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Maternal and child health nursing

Mrs. Lal Joy Sanchez-Ruba

Growth and development calm…it is hard to assess a screaming

baby!

TOPIC OUTLINE TODDLERS

- Age 1-3 years old
- Growth slows, and language develop quickly
1 Infants
2 Toddlers GROWTH
3 Preschoolers • Height increases
4 School age and adolescent by 3 inches per
year
• Weight increases
INFANTS by 4-6 lbs per
GROWTH year
• Head does not
• Rapid growth
grow as rapidly
• Birth weight should double by 6 months and triple as the body;
by 12 months. head
• Fontanelles circumference should equal chest circumference
- Posterior by 1-2 years
closes first • Anterior fontanelle closes between 9 and 18
between 1 and months
2 months
- Anterior DEVELOPMENT
closes I. FINE AND GROSS MOTOR
between 9 and • Should be able to:
18 months o Hold crayons or pencils to color and
draw
DEVELOPMENT o Copy a circle on a paper
o Build a tower of blocker 8-10 blocks high
I. GROSS MOTOR SKILLS o Clap their hands
• Sitting up without support: 6-8 months o Button and unbutton
• Rolling over: 6 months o Work a zipper
• Standing without support: 10-12 months o Ride a tricycle – 3 years
• First step: 12 months o Jump – 2 years

II. LANGUAGE
II. FINE MOTOR SKILLS • Should be able to:
• Palmar grasp: 6 months o Follow simple directions
• Pincer grasp: 9 months o Link words together – 2 years
• Brings object to mouth: 4 months o Vocabulary of 300 works – 2 years
• Transfers objects from hand to hand: 6-8 months o Identify objects
o Identify body parts
III. LANGUAGE
• First words: 12 months III. SOCIAL AND COGNITIVE
• Can understand “no”: 11 months • Erikson stage:
• Following simple directions: 12 months o Autonomy vs. Shame and Doubt
o Children seek to develop a sense of
personal control over physical skills and
IV. PSYCHOSOCIAL DEVELOPMENT
a sense of independence
o When they are successful, they feel
• Erikson’s stages of psychosocial development
independent and it leads to a sense of
o Trust vs mistrust
autonomy. When they are not
• Piaget’s stages of cognitive development successful, they feel they are a failure
o Sensorimotor and it results in shame and self-doubt.
o Task – toilet training
• Parallel play
• Social smile: 6-8 weeks o Children play adjacent to each other, but
• Object permanence: 9 months they do not try to influence one
• Stranger anxiety: 9 months another’s behavior.
• Symbolic play
THERAPEUTIC COMMUNICATION WITH INFANTS o The ability of the children to use objects,
actions or ideas to represent other
• Speak in a soft voice objects, actions, or ideas as play.
• Warm your hands up before touching the baby
• Always involve caregivers TOILET TRAINING
- Explain everything you are doing to them • Important not to start before the child is ready –
- Have them hold the infant control of the sphincters does not happen until
- Parents are your best team member! They 18-24 months old.
know how to keep their child happy and • Signs that the child is ready:

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 o Wake up from their nap dry iii. LANGUAGE
o Tell you they need to go potty • At 5 years of age the child should have a
o Can stay dry for 2 hours during the day vocabulary of about 2,100 words
• During toilet training: • Speak in complete sentences (4-5 words at a
o Never leave the child on the toilet alone minimum)
o Only sit on the toilet for 5-8 minutes at a • Can correctly name:
time o Colors
o Get them their own toilet or a stool that o Objects
will be the right size, their feet should be o People
able to sit on the floor or a stool • Tell stories and use fantasy
o Teach hand hygiene! • Know their name and address.

INJURY iv. PSYCHOSOCIAL AND COGNITIVE

• Common injuries at this age • Erikson Stage: Initiative vs Guilt
o Falls o Children start to assess control and
o Burns power over their environment. Success
o Drowning leads to initiative when they feel a sense
o Poisoning of purpose, but children who try to exert
• Ways to help prevent injuries: too much power and experience
o Lock up any dangerous substance: disapproval end up feeling guilt.
medications, cleaning supplies, laundry o Important to involve the child when
detergent, etc. possible; such as giving them options.
o Put gates at the top and bottom of the This helps develop initiative.
stairs • Cooperative play
o Never leave a bathtub supervised – o Play that involves the division of efforts
even if there is only a little bit of water in among children in order to reach a
it! common goal.
▪ Toddlers can drown in less than • Magical thinking
2 inches of water. o The belief that one’s own thoughts,
wishes or desires can influence the
NUTRITION external world
• Toddlers are the classic “picky eaters” o Do not yet have a concept of time
• Iron deficiency anemia is common due to a lack
of iron rich food
• Iron-rich food offer: THERAPEUTIC COMMUNICATION
o Iron-fortifies cereals • Poor concept of time
o Leafy greens o Avoid delays with treatments
o Red meats • Fear bodily harm
o Fish o Use bandages over any puncture sites
o Beans o Bandages help them feel secure
• Use full fat milk until 2 years old • Magical thinking
• Do not use food as a reward o They may think that their actions or
misbehaving caused them to become
PRESCHOOLERS sick
o View sickness as a punishment
- Ages 3-5 years old o Help them understand this is not their
- Rapid social development fault
- Rapid fine motor development • Language
- Improving coordination o Their developing language skills make
- Getting ready for school age your word choice very important
o Use simple, non-threatening terms.
GROWTH
• Height: increases 2-3 inches every year SCHOOL AGE AND ADOLESCENT
• Weight: increases 5 lbs. every year SCHOOL AGE
- Ages 6-12 years old
DEVELOPMENT - Physical growth gets slower
i. GROSS MOTOR - Social development is pronounced
• Hops on one foot o Friend groups
• Runs o Personal accomplishments
• Skips
• Ride tricycle – 3 years GROWTH
• Ride bicycle – 5 years • Gain 5-7 lbs. each year
• Grow about 2 inches per year
ii. FINE MOTOR • Begin to lose baby teeth
• Pastes things onto paper • Brain will reach full adult size by 9-10 years old
• Complete puzzles with 5 or more pieces
• Copy a circle onto a piece of paper DEVELOPMENT
• Cut out simple shapes with scissors i. MOTOR
• Uses spoon and fork • Write in cursive
• Can dress self • Ride bike
• Brushes teeth • Plays games
• Swim
• Roller skate
• Jump rope

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Maternal and child health nursing
Mrs. Lal Joy Sanchez-Ruba
ii. PSYCHOSOCIAL AND COGNITIVE to be true to themselves and have an
identity, they are proud of. When they
are not successful, there is role
confusion and a weak sense of self.
• Risk behavior increases
• Social interaction with peers prioritized over
family

THERAPETIC COMMUNICATION WITH ADOLESCENTS

• Give them as much privacy as possible

• Peer support groups
• Allow for free time
• Support socializing when possible
• Encourage questions and taking part in their
own care.
• Erikson stage: Industry vs. Inferiority
o In this stage, children need to cope
with new social and academic
demands. When they are successful
with this, they feel competency and
achieve industry. When they are not
successful, they feel failure and it
results in inferiority.
• Egocentrism decreases and importance or
relationships increases.

THERAPEUTIC COMMUNICATION WITH SCHOOL AGE

CHILDREN
• Asks lots of questions
• Peer support
• Allow time for discussion
• Give them privacy when able

ADOLESCENTS
• Ages 13 to 18 years old
• Puberty begins
• Development of personal identity
o Peer groups
o Risky behavior

GROWTH
FEMALE

• Thelarche
o Breast development – 11 years
• Menarche
o First menstruation – 2 years after
thelarche

MALE

• Begins between 9-13 years

• Period of rapid growth
• Testicles enlarge
• Voice deepens

DEVELOPMENT
i. MOTOR
• Increased coordination
• Prolonged endurance
• Better distance judgment
• Increased hand-eye coordination

ii. PSYCHOSOCIAL AND COGNITIVE

• Erikson Stage: Identity vs Role Confusion
o In this stage, adolescents develop a
sense of personal identity. When they
are successful it leads them to the ability

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