Prinsip perawatan anak

Tahap tumbuh kembang anak

Komunikasi pada anak
Pengaturan dan penyediaan
diet untuk anak

Introduction
Perawat bagian dari team
kesehatan yang melayani klien di
sepanjang keadaan sehat-sakit
yang salah satunya memberikan
pelayanan di rumah

Definition of pediatric
nursing
It is the art and science of
giving nursing care to
children from birth through
adolescent with emphasis on
the physical growth, mental,
emotional and psycho-social
development.

Qualities of Good Pediatric

Nurse
The good pediatric nurse must be:
1- Good observer
2- Honest and truthful
3- Sympathetic, kind, patient and
cheerful
4- Love to work with children
5- Interested in family care
6- Able to provide teaching to children
and their families

Role of Pediatric Nurse

The goals of nursing care of children, based on
primary health care are:
1-Promote the healthy maturation of the child
as a physical, intellectual and emotional being
within the context of his family and community
(primary level)
2-Provide health care for the child who requires
treatment from disease(s) (secondary level)
3-Dealing with the Child's disabilities (tertiary
level) or rehabilitation which means maximizing
the child's potential level of his body function.

The role of the pediatric nurse

includes:In primary level
Through health education to the child and his
parents and providing child's basic needs and
immunization.
The nurse can:
1-Maintain child's health.
2-Help the child to achieve his optimal growth
and development.
Prevent diseases and their complications.

secondary level:
The nurse has to provide care to sick children
and their families by:
Assessing their needs.
Planning for their care
.
Implementing the nursing care plan.
Evaluating children's condition and the plan
of care
Providing health teaching to children and
their parents

In tertiary level

The nurse should assist

children to return to their
maximal level of
functioning following
illness and or disabilities.

Family centered care

approach:
Family centered care is
philosophy of care that
acknowledges the importance of
the family unit as the
fundamental focus of all health
care interventions.

 Family centered care is best

understood by explaining the
elements of this care that work
together to move an individual or
an institution toward providing a
family centered approach. These
elements recognize each family's
uniqueness and explain the
influence of the family as a
constant in the child's life.

 Health team should be

flexible and creative in caring
for the child within his family
as their intervention are
based on the needs of parent
and child and on their coping
resources.

 Although the family is the ultimate

coordinator of its own care, the
nurse can help establish a positive
environment for family members
and help them accept and utilize
the care provided.
She/he can guide family members
through the unknown of new
experiences in seeking holistic
health acre utilization.

Parent education
Parents' education : one of the crucial roles that pediatric
nurses should undertake with the child
(according to his age) and his family
members.
The nurse has many
opportunities in providing health
education to parents and for children

Her/his education may be focused

on one or more of the following
Growth and development needs
Child's health promotion and maintenance as
nutritional need and hygienic care.
Preventive aspects such as (accident
prevention, immunization, periodic
examination).
Child's illness (nature of illness and care
needed).
Plan for child's discharge such as child's
medication, follow up, nutrition..etc.

Developmental theory
Freud theory
(sexual development).

Piaget theory
(cognitive development ).

Erikson theory
(psychosocial development).

Freud theory
(sexual development)
Infancy stage Oral-sensory
stage
Toddler stage
Preschool stage Anal stage

School-age
stage
Adolescence
stage

Genital stage
Latency Stage
Pubertal stage

Piaget theory
(cognitive development
Infancy stage
Toddler stage
Preschool stage

School-age stage

Adolescence
stage

Up to2 years sensori

-motor
2-3 years preconceptual phase.
Up to 4years preconceptual phase.
7-12 years concreteoperational.
12-15 years
preoperational formal
operations
15 years - through life
formal operations

Erikson theory
(psychosocial development)
Infancy stage
Toddler stage
Preschool stage
School-age stage
Adolescence stage

Trust versus mistrust.

Autonomy and self
esteem versus shame
and doubt.
Initiative versus guilt.
Industry versus
inferiority.

Identity and intimacy

versus role confusion.

Child Development
Theorists
Although researches dont always agree,
scientific researchers have agreed upon
the five following general rules.
Development is similar for each individual
Development builds upon earlier learning.
Development proceeds at an individual rate.
The different areas of development are
interrelated.
Development is a lifelong process.

Psychoanalytic Theories:
Freuds Psychosexual Theory
Personality has 3 parts
There are 5 stages of psychosexual
development
Oedipus complex allows child to
identify with same-sex parent
Fixation is an unresolved conflict
during a stage of development

Birth to
1 yrs

Freudian
Stages

1 to
3 yrs

3 to 6
years

6 yrs to
puberty

Puberty
onward

Latency
Genital
Oral StageAnal Stage Phallic
Stage
Stage
Stage
Infants
Childs
Child
pleasure pleasure
A time of
Childs
centers onfocuses on pleasure represses
sexual
sexual
mouth
anus focuses on
reawakening;
interest
source of
genitals
and develops sexual
social and pleasure
intellectual becomes
skills
someone
outside of the
family

Figure

 Eriksons Psychosocial Theory:

There are 8 stages of psychosocial
development
Each has a unique developmental task
Developmental change occurs throughout
life span
Key points of psychoanalytic theories:
Early experiences and family relationships
are very important to development
Unconscious aspects of the mind are
considered
Personality is best seen as a
developmental process

Eriksons Eight Life-Span

Stages
Eriksons
Stages
Developmental Period
Trust vs Mistrust

Infancy (first year)

Autonomy vs shame & Infancy (1 to 3 years)

doubt
Initiative vs guilt

Early childhood (3 to 5
years)

Industry vs inferiority Middle and late childhood

Figure

Identity vs identity
confusion

Adolescence (10 to 20 years)

Intimacy vs isolation

Early adulthood (20s, 30s)

Generativity vs
stagnation

Middle adulthood (40s, 50s)

Integrity vs despair

Late adulthood (60s onward)

Cognitive theories:
Piagets cognitive developmental
theory
Stresses conscious mental processes
Cognitive processes are influenced by
biological maturation
Four stages of cognitive development
in children
Assimilation and accommodation
underlie
how children understand the world,
adapt
to it, and organize their experiences

Piagets Four Stages of Cognitive

Development
Sensorimotor Stage:

The infant constructs an understanding of the

Birth to 2 by coordinating sensory experiences with phys
years of actions: progressing from reflexive, instinctual
at birth to the beginning of symbolic thought t
age
end of the stage.
Preoperational Stage:

2 to 7
years of
age
7 to 11
years of
age
1115
years of
age
through
adulthoo
d
Figure

The child begins to represent the world with w

and images. These words and images reflect
increased symbolic thinking and go beyond the
connection of sensory information and physica
Concrete Operational Stage:

The child can now reason logically about concr

events and classify objects into different sets.
Formal Operational Stage

The adolescent reasons in more abstract ideali

and logical ways.

 Vygotskys sociocultural cognitive

theory
Children actively construct their knowledge
Social interaction and culture guide
cognitive development
Learning is based upon inventions of
society
Knowledge is created through interactions
with other people and objects in the culture
Less skilled persons learn from the more
skilled

Information-processing theory
Compares computers to the human mind
Thinking is information processing

Information-Processing
Theory
geograph
y

literatu
re
scienc
e

INPU
T
Information

OUTPU
T
Information is

is taken into
brain
history religio
n

mat
h

used as basis of
behaviors and
interactions
Information
gets
processed,
analyzed, and
stored until
use

Banduras Social Cognitive

Model
Behavior

Person
(cognitive)

Figure

Environment

Banduras
Modeling/Imitation

Child
observes
someone
admired

Child imitates
behavior
that seems
rewarded

 Urie Bronfenbrenners ecological

theory:
Environmental factors influence
development
5 environmental systems affect lifespan development

Eclectic theoretical orientation:

Selects features from other theories
No one theory has all the answers
Each theory can make a contribution to
understanding life-span development

Mesosystems

ic
om s
on rn
Ec tte
pa

ss
Ma dia
me ral
ltu
Cu lues
va
Macrosystem

Family

School &
classroo
m

Chronosystem

Religion
&
groups

Peer
group

Me
ins dica
l
t
So itut
c i
co ial ons
nd
itio
ns

Na
cu tion
s
C o to m al
s
y mmu
n

it

Exosystem

Political
philosophy
School
system

Bronfenbrenn
ers Ecological
Theory of
Development

Figure
2.5

Observed correlation: as
permissive parenting increases,
childrens self-control decreases
Permissive
parenting

caus
es

Childrens lack
of self-control

Childrens lack
of self-control

caus
es

Permissive
parenting

Other factors,
such as genetic
tendencies, poverty,
and sociohistorical
circumstances

caus
ebot
h

Permissive
parenting
and
Childrens lack
of self-control

Possible Explanations for Correlational Data

Figure

Group 1

Time
playing
video
games:
2 hours
each
day

More
playfu
l
and
sociab
le

Group 2

Time
playing
video
games:
6 hours
each
day

More
aggressiv
e
and
antisocial

Other Influences on
Development
Heredity
Blood type, eye color, and hair color

Environment
Children also learn attitudes and beliefs
from their environments

Matching Key
1. Responsive to
children's needs.
2. Indifferent to children,
ignore them
3. Reject their children
4. Critical, derogatory,
dissatisfied with their
children.
5. Warm, understanding
and accepting.

A. Hostile and antisocial

B. Poor self-control,
difficulty with social
interactions when
teenagers.
C. Compliant with
parents wishes
D. Happy and friendly
E. Dissatisfied with
themselves.

Types of Parenting Styles and

Outcomes
Most parent can be classified
into three main types by the
style in which they guide their
children. As we discuss each,
think about where your own
parents fits most appropriately.
Do each of your parents use the
same style? Do you fit the
outcome?

Authoritarian:
Limits without
Freedom.
Definition:

Parents word is law, parents have

absolute control.
Misconduct is punished
Affection and praise are rarely give
Parents try to control children's
behavior and attitudes
They value unquestioned obedience
Children are told what to do, how to do
it, and where to do it, and when to do it.

Outcomes of Authoritarian
Style
Obedient
Distrustful
Discontent
Withdrawn
Unhappy
Hostile
Not High
Achievers
Often Rebel

Children from
authoritarian homes are
so strictly controlled,
either by punishment or
guilt, that they are often
prevented from making
a conscious choice about
particular behavior
because they are overly
concerned about what
their parents will do.

Permissive:
Freedom without
limits.
Definition:

Parents allow their children to do their own

thing.
Little respect for order and routine.
Parents make few demands on children.
Impatience is hidden.
Discipline is lax
Parents are resources rather than standard
makers
Rarely punish
Non controlling, non-demanding
Usually warm
Children walk all over the parents

Outcome of Permissive
Parenting
Aggressive
Least self
reliant
Least selfcontrolled
Least
exploratory
Most unhappy

Children from
permissive homes
receive so little
guidance that they
often become
uncertain and
anxious about
whether they are
doing the right
thing.

Democratic:
Freedom within
Definition:
limits.
Middle ground between the two above

Stress freedom along with rights of others and

responsibilities of all
Parents set limits and enforce rules
Willing to listen receptively to childs requests and
questions.
Both loves and limits
Children contribute to discussion of issues and
make some of their own decisions
Exert firm control when necessary, but explain
reasoning behind it.
Respect childrens interest, opinions, unique
personalities.
Loving, consistent, demanding
Combine control with encouragement
Reasonable expectations and realistic standards.

Outcomes of Democratic
Style
Happy
Mostly self-reliant
Mostly selfcontrolled
Content, friendly,
generous
Cooperative
High-achiever
Less likely to be
seriously
disruptive or
delinquent

Children whose
parents expect them to
perform well, to fulfill
commitments, and to
participate actively in
family duties, as well
as family fun, learn
how to formulate goals.
They also experience
the satisfaction that
comes from meeting
responsibilities and
achieving success.

Principles and Practice in

Communicating With Children

Communicating with Children

National Children's Bureau 2006

Communicating with children in

assessments
Why do it?
Context / background
Benefits
Good practice
Cautions
Communicating with Children
National Children's Bureau 2006

Who says we have to involve children?

The UN Convention on the Rights of the Child
The Children Act 1989, the Children Act 2004
The Framework for the Assessment of Children
in Need (2000)
S11 Guidance (2005)
Working Together to Safeguard Children (2006)

Communicating with Children

National Children's Bureau 2006

Who says...? (cont)

Every Child Matters agenda

The context of consumer rights
Local policy
My manager

My professional standards

Communicating with Children

National Children's Bureau 2006

Messages from inquiries

Communicating with children protects them
Laming found evidence of no, or limited,
conversations with Victoria Climbi
In reality, the conversations with Victoria were
limited to little more than hello, how are you?
The only assessment completed involved the
writing down of limited and sometimes
contradictory information provided by Kouao

Communicating with Children

National Children's Bureau 2006

Messages from inspections

The National Assessment Framework for
Children in Need is well understood in almost all
councils. The majority of assessments of
children and their families are satisfactory. A
significant minority do not include children and
families sufficiently or incorporate all key
information.
From Making Every Child Matter CSCI
(2005)
Communicating with Children
National Children's Bureau 2006

But also from CSCI

We see some excellent assessments that:
fully involve the child and their parents and
take their views into account
make full use of information from the range of
agencies involved with the child and family
and link it together effectively
take account of cultural issues and
influences, using the skills of specialist staff
where appropriate
Communicating with Children
National Children's Bureau 2006

But also from CSCI (cont)

assemble a holistic picture of the child in their
family, that weighs the significance of
information from all sources to determine the
nature and extent of risk to them
use that information and exercise skilled
professional judgement about the issues to be
addressed and needs to be met.

Communicating with Children

National Children's Bureau 2006

Involving children works

Children feel listened to, taken seriously, and
this helps them to deal with difficult situations
When children are involved in decision-making
and planning, the plans are more likely to be
successful
Services developed with the influence of children
and young people are more likely to meet their
needs
Communicating with Children
National Children's Bureau 2006

Good practice 1: Build competence

By providing information so that children and
young people can contribute meaningfully
By giving time and explanations so that they
can properly understand the issues and the
process
By being clear about what will be discussed,
and the likely consequences. Be straight
about the boundaries of confidentiality
By giving access to independent advocacy
services if required
Communicating with Children
National Children's Bureau 2006

Good practice 2: Practical considerations

Pay attention to venues and who will be present.
Children should be involved in deciding who, when
and where
Provide interpreters if required
Think about what tools and techniques you will
use. Preparation and planning
Think about the use of new technologies
Communicating with Children
National Children's Bureau 2006

Good practice 3: Create the right culture

Children are more likely to talk to people they
know and trust it takes time to build trust
Feedback and discuss the outcomes, what
happened
Follow up do what you said you would do
Be flexible in response to what children and young
people say
Communicating with Children
National Children's Bureau 2006

Good practice 4 : Child-led assessments

Start with what is important to the child
Go at the childs pace gradually build a picture
of their needs
Attend to positives as well as negatives
Forms / tick boxes / checklists dont always work
well for children

Communicating with Children

National Children's Bureau 2006

Childrens responses
Developmental considerations childrens
understanding at different ages, adolescents
willingness to engage
(but dont forget individual differences)
Cultural differences
Adverse events affecting childrens responses

Communicating with Children

National Children's Bureau 2006

Cautions
Sensitivity to childrens plans / schedules
Dont let children down be reliable, honest
and accountable
Support carers to support the child involved
Involve other trusted adults outside the family
Dont just talk try other methods
Communicating with Children
National Children's Bureau 2006

The hardest part of taking care of

kids is usually dealing with their
parents and guardians.

Whenever youre caring for a

child, you must consider the
family members to be your
patients too.

What parents like and want

Treat children as people.

Learn and use their preferred name.

At least get the sex right!

Keep children as physically and

emotionally comfortable as
possible.
Basic and advanced pain
management is important.
Try to relieve fear and anxiety as
early and as much as possible.

What parents like and want

Treat every child as if they were the
most special, beautiful, smartest
child in the world. A compliment to
a child is a complement to their
parents.

Listen to what the child has to say,

even if it sounds like nonsense.
Every child has something you should
honestly be able to complement them
on, even if its just that they have
such good lungs for them to be able
to scream so loudly

Romigs Rule of Smiling

If you can make the child smile first, the
parents smiles will follow soon after.
Corollary
A smile is as calming for everyone on
scene as a collective deep breath.

Everybody up for a stretch!

Nonverbal
communication
s

Nonverbal communications
What your face and
body say are every bit
as important as what
your mouth says.

Nonverbal communications
Get to the childs eye level.
Try not to make the child look at
you at an awkward angle.
Make eye contact but dont hold it
in a challenging manner.
Use your eyebrows to exaggerate
your expressions, especially for
babies through elementary-age
kids.

Nonverbal communications
Use a soft voice with a moderate
pace and interrupt only when
necessary.
Use noises like um-hmm and I
see to encourage children to talk.
For preverbal children, use a happy
voice and bring the tone up at the
ends of sentences (inviting a
response from the patient).

Nonverbal communications
Infants less than about 6 months
can be touched anywhere first, but
go to the most painful place last.
For children with stranger anxiety,
offer your hand or a tool for them
to touch and explore first. Go for
their heads and trunks and any
painful parts last.

Nonverbal communications
Touch school-agers in a playful
fashion. High five is often a good
way to start.
Tickling is good in young schoolagers but dont do it until youve
gotten your assessment.
Once a school-ager trusts your
touch, try to maintain some
contact while getting info from the
parent.

Nonverbal communications
Touch teens only as needed for
your exam, unless further touch is
clearly welcome.
Try to always have a witness when
with a teen, especially a teen of
the opposite sex, in case one of
your gestures is misinterpreted.
Watch your facial expressions with
teens! If you look like you dont
believe them, you lose them.

Tools, Toys and Tricks

BREASTFEED OBSERVATION AID

Mother's name _______________________________
Date ___________________
Baby's name _________________________________
Baby's age ______________
Signs that breastfeeding is going well:
Signs of possible difficulty:
GENERAL
Mother:
Mother:
Mother looks healthy
Mother looks ill or depressed
Mother relaxed and comfortable
Mother looks tense and uncomfortable
Signs of bonding between mother and baby
No mother/baby eye contact
Baby:
Baby:
Baby looks healthy
Baby looks sleepy or ill
Baby calm and relaxed
Baby is restless or crying
Baby reaches or roots for breast if hungry
Baby does not reach or root
BREASTS
Breasts look healthy
Breasts look red, swollen, or sore
No pain or discomfort
Breast or nipple painful
Breast well supported with fingers away from nipple
Breasts held with fingers on areola
BABYS POSITION
Babys head and body in line
Babys neck and head twisted to feed
Baby held close to mothers body
Baby not held close
Babys whole body supported
Baby supported by head and neck only
Baby approaches breast, nose to nipple
Baby approaches breast, lower lip/chin to nipple
BABYS ATTACHMENT
More areola seen above babys top lip
More areola seen below bottom lip
Babys mouth open wide
Babys mouth not open wide
Lower lip turned outwards
Lips pointing forward or turned in
Babys chin touches breast
Babys chin not touching breast
SUCKLING
Slow, deep sucks with pauses
Rapid shallow sucks
Cheeks round when suckling
Cheeks pulled in when suckling
Baby releases breast when finished
Mother takes baby off the breast
Mother notices signs of oxytocin reflex
No signs of oxytocin reflex noticed
Notes:

Water: What does it do and how much is enough?

Water cools the body, lubricates the joints, and helps muscles
to work. Infants are comprised of about 75% water while adults
are about 90% water.

Infants: Up

to 16 months, breast milk or formula is enough daily intake of liquid. The

infant can get water intoxication if he/she drinks several bottles of water a day or drinks
formula that has been diluted with too much water. Formula should be 2/3 milk and 1/3
water. Signs of water intoxication include pale urine; sleeping more than usual; difficult to
awaken; and wetting more than 8 diapers a day.

Young Child:

Needs 1.5 oz.

likely to drink cool water. Juice
Avoid cold water because it can
sources of water are fruits and

of water per pound of body weight a day. The child is more

from a squeezed lemon or lime can also be added for taste.
slow the digestive process causing constipation. Other
vegetables.

Pre-teen, Teen, and Adult:

Needs eight 8 oz. glasses a day. Cool water with

squeezed lemon or lime juice is usually preferred. Avoid cold water because it can slow the
digestive process causing constipation. Fruits and vegetables can be sources of water. This
is another reason for pre-teens and teens to regularly include fruits and vegetables in their
meal planning. If the pre-teen and/or teen becomes dehydrated,
he/she is at higher risk for getting constipated and/or developing
kidney stones.

What foods encourage regular bowel movements?

Fiber is necessary in the diet to promote regular bowel
movements. Food sources include fresh/raw fruits and
vegetables, legumes, whole grains. It is also important to
drink the daily requirement of water and eat unsaturated
fats that include omega 3 such as tuna fish.

What foods should be avoided?

Limit the amount of cheese, fried foods, sweets, carbonated drinks, white
flour and all junk food. Avoid ice cold drinks because they will slow the
digestive process.

Constipation is a sign of chronic dehydration

Constipation slows the flow and use of essential nutrients by the body.
This can lead to bad breath, headache, a particular body odor,
hemorrhoids, and varicose veins. Strawberries, blackberries, and
raspberries can cause constipation so eat them moderately and drink
required amount of water each day.

Developing Healthy Habits

Offer a variety of healthy foods and snacks.

Encourage fruit and vegetable intake.
No junk food snacking.
Limit intake of juices ( 4 oz per day).
Increase intake of water (no soda).
Encourage low fat dairy products (3-4
servings/ day).
Make fun physical activity a habit.
Limit TV to no more than 1 to 2 hours per
day.
Track growth and development carefully.
Be a good role model.

What should I know about feeding an infant (birth to 12 months)?

Feed infant 2-3oz. more than age in months. A 3
month old would therefore be fed 5-6 oz. per day.
Baby is getting enough food if he/she wets 4-6 diapers
and poops 3-4 diapers a day.
Introduce 100% juice, not juice drinks, at 6 months of age.
Limit juice, when introduced, to 4oz. per day. More than this will
cause diarrhea and possibly cause the growing baby to become
overweight.
Baby food should be soft/mushy so it can be gummed. At 9 months, the baby can
eat coarser, chunkier textures of food. This food should be cut in tiny chunks.
Introduce a single food at a time. When the baby has adopted the new food, a
previously adopted food can be eaten with the newly adopted food. If feeding
baby only a portion of food from a baby jar, place that portion in a bowl and
feed with a spoon from the bowl. Do not use the jar as a bowl if feeding a
portion of the jars contents. The spoon, contaminated with germs from the
babys mouth, will grow in the jar when it is recapped.

What should I limit and/or avoid when feeding an infant?

Limit the amount of milk to no more than 24oz
per day. Ingesting too much milk will reduce
iron absorption by the body.
Avoid eggs because of possible food allergy.
Limit citrus juices and fruit because they can
possibly cause a rash. Dont give juice in a
bottle. The sugar content against the gums can
ruin teeth buds.
Avoid giving baby honey until after his/her first birthday. Honey can
be a source of botulism.
Dont home prepare beets, collard greens, spinach, and turnip greens
for the baby because these raw foods have nitrates which are
harmful to the baby. Pureed, jar baby food containing these foods,
is free from such nitrates and safe to feed the baby.

What should I know about feeding my toddler (ages 1-3)?

Needs 1000-1400 calories per day. Another
way to determine is to calculate 40 calories
per inch of height per day.
Typical serving size is 1 tablespoon per year of age.
Nutrient
and 210

needs include 16 grams of protein; 44 grams of fat;

grams of carbohydrate.

The toddler also needs 10 milligrams of iron a day. Good sources of iron
include potatoes, spinach, split peas, and strawberries. Milk should not
exceed 24oz. per day to prevent reduced iron absorption.
Feed a toddler who eats too much by using a small plate; cut food in small
pieces to allow hand eating; serve low calorie foods; be sure he/she is
eating fiber foods and exercising (both will reduce appetite).
Food Guide Pyramid for toddlers
Lunch snacks for toddlers
Library of toddler recipes
Dont panic if your toddler doesnt eat three meals a day
Nutrients and your toddler

Good nutrition for school age children and teens

Involve school age children in helping to plan, shop for, and cook meals.
Remember, it takes 11 tries for a child to accept a new food. Dont
give up. Serve new food in small amount. Make the food presentation
colorful and appealing.
School age children and teens require 1600-2400 calories a day
depending on age and activity level. Food Guide Pyramid
School children require 800 milligrams of calcium and 10
milligrams of iron while teens require 1200-1500 milligrams of
calcium and 12-15mg.of iron a day. Junk food can cause iron
deficiency. An iron supplement can significantly improve learning,
memory, and cognitive test performance.
Motivators for school age children and adolescents
Food smarts, myths and facts
Caf Zoom recipes
How to get your child to eat healthy at school
How to get your teen to eat healthy

Feeding Skills Development

4-6 mos - experience new tastes.
Give rice cereal with iron.

6-7 mos - sits with minimal

support.
Add fruits and vegetables.

8-9 mos - improved pincer grasp.

Add protein foods and finger foods.

10-12 mos - pulls to stand,

reaches for food.
Add soft table food, allow to self-feed.

Feeding Skills Development

12-18 mos - increased independence.
Stop bottle, practice eating from a
spoon.

18 mos -2 yrs - growth slows, less

interest in eating.
Encourage self-feeding with utensils.

2-3 yrs - intake varies, exerts control.

Teen nutrition deficiency and consequences

Most eating habits are already established by the late teen years
Teens are growing rapidly during adolescence. Twenty
percent of adult height and 50% of adult weight is gained
during adolescence.
Because 45% of adult bone mass is added during
adolescence, the daily requirement of calcium increases to
1200-1500 milligrams. A significant number of teens are
deficient in calcium and other nutrients due to junk food..
Calcium aids in movement of nerve impulses; muscle
contraction and relaxation; blood pressure; and the immune
system. Caffeine ingestion has been noted to lower bone
mineralization and thus increase fracture risk.
Typical caffeine food sources ingested by teens include chocolate,
coffee, soft drinks, and tea. The effect of caffeine is enhanced
in the absence of a diet inclusive of required amounts of milk.
Symptoms of calcium deficiency include insomnia, tooth decay,
depression, headache, and inability to relax.

Application Activity
1. Determine the amount of water each family member is
consuming, then develop a plan to have that consumption
meet the daily requirement.
2. Determine how healthy each family member is eating by
inputting each members meals in the Pyramid tracker.
3. What change is each member willing to make to include more
healthy foods?
4. What information from this Marvelous Moment was most
helpful to you and how was it helpful?

child abuse

Indicators of Child Abuse (Discovered by

Family Doctor)

Type of Abuse

Physical Indicators

Behavioral Indicators

Physical

Unexplained bruises, welts, burns,

fractures, or bald patches on scalp

Wary of adult contact, frightened of

parents or afraid to go home,
withdrawn or aggressive, moves
uncomfortably, wears inappropriate
clothing for weather

Sexual

Difficulty walking or sitting; torn or

stained/blood underclothes; pain,
itching, bruises, swelling in genital
area; frequent urinary or yeast
infections

Advanced sexual knowledge,

promiscuity, sudden school
difficulties, self-imposed social
isolation, avoidance of physical
contact or closeness, depression

Emotional

Speech or communicative disorder,

delayed physical development,
exacerbation of existing conditions,
substance abuse

Habit disorders, antisocial or

destructive behaviors, neurotic traits,
behavior extremes, developmental
delays

Neglect

Consistent hunger, poor hygiene,

inappropriate dress, unattended
medical problems, underweight,
failure to thrive

Self-destructive behaviors, begging or

stealing food, constant fatigue,
assuming adult responsibilities or
concerns, frequently absent or tardy,
states no caretaker in home

 Common Features of Successful Child Abuse Prevention

Programs _______________________________________

Strengthen family and community connections and

support.
Treat parents as vital contributors to their children's
growth and development.
Create opportunities for parents to feel empowered
to act on their own behalf.
Respect the integrity of the family.
Enhance parents' capability to foster the optimal
development of their children and themselves.
Establish links with community support systems.
Provide settings where parents and children can
gather, interact, support and learn from each other.
Enhance coordination and integration of services
needed by families.
Enhance community awareness of the importance