hesi blue book pg. 182 developmental milestones (1)

5/28/2018 HESI BLUE BOOK Pg. 182 Developmental Milestones (1)

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Growth and Development

Description: Growth and development follow an orderly yet individual pattern. Nurses

should assess growth and the emergence of developmental skills in all pediatric client

Knowledge of cognitive abilities allows a nurse to adapt teaching to the level of the

child. Knowledge of appropriate toys and interests of children at different ages enabl

the nurse to use play to facilitate the child's development and minimize problems caus

by the hospitalization.

INFANT (BIRTH TO 1 YEAR)

A. Developmental milestones

1. Birth weight doubles by 6 months, triples by 12 months.

2. Birth length increases by 50% at 12 months.

3. Posterior fontanel closes by 8 weeks.

4. Social smile occurs at 2 months.

5. Head turns to locate sounds at 3 months.

6. Moro reflex disappears around 4 months.

7. Steady head control is achieved at 4 months.

8. Rolls from abdomen to back and back to abdomen at 5 to 6 months.

9. Plays peek-a-boo after 6 months.

10. Transfers objects from hand to hand at 7 months.

11. Develops stranger anxiety at 7 to 9 months.

12. Sits unsupported at 8 months.

13. Crawls at 10 months.

14. Fine pincer grasp appears at 10 to 12 months.

15. Waves bye-bye at 10 months.

16. Walks with assistance at 10 to 12 months.


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17. Says a few words in addition to mama or dada at 12 months.

18. Explores environment by motor and oral means.

B. Erickson's theory: Developing a sense of trust (trust versus mistrust)

C. Nursing implications

1. During hospitalization, the infant's emerging skills may disappear.

2. If the parents are not able to be with the infant, the baby may be inconsolab

due to separation anxiety.

3. The nurse should plan to have the parents be part of the infant's care and

should encourage them to do so.

4. Respect the infant's schedule at home by assessing and implementing componentas possible.

5. Preparation and teaching should be directed to the family. However, the nurse

should always speak to the infant and console the infant, especially while

performing painful or stressful procedures.

6. Toys for hospitalized infants include mobiles, rattles, squeaking toys, pictu

books, balls, colored blocks, and activity boxes.

H SI Hint Questions on the NCLEX-RNexamination are the only ones tested. Howevethese are frequently tested content areas:

When does birth length double? Answer: by 4 years.

When does the child sit unsupported? Answer: 8 months.

When does a child achieve 50% of adult height? Answer: 2 years.

When does a child throw a ball overhand? Answer: 18 months.

When does a child speak two- to three-word sentences? Answer: 2 years.

When does a child use scissors? Answer: 4 years.

When does a child tie his or her shoes? Answer: 5 years.

Be aware that a girl's growth spurt during adolescence begins earlier than a

boy's (as early as 10 years of age).


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Temper tantrums are common in the toddler (i.e., they are considered normal o

average behavior).

Be aware that adolescence is a time when the child forms his or her identity

and that rebellion against family values is common for this age group.

H SI Hint Knowledge of normal growth and development is used to evaluateinterventions and therapy. For example, what behavior would indicate that thyroid

hormone therapy for a 4-month-old is effective? You must know which milestones are

accomplished by a 4-month-old. One correct answer would be: Has steady head control

which is an expected milestone for a 4-month-old and indicates that replacement

therapy is adequate for growth.

TODDLER (1 TO 3 YEARS)


1. Birth weight quadruples by 30 months.

2. Achieves 50% of adult height by 2 years.

3. Growth velocity slows.

4. Appears to be bowlegged and potbellied.

5. All primary teeth (20) are present.

6. Anterior fontanel closes by 12 to 18 months.

7. Throws a ball overhand at 18 months.

8. Kicks a ball at 24 months.

9. Feeds self with spoon and cup at 2 years.

10. Daytime toilet training can usually be started around 2 years.

11. Two- to three-word sentences are spoken by 2 years.

12. Three- to four-word sentences are spoken by 3 years.

13. Own first and last name can be stated by 2 to 3 years.

14. Temper tantrums are common.


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B. Erikson's theory: Developing a sense of autonomy (autonomy versus doubt and

shame)


1. Give simple, brief explanations before procedures, keeping in mind that a 1-year-old does not benefit from the same explanation as that given to a 3-year-old.

2. During hospitalization, enforced separation from parents is the greatest thre

to the toddler's psychological and emotional integrity.

3. Security objects or favorite toys from home should be provided for a toddler.

4. Teach parents to explain their plans to the child (e.g., I will be back aft

your nap).

5. Respect the child's routine and implement when possible.

6. Expect regression (e.g., bed-wetting).

7. Toys for the hospitalized toddler include board and mallet, push-pull toys, t

telephones, stuffed animals, and storybooks with pictures, depending on the reason

for hospitalization. Toddlers benefit from being taken to the hospital playroom wh

able, because mobility is very important to their development.

8. Toddlers are learning to name body parts and are concerned about their bodies

9. Very basic explanations should be given to toddlers about procedures.

10. Autonomy should be supported by providing guided choices when appropriate.

PRESCHOOL CHILD (3 TO 6 YEARS)


1. Each year, a child gains about 5 pounds and grows 2 to 3 inches.

2. A child stands erect with more slender posture.

3. A child learns to run, jump, skip, and hop.

4. A 3-year-old can ride a tricycle.

5. Handedness is established.


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6. A child uses scissors at 4 years.

7. A child ties shoelaces at 5 years.

8. A child learns colors, shapes.

9. Visual acuity approaches 20/20.

10. Thinking is egocentric and concrete.

11. A child uses sentences of five to eight words.

12. A child learns sexual identity (curiosity and masturbation are common).

13. Imaginary playmates and fears are common.

14. Aggressiveness at 4 years is replaced by more independence at 5 years.

B. Erikson's theory: Developing a sense of initiative (initiative versus guilt)


1. Nursing care for hospitalized preschoolers should emphasize understanding of

the child's egocentricity. Explain that he or she did not cause the illness and th

painful procedures are not a punishment for misdeeds.

2. The child's questions should be answered at the child's level. Use simple wor

that will be understood by the child.

3. Therapeutic play or medical play that allows the child to act out his or her

experiences is helpful.

4. Fear of mutilation by procedures is common. A Band-Aid may be quite helpful i

restoring body integrity.

5. Toys and play for the hospitalized preschooler include coloring books, puzzle

cutting and pasting, dolls, building blocks, clay, and toys that allow the

preschooler to work out hospitalization experiences, depending on the reason for

hospitalization.

6. The preschooler needs preparation for procedures. He or she should understand

what is and what is not going to be fixed. Simple explanations and basic

pictures are helpful. Let the child handle equipment or models of the equipment.


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H SI Hint Use facts and principles related to growth and development in planningteaching interventions. For example: What task could a 5-year-old diabetic boy be

expected to accomplish by himself? One correct answer would be to let him choose th

injection sites. This is possible for a preschooler to do and gives the child some

sense of control.

SCHOOL-AGE CHILD (6 TO 12 YEARS)


1. Each year, a child gains 4 to 6 pounds and about 2 inches in height.

2. Girls may experience menarche.

3. Loss of primary teeth and eruption of most permanent teeth occurs.

4. Fine and gross motor skills mature.

5. A child is able to write script at 8 years of age.

6. A child can dress self completely.

7. Egocentric thinking is replaced by social awareness of others.

8. A child learns to tell time and understands past, present, and future.

9. A child learns cause-and-effect relationships.

10. Socialization with peers becomes important.

11. Molars (6-year) erupt.

B. Erikson's theory: Developing a sense of industry (industry versus inferiority


1. The hospitalized school-age child may need more support from parents than the

wish to admit.

2. Maintaining contact with peers and school activities is important during

hospitalization.

3. Explanation of all procedures is important. They can learn from verbal

explanations, pictures, and books and by handling equipment.


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4. Privacy and modesty are important and should be respected during

hospitalization (e.g., close curtains during procedures, allow privacy during

baths).

5. Participation in care and planning with staff fosters a sense of involvement

and accomplishment.

6. Toys for the school-age child include board games, card games, and hobbies,

such as stamp collecting, puzzles, and video games.

H SI Hint School-age children are in Erikson's stage of industry, meaning they lito do and accomplish things. Peers are also becoming important for children of this

age.

ADOLESCENT (12 TO 19 YEARS)


1. Girls' growth spurts during adolescence begin earlier than boys' (may begin a

early as 10 for girls).

2. Boys catch up at around 14 and continue to grow.

3. Girls finish growth at around 15, boys at around 17.

4. Secondary sex characteristics develop.

5. Adult-like thinking begins around 15. They can problem-solve and use abstract

thinking.

6. Family conflicts develop.

B. Erikson's theory: Developing a sense of identity (identity versus role

confusion)


1. Hospitalization of adolescents disrupts school and peer activities; they needto maintain contact with both.

2. They should share a room with other adolescents.

3. Illnesses, treatments, and procedures that alter the adolescent's body image

can be viewed by the adolescent as being devastating.


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4. Teaching about procedures should include time without the parents being

present. When parents are present, direct questions to the adolescent, not the

parents.

5. The age of assent for making medical decisions in children and adolescents

ranges from 7 to 14 years. Parental consent is also needed for treatment.

6. For prolonged hospitalizations, adolescents need to maintain identity (e.g.,

have their own clothing, posters, and visitors). A teen room or teen night is very

helpful. Parents rooming in is discouraged.

7. Some assessment questions should be asked without parents' presence.

8. When teaching adolescents, the focus should be on the here and nowHow will

this affect me today?

H SI Hint Age groups' concepts of bodily injury:

Infants: After 6 months, their cognitive development allows them to remember

pain.

Toddlers: They fear intrusive procedures.

Preschoolers: They fear body mutilation.

School-age children: They fear loss of control of their bodies.

Adolescents: Their major concern is change in body image.

H SI Hint Accidents are a major cause of death in children and adolescents. Teachparents and children developmentally appropriate safety and accident-prevention

techniques.

hesi blue book pg. 182 developmental milestones (1)

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