BACHELOR OF SCIENCE IN NURSING:

CARE OF MOTHER, CHILD AND

ADOLESCENT (Well Clients)
COURSE MODULE COURSE UNIT WEEK

3 13 15
Health promotion and disease prevention in different
stages of growth and development

✔ Discuss the course and unit objectives

✔ Comprehend study guide prior to class attendance
✔ Read required learning resources; refer to unit terminologies for jargons
✔ Actively participate in classroom discussions
✔ Accomplish and submit assigned course unit tasks on time
✔ Participate in weekly discussion board (Canvas) Answer and submit course unit tasks

At the end of this unit, the students are expected to:

Cognitive:
1. Identify areas related to care of the different stages of growth and development that could benefit
from additional nursing research or application of evidence-based practice.
 2. Determine the health promotion and disease prevention applied in the different stages of growth and
development as well as common parental concerns.
3. Plan nursing care from infant to adolescent to meet needs such as anticipatory guidance to prevent
problems
Affective
1. Listen attentively during class discussions
2. Demonstrate tact and respect of other students’ opinions and ideas
3. Accept comments and reactions of classmates openly.
Psychomotor:
1. Implement nursing care to promote normal growth and development of an infant to adolescent.
2. Use critical thinking to analyze methods of care for infant to adolescent to be certain care is
family centered.
3. Integrate knowledge on growth and development with nursing process to achieve quality maternal
and child health nursing care.

HEALTH PROMOTION FOR A PRESCHOOLER AND FAMILY

Promoting Preschooler Safety

● By 4 years of age, children may demonstrate an attitude of independence and the ability to take care of
their own needs. However, they still need supervision to be certain they do not injure themselves or
other children while roughhousing and to ensure that they do not stray too far from home.
● Their interest in learning adult roles may lead them to explore the blades of a lawn mower or an electric
saw, or a neighbor’s pool. They may also imitate adults taking medicine.
● Gun safety must also be ensured.
● Preschoolers must be reminded repeatedly to buckle their booster seat and no to walk behind or in
front of automobiles.

Keeping Children Safe, Strong, and Free

● Educating children about the potential threat of harm from strangers or how to address bullying
behavior from children or adults may begin at this stage through these measures:
● Never talk with strangers or accept a ride from a stranger.
● How to call for help in an emergency such as yelling or running to a designated neighbor’s
house if outside, dialing emergency hotlines if near a phone.
● Describing what police officers look like and explaining that police can help in an emergency.
● Explaining that if children or adults ask them to keep secrets about anything that has made
them uncomfortable, they should tell their parents or another adult, even if they promised to
keep the secret.
● Explaining that bullying behavior from other children is not to be tolerated and should be
reported so they can receive help managing it.
● If these measures are presented in a calm and everyday manner, children can use it to begin to build
safe habits that will help them later when they are old enough to walk home from school alone or play
with their friends unsupervised.
 Motor Vehicle and Bicycle Safety
● Because of front seat airbags, preschoolers need to be buckled into car seats or booster seats in the
back seat (AAP, 2012).
● Urge parents to stress the importance of seat belts in preventing injury and to make a rule that the car
does not move until seat belts are fastened.
● Remind parents to check the position of shoulder harness in car seats or booster seats so the belt does
not cross a child’s face or throat.
● To promote bicycle safety and prevent falls from bicycles, preschoolers need age- and size-appropriate
safety helmet.
● Encourage parents to demonstrate safe riding habits by wearing helmets as well.

Possible Unintentional Injuries to Preschoolers

● Motor vehicles
● Falls
● Drowning
● Animal bites
● Poisoning
● Burns

Promoting Preschooler Nutrition

● Preschool years are not a time of fast growth, they are not likely to have ravenous appetite.
● Since children this age have sense of initiative or are learning to do things, allowing a child to prepare
simple foods, such as making sandwich or spreading jelly on a toast.
● To prevent childhood obesity, urge parents to offer snacks such as fruit, cheese, or milk rather than
cookies and a soft drink or juice.
● If a child is eating foods from all five groups and meets the criteria for a healthy child such as being
alert and active with height ang weight within normal averages, additional vitamins are probably
unnecessary.
● Caution parents not to give more vitamins than the recommended daily amount or poisoning from high
doses of fat-soluble vitamins or iron can result.
● If a child consumes a vegetarian diet, it is usually deficient in calcium, Vit B12, and vitamin D. Check to
be sure that the child is ingesting a variety of calcium and Vit D sources.
● Vit B12 is found almost exclusively in animal products, so a child on a vegetarian diet may need a
supplemental source (Whitney & Rolfes, 2013).

Promoting Preschooler Development in Daily Activities

1. Dressing
● One way for parents to solve problems of clothes mismatching is to fold together matching shirts and
slacks so a child sees them as a set instead of individual pieces.
● If children insist on wearing mismatched clothes, urge parents to make no apologies for their
appearance. A simple statement, “Mark chose his own clothes today” explains the situation. It would
mean that the child is given autonomy to select their own clothing and is worth more than a perfect
appearance by adult standards.

2. Sleep
● Preschoolers are more aware of their needs than toddlers. When they are tired, they often curl up on a
couch or soft chair and fall asleep.
 ● On some occasions, even though they may be tired, refused to sleep because of fear of the dark and
may wake up terrified by a bad dream.
● Preschoolers may need a night-light turned on. Screening out frightening stories or TV watching just
before bedtime may help.

3. Exercise
● Roughhousing helps relieve tension and should be allowed if it does not become destructive.
● Promoting active games and reducing TV watching can be steps toward helping children develop motor
skills as well as preventing childhood obesity (Hodges, Smith, Tidwell, et al., 2012; Mitka, 2012).

4. Hygiene
● Preschoolers can wash and dry their hands adequately if the faucet is regulated for them. Parents
should turn down the temperature of the water heater in their home to under 120 deg F to help prevent
scalds.
● They should not be left unsupervised at bath time in case they decide to add more hot water or practice
swimming and then be unable to get their head out of the water again.
● Some girls develop vulvar irritation (and perhaps bladder irritation) from exposure to bubble bath so
parents shouldn’t add such products to the water.
● Children may not clean their ears and fingernails during bath time and often need “touching up” by a
parent or older sibling.

5. Care of Teeth
● Electric or battery-operated toothbrushes can be used safely if the child is taught not to use it or any
other electrical appliance near a basin of water.
● Parents should also floss the child’s teeth because this is a skill beyond a preschooler’s motor ability.
● Preschoolers should continue to drink fluoridated water or receive a prescribed oral fluoride supplement
if fluoride is not provided in the water supply.
● Encourage children to eat apples, carrots, chicken, or cheese for snacks rather than candy or sweets to
prevent tooth decay. If allowed to chew a gum, it should be the sugar-free variety.
● A first visit to a dentist should be arranged no later than 2 years of age for an evaluation of tooth
formulation because deciduous (baby) teeth must be preserved to preserve the dental arch.
● Dental services can be performed at 3 years of age. Initial visits usually reveal no cavities and should
be a pain-free experience for the preschooler.
● Teeth-grinding (bruxism) may begin at this age as a way of “letting go”, similar to body rocking. If
grinding is extensive, the crowns of the teeth can become abraded. If damage is evident, refer the
family to a pediatric dentist so the teeth can be evaluated, repaired (capped), and conserved.

Promoting Healthy Family Functioning

● An important role of preschooler parent is to respect creativity. Part of encouraging creativity is
encouraging vocabulary building by reading aloud to their child and by answering questions, so the
child sees language as an organized system of communication.
● Discipline
o Time-out – useful for parents to correct behavior throughout the preschool years. 3 to 5
minutes is appropriate for preschoolers.

Common Health Problems of the Preschooler

● Major cause of death (CDC, 2012)
● Automobile accidents
● Poisoning
● Falls
● Higher incidence of ear infections and respiratory infections among children whose parents are
smokers.
 ● Increased incidence of gastrointestinal disturbances and upper respiratory infections among children
who attend childcare and preschool programs from the exposure to other children unless frequent
handwashing is performed.

Common Fears of the Preschooler

● Because preschoolers’ imaginations are so active, this leads to a number of fears such as fear of the
dark, mutilation, and separation or abandonment.

1. Fear of the Dark

● The tendency to fear the dark is an example of a fear heightened by a child’s vivid imagination.
● Parents should monitor the stimuli their children are exposed to especially before bedtime, such
as TV, adult discussions, and frightening stories.
● Leaving on a dim night-light can solve the problem.
● Children who awake terrified and screaming need reassurance that they are safe and that
whatever was chasing them was a dream and is not in their room.
2. Fear of Mutilation
● Fear of mutilation is also significant during preschool age, as revealed by the intense reaction of
a preschooler to even a simple injury such as falling and scraping a knee or having a needle
inserted for immunization.
● According to Freud, boys develop a fear of castration because developmentally, they are more in
tune of their body parts and are starting to identify with the same-sex parent as they go through
he Oedipal phase.
● Preschoolers dislike procedures such as needlesticks, rectal temperature assessments,
otoscopic examinations, or having an NGT passed into their stomach. They need good
explanations of the limits of healthcare procedures, such as clarifying a tympanic thermometer
does not hurt or a finger prick heals quickly as well as distraction techniques to feel safe.
3. Fear of Separation or Abandonment
● Fear of separation is yet another major concern for preschoolers.
● Their sense of time is still distorted that they cannot be comforted by assurances such as
“Mommy will pick you up from preschool at noon.” Their sense of distance is also limited, so
making a statement such as “I work only a block away” is not reassuring.
● Relating time and space to something a child knows better, such as meals, TV shows, or a
friend’s house is more effective. For example, stating, “Mommy will pick you up from preschool
after you had your snack” is apt to be more comforting than “Mommy will pick you up at 3 PM.”
● A hospital admission or going to a new school often bring a child’s fear of separation to the
forefront. Help parents thoroughly prepare preschoolers for these experiences so they can
survive them in sound mental health.

Behavior Variations
● A combination of a keen imagination and immature reasoning results in several other common behavior
variations in preschoolers.
1. Telling Tall Tales
● Stretching stories to make them seem more interesting is a phenomenon frequently
encountered in preschoolers.
● For example, after a trip to the zoo, if you ask a preschooler, “What happened today?”, a child
perceives you want something exciting to have happened, and so might answer, “A bear
jumped out of his cage and ate the boy next to me.” This is not lying, but merely supplying an
expected answer.
● Caution the parents not to encourage this kind of storytelling but instead help the child separate
fact from fiction.
2. Imaginary Friends
 ● Imaginary friends are a normal, creative part of the preschool years and should not pose a
problem and often leave as quickly as they come.
● Pretend friends can encourage language development, may provide an outlet for the child to
express feelings or serve as a handy scapegoat for behavior about which the child has some
conflict.
3. Difficulty Sharing
● Sharing is a concept that the child would come to understand by the age of 3. Before this, the
child engages in parallel play.
● Around 3 years of age, children begin to understand some things are theirs, some belong to
others, and some can belong to both.
● Assure parents that sharing is a difficult concept to grasp and preschoolers need practice to
learn and understand it.
● Defining limits and exposing children to the concepts of mine, yours, ours helps them determine
which objects belong to which category.
4. Regression
● Some preschoolers, in relation to stress, revert to behavior they previously outgrew, such as
thumb-sucking, negativism, loss of bladder control, and inability to separate from their parents.
● Help parents understand that regression in these circumstances is normal.
5. Broken Fluency
● Broken fluency is the repetition or prolongation of sounds, syllables, and words, such as “I-I-I
want a n-n-new spoon-spoon-spoon.”
● It is often referred to as secondary stuttering because the child began to speak without these
problems and then, during the preschool years, develops it.
● Remind parents that this is a part of normal development, and if accepted as such, will pass.

HEALTH PROMOTION FOR A SCHOOL-AGE CHILD AND FAMILY

Promoting School-Age Safety

● Advise parents to look at the effect of carrying heavy backpacks on children’s posture. A backpack that
weighs more than 10% of the child’s body weight is enough to cause a child to have to lean forward
chronically to bear the weight and can lead to chronic back pain.
● Sexual maltreatment is an unfortunate and all-too-common hazard for children. Educate the school-age
child about these safety measures:
● Your body is your property, and you can decide who looks at it or touches it.
● It’s all right to tell someone about something that was done to you that you didn’t like,
● Don’t go anywhere with a stranger.
● You don’t have to allow anyone to touch you in a way you don’t like
● Avoid meeting with people you talk on social media and the internet.
● A “private part” is the part of you a bathing suit touches. If anyone asks you to show them a
private part or touches a private part, tell them to stop, and tell someone what happened.
● If the person you tell doesn’t believe you, keep telling people until someone does believe you.

Possible Unintentional Injuries to School-Age Children

● Motor vehicles
● Bicycle
● Drowning
● Burns
● Falls
● Sports injuries
● Drugs
 ● Firearms

Promoting Nutrition of a School-Age Child

● School-age children should be encouraged to eat a healthy breakfast to ensure the ability to
concentrate during the school day.
● Nutritious after-school snacks are important.
● Poor eating habits developed at this stage may last through adulthood and lead to an increased risk of
type 2 diabetes, hypertension, cardiovascular disease, and obesity.
● Proper etiquette is important in the school- age years. Parents can model this behavior for their child
and encourage meals to be eaten at the table rather than while watching TV.
● Boys require more calories and other nutrients than girls at this time.
● Both girls and boys require more iron in prepuberty than they did between the ages 7 to 10.
● Calcium and fluoride are important to ensure good teeth and bone growth.
● A major deficit may be fiber because they dislike vegetable.

Promoting School-Age Child Development in Daily Activities

1. Dress
● This is the right age to teach children the importance of caring for their own belongings.
● School-age children often base their clothing styles on the likes of their friends or their idols rather than
their parent’s preferences

2. Sleep
● Younger school-age children typically require 10 to 12 hours of sleep each night. Older children require
8 to 10 hours.

3. Exercise
● Increasing time spent in exercise need not involve organize sports. It can come from neighborhood
games, walking with parents or a dog, or bicycle riding.
● Urge them to participate in some form of daily exercise or obesity or osteoporosis can result later in life
.
4. Hygiene
● Children 6 to 7 years of age still need help in regulating bath water temperature and in cleaning their
ears and fingernails.
● By age 8 years, they are generally capable of bathing but may not do it well because they are too busy
or may not find bathing important.
● Showering must be encouraged because perspiration increases with puberty, along with sebaceous
gland activity.

5. Care of Teeth
● School-age children should visit a dentist at least twice yearly for a checkup cleaning, and possibly a
fluoride treatment to strengthen or harden the tooth enamel or sealants on secondary teeth.
● School-age children have to be reminded to brush their teeth daily using a soft toothbrush, fluoride-
based toothpaste, and dental floss.

Common Health Problems of the School-Age Period

● School-age children may have small health concerns such as head lice or ringworm.
● The two causes of death seen most frequently are more from unintentional injury and cancer.
 ● Minor illness is largely due to dental caries, GI disturbances, and upper respiratory infection.
1. Dental Caries
● Dental caries is largely preventable with proper brushing and use of fluoridated water or fluoride
application.
● Dental visits are recommended every 6 months.
2. Malocclusion
● Malocclusion is a deviation of tooth position from the normal and may be congenital due to
conditions such as cleft palate, a small lower jaw, or familial traits tending toward malocclusion.
● Children with a malocclusion should be evaluated by an orthodontist to see if orthodontic braces
or other therapy is necessary.

Concerns and Problems of the School-Age Period

1. Problems Associated with Language Development

● The most common problem of a school-age child is articulation. The child has difficulty pronouncing s,
z, th, l, r, and w or substitutes w for r (“westroom” instead of “restroom”) or r for l (“radies’ room” instead
of “ladies’ room”).
● This is noticeable during the first and second grades; it usually disappears by the third grade.

2. Common Fears and Anxieties of a School-Age Child

a. Anxiety Related to Beginning School

● Adjusting to grade school is a big task for 6-year-olds (AAP, Council on early childhood, Council
on School Health, 2016). Also, where preschool learning was carried out through fun activities,
part of everyday in grade school involves obvious work.
● Many first graders are capable of mature action at school but appear less mature when they
return home. They may bite their fingernails, suck their thumb, or talk baby talk.
● Urge the parents to spend some time with the child after school or in the evening so the child
continues to feel secure in the family and does not feel pushed out by seeing sent to school.

b. School Refusal or Phobia

● School refusal is a fear of attending school.
● Children who resist attending school this way develop physical signs of illness, such as vomiting,
diarrhea, headache, or abdominal pain on school days.
● As a rule, once it has been established that the child is free of any illness and the resistance
stems from separation or phobia, the child should be made to attend school.

c. Homeschooling
● Because the main contact of homeschooled children is with well-educated parents at home, their
vocabulary may be advanced or may suggest that they are older than their actual age.
● Assess if children have peer experiences such as participation in community sports teams or
clubs. Ask if they receive exposure to other cultures or families, so they can better adjust to
people different from themselves later at college or at a job.

d. Children Who Spend Time Independently

● Both parents work outside the home and children may spend time alone without adult
supervision for a part of each weekday.
● A major concern is that they will experience an increased number of unintentional injuries,
delinquent behavior, alcohol or substance abuse, or decreased school performance from a lack
of adult supervision.
 ● Safety points for children, safety responsibilities for parents, parental actions to prevent
loneliness, parental actions to socialization, and parental actions to increase self-esteem must
be discussed at health visits.

e. Sex Education
● It is important that school-age children be educated about pubertal changes and responsible
sexual practices.
● Preteens should have adults they can turn to for answers to questions about sex.
● Nurses can take steps to improve health outcomes for LGBT youth by providing care that is
affirming and inclusive.

f. Stealing
● Stealing occurs because, although a child is gaining an appreciation for money, this appreciation
is not yet balanced by strong moral principles or an understanding of ownership.
● As a rule, early childhood stealing is best handled without a great deal of emotion.
● Shoplifting must be taken seriously because it is a punishable crime and should be confronted
immediately to prevent children who succeed once form taking something even bigger the
second time.

g. Violence or Terrorism
● Assure children they are safe.
● Observe for signs of stress such as sleep disturbances, fatigue, lack of pleasure in activities, or
signs of beginning substance abuse.
● Do not allow children or adolescents to view footage of traumatic events over and over.
● Watch news programs with children so it can be explained.
● Prepare a family disaster plan.
● Designate a “rally point” where the family will meet if ever separated by a disaster or evacuation.

h. Bullying
● A frequent reason school-age children cite for feeling so unhappy that they turn guns on
classmates or commit suicide is because they were ridiculed or bullied to the point they can no
longer take such abuse (Cooper, Clements, & Holt, 2012).
● Alerts parents that Internet or text bullying are both also possible and that a bully doesn’t have to
be in fact-to-face contact with their child to be harmful (D’Auria, 2014).

i. Recreational Drug Use

● Illegal drugs such as marijuana, cocaine, and amphetamines are now available to children as
early as elementary school and certainly by the time they reach the seventh and eighth grades.
● Children who report being happy and can communicate with their family are less likely to be
regular users than others (Farmer & Hanratty, 2012).
● Parents should suspect recreational drug use if their child regularly appears irritable, inattentive,
or drowsy.
● Cigarette smoking also begins in school-age children. Caution children against experimenting
with smokeless tobacco as well because this can lead to mouth and throat cancer, the same as
smoking.
● To discourage use of tobacco by school-age children, healthcare professionals and parents need
to be role models of excellent nonsmoking health behavior.

HEALTH PROMOTION FOR AN ADOLESCENT AND FAMILY

Promoting Adolescent Safety

 ● Unintentional injuries, most commonly those involving motor vehicles, are the leading cause of death
among adolescents.
● Some adolescents dismiss seat belts as childish and that safety precautions must be used.
● Wear safety helmets to prevent head injury, long pants to prevent leg burn, and a full body covering to
prevent abrasions in case of an accident.
● Teaching water safety, such as not swimming alone or when tired, is as important as teaching the
mechanics of swimming (CDC, 2016b).
● Other common causes of death in adolescents are homicide and self-harm such as suicide (Swahn, Ali,
Bossarte, et al., 2012).
● Athletic injuries, especially overuse from poor conditioning, tend to increase in number during
adolescence because of the vigorous level of competition that occurs in organized sports (Khan,
Thompson, Blair, et al., 2012)

Promoting Nutritional Health for an Adolescent

● Adolescents tend to eat faddish or quick snack foods rather than more nutritious foods. This type of
eating pattern, combined with a lack of exercise, also leads to obesity (Wengle, Hamilton, Manlhiot, et.
al., 2012).
● Giving an adolescent some responsibility for food planning or meals can teach some important lessons
about nutrition without conflict.
● A weight-loss diet is appropriate during adolescence, but it must be supervised to ensure the
adolescent is consuming sufficient calories and nutrients for growth.
● Some adolescents may find it difficult to follow a vegetarian diet because that makes them different
from their peers and limits the food they can eat.

Promoting Development of an Adolescent in Daily Activities

1. Dress and Hygiene

● Adolescents are capable of total self-care and may even be overly conscientious about personal
hygiene and appearance.
● When caring for hospitalized adolescents, providing time for self-care, such as shampooing hair,
is important to include in an adolescent’s nursing care plan.
● When hospitalized, most teenagers seem to improve markedly when allowed to wear their own
clothing rather than a hospital gown.

2. Care of Teeth
● Adolescents are generally very conscientious about tooth brushing because of fear of developing
bad breath.
● They should continue to use a fluoride toothpaste and drink fluoridated water to ensure firm
enamel growth.
● Teens with braces must be extremely conscientious about tooth brushing to prevent plaque
buildup on hidden tooth surfaces.

3. Sleep and Exercise

● This age group may need proportionately more sleep than any other age group because
adolescents are building new cells during protein synthesis.
● Adolescents need exercise every day to maintain muscle tone and to provide an outlet for
tension.
● If they have not participated in competitive sports before, they may need advice on increasing
exercise gradually, so they do not overdo it and consequently develop sprains or other overuse
injuries (Huang, Coel, Vidal, et al., 2012).

Common Health Problems of an Adolescent

1. Hypertension
● Hypertension is present if the blood pressure is above the 95 th percentile, or 127/81 for 16-year-
old girls and 131/81 for 16-year-old bo0ys for two consecutive readings in different settings.
● Adolescents who have a family history, who are black, who eat a high salt diet, or have a family
history if hypertension are more susceptible to develop the condition.
● All children older than 3 years old must have their BOP checked at all health visits.
● New medications plus education can help to greatly reduce the incidence of cardiovascular
diseases when they reach adulthood.

2. Poor Posture
● Urge children of both sexes to use good posture during these rapid-growth years.
● Assess posture at all adolescent health visits to detect differences between simple poor posture
and the beginning of spinal dysplasia or scoliosis.

3. Body Piercing and Tattoos

● Body piercing and tattoos are a strong mark of adolescence (Stein & Jordan, 2012).
● Be certain they know the symptoms of infection at a piercing or tattoo site.
● Caution that sharing needles for piercing and tattooing carries the same risk for contracting a
blood-borne disease.

4. Fatigue
● Always assess the diet, sleep patterns, and activity schedules of fatigued adolescents.
● Be aware that if fatigue begins as a short period of extreme tiredness, it suggests disease more
than a long, ill-defined report of always being tired.
● Blood tests may be indicated to rule out anemia and common infections in adolescents.

5. Acne
● Acne is a self-limiting inflammatory disease that involves the sebaceous glands, which empty into
hair shafts.
● It is the most common skin disorder of adolescence and occurs slightly more frequently in boys
than girls.
● The goal of therapy for acne is threefold: decrease sebum formation, prevent comedones
(blocked hair follicle), and control proliferation.

6. Obesity
● Inheritance and environment play a part in the development of adolescent obesity.
● Health teaching with these adolescents may need to begin with a discussion of normal weight and
standard food portion.
● In addition to reducing calories consumed, encourage activities that burn calories, such as
swimming, gym classes or walking their dog.

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Textbook:

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Devakumar (2019). Oxford Textbook of Global Health of Women, Newborns, Children, and Adolescents.
PB Publishing.

Murray (2019). Foundations of Maternal-Newborn and Women’s Health Nursing, 7th edition. Elsevier.

Flagg (2018). Maternal and Child Health Nursing: Care of the Childbearing and Chilrearing Family.
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Wolters Kluwer. Audrey Berman, Shirlee J. Snyder, Geralyn Frandsen. (n.d.). Fundamentals of Nursing
by Kozier and Erbs (10th ed.).

Pearson. Maternal and Child Health. (n.d.). https://apha.org/topics-and-issues/maternal-and-child-health

Maternal, newborn and adolescent health. (n.d.). https://www.who.int/maternal_child_adolescent/en/

Rosalinda Parado Salustiano. (2009). Dr. RPS Maternal & Newborn Care: A Comprehensive Review
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