NR 602 MIDTERM STUDY GUIDE WEEK 4

NR 602 MIDTERM STUDY GUIDE Toddler: 12-24 months Preschoolers: 2-5 years old WHO growth charts should be used to measure weight and length for children less than 24 months CDC weight and length charts used for children older than 24 months Average 24 month weighs 26 lbs, length 33.5 in and HC 18.5 in Most have no palpable fontanelle by 12 months Ant fontanelle closes by 18-19 months 3-6 yrs weight gain expectation is 4.5-6.5 lbs/year 3-6 yrs height gain expectation is 2.5-3.5 inches/yr 4 yrs length at birth has doubled 4-5 years old legs grow faster than rest of the body Use of dominant hand may appear as early as 8-12 months generally emerges 2-4 years old; handedness established at 5yrs May develop bowel and bladder control by age 3, but many will not. Boys usually take longer than girls to maintain bedtime bladder control. Articulation: -24 months- 25% is understood by a stranger -24m-36m- 66% is understood by a stranger -3 years old- 90% should be understood by a stranger 3 and 4-year-old have a normal hesitance or show stuttering, considered abnormal if beyond 5 years of age Speech problems often can be from lack of stimulation, hearing problems, ear infections, developmental delay. Early detection important. Lexicon: girls typically say their first word between 8-11 months; boys by 14 months 2 year olds: have more than 200 words in their vocabulary 3 years old: 900 words in vocabulary 3-4 yrs old: able to follow simple commands, talks incessantly 4-5 year olds: add at least 50 new words a month; words in vocabulary (including names, coins, colors, knows days of the week) 5 year olds: should be able to define certain words with other words (cup: something you drink with) Syntax: 8 months: develop receptive language- they understand what a word means before they are able to use it themselves 12-28 months: use holophrases (single words) to express whole ideas 18 months: use telegraphic speech (get milk, go bye-bye) 2 years old: short sentences 3 years old: add plurals, 3-4 word sentences 4 years old: past tense 5 years old: syntax is close to adult style, 5-6 word sentences Peer relationships: Toddler: parallel play Preschoolers: more interactive and social, imaginary play Body image: Masturbation starts around 3-4 years old Theories: Erikson Industry team sports/cooperation Master social studies, math and reading sense of competence and accomplishment Development of a of “superego” or conscious develops during preschool age Inferiority children must learn that they will not be able to master every skill they attempt Criticism detrimental at this age Piaget Concrete operations More tolerant and perceptive of other’s viewpoint Children are able to use thought processes to experience events and actions Judgments made based on reason (conceptual) Ages 2-4-Starting to realize world outside their own, realizing they can make things happen (shift from egocentric. Belief in “magical” power of words. Ages 4-7- Preoperational intuitive thought- starting to understand time concept but limited. Example may understand “after lunch” instead of in 2 hours. Kohlberg (moral development) Judge an act based on consequences of reward and punishment They know the rules and behaviors expected of this, but do not understand the reasons behind them Can accept the concept of treating others as they would want to be treated. Judge an act based on intention not just consequences Piaget: Preoperational thinking (2-4yrs) - problem solving based on what they see directly egocentrism - only about them Centration - Focus only on 1 thing at a time Animism - things around them are alive Magical thinking - thoughts are all powerful - their thoughts can cause things to happen Developmental Assessment: BP starts at 3 years old or if at high risk Hearing and Vision at 4-5 years old Dentist: first tooth eruption or before 12 months; eruption of permanent teeth start at 5 yrs 3 years: Draw circle, cross and vertical/horizontal lines 4-5 years: Trace cross & copy a square, ties shoelaces 5-6 years: Draw a person, copies a diamond and triangle, can print name 2-4 yrs: Animism and magical thinking Magical thinking continues into 4-7 years Screening Tools: Ages and stages Questionnaire: helps with evaluating fine and gross motor development M-CHAT: evaluates for autism (used for children 16-30 months) Early language milestone (ELM): brief screening for speech intelligibility (3-4 years old) Preschool decision: parents should select a preschool with a play based learning curriculum Immediate referral is required for children who stop eating, demonstrate cruelty to animals or other people, are self- harmful, start fires, or talk of harming themselves, their peers or others Children with scores below 85 on intelligence scales predictably have more difficulty in school Language development is the best indicator of cognitive development, language delays may indicate serious issues that require developmental and educational intervention Vision screening 5y, 6y, 8y, 10y, 12y. Referral with acuity less than 20/40 (aap guidelines) Hearing screening 5y, 6y, 8y, 10y. (aap guidelines) Immunization: Hep Bx3: NB, 1-2 mths, 6mths Hib x4: 1-2 mths, 4 mths, 6 mths, 12-15 mths Rotavirus x3: 1-2 mths, 4 mths, 6 mths PCV x4: 1-2 mths, 4 mths, 6 mths, 12-15 mths DTaP x5: 1-2 mths, 4 mths, 6 mths, 15-18 mths, 4yr Polio x4: 1-2 mths, 4 mths, 6 mths, 4-6y MMR x2: 12-15mths, 4yr Varicella x2: 12-15mths, 4yr Older child Tdap x 1: 11-14yr Meningitis x2: 11yr, 17yr HPV x2 (6mths apart): 11-13yrs Hep A x2 (6 mths apart): between 12-23mths, recommended before middle school if not had earlier Safety Helmets, seat belts, still keep cleaning supplies out of reach/locked up. Gross Motor Development 3 years •Rides a tricycle •Walks on tiptoes •Stands on 1 foot for a few seconds •Broad Jump 4 years •Catches a ball •Hops & skips on one foot •Walks up and down stairs using alternate feet 5 years •Jumps rope, begins to skate and swim •Walks backwards heel to toe •Skips and hops (alternate feet) Sleep 12 hours at night, no naps but quiet time Nightmares - During REM sleep, fully awakes, able to be reassured, occurs at end of the night Night terrors - No during REM, not aware of others, partial arousal, no memory of dream, earlier in the night Child Aggression: Not necessarily the behavior itself that is the issue but the frequency, severity, timing. Frustration is the biggest reason they act out. Can also happen if parent is depressed, child is neglected, etc. School Age Children Age 5-12 years Early Childhood (5 to 7 years) Middle (8 to 10 yrs) Late (11 to 12 yrs) Small amount of breast tissue in males normal during puberty-gynecomastia Encourage sports activities Growth and Development Building self-esteem- praise important Check immunizations at sick visits- no immunizations if fever within past 24 hours Get them to talk to you during the visit No shots until age 11 after 4 year old ones Age 7 cholesterol (guidelines between 7 and 11) If BMI 95%, obesity panel- A1c Vision and hearing often done in school Important to ask about friends and peer groups Physical development: strength coordination increase, growth spurts occur, cerebral cortex/frontal lobe develop Motor skills: run, jump, skip, hop, overhand motion, balance coordination improves Fine motor skills: improve dexterity, use scissors, writing tools, hand-eye coordination improves Psychosocial development: Erikson. Industry vs Inferiority. Industry: Development of formal skills, extrinsic rewards important like grades, cooperation, competition and coping leads to sense of accomplishment. Inferiority: ▪Danger during this period, especially for those with physical and mental limitations * No child is able to do everything well, and children must learn that they will not be able to master every skill they attempt Conceptual vs perceptual thinking: based on reason (conceptual) rather than what you see (perceptual). 95210 plan might be important, encourage reading. Communication and language development: Improved communication skills, 8-9 year olds can understand jokes, meanings, stuttering should resolve by school age. 10-12 year olds understand metaphors, ambiguities of language, speech and language disorders among the most developmental delays. Language development: 6-7 years: 2000 words, trouble with s, l, and r 7-8 years: should not have reversal of letters 8-9 years: can recognize and correct spelling and grammar 12 years: 4000 words, can correct syntax and semantics Social/Emotional: Social cognition results from parent child relationship Gain impulse control/manage emotions, learning to interpret social cues, parent should be parent, no friend Through peer relationships children learn that the world is somewhat different from their own. They learn how to deal with dominance and hostility, to relate to people in leadership and authority positions, and explore different ideas. -”Best Friends”: Important to the foundation of relationships in adulthood. They share secrets, private jokes, adventures, and come to each other’s aid in times of trouble. They also fight, break-up, and re-unite. -Clubs and Peer Groups: Rules and selection of joining. -Bullying: “Any recurring activity that intends to cause harm, distress, or control towards another in which there is a perceived imbalance of power between the aggressor and the victim” (Lamb, Pepler, and Craig, 2009). -Bullies are usually defiant towards adults, antisocial, and likely to break school rules. Victims often experience social distress such as worry, sadness, anxiety, depression, and nightmares. Gender: Early school-age – few gender differences; Older school-age – tend to associate with own gender Rules: Part of the enjoyment of the game is knowing the rules “Chants and Taunts”: Sense of power and pleasure with saying them. “Last one is the rotten egg!” “Step on a crack, you’ll break your mothers back!” Collections: Early School Age- odd assortment of things, messy Later School Age- more organized and selective Games: Adhering to the rules is a must! Reading: Newly acquired skill becomes increasingly satisfying. Never tire of stories (hearing or reading). Also enjoy creative and physical activities such as sewing, cooking, painting, swimming, soccer, or dance. Common fears: fear of the dark, self-consciousness, excessive worrying about past behavior. Symptoms of stress / fear: recurring stomach pains or headache, aggressive or stubborn behavior, regression to earlier behaviors such as thumb sucking, reluctance to participate, sleep problems, changes in eating, bed-wetting. Must provide reassurance to the child that they are safe, have honest and open communication, encourage them to express their feelings, and provide time for structured play. Just a noted about self-consciousness: school-age children generally have an accurate and positive self-perception. The more confidence that can be built during this period the better – it will carry forward into the future. May respond to pain with muscular rigidity: Anticipatory guidance: discuss sources of iron, calcium, vitamin c, vitamin d. Discuss prevention of obesity, exercise. Physical characteristics: ▪Slowed growth ▪2 inches per year ▪4-6 pounds per year Average 6 year old: 45 inches and 46 pounds Average 12 year old: 59 inches and 88 pounds ▪Pre-pubescence ▪From middle-childhood until 13 yrs old ▪Secondary characteristics Body image & Self concept Dental: ▪Permanent adult teeth development, Lose 4 teeth per year, Begin with eruption of 6 year molars ▪Attention to dental hygiene and caries is important The first physiological signs appear around 9 years of age (especially in girls) and are usually evident clearly visible in 11 to 12 year olds. Generally puberty begins at age 10 in girls and 12 in boys, but it can be normal for either sex after the age of 8 years. Nutrition: avoid empty calories, develop a new taste. Caloric needs for 6-12 year olds: boys 16-17 kcal/cm. girls: 13-14 kcal/cm. Sleep: start good habits such as no tablets in bed. ▪Highly individualized, Rarely takes naps Average 5 year old: 11 hours per night Average 12 year old: 9 hours per night ▪Bedtime resistance peaks from 8-11 years