Chapter 3: Communicating with Children and Families Components of effective communication with children involve verbal and nonverbal

interactions that include touch, physical proximity, environment, listening, eye contact, visual cues, pace of speech, tone of voice, and overall body language. Touch is particularly important when communicating with infants, but positive and reassuring touch is valued by children of all ages. Nurses should always respect each childs sense of personal space. Creating and maintaining privacy facilitates communication, particularly for adolescents and families. The best communication approach for an individual child should be determined on the basis of the childs age, developmental abilities, and cultural preferences. Listening is an essential component of communication. Active listening skills include being attentive, clarification through reflection, empathy, and impartiality. The nurse also needs to be aware of the effects of visual communication, such as eye contact, body language, dress and adverse visual stimuli. When communicating with families, it is essential for the nurse to first establish rapport and create a climate of trust. When the nurse is available and open to questions, the family feels empowered and more in control. Involving the family in the childs care and teaching them the skills needed to care for their child also is empowering. Conflict between families and the health care team is not unusual. The nurse can prevent conflict and facilitate conflict resolution by creating a welcoming climate and choosing words carefully when communicating with families. Communicating with families whose primary language is not English provides additional challenges; recognizing ones own cultural beliefs and attitudes and how they affect communication with others is important. For bridging the communication gap with families of different cultures, the nurse assesses child-rearing practices, family supports, who is the primary decision maker, communication practices, and approaches to seeking health care. The nurse must be cautious about both overinvolvement and underinvolvement when caring for children and their families. Interventions that facilitate communication include such strategies as incorporating play and storytelling in care, and modeling communication practices that enhance self-esteem. Communication pitfalls, such as using jargon, talking down to children or beyond their developmental level, and avoiding or denying a problem, can lead to a breakdown in the relationship between the nurse and the child and family. Children with special communication needs include those who have a visual or hearing impairment, speak another language, have a communication disorder, and have profound neurologic impairment. In working with children with special needs, the nurse should carefully assess each childs physical, mental, and developmental abilities and determine the most effective methods of communication. Chapter 4: Health Promotion for the Developing Child

Growth, development, maturation, and learning are complex, interrelated processes that produce complicated series of changes in individuals from conception to death. Growth and development proceed from simple to complex, from proximal to distal, and from head to lower extremities. As children grow and develop, wide variations within normal limits occur. Weight, height, and head circumference, common parameters used to monitor growth, should be measured and evaluated at regular intervals. The earlier that delays and deviations from normal are treated, the less severe the effect will be on growth and developmental outcomes. Numerous factors, including genetics, environment, culture, nutrition, health status, and family structure, affect how children grow and develop. Piagets theory of cognitive development describes how children learn to deal with their environment through thinking and reasoning. Progress in learning during various periods is based on the childs ability to create patterns of understanding and behavior. Freuds psychosexual theory attempts to explain how humans struggle in both conscious and unconscious ways to become individual beings. During each stage of sexual development in children, a different area of the body is the focus of attention and pleasure. Eriksons theory of psychosocial development describes a series of crises emerging at specific times and in a particular order. These stages occur throughout life, and each must be resolved for an individual to progress emotionally. Kohlberg discusses moral development as a complex process involving progressive acceptance of the values and rules of society in a way that determines behavior. A maturing individual becomes less concerned with avoiding punishment and more interested in human rights and universal justice. Language development, a complex process involving extensive neuromuscular maturation, begins as undifferentiated crying at birth and proceeds throughout life to provide a vehicle for communication, thought, and creativity. A variety of screening tools are used by nurses to gain an overall picture of a childs developmental progress and to alert the nurse to potential developmental delays. Both developmental surveillance and formal screening at 9, 18, and 24 to 30 months improve health care providers assessment and identification of children with developmental delays. To provide high-quality, developmentally appropriate care to children and parents, nurses must be aware of normal patterns of growth and development. The 46 human chromosomes are long strands of DNA, each containing up to several thousand individual genes. With the exception of those genes located on the X and Y chromosomes in males, genes are inherited in pairs that may be identical or different. Some genes are considered to be dominant and others, recessive. Inherited predisposition to disease can occur through Mendelian inheritance patterns, chromosomal abnormalities, or multifactorial influences. Pediatric nurses must obtain competencies in genetics and genomics to provide appropriate counseling to parents and children.

Piaget described three types of play, related to periods of sensorimotor, preoperational, and concrete operational functioning: practice play, symbolic play, and games. Play enhances the childs growth and development through physical, cognitive, emotional, social, and moral development. Personnel who administer and handle vaccines must be aware of recommendations for handling, storing, and administering the vaccines. Special attention should be given to the site of administration, dosage, and route. When a lapse in immunization occurs, the entire series does not have to be restarted. Children who are immunologically compromised should not receive live bacterial or viral vaccines. The six basic nutrients are carbohydrates, protein, fat, vitamins, minerals, and water. Components of a nutritional assessment are anthropometric data, biochemical data, clinical examination, and dietary history. Many childhood injuries and deaths are predictable and preventable. Understanding the developmental milestones of each age-group is important for promoting safety awareness for parents, caregivers, and children.