Pediatric Nursing lesson for developmental milestones

Pediatric nursing lesson to understand pediatric developmental milestones

1. Introduction to Pediatric Nursing & Growth and Development Lesson 1-Week 4 | Lecturer: Dr. Anne Nyambura

2. Introduction

3. Introduction

4. Overall Learning Objectives Describe pediatric emergencies and outline their immediate management. Explain the management of pediatric conditions by body systems. Apply the nursing process in providing care for children across developmental stages. Discuss the principles and application of Integrated Management of Childhood Illness (IMCI). Apply family-centered care in the management of childhood diseases and conditions. Demonstrate effective communication with children and their families in different clinical situations.

5. Learning Objectives -Lesson 1 By the end of this session, students should: - Define pediatric nursing - Explain its scope and importance - Identify differences between pediatric and adult nursing - Describe roles of pediatric nurses - Apply principles of pediatric nursing in practice - Describe Growth and Development and its assessments.

6. Definition of Paediatric Nursing The word “Paediatric” (or Pediatric in American English) comes from Greek origins : “Pais / Paidos ” (πα ῖς / πα ιδός ) → meaning child . “ Iatros ” (ἰα τρός ) → meaning doctor or healer . So, Paediatrics literally means “the healing/treatment of children.” 👉 In simple terms: Paediatrics = Child healer / medicine of children.

7. Definition of Pe a diatric Nursing Nursing is a health profession that focuses on the protection, promotion , and optimization of health and abilities , prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response , and advocacy in the care of individuals, families, and populations (American Nurses Association 2010). Pediatric nursing is the practice of nursing that focuses on the care of infants, children, and adolescents , promoting health, preventing illness, and providing holistic family-centered care.

8. Definition of Pediatric Nursing The purpose of Paediatric Nursing is to promote the highest possible state of health in each child. The Key Elements of Family- Centered Care: Family is constant in child’s life. Facilitating family collaboration at all levels of hospital, home, and community care in program development, implementation and evaluation of care.

9. ROLE OF THE PEDIATRIC NURSE The paediatric nurse is responsible for promoting the health and well-being of the child and family .

10. What are the Roles of Child- Health Nurse Therapeutic Role Family advocacy/ caring Disease prevention/ Health promotion Health teaching Support / Counseling Restoration role Coordination/ Collaboration Ethical decision making Research Health care planning

11. Therapeutic role Therapeutic Relationship The establishment of a therapeutic relationship is the essential foundation for providing high-quality nursing care. It is built on trust, empathy, respect, and communication , with the goal of promoting the child’s health and well-being

12. Family advocacy / Caring As an advocate , the nurse assists the child and family in making informed choices and acting in the child’s best interest . Advocacy involves ensuring that families are aware of all available health services , adequately informed of treatments and procedures , involved in the child’s care , and encouraged to change or support existing health care practices .

13. Disease prevention/ Health promotion Current health care focuses on prevention of illness and maintenance of health , rather than treatment of disease or disability . The best approach for prevention is education and anticipatory guidance . e.g. For example, a school nurse, can work in any setting to prevent disease and promote health .

14. Health teaching Health education involves transmitting information to the child’s and the family’s level of understanding , and also by giving appropriate feedback and evaluation to promote learning .

15. Support/ Counseling Support can be provided through attention to emotional needs , this is by listening, touching, and through physical presence (non verbal communication). Counseling involves a mutual exchange of ideas and opinions that provide the basis for mutual problem solving and coping with stress and crises .

16. Restorative Roles The most basic of all nursing roles is the restoration of health through care- giving activities (feeding, bathing, toileting, dressing, security, socialization, continual assessment and evaluation of physical status).

17. Coordination/Collaboration The nurse as a member in health team, collaborates and coordinates nursing services with the activities of other professions and with the child’s family .

18. Ethical Decision Making The nurse is forced to determine the most beneficial or least harmful action within the framework of : Social morals professional practice standards the law; Institutional rules; Religious traditions; Family’s system; and The nurse’s personal values while giving care to children.

19. Research It involves analyzing and translating published clinical research into everyday clinical practice . When nurses base their practice on science and research and document clinical outcomes , they validate their contribution to health not only to client, third- party payers, and institution but also for the nursing profession . Evaluation is essential to the nursing process , and research is one of the best ways to accomplish it .

20. Rights of the child Be Free from discrimination Develop physically & mentally in freedom and dignity. Have a name and nationality. Have adequate nutrition, housing, Recreation, and medical services. Receive treatment

21. Rights of the child Receive love, understanding, and maternal security. Receive an education and develop his or her abilities. The first to receive protection in disaster. Be Protected from neglect, cruelty and exploitation. Brought up in a spirit of friendship among people.

22. Principles of Pediatric Nursing 1. Family-centered care : Example : When a child with asthma is admitted , the nurse not only cares for the child but also educates the parents on medication use, triggers, and how to manage attacks at home. Parents are encouraged to stay with the child in hospital. 2. Atraumatic care : Providing care that minimizes physical and emotional stress or trauma to the child. 3. Growth & Development focus 4. Holistic approach.

23. Trends in Paediatric Nursing The current trends in the practice are based on research include: Family- Centered & Culturally Sensitive Care Preventive & Community-Based Care Use of Technology & Telehealth Holistic & Mental Health Support Evidence-Based Practice & Research Advanced Roles & Specialization Integration of Complementary Therapies.

24. Discussion Question Why do children require specialized nursing care? 5 minutes

25. Introduction to Growth & Development

26. Introduction to Growth & Development Growth: it is the process of physical maturation resulting an increase in size of the body and various organs . It occurs by multiplication of cells and an increase in intracellular substance . It is quantitative changes of the body. E.g.,. height, weight, head circumference, or organ size Example: A newborn weighing 3 kg grows to 6 kg at 6 months . Development: It is the progressive improvement in skills, functions, and abilities of the body and mind . It includes motor, emotional, social, and intellectual skills . Example: A baby learning to sit, crawl, stand, and eventually walk.

27. Paediatric Care Children were viewed as little more than "small adults" until the late 1800’s. They had little relative value in the society and were viewed as property . The head of the household had the power of life and death over the children and could determine their fates even unto adulthood . Children were expected to behave as adults and play was viewed as foolish or sinful . Children were workers and began helping out at home at a very early age . Formal Schooling was viewed as a luxury and reserved for males only .

28. Paediatric Care Beginning 19th century and continuing today, several theories have attempted to explain the developmental process . Each theorists has studied different aspects of development. Some focused on physical growth and neurological development while others looked at cognitive aspect . Information and the central ideas of each of these theorists are presented in the following:

29. Children development theories Theory Key Thinker(s) Main Focus Stages / Concepts Key Point Cognitive Development Jean Piaget How children think and reason 4 stages: Sensorimotor, Preoperational, Concrete Operational, Formal Operational Children actively construct knowledge through stages Sociocultural Theory Lev Vygotsky Role of culture and social interaction Zone of Proximal Development (ZPD), Scaffolding Learning is guided by interaction with others Psychosocial Theory Erik Erikson Emotional and social development 8 stages (focus on childhood: Trust vs Mistrust, Autonomy vs Shame, Initiative vs Guilt, Industry vs Inferiority) Each stage involves resolving a conflict to build identity Psychosexual Theory Sigmund Freud Influence of unconscious drives and early childhood 5 stages: Oral, Anal, Phallic, Latency, Genital Early experiences shape later personality and behavior Behaviorist Theory B.F. Skinner, John Watson, Ivan Pavlov How environment shapes behavior Classical Conditioning, Operant Conditioning Behavior is learned through reinforcement, punishment, and association

30. Principles of Growth and Development : Growth and Development is a continuous process from conception till death . Growth and development proceed in an orderly sequence . Different children pass through predictable stages at different rates . All body systems do not develop at same rate . Development is Development proceeds from proximal to distal body parts . Development proceeds from gross to refine skills .

31. Principles of Growth and Development :

32. Principles of Growth and Development :

33. Principles of Growth and Development : General to Specific : Children use their cognitive and language skills to reason and solve problems. Children at first are able hold the big things by using both arms , In the next part able to hold things in a single hand , then only able to pick small objects like peas, cereals etc. Children when able to hold pencil , first starts draw circles then squares then only letters after that the words .

34. Factors Influencing Growth and Development Includes: Genetic factors Sex Race and Nationality Prenatal factors; various conditions influences the foetal growth in utero. e.g., maternal malnutrition, infection, substance abuse, illness and hormones.

35. Factors Influencing Growth and Development: Includes: Postnatal factors: Growth potential Nutrition Childhood illness Physical environment Psychological environment Cultural influence Cultural influence Social economic-status Climate economic status Climate and season Play and exercise Birth order of the child Hormonal influence

36. Growth and Developmental Age Periods Neonate -Birth to 1 month Infancy -1 month to 1 year Early Childhood : -T oddler : 1-3 years -Preschool: 3-6 years Middle Childhood -School age -6 to 12 years Late Childhood Adolescent -13 years to appropriately 18 years.

37. Growth Monitoring Assessment of physical growth can be done by anthropometric measurement and the study of velocity of physical growth . Measurement of different growth parament is the important nursing responsibility in child care .

38. a) Weight Weight is one of the best criteria for assessment of growth and a good indicator of health and nutrition status of child . Weight of the full terms neonates at birth is about 2.5 to 3.5kgs. There is about 10% loss of weight first week of life, which regains by 10 days of age .

39. a)Weight Weight gain is about 25-30 gm per day for first 3 months and 400gm/month till one year of age. The infants double weight gain their birth weight by 5 months of age , triple by one year, fourth time by two years, five times by three year, six times by five year, seven times by seven year and ten times by ten year . Then weight increase rapidly during puberty followed by weight increase to adult size.

40. b)Length and height Increase in height indicate skeleton growth . Average length of a full-term neonate is 50 cm. 3 months-60cm 9-months-70cm 1 year → Average length is 75 cm. 2 years → Average height is 85–90 cm. 4 years → Height is 100 cm. 6 years → Height is about 115 cm. Increase 5 cm every year till onset of puberty . 12 years → Height is about 150 cm. Growth continues until 18–20 years, with peak growth during adolescence

41. b)Length and height

42. c)Head Circumference It is related to brain growth and development of intracranial volume. At birth → Average head circumference is 35 cm. First 3 months → Increases rapidly by about 2 cm per month (40 cm). 3 – 6 months → Increases by about 1 cm per month (43 cm). 6 – 12 months → Increases by about 0.5 cm per month. By 1 year → Head circumference is about 45 cm. By 2 years → About 47 – 48 cm. By 5 years → About 50 cm. By 12 years → Nearly adult size (52 – 54 cm). Clinical importance: Monitoring head circumference helps detect abnormal growth patterns such as microcephaly or hydrocephalus.

43. d)Head Circumference Head circumference is measured by ordinal tap , placing it over the occipital protuberance at the back , above the ear on the side and just over the supraorbital ridges in front measuring the point of height circumference .

44. e)Fontanelle Closure Clinical importance : offers insight into the newborn’s state of health, hydration and intracranial pressure status. At birth, anterior and posterior fontanelle are usually present. Posterior fontanelle closes early few weeks (6-8 week) of age. Delay closure is associated with hydrocephalus or congenital hypothyroidism The anterior fontanelle closes by 12-18 months of age . Early closure of fontanelle indicates craniostenosis due to premature closure of skull sutures. If it is too large or delay to closed is associated with conditions such as Down syndrome, rickets, and elevated intracranial pressures.

45. e)Fontanelle Closure

46. f)Chest Circumference At birth → Chest circumference is about 30 – 33 cm , usually 2 cm less than head circumference . By 6 – 12 months → Chest circumference becomes equal to head circumference . After 1 year → Chest circumference becomes greater than head circumference and continues to increase with age. E.g., 2.5 cm by year 1 and 5 cm at 5 years. By 5 years → Average chest circumference is around 50 cm. By adolescence → Chest circumference varies widely depending on sex, body build, and nutrition status.

47. f)Chest Circumference 📌 Clinical Importance: Helps assess nutritional status (e.g., malnutrition may cause chest to lag behind).Important in evaluating respiratory and thoracic development. It is measured by placing the tape measure around the chest at the level of nipple , measurement is measured between inspiration and expiration .

48. g)Mid Upper Arm Circumference (MUAC) This measurement helps to asses the nutritional status of young children. It is a simple and useful measurement.

49. g)Mid Upper Arm Circumference (MUAC) The average MUAC at birth is 11 to 12 cm , at one year it is 12 to 16cm , at 1 to 5 years it is 16 to 17 cm, at 12 years it is 17 to 18cm and at 15 years it is 20 to 21cm .

50. h)Eruption of teeth There is a variation for the time of eruption of teeth. First teeth commonly the lower central incision may appear in 6 to 7 months of age . It can be delayed even up to 15 months, which also can be considered within the normal range of time for teething. So, dentition is not a dependable parameters for assessment of growth. There are two sets of teeth; deciduous (milk)/wisdom teeth 👉 Rule of thumb for deciduous teeth : Number of teeth ≈ Age of child in months – 6. (e.g., at 12 months → 12–6 = 6 teeth expected).

51. h)Eruption of teeth

52. 1)Body mass index (BMI)

53. Standards of Growth Monitoring Charts In Kenya, the Ministry of Health (MoH) uses the Mother and Child Health (MCH) Handbook as a key tool for monitoring and promoting maternal, newborn, and child health .

54. Standards of Growth Monitoring Charts

55. Standards of Growth Monitoring Charts

56. Standards of Growth Monitoring Charts

57. Standards of Growth Monitoring Charts

58. Assessment of Development Normal development is complex process and has a multiple of facets. However, it is convenient to understand and assess development under the following domains: Gross motor development Fine motor skill development Personal and social development Language Vision and hearing.

59. Assessment of Development a) Gross motor development: Motor development progress is an orderly sequence to ultimate attainment of locomotion and more complex motor tasks thereafter. In an infant it is assessed and observed as follows:-

60. Assessment of Development

61. Assessment of Development a) Fine Motor Skill Development refers to the growth and strengthening of small muscles in the hands, fingers, and wrists that enable a child to perform precise movements and tasks. Other activities include eye coordination, hand eye coordination, hand to mouth coordination, grasping and dressing etc,.

62. Assessment of Development

63. Assessment of Development c) Personal and social development ; includes personal reactions to his own social and cultural situations with neuromotor maturity and environment stimulation. It is related to interpersonal and social smile, recognition of mother, use of toys.

64. Assessment of Development

65. Assessment of Development; c) Language

66. Assessment of Development

67. Quick Quiz 1. What is the difference between growth and development ? 2. Name two principles of pediatric nursing . 3. Give one role of a pediatric nurse . 4. By what age does birth weight triple ? 5. Why is family-centered care important ?

68. Summary Key takeaways: - Pediatric nursing focuses on specialized care for children . - Growth and development are predictable but individualized . - Nurses play a critical role in supporting both health and development .

69. Next Lesson-2 Family dynamics & communication with children and families. Integrated Management of Childhood Illness (IMCI)-overview &application .