Transcript for:
Pediatric Nursing: Developmental Milestones Across Age Groups

in pediatric nursing you'll need to know how to provide care to children at different age groups because each stage of a child's development requires a different nursing approach so first let's talk about the infant when we're talking about infant developmental Milestones we're talking about children from the age of birth to one year now whenever you're studying these developmental Milestones there is specific categories that you want to know for your exams so to help us remember those categories for the infant we are going to remember the word babies because we're dealing with babies here so B is going to stand for body changes all the body changes that are going to occur in that infant that you want to know for exams and then a is for achieving Milestones specifically we're talking about motor and cognitive milestones and we're talking about the specific months when they should hit those Milestones then the other B is for Baby safety I is for interventions that you want to consider as a nurse whenever you're providing care to that infant e is for the eating plan and then s is for social stimulation play so first let's talk about body changes okay big thing you want to know about these infants is when those font nails are going to close we have an anterior font now and we have a posterior font now if you feel on a baby's head you can feel the area where these font nails are they feel squishy and soft so the anterior font nail it closes at about 18 months of age the posterior closes around two months of age so as a nurse whenever you're assessing that infant you're going to see if those fontenils have clothes also you want to know about weight and length okay what about weight well you want to know how much they should weigh as time goes on so remember this at about six months their weight should double from their birth weight at 12 months that weight should be tripled compared to their birth weight so let's do a little quiz if the baby was born and they weighed eight pounds how much should they weigh at six months well their weight should double so 8 plus 8 is 16. so about six months they should be about 16 pounds well how much should they weigh at a year 12 months well that weight should triple from that birth weight so they should weigh about 24 pounds now let's look at their length generally their length they should be growing about a half inch to an inch every month so let's say our baby when they were born they were 21 inches how much how long should they be at six months well if you apply this little rule they should be anywhere between 24 to 27 inches long then you want to look at teeth their mouth is going to start changing so usually the first teeth to pop up will be those lower Central incisors and these are found at in the bottom gum line in the middle hence why we call them the Central and they they tend to erupt in most babies around 10 months of age some some get them a little bit sooner now whenever we talk about the preschooler school age child they will actually lose these Central incisors and they tend to lose those around six to seven years old and actually my son has just lost his Central incisors next is a for achieving Milestones so we're looking at specific months when they should be hitting certain milestones and as we go through these Milestones I'm going to try to point out the ones that Tess love to ask you about so whenever you are assessing an infant every like Well Visit they come in or whenever you're providing care to them you're going to look at their age and you're going to ask yourself okay are they doing what they should be doing at this age for instance if they're two months old the baby should be doing these if they're four months old they should be doing these so those so that's why it's really important we know these developmental Milestones so at two months an infant should be doing the following they should be moving their head from side to side they should be able with their eyes to track people's faces so follow the face or an object they will be starting early language like they will be making verbal noises like those cool sounds a big thing that I personally love is they should be smiling by this age so you'll see that also they should be able to hold their head up when they're on their stomach so tummy time is very important for these little infants so they can start getting those motor skills now at four months what should they be able to do well this is when the baby actually starts to enjoy play especially with the parents now this is just very early play also they're cooing that they did over here at two months is actually going to transition into babbling and they may start copying noises that the pain that the parent makes also they will hold toys maybe like a Rattle and they will start to reach for things so that's when things start getting fun when they start to reach for stuff also they have the ability to start remembering faces and certain objects and this is another big milestone that they do over here that you want to remember this is when they start to roll over so some things whenever we're talking about safety whenever they start rolling over a parent needs to definitely be more aware of baby because instead of baby just laying there chilling now they can flip over and they can potentially fall also swaddling whenever you wrap the baby in that burrito type thing with the blanket that's when you want to stop swaddling is whenever they can start rolling over next is six months so it's six months the infant should be able to set up with support they will start to have stranger anxiety so whenever people come around them that they're not familiar with they will not like that and they will display that in their her face and they may even cry and they won't want to go to that stranger also the Babbling that they had before at four months is starting to progress where they're going to have early vowel sounds in that babbling also they'll be able to recognize and respond to their name which is always so fun whenever they start to understand what their name is and they will start to have fun looking at themselves in the mirror so that's a little bit of play that they can do around this time then at eight to nine months they can actually start to sit up without support so over here they need support but over here they don't need that support they can actually set up and hold their own also they start to crawl at this age and they may start to stand by pulling up on an object and actually holding on to the object while they're standing this is the beginning of walking which they'll start doing a little bit later on also a big thing that you want to remember in this age category is that they start to use the pincer grass now what is that well this is where they use their thumb in their index finger and they will go and pick up little small objects like Cheerios or something like that also this is where they start to move objects from hand to hand so you may be able to give them a little block and they can switch it from hand to hand and they start to have object permanence now what is this well this is where they finally realize that when something disappears it still exists so this is where you can start getting a little more creative with play you can hide objects and they can try to look for them because they know that they still exist or you can play peekaboo and they will start to enjoy that and lastly we have 10 to 12 months so what should this child be doing by their first birthday well they should begin walking this is a huge milestone so they went from crawling to now walking they will be able to do this by either holding the parents hand and then we'll be able to take steps some children can actually walk on their own without their parents help but it really depends on the Infant and this is really the beginning stages of it they're not Masters out of they're going to trip they're going to stumble and they're going to fall also they should be able to follow very simple commands like if you tell them no they'll know they shouldn't do that also if you tell them to wait by a lot of children they can Wave by so just very simple things also they should be able to take objects and put them inside of a container or they can take the objects and bang them together so notice as we progress with age play has changed they went from liking to look at themselves in the mirror from playing peek-a-boo to now taking objects and putting them in containers so whenever you're looking on exams and they're asking okay you have a hospitalized infant what's an appropriate play situation you can do with this infant you'll want to know what you can do also they should be able to say simple words like Mama or dada and this is when separation anxiety happens so this is when the caretaker the main caretaker like the mom or the dad is removed from the site of that infant that infant freaks out does not like it will cry until they can see their caregiver again so again you want to keep that in mind as the nurse so this starts around this age next is B for Baby safety now there's some specific topics that you want to know for exams about baby safety that you're going to educate the parent about that you really have to watch out with these infants so first is SIDS this stands for sudden infant death syndrome now what is this well this is where a healthy infant under the age of one dies usually in its sleep for some unexplained reason they're not totally sure but they know that if you do some preventative measures that that helps decrease the risk so you want to teach the parent the following things number one the best sleep position the best sleep position for an infant is on their back not their side not their timing but their back second you want to educate them the importance of avoiding smoking around that infant because that can irritate the respiratory system third you want to educate them about removing extra items from the crib like blankets toys because that can smother the baby's face also the importance of not over dressing the infant when it sleeps we don't want them to get really hot and um sweat that can increase the risk of Sids and then lastly the importance of making sure that the parent doesn't sleep in the same bed as the infant they can sleep in the same room that's totally fine but have the infant's own place where they can sleep the next topic you want to educate the parent about is about shaken baby syndrome this is where you want to stress to the parent that they never want to shake a baby because a baby's brain is very fragile inside of their skull and if a baby is shaking that brain in a sense will just rock back and forth against the front and the back of the skull and it can cause a traumatic brain injury which can lead to a severe disability or even death so you know caring for an infant can be stressful so you want to tell the parent you know if you're going through one of those stressful times lay the baby down make sure they're safe and just take a break for a second and you want to stress to never ever ever do this another topic you want to talk about is choking from birth to one they are definitely at risk for choking whenever they're born they're at risk for choking on breast milk mucus that gets built up in the respiratory system you need to teach them how to suction that out with those little bulb suctions CPR recommend that they take a CPR class and then as they get older and progress there's a risk of them choking on Foods because around six months of age that's when you start introducing foods so you want to tell them to avoid giving them small round little foods like grapes uncooked vegetables popcorn because the infant can get choked on that then we have cars seat safety where's the best place for an infant to be whenever they're riding in the car well in that back seat and you want to put them in a car seat that is rear facing so in a sense they're like backwards in the car and that is where they want to be they don't want to be in the front and they don't need forward facing that comes a little bit later and then Burns Burns becomes a big issue especially when that infant starts becoming more mobile where they're starting to reach for things because that starts around four to six months and they get really good at it so you want to make sure that they're not close to a stove while you're cooking and watch those electrical outlets also the water some water heaters can get really hot so you want to make sure that you have it on an appropriate temperature so the infant doesn't turn on the water and scald themselves and then we have the whole rolling over issue so here's your baby it's born they normally just lay there they don't really move except their arms and then all of a sudden around the four month Mark they will start rolling over it's exciting but this is a time when that baby's starting to become more mobile and they can get hurt so you want to teach the parent that this starts happening you want to make sure that they're always in a safe spot that they're not going to roll off and hurt themselves and again as I pointed out earlier this is the time when you want to stop swaddling them because when you swaddle them you put them on their back but if they're starting to roll over in the middle of the night they can roll over they could get their face on the mattress and couldn't be able to breathe next is I for interventions that the nurse wants to consider whenever this infant is hospitalized so infants whenever we look at Erickson's stage of development they are in the trust versus mistrust stage so I would commit that to memory and in a nutshell what that means is that that infant is building trust so building trust with their caregiver that their needs are going to be met so as a nurse we need to help the infant in this stage and meet those so what can we do well an infant how do they tell you that they need something they cry so it's your job to figure out what's wrong do they need a diaper change are they hungry are they in pain they have gas what's going on so you're going to respond differently to a younger infant compared to an older infant so to help build this trust whenever they cry you want to respond to that promptly and investigate what's going on and you want to sue them so for the younger infant how a young baby is sued is that you rock them you swaddle them you hold them or you give them the ability to suck all those things are going to help soothe them and calm them down now with the older infant you're going to look at some other things that could be causing their crime to help keep them calm and build that trust because remember as they got older they started experiencing stranger anxiety separation anxiety so for separation anxiety what could we do help keep that parent there their caregiver there so it keeps the infant calm like whenever we're assessing them or something keep the infant on the parent while we assess that'll help calm them a little bit also with stranger anxiety how can we help with that well this infant starts to recognize hey I don't know you and I don't trust you but to help with that nursing the same nursing staff can be scheduled to provide care to that infant and also play is starts to become really important as this infant gets older so um depending on their age you want to implement certain play strategies with them give them time out of that crib out of that bed to play then we have e for eating plan how's this infant supposed to eat well breastfeeding is gold standard that's the absolute best for an infant and you'll want to educate the mother about that so the first six months that's all that infant needs they don't need any extra fluids or food just for the first six months exclusively breastfeed and then after those six months continue breastfeeding but you can start implementing food over time now the American Academy of pediatric Matrix recommends if an infant is exclusively breastfed that's all they have they don't have a formula or anything that they should be supplemented with vitamin D 400 international units on top of their breast milk to help with those levels now if they can't breastfeed the next best is Formula that has iron in it and some things that you definitely want to tell them to avoid during those first 12 months of life is that they don't need any cow's milk or honey and lastly s for social simulation so we're talking about play now infants aren't big about playing with other children of course they're just not there yet they're more of independent players so they do what's called independent play now it starts out with observation during the birth to first four months of life and then it progresses to interaction where they want to interact with their environment so with observation during that birth of four months what can you do to play with them well you can just be there with them because they love love to look at faces and they also love to look at high contrast items also they love the sound of voices so being sung to talk to that is how they play and then after four months they start to break out of that and they start to interact with their environment so this is where Toys start coming in handy like letting them hold rattles hearing that shake of that Rattle and moving that um blocks hitting the blocks together putting them in a bucket and just hearing that noise and hitting them together and then the push toys that you can buy because remember they like to pull up and stand and push and that's going to help build those muscles and that body up as they progress for whenever they start walking and they love again hiding objects playing peekaboo now let's talk about the toddler the term toddler typically includes children between the ages of one year to three years now toddlerhood has a lot of changes with it they are changing physically especially in the way they look however they are changing mentally and they are developing their fine and gross motor skills now the toddler is becoming aware of their environment compared to the infant so because of that they want to test that environment out they want to explore it and also they are developing this term that I would definitely remember about the toddler called autonomy and this is where this toddler has figured out I am an individual I'm so separate from my caregiver which is usually the mother and I have my own will I want to be independent and I want to do things that I want to do so they will try to test that out they'll go back and forth between being independent and dependent also they have realized that their actions influence others around them so really a lot of things that we're going to be talking about with categories about the toddler that you want to remember for exams is going to be dealing with this autonomy and how we can foster that now the toddler is going to change in their appearance they're going to lose that baby look to them and they're going to start looking more like a little child and as you can see here on the left here's a picture of a baby and then three years later this is what they look like and it's absolutely amazing to see the changes that a child undergoes within that first three years of life some fine and gross motor skills that the toddler is learning to do is that they are learning to throw a ball to another person they can also take that ball and kick it back and forth they're also beginning to learn how to run and they can climb on things they can also take like a marker and scribble on some paper they love coloring and drawing they may not be good at it but they like doing it also they like to take blocks and build them they can also say hundreds to thousands of words and they can talk in three word sentences now first let's talk about the body changes of the toddler that you want to know for exams so first they're weight so a toddler by 24 months so about two years should be gaining anywhere between four to six pounds per year so the toddlers should be about four times their birth weight so let's say we have our toddler here whenever they were born they weighed seven pounds so how much should they weigh by the age of two to three well they should be 4 4 times that so 7 times 4 is 28 so they should be about 28 pounds now the average weight can vary based on if they're a boy or a girl so the average weight for a toddler girl that's about two years is about 26.5 pounds and a boy it's 27.5 pounds next is their hype so by two years of age the toddler should increase by two to three inches per year so a two-year-old is going to be about half their adult height and a typical height for a two-year-old is anywhere between 33 to 34 inches and then there's head to chest circumference and this measurement is actually going to become equal at about one to two years of age now remember with the newborn the head circumference was actually one to two centimeters larger than the chest circumference but around one to two it evens itself out now let's take a deeper look into the main main Concepts that you need to know about the toddler for exams and to help us remember those Concepts and to tie it all together let's remember the word toddler so T stands for temper tantrums o stands for on the move and we're talking about safety because remember that toddler loves to explore their environment so that fits them at risk for hurting themselves d stands for diaper to potty transition a big thing that you want to remember about this toddler is toilet training and then the other d stands for developmental stage Theory L stands for loves to say no the toddler loves to tell you no whenever we tell them to do things and this is a term called negativism e stands for eating plan and then R stands for the three R's you want to remember about the toddler which is rivalry and we're talking about sibling regression and then ritualism so first let's talk about tea Timber Tantrums why do these occur well you've probably heard of the Terrible twos and this is the time when these tantrums like to manifest themselves and the reason they occur is for several different reasons but one of the main reasons is it goes back to that autonomy where the child is becoming independent they have their own will they want to do things and they can become easily stressed or agitated for instance it can be as simple as trying to get into a container to access their toys but you know they don't have those fine motor skills to get in there very properly so they get really mad they throw it and they have a tantrum and they're just really still immature in how they process their emotions so how a tantrum may look is that they scream they cry they throw themselves on the ground they hit Etc so where you come into play is with education for the parent and what you want to educate them about is that this is normal part of childhood and it will go away whenever a tantrum occurs you want to stay calm even though that's really hard to do sometimes you also don't want to give in to the child's request of why they're having that tender temper tantrum because that's going to teach them that this works and they will keep going back to that and you don't want to try to reason with a toddler because they're not mentally there to reason with you they're not going to understand it and whenever they do this you want to ignore it but you want to stay close with them you just don't want to leave them just let them know that you're there still but just ignore their behavior and protect them from hurting themselves if it's escalating to that point and be consistent in your approach now what are some preventative measures because believe it or not there are some things that you can do sometimes to prevent one of these tantrums so a toddler's attention span is really short so whenever you perceive that Tantrums coming on you can actually distract them so divert their attention to something else also check for triggers what is something that's going on with that toddler that that makes them more susceptible to a tantrum coming on like for instance are they hungry are they sick are they tired or over stimulated that could be something you wouldn't want to do with him like you don't want to go take them grocery shopping with you because they might have a meltdown also giving them choices helps with their tan Tantrums because they're developing that autonomy so some things that you can do let's say that they have a tantrum before they go to bed well you can maybe give them a choice like for instance it's time for bed we can read this book or that book so they get to pick which book they want to read before they go to bed that might help also praising them for their good behaviors so they can start to learn this is good behavior this isn't so good and preparing them ahead of time before there's a change in like an event or something for instance I can remember with my first son going to the park you know they're running they're playing they're having fun but whenever it's time to leave they don't want to leave and if you abruptly throw that on them they can have a tantrum my son would also would always just run away and I'd have to run through the park to try to find them and instead I figured out that if I prepared him ahead of time it was so much easier to leave the park so for instance you could tell the toddler okay we're going to be leaving the park but I want you to go down the slide three more times and then we're going to go home and get ice cream whenever I would do that it would work like a charm next is oh on the move so we're talking about safety so our toddler has increased in their Mobility they're very curious and they're into everything and at this age there is a huge risk risk of death where they accidentally hurt themselves so you want to educate the parent about those things that tend to hurt a toddler and to help us remember those remember the word dangers so D for drowning huge risk for toddlers is getting into water unsupervised and they drown even keeping your toilet closed because some toddlers have Believe It or Not drowned in a toilet a for automobile accidents so with this ties in car seat safety you want to make sure that the toddler if they're under two years that they are in a rear-facing car seat but after two years they can be in a forward-facing car seat of course in the back of the car n is for nose Dives that's Falls accidental Falls G is for getting burned they Um this can be electrical outlets can be stoves anything like that e for eating toxins teach the parent to all always keep all toxic substances not only things that they ingest but things they can get on their skin away from the toddler are for revolvers and rifles these are unsecured Firearms toddlers are very curious about these things and they can go up and pull the trigger hurt themselves to hurt someone else and then s for suffocate or choke so teach the parent about potential foods that the toddler can choke on keeping plastic bags away from the toddler that could get around their face and also knowing how to do CPR to relieve a choking toddler next is D diaper to potty transition so we're talking about toilet training now in order for a toddler to be successfully potty trained they have to be physically and mentally ready because if they're not it's not going to be successful and physically ready what we're talking about are sphincters specifically the anal sphincter and the urethral sphincter and these are not really voluntarily controlled until the child's about 18 to 24 months of age so that's a great time you can start potty training because says they're physically ready now bowel control will come before bladder control and the reason is is it's a lot easier to feel when you have to go to have a bowel movement that sensation is a lot stronger than when you have to void so most kids are going to be daytime potty trained by the ages of three years one thing you want to remind the parent is that daytime potty training and nighttime potty training are going to be different when the child is independent on it with daytime they tend to be a lot faster with that so with night time going to bed at night they're probably going to still need a diaper and most children are trained at about four to five years of age so let's talk about those key points that you want to teach the parent about potty training that you may see on an exam and to help us remember those we are going to remember the word toilet so T stands for two or more hours with a dry diaper o stands for on and off the potty by themselves and they can put on and off their pants all by themselves I is interested in the potty they actually are interested in doing this and they want to see if they can L stands for like sitting on the toilet this is where they can sit on the toilet for at least five to ten minutes without wanting to get off of it and then e stands for experiencing regular bowel movements so they're having regular times that they're passing stool during the day and then T stands for tells you they have to go so they can verbally tell you that hey I've got to go to the bathroom next is D for development stage Theory now there are two theories that you want to know about the toddler's development we have Piaget and we have ericssons so let's talk about Piaget so with this Theory it really deals with that a person is going to go through these stages and how they progress through these stages and learn their environment is that they have to interact with their environment and explore it and they do these in these various stages so the toddler depending on their age because remember the toddlers about one to three years that's what we include with this age category they can be in either the sensory motor or the pre-operational sensory motor is birth to two years pre-operational is two to seven years so some main Concepts that you want to remember about the pre-operational is that the toddler has a big problem seeing things from other people's point of view so they're very much about themselves so we consider them egocentric also they're thinking and how they play and process things is really symbolic so for instance if you give a toddler a stick they may pretend that it's a sword and the other objects outside are monsters and they're fighting those monsters with their sword so that's how they process and think and play which leads me to types of play that the toddler likes to do and I would remember this the toddler does what's called parallel play now what is this this is where the toddler will observe others playing they will actually go and let's say play with some blocks with other children around them but they won't go and interact with other children and those children don't really play together in that age category now what are some toys that toddlers love playing with well they love playing with blocks and building them they also love playing with toys that you can push and pull because remember at this time they are really good at walking and they're starting to run so they love to play with like pretend push lawn mowers strollers wagons they also like to look at books that are interactive like ones that make sounds or ones that are pop-up or where you may have to find little hidden things in the book but by pulling up a little cardboard door on the book or they like to play with pretend objects like cooking sets shopping sets building sets Etc now with Erickson's stage of development you want to remember that the toddler is in autonomy versus shame so again this is where the toddler is transitioning to becoming more independent versus so dependent on their caregiver and in order for them to have got to this stage they had to get through that first stage which was in the infant stage where it's trust versus mistrust so they have developed trust with their caregiver now they feel confident in being able to try things themselves plus they are now discovering that they are an individual separate from their caregiver and that their actions affect people in their environment so the result of this stage is that the toddler is going to have confidence in completing or attempting new skills like toilet training feeding themselves dressing themselves and as the nurse who may be caring for a Toler who's hospitalized or educating the parents you want to do the following you want to provide opportunities for that toddler to be independent like those things I just named give them chance to try it also give them choices so they feel like they have a say-so like choices with their food or drinks or activities or books to read and giving them positive feedback whenever they do a good job completing one of these new skills that's going to instill confidence in them and avoiding punishing them when they do that skill wrong another thing you want to remember about the toddler since we're talking about the development is separation anxiety now in our previous lecture with the infant we touched on this because this is when this is starting to happen but with the toddler this is definitely something that they can experience and this is whenever they're removed from their caregiver they experience severe anxiety and they'll cry and things like that so what you want to know for exams is that you want to know about these three stages of separation anxiety and some interventions to help the toddler dealing with us especially during hospitalization if the parent has to be removed from the child so the first stage is the protest and just as the name says they're going to protest this they're going to scream and cry and it's going to be hard to calm them down whenever the parent has left then if the parent still hasn't returned they can go to the despair phase or stage this is the second one and this is where they have quit crying they're quiet but just as the name says despair they're depressed and they're sad and they're withdrawn and quiet but whenever the parent comes back they're going to cry and want the parent and want to be held and then we have the last stage which is called the Detachment stage and it's very rare for a child to actually get to this stage but if they do they have detached themselves from the parent to help themselves cope with not having the parent around them anymore so to you the child will appear happy like they've coped very well with it but in reality they have him and whenever a child gets to this it can actually affect the parent-child relationship so how as the nurse can you help a child who's dealing with separation anxiety as a toddler well if the parent is coming back indeed at a certain time you can reassure and remind the child that the parent will be coming back also you want to maintain those routines that schedule of that toddler remember they love rituals we're going to be talking about that whenever we get to our R of our mnemonic and encourage the child to talk about their parent then we have Elle love to say no now no is a toddler's favorite word and we term this negativism this is where a toddler is going to do the opposite of what is being asked they have a negative response to it it doesn't necessarily mean they don't want to do it but they're exerting their independence and they're going to tell you no so as a nurse what you want to know about this topic is how to avoid getting that no response so you can get your job done so you want to avoid asking questions or giving commands where that toddler can tell you no instead you want to give them a choice so let's say it's medication time so instead of going to that toddler and saying would you like to take your medicine now they're going to tell you no instead you can say you can take your medicine in a blue cup or a green cup which one do you choose and hopefully they're not going to tell you no and that will help avoid that response then we have e for eating plan so toddlers tend to be what we call grazers they just like to snack throughout the day they're not big about setting down for breakfast lunch and dinner with large portions they do better with small nutritious snacks so you want to make sure that they have access to finger foods that are like vegetables fruits things like that that they can grab and eat that's going to help them learn those fine motor skills as well and you want to avoid a lot of sugary processed fatty items the toddler will love those but they're not good for them to eat we want to make sure they maintain a healthy weight also another big thing with the toddler is that their teeth are starting to come in so we want to make sure that they don't get dental decay toddlers can't experience this as you can see in this picture here so how can we educate the parent on how to prevent this one big thing is avoiding a nighttime bottle especially with juice in it because that is going to set on those teeth and cause them to Decay also they need to visit the dentist a lot of people are shocked that they need to go to the dentist around this age so this is when the teeth start to come in we talked about in the infant lecture that those lower incisors tend to come in around 8 to 10 months the central ones so about by 12 months they need to visit a dentist also they'll need help brushing their teeth with assistance they can't really brush their teeth all by themselves they haven't really masked concerned that skill yet and you want to assess their water at home ask the parent do you guys have fluoride added to your water and if they don't they may need a fluoride application to the teeth another thing about the toddler is that this is going to be a phase in their life where most toddlers are going to be considered picky eaters they are big about how their food looks and so they're going to be not very excited to eat a bunch of food like if they see that there's large amounts of food they're going to feel very overwhelmed by that and may refuse to eat it also they don't like their food mixed together so stir fries where you have rice and vegetables and meats mixed together they probably aren't going to like that or casseroles because a lot of toddlers they prefer for their meats to be here vegetables to be here and fruits to be here and some toddlers may go as far as requesting that they don't even touch together they'll refuse to eat that and they're going to have a limited selection of foods that they like to eat they may like to eat just macaroni for breakfast lunch and dinner but hey at least they are eating so this is not a time for them to try new foods they'll probably refuse to try something new but you know whenever they all get older they will and if you're having trouble getting your toddler to eat you have to think of some creative ways um toddlers are big on rituals which we're about to talk about here in a moment so they may prefer to have a certain plate um to eat their food on in a certain cup to drink they may want certain foods at certain times because that's what they eat every day they also some toddlers like fun colorful plates that might entice them to eat so sometimes you have to get creative now whenever because the toddler is starting to eat more complex foods that require chewing precise chewing they're still learning this skill so you want to take care to make sure you're not giving them big chunks of meat so make sure you chop those up because they're at risk for choking so watch foods that are stringy like for instance celery that takes a lot of chewing and they can get choked on the strings in the throat also hard round candies or even hot dogs popcorn Etc and lastly we have our for ritualism rivalry and regression so let's talk about ritualism so this is where the toddler wants to do the same things the same way now why do they want to do this well it's predictable comfortable and it will actually help promote learning because whenever they keep doing the same things they know what to expect so they feel comfortable to Branch out try a new skill because it'll help decrease their stress because here in a minute whenever you see a toddler get stressed they can actually regress and go down in their skills so know about ritualism then we have rivalry and we're specifically talking about sibling so a lot of times whenever a toddler they hit the age of two to three a sibling comes along like a brother or a sister now this changes things and we have learned that toddlers really don't like change they like their routines so they can have this because of that also the attention is going to be diverted off of them so what can happen is that the toddler can start having those temper tantrums and they can experience regression so what can you educate the parent about on how to decrease this well um one thing is to try to include the toddler as much as possible in the care of that baby also try to maintain important routines to that toddler to maintain that consistency for them because breaking the routine really stresses them out and watch out for Jealousy on the part of the toddler because some toddlers can become so jealous that they may physically try to hit the infant and then finally regression what is this well this is where the toddler actually reverts back to like infancy infancy type skills for instance let's say that they've learned to be potty trained but all of a sudden they're using the bathroom on themselves or they were feeding themselves just fine but now they want a bottle and they refuse to eat or they're not sleeping at night or they're talking like a baby wanting a pacifier Etc so why does this happen well toddlers learn differently than older children and adults toddlers have these bursts of learning in certain stages hence these Milestones while we can measure and say taller should be doing this at this age Etc compared to like an adult who builds upon their learning and they are mentally mature where they can deal with the stresses and failures of not getting that skill right then and there compared to a toddler whenever they're getting overwhelmed and stressed or something stressful going on in their life they will revert back to like infancy type skills so some causes that can cause this is that they have a change in their routine we've learned that routines are so important for toddlers so if that sibling comes along or they're hospitalized where things aren't going the way that they go at home that can cause it so anything that causes stress also overwhelming them with a new skill where they feel like they just can't get this skill can also cause them to do this so what are some things that we can do to help the toddler who is going through this well one we wouldn't want to punish them for not being able to do something or if they have reverted back it's going to increase stress and make it worse looking at what's causing this regression possibly being able to remove it or alleviate it so they're not going to be regressing as much not taking the time to teach them a new skill this isn't the time to do that so let's say they're hospitalized and they're losing their skill of potty training you wouldn't want to try to potty train them again because that hospitalization is causing that and taking the time to praise them for what they are doing well instead of focusing on their regression now let's talk about the preschooler the preschooler includes the age range between three to five years of age now to help us remember all those important Concepts we need to know about the preschoolers growth and development let's remember the word pre-school so first P we're talking about physical changes so our preschooler has went from toddlerhood to now preschoolhood so with the preschooler what you have is that they're changing physically they're starting to look more like a little kid they're going to start losing that chubby little face it's going to become more defined they're also going to start losing that protruding belly as those muscles tighten up and their limbs start to elongate so by the end a preschool Hood you're going to have a little child that is talkative rambunctious very active and social and they're going to have their own little personality now some physical things you want to remember about the preschooler is their hype and their weight so during this time period they're not having that rapid growth like how they did whenever they were an infant so it slows down a little bit so Weight Wise they'll gain about five pounds per year with an average weight for the preschooler towards the end of preschoolhood being about 42 pounds their height they grow about three inches per year with the average height of a preschooler about 44 inches and then we have gross and fine motor skills so what are they able to do so whenever we're talking about gross and fine what's the difference well gross motor skills require large muscle groups in order to complete that skill so we're talking about skills like a preschooler should be able to write a tricycle they should be able to bounce and catch and throw a ball run hop skip and climb and as they progress from three to four to five these skills are going to become really well established then we have fine motor skills and these are skills that use those small muscles that allow us to do things like the preschoolers should be able to write their first name like copy it and write it so see you're using your little muscles to do that they should be able to zip up their jacket button up their shirt cut with scissors copy shapes like basic shapes like the triangle in the circle and you can see all of these skills is preparing them for school so then they'll become school age which we'll review in our next lecture sure next is R for reduced separation anxiety so we talked a lot about separation anxiety with the toddler because they really struggle with this and this is where when the parent is removed from the child the child will become extremely anxious and will cry and go through these different stages so with the preschooler the separation anxiety is going to occur especially in that three-year-old but it tends to Disappear by the ages of four to five and it really varies depending on that child and the thing to remember with the preschooler is that they're going to tolerate separation anxiety a little bit better than the toddler think Heavens so what you really want to remember about separation anxiety are those stages and how the child is expected to act in those so with the preschooler with the protest stage that's the first stage when that parent's removed it's going to be less intense compared to like with the toddler like the toddler freaks out they scream even cry really loudly and they're hard to calm down but with the preschooler they're going to cry quietly and they're going to act out now the Despair and Detachment stage is going to be the same as the toddler now one thing you want to remember about our preschooler is that they are magical thinkers definitely sear that in your brain because we're going to talk a little bit more about that later so the preschooler may be concerned that their parent may never return or that they are hurt or something's wrong with them and I remember with my preschooler whenever he was preschool age he would think that I was kidnapped like if I had to go somewhere he was worried that I'd been kidnapped or something crazy like that so they are magical thinkers and so as the nurse you really want to reassure them frequently that their parent will be coming back and encourage them to talk about the parent and avoid giving them a specific time when the parent's going to return because the preschooler doesn't understand time so you can't say you know your parents going to be back at two o'clock they have no idea what that means then we have e for Erickson and Piaget's theories so with these theories what you want to know is really that stage that that preschooler is in so first Erickson with Erickson we talked about with the infant that whole goal of that first stage was to develop trust then they progressed to the second stage and this is when they're a toddler and the goal of that stage was to develop autonomy now they're in this third stage and the goal of this stage is for the preschooler to develop a sense of purpose so we really want to get them there so the stage for the preschooler that they're in it's called the initiative versus guilt so the preschooler to help progress where they're going to get that sense of purpose is that they're going to need opportunities to try new things make decisions be in situations that challenge them so they can be independent and feel like a sense of purpose and this is also when their conscience is develop so they have that simple understanding of right and wrong now if the preschooler is not given these opportunities to do new things let's say that the caregiver really controls all the choices or belittles them for their decisions they're going to have issues with trying new things branching out being independent and wanting to make decisions and then because of that they're going to experience guilt so whenever they try to do those things and they're not going to have a sense of purpose now what are some interventions that we can help the preschooler where they can have a sense of purpose so they can progress through that fourth stage with the school-aged child well one thing you can do is to encourage play for the preschooler preschoolers learn by playing they love playing and that will give them opportunities to try new things to do things so you want to make sure you encourage that along with imaginary play because remember they're magical thinkers so encourage that also give them Freedom within reason to try new things and to make choices allow them to pick and if they do fail try to avoid criticizing them but encourage them and try to accept the choices that they make and avoid trying to control all aspects of choices but give them some freedom to make those then we have Piaget's theory and with this the preschooler is in the pre-operational stage so this overlaps with that toddler because this stage includes children between the ages of two to seven and preschoolers are still egocentric just like the toddler so they only really see things from their own point of view they can't see things from other people's point of view but as a preschooler is transitioning from being a preschooler to a school-aged child they're going to be able to see things from other people's point of view now the preschooler as I pointed out earlier they are magical thinkers and they love to play pretend they will have imaginary Playmates and things like that and that really helps their growth and development so you want to encourage that and preschoolers are literal thinkers and this is really funny if you've ever like interacted with a preschooler and if you say certain like metaphorical phrases that are commonly said they will interpret them literal and let me share an example with you my son it was like hot you know one day and I'm like let's crack a window and he was like crack a window we can't crack a window and I'm referring to crack a window like put the window down let some air in but he literally thought I was talking about cracking a window to make us cool down and the preschooler is also they think of things in an animistic like way and what this means is that they will look at like inanimate objects like their toys and they will think that they are living that they're alive and that they have feelings and whenever you look at this word it like has the word animal in it the first part of it so that will help you remember it so they think it's alive and again my son whenever he's preschooler he would do this as well and for instance like he had like a little stuffed monkey and whenever we would eat the monkey would need to eat as well because he was hungry and we really had to pretend we were feeding the monkey because he would get full so they think of their little toys like they're alive then we have S for scared of things the preschooler has real fears because their young mind has problems distinguishing between fact versus fiction plus the really creative thinkers and some fears can stem from that animism that we just talked about where they can think that their toys are alive and here in this example you can see a preschooler with this toy dinosaur it makes really loud noises and it moves in these abrupt ways and the preschooler is scared they think that this dinosaur can hurt them which it cannot because it's a toy there's toy and it scares him so I'm going to turn it on and let it walk and I'll show you how it walks [Music] whoa yeah that's what he did you want me to make him walk again no no they also fear hospitalizations and procedures and this is really where you want to be thinking about as the nurse who's going to be taking care of that preschooler so with hospitalizations they can fear that the reason that they're in the hospital sick with illness is because of a punishment something that they have done wrong and you have to reassure them that this is not the case also they have a fear of Mutilation to their body especially with procedures that will have to be done like those invasive procedures so you have to take a lot of care with the preschooler when you are having to perform those so let's talk about some interventions prior to like a procedure or during a hospitalization so with a preschooler you want to be honest with them you don't want to lie to them you want to explain things to them but in simple terms they're not ready for in-depth explanations that comes a lot later also medical play is very essential for the preschooler before you do a procedure this will help them cope with it so let's say the preschooler needs an IV some things you can do with like medical plays that you can get a doll and show the preschooler how this will be done let them participate in giving the doll a pretend IV let them look at the equipment encourage and answer questions also you want to give the pre schooler choices and allow them to be as independent as possible given their circumstance with their illness and be aware that the preschooler can experience a loss of control and this is where we have disrupted you know how they normally go on through their day like with play with eating and being able to do what they normally do on a daily basis and they'll sense that hey I don't have control of this situation and this will cause them to regress so be aware of that that was a big thing with the toddler but your preschooler can't have regression where they really lose skills and revert back to those infantile behaviors and then with time like whenever you're preparing the preschooler for a procedure you want to avoid telling them a specific time of when it's going to take place because again they have no concept of time and they're not going to understand it so you want to tell them in stages about as it's about to happen and give them like a time frame where they can relate to it like for instance let's say that they need their IV changed out you can tell them you know we're going to do that after you eat your breakfast so they know okay after I eat breakfast this is going to happen instead of saying at eight o'clock we're going to do that they wouldn't understand that and whenever you are doing any procedure or something that's going to cause that preschooler stress try to keep the parent with the child if possible because that'll help alleviate and decrease their anxiety the next is c for child safety so we're a preschooler is not as rambunctious and a danger to themselves like how the toddler was they're a lot more aware of dangers that can happen and plus they have some experience to know oh I shouldn't do this this is a little bit dangerous and you can work with them more and plus they can follow the rules and Obey a lot better however there are still some things you want to educate the parent about so they can keep their preschooler protected one thing is with like gun safety the importance of always keeping Firearms protected away from reach in addition swimming they're going to be active swimming you don't want them to drown so you may want to encourage the parent to get them swimming lessons also activities are going to be very active using those gross motor skills so riding bikes they may towards the end of preschoolhood learning to skate so they want to make sure that the preschooler is wearing helmets to protect their head from any accidental fall with a brain injury pads on the elbows and the knees and teaching them about strangers preventing any type of like child abduction so teaching them never to trust people they don't know never to get into a car with a stranger and always educating the importance of never doing that and next we have eight for healthy eating so thankfully our preschooler is starting to become less picky about what they eat compared to the toddler they're going to expand their horizons with their food and they're going to be more willing to try new foods because remember with the toddler they were very ritualistic many toddlers with how they eat like they'll eat just certain foods they don't really want to try new foods they're big about textures and how things look and they're very specific about what place they have for a certain time or cup or spoon or whatever but the preschooler starts to chill out with that and they're going to actually enjoy setting and eating for meals compared to that toddler the toddler I turn were like grazers they'll be active they eat be active and eat they're not going to really set down compared to the preschool especially as they approach five and thankfully by three all those baby teeth have came in and that's good news for Mom and Dad because if you've ever dealt with a child who is teething it can be very um exhausting to say the least with some children they have a rough time with it so they came in by three and then about five to six depending on the child every child is different they'll start losing their teeth usually those lower Central incisors will be the first ones to go and then they'll start cutting other teeth and it's a lot easier this time around when they start cutting teeth and you'll want to stress to the parent about those Dental visits to maintain that teeth integrity and choking so with the infant and the toddler choking was like a big risk especially with the toddler when they're starting to eat more Foods because they're not really good at chewing and swallowing it they're still mastering that or a preschooler you know they have their teeth they're swollen they're too and they're doing great so they're have a little bit of a decreased risk of choking but you still want to make sure that you're not giving them food that could potentially cause choking and you want to teach them about the importance of not running with food in their mouth like for instance like suckers they don't want to run with a sucker in their mouth or talking with their mouth full because preschoolers they have an explosion of their language they are talking talking and they may want to talk with their mouth full and that could pose a choking risk next is oh others are starting to become important for play so preschoolers are now starting to transition where they want to incorporate others in their play so before like with the infant and with the toddler they didn't really do that like the toddler did parallel play but now we have progressed on Parallel play to associative play and this is at about three years and this is where the child will be playing with others in a sense that they'll be doing the same activity by using the same toys or the same equipment but they won't be working together to accomplish something instead they'll be using that equipment or toys to be doing their own activity and let me give you an example okay we have some children in a sandbox and they're all using you know some shovels and some sand molds they may even be you know borrowing each other's like sand molds and shovels but they're doing their own activity they're digging their own sand they're making their own sand molds and they're not really communicating to work together with something now this type of play is great because it's starting to build those social skills and it's teaching them those early aspects of sharing and getting along with others then we have cooperative play and this is about four to five years now what happens with this type of play is that the children now start working together and playing together to accomplish something hence they're cooperating with each other so let me go back to the sand example you have children together and they are working together to build a sand castle so that requires that they get along with each other that they follow rules you'll start to see a leader emerge and along with followers and then they're all just working together to accomplish something and then the next uh with outline Behavior expectations for the parent so the parent just got out of toddlerhood and now they're going into preschoolhood and toddlerhood can be a really trying time for parents because the child is developing cognitively they're trying to exert their autonomy they have temper tantrums regression negativism and so forth so it can be a time where it's really hard but reassure the parent that parenting is starting to get a lot easier especially when this child hits five years old so to hang in there but some things they can expect is that this child can experience what's called loss of control and I hit on this a little bit earlier with the hospitalization so whenever the preschooler you know is interrupted and how they can play eat do things how things normally go where they have a sense of control it can cause them anxiety where they can regress so prepare them for that and let them know that this is why it's happening and to watch out for it also they have those fears and anxieties that we were talking about earlier and they can have aggression and this can be due to modeling from seeing a parent who may be aggressive so they may be modeling their behavior or media like TV shows that they're watching so they definitely want to be aware of this and reassure them like I said that negativism and ritualism should be decreasing where they're not going to be getting a no for everything and one thing that the preschooler can start having is nightmares so let the parent know this and that if this does happen that they need to reassure their child listen to their child explain what happened during the Nightmare and let them know that they're there and help them go back to sleep in their own bed and then lastly L for language explosion so during this time from three to five this preschooler is really going to make some Leaps and Bounds in their ability to speak so by the end of five they should be able to speak around 2400 words and it really varies among each child and speak five word sentences that are very descriptive and they're even joining them with those conjunctions and or but so because we have such an explosion of language there can be some stammering and stuttering by the child and this is normal at this age because they're rapidly developing in here they have this vocabulary in their brain and so they have to take that and they have to articulate it and they can have trouble getting that out sometimes so reassure the parent that you know during this time it is normal but keep an eye on it because we want to identify it early if they do have a speech problem so they can get a referral and help get it corrected so it doesn't progress into adulthood so tell the parent to be patient with the child as they speak don't try to rush them or finish their word but you know listen to them and to not make a big deal about it at this time or make fun of them or scold them because they're just really learning how to put their words together with their speech now let's talk about the school age child when we talk about the school age child we're talking about children who fall within the ages of 6 to 12 years old so the school-aged child Falls within that range where they quit being a preschooler but they're not quite yet an adolescent or teenager so our school-aged child they are really growing and developing and trying to discover the role in this world and a main driver and helping them do that will be of course their parents but something else is going to be thrown into the mix this is when they start school so school is going to be a big driver with this because they're going to start having that peer-to-peer relationship with other people and they're going to start having relationships with someone other than their parents such as their teachers so this is really going to help them grow and develop now to help us remember all those main Concepts we need to know we're going to remember the word school so first is s for skills the school-aged child has learned so much up to this point they started learning whenever they were a baby all the way to the time whenever they were a preschooler so they're taking those skills they're mastering them and fine-tuning them but they're building upon them and they're becoming very independent with them so first let's talk about fine motor skills that they have well these are skills that use those smaller muscles and one skill that they're going to start getting really good at is writing and of course school is going to be a main driver with that so not only are they going to start out writing their name but they're going to start writing sentences which are going to evolve into stories then they're going to learn how to draw with greater detail so they'll start out maybe as little stick people here but then their drawings can start having more detail to them they can also begin to learn to type and do complex tasks that are required in cooking and cleaning next will be gross motor skills these are skills that use those large muscles so the school-aged child loves to be active and they definitely are using those larger muscles so they're going to really learn how to ride their bike without training wheels they're going to learn how to start using skates and scooters and they're going to learn to to swim now our school-aged child loves to compete with their peers and be very active with their peers so this is a time where they love to be in team sports competitive Sports and then plus they like to start having Hobbies next is cognitive skills so at this age children have an increased ability to pay attention and to concentrate which is very useful in the school setting so now they can memorize and learn material they can also learn to read and as time goes on and they practice their reading skills those skills will even Advance even more next they can learn how to solve math problems so they can go from counting to adding subtracting even multiplying and dividing and solving word problems plus they're going to be learning about conservation and classification they're starting to have those abilities to do that next will be their language so their language is starting to advance and they're fine-tuning it it's almost this adult-like in many ways so whenever they speak it will sound a lot like an adult speech so they can take those words but now they can write those words out so they can have creative writing plus you can teach them grammar rules and they can follow those for their writing and they can even learn how to spell words and write their definitions and then lastly social skills so before when the child was younger they were really egocentric where everything was about them and they didn't really have the ability to see things from other people's perspective but now that is changing they're starting to become more concerned about others and their perspective so this is why you're going to start to see this shift with the child now wanting to form relationships with other people they'll have these special friendships especially in the school setting so with the school-aged child it typically is among the same gender where girls with girls and boys with boys but that will change once they approach adolescence so during this time you will start to see the child child playing with others there's a variety of play styles of the school-aged child engages in such as cooperative play competitive play physical and constructive play and they love doing this with challenges so you'll see them maybe play board games sports like I said competitive sports but they also like to do things by themselves they like to sit and read play video games and like to collect things in some games you may see a school-aged child playing would be like Simon Says Hopscotch charades jump rope Kick the Can tag hide and seek and so forth next is c for changes and we're talking about the physical changes that that school age child is going to undergo during this time period first is hype you can expect them to grow about two and a half inches per year with the average six-year-old being around 45 inches two whenever they hit 12 about an average of 59 inches and then white wise they gain about four and a half to seven pounds per year so the average six year old should weigh around 45 pounds so remember 45 for the height and the weight and then an average 12 year old is around 90 pounds now these averages are just averages because if a child has the genetics let's say both of their parents are really tall well they're probably going to exceed this height range so just keep that in mind whenever you look at these figures next is their teeth so before when they were younger they were getting their teeth having to go through all that pain but now it's time to shed those and get their permanent teeth that they'll have for the rest of their life so around five or six most children tend to lose those Central incisors and then they will erupt the brand new permanent teeth and typically by the end of this age period about 12 to 13 they will have most of their permanent teeth with 28 being in now the average adult has 32 permanent teeth so in a sense we don't quit teething until we hit around the age of 21 where those last sets come in those wisdom teeth so during this time the nurse definitely wants to provide Dental Care education so teach the parent and the child the importance of brushing twice per day and flossing and going to the dentist regularly at least twice a year every six months because we really want to take care of those permanent teeth because a child's at risk for cavities if they have any bite problems or really a lot of crowding in their teeth they may need Orthodontics so they can be evaluated for that and then lastly puberty so as the child is approaching adolescence their body is going to start changing now for girls this tends to happen earlier than with boys the girls the average is anywhere between 8 to 13 and boys is 9 to 14. so as you can see with those ages it falls within the school age and with this you want to make sure that you are educating the child about these potential changes that are happening and what's going on with their body next is H for harmful risk these are safety issues we got to watch out for in the school-aged child that you want to educate the parent and the child about because again these children are very active and they like to take risk and show off and compete with their peers so we want to make sure that they're doing that safely one thing they like to do is they like to get outside and they like to use equipment to play with such as bikes skates and scooters so we want to make sure that they're wearing protective gear a helmet on the head and other protective gear like elbow pads wrist pads and knee pads whenever they're using that equipment next is swimming so you want to make sure that they are aware of diving dangers or deep water like in lakes that could have undercurrents they want to wear life jackets and if they haven't already to consider swimming lessons to help them with their swimming skills next you want to educate them about stranger issues where possible kidnappings Could Happen methods that kidnappers use to lure children in to be kidnapped plus inappropriate touch what's okay versus what isn't and fire and gun safety keep these things out of children's reach because at this age they're curious they think they're big enough to play with these things but they really don't understand how to use them so keep them in a secure location and then Traffic Safety so during this age range most children are still in a booster seat so you want to make sure that you're following state laws with that for instance If the child is older than eight and at least four nine they can ride without a booster seat and then seal with 12 12 and under should always be in the back they should never set in the passenger seat this back is the safest for them next is O obstacles at this age so during this time the school-aged child is forming self-concept and this is where the school-aged child is going to ask themselves you know who am I and how do I fit in and we want them to walk away from this stage of Life having a good self-concept because if they don't they may experience depression and have low self-worth that may carry them throughout the rest of their life so a main driver in helping them develop their concept will be of course their parents but that school setting for instance with their peers do they fit in with their peers do they have the approval of their peers and their teachers because the teachers give them their grades and feedback and that helps them determine okay yeah I'm good at this maybe I'm not good at that I can do this I excel at that and drives them with that so what are some things that help a child with their self-concept that you can educate the parent about one thing is to be positive and help highlight the child's strengths guide them with setting obtainable goals so whenever they complete those goals praise them so they feel confident with that and care about their interests to help them grow in them and let them grow and when they mess up help them reflect back on what happened and how to improve next time another obstacle is bullying this is where a child is being harmed or intimidated by another child and typically this happens in the school setting but it can happen outside of school another common place that's happening is through social media online now boys and girls tend to bully a little bit differently with boys it tends to be physical with girls it's more of rumors teasing mocking making fun of them now what are some signs that a child is being bullied you may see physical injuries on the child when whenever they come home from school and whenever you ask them about it they can't really tell you a good answer of how they got there they may be missing some school items they may not want to go to school you may they may be faking sickness a lot their grades are really poor they're starting to have Behavior changes where you know before they're excited about going to school or didn't really care but now they're starting to withdraw become agitated and depressed and you may see suicidal Behavior now what are some interventions for this well you don't want to ignore it and hoping that it'll go away but instead you want to get your child to open up and communicate to you what exactly is going on their fears and concerns just let them know that you care and then whenever you figure out what's going on you want to report it immediately to the proper authorities and take an active part in getting it stopped and let your child know that you want to get it stopped and that you care about them and that you are there for them through this next is weight and nutrition so children at this age are at risk for obesity known known as childhood obesity and obesity can lead to many health problems in a child such as high blood pressure type 2 diabetes and joint pain so as a nurse you want to look at those risk factors with that child and see if they are at risk and to help you remember those risk factors remember the word heavy H is for high caloric diet so ask the child what they eat on a regular basis and look for things like junk food fast food sugary drinks because these are things that add a lot of calories and not a lot of nutritional needs e is for exercise lacking and the U.S Department of Health and Human Services recommends that children in adolescents ages 6 through 17 do 60 minutes so one hour or more a moderate to vigorous physical exercise daily A is for accessibility limited to healthy foods these view food as a way to deal with stress some children who are experiencing stress at home in school or depression will eat to help cope with that and then why is your genetics and family Dynamics so how the family members eat what's prepared on a daily basis exercise habits and genetics will determine how a person puts on weight now some educational points you can provide to the child and the family about this issue is to try to make it a family effort so set weight goals together and change eating patterns together and to start slow it'll make a little bit more funner and make it a little bit more successful then to replace junk food the child likes with creative healthy foods so instead the child likes lots of candy try replacing that with vibrant really pretty sweet fruits and to avoid sugary drinks and set a lemon on that and then avoid rewarding with food you don't want to teach the child that whenever good things happen it's always associated with food use something else as a reward and to make exercise fun so try bike trails team sport it's things that will burn calories but it's fun and another obstacle children may face during this time period is exposure to drugs violence and sexual content through media like social media or the school system so some educational topics to talk to the parent about because at some point these topics are definitely going to come up they want to make sure that they're listening to their children see what their children is being exposed to pay attention to who their child's hanging out with what they're doing on their social media and to leave an open line of communication so whenever these topics do come up that you discuss them honestly because they're real and they're just going to happen and ways to deal with them whenever that does happen now during this time these children especially as they approach adolescents are going to start testing limits and they're highly competitive they like to win they don't like to lose so some behaviors that may start to happen is that they may start to cheat lie or steal next is the other o which is for outcome of hospitalizations so whenever the school-aged child is hospitalized there are some things that the nurse needs to be familiar with that the child can experience during their hospitalization and one thing is fears so the square child can fear pain slash injury really being stressed that a procedure coming up is going to be painful or it may cause them a deformity or they may lose a body part so as the nurse you want to be honest with the child teach them with visuals with letting them play with medical equipment going through it step by step and helping them develop coping techniques to deal with this they can also have a fear of death or dying they're familiar with this concept and that it does happen they've seen it happen to people around them and losing Independence slash control so in the younger ages whenever we were talking about like autonomy and losing control like for instance like with the toddler this is a little bit different the school-aged child's loss of control is going to be coming from because they're going to have an interruption into their school routines when they're hospitalized they really can't go to school so that leaves them without being able to see their friends on a regular basis be part of what's going on in school they may feel like they're going to get behind along with being separated from their friends and even their family so this is different it's not that separation anxiety like our younger children had it's more I don't get to see them are they going to forget about me type thing and then another thing is Modesty so as that school-aged child gets older they start to become aware of how it feels uncomfortable to expose your private parts so if you have to do procedures that expose them you want to take care that you are preserving modesty and that you're letting the child know that you are taking those steps now as a nurse there are some things that we need to remember as our role whenever we are taking care of the hospitalized school age child so I want you to remember the seven T's the first T is to take time to let them Express fears and then let them talk about those fears and coping techniques to maintain control and be truthful about procedures and tests all of that is going to help decrease their fear and anxiety about you know the hospitalization and what's coming up and when you have to teach them teach them with pictures outlines age-appropriate videos and medical equipment and lay out how it will happen step by step and be tactful with privacy especially during procedures that expose their private parts we want to maintain modesty and then give them time for activities throughout the day this is going to help provide distraction from the sickness the hospitalization itself and upcoming procedures and plus they start to get a little restless and bored when they're hospitalized and that'll help pass the time and then lastly they're friends keeping it in communication with school friends is really important so collaborate with the parents on how they can still stay into contact with their friends why they are hospitalized and then the last part of our mnemonic is L learn developmental theories for the school-aged child one of those theories you want to know is by Erickson and specifically what you want to know is what stage this child is in the school-aged child is in the industry versus inferiority stage now our school-aged child is very industrious they yearn to accomplish things because whenever they accomplish and succeed at things it instills satisfaction in them they feel confident and the whole goal of this stage in order for them to progress to the other stages is to have competency so we want our child to walk away from the stage with a sense of Competency now this is really cultivated in a lot of settings like in school and sports and with their schoolwork because once they succeed at things they're able to do it it's like hey I can do it everyone else can do it I feel confident I'm knowing my role in this world now what can happen is that they can struggle with feeling feeling inferior like inferiority and what can happen with this is if a child has a physical limitation that prevents them from being able to accomplish something or maybe they just don't have the talent to do it so they feel inferior so what we need to do with that whenever that occurs is help the children be able to cope with this let them know that not everyone can Master everything sometimes it takes time and just point out what things they are good in so they don't go there because whenever they start to feel that way it can lead to low self-esteem and just cause them to not really want to try anymore to try to accomplish things and then the next area you want to be familiar with is Piaget's so up until the age of seven they're in the pre-operational stage but whenever they get to seven to twelve they're in the concrete operation so remember concrete operations so our child is losing their egocentric thinking they're starting to know that hey other people have opinions and perspectives and they're turning into concrete thinkers which is really going to help them learn skills and understand the world around them we're not here at abstract thinking yet that comes a little bit later so with concrete thinking with statements they take it as it is said they don't think Beyond it or other scenarios or really look at that deep hidden meaning that's a little bit later on so here as a child starts really going from 6 to 12 they're going to start being able to develop some skills such as conservation and classification so let me give you an example of conservation so let's say we have two plates there is the same exact size and I put one scoop of food and it's the same amount of food on each plate well I'm going to now remove one of those plates and put a smaller plate but I'm going to keep that same amount of food on that plate so whenever I have a child who let's say is a preschooler they look at that they're going to look at that smaller plate and they're going to think that there's more food on that smaller plate than that larger plate but if I have a child who let's say eight or nine whenever they look at that plate and see what I did they're going to say hey that's the same amount of food you just switched the plate and made it smaller so they were able to see the difference where that younger kid wasn't now another thing that children can start doing is they can start classify fine objects so they can start to group objects based on their color their size and their weight or even what that tool or specific thing is used for and then the last Theory deals with moral development by kohlberg so whenever we're talking about rules and conforming to rules different age groups are going to do it for different reasons so early on up till the age of seven a child is going to conform to the rules based on a reward that they get or a punishment they get so if they act good they get a reward if they act bad they get punished but they don't really understand the meaning behind these rules and why they are there then as a child ages up till about the age of 10 they're going to start conforming to the rules because it lets people know around them that they are good if they have good behavior people are going to know them as being a good boy or a good girl so this is known as the good boy or nice girl orientation then as they get a little bit older towards the end of this age range the child is going to conform to the rules because of Law and Order orientation so they follow the rules because that is what society says and it's good for social order finally let's talk about the Adolescent age group the Adolescent also called the teenager Falls within the age range of 13 to 18 or 19 years of age now during adolescence there's a lot of changes that are occurring this child is changing physically emotionally and cognitively and if you look at a 13 year old and then compare them to an 18 or 19 year old you're going to see there is a difference in how they look they should look more adult-like also they should be more mature in their thinking abilities and their skills so adolescence is a very challenging time for a child because they are dealing with all of those changes physically that are younger age groups really didn't have to deal with plus they're trying to find their identity dealing with their body image and trying to maintain relationship ships because peers are really important to them so to help us remember all those important Concepts about the Adolescent we're going to remember the word teen so T is for the big changes and one huge change we're dealing with during this age range is puberty and puberty what it is is where the reproductive organs are becoming active hence that person is going to become sexually mature and they can make Offspring so they're going from child to adult and what becomes active for the girls are the ovaries and boys the testes now let's look at some quick facts about puberty so girls tend to start puberty about two years earlier than boys and puberty lasts about five years so all these changes that that person is undergoing doesn't happen over a month or two it happens in stages over this time period therefore you can look at the changes that are occurring in a girl or a boy and determine how far along they are in puberty so you can use what's called Tanner stages and this is a one to five point scale with five being the most mature so for girls it looks at the breast development and the growth of pubic hair and in boys it looks at the genital area the enlargement of the penis and the scrotum and the pubic hair so first let's go over the changes of puberty for a girl now girls tend to start puberty anywhere between 8 to 13 years of age and the first sign that a girl is starting puberty is that there will be breast changes so the development of breasts other changes that will happen to that girl throughout puberty is that there will be an increase of hair growth which will be under the armpits and in the pubic region and there will also be the increase of weight so fat is now going to start to be stored on the abdomen the butt and the thighs also the hips are going to widen over time as well so the average weight for a girl in the U.S that's 18 years old is about 125 pounds and then there's the increase in height so for both girls and boys this is a time of major growth so depending on the female's genetics and other factors she could potentially grow up to eight inches during this time period so the average height for a female in the U.S is 18 is about 64 inches so 5'4 now this the thing with girls is that they tend to stop growing two years after menstruation so once they get their period two years after that they will typically quit increasing in their height and menstruation tends to occur about two to three years after puberty Starts Now other changes that occur not only do we have a reproductive organs like our ovaries being active but other things start to become active like glands and we're talking about the sebaceous and the apocrine glands so sebaceous glands secrete oil so there's going to be an increased risk of acne developing zits pimples and the African glands which are sweat glands and this can increase the amount of sweat that the person puts out plus it can lead to body odor and finally there are emotional changes during this time as well because we have hormones involved especially with the ovaries things being released like estrogen so we can have emotional outbursts mood swings irritability and Sun depression now let's look at puberty changes for boys so boys can enter puberty anywhere between 9 to 14 years of age and what happens is that the penis and the testes will start to increase in size also there will be an increase of hair growth so you'll start to see an increase of hair growth under the armpits and the pubic area on the chest legs the arms and even the face there will also be voice changes so at first it may sound like that boy's voice is just squeaky and starting to crack But as time goes on it will start to become deepen and you can actually see these changes because the larynx on the throat will start to increase in size and we refer to this as the Adam's apple so you can start to see that now the larynx does increase in size on girls but it's not as prominent as it is in boys and that's just telling us that we have voice box changes there will also be the increase in weight and this is due to the increase of muscle mass this boy is putting on the average weight for a boy in the U.S that's eight teen is about 147.5 pounds there will also be the increase in height so during this time the boy can increase by a foot in their height with the average 18 year old boy here in the U.S with a height of 69.3 inches and boys tend to keep growing until they're about 20 years of age other changes that occur are similar to the to the girls with their skin those glands become active so they get those problems and they will have emotional challenges as well because reproductive organs are becoming active so we have testosterone on board along with other things which can lead to moodiness and agitation now some other changes that the Adolescent will be going through will be some teeth changes so before with our younger age groups we were cutting teeth we were losing teeth but now we're starting to wrap up that process where we're going to fine tune and have all of our nice 32 permanent teeth so by the age of 13 they should cut their second mole dollars and then by the age of 17 to 21 those last set of molars the wisdom teeth will come in so during this time some adolescents have braces to correct any crowding or other orthodontic issues so it's important you stress that they go to the dentist regularly at least twice a year every six months and the importance of continuing to brush their teeth twice a day into floss a daily plus the Adolescent is changing socially so before during the school age time friends were important they were starting to love to hang out with their friends but now pure influence is a major part of the teen's life they will dress how their friends dress consume the foods that are friends consumed and do the same activities of them and there's a lot of peer pressure during this time period so what teens like to do for fun is that they like to keep into contact with their friends so this will include text messaging using social apps talking on the phone surfing the internet they may also be working at jobs they like to go to the movies and they just like to hang out with their best friend groups and have a close relationship with them and then they may even play competitive Sports now during this time the relationship between the child and the parent is also changing because they are starting to separate from their parents and challenge their Authority this is all very normal so they are yearning for Independence and they don't want to be restricted by rules especially the older they get so the child and the parent relationship can become strained but once a child becomes an adult and they mature the relationship can actually become really close but during this time they need to Branch out and find their identity so with all these changes that are occurring to the team during this time period it can lead some teens feel not too sure about these changes and then plus when you throw on peer influence it can possibly lead to a negative body image so let's talk about body image for a second so body image is how you view your body and if you don't have a positive body image about yourself it can really affect how you view yourself like self-esteem your self-concept which in the end can lead to depression and eating disorders and this isn't a thing that just affects girls it also affects boys as well now during the time that we live this generation faces more challenges because we have the internet which bombards US with media and social media and it's constantly showing us what's pretty versus not what's pretty what's the ideal body and what isn't the ideal body so with this teens they like to use social apps and one thing they like to do is they like to post pictures and post videos and they get feedback on those and if they're not getting the feedback that they want it could lead to a negative body image or they're looking at other people their friends or celebrities and they see these pictures and these pictures sometimes aren't what really is reality it may be filtered it may be manipulated but to them that's why it really is so it can lead to problems and one thing an interesting article by the Mayo Clinic was talking about how teenagers are really affected by social media and this is one thing it said in the article and I quote a 2015 study found that social comparison and feedback seeking by teens using social media and cell phones was linked to depressive symptoms so this is something that we really need to help the teen understand and help them not have a negative body image so what are some things that we can do well we want to be real with that team so one thing is to be a role model for that team so as a parent or whoever is with that teen a lot you want to make sure that you yourself have a positive body image and that you put an importance on being healthy rather than looking a certain way or having a certain weight and if you've struggled with this as well share that with the team to let them know that this is something that people struggle with e is for eating disorder signs so you want to be looking for signs and symptoms that your teen may have an eating disorder one eating disorder is anorexia this will present with where the teen won't eat they'll restrict food they will be obsessive about losing weight exercising they'll be negative about themselves or there's also an eating disorder called bulimia and this is where the teen May consume lots of food and then they will just run to the bathroom and throw up afterwards they'll do this a lot or they will use laxatives next is is to avoid the media trap and I touched on this just moments ago but you want to make sure that there's understood rules for how the teen should use social media and talk to the teen about how not everything you see on TV or in a magazine is necessarily how a person looks or how their life is and then lastly love the team so let that team know that you love them and that you care for them and don't concentrate on how they look or on other people's looks but qualities and praise them and build them up and help them to feel confident the next part of our mnemonic is e for education so these are the educational points you want to go over with the team to help promote their safety because this is actually a dangerous time for the teen due to accidents that could lead to death so we have the teenager their body has changed physically they're adult-like they have amazing strength and endurance so they have maturity in some things but in some things not so much and some teens just really don't have a great ability to really see the consequences that are going to happen like yeah they know it can happen but they think that's not going to happen to me that happens to everyone else I'm mortal so they engage in like risky activities one thing that is big during this age time is driving around 16 that is when most teenagers start to drive so that leads to a lot of dangers and unfortunately according to the cdc.gov motor vehicle fatality is the leading cause of accident death among teenagers representing over one-third of all deaf to teenagers so as you can see driving safety is really important for the teenager so some things you want to include in education would be taking a driving course which is usually offered by most high schools the importance of always wearing a seatbelt whether you're driving the car or if you're a passenger in a car rules on driving so who you can ride with who you can't ride with not text messaging while you're driving or using your your cell phone and not driving under the influence of any substance and some other safety concerns would be self-harm like suicide and unfortunately a recent article by UCLA health said that suicide is the second leading cause of death in people ages 15 to 24 in the U.S so as a nurse you want to make sure you are assessing for those risk of suicide which could include the following leaving messages on social media or hints telling you that they want to die telling people goodbye they quit socializing all of a sudden they have outbursts of anger or depression giving away things they own Express being let down to others and saying life would be better without them having a plan that they have written or shared with you or they've experienced a recent traumatic event like a death of someone they're being bullied or a rejection and if the Adolescent is displaying any of these signs you want to get them help immediately via a mental health facility so in addition to the safety concerns with self-harm there's concerns about substance abuse because teens can be around other teens or other people who are using substances they may feel pressured to use those because they want to fit in with the peer group or they're Rebellion against their parents so you want to make sure you discuss with the teen substances that they may come into contact with and how to handle those situations and also discuss swimming dangers Sports make sure they're wearing that protective gear to protect their head and other organs dangerous with gangs and Firearms next is health education and there are several categories you want to discuss with them about this one is sleep so make sure the teen understands that they need at least eight to ten hours of sleep per night it's going to help them feel better throughout the day help them with their mood it decreases the risk of obesity and believe it or not you do a lot of your growing at night as a teenager because that's when your growth hormone is secreted so some things that can affect sleep is that you're staying up too late so you don't go to bed until 11 or 12 then you have to get up really early for school you're not getting in that time so you want to set a schedule and say hey I'm going to sleep at this time every night so I can get that period of time of sleep also the teens like to use devices you know they're on their cell phone a lot or computer or any device that puts out that blue light that blue light can affect your ability to sleep throughout the night messes with your sleep cycle so you want to make sure that you're limiting your device usage before bedtime also they need to know that they need to exercise at least one hour every day moderate to vigorous exercise to help just promote health and decrease obesity and they need sex education along with nutritional education so during this time they are growing as you've seen they can grow a lot of inches throughout this time and their body is just changing with hair growth the increase in a muscle mass Etc so we need to make sure that they are consuming enough minerals and vitamins to facilitate that growth so they want to make sure they consume good calcium iron protein folic acid zinc and vitamin D now the teenager again they have a lot of social influence they are busy with school and other activities so they may not consume what they need now why would they not consume what are some reasons why teenagers have poor nutrition well one thing obviously is that their life becomes very busy with activities friends and other commitments and it's just easier to eat foods that are high in calories and really don't have nutrition plus parents influence on food choices is limited they are eating and drinking what their peers drink and that includes usually a lot of soft drinks energy drinks or coffee type products where you know there's going to be less milk and water intake and they may have a negative body image so they may start skipping meals thinking that will help with weight loss or they may overeat to cope with stress which could lead to obesity so as a nurse you're going to be measuring their height the measuring their weight and you want to see what their BMI is so here's the following BMI chart for the team they are considered underway if their BMI is less than fifth percentile for the age height and gender normal if the BMI is fifth percentile or greater but not higher than 85th percentile overweight if BMI is 85th percentile or greater but less than 95th percentile and obese if BMI is 95th percentile or greater next we have our other e for Erickson's Piaget and Kohlberg's theories so for exams you definitely want to be familiar with these series for the Adolescent first I want to talk about Erickson's psychosocial development theories so the stage that the Adolescent is in that you need to remember is identity versus role confusion so the team is independent they're allowed to get out experience the world of course with their parents somewhat supervision and this really helps them form their identity because they're going to be in different social relationships and other experiences which is going to help them grow and explore and figure out who they are and what they want to do so this is going to drive them in their future relationships their careers and goals so the goal of this stage before we can get to the next is for this person to get Fidelity and this is where they have a commitment or faithfulness to obligations so if we can get them to form an identity they will become a stable productive person who is faithful to their obligations in Life or duties now they can enter in with role confusion where they get confused about who am I what am I supposed to do so what can happen is they become unsure of themselves and they sort of just drift around in their educational career and relationship Pursuits and really can't settle on anything because they really don't have an identity then next we have Piaget's theory on cognitive development so you want to remember that the Adolescent is in the formal operational stage and this is ages 12 years to adulthood so our adolescent is really mature in their thinking they went from being concrete thinkers like how our school-aged children were to more abstract thinkers they can plan for their future especially later on through this age range they're starting to understand cause and effect and they can hypothesize they can manipulate ideas or situations in their mind without actually seeing it and they can solve problems in their mind without actually having to figure it out on paper actually see it so they're really advancing in their thinking abilities and the next is Kohlberg's moral development theory and the Adolescent is in the social contract orientation period so we know that the teen knows that others have different ideas on what is right or wrong hints everyone has their own moral values so the teen yes understands that we have laws and rules that majority of people agree on although some groups of people will disagree on them but everyone will try to work together hence reciprocate or have like a social contract to follow these rules and laws so Society can exist and function however the teenager is starting to understand that people have rights and basic human freedoms and moral personal values they follow and if laws and rules hinder go against these there's an exception for the rules or the laws so they're starting to understand that people may not follow the rules or the laws if it goes against their personal values and then the last part mnemonic is in for nurses role with the hospitalized team so whenever the teen is hospitalized or some things you want to be aware of especially their fears so some fears that the team will have will be separation from their peers before with our younger children it was separation from their parents and in the school-aged child yeah there was separation from peers they didn't want to be forgotten about but this is a little bit deeper for the Adolescent it's fear of being rejected that they're no longer going to be part of the group because they're not there another thing is loss of control and again this is different we're in there we are interrupting the way that they live we're invading their privacy which is another thing that they fear and they're not being able to be independent and do what they normally do throughout the day with school and friends so they've lost control and the teenager will act out they may get really angry they'll May refuse to do something and that when they do that that gives them a sense of control I already touched on privacy invaded so with that make sure you are taking that into account and letting them have their time in their room and that if you have to do anything that shows private parts that you take care to cover them up as much as possible and then they have a fear of death and becoming deformed because remember body image is a huge thing for teenagers because they're changing they have peer influence so you want to take all that into account therefore there are some interventions we need to to remember as a nurse to help detain with dealing with these fears one thing we can do is be completely open and honest with the teenager about procedures about things that are coming up because teenagers are really good at knowing if you're being thrilled or not and they may hide their feelings so not really communicate if they're scared or anxious or ask you certain questions they won't they'll avoid doing that so as a nurse you want to anticipate questions that they're going to have about certain things and answer them without them having to actually ask the question you also want to give them as much control as possible in decisions and activities so if possible let them eat food that they want to eat have their parents or someone bring them food let them wear their pajamas instead of that not so nice looking gown in the hospital and let them have their own routines if possible also encourage social activities if there's a recreation room on your unit incorporate the teen as much as possible and get other teens involved so they can socialize and maintain privacy and whenever you have to teach them teach them with creative ways such as with videos that are age-appropriate diagrams photos and again encourage questions and anticipate those questions okay so that wraps up this comprehensive video on growth and development and don't forget to access the free quiz below to test your knowledge on this content