tumbuh_kembang_stunting hubungan todler.ppt

tumbuh kembang

1. ﻢﻴﺣﺮﻠﺍﻦﻤﺤﺮﻠﺍﷲﺍﻢﺳﺒ
•Irwan
Subekti,SKep,Ners
TUMBUH KEMBANG TODDLER

2. REVIEW TUMBANG

3. TEORI PERKEMBANGAN

6. TeoriperkembanganKognitifPiaget (1952)
A.FASE SENSORIMOTOR (LAHIR –2 TAHUN)
PERKEMBANGAN KOGNITIF
TAHAPI 0-1BULAN PENGGUNAAN AKTIVITASREFLEKS
TAHAPII1-4BULAN REAKSISIRKULARPRIMER
TAHAPIII4-8BULAN KOORDINASI DARI SKEMA
SEKUNDER
TAHAPIV8-12BULAN REAKSISIRKULARTERSIER
TAHAPV 12-18BULAN REAKSISIRKULARTERSIER
TAHAPVI18-24BULAN INTERVENSIDARIARTIBARU
mencari dan mengisap, menggenggam bila
sesuatu ditempelkan ke tangan bayi
Perilakutersebutberulang-ulang,sehinggadipandangsebagaisirkular.Beberaparefleksbayi
menghilang,sementarayanglainmenjadilebihhalus,sepertimenggabungkanmenggenggamdan
mengisap.
Bayimenjadilebihresponsifterhadapduniadisekitarnyadanmelihatbahwaperilakunyamemiliki
efekyangmenarik,tetapimungkintidakbisamenghubungkanantaratindakandankonsekuensinya.
Mulaimampuberasosiasisederhanaketerampilanfisiktelahmembaik.Kegiatanmeliputimencapai
danmemegangbenda-benda,danmemindahkanmainandarisatutanganketanganlain
Pada tahap ini, perilaku bayi menjadi sengaja dan tujuan-diarahkan, mulai memahami tentang sebab dan akibat. Bayi
mulai mampu menangis untuk perhatian, mencari benda yang tersembunyi, mengguncangkan kerincingan yang
berbeda cara dan meniru orang lain dengan perubahan beberapa.
Bayisekarangmenunjukkanlebihbanyakkreativitasdalamperilakunyadanbereksperimendenganbenda-benda
untukmemperolehhasilyangbaru.Adajugahubunganyanglebihkuatantaraobjekdanide-ide
Balitadapatmenginternalisasiperistiwamasalaludangambardariobjek.Masihfokuspadadiri
sendiri,tetapiadajugapenerimaanlain.Perencanaanmentaldanprediksimenggantikanperilaku
berbasistrial-and-error,pintarmeniruoranglain.Contohkegiatanpadatahapinimeliputi"berbicara"
ditelepondanbermainrumah.

7. B.FASE PREOPERASIONAL ( 2-7
TAHUN)
•Simbolsepertikatauntukmewakili
manusia, bendadantempat.
•Kemampuanberfokushanyapadasatu
aspekpadasatuwaktu, danpemikiran
seringterlihattidaklogis
•Mobil menabrakanjingkarenaanak
laki-lakimarahpadaanjingtersebut
-Tahappre konseptual(2-4 tahun)
Sangategosentris, “saya”,
perkembanganbahasa, kata-kata
denganobjek
-Tahapintuituf(4-7 tahun)
Egosentrisanakmulaiberkurang,
Klasifikasisesuatudengansatuatribut
biasanyawarnaataubentuk
PERKEMBANGAN KOGNITIF

9. TEORI PERKEMBANGAN PSIKOSOSIAL
(Erik H Erickson)
TEORI PERKEMBANGAN PSIKOSOSIAL

11. TAHAPANAL-MUSKULAR (USIA1-3TAHUN /
TODDLER)
KARAKTERISTIK:
MENGOTORIADALAHAKTIVITASYANGUMUM
ORGAN ANUSDANRECTUM MERUPAKAN
SUMBERKENYAMANAN
MASA“TOILETTRAINING”---DAPATTERJADI
KONFLIK
GANGGUAN PADA TAHAP INIDAPAT
MENIMBULKAN KEPRIBADIAN OBSESIF-
KOMPULSIF SEPERTIKERASKEPALA,KIKIR,
KEJAMDANTEMPERTANTRUM
IMPLIKASI:“TOILETTRAINING”SEBAIKNYA
ADALAH SEBAGAI PENGALAMAN YANG
MENYENANGKAN, PUJIANYANGTEPATDAPAT
MENIMBULKAN KEPRIBADIANYANGKREATIFDAN
PRODUKTIF&TDKMALUMENGAMBILKEPUTUSAN
PerkembanganPsikoSeksual

12. Tahap1:Berorientasipadahukumandan
kepatuhan.“Apayangakanterjadipadasaya?”
Anakakanmematuhiaturandanakan
mengacuhkanalasanataumotifdarisuatu
perilakudanberfokuspadabentukfisik
(contohnyaseberapabesarkebohonganitu)atau
konsekuensinya (misalnyaakibatyang
ditimbulkan)
Tahap2:Tujuandanpengembalian.“Kamu
mencubit,sayaakanmencubitkamujuga”Anak-
anakakanmenyesuaikandiripadaaturandan
memikirkanakanapayangdapatoranglain
perbuatpadamereka,sertamemfokuskandiri
padakonsekuensilangsungdaritindakan
merekayangdirasakansendiri(semakinkeras
hukumandiberikandianggapsemakinsalah
tindakanitu)

13. FAKTOR YANG BERPERAN
TERHADAP TUMBANG
1.BIOLOGIK/FISIOLOGIK:GENETIKA, ADANYA
KELAINAN FISIOLOGIS(SEPERTI:DISFUNGSI
SARAFPUSAT,MALNUTIRI,DANLAINNYA).
2.PSIKOLOGIK:PROSES MENTAL-PSIKOLOGIKS
(SEPERTI:HUBUNGAN EMOSIONAL, MOTIVASI,
MINAT, BAKAT, PERKEMBANGAN KOGNISI,
PERSEPSI,DANKREATIVITAS).
3.LINGKUNGAN: KEADAAN LINGKUNGAN,
STIMULASI,FASILITAS(SEPERTI:KESEHATAN
LINGKUNGAN, INSTRUMEN LINGKUNGAN,
KETERSEDIAAN PERMAINAN,DANLAINNYA).
4.INTERAKSIDARIBEBERAPAFAKTOR.

14. FASE-FASE TUMBANG TODDLER
Tahapperkembangananakusia12 -18 bulan
PERKEMBANGAN MENTAL

15. •Perkembanganfisisnyacenderungmenetap
•Rumuspengukuranpanjangbadan=5(panjangbadan
lahir)+80
•Rumuspengukuranberatbadan2(beratbadanlahir)+
8
•Lingkarkepala:47-50cm.
Tahapperkembangananakusia18 -24 bulan
PERKEMBANGAN MENTAL

16. TAHAP PERKEMBANGAN ANAK USIA 2 -3 TAHUN
•Anakbiasanyamemiliki20gigisusu.
•Lingkarkepalasudahlebihdari50cm
•Perkembanganmentalanakusia2-3tahunmenurutSkala
YaumilmimidalamMarkum(1994)adalah:
Belajarmelompatdengansatukaki,meloncat,dan
memanjat.
Membuatjembatandengan3kotak.
Mampumenyusunkalimat.
Mempergunakankata-katasaya,bertanya,mengerti
kata-katayangditunjukkepadanya
MenggambarlingkaranBermaindengananaklaindan
menyadariadanyalingkunganlaindiluarkeluarganya

17. ANALISIS PERTUMBUHAN PADA KMS DAN GC WHO

19. PENYAKIT YAN SERING TERJADI
PADA TODDLER

20. Examination and Assessment of
the Pediatric Patient

21. Patient History
•The history for a new patient can be divided into:
–Chief complaint or primary concern
–History of the present illness (HPI)
–Past medical history (PMH)
–Review of symptoms (ROS)
–Family history (FH)
–Social and environmental histories

22. Patient History (cont.)
CHIEFCOMPLAINT/KELUHAN UTAMA
–Currentsignsandsymptoms
–Typicallyassessedbyaparentorcaregiver
–Includescough/fever/chestpain…
–Givenintheinformant'sorpatient'sown
words,thechiefcomplaintisabrief
statementofthereasonwhythepatientwas
broughttobeseen.
HISTORY OF PRESENT ILLNESS
•Present illness are recorded in chronologic
order.
•"The child was well until "X" number of days
before this visit.“

23. Past Medical History
A.Antenatal:Healthofmotherduringpregnancy.Medicalsupervision,
drugs,diet,infectionssuchasrubella,etc.,otherillnesses,vomiting,
toxemia,othercomplications;Rhtypingandserology,pelvimetry,
medications,x-rayprocedure,maternalbleeding,mother'sprevious
pregnancyhistory.
B.Natal:Durationofpregnancy,birthweight,kindanddurationoflabor,
typeofdelivery,presentation,sedationandanesthesia(ifknown),
stateofinfantatbirth,resuscitationrequired,onsetofrespiration,
firstcry.
C.Neonatal:APGARscore;color,cyanosis,pallor,jaundice,cry,
twitchings,excessivemucus,paralysis,convulsions,fever,hemorrhage,
congenitalabnormalities,birthinjury.Difficultyinsucking,rashes,
excessiveweightloss,feedingdifficulties.Youmightdiscovera
problemareabyaskingifbabywenthomefromhospitalwithhis
mother.

24. Growth and Development:
Mother and Mental Development
a.Firstraisedhead,rolledover,satalone,pulled
up,walkedwithhelp,walkedalone,talked
(meaningfulwords;sentences)
b.Urinarycontinenceduringnight;duringday.
c.Controloffeces.
d.Comparisonofdevelopmentwiththatof
siblingsandparents.
e.Schoolgrade,qualityofwork.

25. Growth and Development:
Nutrition
1.BreastorFormula:Type,duration,majorformula
changes,timeofweaning,difficulties.Bespecific
abouthowmuchmilkorformulathebabyreceives.
2.VitaminSupplements:Type,whenstarted,amount,
duration.
3."Solid"Foods:Whenintroduced,howtaken,types.
4.Appetite:Foodlikesanddislikes,idiosyncrasiesor
allergies,reactionofchildtoeating.Anideaofchild's
usualdailyintakeisimportant.

26. Past Illnesses
Yangperludigalisebagaiberikut:
1.Infections:Age,types,number,severity.
2.ContagiousDiseases:Age,complications
followingmeasles,rubella,chickenpox,mumps,
pertussis,diphtheria,scarletfever.
3.PastHospitalizations:includingoperations,age.
4.Allergies,withspecificattentiontodrug
allergies-detailtypeofreaction.
5.Medicationspatientiscurrentlytaking.

27. Immunizations and Tests
a.Listdateandtypeofimmunizationaswellasany
complicationsorreactions.
b.AccidentsandInjuries(includeingestions):Nature,
severity,sequelae.
c.BehavioralHistory
1)Doeschildmanifestanyunusualbehaviorsuchas
thumbsucking,excessivemasturbation,severeand
frequenttempertantrums,negativism,etc.?
2)Sleepdisturbances.
3)Phobias.
4)Pica(ingestionsofsubstancesotherthanfood).
5)Abnormalbowelhabits,ex.-stoolholding.
6)Bedwetting(applicableonlytochildoutofdiapers).

28. Family History
A.Fatherandmother(ageandconditionofhealth).What
sortofpeopledotheparentscharacterizethemselvesas
being?
B.Maritalrelationships.Littleinformationshouldbe
soughtatfirstinterview;mostinformationwillbe
obtainedindirectly.
C.Siblings.Age,conditionofhealth,significantprevious
illnessesandproblems.
D.Stillbirths,miscarriages,abortions;ageatdeathand
causeofdeathofimmediatemembersoffamily.
E.Tuberculosis,allergy,blooddyscrasias,mentalor
nervousdiseases,diabetes,cardiovasculardiseases,
kidneydisease,rheumaticfever,neoplasticdiseases,
congenitalabnormalities,cancer,convulsivedisorders,
others.
F.Healthofcontacts.

29. System Review
a.Asystemreviewwillserveseveralpurposes.It
willoftenbringoutsymptomsorsignsmissed
incollectionofdataaboutthepresentillness.
b.Itmightdirecttheinterviewerintoquestioning
aboutothersystemsthathavesomeindirect
bearingonthepresentillness(ex.-eczemain
achildwithasthma).
c.Finally,itservesasascreeningdevicefor
uncoveringsymptoms,pastorpresent,which
wereomittedintheearlierpartofthe
interview.

30. System Review
A.Skin:Askaboutrashes,hives,problemswithhair,skin
textureorcolor,etc.
B.Eyes:Havethechild'seyeseverbeencrossed?Any
foreignbodyorinfection,glassesforanyreason.
C.Ears,NoseandThroat:Frequentcolds,sorethroat,
sneezing,stuffynose,discharge,post-nasaldrip,mouth
breathing,snoring,otitis,hearing,adenitis.
D.Teeth:Ageoferuptionofdeciduousandpermanent;
numberatoneyear;comparisonwithsiblings.
E.Cardiorespiratory: Frequencyandnatureof
disturbances.Dyspnea,chestpain,cough,sputum,
wheeze,expectoration,cyanosis,edema,syncope,
tachycardia.
F.Gastrointestinal:Vomiting,diarrhea,constipation,typeof
stools,abdominalpainordiscomfort,jaundice.

31. System Review
G.Genitourinary:Enuresis,dysuria,frequency,polyuria,pyuria,
hematuria,characterofstream,vaginaldischarge,menstrual
history,bladdercontrol,abnormalitiesofpenisortestes.
H.Neuromuscular:Headache,nervousness,dizziness,tingling,
convulsions,habitspasms,ataxia,muscleorjointpains,
posturaldeformities,exercisetolerance,gait.
I.Endocrine:Disturbancesofgrowth,excessivefluidintake,
polyphagia,goiter,thyroiddisease.
J.Specialsenses.
K.General:Unusualweightgainorloss,fatigue,temperature
sensitivity,mentality.Patternofgrowth(recordprevious
heightsandweightsonappropriategraphs).Timeand
patternofpubescence.

32. Vital Signs by Age
Age Respirations
(breaths/min)
Pulse
(beats/min)
Systolic Blood
Pressure
(mm Hg)
Newborn: 0 to 1 mo 30 to 60 90 to 180 50 to 70
Infant: 1 moto 1 yr 25 to 50 100 to 160 70 to 95
Toddler: 1 to 3 yr 20 to 30 90 to 150 80 to 100
Preschool age: 3 to 6 yr 20 to 25 80 to 140 80 to 100
School age: 6 to 12 yr 15 to 20 70 to 120 80 to 110
Adolescent: 12 to 18 yr 12 to 16 60 to 100 90 to 110
Older than 18 yr 12 to 20 60 to 100 90 to 140
Slow or fast respirations are worrisome