peds final

• Nursing in Pediatrics


  Focus is on infants, children, adolescents and their families
• Pediatric and family theories

  Growth and development is key!
• Stages of Growth and Development


  • Infancy –Birth to 12 months
  • Toddlerhood – 1-2 years
  • Preschool – 3-5 years
  • School Age – 6-11/12 years
  • Adolescence – 11/13-18/20 years
• Development


  The sequential process by which infants and children gain various skills and functions
• Growth


  An increase in physical size
• Principles to Guide Practice

  • Growth is an orderly process, systematic, and specific to certain parts of the body
  • Wide individual differences exist in growth rates and they are influenced by multiple factors
• Development proceeds from


  1. The simple to the complex

  2. The general to the specific

  3. In a cephalocaudal progression

  4. In a proximodistal progression
• Experiences in childhood and adolescents affect lifelong health, and the earlier we invest in children's health, the greater return
• Understanding and caring for children is a fundamental right and a nursing obligation
• Canada is a Signatory to the United Nations Convention on the rights of Children which defines a set of fundamental Rights of Children and obligations of governments
• Rights of Children in Canada

  • Respect as full members of society
  • Affection, care and support
  • A healthy environment
  • Access to adequate nutrition, housing, and essential services
  • Access to appropriate health care services
• Assessment


  • Why is assessment important?
  • What do you need to assess?
  • How do you assess growth and development?
• Framework Used in Assessment: THEORY!!!!!
• Theoretical Tools


  • Bowlby's Attachment Theory
  • Erikson's Psychosocial Theory
  • Piaget's Theory of Cognitive Development
  • Freud's Theory Psychosexual Development
  • Kohlberg's Theory of Moral Development
• Attachment Theory


  • Attachment is a motivational-behavioral control system
  • Bowlby identified that infants need one special relationship for internal development
  • Successful early attachment to one person facilitates the child to learn to cue her behavior to the subtle social cues of many
  • This experience allows the child to develop the ability to engage in social relationships, to make friends, and, to eventually attain physical intimacy
• Attachment Theory


  A child's experience with caregivers gives a sense of worth, a belief in the helpfulness of others, and a favorable model on which to build a future relationship
• Erikson's Theory of Psychosocial Development

  • Trust vs. mistrust
  • Autonomy vs. shame
  • Initiative vs. guilt
  • Industry vs. inferiority
  • Identity vs. role confusion
• Piaget's Theory of Cognitive Development

  • Sensorimotor – 0-2 years of age
  • Preoperational – 2-7 years of age
  • Concrete thoughts – 7-11 years of age
  • Formal operational – 12-18 years of age
• Other Great Resources


  • The Centres for Disease Control and Prevention
  • Canadian Pediatric Society/Caring for Kids
• You will use theory and your skills to assess infant development
• Gross Motor: Head and Neck


  • Newborn: barely able to lift head
  • 6 months: easily lifts head, chest and upper abdomen and can bear weight on arms while on tummy
• Gross Motor: Sitting


  • 2 months old: needs assistance
  • 6 months old: can sit alone in the tripod position
  • 8 months old: can sit without support and engage in play
• Gross Motor: Crawling - Not a good developmental indicator on its own – vast differences in abilities, ages and some skip crawling all together!
• Gross Motor: Getting Around

  • 1 year: stand independently from a crawl position
  • 13 months: walk and toddle quickly
• Fine Motor


  • Newborn has very little control. Objects will be involuntarily grasped and dropped without notice
  • 6 month old: palmar grasp – uses entire hand to pick up an object
  • By 9 months: pincer grasp – can grasp small objects using thumb and forefinger
• Speech and Language


  • 1-2 months: coos
  • 2-6 months: laughs and squeals
  • 12 months: mama and dada as sounds at first and then as understandable words with meaning, and vocabulary is developing
• At birth = Universal newborn hearing screening (UNHS) for all newborns in Canada
• On assessment remember to ask about ear infections and placement of tubes
• Early referral is essential(audiologist, speech language pathologist, ENT)
• Infant Play


  Play is an infant's and child's work and is a reflection of every aspect of development
• Potential "Red Flags": Infants

  • Frequently in 'fisted position' after 6 months of age
  • Not bringing both hands to midline by 10 months of age
  • Floppy tone
  • Not smiling by 4 months of age
• Gross Motor: Toddlers (1-3 Years)


  • Begins to walk with ease
  • 15 months: able to run
  • Kicks and throws ball well, jumps
• Fine Motor: Toddlers (1-3 Years)


  • 12 months – transfers objects from hand to hand
  • 24 months – can hold crayon/markers and begins to colour, turns pages of book, builds tower of at least 6-7 blocks
  • 36 months – copies a circle and cross shapes, if asked can colour within the lines, builds towers of 9-10 blocks
• Speech and Language: Toddlers (1-3 Years)


  • 18-20 months: 20 to 30 words – 50% understood by strangers
  • 22-24 months: two word sentences, >50 words, 75% understood by strangers
  • 30-36 months: almost all speech understood by strangers
• Toddler Specifics


  • Stranger anxiety –typically subsides by age 2 ½ to 3 years
  • Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3
  • Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely
  • Thumb sucking
  • Toilet Training
• Toddler Play


  Parallel Play
• Potential "Red Flags": Toddlers

  • Not walking by 18 months of age
  • Unaware of changes in environment and routine
  • Poor or no eye contact
  • Difficulty with calming self
  • Not responding to noise, sounds, or familiar voices
  • Not engaging in pretend play
• Fine Motor and Cognitive Skills: Preschool (3-6 Years)

  • Buttoning clothing
  • Holding a crayon / pencil
  • Building with small blocks
  • Using scissors
  • Playing a board game
  • Have child draw picture of himself
• Preschool Play


  Associative Play
• Potential "Red Flags": Preschool

  • Lack of socialization and inability to play with others
  • Inability to follow simple directions and carry out self care tasks: hand washing, simple dress, toileting
  • Unable to undo large buttons, shoe laces by age 3 years