GROWTH AND DEVELOPMENT

Growth and development begins at conception and end at maturation. Human development is a lifelong process of physical, behavioral, cognitive, and emotional growth and change. In the early stages of lifefrom babyhood to childhood, childhood to adolescence, and adolescence to adulthoodenormous changes take place. Throughout the process, each person develops attitudes and values that guide choices, relationships, and understanding. DEFINITION OF GROWTH Growth is defined as the increase in the size of an individual due to increase in number and size of the cells. DEFINITION OF DEVELOPMENT Development is the maturation of function and acquisition of variety of skills for functioning optimally in a society. Stages of Growth and Development Infancy Neonate y Birth to 1 month

Infant y 1 month to 1 year

Early Childhood Toddler y 1-3 years

Preschooler y 4-5years

Middle Childhood School age y 6years to 13 years Late Childhood Adolescent y 14 years to approximately 18 years

Principles of Growth and Development Development proceeds from head downward. Development proceeds from the center of the body outward. Development depends on maturation and learning Development proceeds from simple to more complex. Growth and development is a continuous process Growth and development proceeds from general to specific. There are individual rates of growth and development Factor influencing growth and development 1. Genetic 2. Nutritional 3. Socio-economic 4. Environmental: physical surrounding, psychological, social, cultural factor 5. Chronic disease 6. Emotional and cultural like unstable family, insecurity, loss of parents inadequate schooling have negative effect on growth and development 7. Intrauterine growth retardation and maternal infection adversely affect the fetus and thereby newborn Growth Patterns The childs pattern of growth is in a head-to-toe direction, or cephalocaudal, and in an inward to outward pattern called proximodistal Why developmental assessment? y y y Early detection of deviation in childs pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive

INFANCY STAGE INFANCY

Infancy is a time when babies are totally dependent upon their parents and care givers for their protection and care. Consistent, adequate, gentle care can encourage the infant to develop the capacity to trust people. GROWTH OF AN INFANTS

HEAD CIRCUMFERENCE:33-37 CM CHEST CIRCUMFERENCE: In infant chest circumference is 2.5 cm lesser than head circumference WEIGHT: 2700-3850 gm LENGTH : 50CM (GIRL),49 CM(-BOY)- NORMAL RANGE 47.5-53.75

Respiratory Rates Age Infant (birth1 year) Rate (breaths per minute) 3060

Pulse Rates Age Infant (birth1 year) Low 100 High 160

Systolic Blood Pressure Age* Infant (birth1 year) Low Normal greater than 60*

THEORIS APPLICABLE Freuds Psychosexual Development Theory

DEVELOPMENTAL TASK

Havighursts Developmental Stage and Tasks DEVELOPMENTAL STAGE 1. Infancy DEVELOPMENTAL TASK - eat solid foods - walk - talk - control elimination of wastes - relate emotionally to others - distinguish right from wrong through development of a conscience - learn sex differences and sexual modesty - achieve personal independence - form simple concepts of social & physical reality

DEVELOPMENTAL ASPECTS OF PEDIATRIC PATIENTS Age* Newborn (birth to 1 month) Keys to Successful Interaction Likes to be held and kept warm May be soothed by having something to suck on Avoid loud noises, bright lights Infant (112 months) Likes to be held Parents should be nearby Examine from toes to head Normally alert, looking around Eyes follow examiner Slightly flexed extremities Can straighten arms and legs DEVELOPMENTAL MILESTONE Characteristics Normally alert, looking around Focuses well on faces Flexed extremities

AGE

0-4 MONTHS

4-8 MONTHS

8-12 MONTHS

FOCUS

y y y y

Physical care. Bonding to mother. Visual stimulation. Gentle physical handling.

y Responsive physical

y Mobility

care. y A close relationship with a special adult. y A safe play environment.

increases and infant begins to walk. y Infant can make choices. y Language use and understanding increases.
y Enjoys crawling,

PHYSICAL DEVELOMENT

y By 6-8 weeks can

move head from side to side y Can lift head when placed on tummy by about 6 weeks. y Begins to notice hands by around 6 weeks. y May roll over by 34 months.

y Can roll over. y Sits with support, then

alone by 8 months.
y Begins to push feet

against floor or lap and then bounces. y Can see an object, then opens hand to grasp it. y Passes toys from hand to hand.

y y

walking around furniture, & standing. Can pick up tiny objects (uses thumb and fingers well). Very oral everything goes in mouth. Develops arm and hand control. Enjoys taking off clothes, climbing up and onto furniture, & crawling up stairs.

EMOTIONAL DEVELOPMENT

y Attachment of baby

y Attachment of baby to y y

y Strong

to adult(s) taking place. y Early trust develops. y Eating/sleeping schedules vary greatly. y By 4 months can be comforted when unhappy.

adults occurs. Early trust develops. Eating/sleeping schedules becoming more regular. Enjoys playing peek-aboo and begins to grab at blanket. Uses cry to call for attention, not always a distress call.

attachment to adult(s). y Fears can be shown, especially to things such as Santa, clowns, fast moving objects and large dogs. y Infant can tantrum when frustrated.
y Smiles easily and

SOCIAL DEVELOPMENT

y Turns head toward

familiar voice.
y Will begin to smile

y Enjoys being held. y Smiles to show

when talked with or held. y By two months

pleasure. y Less smiling around strangers (by 8

shows enjoyment of people. y Demonstrates signs of independence.

shows excitement and pleasure when held. y Visually attracted to bright colors and contrasts. y By two months may gurgle to get attention. y Appears to enjoy being held.

months).

y Beginning of

understanding that some behaviors are acceptable and some are not. y Watches people and their activities. y Prefers to be with others while playing.
y Babbles and coos. y Looks when name is y Uses names of

LANGUAGE/ INTELLUCTUAL DEVELOPMENT

y Crying is main

source of communication (when wet, hungry, frightened, uncomfortable, or lonely). y Make gurgle throaty sounds by 4 months.

called.
y Imitates sounds. y Repeats interesting y y y

actions.
y Continues to develop

eye-hand coordination.

familiar objects and people. Loves to imitate actions of others. Connects words to objects. Looks at books and chooses them. May scribble randomly.

TOYS TO BE GIVEN 0-4 MONTHS

y Music Box y Small Toys To

4-8 MONTHS
y Music Box y Small Toys To y y y y y y y y y y y y y y y

8-12 MONTHS Small Riding Toys Push & Pull Toys Balls Stacking or Nesting Toys Pictures, Books, Simple Puzzles Crayons (With Supervision Only) Busy Boxes Teething Toys Shape Boxes or Balls (To Drop

TOYS TO BE GIVEN

y y y y y y

Grasp Teething Toys Balls Push and Pull Toys Rattles Books Busy Box or Other Noisy Toy

Grasp Teething Toys Balls Push and Pull Toys Rattles Books Busy Box or Other Noisy Toy

Blocks Into) WHAT PARENTS CAN DO?

y Talk to baby. y Hold baby face to y Talk to baby often. y Read to baby daily. y Allow floor time y Show pleasure in y

y y

face, especially during the first month, when singing or talking. Be flexible about eating and sleeping routines. Hold baby during feeding times. Take baby for walks and talk about the sounds, trees, etc. Have playtime with baby: peek-a-boo, read stories, talk and touch body parts (nose, chin, hand). Shake a rattle and slowly move it so baby follows with his/her eyes.

y y

y y

y y y

for wiggling, and eventually, crawling. Put toys just out of reach. Place objects in boxes or cans with lids to make noise. Play peek-a-boo and hide toys under a blanket or diaper. Hold baby during reading or feeding times. Establish routines in baby's daily life (bathing, meals and snacks, naps, bedtime). Imitate baby's sounds. Freeze a wet washcloth for baby to teethe on and mouth. Talk calmly to a crying baby. Do not shake or toss baby in the air. Hold baby close to a mirror and talk about baby's face.

y y y y y

baby's abilities. Baby proof the home (cover outlets, put away breakables, check safety of plants). Help baby practice pulling up, walking, and climbing. Watch for small objects that baby can choke on and remove from play area. Read to baby using simple books. Play simple games. Take walks together. Name objects you see. Encourage baby to play games of imitation (sounds, words, pointing, body parts).

TODDLER A toddler is a young child, usually defined as being between the ages of one and three. Registered nurse, midwife and author, Robin Barker, states 'Any time from eight months onwards your baby will begin to realise he is a separate person from you. He will find it exciting to be able to move away from you but scary when you move away from him.' The toddler years are a time of great cognitive, emotional and social development. Toddler development refers to the changes that occur in children aged between 1 and 3 years. Change

may occur as a result of genetic processes known as maturation, or may be due to environmental factors and learning. GROWTH OF ATODDLER HEIGHT CIRCUMFERENCE GROWTH VELOCITY: 1cm/ 6 months WEIGHT : 1.8-2.7 KG/YEAR FORMULA TO CALCULATE WEIGHT: (AGE IN YEARS X 2) + 8 HEIGHT: AT 1 YEAR= 75 CM 2 YEAR -85 CM FORMULA: ( AGE IN YEARS X 6) + 77 RATE OF INCREASE6 TO 8 CM/YEAR

Respiratory Rates Age Toddler (13 years) Rate (breaths per minute) 2440

Pulse Rates Age Toddler (13 years) Low 90 High 150

Systolic Blood Pressure Age Toddler (13 years) Low Normal greater than 70*

THEORIES APPLICABLE TO TODDLERS Freuds Theory

STAGE 1. Oral

AGE Birth to 1 y/o

CHARACTERISTICS Center of pleasure: mouth (major source of gratification & exploration) Primary need: Security Major conflict: weaning

2. Anal

1 to 3 y/o

Source of pleasure: anus & bladder (sensual satisfaction & self-control) Major conflict: toilet training

Eriksons Stages of Psychosocial Development Theory 2. Early childhood 1 to 3 y/o Autonomy vs Shame & doubt Self control w/o loss of self esteem Ability of cooperate & express oneself Compulsive, selfrestraint or compliance. Willfulness & defiance.

Piagets Phases of Cognitive Development Stage 5: Tertiary circular reaction Stage 6: Invention of new means 12-18 months Experiments with methods to reach goals. Develops rituals that become significant. 18-24 months Uses mental imagery to understand the environment. Uses fantasy.

Kohlbergs Stages of Moral Development LEVEL AND STAGE LEVEL I: Pre-conventional (Birth to 9 years) Stage 1: Punishment & obedience orientation DESCRIPTION Authority figures are obeyed. Misbehavior is viewed in terms of damage done. A deed is perceived as wrong if one is punished; the activity is right if one is not punished.

Stage 2: Instrumental-relativist orientation

Right is defined as that which is acceptable to & approved by the self. When actions satisfy ones needs, they are right.

Fowlers Stages of Faith Stage 1: Intuitiveprojective faith Toddler-preschooler Imitates parental behaviors and attitudes about religion and spirituality. Has no real understanding of spiritual concepts.

DEVELOPMENTAL TASK Havighursts Developmental Stage and Tasks DEVELOPMENTAL STAGE 1. Early childhood DEVELOPMENTAL TASK - eat solid foods - walk - talk - control elimination of wastes - relate emotionally to others - distinguish right from wrong through development of a conscience - learn sex differences and sexual modesty - achieve personal independence - form simple concepts of social & physical reality

DEVELOPMENTAL ASPECTS OF PEDIATRIC PATIENTS Age* Keys to Successful Interaction Characteristics

Toddler (13 years)

Make a game of assessment Distract with a toy or penlight Examine from toes to head Allow parents to participate in exam

Normally alert, active Can walk by 18 months Does not like to sit still May grab at penlight or push

Respect modesty, keep child covered when hand away possible

PLAY PARALLEL PLAY

y y y y

Child plays alongside other children but not with them Mostly free and spontaneous, no rules or regulations Attention span very short and change of toys occur at frequent intervals Imitation and make-believe play begins by end of the second year

GAMES: Throwing and retrieving objects SUGGESTED TOYS:

y

Play furniture, dishes, cooking utensils, play telephone, puzzles with large pieces, pedal propelled toys, rocking horse, clay crayons, finger paints, pounding toys, blocks, push-pull toys, balls

TOILET TRAINING 1. Psychological readiness 2. Process training 3. Parental response

LEARNING EXPERIENCE FOR 2 YEARS

y

Talk to me: Practicing the art of conversation -- what preschool experts call "cycles of conversation" -- is another goal for the year. Taking turns to talk is about a growing sense of respect for others -- an important piece of the school-preparation puzzle. Same goes for asking for permission before taking that red crayon. Physical gains: The biggie now is no surprise: toilet training! A preschool teacher's aim this year should be guiding each child, depending on her potty readiness, toward independent self-care (pulling up pants, washing hands). Meanwhile, fine motor skills still need lots of work; most twos use their whole fist to grab a crayon and move their whole arm to make marks on paper. LEARNING EXPERIENCE FOR 3 YEAR OLD CHILD
y

y y

The write stuff: Writing is rudimentary, but practice is key. Also, at the end of this year, many threes are able to pick out sounds at the beginning of a word and to recognize rhymes, which are critical skills for reading success. Count on it: Most kids this age can count by rote, at least to 10 if not much higher. "Still, they might not be able to count 10 actual objects accurately. I'll help myself, thanks: By the end of this year, threes should be expected to take out -and put away -- the items they use. "In an ideal classroom, things are organized in such a way that students can help themselves to what they need to start a game or complete a project.

PRESCHOOLERS Preschool children want to touch, taste, and smell, hear, and test things for themselves. They are eager to learn. They learn by experiencing and by doing. Preschoolers learn from their play. They are busy developing skills, using language, and struggling to gain inner control. Preschoolers want to establish themselves as separate from their parents. They are more independent than toddlers. They can express their needs since they have greater command of language. GROWTH OF A PRESCHOOLER Head circumference growth velocity- 1 cm/year(1/24 th of initial velocity) Rate of increase in height: 6 to 8 cm/year Formula to know the height: (age in years x 6) + 77 Formula to estimate weight : ( age in yearsx2) + 8

Respiratory Rates

Age Preschooler

Rate (breaths per minute) 2234

Pulse Rates Age Preschooler Low 80 High 140

Systolic Blood Pressure Age Preschooler Low Normal greater than 75

THEORIESAPPLICABLE TO PRESCHOOLERS Freuds Psychosexual Development Theory Phallic 4 to 6 y/o Center of pleasure: childs genital (masturbation) Major conflict: Oedipus & Electra Complex

Eriksons Stages of Psychosocial Development Theory STAGE 3. Late childhood AGE 3 to 5 y/o CENTRAL TASK Initiative vs guilt (+) RESOLUTION Learns to become assertive Ability to evaluate ones own behavior (-) RESOLUTION Lack of selfconfidence. Pessimism, fear of wrongdoing. Over-control & over-restriction.

Piagets Phases of Cognitive Development PHASE b. Pre-operational Pre-conceptual stage AGE 2-7 years 3-4 year DESCRIPTION Emerging ability to think Thinking tends to be egocentric. Exhibits use of symbolism. Intuitive stage 4-5years Unable to break down a whole into separate parts. Able to classify objects according to one trait.

Kohlbergs Stages of Moral Development LEVEL AND STAGE LEVEL I: Pre-conventional (Birth to 9 years) Stage 1: Punishment & obedience orientation Stage 2: Instrumental-relativist orientation DESCRIPTION Authority figures are obeyed. Misbehavior is viewed in terms of damage done. A deed is perceived as wrong if one is punished; the activity is right if one is not punished. Right is defined as that which is acceptable to & approved by the self.When actions satisfy ones needs, they are right.

Fowlers Stages of Faith STAGE Stage 1: Intuitiveprojective faith AGE Toddler-preschooler CHARACTERISTICS Imitates parental behaviors and attitudes about religion and spirituality. Has no real understanding of spiritual concepts.

DEVELOPMENTAL TASK Havighursts Developmental Stage and Tasks DEVELOPMENTAL STAGE DEVELOPMENTAL TASK

1. Infancy & early childhood

- eat solid foods - walk - talk - control elimination of wastes - relate emotionally to others - distinguish right from wrong through development of a conscience - learn sex differences and sexual modesty - achieve personal independence - form simple concepts of social & physical reality

DEVELOPMENTAL ASPECTS OF PEDIATRIC PATIENTS Age* Keys to Successful Interaction Explain actions using simple language Preschooler Tell child what will happen next Tell child just before procedure if something will hurt Distract child with a story Respect modesty Can sit still on request Can cooperate with examination Understands speech Will make up explanations for anything not understood Characteristics Normally alert, active

DEVELOPMENTAL STAGES OF PRESCHOOLERS Areas of Development 3-4 Years 4-5 Years 5Years

Sits with knees crossed. Ball games skill increases. Goes down stairs one foot per step. Imitates gate with cubes. Copies a cross. Can turn sharp corners when running. Builds a tower of 10 cubes. Social&Emotional Argues with other children. Plans games Development co-operatively. Dresses and undresses with assistance. Attends to own toilet needs. Developing a sense of humor. Wants to be independent. Counts up to 20. Asks meanings of words. Intellectual Questioning at its Development height. Draw recognizable house. Many infantile substitutions in speech. Uses correct Language grammar most of the Development time. Enjoy counting up to twenty by repetition Physical Development TOYS OF PRSECHOOLERS

Skips. Well-developed ball skills. Can walk on along a thin line. Skips on both feet and hops. Draws a man and copies a triangle. Gives age. Can copy an adult's writing. Colors pictures carefully. Builds steps with 3-4 cubes. Chooses own friends. Dresses and undresses alone. Shows caring attitudes towards others. Copes well with personal needs.

Learns to skip with rope. Copies a diamond. Knows right from left and number of fingers. Ties shoe laces.

Stubborn and demanding. Eager for fresh experiences. May be quarrelsome with friends.

Writes name. Draws a detailed person. Matches most colors. Understands numbers. Fluent speech with few infantile substitutions in speech. Talks about the past, present and future with a good sense of time.

Draws with precision and to detail. Developing reading skills well. May write independently Fluent speech. Can pronounce majority of the sounds of his own language. Talk fluently and with confidence.

Preschoolers are interested in dramatic play for eg:

y y y y y y y y y y y

Dinnerware Table/Chairs Kitchen Furniture Kitchen Items Aprons Vase and Flowers Broom, Dustpan Home Living Furniture Phones Family Themed Dress Up Clothes Suitcases

y y y y y y y y

Purses Wallets Dolls and Baby Items Toiletries Old Hair Dryers - Cords Removed Full Length Mirror Lunch Boxes Tools and Tool Box

Supervision and Tips:

y y y y y y y y

Observe and listen to the childrens behavior Interact on the childs eye level by sitting or kneeling Encourage children to talk about what it is they are doing Participate when invited ("tea party" guest, etc) Help encourage socialization and social play Avoid making yourself the focus of interest excuse yourself when appropriate Allow children to work out their difficulties and conflicts independently if at all possible Do not have too many props in this area, or clean up can be overwhelming

LEARNING EXPERIENCE FOR 4-5 YEAR OLD CHILD

y

See Spot run: child is not expected to graduate from preschool knowing how to read. But he should show that he's ready to make a start by identifying the starting sounds of words and being able to rhyme easily. This is also the time to introduce him to concepts of handwriting, such as how letters are formed from top to bottom, and how words are written from left to right across the page. Class rules: In most cases, the kindergarten your child attends will have more kids and fewer teachers -- and possibly a longer day -- than he's accustomed to in preschool. That's why there's much emphasis in the pre-K year on increasing attention span, understanding rules, and following directions. Playing it up: Kids are far more adept now at playing cooperatively, which does not mean without conflict. PARENTING TIPS y y y y y y y y Talk to the child when performing daily activitie Talk to the child in a normal tone of voice . Tell the child what to do instead of focusing on what not to do. Put away objects that are easily broken Read to the children. Let them choose the books Set a routine for going to bed. When the child is behaving well, comment on it Listen when the child talks . Plan ahead to avoid behavior problem

SCHOOLERS Within the family school children continue to learn those values, competencies they will bring into adult world. Continued achievement of child depends on a variety factors eg parentral expectations. School age children should have widened social horizons beyond the confines of their own homes. The child competitive relationships with the parents of the same sex, has been resolved, but may resurface during puberty and early adolescence.

GROWTH OF SCHOOLER WEIGHT:17.5-25.5KG( HAS GAINED 3.5 KG/YEAR) FORMULA TO CALCULATE WEIGHT: (AGE IN YEARS X 7) + 5/2

HEIGHT: 110-124CM ( GAINS-1.13) FORMULA TO CALCULATE HEIGHT : (AGE IN YEARS X 6) + 77 DENTITION: STARTS TO LOOSE TEMPERORY TEETH, AQUIRES FIRST PERMANENT MOLARS. MEDIAL INCISORS AND LATERAL INCISORS

Respiratory Rates Age School-age (612 years) Rate (breaths per minute) 1830

Pulse Rates Age School-age (612 years) Low 70 High 120

Systolic Blood Pressure Age School-age (612 years) Low Normal greater than 80

THEORY APPLICABLE TO SCHOOL AGE CHILD Freuds Psychosexual Development Theory STAGE Latency AGE 6 y/o to puberty CHARACTERISTICS Energy directed to physical & intellectual activities Sexual impulses repressed Relationship between peers of same sex

Eriksons Stages of Psychosocial Development Theory STAGE 4. School Age AGE 6 to 12 y/o CENTRAL TASK Industry vs Inferiority (+) RESOLUTION Learns to create, develop & manipulate. Develop sense of competence & perseverance. (-) RESOLUTION Loss of hope, sense of being mediocre. Withdrawal from school & peers.

Piagets Phases of Cognitive Development PHASE Intuitivepreoperational Concrete operations AGE Ages 6 to 7 DESCRIPTION begin cause-effect

Ages 7 to 11

collecting; mastering fact

Kohlbergs Stages of Moral Development

LEVEL II: Conventional (9-13 years) Stage 3: Interpersonal concordance Stage 4: Law and order orientation

Cordial interpersonal relationships are maintained. Approval of others is sought through ones actions. Authority is respected. Individual feels duty bound to maintain social order. Behavior is right when it conforms to the rules.

Fowlers Stages of Faith Stage 2: Mythicalliteral faith School-aged child Accepts existence of a deity. Religious & moral beliefs are symbolized by stories. Appreciates others viewpoints. Accepts concept of reciprocal fairness.

DEVELOPMENTAL TASK Havighursts Developmental Stage and Tasks Middle childhood - learn physical skills, required for games - build healthy attitudes towards oneself - learn to socialize with peers - learn appropriate masculine or feminine role - gain basic reading, writing & mathematical skills - develop concepts necessary for everyday living - formulate a conscience based on a value system - achieve personal independence - develop attitudes toward social groups & institutions DEVELOPMENTAL ASPECTS OF PEDIATRIC PATIENTS

Age* School-age child (612 years)

Keys to Successful Interaction Respect modesty Let child make treatment choices when possible Allow child to participate in exam

Characteristics Will cooperate if trust is established Wants to participate and retain some control

DEVELOPMENTAL STAGES OF SCHOOLERS Areas of Development Physical Development 6 YEARS 7-8YEARS 9-10YEARS 11-13 YEARS

Competes with friends. Loves to cut, color, and shape things. Has lots of energy.

Likes learning how to use tools.Can bathe and dress with a littlehelp from parents. Is losing babyteeth and growing permanentteeth

Hormones that start sexual maturity begin to work (somegirls begin their periods at thisage.) Likes crafts and skills thatuse fine muscles.

They may show talent for sport at thisstage. As they grow taller, they maybecome awkward all arms andlegs. Hormones start to flow. This begins sexual development. Physically, girls mature earlier thanboys Young teens have strong beliefs.They want to be heard. They can state their thoughts more clearly.They still think more about he present than the future. They are able to sitand listen for longer amounts of time.Talents in are and music mayblossom They are very self-centered.

Mental Development

Is learning to read; learning how to think things through. Learnsbest by working with materialsand people. Needs to practice athome what is learned at school.

Likes doing things over and over.Likes to read. Enjoys secretcodes or languages. Likes tohave successes noticed. Wants to know how things work. Likesroutines and rituals.

Learns and understand rules.Thinks in more adult terms.Enjoys learning about differentpeople and places. Likes to collect things. Enjoys groupprojects

Emotional Development

Has mood swings; is easily

Very concerned about right

Changes in body can be

hurt

andwrong. Develops strong likes and Dislikes Points out when parentsare wrong or do things they tell Children not to do.

Social Development

Can be bossy with friendsandfamily. May switch friendsoften.Likes to help with chores suchas preparing meals andshopping for groceries.

Plays well with other children, butparents are still the mostimportant role models

Frightening, especially if monthlyperiod has begun. Children varygreatly in rates of growth and often are selfconscious if theyare much taller or much shorterthan peers Peers are important. Needssome privacy at home. Likes tobe in planned group activitiessuch as sports. Enjoys one-on-one time with adults.

Becauseof the many changes in their bodies,they may have mood swings. Thesweet little girl and the friendly littleboy seem to vanish.

They want to be like their friends, tobe normal. They fear being different.They enjoy being with friends, andthey like one-on-one time with adults. They begin to doubt their parentsbeliefs. Girls begin to like boys

PLAY Blocks and construction Block play, with a variety of blocks and accessories, allows children the opportunity to explore spatial, mathematical, and role-play possibilities as well as practice problem-solving skills. Construction permits the completion of a project from design to finished product. Drama/theater Dramatic play gives children opportunity to discover an array of roles and responsibilities as well as providing a vehicle through which they make sense of their world. Space, time, props, materials, and supportive teachers enhance dramatic play and drama productions. GAMES AND PUZZLES y y y y y Strategy board games(eg: checkers, chess) Social board games( eg: Mouse trap) Play cards and variety of puzzles for different age group Word games, pencils, papers, score cards, chalk boards, chart. Factual card games( Dinosaurs)

PARENTING TIPS y y y y y y y y y y y Give children things to read at home. Read books with the children. Take turns reading to each other. Give children lots of chances to use their hands to cut, paste, paint, or shape things. Let the child to join groups with activities for children such as church, scouts and other group sports. Take the children to visit places and people in the community. Help the children to understand when they hurt others feelings. Teach the children what is right and wrong. Let the children help with house work. Let the children help with house work. Try to make a place for each child that can be their own. Make a comfortable place for the children to study.

ADOLESCENTS The word adolescence is a latin word derived from the verb adolescence which means to grow into adulthood . Adolescent is a term of moving from the immaturity of childhood into the maturity of adulthood.

GROWTH OF AN ADOLESCENTS

WEIGHT:MALE:APPROX 38-60 KG FEMALE: APPROX 40-60 KG HEIGHT: RATE OF INCREASE IN HEIGHT 5CM/YEAR MALE: APPROX 154-172 CM FEMALE : APPROX 153-167 CM DENTITION: PERMANENT TEETH NUMBER INCREASES Respiratory Rates Age Adolescent (1218 years) Rate (breaths per minute) 1216

Pulse Rates Age Adolescent (1218 years) 60 Low 100 High

Systolic Blood Pressure Age Adolescent (1218 years) Low Normal greater than 90

THEORY APPLICABLE TOADOLESCENTS Freuds Psychosexual Development Theory STAGE Genital AGE Puberty onwards CHARACTERISTICS Energy directed towards full sexual maturity & function & development of skills to cope with the environment

Eriksons Stages of Psychosocial Development Theory STAGE Adolescence AGE 1220 y/o CENTRAL TASK Identityvs role confusion (+) RESOLUTION Coherent sense of self. Plans to actualize ones abilities (-) RESOLUTION Feelings of confusion, indecisiveness, & possible anti-social behavior.

Piagets Phases of Cognitive Development PHASE Formal Operations AGE 11+ years DESCRIPTION Able to see relationships and to reason in the

abstract.

Kohlbergs Stages of Moral Development LEVEL AND STAGE LEVEL III: Post-conventional (13+ years) Stage 5: Social contract orientation Stage 6: Universal ethics orientation DESCRIPTION Individual understands the morality of having democratically established laws. It is wrong to violate others rights. The person understands the principles of human rights & personal conscience. Person believes that trust is basis for relationships. Fowlers Stages of Faith STAGE Stage 3: Syntheticconventional faith AGE Adolescent CHARACTERISTICS Questions values & religious beliefs in an attempt to form own identity.

DEVELOPMENTAL TASK Havighursts Developmental Stage and Tasks DEVELOPMENTAL STAGE Adolescence DEVELOPMENTAL TASK - establish more mature relationships with same-age individuals of both sexes - achieve a masculine or feminine social role - accept own body - establish emotional independence from parents - achieve assurance of economic independence - prepare for an occupation - prepare for marriage & establishment of a family - acquire skills necessary to fulfill civic responsibilities - develop a set of values that guides behavior

DEVELOPMENTAL ASPECTS OF PEDIATRIC PATIENTS Age* Adolescent (1218 years) Keys to Successful Interaction Explain the process as to an adult Treat the adolescent with respect Characteristics Has clear concepts of future Can make decisions about care

DEVELOPMENT STAGE OF ADOLESCENTS Areas of Development Physical Development 13- 16 Years 16 - 18 Years

Mental Development

They need lots of rest more than at any time since they were babies. Sexual growth continues. They may worry about their weight because looking good and being popular are important to them . Teens who are slow to grow may have low self-esteem. Teens may pay more attention to school and grades. They are becoming self-reliant. They are more responsible. Being treated fairly is important to them. They can think about things that cant be seen such as spiritual ideas and things like love ,respect and justice. They need love and respect of parent sand friends, but they may pretend not to care. They have a clearer idea of right and wrong. They sometimes behave like children when they are under stress.

Girls complete physical and sexual growth. Boys may continue to grow through late teen years and into their early 20s. W eight and being fit are concerns to older teens.

Older teens are able to think ideas through. They are concerned about future education and career goals. Their work habits are being set. They want to know where they fit in their family and other groups. They are able to see both sides of an issue

Emotional Development

Social Development

They need rules and structure for security, but rebel against rules. They may stop hugging and kissing parents, especially in public. Friendships change often.

They can have deep feelings of love and passion; they have a better sense of who they are sexually; they are better able to wait for results. They can work through conflicts with others and have more stable emotions. Friends are important but there is room for other relationships; conflict with parents begins to decease; concern for others increases.

Language development

They may try alcohol drugs, They are more independent. and/or tobacco. They enjoy some family and community traditions. Able to understand advanced Talks fluently and understands levels of communication.May advance level of respond with monosyllable communications answers.High level of comprehension and vocabulary.

RECREATIONAL ACTIVITIES Recreation programs focused to enhance recreational interest among adolescents. LEISURE ACTIVITIES y y y Competitive sports Giving more interest to special activities like drawing, painting dancing etc Listening to TV and Radio

PARENTING TIPS y y y y y y y Give the teens the facts about tobacco, alcohol, and drug use Tell the teens often that you love them. Build the teens confidence by noticing the things they do well. Listen to the teens when they talk to you Teens want to be like their friends and unlike their parents. Get to know the friends of the teens. Keep track of what the teens are doing. Build the teens confidence by noticing the things they do well.

ROLE OF SCHOOL NURSE  School nurses facilitate normal development and positive student response to interventions;  Promote health and safety including a healthy environment;  Intervene with actual and potential health problems;  Provide case management services;  Actively collaborate with others to build student  Family capacity for adaptation,self-management, self advocacy, and learning

ROLE OF COMMUNITY HEALTH NURSE 1. provide a skilled nursing resource to both individual children and families and within the community as a whole 1. Assess the particular needs of a family that has a child with a health need 2. Enable children to be nursed in all community settings for example, play groups ,nurseries, schools, residential homes, respite care facilities and the childs own home 3. Provide health promotion for the whole familyin co-operation with the family, plan the special nursing needs of a child 4. Through crisis intervention, offer continual support to families who live with a high level of stress associated with caring for a child with chronic illness. 5. Teach families to carry out specific nursing care, including hi-tech procedures 6. Make effective links within the primary care team particularly with general Practitioners, health visitors and school nurses and between hospital and Community settings

7. Prevent hospital admission and attendance through appropriate interventions. 8. Teach student nurses, community nurses, medical students, general practice trainees and others 9. Act as a specialist resource for all healthcare

CONCLUSION From the moment a newborn baby is brought home from the hospital most parents eagerly monitor their childs development. Every milestone is excitedly anticipated and it is so tempting to compare the own little one with other children of the same age after all everyone wants the assurance that their child is growing healthily along normal growth patterns. But normal is a relative term, and its important to remember that all children grow and develop at different rates, and that they all come in different shapes and sizes unique to their own genetic coding. Some children tend to grow steadily over time, while others may fluctuate between periods of slow growth and rapid growth spurts where they often catch up to their peers. Nevertheless, it is useful to keep an eye on the childs development patterns and alert the childs pediatrician if the are concerned