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NURS 4352 Nursing Care of Children Growth and Developmental Norms Infant
Assessment Area Physical Characteristics* Expected for Age Height: 0-6mo 1in/mo; 6-12mo 1/2in/mo Weight Gain: Birth weight doubles at 6mo (1-1 ); Birth weight triples at 12mo Teeth: First appear 6mo then 1/mo Head Circumference: 0-6mo in/mo; 6-12mo in/mo Fontanels: Posterior fontanel closes at 2 mo; Anterior fontanel closes at 12-18 mo Vision: 4 mo. Binocularity well established; 7-9 mo. Depth perception HR-110-160; BP- 82/46; Respiration: 32-60 Grasping occurs during 2-3 months as reflex then become voluntary. By 6 mon. hold bottle, grasp feet, feed themselves crackers. Gradually palmar grasp is replaced by pincer grasp Bu 4-6 months head control is established. Turn from abdomen to back by 5 months. Back to abdomen 6 months. Parachute reflex by 7 months Crawling progresses to creeping by 9 months By 1-12 mon. walk while holding on. Moro (Disap 1-4mo), tonic neck(Disap 5-7mo), palmar grasp (Disap 4mo), babinski (Disap 2yr): >>>>Appear at birth Blinking& turning, rooting awake (Disap 3-4mo), rooting sleep (Disap 7-8mo), sucking (Disap 12mo) Stepping (Disap 4-5mo): >>>>>Appear at birth. Actual

Motor (Include Reflexes)

Language

Cognitive

Moral/Faith (Kohlberg/Fowler) Psychosocial

Prelinguistic: 10-12 mo (Crying>cooing>Babbling>first word) Holophrasic: 1 yr(single word phrases/sentences) 10 mo: mama dada with meaning, says 1 word 12 mo: shows emotion, imitates animal sounds, recognizes objects by name, understands simple verbal commands 0-1mo: Sucking, swallowing, rooting, grasping, crying 1-4mo: voluntary behavior, realizes progression of events, beginning separation of self-no stranger anxiety 4-8mo: Intentional activity, object permanencesearch for fallen objects, imitates sounds and simple gestures, begin recognizing symbols, stranger anxiety. 9-12 mo: Object permanence-actively searches for hidden objects, associates symbols w/ events, distinguish objects from related activities, works to achieve goals Kohlberg: N/a Fowler: Undifferentiated Trust vs. Mistrust

2 (Erikson) Play/Toys Trust feeding, comfort, stimulation, and caring needs will be met Mobiles, colors, sounds, texture toys, peek-a-boo

Toddler
Assessment Area Physical Characteristics* Expected for Age Anterior fontanel closes 12-18mo At age 2 about half of adult height Birth weight quadrupled by age 2-2 yrs. Bowed legs Pot bellied Age 1:walking; refined pincer grasp Age 1 : Throw ball overhand; build tower of 3-4 blocks Age: 1 : place raisin in narrow necked bottle Age 2: Walk up and down stairs one foot at a time; imitate drawing a circle Age 3: walk up and down stairs alternating feet. One word sentences or holophrases. up=pick me up or look up there By 2, child uses multiword sentences by stringing together 2 or 3 words. By 3 child puts words together into simple sentences, begins to master grammatical rules, acquires 5 or 6 new words daily 12-18mo: increased understanding of object permanence, early trace of memory, beginning awareness spatial, causal, temporal relationships 19-24mo: can infer cause, begin imitating, beginning sense of time 2-4yrs: uses preposition back, up, under, increasing vocab (2-3 word sent), begin to assoc. time w/ events, focus on 1 thing only (centration), assign life to inanimate objects (Animisim), magical thinking, Egocentric Kohlberg: Associate bad behavior w/ punishment, Associate good behavior w/ reward, If hitting/biting allowed then behavior not bad Fowler: Intuitive/Projective Faith Autonomy vs. Shame & Doubt Control (negativism, Ritualism), imitation Parallel imitation/fantasy(adult clothing, dolls, dishes, trucks) locomotive skills (push-pull toys, large balls, riding toys) fine motor skills (chalk, crayons, interlocking puzzles) language skills (cassette recorder, talking toys, appro. television, reading books) tactile toys (water toys, sandbox, soap bubbles, clay, finger paints) Actual

Motor (Include Reflexes)

Language

Cognitive

Moral/Faith (Kohlberg/Fowler)

Psychosocial (Erikson) Play/Toys

Preschool
Assessment Area Physical Characteristics* Expected for Age Rate of physical growth slows Average weight 32lbs at 3 yrs; 4.5-6.5lbs per year Height remains steady w/ yearly increase of 2.5- 3.5 in. Slender but sturdy, graceful, agile, posturally erect Walking, running, climbing, jumping established by 36mo. Age 3: rides tricycle, walks on tiptoe, balances on 1 foot Age 4: Skips & hops on one foot, catches ball well Age 5: Skips on alternate feet, jumps rope, skates, swims Increasing ability to draw Vocab 300 words (age 2); 2100 words (age 5) Telegraphic speech: me go there Cam use prepositions at age 4 2-4: preconceptional 4-7: developments of conscience, able to verbalize, thinking w/o acting on it, able to see anothers point to view. Kohlberg: Nave Instrumental Orientation (Punishment/ Obedience), try to satisfy own needs, some elements of fairness, reciprocity and equal sharing (Fairness), Concrete sense of justice Fowler: Mythical-literal faith Initiative vs. Guilt Great satisfaction in achieving skills, very energetic, feel sense of guilt from bad thoughts Associative: imaginary playmates, imitate grown-ups, dramatic play Actual

Motor (Include Reflexes)

Language

Cognitive

Moral/Faith (Kohlberg/Fowler)

Psychosocial (Erikson) Play/Toys

Schoolage
Assessment Area Physical Characteristics* Expected for Age Height: 2-4 in/yr (1-2 ft) Weight: 4.5-6.5 lb/yr Avg. 6 yr old weighs 46lbs, 45 in. tall Avg. 12 yr old weighs 88lbs, 59 in tall More coordinated More coordinated Speaks clearly and uses correct grammar Forms 5-6 word sent. Uses more complex grammatical forms Has a vocab of 2500- 3000 words Develop ability to understand metaphors. Concrete Operation 7-11 Perceptual thinking- judgments based on what they see Conceptual thinking- judgments based on reason, past experiences used to interpret present Kohlberg: Good Boy-Nice Girl (6-7 yrs old): Know the rules, rewards/punishment guide judgments, judge acts by consequences, interpret accidents a s punishment for bad deeds, worry about past behaviors Actual

Motor (Include Reflexes) Language

Cognitive

Moral/Faith (Kohlberg/Fowler)

4 Law and Order Orientation ( >7 yrs old): Consider different point of view, understand ;golden rule Fowler: View God as human w/ traits such as loving and helping, Go to hell for misbehavior, Comforted by prayer. Industry vs. Inferiority Stage of Accomplishment If unable to master skill fells inferior, fear of failing See need for rules, team play/sports, hero worship, need opportunities for physical activity and board games.

Psychosocial (Erikson) Play/Toys

Adolescent
Assessment Area Physical Characteristics* Expected for Age Girls: 2-8 in. and 15-55lb height/weight gain. Peak height growth at menarche. Growth spurt b/n 9 -14 years. Boys: Gains 4-12in. and 15-65lb; peak height growth at 14 y following growth of testicles and penis and appearance of axillary and mature pubic hair. Growth spurt b/n 10 - 16 y. Growth in length of extremities and neck precedes growth in other areas. Hands and feet appear larger than normal Increase in hip and chest take place in a few months followed by increase in shoulder width. Sex Characteristics develop.Puberty begins Reflexes developed Language developed 11-14- abstract thinking, hypothetical thinking, futuristic thinking, decision making abilities, adolescent egocentrism (self absorption, imaginary audience, feel own experience is unique) Kohlberg: absolute moral guidelines, abstract reasoning of right and wrong, individuating, reflexive, more skeptical, compare religious standards, time of researching. Fowler: Synthetic- Convention Faith Identity vs. Role Confusion Picture of oneself from past/present experiences sense of where one is headed in future. Make own decisions w/ advice of others. Diffusion- lack of firm identity. Leisure activities (peer-centered) Actual

Motor (Include Reflexes) Language Cognitive

Moral/Faith (Kohlberg/Fowler)

Psychosocial (Erikson)

Play/Toys

May use bullets to list. *(height, weight, body structure/ composition/ proportions, stature, etc. For infants include characteristics such as teeth, fontanels ) References Professor Kathy Horton Class notes. Hockenberry, M.J., Wilson, D. (2009). Wongs essentials of pediatric nursing (8th ed.).St. Louis: Mosby Elsevier.