01.03 Growth & Development – Overview

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Eriksons Stages (Cheat Sheet)
Theories of Development (Cheat Sheet)
Pediatric Growth Charts (Cheat Sheet)

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Hey Guys! This lecture is going to provide an overview of info related to growth and development. This information matters so much because a lot of times, our first clue that a child might be having a problem, is that they aren’t meeting expected milestones.

To pick up on these delays you’ve got to know what to look for in the first place. We are going to look at patterns and cover some basic terminology. And guys, I’ll be the first to admit that some of the things we cover here are not things you are going to use on a daily basis- but they are super testable- and they do help with understanding the big picture when it comes to pediatric nursing. So, let’s get going.
So, big picture- A child’s development is an interaction between genetics and environmental factors. (draw arrows)

If that development isn’t happening like we would expect it to- we have to figure out why! So we need to ask questions about family history and we are going to explore their environment. Key factors in the environment are 1) nutrition 2) play, 3) sleep/rest, 4) stress, 5) illness, and 6) injury

Let’s look at some examples of how this might play out.

So, you could have a 3 month old that isn’t developing head control like we would expect. Or a toddler that hasn’t started talking at all yet. Or a school age child that has all the sudden started losing weight and can’t keep up with his classmates. These examples are some of the most common problems we might pick up on.

For more details on what clues to be looking for during each phase of development check out the growth and development lessons specific to each age group.

Okay let’s get into some of the terminology I mentioned earlier. Growth and development follow a few general patterns and if you can learn these they will help you think about what should be happening rather than just memorising milestones.

First, development occurs from the top down or cephalocaudal - this just means that a baby has to gain head and neck control before they can do something like sit up or walk. (draw stick figure)

The second pattern is that it occurs from the center outward- or proximodistal. (draw arrow) This means that core control happens before those milestones involving the extremities. Sitting before crawling, crawling before walking.

The last pattern to know is that skills develop from general to specific. Babies get control of their hands (palmar grasp) before they are able to use fingers individually (pincer grasp), or another example, they can scribble before they can draw a circle.

Our assessment of a child’s growth is pretty straight forward, The 3 things we are measuring are weight, height and head circumference. Weights are always measured in kg. Height is called length if they are less than 2 years and we measure it with the child lying down. Head circumference is measured up until the child is 3 years old because this is the time period when the brain is growing the fastest.

From a nursing point of view, the most important thing with all of these measurements is to ensure consistency and accuracy. Weights and heights mean nothing if they aren’t done properly. So this means always use tools that have been calibrated.

Results should be documented on growth charts. Growth charts tell you, out of 100 kids where this particular kid would fall. So, if you measure little Johnny and he is on the 99th percentile, you would explain to his parents that this means that in a room of 100 kids he would be taller than 99 of them.

Okay we’ve talked about measuring growth, let’s talk about assessing development. Listed here are some basic facts and concepts that you need to know.

So, first, you have to know the different stages of development - they are neonates, infants, toddlers, preschoolers, school age and adolescent. Take a look at the outline for the exact ages for each of these stages.

The developmental theories are covered in the Foundations course, but the two that are most relevant to peds are Erikson’s, which is about psychosocial development and Piaget’s which is about cognitive development.

Milestones are the specific activities we are looking for a child to do at a certain age and they are divided into categories: 1) Motor (gross motor, fine motor) 2) Language 3) Psychosocial, and 4) Cognitive. It’s important to know that every child will develop slightly differently. When we talk about milestones we are always looking at the median or average time that most kids will accomplish something.

Delays occur when a child isn’t accomplishing a milestone when expected.

Regression is when they are no longer able to do something that they previously were able to do. Regressions are really because they usually mean that there is some kind of active disease process going on and we need to figure it out quickly. For example- a child with a tumor may suddenly have a change in their coordination.

Your priority nursing concepts for this lesson are, clinical judgement, prioritization and health promotion.

Okay guys , I hope you’ve found this quick lesson helpful as a review of why growth and development matters and some of the important terms to know! Your key points are, 1) Think of growth and development findings as important clues. If there is a delay or regression, ask why and assess! 2) Learn those milestones so you can spot delays and finally 3) Be familiar with the terms and theories- not the most fun thing to learn but like I said, very testable!

That’s it for our overview of growth and development. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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