child

• Childhood


  Period of remarkable physical, cognitive, and social growth - the greatest in a person's lifetime
• Within a few short years, children's size increases 20-fold. They acquire sophisticated language and reasoning. They develop complex social interactions, and progress toward mature adulthood.
• Growth


  Increase in physical size, measurable
• Development


  Behavioral aspect of growth; the capacity and skill of the person to adapt to the environment
• Four principles of child development

  • Child development proceeds along predictable pathway
  • The range of normal development is wide
  • Various physical, social, and environmental factors as well as diseases can affect child development and health
  • The child's developmental level affects how you conduct the history and physical examination
• There are specific milestones for every child's age-group.
• Although children belong to the same age, they mature at different rates, but normally it should still fall within a broad developmental range.
• Factors like poverty, illnesses, child abuse can affect a child's growth and development.
• Before physical examination attempt to ascertain the child's approximate developmental level and adapt your PE to that level.
• Health promotion


  Includes the detection and prevention of disease as well as active promotion of the well-being of children and their families
• Parents are the major agents of health promotion for children, and our advice as nurses should be coursed through them.
• Children must get important "shots" to prevent them from being sick with deadly but preventable diseases.
• Screening procedures


  • Growth and Development
  • Blood Pressure
  • BMI-Body Mass Index screening
  • Vision and Hearing Screening
  • Behavior and mental health screening
• Key components of pediatric health promotion

  • Age-appropriate developmental achievement of the child
  • Health supervision visits
  • Integration of physical examination findings with healthy lifestyle recommendations
  • Immunizations
  • Screening procedures
  • Anticipatory guidance
• Infancy


  Period from birth through the completion of the 12th month of life
• A child doubles the birth weight by 5 months and triples it by 12 months of age. Length increases by 50 % by the end of the first year of life.
• Approach the infant gradually using a toy or object for distraction. Perform as much of the examination as possible with the infant in the parent's lap.
• Physical development facts in infancy

  • Physical growth is faster than at any other age
  • By 1 year: Birth weight triples, Height increases by 50%
  • 3 months: lift head, clasp the hands
  • 6 months: rolls over, reach for objects, turn to voices, sits with support
  • 1 year: stands, puts everything in the mouth
• Cognitive and language development in infancy

  • Cause and effect (shaking a rattle produces sound)
  • Object permanence; Use of tools
  • 2 months: cooing
  • 6 months: babbling
  • 9 months: recognizes stranger, seek comfort from parents during exams, actively manipulate reachable objects
  • 1 year old: 1-3 words
• Social tasks in infancy: bonding, attachment and trust to caregivers. Variation in temperaments: others respond positively or negatively to new stimuli.
• Early childhood (1 to 4 years)


  After infancy, the rate of physical growth slows approximately by half. After 2 years, toddlers gain about 2 to 3 kg (4.5 to 6.5 lb) and grows 5 cm (2 in) per year. Physical changes are impressive. Chubby, clumsy toddlers transform into leaner, more muscular preschoolers.
• Examine a child sitting on parent's lap. Try to be at the child's level. Let the child do some of the examination (e.g. move the stethoscope). Then go back and "get the places we missed."
• Developmental milestones during early childhood

  • Walks (2 yr)
  • 2-3 words (1 yr)
  • Throws (2-3 yr)
  • 2-3 word phrases (3 yr)
  • Jumps in place, Balances on 1 foot (3 yr)
  • Feeds self (3 yr)
  • Sentences, Speech all understandable (4 yr)
  • Hops, Pedals tricycle (4 yr)
  • Copies figures, Defines words (5 yr)
  • Skips, Balances well (5 yr)
• Middle childhood (5 to 10 years)


  An active period of growth and development. Goal directed exploration, increased physical and cognitive abilities, and achievements by trial and error mark this stage.
• Include the child in the conversations, using age-appropriate language and examples. Discuss the child's experience and perception of her major environment beyond the family.
• Developmental tasks during middle childhood

  • Enhanced strength and coordination, Competence in various tasks and activities
  • "Concrete operational", Focus on the present
  • Achievement of knowledge and skills, self-efficacy
  • Achieving good "fit" with family, friends, school
  • Sustained self-esteem
  • Evolving self-identity
• Adolescence


  Developmental stage between childhood and adulthood. The age at which adolescence begins and ends is imprecise, partly because society is unclear about the roles of people in this stage (no longer children, not yet adults)
• Stages of adolescence


  • Early adolescence (10-14 years old)
  • Middle adolescence (15-16 years old)
  • Late adolescence (17-20 years old)
• The key to successfully examining adolescents is a comfortable, confidential environment. Adolescents usually respond positively to anyone demonstrating a genuine interest in them.
• Confidentiality, privacy, protection of modesty are important when examining adolescents.
• Physical development facts in adolescence

  • Growth & changes (breast, body hair, voice, etc)
  • Body composition (body fat, bigger body, chest/ buttock widen, slimmer waist, etc.)
  • Respiratory system
  • Development of sexual functioning maturity, reproductive organ & functioning
  • Growth Spurt
• Cognitive development facts in adolescence

  • Progress from concrete to formal operational thinking
  • Acquires ability to reason logically and abstractly
  • Considers future implications of current actions
• Social and emotional development facts in adolescence

  • Marked by the transition from family-dominated influences to autonomy then peer influence
  • Struggle for identity, independence leads to stress, health-related problems, and high-risk behaviors
• When assessing Health History of Adolescents you should explain to both parents and adolescents that the best health care allows adolescents some degree of independence and confidentiality.
• Before the parent leaves, obtain relevant clinical history from him or her, such as certain elements of past history, and clarify the parent's agenda for the visit.
• The sequence and content of the physical examination of the adolescent are similar to those in the adult.