Growth and developmental assessment of the child Principles of growth & development P25 Major theories of development ＆nursing application P26~P36 Influences on developmentP36 各年齡層兒童的生長與發展 P39~P66 評估
Principles of growth & developmentP25 • The exact age at which skill emerge differs, but the sequence or order of skill performance is uniform among children. 第2段第2行 • Cephalocaudal development • Proximodistal development • Physical size, motor skills, cognitive ability, language, sensory ability, and psychosocial patterns. • These assessments can guide the nurse in planning interventionsfor the child and family.
Major theories of development ＆nursing application P26~P36 • Simon Freud－psychosexual • Erik Erikson－psychosocial • Jean Piaget－cognitive development • Chess ＆Thomas －Temperament theory
心理社會發展 • Simon Freud • Psychosexual • id 、ego (defense mechanism P27)、superego • oral、anal、phallic、latency、genital P27
心理社會發展 P27, 29, 30 • Erik Erikson • Psychosocial • Trust v.s. mistrust (birth to 1 year) • Autonomy v.s. shame and doubt (|1 to 3 years) • Initiative v.s. guilt (3 to 6 years) • Industry v.s. inferiority (6 to 12 years) • Identity v.s. role confusion (12 to 18 years) • Two possible outcomes P27倒數第四行最後 • Healthy＆moves on to future stages • Unhealthy outcome＆will influence future social relationships.
Jean Piaget P30~32 • Cognitive development • Accommodation(適應) • Assimilation(同化)&change • Sensorimotor (birth to 2 years) • Preoperational (2 to 7 year) • Concrete operation (7 to 11 years) • Formal operation (11 years to adulthood)
Chess ＆Thomas P34~36 • Temperament theory 先天就決定的對內在或外在刺激的反應模式 • Nine parameters of response to daily events (Table 2-5) P35 • Three major personality types (Table 2-6) P35 • Nursing Application
Influences on developmentP36 • Genetics • Prenatal influences • Cultural influences • Others influences • Nutrition、Family structure、School、Stress、Socioeconomic influences、Community、Media
各年齡層兒童的生長與發展 P39 • Physical growth and development • Cognitive development • Injury prevention • Personality and Temperament • Play and communication • Sexuality
Infant • Physical growth and development P40-42 • The first year of life is one of rapid change for the infant. P40第1段 • The birth weight usually doubles by about 5 months and triples by the end of the first year(Figure 2-7*). • Height increases by approximately l foot during this year. • Teeth begin to erupt at about 6 months, and by the end of the first year the infant has six to eight deciduous teeth (see Chapter 4). • Kidney and liver maturation helps infant excrete drugs or other toxic substances. P40第2段 • Maturation of the nervous system is demonstrated by increased control over body movements, enabling the infant to sit, stand, and walk. • Sensory function also increases as the infant begins to discriminate visual images, sounds, and tastes. • 參考Table 2-11
Infant • Cognitive development P42-43 • The newborn's eyes widen an response to sound. • Turns to the sound and recognizes its significance. • The 2-month-old cries and coos • 1/y says few words and understands many more. • The 6-week-old grasps a rattle . • The l-year-old reaches for toys and self-feeds. • The infant receives stimulation through sight, sound, and feeling, which the maturing brain interprets. This input from the environment interacts with internal cognitive abilities to enhance cognitive functioning.
Infant • Injury prevention P44 • Major cause of death in childhood. • Increasing mobility
Infant • Personality and Temperament P45 • They may display varying degrees of regularity in activities of eating and sleeping, and manifest a capacity for concentrating on tasks for different amounts of time . • The parents can appreciate more fully the uniqueness of their infant and design experiences to meet the infant's needs. Parents can learn to modify the environment to promote adaptation. • Although the infant's temperament is unchanged, the ability to fit with the environment is enhanced.
Toddler • First adolescence. • Displaying independence and negativism . • Physical growth and development P47 • Growth slows • By age 2 years, the birth weight has usually quadrupled and the child is about one half of the adult height. • Body proportions begin to change, with legs longer and head smaller in proportion to body size than during infancy (see Figure 2-7). • The toddler has a pot-bellied appearance and stands with feet apart to provide a wide base of support. • By approximately 33 months, eruption of deciduous teeth is complete, with 20 teeth present. • 粗及精細動作發展圖P48, P49Table 2-16 Toilet Training
Toddler P47 • Cognitive development • Preoperational stage • Object permanence is well developed. • About 2 years of age, increasing use of words . • Rudimentary problem solving, creative thought, and an understanding of cause-and-effect relationships are now possible.
Toddler • Injury prevention P49 • Family want to know P50 • Table 2-18 Injury Prevention in Toddlerhood P51
Toddler • Personality and Temperament P50 • The toddler retains most of the temperamental characteristics identified during infancy, but may demonstrate some changes. • Increasing independence characteristic of this age is shown by the toddler's use of the word no.
P52 Preschool child • A time of new initiative and independence. • Most children are in a child care center or school for part of the day and learn a great deal from this social contact. • Language skills are well developed, and the child is able to understand and speak clearly. • The world of busy preschoolers.
Preschool child P52-54 • Physical growth and development • Grow slowly and steadily, with most growth taking place in long bones of the arms and legs.. • Runs with ease, holds a bat, and throws balls of various types. • Writing ability increases, enjoys drawing and learning to write a few letters. • Begin to brush their own teeth, and schedule the first dental visit so the child can become accustomed to the routine of periodic dental care. • Table 2-20.
P54 Preschool child • Cognitive development • Preoperational thought. • Symbols or words • Still has some limitations in thought (Table 2-22).
Preschool child P55 • Injury prevention • Increasing independence. • At high risk of injury from fire, drowning, and motor vehicle and pedestrian accidents.
Preschool child P55 • Personality and Temperament • Characteristics of personality tend to persist over time. • The preschooler may need assistance as these characteristics are expressed in the new situations of preschool or nursery school • To identify the child's personality or temperament characteristics and to find the best environment for growth..
School-age child • Physical growth and development P58 • Long bones continue to grow, leg length increases. • Fat gives way to muscle, and the child appears leaner. • tooth • the first deciduous tooth is lost at 6 years and permanent teeth begin to erupt. • Closely monitored to ensure that brushing and flossing are adequate. • Loose teeth are identified before surgery or other events that may lead to loss of a tooth. • Body organs and the immune system mature. • Medications are less likely to cause serious side effects. • The urinary system can adjust to changes in fluid status. • Rapid increases in size commonly occur during school age. • Physical skills are also refined . (Table 2-25).
School-age child P59 • Cognitive development • Concrete operational thought at about 7 years. • Consider alternative solutions and solve problems. • Rely on concrete experiences and materials to form their thought content. • Learns the concept of conservation.
School-age child • Injury prevention Play in unsupervised settings for longer periods . P61
School-age child P62 • Personality and Temperament • The enduring aspects of temperament continue to be manifested during the school years. • Creative efforts and alternative methods of learning should be valued. • Encourage parents to see their children as individuals who may not all learn in the same way.
School-age child P62 • Sexuality • Although children become aware of sexual differences between genders during preschool years, they deal much more consciously with sexuality during school age. • Need information about their bodily changes . • Become interested in sexual issues .
Adolescent child P62 A period of identity formation. • Physical growth and development • The physical changes ending in puberty, or sexual maturity, begin near the end of the school-age period. • The prepubescent period : growth spurt. • The increase in height and weight is generally remarkable. • Girls :breast size , pubic hair & menstruation occurs. • Boys: penis and testes size , pubic hair, deepening of the voice and growth of facial hair occur later. • Take adult doses of medications. • Table 2-28
Adolescent child • Cognitive development P63 • Formal operational thought. • The ability to reason abstractly. • The ability to think and act independently leads many adolescents to rebel against parental authority. Through these actions, adolescents seek to establish their own identity and values.
Adolescent child P63-65 • Injury prevention • They often believe they are immune from harm. This encourages adolescents to put themselves at high risk from dangerous behaviors . P63倒數第3行 • Motor vehicle crashes, suicides, and homicides cause 75% of adolescent deaths . P63此段第1行 • Suicide among adolescents has increased by 300% over the past four decades and is the second leading cause of death from l5 to l9 years(MMWR, 1995; Hayden & Leuer, 2000) . P64第2行 • The high rate of stress experienced, harmful substances and firearms promotes death by suicide. P64倒數第4行 • Violence is an increasingly important factor in adolescent injury. P65 第2段第1行
Adolescent child P65 • Personality and Temperament • Characteristics of temperament manifested during childhood usually remain stable in the teenage years. • It is also common for an adolescent who was an easy child to become more difficult because of the psychologic changes of adolescence and the need to assert independence.
Adolescent child • Sexuality • Achieves sexual maturity • Interactions with members of the opposite sex. • The forces of society and family • Identity formation. P66
評估 • 兒童完整健康史 • 身體檢查與評估 • 身心發展評估工具
兒童完整健康史 • 個人：病史、營養史、發展史 • 家庭評估：家族史、家庭內/外在結構、家庭互動 • 營養評估：體重及生長發育的情形、血比容及血紅素、皮膚及皮下脂肪、排泄睡眠精力）（飲食習慣、進食的量與質、對食物的喜好以及吸收的狀況 • 熱量需要量 • 奶量的計算 • 副食品添加（嬰幼兒每天飲食建議量） • Physiologic anorexia
熱量需要量 • 0-6M 115 Cal/Kg • 6-12 105 Cal/Kg <1y/o 110-120 Cal/Kg • 1y/o左右 1300 Cal/day • > 1y/o 每增1歲增加100 Cal
奶量的計算 • 全奶 14% 30 ml = 20Cal
嬰幼兒每天飲食建議量 • 1~3個月大 • 牛奶占100％ • 4～6個月大 • 牛奶占80～90％ • 副食品：果汁、青菜湯、麥糊或米糊 • 7～12 個月大 • 牛奶占50％～70 ％ • 副食品：稀飯、麵條、蛋 • 1～2歲 • 牛奶占30％
身體檢查與評估 • 技巧--視、聽、叩、觸診 • 生長測量 • 身高、體重、頭圍之生長曲線圖、成長曲線圖 • 生理測量 • 體溫、脈搏、呼吸、血壓 • 器官或系統的檢查與評估
兒童生長可能有問題的情況 • 身高與體重的百分位相距太大 • 無法達到預期的生長速度(尤其是嬰幼兒及青少年期) • 成長突然增快或遞減
身心發展評估工具 P197 Table 6-2, P198 Table 6-3 • DDST（Denver Developmental Screening Test） • 社會適應、精細動作、粗動作、語言發展 • BSID（Bayley Scales of infant Development） • 心智、動作、行為量表 • PDMA（Peabody Developmental Motor Scales and Activity Cards） • 氣質評估量表 活動量、規律性、注意力分散度、趨避性、堅持性、反映閥、適應性、反應強度以及情緒本質。
氣質量表 • 嬰兒氣質評估量表 • 學步期幼兒氣質量表 • 兒童氣質量表 • 青少年氣質量表 徐澄清， “小時了了”