Outline chapter 28- developmental and genetic influences on child health promotion Foundations of growth and development Growth:

h: increase in number and size of cells as they divide and synthesize new proteins, results in increased size and weight of whole or any of its part Development: a gradual change and expansion, advancement, from lower to more advanced stage of complexity; increased capacity through growth, maturations and learning Maturation: an increased in competence and adaptability, usually described as a qualitative change to function at higher level Differentiation: processes by which early cells and structures are systematically modified and altered Prenatal period: conception to birth Infancy period: birth to 12 months Early childhood: 1 to 6 years Middle childhood: 6 to 11 years Later childhood: 11 to 19 years a developmental task is a set of skills and competencies peculiar to each developmental stage that children must accomplish or master to deal effectively with their environment

Patterns of growth and development Directional trends 1st trend is the cephalocaudal or head to tail direction. The head develops first and is large and complex; the lower end is small and simple and takes shape at a later period Second trend is the proximodistal or near-to-far, trend applies to the midline-to-peripheral concept. Limbs dubs development followed by rudimentary fingers and toes. Third trend is development from simple operations to more complex activities and functions. Physical, mental, social and emotional development

Sequential trends Predictable sequence with each child normally passing through each stage Crawling before creep, creep before stand

Development trends Although development has a fixed, precise order, it does not progress at same rate or pace Distinct differences are observed among children as they reach development milestones

Sensitive periods At limited times during the process of growth the organism interacts with a particular environment in a specific manner.

Periods termed critical, sensitive, vulnerable and optimal are times in the lifetime of an organism when it is more susceptible to positive or negative influences.

Individual differences Each child grows in his or her own unique and personal way. Great individual variation exists in the age at which developmental milestones are reached

Biologic growth and physical development External proportions During fetal development the head is the fastest growing body part At 2 months of gestation it constitute 50% of total body length As growth proceeds the midpoint of head-to-toed measurements gradually descends from a level even with the umbilicus at birth to the level of the symphysis pubis at maturity.

Biologic determinants of growth and development Throughout development various tissue in the body undergo changes in growth, composition and structure Both bone age determinants and state of dentition are used as indicators of development.

Skeletal growth and maturation Bone age is determined by comparing the mineralization of ossification centers and advancing bony form to age-related standards. Bone formation begins during the second month of fetal life when calcium salts are deposited in the intercellular substance (matrix) to form calcified cartilage first and then true bone.

Neurologic maturation two periods of rapid bran cell growth occur during fetal life: a dramatic increase in number of neurons between 15 and 20 weeks of gestation and another increase at 30 weeks, which extends to 1 year of age the rapid growth continues during early childhood and slows to a more gradual rate during later childhood and adolescence

Lymphoid tissues lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils, adenoids and blood lymphocytes follow a growth pattern unlike that of other body tissues they increase rapidly to reach adult dimensions by 6 years of age and continue to grow

Development of organ systems all tissues and organ systems undergo changes during development

some are striking, other are subtle

Physiologic changes Metabolism the rate of metabolism when the body is at rest (basal metabolic rate or BMI) demonstrate a distinctive change throughout childhood highest in newborn infants, the BMR closely relates to the proportion of surface area to body mass, which changes as the body increases in size

Temperature Thermoregulation is one of the most important adaptation responses of infants during the transition from intrauterine to extrauterine life. Hypothermia can lead to elevated bilirubin levels, metabolic acidosis Kangaroo care, also referred as skin to skin care, is an effective way to prevent neonatal hypothermia in infants

Sleep and rest Sleep, a protective function in all organisms, allows for repair and recovery of tissues after activity As they mature, the total time they spend in sleep and the amount of time they send in deep sleep changes The quality of sleep changes as children mature

Nutrition Nutrition is the single most important influence on growth Dietary factors regulate growth at all stages of development, and their effects are exerted in numerous and complex ways

Temperament Manner of thinking, behaving, or reacting that is characteristics of an individual Easy child: easy going child, regular and predictable in their habits and have a positive approach to new stimuli Difficult child: highly active, irritable and irregular in their habits Slow to warm up child: react negatively and with mild to intensity to new stimuli and unless pressured, adapt slowly with repeated contact

Theoretic foundations of personality development Psychosocial development (Freud) Oral stage: (birth to 1 year) sucking, biting, chewing, and vocalizing. Anal stage (1 to 3 years): anal region as sphincter muscles develop and children are able to withhold or expel fecal material at will

Phallic stage (3 to 6 years): genitalia become an interesting and sensitive area of the body. Children recognize differences between sexes and become curious about dissimilarities Latency period (6 to 12 years): children elaborate on previously acquired traits and skills. Genital stage (12 years and older): puberty with maturation of the reproductive system and production of sex hormones

Psychosocial development (Erikson) Trust vs. mistrust (birth to 1 year): trust dominates the first year of life and described all of the child satisfying experience at this age. Mistrust develops when trust-promoting experiences are deficient or lacking or basic needs are inconsistently or inadequately met. Autonomy vs. shame and doubt (1 to 3 years): childrens increase ability to control their bodies, themselves and their environment. They want to do skills for themselves using newly acquired motor skills of walking, climbing and manipulation. Negative feelings of doubts or shame arise when children are disastrous, when other shame them or when they are forced to be dependent in areas in which they are capable of assuming control Initiative vs. guilt (3 to 6 years): children explore the physical world with all their senses and powers. They develop a conscience. Children sometimes undertake goals or activities that are in conflict with those of parents or others, and being made to feel that their activities or imaginings are bad produces a sense of guilt Industry vs. inferiority (6 to 12 years): children are ready to be workers and producers. They want to engage in tasks and activities that they can carry through to completion; they need and want real achievement. Feelings of inadequacy and inferiority may develop if too much is expected of them or if they believe that they cannot measure up to the standards set for them by others. Identity vs. role confusion (12 to 18 years): identity is characterized by rapid and marked physical changes. Children become preoccupied with the way they appear in the eyes of other compared with their own self-concept. Adolescent struggle to fit the roles they have played and those they hope to play with the current roles and fashions adopted by their peers to integrate their concepts and values with those of society.

Cognitive development (Piaget) Sensorimotor (birth to 2 years): children progress from reflex activity through simple repetitive behaviors to imitative behavior. They develop a sense of cause and effect as they direct behavior toward objects. Problem solving is primarily by trial and error. Object have permanence Preoperational (2 to 7 years): egocentrism is the inability to put oneself in the place of another. Children interpret objects and events not in terms of general propertied but in terms of their relationships or their use to them. They cannot reason beyond the observable and lack ability to make deductions or generalizations Concrete operations (7 to 11 years): children able to classify, sort, order and organize facts about the world to use in problem solving. Conservation is realizing that physical

factors such as volume, weight, and number remain the same even though outward appearances are changed. Formal operations (11 to 15 years): characterized by adaptability and flexibility. Adolescent can think in abstracts terms, use abstract symbols and draw logical conclusions from a set of observations.

Language development Born with mechanism and capacity to develop speech and language skills Environmental means (respiratory, auditory and cerebral) plus intelligence, need to communicate and stimulation Intact physiologic structure and function Intelligence A need to communicate Stimulation

Moral development (Kohlberg) Preconventional level: culturally oriented to the labels of good/bad and right/wrong, children integrate these in terms of physical or pleasurable consequences of their actions Conventional level: concerned with conformity and loyalty. They value the maintenance of family, group, or national expectations regardless of consequences Post conventional, autonomous or principled level: individual has reached cognitive stage of formal operations. Correct behaviors tends to be defined in terms of general individual rights and standards that have been examined and agreed on by the entire society

Spiritual development (Fowler) Stage 0: undifferentiated: encompasses the period of infancy during which children have no concept of right or wrong, no beliefs and no convictions to guide their behavior. Stage 1: intuitive projective: toddlers primarily a time of imitating the behaviors of others. Children imitate the religious gestures and behaviors of others without comprehending any meaning or a significance to the activities Stage 2: mythical literal: cognitive development and is closely related to childrens experiences and social interaction. Most children have a strong interest in religion during the school age years. Stage 3: synthetic convention: become increasingly aware of spiritual disappointments. They recognize that prayers are not always answered and may begin to abandon or modify some religious practices Stage 4: individuating reflexive: become more aware of skeptical and begin to compare the religious standards of their parents with those of others. Which standards to adapt and incorporate into their own set.

Development of self-concept Body image

Body image refers to the subjective concepts and attitudes that individuals have toward their own bodies. Consists of physiologic (perception of ones physical characteristics) Psychologic (values and attitudes toward the body, abilities and ideals) Social nature of ones image of self (the self in relation to others)

Self-esteem Competence: how adequately are my cognitive, physical and social skills? Sense of control: how well can I complete tasks needed to produce desired actions? Is someone or something specific versus luck or chance responsible for my successes and failures? Moral worth: how closely do my actions and behaviors meet moral standards that have been set? Worthiness of love and acceptance: how worthy am I of love and acceptance from parents, other significant adults, siblings and peers? Factors that influence the formation of childs self-esteem include the childs temperament and personality, abilities and opportunities available to accomplish ageappropriate developmental tasks, how significant others interact with the child and social roles assumed and the expectations of these roles

Role of play in development Classification of play Pattern of childs play can be categorized according to content and social character Both there is an additive effect; each builds on past accomplishments and some elements of each is maintained throughout life

Content of play Social affective play: begins with social affective play, where in infants take pleasure in relationships with people, talk, touch, nuzzle, parental emotions Sense-pleasure play: nonsocial stimulating experience that originates from without. Objects in environment attract childrens attention, stimulate their senses and give pleasure Skill play: after ability to grasp and manipulate, infant demonstrate and exercise their newly acquired abilities through skill play, repeating an action over and over again. Unoccupied behavior: children are not playful but focusing their attention momentarily on anything that strikes their interest Dramatic or pretend play: dramatic play, known as symbolic or pretend play, begins in late infancy (11 to 13 months) and is the predominant form of play in preschool children. They can pretend and fantasize almost anything

Games: solitary activity involving games begins as very small children participate in repetitive activities and progress to more complicated games that challenge their independent skills such as puzzles, solitaire and computer or video games.

Social character of play Onlooker play Watch what other children are doing but make no attempt to enter into the play Active interest in observing the interaction of others but no movement toward participating

Solitary play Play alone with toys different from those used by other children in the same area Enjoy presence of other children but make no effort to get close or speak to them

Parallel play Play independently but among other children Play with toys similar to those of other children around them but as each child sees fit, neither influencing nor being influenced by other children

Associative play Children play together and are engaged in a similar or even identical activity but there is no organization, division of labor, leadership assignment or mutual goal They borrow and lend play material, follow each other and attempt to control who may or may not play in the group

Associative play Organized and children play in a group with other children They discuss and plan activities in purpose of accomplishing an end To make something, attain a competitive goal, dramatize situations of adult or group life or play formal games

Functions of play Sensorimotor development Children explore the nature of the physical world Gains impressions of themselves and their world through tactile, auditory, visual and kinesthetic simulation With increasing maturity sensorimotor play becomes more differentiated and involved

Intellectual development Through explorations and manipulation children learn colors, shapes, textures and significance of objects

Learn significance of numbers and how to use them Associate words with objects and develop understanding of abstract concept and spacial relationships such as up, down, under and over

Socialization Show interest and pleasure in the company of others Initial social contact is with the mothering person, but through play with other children they learn to establish social relationships Learn to give and take

Creativity Children can experiment and try out their ideas in play through every medium at their disposal such as raw materials, fantasy and exploration After children feel the satisfaction of creating something new and different, they transfer this creative interest to situations outside the world of play

Self-awareness Active explorations of their bodies and awareness of themselves as separate from their mothers, the process of developing self-identity Learn who they are and their place in the world

Therapeutic value Play is therapeutic at any age In play children can express emotions and release unacceptable impulses in a socially acceptable fashion They are able to experiment and test fearful situations and can assume and vicariously master the roles and position that they are unable to perform in the world of reality

Morality Although children learn at home and at school the behaviors considered right and wrong in culture, the interactions with peers during play contributes significantly to their moral training Enforcement of moral standards as rigid as in the play situation

Toys

Can support and enhance childrens development Offer an opportunity to bring children and parents together Pushing, pulling, rolling and manipulating help develop muscles

Genetics factors that influence development Genetics and genomics

Genes are segments of DNA that specify for proteins, segments of proteins or strands of ribonucleic acid necessary to control physiologic functions or characteristics Variants forms of a gene commonly occur within a population Referring to a particular form of a gene, the term is allele Difference within a gene are called mutations if they are rare within a population or a are polymorphisms if they are found within more than 1% of a particular population.

Congenital anomalies Embryogenesis and fetal development are an intricate and precisely timed series of events in which all parts must be properly integrated to ensure a coordinated whole Deformations are often caused by extrinsic mechanical forces on normally developing tissue Types of anomalies that can result from genetic or prenatal environmental causes can be major structural anomalies with serious medical, surgical or quality of life consequences or they can be minor such as sacral dimple, extra nipple, or caf au lait spot

Disorders of intrauterine environment It can have permanent effect on developing fetuses with or without chromosome or single gene abnormalities Intrauterine growth restrictions can occur with many genetic syndromes such as down, russel-silver, prader-willi and turner syndromes Placental anomalies are increasingly being found to be the etiology factor in neurodevelopmental disorders that were previously attributed to asphyxia during delivery

Genetic disorders Can be caused by chromosome abnormalities as seen in turner, down or velocardiofacial syndrome Single gene mutations as seen in sickle cell anemia, neurofibromatosis or Duchene muscular atrophy Both numeric and large structural abnormalities of autosomes account for a variety of syndromes usually characterized by cognitive deficiencies

Roles of nurses in genetics Nursing assessment Family heath history Collect pregnancy, labor and delivery, perinatal medical and developmental histories Physical assessments

Identification and referral Be alert to situations in which families could benefit from genetic evaluation and counseling

Know about special services that can help manage and support affected children Be familiar with facilities in their areas where these services are available Able to direct individuals and families to needed services and be active participants in the genetic evaluation and counseling process

Education Maintaining contact with family or making referral to a health care practice or an agency that can provide a sustained relationship is critical It is becoming more common for genetics health care professionals to provide regular follow-up and management Nurses can help patients and families and clarify the information they receive during a genetic visit Misunderstanding of this info can have causes including cultural differences, the disparity of knowledge between the counselor and the family, and the heightened emotion surrounding genetic counseling