Growth

>Refers to quantitative changes-increases in size and structure

>As aOF
result
the growth
of FAMILY
the brain,(escalante-saac)
the child has a greater capacity for learning,
1 PEDIATRIC NURSING: CARE
THEofCHILD
AND
for remembering, and for reasoning. He grows mentally as well as physically
Development
>refers to qualitative changes
>its used to denote an increase in skill and ability to function
>it is a progressive series or orderly coherent changes
Progressive
>changes are directional
Orderly
>suggests that there is a relationship between a given stage and the stages which
precedes or follow
Principles of Growth and Development
1. Growth and Development are continuous processes from conception until death
2. Growth and Development proceeds in an orderly sequence
a) Cephalo- caudal
b) Proximal- distal
3. Different children pass at different rates

All body systems does not develop at same rate

There is an optimum time for initiation of experiences in learning
Primitive reflexes must be lost before development can proceed

A great deal of skill and behavior is learned by practice

Factors influencing Growth and Development
Genetic influences

Race and nationality

Sex
Intelligence level
Health
Environmental influences

HAVIGHURSTS developmental task for childhood

Birth to 6 years
Learning to walk
Learning to take solid foods
Learning to talk
Learning to control the
elimination
Achieving physiological
stability
Forming simple concepts

Learning to relate oneself

emotionally

Learning to distinguish right

and wrong

Learning physical skills

6-12 years

necessary for ordinary

games
Building wholesome attitude
toward oneself as a growth
organization
Learning to get along with
age mates
Learning an appropriate
masculine or feminine sex
roles
Developing fundamental
skills in reading writing
calculations
Developing conscience,
mortality, and as scale of
values
Achieving personal
independence
Computation of the weight and height of infants and children

From 1-6 years

Weight in pounds(lbs.) = age in years x 5 + 17
From 6-12 years
Weight in pounds(lbs.)= age in years x 7 +5
For infants below 6 months of age
Weight in grams= age in months x 600 + birth weight (300 grams)
For 6-12 months
Weight in grams= age in months x 500 + birth weight (300 grams)
Usual changes in weight at different age
At 4-5 months -------------------------------------------------------------- 2 x birth weight
At 1 year --------------------------------------------------------------------- 3 x birth weight

At 2 years -------------------------------------------------------------------- 4 x birth weight

At 3 years---------------------------------------------------------------------5 x birth weight
At 5 years -------------------------------------------------------------------- 6 x birth weight
At 7 years -------------------------------------------------------------------- 7 x birth weight

2 PEDIATRIC NURSING: CARE OF THE CHILD AND FAMILY (escalante-saac)

CRITERIA
Appearance(color)
Pulse, HR,
Grimace(reflexes)
Activity(muscle tone)
Respiration

0
Pale
Absent
No response
Flaccid
Absent

1
Blue
<100 bpm
Grimace
Some flexion
Weak

2
Pink
>100bpm
Cough/ sneeze
Well flexed
Good cry

TEMP REGULATION
-In utero, its increased than mothers temp
-Heat loss/unit body wt is 4x than that of adult due to its greater surface are in relation to the BW.
-Temp should be taken/rectum
PE
Color, respiration, cry is lusty, vigorous
Skin
Pink tinged and warm to
-Increased concentration of RBC in the blood vessels and SQ fats
touch
-White cheese like substance w/c serves as skin lubricant
Vernix caseosa
-Vasomotor disability
Acrocyanosis
-When lying skin appears red on the dependent side
Harlequin sign
-Plugged sebaceous glands
Milia
-Bluish black pigmentation
Mongolian spots
-Breakdown of RBC at birth, inc lvl of bilirubin leads to jaundice
Physiologic jaundice
HEAD
Inc ICP
Bulging fontanelles, fontanelle tenses
Diamond shape(2-3 cm
Anterior fontanelle
width, 2-4 cm length)
Triangular shaped
Posterior
Molding
Assymetrical
Caput succedaneum
Localized soft are of scalp
Cephalhematoma
Collection of blood resulting from ruptured blood vessels bet surfaces of cranial base
and periosteum
Signs of bone pathology:
*Microcephaly
*Craniotabes
POSTURE
Fit are dorsiflexed, flexed body and will offer resistance when extremities are
straightened
Chest
Bell shaped and <HC
Face and neck
Tongue is large-cretinism
High palatine arch- small head and mental retardation
Laxity and webbing of neck- Down/turner syndrome
Abdomen
Cardiac sphincter not well developed
Umbilical stump 6-10 days healed slough off
Omphalocele-esophageal atresia
Liver is palpable 2-3 cm below right costal arc
Genitalia
-Undesceded testes
-Slightly swollen owing to hormone activites w/ mother
Skeletal
Bones are soft- Compose of cartilage
Feet is flat- plantar fat pads
Blood coagulation
The majority of newborns are born w/ prolonged coagulation time because there
blood levels of vit K are lower than normal
Vit K is synthesized to the action of intestinal flora
A newborn intestine is sterile @ birth unless membranes were ruptured >24 hrs of
delivery
Flora must therefore accumulate before Vit K be synthesized
Autoimmune system
The newborn infant has difficulty antibodies against invading antigens until he
reaches 2mos of age
This is why immunization against childhood dx are not given to babie <2mos old
Neuromuscular system
Limpness or total absence of muscular responses to manipulation is never normal
and suggests narcosis, shock or cerebral injury
Blink reflex
Protects the eye from any objects coming near it by rapid eye closure
Rooting reflex
Newborn check is brushed/stroke near the corner of his mouth, the child turns his
head in that direction. Serves help baby find the food.
Sucking reflex
Infant lip is touched makes sucking motion
Extrusion reflex
Any substance is placed in the anterior portion of infants tongue, he will extrude it.
Its a protective reflex to prevent infant from swallowing inedible substances.
Disappears in 4mos of age
Palmar grasp reflex
When object is placed in newborns palm, child will grasp it by closing fingers on it;
disappears 6 wks-3 mos
Plantar grasp reflex
When an object touches the sole of newborns foot at the base of toes, his toes grasp
in some manner as his fingers; disappears 3 mos
Lies on his back, his head turns to other side; the arm and leg on the side to w/c his
head turns extend and the opposite arm and leg contrasts; disappear 2 nd-3rd mos of
life
Moro reflex
Startling the infant by loud noise or jumping his bassinet, the infant abducts and
extends his arm and leg; his fingers assume atypical C-position
Babinski reflex
When the side of sole of newborns foot is stroked in J curve from the heel upward,

3 PEDIATRIC NURSING: CARE OF THE CHILD AND FAMILY (escalante-saac)

Magnet reflex
Landau reflex
Step in place reflex
INFANT CARE CONCERS
1. Bathing

2. Diaper area care

3. Clothing
4. Care of teeth
5. Exercise

6. Sleep

HEALTH PROBS IN INFANT

1. Constipation

Ribbon like stools

Bouts of diarrhea
Failure to meet dvptal
milestone
Congenital hypothyroidism
2. Loose stools
Loose stools, distended
abdomen, def. in fat soluble
vitamins

3. Lactose intolerance

4. Colic

5. Spitting up

6. Miliaria

the newborn fans his toes in contrast w/ adult; occurs because of immaturity of
nervous system; fade 3 mos of age
If pressure is applied to soles of ft of infant in supine pos, he pushed back against
pressure
When newborn is hel in prone pos w/ hand underneath him supporting his trunk, he
should demonstrate some muscle tone
Newborn in vertical pos, his ft touches a hard surface, he will take few quick
alternating steps, disappear 3 mos
Helps infant learn different textures and sensations and provide opportunity to
exercise and kick
A good time for parent to spend time talking to child and communicating
Dont allow infant to wear a lengthy period of time
Frequently changed every 4hrs
Easily laundried
Not be binding dapat
Teach parents to begin brushing an infant as 1st tooth arise
Use soft brush and water once a day to prevent plaque from forming
2 wks- expose skin to sunlight, it provides natural source of vit D, no >3-5min if 1 st
day
Best time-11 am and after 3 pm
Suggestion to eliminate or at least cope w/ night walking
Delay bedtime 1 hr shorten an afternoon sleep period dont respond immediately to
the child at night to be certain that baby wont fall asleep again
Because stools tend to be loose
Stools infrequent in formula fed infants if diet is too high in protein, fat/ deficient in
fuid
If it persists beyond 5-6 mos- add food w/ bulk such as foods/veges such as
increased fluid intake
Prune juice maybe given but too much may cause diarrhea
Infants w/ hx of constipation for >1 wk should be examined for anal fissure/ tight
anal sphincter
SX OF HIRSCHPRUNGS DISEASE

Chronic constipation may occur in children w/ _

Stools of breast fed infants are generally softer than those who are formula fed
infants
May begin w/ introduction of solid foods such as fruits
Malabsorption syndrome/celiac disease or inability to digest fats may manifest itself
1st by:
Inquire about duration of loose stools:
*The number os stools/day
*Color and consistency
*any mucus ot blood in tehm
*Associated fever cramping & vomiting
Lactose is broken down in the intestines by the enzyme lactase
Sx:
Abdominal pain, flatulence, bloating, diarrhea
Paroxysysmal abd pain that generally occur in infancts under 3 mos of age
Sx:
Infants cries loudly and pulls leg up against abdomen
Face is red and flush
Fist clenched
Abdomen is tense
-major prob for parents because its frightening
-The infant appears to be in acute pain and the distress persist for hrs usually in
middle of night
BASIC RULE:
-Avoid heat in case appendicitis is developing
-Hot water bootles and heating pads shouldnt be used because eof the possibility of
burning the delicate skin of infants and young children
Ask pts to describe how they burp the infant, sicne burping thoroughly often helps
limit spitting up
They may put infant in an infant chair for half an hr after feeding
Reassure parents that it decreases in amt as baby can better coordinate swallowing
and digestive process
Or prickly heat- rash occurs most often in warm weather or when babies are
overdressed or in overheated rooms
SX:
Cluster of pinpoint
Reddened papules w/ occasional vesicles and pustules surrounded by erythema

4 PEDIATRIC NURSING: CARE OF THE CHILD AND FAMILY (escalante-saac)

-Bathing infants 2x a day during hot weather is added to bathwater- may improve
rash
CHILD REARING CONCERNS
1. Teething

High fever, convulsions, vomiting, diarrhea and earache are never normal
signs of teething.
Discourage use of OTC drugs because they may contain bentocaine and if applied
too far back in the throat may interfere with gag reflex
Acetaminophen is the best treatment
2. Thumb sucking
Parents should be taught that thumb sucking is normal and does not deform the jaw
line as long as it stops by school age
Be sure the infant has adequate sucking pleasure and then ignore thumb sucking
3. Pacifier
A baby who has colic craves sucking and enjoys pacifiers because his abdomen
hurts and interprets this as hunger sensation
EFFECTS OF SEPARATION FROM PARENTS
Kind of parenteral care
Factors
Kind of person
Maternal deprivation
Term used for an infants lack of warm relationship
EFFECTS OF DEPRIVATION (1ST 6 MONTHS)
1. Becomes emotionally isolated from adults
2. Retarded mental development
3. Cry great deal
4. Poor motor development
5. Will refuse contact with adults
EFFECTS OF DEPRIVATION (2nd 6 MONTHS)
Period of analyctic depression occurs
1. Depressed infants
2. Look sad cry a great deal
3. Withdrawn in their relationship with adults
4. May refuse to eat, loose weight
5. Respiratory disturbance
Walks alone
The 15 month old (toddlerhood)
Creeps upstairs
Build a tower of 2 blocks
Holds a cup with fingers
around it
Grasps spoon but spills
content
Pat pictures in book