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Health Promotion in Pediatrics

Physical Development
-

Infant (birth to 1 year old)


o Posterior fontanel closes by 6 to 8 weeks of age
o Anterior fontanel closes by 12 to 18 months of age
o Dentition- six to eight teeth should erupt by the end of the first year.

First teeth erupt between the ages of 6 to 10 months

Teething pain can be eased


1. Cold teething rings
2. OTC teething gels
3. Acetaminophen/ Ibuprofen
o NO MORE THAN 3 DAYS
o Ibuprofen only in infants over the age of 6 months

Clean the teeth using cool wash cloth

Do not give bottles to infants when they are falling asleep


o Bottle mouth syndrome: Dental Caries.

Infant
1 month
2 months
3 months
4
5
6
7
8
9

months
months
months
months
months
months

10
months
11
months
12
months

Gross Motor Skills


Head Lag
Lifts head off mattress
Raises head and shoulders off mattress

Fine Motor Skills


Grasp Reflex
Holds hands in an open position
No longer has a grasp reflex.
Keeps hands loosely open
Places objects in mouth
Uses palmar grasp dominantly
Holds bottle
Moves object from hand to hand
Begins using pincer grasp
Has a crude pincer grasp

Rolls from back to side


Rolls from front to back
Rolls from back to font
Bears full weight on feet
Sits unsupported
Pulls to standing position
Creeps on hands and knees instead of crawling
Changes from a prone to a sitting position

Grasp rattle by its handle

Walks while holding on to something

Places objects into a container

Sits down from a standing position without


assistance

Tries to build a two block tower without success

Toddler (1 to 3 years old)


o Anterior fontanel close by 18 months of age

Age
15
months
18
months

Gross motor skills


Walks without help
Creeps up stairs
Assumes a standing position
Throws a ball overhand

2 years
2.5 years

Walks up and down stairs by placing both feet on each step


Jumps in place with both feet
Stands on one foot momentarily

Preschooler (3 to 6 years old)

Preschoole
r
3 years

4 years
5 years

Fine motor skills


Uses a cup well
Builds a tower of two blocks
Manages a spoon without rotation
Turns pages in book, two or three a
time
Builds a tower of six or seven blocks
Draws circles
Has good hand finger coordination

Gross motor skills

Fine motor skills

Rides a tricycle
Jumps off bottom step
Stands on one foot for few seconds
Skimps and hops on one foot
Throws ball over head
Jumps rope
Walks backward with heel to toe
Throws and catches ball with ease

Show improvement in fine motor skills


Copying figures on paper
Dressing independently

School
o
o
o
o
o

Age Children (6 to 12 years)


Permanent teeth eruption
Visual acuity 20/20
Auditory acuity and sense of touch fully develop
Rapid growth
Females

Budding of breasts

Appearance of pubic hair

Onset of menarche
Males

Enlargement of testicles

Appearance of pubic hair

School age child

Gross Motor Skills


Continue to improve

Fine Motor Skills


Continue to improve

Adolescent (12 to 20 years old)


o Acne may appear
o Increase in metabolism and rapid growth alter sleeping habits: sleep late and more
o Females

Budding of breast

Growth of pubic hair

Onsent of menstruation
o Males

Increase in size of testes and scrotum

Appearance of pubic hair

Growth of axillary hair

Change in voice
Adolescent

Gross Motor Skills


Continue to improve

Fine Motor Skills


Continue to improve

Physical development (weight and height)


AGE
INFANTS (birth to 1)

TODDLER (1 to 3)

PRESCHOOL (3 to 6)
SCHOOL AGE (6 to 12)
ADOLESCENCE (12 to 20 years)

Cognitive Development

WEIGHT
150 to 210 g per week the
first 6 months
Double by 6 months
Tripled by 12 months
Should weight four times their
birth weight
Gain 2 to 3 kg per year
2 to 3 kg per year
Boys: 7 to 30 kg
Girls: 7 to 25 kg

HEIGHT
2.5 cm per month the first 6
months
Increases by 50% by the age
of 12 months
7.5 cm per year

6.5 to 9 cm per year


5 cm per year
Girls: 5 to 20 cm
Boys: 10 to 30 cm

AGE
INFANT (birth to
1)

PIAGET
Sensorimotor (birth to 24 months)
Infants begins to understand the world by coordinating
experiences with physical interactions with objects
Differentiates self from objects
Recognizes self as agent of action and begins to act
intentionally: e.g. pulls a string to set mobile in motion
or shakes a rattle to make noise
Achieves object permanence

LANGUAGE
Crying is the first form of
verbal communication
Responds to noises
Pronounces single syllable
words
Two word phrases three
words
3 -5 words and understands
no by the age of 1 year old

1.

TODDLER ( 1 to
3)

Separation learn to separate themselves from


other objects in the environment
2. Object permanence (9 months)-object still exists
when it is out of view. Peek a boo is a good test
3. Mental Representation
Sensorimotor to preoperational stage
1. Object permanence is fully developed
2. Demonstrate memories of events that relate to them
3. Playing house is evident
4. Preoperational thought does not allow for toddlers to
understand other viewpoints but it does symbolize objects
and people to imitate previously seen activities

PRESCHOOL (3
to 6)

SCHOOL AGE ( 6
to 12)

ADOLESCENCE
( 12 to 20)

Pre-operational stage ( 2 to 7 years)


Learns to use language and to represent objects by
images and words
Thinking is still egocentric: has difficulty taking the
viewpoint of others
Classifies objects by a single feature: groups together
all the red blocks regardless of shape or all the square
blocks regardless of color
1. Intuitive thought ( 4 to 7)
Moves from egocentric thoughts to social awareness
and understanding the viewpoints of others
2. Pre operational thought
Magical thinking- thoughts can cause events to occur
Animism- inanimate objects are alive
Centration- focus on one aspect instead of considering
the whole
Concrete operations (7-11)
Can think logically about objects and events
Achieves conservation of number, mass, and weight
Classifies objects according to several features and can
order them in serious along a single dimension such as
size
1. Masters the concept of conservation
Mass, weight, and volume is understood
2. Learns to tell time
3. Classifies more complex information
4. Able to see the perspective of others
5. Able to solve problems
Formal Operation ( 11 years and up)
Can think logically about abstract propositions and test
hypotheses systematically
Becomes concerned with the hypothetical, the future,
and ideological problems.
1. Able to think through more than two categories of variables
concurrently
2. Capable of evaluating the quality of their own thinking
3. Able to maintain attention for longer periods of time
4. Highly imaginative and idealistic
5. Increasingly capable of using formal logic to make

Language increases to about


300 words by the age of 2
years
1 year- use one word
sentences
2 years- use multiword
sentences by combining two
to three words
3 years- combine several
words to create simple
sentences using grammatical
rules.
2100 words by the end of the
5th year
Speak in sentences of 3 to 4
words at the ages of 3 and 5
4 to 5 words at the age of 4
to5 years
Enjoys talking. Language
becomes their primary
method of communication

Defines many words and


understands rules of grammar
Understands that a word may
have multiple meanings

Develops jargon with their


peer groups

6.
7.

decisions
Think beyond current circumstances
Able to understand how the actions of an individual
influence others

Freud
STAGE

AGE

ECOGENOUS
ZONE

CHARACTERISTIC

Oral Stage

Birth to 1

Mouth

1.
2.

3.
4.

Anal Stage

1 to 3
years

Bowel and
bladder
control

1.

2.
3.

4.

Phallic
Stage

4 to 6
years

Genitals

1.
2.
3.

4.

Latency
Stage

6 to
puberty

Sexual
feelings are
inactive

1.
2.
3.

4.

Pleasures centres around the


mouth and the ingestion of food
Chewing, sucking, biting and
swallowing are the chief source
pleasure
These actions reduce tension in
the infant
A child derives pleasure
through mouth by sucking,
biting, and swallowing etc.
conflict arises when the oral
needs of a child are not met
Withholding elimination until its
ultimate release is a source of
pleasure
The exercise of anal muscles
reduces tension
Anus becomes the center of
gratification as toilet training
starts
Pleasure centres around the
anus or the eliminative
functions
Pleasure centres around the
genitals
Self-manipulation is the chief
source of pleasure
The child identifies with the
same sex parent to reduce
tension
Genitals become the centre of
gratification and children
develop attraction towards the
parent of opposite sex.
Pleasure centres around social
interactions with others
Child represses all interest in
sexuality
The child channels his/her
energy into emotionally
acceptable relationships to
reduce the tension experienced
in the phaillic stage
No psychosexual develop
occurs in children. The libido is
diverted towards sexual

NURSING ACTION
(give examples)

activities.

Genital
stage

Puberty to
death

Maturing
sexual
interest

1.
2.

3.

4.

The genital stage is a time of


sexual reawakening
The source of pleasure now
becomes someone outside the
family
Freud believed that unresolved
conflicts with parents reemerge during adolescence.
When these conflicts have been
resolved the individual is
capable of developing a mature
love relationship and function
independently as an adult
It is the puberty period when
sexual urges reawaken that
may lead to children exploring
their sexuality

Psychosocial Development
Erikson
Ages
Infants ( birth to
1)

Erikson
Trust vs Mistrust ( Birth to 1)
1. Achieving this task is based on the quality fo
the caregiver infant relationship and the
care received
2. The infant begins to learn delayed
gratification
3. Trust is developed by meeting the needs:
comfort, feeding, stimulation and
caring.needs
4. Mistrust develops if needs are inadequately
or inconsistently met, or if needs are over
met

Toddler (1 to 3)

Autonomy vs Shame & Doubt ( 1 to 3)

Children learn to either be self-sufficient in


many activities, including toileting, feeding.
Walking, and talking <OR> to doubt their
own abilities.

Nursing action

Preschooler ( 3 to
6)

School Age ( 6 to
12)

Adolescence ( 12
to 20)

Initiative vs Guilt (3 to 5)
1. Preschoolers become energetic learners,
despite not having all of the physical abilities
necessary to be successful at everything
2. Guilt may occur when preschoolers believe
they have misbehaved or when they are
unable to accomplish a task
3. Guiding preschoolers to attempt activies
within their capabilities while setting limits is
appropriate
Industry VS inferiority (5 to 12)
1. A sense of industry is achieved through the
development of skills and knowledge that
allows the child to provide meaningful
contributions to society
2. A sense of accomplishment is gained
through the ability to cooperate and
compete with others
3. Children should be challenged with tasks
that need to be accomplished, and allowed
to work through individual differences in
order to complete the task
4. Creating systems that reward successful
mastery of skills an tasks can create a sense
of inferiority in children unable to complete
the task or acquire the skills
5. Children should be taught that not everyone
will master every skill
Identity VS role Confusion ( 12 to 18)
1. Adolescents develop a sense of personal
identity, and come to view themselves as
unique individuals
2. Group identity- adolescents become part of a
peer group that greatly influences behaviors

Psychosocial development (Continued)


AGE

SOCIAL

SELF CONCEPT

INFANT
(birth to
1)

1.

Separationinfants first
distinguish
themselves
and their
primary
caregiver as
separate
individuals

2.

3.

Attachmentbegin to bond
with parents.
Seen within the
first month
Separationinfants first
distinguish
themselves and
their primary
caregiver as
separate
individuals
Separation
anxiety 4 to 8
months. Infants
will protest when
separated from

MORAL

BODY IMAGE

ACTIVITES

1.

1.
2.
3.
4.
5.

2.

3.

Mouths are
pleasure
producers (oral
phase
Hands and feet
are objects of
play
Smiling causes
others to react

6.
7.
8.
9.
10.

Short attention
solitary play
rattles
teething toys
playing pat a
cake
playing with
balls
reading books
mirrors
brightly colored
toys
playing with
blocks

4.

TODDLER
( 1 to 3)

1.

parents
Stranger fear- 6
to 8 months. Less
likely to accept
strangers
separation
anxiety

1 separation
complete
2. Begins
exploration
on own

1.

2.

3.

PRESCHO
OLER ( 3
to 6)

1.

2.

3.

Do not exhibit
stranger anxiety
and have less
separation
anxiety
Prolonged
separation,
during
hospitalization,
can provoke
anxiety
Favorite toys
and
appropriate
play should
be used to
help ease
preschoolers
fears
Pretend play is
healthy and
allows

1 mastering
skills make
them feel good
2 regression
may occur
during stress

Closely associated
with cognitive
development
Egocentric
unable to see
things from the
perspectives of
others
Punishment and
obedience begins
with a sense that
good behavior is
rewarded and bad
behavior is
punished

Early
preschoolers
continue in the
good-bad
orientation of the
toddler years.
Actions are taken
based on whether
or not it will
result in a reward
punishment
Older
preschoolers
primarily take
actions based on
satisfying
personal needs,
yet are beginning
to understand the
concepts of
justice and

1.

2.

Appreciate
usefulness of
various body
parts
Gender
identity by 3
years of age

Begin to
recognize
differences in
appearances,
and identify
what is
considered
acceptable and
unacceptable
By the age of 5
years,
preschoolers
begin
comparing
themselves
with peers
Poor
understanding
of anatomy
makes intrusive
experiences,
such as

1.

Parallel playtoddlers observe


other children
then may
engage in
activities nearby
2. Filling/ emptying
containers
3. Playing with
blocks
4. Looking at books
5. Push pull toys
6. Tossing balls
7. Finger paints
8. Large piece
puzzles
9. Thick crayons
10. Temper
tantrums:
frustrated with
restrictions on
independence.
11. Toilet training
can begin when
toddlers have
the sensation of
needing to
urinate or
defecate
12. Discipline should
be consistent
with well-defined
boundaries that
are established
to develop
appropriate
social behavior.
Shifts to associative
play
Play is not highly
organized but
cooperation does
exist between
children
Playing ball
Putting puzzles
together
Riding tricycles
Playing pretend and
dress up activities
Role playing
Paining
Simple sewing
Reading books
Wading pools
Skating
Computer programs
Electronic games

preschoolers to
determine the
difference
between reality
and fantasy

SCHOOL- - Peer groups play an


AGE (6 to
important part in
12
social development
- Peer pressure begin
to take effect
- Clubs and best
friends are popular
- Bullying
- Prefer the company
of same gender
companions, but
begin developing
an interest in the
opposite sex
toward the end of
school age years
- Most relationships
come from school
associations
- Conformity becomes
evident

fairness

injections or
cuts,
frightening to
preschoolers
1.
2.
3.
4.
5.

- Develop an
awareness of
themselves
in relation to
others.
- Understanding of personal
values,
abilities, and
physical

Early school age


Do not understand the
reasoning behind
rules and
expectations for
behavior
Believe what they
think si worng and
what others tell
them is right
Judgement is guided
by rewards and
punishment

characteristi
cs
- Confidence is
gained
Late School age years
through
- Able to judge the
establishing
intentions of an act
a positive
rather than just its
self-concept
consequences
- Parents
- Understand different
continue to
points of view
influence
instead of whether
the school
or not an act is right
age childs
or wrong
self-ideals, - Conceptualizes
treating others as
but by
they like to be
middle
treated
childhood
the opinions
of peers and
teachers
become
more
valuable

Solidification of
body image
occurs
Curiosity about
sexuality
should be
addressed with
education
regarding
sexual
development
and
reproductive
process
School age
children are
more modest
than
preschoolers
and place more
emphasis on
privacy issues

ADOLECE - Peer relationships


- View
- Solve moral dilemma - Base their own
NT (12
develop. These
themselves
using internalized
normality on
to 20)
relationships act as
in relation to
moral principles
comparison with
support system for
similarities - Question relevance of
peers
existing moral
- The image
adolescents
with peers
- Best friend
values to society
established
during
relationships are
and individuals
during
younger
more stable and
adolescence is
adolescence
longer lasting than - View
retained
they were in
themselves
throughout life
prevous years
according to
- Parent child
their unique
relationships
characteristi
change to allow
cs as the
greater sense of
adolescent

Competitive and
cooperative play
is predominant
6 9 years of age
Simple
board and
number
games
Play
hopscotch
Jump rope
Collect
rocks,
stamps,
cards, coins,
or stuffed
animals
Ride bicycles
Builde
simple
models
Join
organized
sports
9- 12 years of age
Make crafts
Build models
Collect
things/
engage in
hobbies
Solve jigsaw
puzzles
Play board
and card
games
Join
organized
competitive
sports
Non-violent
games
Non- violent
music
Sports
Caring for a pet
Career training
programs
Reading
Social events
( going to
movies, school
dances)

independence

years
progress

Health promotion
Age
Infant
(birth to
year )

Immunization
- Birth hepatitis B
2 months: DtaP, rotavirus
vaccine (RV), inactivated
poliovirus (IPV), haemophilu
influenza type B (HIB),

pneumococcal vaccine
(PCV), Hep B
4 mos DtaP, RV, IPV, Hib,
PCV
- 6 months : DtaP, IPV (6 to
18 mos), PCV, Hep B (6
to 12 mos), rotaTeq
(alternative formulation
for RV, requires 3 doses
that must be completed
by 32 weeks of age)
6 to 12 mos seasonal
influenza vaccination
yearly; can give
trivalent inactivated
influenza vaccine (TIV)
as IM

Nutrition
Breastfeeding provides
complete diet for infants during
the first 6 months
Iron fortifed formula is
acceptable alternative to breast
milk
Cows milk is not recommended
Begin vitamin D supplements
within the first few days of life
Alternative source of fluids are
not needed during the first 4
months of life
After 6 months, 100% fruit juice
should be limited to 4 to 6 oz
per day
Solid foods are introduced
around 4 to 6 months
Readiness include interest in
solid foods, voluntary control of
the head and trunk
Iron fortified cereal is
introduced
New foods should be introduced
one at a time, over a 4 to 7 day
period, to observe for signs of
allergy or intolerance, which
may include fussiness, rash,
vomiting, diarrhea, and
constipation
Vegetables/ fruits started
between 6 to 8 months of age.
After both have been
introduced, meats may be
added
Citrus fruits, meat, and eggs are
not started until 6 months of
age
Breast milk/ formula should be
decreased as intake of solid
foods increase, but breast milk
should remain the primary
source of nutrition through the
first year
Foods that are cooked,
chopped, and unseasoned are
appropriate by 9 months of age

Injury prevention
Aspiration of foreign objects
Avoid grapes, coin, candy
Clothing should be checked
for hazards (loose button)
Bodily harm
Sharp objects should be
kept out of reach
Should not be left
unattended with any
animals present
Burns
Temperature of bath should
be checked
How water should be set
below 49 C
Handle pots and pans
should be kept turned to
the back of stoves
Electrical outlets should be
covered
Drowning
Should not be left
unattended in bath tubs
Falls
Kept at the lowest position
with the fails all the way up
Restrains should be used in
infants seats
Place safety gates on the
top and bottom of stairs
Poisoning
Exposure to lead paint
should be avoided
Toxin should be kept out of
reach
number of poison control
center should be kept near
the phone
Motor vehicle injury
infant only and convertible
infant toddler car seats
rear facing car seat until the
age of 2 years or the
recommended height
safest area for infants and

Toddler (1
to 3
years)

12 to 15 mos IPV; Hib;


PCV; MMR; varicella
12 to 23 mos Hep A, in 2
doses, 6 mos apart
-

Preschool
er ( 3 to 6
years)

4 to 6 years old DTaP;


MMR; varicella; IPV
36 to 59 mos seasonal
influenza vaccine; TIV; or
live attenuated influenza
vaccine (LAIV) by nasal
spray
Vision screening is done:
myopia and amblyopia are
two vision impairments
that can be detected
during screening of the
preschooler

Finger foods include: ripe


banana, toast strips, graham
crackers, cheese cubes,
noodles, peeled checks of
apples, pears, peaches
Weaning can be accomplished
when the infants are able to
drink for a cup.
One meal may be replaced with
breast milk or formula in a cup
with handles
Bed time feedings are the last
to be stopped
Life time eating habits
Begin developing taste preference
Should consume 24 to 30 oz of milk
per day. May switch from drinking
whole milk to drinking low fat milk
after 2 years of age
Juice should be limited to 4 to 6 oz
per day
Trans fatty acid should be avoided
Diet should include 1 cup of fruit
Food serving should be 1 tbsp for
each ear of age
Prefer finger foods because of
increasing autonomy
Regular meal times and nutrition
snack best meet nutrient needs
Foods that are potential choking
hazards ( nuts, grapes, hot dogs,
peanut butter, raw carrots, tough
meats, popcorn) should be
avoided
Adult supervision during snack and
meal times
Should not drink and play during
activities or lying down

child is the back seat of a


car
suffocation
plastic bag should be
avoided
balloons should be kept
away from infants
crib mattress should fit
pillows should be kept out
of reach
placed on their backs for
sleep

Consume about half th3 amount


of energy that adults do (1800
Kcal)
Food jags continue; become
more willing to sample different
foods by 5 years of age
Need 13 to 19 g/day of complete
protein in addition to adequat3
Ca, Fe, folate and Vitamins A & C

Bodily harm
1. Firm arm should be kept away
2. Preschoolers should be taught
stranger safety
3. Wear protective equipment
Burns
4. Thermostat should be turned
down on hot water heaters
5. Sunscreen
Drowning
6. Should not be left unattended in
bath tubs
7. Supervised when near pool
8. Taught to swim
MVI
9. When the forward facing car
seat is outgrown, the
preschooler transitions to a
booster seat
10. Safest area for children is the
back seat of the car
11. Wear seat belt
12. Do not allow them to play near
curb or parked cars
13. Teach pedestrian safety rules to
preschool age children

Saturated fats should be less than


10% of preschoolers total caloric
intake, and total fat over several
days should be 20% to 30% of total
caloric intake

MVA: rear-facing car seats in the


back seat, preferably in the
middle, for the first year of life
until they weigh 9.1 kg, then
can sit in forward-facing car
seat until 4 years of age and/or
40lbs
Aspiration of foreign objects:
small objects, toys with small
parts; balloons; clothing with
loose buttons
Bodily harm: sharp object,
firearms, animals, strangers
Burns: same as infants
Drowning: same as infants +
close toilet lids, teach how to
swim
Falls: same as infants + keep
doors and windows closed
Poisoning: same as infants +
safety locks
Suffocation: same as infants

14. stand back from curb while


waiting to cross the street
15. Wear light colored clothing with
fluorescent materials attached
School
age (6 to
12 years)

By 6 years of age, if not


given between 4-5 years
of age: DTaP; IPV; MMR;
varicella
11-12 years old: Tdap;
HPV 2 (for females) in 3
doses and HPV4 (for
males)

By the end of school age, children


should eat adult portion of foo.
Avoid using food as reward
Emphasize physical activity
Teach children to make healthy food
selections for meals and snacks
Avoid eating fast food frequently
Avoid skipping meals
Model healthy behavior

- Bodily harm
Keep away from firearms
Should not be allowed to use
trampolines
Identify safe play areas
Stranger safety
Wear helmets and pads
Burns
Fire safety
Working smoke etector
Sunscreen
Precaution to take whle cooking
- MVI
Children use approved car
restraint when they achieved
49
- Poisoning/substance
abuse
Chemicals should be locked
Teach about illegal drugs and
alcohol

Rapid growth and high metabolism


require increases in quality nutrients
Ca, fe, zinc
Folic acid
Vitamin B6, A, iron, calcium,
and zinc
Both overeating and under eating
need to be checked
Avoid using food as reward
Emphasize physical citivity

1. Bodily harm
Keep firearms unloaded and in a
locked cabinet or box
Proper use of sporting equipment
prior to use
Be aware of changes in mood
Poor school performance
Lack of interest in things
that were of interest
Social isolation
Disturbance in sleep or
appetite
Expression of suicidal
thoughts
2. Burns
Teach fire safety
Avoid tanning beds
Apply sun Screen
3. Drowning
Teach adolescents to swim
4. MVI:
Drivers education
5. Substance abuse
Teach to say no

Influenza vaccine
Scoliosis screening should
be done

Adolesce
nce (12
to 20
years_

If not give at age 11 12


years of age: Tdap; MCV4;
PRV2 series for females
and HPV4 series for males
Influenza vaccine
Scoliosis screening

Sleep, dental, and sexuality


Age
Infants ( 1 month to 1 year)

Toddler ( 1 to 3 years)

Sleep
1. Nocturnal sleep pattern
is established by 3 to 4
months of age
2. Infant sleeps 14 to 15
hours daily and 9 to 11
hours at night around
the age of 4 months
3. Infant sleeps through
the night and takes one
to two naps during the
day by the age of 12
months
1. Typically 11 to 12 hr of
sleep per day, including
one nap
2. Naps often are
eliminated in older
toddlerhood
3. Resistance to bed time

Dental

1.

2.

Should have an
established dental home
by the age of 1 year
Flossing and brushing
should be performed by
the adult caregiver, and
is the best method of

Sexuality

4.

and expression of fears


are common in this age
group
Maintaining a regular
bedtime and bedtime
routines are helpful to
promote slee[

3.

4.

5.

6.

Pre School (3 to 6 years)

1.

2.
3.
4.
5.

School Age ( 6 to 12 years)

1.

2.

3.

Adolescents (12 to 20 years)

Need about 12 hours of


sleep per day. Some
may still require a
daytime nap
Keep consistent bed
time routine
Use night light
Reassure preschoolers
who are frightened
Avoid allowing
preschoolers to sleep
with their parents
Require sleep is highly
variable in the school
age years, and is
dependent on
Age
Level of activity
Health status
9 hours of sleep is
needed each night at
the age of 12 years
Resistance to bed time
is sometimes
experienced around the
age of 8 and 9 years,
and again around the
age of 11 years, but is
typically resolved by the
age of 12
Sleep habits change
with puberty due to
increased
metabolism and
rapid growth
Tend to stay up late,
sleep in later in the

1.

2.

3.

removing plaque
Brushing should occur
after meals and at bed
time. Nothing to eat or
drink, except water, is
given to the child after
the bed time cleaning
Fluoride is
supplemented to
children living in areas
without adequate levels
in drinking water
Early childhood caries is
a form of tooth decay
that develops in the
toddlers, and is more
common in children who
are put to bed with a
bottle of juice or milk
Consumption of
cariogenic foods should
be eliminated if
possible. If not, the
frequency of
consumption should be
limited.
Eruption of primary
teeth is finalized by the
beginning of the
preschool years
Parents need to assist
and supervise brushing
and flossing
Trauma to teeth is
common in preschool
age children and should
be immediately
assessed by a dentist
Brush after meals
and snacks, and at
bedtime
Floss daily
Have regular check
ups
Have regular
fluoride treatments

Corrective
appliances are most
common with this
age group
Brush after meals
an snacks, and at
bedtime

Provide adolescents
with accurate
information and
discuss what is
heard from peers
Emphasize
abstinence and

morning, sleep mre


than during the
school age years
During the periods
of active growth, the
ened for sleep
increases

Floss daily
Have regular check
ups
Have regular
fluoride treatments

practicing safe sex


Provide information
about preventing
sexually transmitted
infections and
pregnancy
Promote an
atmosphere where
adolescents are
comfortable asking
questions
Assist adolescents
with problem solving
and decision making
skills

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