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Growth patterns

______________ pattern- growth happens in a sequential pattern for most children

 Missed or lost milestones should be further evaluated
 Anticipatory guidance – education for the current stage of development

Cephalocaudal- growth from ____ to _____ (rapid brain development first as well as motor control of
head and neck
Proximodistally- grow from near to far or midline to periphery
Differentiation- proceed from _____ motor skills to _______ motor skills (simple to complex)

Psychosocial- (in each age group)

 Freud
 Erikson
Cognitive theories-
 Piaget
o Sensorimoter (birth to 2 years)
 Cognition (learning) thru the ______ on physiological and emotional level
o Preoperational (2-7 years)
o Development of motor skills
 Preconceptual – 2-4 years
 Egocentric
 Magical thinkers
 Associates words with objects/symbols
 Intuitive- 4-7 years
 Thinks of others more so not as egocentric
 Can think of one idea at a time
 Words are used to express thoughts
 Concrete operational 7-11 years (school age)
 Can organize thoughts in an organized manner (categories)
 Solve concrete problems
 Formal operational – 11 and older (adolescent)
 Abstract reasoning to handle difficult concepts
 Can analyze both sides of an issue

Moral Development theory

 Kohlberg – learning the thinking processes needed for moral development
o Level I. Preconventional Morality
o Morality is determined by external sources—rules, laws, possibility of
punishment.
 Stage 1: Obedience and _____________—The child will obey to avoid
being punished.
 Stage 2: Individualism and Exchange—The child thinks that it may be
okay to do something wrong if good comes from it (in other words, the
end justifies the means).
o Level II. Conventional Morality
o Morality is determined by being a “__________” The intent is to please others and to do
the “right thing.”
 Stage 3: Good interpersonal relationships—The child’s moral decisions are based
on the “goodness” of motivation and on what others expect.
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 Stage 4: Maintaining the social order—The child’s good moral decisions are
those that preserve the needs of society.
o Level III. Postconventional Morality
 Stage 5: Social contract and individual rights—The individual’s thinking is
characterized by a deeper questioning of social order versus an individual’s
personal rights. A person in this stage works tirelessly to change unjust laws.
 Stage 6: Universal principles—An individual incorporates a deep awareness of
justice. An example would be breaking an unjust law to save the lives of innocent
people.

Infant (birth to turning 1)

Developmental stages:
Erikson: trust vs Mistrust- trust is made by having others meet their needs, __________ is how
they show a need
Freud: oral stage- everything goes in their ___________
Fear:
 __________ anxiety- around 8 months, any new or infrequently seen person may illicit
response
o Approach slowly and with parent within sight of child
 Separation Anxiety- around 8 months, do not understand that parent will come back when
they go
Play- solitary play
 “play is the ________ of children” – practice gross and fine motor skills, Problem solving
 Would rather play with parent than toy
 Older infant- stacks cups or large blocks
 Reading
Hospital setting:
 Separation anxiety
 Stranger anxiety
 Disruption in normal routine
What can nurses do?
 Encourage ____________ among caregivers.
 Encourage the parents to stay with the infant.
 Encourage bonding.
 Allow the infant’s home routine whenever possible.
 Comfort the infant; rock, hold, cuddle, swaddle.
 Encourage parents to bring familiar toys/blanket from home.
 Communicate with parents.
Growth pattern: read thru table 13.5 noting when these happen:
Milestones-
Gross motor: rolling over, sitting up, walking
Fine motor: carries objects to mouth, pincer grasp
Communication
Communicate thru the senses- touch, sight, and hearing
 Respond to crying in timely manner
 Talk to the baby directly but allow them time to warm to you
 Use soothing, calm tone
 Use play with older infant
 Watch for signs of ______________: yawning, turning away, decreased eye contact, irritability
Preparing an Infant for a Procedure
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■ Describe the procedure to the parents, explaining what will happen and how long it will take.
Encourage the parent to stop you at any point if they have a question.
■ Remind parents that infants often cry for reasons other than discomfort but be honest about any
discomfort the infant may experience with the procedure.
■ Identify what ____________ may be used and give an explanation as to why they are needed.
■ Allow parents to decide whether they would like to be present for the procedure. Parents may
prefer to leave the room and return immediately following the procedure to comfort their child.

Safety concerns: most common fatal is suffocation

 Injury prevention:
o Falls- safety gates on both ends of stairs, never left alone on raised surface, keep hand on
them when changing diaper
o Water safety- can drown in very small amount of water
 keep all sources of water behind closed door- toilet, pools, buckets
 The bath water must be below 120°F
 Keep ____________ on infant at all times in bathtub.
o Chemicals/electrical- outlet plugs, safety latches for stored cleaning supplies/meds
 smoke and carbon dioxide detector and fire extinguisher
o Car seat- ____________ until 2, no children left alone in cars (inside 3-5x outside temp)
o Strangulation- no hanging cords (blinds, curtains, IV tubing?)
 Never attach a pacifier with clip to infant’s clothes or around neck.
 Choking hazards
o Age appropriate toys (no small parts that can come off if chewed and choke child)
o Floors clear of small objects-coins, paper clips,
o Proper food choices- no hot dogs, popcorn, nuts, grapes, hard candy, carrot slices
 Safe sleep (SIDS prevention)-
o Sleep on their __________ (back to sleep)
Crib safety: Suffocation risk
 the distance between slats of railings should be less than 2 ⅜ inches to prevent
head entrapment or strangulation, no sharp edges
 mattress and sheets snug with no blankets, toys, pillows in bed
 Never leave _________ down
 Furniture paint should be nontoxic
 positioned to avoid cords, windows, curtains, blinds, outlets, and lamps.
 If placed in car seat or swing, always use safety straps
 Do not let sleep in playpen (suffocation risk depending on type)
Nutrition: (more info in newborn content)
 Breastfeeding or formula exclusive until 4-6 months
o Bottles are warmed slowly in hot water, and the ___________ is never used to warm a
bottle.
o Keep hot liquids and foods away from the baby.
 Solids- (start with soft/pureed foods on spoon)
o If breast fed, start with Breast milk mixed with cereals or other soft foods first
o Lacks proper enzymes to digest and ability to swallow safely
o No __________ until 1 yr old due to botulism risk
 Fruit juice- may take up space with empty calories. (opt for real fruit, not juice)
 Balance- time to adjust to new food option but do not expect them to eat it all

Concerns:
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 Teething- pain from inflammation from tooth eruption, use cold teething ring (starts around 6
months usually but differences vary)

 Failure to thrive

Anticipatory Guidance for Infants

Nutrition: Review breast- and bottle feeding guidelines; introduction of solid foods (6 months); encourage
self-feeding when appropriate; finger foods; weaning to cup (9–12 months); family meal time; change to
whole milk at 12 months

Health Promotion: Signs and symptoms of illness: vomiting, diarrhea, fever, dehydration, and jaundice;
immunizations (see immunization schedules at http://www.cdc.gov/vaccines/schedules/); recommend
CPR training; review emergency procedures; oral health—brushing with nonfluoride toothpaste after
eruption of first tooth, schedule first dentist appointment

Focus on Safety: Safety guidelines for crib; place car seat in back of car in a rear-facing position; position
on back for sleeping to decrease risk of sudden infant death syndrome, do not leave infant unattended,
install smoke detectors; lower crib mattress and childproof environment as child becomes more mobile;
close supervision; discourage use of baby walkers

Sleep-Wake Patterns: Expected patterns at each month of age; expectations for sleeping through the night,
naps; establishment of nighttime rituals (see Family Teaching Guidelines: Sleep/Rest)

Cognitive and Emotional Development: Age-appropriate toys and interactive games; talk and sing to
infant; read stories; respond to infant cries; face-to-face time

Motor Development: Support head and neck; supervised “tummy time” to increase neck, arm, and torso
strength; provide safe space for child to move about; provide opportunities for sitting, crawling, and
walking

Discipline: Discuss discipline versus punishment; limit-setting; apply rules consistently

Toddlers between 1& 2 years old (two years- from turning 1 to turning 3)
Developmental stages:
 Erikson: Autonomy vs shame and doubt—
o Power struggles: Finding their independence, sense of control,
o “do it myself”
o Negativism: “_____” is often the answer even if they mean yes
 Freud: anal stage- focus on achieving sphincter control
 Fears:
o Separation anxiety: 18-24 months
o Strangers, _______, loud noises, large or unfamiliar animals
 Emotional lability- happy and pleasant one minute, ______________ to limit setting next minute
 Play- parallel (play along side rather than cooperatively)
 Delayed imitation of others using symbols (making “cupcakes” using blocks)
 Animism- human feelings given to objects- (my truck is sad)
 Its “_______”- do not do well taking turns or sharing until 3
 Need 30 minutes of structured physical activity/day and 1 or more hours of unstructured
 Reading part of everyday
Hospital setting:
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 __________- normal moving backwards with new learned tasks, focus on other positive things
and do not draw attention to the loss in skill (example- sleep regression, thumb sucking, pacifier)
o Not the same as a loss of milestone such as being unable to walk or sit up
 Separation anxiety
 Negative behavior
 Increase in tantrums
 Fearfulness
What can nurses do?
 Encourage consistency among caregivers.
 Encourage the parents to stay with the toddler.
 Allow the child’s home routine whenever possible.
 Encourage parents to bring familiar toys/blanket from home.
 Communicate with parents.
 Allow the child to participate in care whenever possible.
 Use therapeutic play.
 Offer praise.
 Ensure a _________environment.

Growth pattern:
Milestones- may reach half of adult height by 2 years
Communication-
 will repeat phrases that they do not understand, will use only important words in sentences
(“want cookie milk”)
 Approach toddlers carefully, expect ______ with some natural resistance
 Use toddlers’ words preferred words for objects or actions to help them understand (go potty,
booboo, etc)
 Play ____________them--- dolls, stories, books, stickers
 Comment on their toys, role play with procedures on the dolls
 Allow them time to ask/answer using their own words and thoughts
 Give ______ possible choices and use simple honest language
o Which yummy medicine do you want first? Cherry or grape.
o Not: do you want to take your medicine. The answer would be NO
Preparing a Toddler for a Procedure
■ Describe the procedure to the parents, explaining what will happen and how long it will take.
■ Use play to demonstrate the procedure to the toddler; encourage them to demonstrate or
practice with _____________________.
■ Use simple, concrete language to describe the procedure and how it might feel to the toddler.
Limit preparation to 5 to 10 minutes because of the child’s short attention span and anxiety
■ Identify what restraints may be used and explain why they are needed.
■ Allow parents to decide whether they would like to be present for the procedure. Parents may
to leave the room and return immediately after the procedure to comfort their child. Allow the
parents to stroke their child or speak soothingly to their child if they remain in the room.
Safety concerns: Most common fatal drowning
 Car- rear-facing car seat until 2 in backseat (middle).
 Smoking-
o linked with respiratory illness, ear infections, decreased lung function
o No smoking in the house
o Outdoor smoking is still exposing children via parent’s clothing
 Injury- able to open drawers, unlock deadbolts, climb anywhere, no fear of danger
o Safety Lock: unsafe rooms, windows, exterior doors, gates to pools, firearms lockbox
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o Burns: turn __________ inward on stove, safety outlets, hide matches/lighters

o Outside: _________ if riding, watch for cars, never left alone, avoid unknown animals
 Choking
o Add difficult to chew foods slowly and cut all food into small bite size pieces
o Avoid very hard to chew foods: nut, chewy candies, raw carrots, PB butter, popcorn
o Cut hot dogs and grapes into quarters
o Steam or cook hard foods such as carrots until soft
o Always ______________ while eating
 Poisoning- poor take discrimination, curiosity
o Keep in original bottle and never place in food containers
o Never discuss medicine as _________
o High danger- button batteries, strong chemical/street drug vapors, transdermal patches
o Medicines- should be in child safe bottles and kept out of child’s reach
o ______________ number nearby
 Water-
o Cannot truly learn to swim until age 4/5
o May still drown in small amount of water: toilet, bathtub, buckets
o Fence around all pools with locked gates
o Never left _______________ in water (even during bath time or if in float device)
o CPR
Nutrition:
Weaning: Breast- (EBP)- longer the mother breastfeeds, less likely for child to be obese
o Supportive for mothers regardless of when they chose to wean. Recommended for at least
1 year in US and at least 2 years by World Health Organization
 Bottle feeding- wean by 12-15 months due to risk of cavities
Nutrients
o Calories- 1000-1400cal/day depending on lifestyle – reference fast food meal
o Include a variety of foods with each meal and always include a fruit or vegetable
o Use whole grain options
o Do not require toddlers to finish their plate of food (they will usually self-regulate what
their bodies need if given healthy options instead of junk food)
o Calcium- dairy, broccoli, oranges, sweet potatoes, tofu, dried beans, legumes
o Iron- limit iron poor cow’s milk and fruit juice- replace with iron rich food
o Fiber- recommended 19 grams – apple sauce, carrots, green beans, mango, pears
Sugar
 Juice- Juice should be avoided or limited to 4-6 oz/day due to high sugar content and studies
showing that children who eat healthy but drink juice may still be obese.
 EBP: A study conducted by the AHA found children as young as 1-3 years already bypass the
daily recommendations, and typically consume around 12 teaspoons of sugar a day.
 Cavities- teeth brushing with small amount of fluoride twice daily
Concerns:
Tantrums- rest if tired, feed if hungry, calming setting if overwhelmed,
keep safe but allow to work thru their emotions

Anticipatory Guidance for Toddlers

Nutrition: Family meals; allow toddler to self-feed and use a cup at meal times; allow child to make food
choices; provide finger foods; provide two to three healthy snacks per day; do not force eating
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Health Promotion: Signs and symptoms of illness: vomiting, diarrhea, fever, and dehydration;
immunizations (see immunization schedules at http://www.cdc.gov/vaccines/schedules/); recommend oral
health: brushing, routine cleanings

Focus on Safety: Lower crib mattress; transition to toddler bed by age 3; toddler car seat; lock windows
and secure curtains and mini-blind cords to prevent asphyxiation; secure doors; update childproofing of
home; use bike helmet; water safety; check smoke detectors; supervise play; sunscreen

Sleep-Wake Patterns: Continue nighttime rituals; consistent bedtime; expect nightmares and develop
strategies to deal with them (see Family Teaching Guidelines: Sleep/Rest)

Cognitive and Emotional Development: Read short stories daily; provide simple explanations; respond to
child’s verbalizations; praise accomplishments; schedule play dates; teach child how to express feelings;
expect child to test limits; encourage self-expression and self-care; limit TV to 1 to 2 hours/day

Motor Development: Promote fine motor skills: crayons, blocks; provide outdoor play with balls, push
and pull toys; play with toddler

Discipline: Apply rules and consequences consistently; provide brief time-outs

Preschool age (between 3-6 years old 3,4,5)

Developmental stages:
 Erikson: Initiative vs guilt- ________when they accomplish something and guilt when they can’t
 Freud: pleasure centers on genitalia and masturbation
o rivalry with same-sex parent, love of opposite sex parent
 Fears- loud noises, imaginary monsters, dark, strange people/animals, previously painful place
 Play: _______________ begins
o ______________-use make believe to satisfy curiosity in the world (imaginary friend)
o Good vs bad based on whether they are punished (testing limits)
Hospital setting:
 Play restrictions
 Fearfulness
 Thinks that hospitalization is a________________
What can nurses do?
 Encourage consistency among caregivers. Encourage the parents to stay with the preschool child.
Allow the child’s home routine whenever possible. Encourage parents to bring familiar toys from
home. Communicate with parents.
 Allow the child to participate in care whenever possible. Use therapeutic play. Offer praise.
 Ensure a safe environment.
 Encourage use of the playroom and interaction with other children.
 Explain a procedure, treatment, and/or surgery in simple terms. Allow the child to ask questions.
 Encourage realistic choices whenever possible.
Growth pattern:
Milestones- more voluntary control, less clumsy
Communication
 Use play, puppets, or storytelling
 Speak ___________ and use simple concrete terms
 Use “soft” or less scary words when possible.
o IM shots: This may be warm instead of this may burn.
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o Blood pressure: check your muscles to see how strong you are instead of let me check
your blood pressure.
 Allow the child choices as appropriate
 May use imaginations to make wrong assumptions important to clearly communicate in a timely
manner to promote trust, calmness, and control
 Praise the child for their help and use please, thank you and other manners.

Preparing a Preschooler for a Procedure

■ Explain the procedure in terminology the child can understand.
 Simple concise concrete explanations >
o Explain what a procedure will look like using all the senses (MRI=sounds like train,
Treatment room=cold with bright sunny lights)
■ Begin preparation immediately before the procedure so the child will not worry for hours or
days.
 Time explanations to decrease anxiety and worry.
 Avoid telling anything bad before bedtime (nightmares or afraid to fall asleep)
■ Use play to demonstrate the procedure to the child; encourage them to demonstrate or practice
with a doll or teddy bear.
■ Set__________ for the child so they are aware of expectations.
 For example, tell them they can yell and scream as much as they want but must
hold very still.
■ Allow parents to decide whether they would like to be present for the procedure. Parents may
prefer to leave the room and return immediately after the procedure to comfort their child.
■ Allow the parents to stroke their child or speak soothingly to their child if they remain in the
room.
■ Use ______________ techniques and other coping strategies such as deep breathing, singing,
or squeezing a parent’s or nurse’s hand.
 Provide active role if possible to build self-confidence and sense of control
o Holding Band-Aids or other simple tasks
o Can role play on dolls

Safety concerns:- Most common fatal- drowning

 Car
o Front facing car seat- up to age 4 and no longer meets the height restriction
o Booster seat with should and lap belts- up until 4’9” and 8-12 years old
 Street safety-
o Teach the child about _______________
o Never in street without grownup
o Bike helmets and correct size bike
o Look for safety concerns at playgrounds
 Burns/ Firearms
o Smoke detectors – improved dexterity can use lighter, matches, stove, microwave
o Fire safety includes teaching stop-drop and roll and how to exit the home in case of a fire.
o Water temp to 120ºF or below
o Gun lock box-Imaginary play makes them more at risk for hand gun injury
 Poisoning
o Same as in toddler
 Water safety
o 5 year olds can learn water safety and how to swim but should still not be alone in water
o Diving areas need to be checked by adults to check for depth
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o Life jacket when around playing around water(fishing) or in boat

Nutrition:
 1000-1600 calories/day or 85kcal/kg
 Calcium rich foods
 Iron
 Fiber
 Avoid high calorie junk foods and fast food
 Will self-regulate if healthy options available and should not “clean their plate”
 Do not ______________ with food
 Sugar:
 EBP: Preschoolers with a daily caloric intake of 1,200 to 1,400 calories shouldn't consume
any more than 170 calories, or about 4 teaspoons, of added sugar a day. (AHA)
Concerns:
 lying, masturbation

Anticipatory Guidance for Early Childhood (Preschooler)

Nutrition: Family meal times should be pleasant; provide three meals and two nutritious snacks per day;
allow child to make nutritious choices

Health Promotion: Signs and symptoms of illness: vomiting, diarrhea, fever, dehydration; immunizations
(see immunization schedules at http://www.cdc.gov/vaccines/schedules/); recommend CPR training; oral
health: brushing, routine cleanings

Focus on Safety: Car seat (see guidelines at safercar.gov: http://www.safercar.gov/parents/CarSeats.htm);

update home childproofing (secure matches, guns, outlets, medications, poisons); sunscreen; bike helmet;
water and playground safety; teach about stranger safety; continue close supervision

Sleep-Wake Patterns: Dreams and nightmares are evident now; develop strategies to handle them; naps
start to disappear; maintain consistent bedtime routine (see Patient Education: Sleep/Rest)

Cognitive and Emotional Development: Offer praise; show affection; expect fantasy play as child tries
new roles; address fears as they occur; read, sing, and talk to child to develop language skills; creative
toys; expose child to various places within the community; encourage assertiveness, not aggression; teach
how to solve conflicts; encourage self-expression; expect sexual exploration and answer questions; assign
simple chores; encourage self-care: toileting, dressing

Motor Development: Encourage peer play and physical activities; may want to join an organized sport;
bike safety; water safety

Discipline: Continue with consistent rules; teach right from wrong; teach respect for authority; continue
with time-outs

School age (6-12 years old) preadolescence

Developmental stages:
Erikson: industry vs inferiority – seek to master new skills to promote ______________but
worried about inferiority if do not meet adult expectations
Freud: latency- tranquil phase, focus on activities that develop social and cognitive skills
Fears: dark, death, surgery, kidnapping, worry about past behavior, loss of control
Play: cooperative play (sports) and solitary play, need approval of peers
Hospital setting:
 Play restrictions
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 Questions identity
 Increased need for attention
 Regression
 Fear of _______________
What can nurses do?
 Encourage the parents to stay with the school-age child.
 Allow the child’s home routine whenever possible.
 Encourage parents to bring familiar toys from home.
 Communicate with parents.
 Allow the child to participate in care whenever possible.
 Use therapeutic play. Offer praise.
 Ensure a safe environment.
 Encourage use of the playroom and interaction with other children.
 Explain a procedure, treatment, and/or surgery in simple terms. Allow the child to ask questions.
 Encourage realistic choices whenever possible.
 Encourage the child to verbalize feelings.
 Alleviate fears about changes in body image.
 Respect the child’s _____________
Growth pattern:
Milestones- Prepubescence- Secondary sex characteristics
 Grow about 4-6 lbs a year and 2 inches
Communication
 Very interested in learning and appreciate simple but honest responses directed directly to them
(Don’t ignore them and just talk to parents)
 Like to participate in their care unless severely ill
 Use diagrams, illustrations, books, videos
 Allow child to honestly express feelings
 Allow time for child to ask questions related to care
 Praise them to let them know how much you appreciate their help and cooperation- Use please,
thank you, good manners

Preparing a School-Age Child for a Procedure
■ Explain the procedure in terminology that the child can understand.
 Children in this stage of development have a better concept of time than younger children
do, so preparation can begin in advance of the procedure.
■ For the younger school-age child, use play to demonstrate the procedure and if possible,
have the child demonstrate on and practice positioning with a doll or teddy bear.
 use props, dolls, games, and computers to enhance learning- (technology options)
 able to sequence, understand __________, and make sense of time- Can teach steps to
changing dressing
■ Allow the child to touch and explore equipment to be used in the procedure and involve the
child in simple tasks during the procedure when possible.
 Insulin shots, eye drops, etc.
■ Set limits for the child so they are aware of expectations. For example, tell them they can yell
and scream as much as they want but must hold very still.
■ Give legitimate choices to the child whenever possible.
 Choice of how to take medicine (with water or juice) or which arm to give shot
 Control over the situation and mentally preparing is important for self confidence

■ Allow parents and the child to decide together whether parents will be present for the
procedure. Some school-age children may be modest about exposing body parts in front of family
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members. Allow the parents to stroke their child or speak soothingly to their child if they remain
in the room.
■ Teach the child techniques such as deep breathing, counting, reciting a silly rhyme, or anything
else that might help distract and relax the child during the procedure.

Safety concerns: most common fatal motor vehicle accident

■.Teach about safe _________.
■ Teach hand washing.
Car safety
 Seat belt or age- and weight-appropriate booster seat (usually until 80 pounds and about 4 feet 9
inches) should be used at all times.
 Children under ____________ must sit in back seat.
 Childproof locks should be used in back seat.
Pedestrian safety-
 Child should be instructed on looking right, left, then right again before crossing the street
 Use the ________ system when walking home from school.
 In parking lots, children should know to watch for cars backing up and not dart out between
parked cars.
 If children are playing outside, drivers should be aware of their presence before backing up.
Bike safety: general
 Wear helmets, close fitting clothing, sturdy shoes
 Child shows safe riding technique on safe pathways before left alone to ride
 Don’t carry heavy objects (place in basket) or passengers.
Sports safety
 Appropriate warm-up procedures and protective equipment in use.
All-terrain vehicle safety
 Helmets, rider safety, no riding at nighttime or on public roads
Fire safety (children learning to cook with parents)
 Well maintained smoke detectors and fire extinguishers, practice __________
plan
 Use stove and other cooking facilities under adult supervision.
 All flammable materials and liquids should be stored safely.
Water safety
 Child should know never swim alone (lifeguard on duty best)
 Understand basic CPR.
 Life jackets should be worn when on boat.
 Make sure water is deep enough to support diving.
Firearm safety (same as before)
 Never point a gun at a person.
Toxin safety
 Teach child the hazards of accepting illegal drugs, alcohol, or dangerous drugs. Store
potential dangerous material in safe place.
 Poison control number
Nutrition: (See box 28.3)
Boys (Moderately active)
 4-8 years old: 1400- 1600 cal/day,
 9-13 years old: 1800-2000 cal/day,
Girls
 4-8 years old: 1400-1600 cal/day, 9-13 years old: 1600-2000 cal/day,
Types of foods:
 Dark leafy greens, yellow vegetables, whole grain breads, eggs, variety of fruits/ veggies
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 High quality meat with every meal

AHA found this group averages- 21 teaspoons a day
Children ages 4-8 with a daily caloric intake of 1,600 calories should consume no more
than 130 calories, or about 3 teaspoons a day.
Concerns/Disorders:
screen times, school phobia, bullying, tobacco and alcohol teaching

Anticipatory Guidance for School-Age Children

Nutrition: Family meals; provide three healthy meals and two to three nutritious snacks per day; teach
child how to make nutritious choices; avoid high-fat, processed, and “fast” foods; manage weight through
exercise and healthy nutrition

Health Promotion: Immunizations (see immunization schedules at

http://www.cdc.gov/vaccines/schedules/); oral health: brushing, routine cleanings; be alert to mood
changes, stress; discuss smoking and substance abuse avoidance; discuss sexual feelings and how to say
“no” to sex

Focus on Safety: Seat belt and car safety (use seat belt safety information based on the state of residence;
see general guidelines at safercar.gov: http://www.safercar.gov/parents/index.htm); sunscreen; safe home
environment: secure matches, guns; bike helmet; water, sports, and playground safety; check smoke
detectors; protective equipment for sports; review rules for being home alone

Sleep-Wake Patterns: Require 8 to 12 hours of sleep a night; night terrors may occur

Physical Development: Discuss physical changes related to secondary sex characteristics in later
childhood; body odor; some girls may start menstruation in late childhood

Cognitive and Emotional Development: Stimulate thinking; praise academic achievement; provide
regular time and space for homework; teach organizational skills; teach and encourage problem-solving
skills; implement goal-setting through calendars or charts; assign regular chores; provide for family
centered activities and trips; assist child to recognize and handle new emotions; teach social skills;
demonstrate acceptance, love, concern for the child; support participation in hobbies, clubs, and
extracurricular activities; discuss ways to handle peer pressure; encourage taking on new responsibilities:
volunteering in the community

Motor Development: Daily regular exercise; support participation in organized sports

Discipline: Clearly defined limits; restriction of privileges

Adolescents - 12-19 (may be some overlap based on when puberty starts for a child)
Developmental stages:
Erikson: identity vs role confusion/diffusion – depends on how well they completed earlier
_________, frequent mood changes, struggles with separation from parents
Freud: genitals
Fears: body system issues, changes in___________, separation from peers and maybe parents
Play: Peer groups essential
Hospital setting:
 Concerns about body image
 Separation from peers
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 Loss of_________________
 Decrease in socialization
What can nurses do?
 Encourage visits or contact from _____
 Explain a procedure, treatment, and/or surgery in understandable terms.
 Be honest.
 Allow the teen to ask questions.
 Encourage realistic choices whenever possible.
 Encourage the teen to verbalize feelings.
 Alleviate fears about changes in body image.
o Very concerned with how they look and how they fit in with peers
o ______________ to determine best approach to deal with body changes- wigs, makeup,
fashion scarf, prosthesis
 Respect the teen’s privacy.
 Encourage parent’s involvement in care.
 Recognize the teen’s tendency to _________authority.
o Strive for independence and their values may not agree with their parents or the medical
community
o Expect some _______________ with care
o Work together for best possible outcomes.

Growth pattern: Table 13.9

Milestones- puberty, sexuality
Communication-
 Sensitive to maintaining body image and feelings of control and autonomy
 Use appropriate medical __________ and define as needed (before they web MD it)
 Can process abstract information and how it will affect their lives in the longterm
o Discuss reasons why important to take care of self-
 Better play in sports, concentrate better in school, etc.
Preparing an Adolescent for a Procedure
■ Describe the procedure, explaining exactly what will happen and how long it will take.
Encourage the adolescent to stop you at any point if they have a question.
■ Be honest. Describe potential risks and pain associated with the procedure, but don’t dwell on
it.
■ Allow the adolescent to take as active a role as possible in the procedure. Practicing positioning
or demonstrating the equipment before the procedure helps give the adolescent a sense of control.
■ Provide a peer video of the procedure if possible.
■ If possible, allow the adolescent to make decisions such as when the procedure should take
place.
■ Allow the adolescent the option of having a parent present.
■ Offer tips for distraction such as deep breathing, relaxation, counting, or squeezing an object or
parent’s hand.

Safety concerns:
Adolescent Safety- most common fatal motor vehicle accident
Motor vehicle:
 Everyone in the care wears seat belt at all times
 NO cell phone use (texting)
 Do not drive or get in the car with anyone who has used any mood altering item: street
drugs, alcohol, pills
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Bike, skateboards, water and ATV: same as school age

Fire safety: same as school age but add smoking education (no smoking in bed)
Firearms:
 should take firearms safety class if gun in household
 Keep gun on safety and in locked place
 Never point a gun at a person
Sports:
 Wear protection for each sport
 Physical before starting
Sun: use sunscreen (UVA and UVB), reapply as needed and avoid outdoors during hottest times
Personal safety: (memphis sex trafficking)
 Sexual Risky behaviors
 Keep cellphones charged and let someone know where you are (especially after dark)
 Teach hazards of use of street drugs, prescription drugs, tobacco, and alcohol
Nutrition: (obesity has tripled from 5% to now 18%)
 Boys- moderately active- 2400 – 2800 cal/day
 Girls- moderately active- 2000 cal/day
 Recommended 60 minutes of moderate to vigorous exercise daily
AHA found 14-18 year old children intake the most sugar on a daily basis, averaging about 34.3
teaspoons.
Concerns:
 Homicides
 suicide
 substance abuse- pills, chemicals, street drugs, alcohol, tobacco
 Violence- dating, gang

Anticipatory Guidance for Adolescents

Nutrition: Provide three healthy meals and two to three healthy snacks per day; avoid high-fat, processed,
and “fast” foods; manage weight through exercise and healthy nutrition

Health Promotion: Immunizations (see immunization schedules at

http://www.cdc.gov/vaccines/schedules/); oral health; discuss sex, sexual feelings, protection against
sexually transmitted infections; abstinence as the best way to prevent pregnancy and sexually transmitted
infections; if having sex, discuss birth control and safe sex practices; discuss smoking and substance
abuse avoidance; symptoms of stress and how to deal with it

Focus on Safety: Seat belts; driving safety; sports and water safety; sunscreen; avoid tanning salons

Sleep-Wake Patterns: Require 8 to 10 hours of sleep per night

Physical Development: Explain development of secondary sex characteristics; females: explain

menstruation and masturbation; males: explain masturbation and nocturnal emissions

Cognitive and Emotional Development: Praise academic success; monitor for academic struggles;
encourage new challenges; model respect for differing opinions and needs of others; model conflict
resolution strategies; expect increasing independence from family; peer groups and activities with peers
are increasingly important; provide for some privacy at home; development of intimate relationships;
teach to balance school, work, and peer group participation; begin planning for the future

Motor Development: Daily regular exercise; support participation in organized sports

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Discipline: Increase levels of responsibility at home to foster movement to adulthood; restriction of

privilege