems?

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Student Health The DH provides health checks and individual counselling 12 student health service centres and three special assessment centres. A total of 403 592 primary one to secondary one students used the services in the

2009-10 school year. School health inspectors pay visits to schools to check on their hygiene standards Health officers and nurses provide advice on preventing communicable diseases. School Immunisation Teams under the auspices of the department’s Centre of Health

Protection make annual visits to primary schools to administer vaccinations.

Adolescent issues/concerns in Hong Kong

Student Health The DH provides health checks and individual counselling 12 student health service centres and three special assessment centres. A total of 403 592 primary one to secondary one students used the

services in the 2009-10 school year. School health inspectors pay visits to schools to check on their hygiene

standards Health officers and nurses provide advice on preventing communicable

diseases. School Immunisation Teams under the auspices of the department’s

Centre of Health Protection make annual visits to primary schools to administer vaccinations.

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Exploring Psychosocial Functioning of Adolescents

L1Home Study

Student please refer to FACTSHEET, NOTES & BOOKS for reference!

“HEADSS” Approach

“HEADSS” (Cohen, 1988) is a valuable screening for exploring psychosocial functioning with adolescents– H- Home– E- Education/ employment– A- Activities– D- Drugs– S- Sexuality– S- Suicide/ depression screen

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“HEADSS” Approach

Many young people at your age are starting to experiment with

Example of HEADSS screening questions

H- Home• Where do you live and who lives with you?• How do you get along with each member?• Who could you go to if you needed help with a problem?

E- Education/employment• What do you like about school (or work)?• What are you good and not good at?• How do you get along with teachers and other students (or work

colleagues)?A- Activities

• What sort of things do you do in your spare time out of school?• Do you belong to any club, groups, etc?• What sort of things do you like to do with friends?

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“HEADSS” Approach

Many young people at your age are starting to experiment withExample of HEADSS screening questions

D- Drugs cigarettes or alcohol• Have you tried these or other drugs like opiates,ecstasy, and injecting

drugs?• How much are you taking and how often?

S- Sexuality• Some young people are getting involved in sexual

relationships. Have you had a sexual experience with a guy or girl or both?

S- Suicide/depression screen• What sort of things do you do if you are feeling sad /angry / hurt ?• Some people who feel really down often feel like hurting themselves or

even killing themselves. Have you ever felt this way?• Have you ever tried to hurt yourself? 1-80