PREGNANCY Presumptive Sign Signs and Symptoms M orning sickness A menorrhea C hanges in Breast F atigue L assitude U rinary Frequency

ry Frequency Q - uickening PREGNANCY Diagnosis of Pregnancy 1. Amenorrhea is usually the first sign of conception 2. Urine Pregnancy Test maybe positive within days of the first missed menstrual period th a. HCG present at 40-100 day of pregnancy th b. HCG peaks at 60-70 day th c. 6 week after LMP: best time to do the test d. Enzyme Link Immunosorbent Assay (ELISA) test; done as early as 7-10 days e. Radio Immunosorbent Assay (RIA) test: It can detect a beta sub-unit of HCG as early as 8 days PREGNANCY Diagnosis of Pregnancy 3. Fetal heart tones can be detect as early as 8 weeks from the last menstrual period by DOPPLER Normal HR is 120 160 beats/minute and it is irregular 4. Fetal movements (quickening) are first felt by the primaparous mother at 18-20 weeks 5. Ultra sound will visualize a gestational sac at 5-6 weeks; fetal pole with movement and cardiac activity by 7-8 weeks PREGNANCY Probable changes observed by examine Chadwicks bluish discoloration of vaginal wall Hegar softening of lower uterine segment Uterine Enlargement at 12 weeks gestation felt just above symphysis pubis Positive pregnancy test presence of gonadotropin in urine Ballottment sinking and rebound of fetus Outlining of Fetal body Goodells softening of the cervix Souffle, Contraction, Braxton Hicks Painless Contraction at 28 weeks PREGNANCY Positive FETAL SIGNS of Pregnancy 1. Fetal Heart beat = 12 weeks by doppler; 18 -20 weeks by Auscultation

2. 3.

Movement = felt by examiner usually 20 weeks Skeleton = by sonography or X -ray

PREGNANCY Tetanus Immunization prevents tetanus neonatorum 1. TT1 administered anytime during pregnancy 2. TT2 - administered 4 weeks after TT1; 3 year protection 3. TT3 administered 6 months after TT2; 5 years protection 4. TT4 administered 1 year after TT3; 10 years protection 5. TT5 administered 1 year after TT4; lifetime protection PREGNANCY Physical Examination (done cephalocaudally from head to foot) 1. Weight, funduscopic examination, thyroid, breast, lungs, and heart are examined 2. An extremity and neurologic exam are completed, and the presence of a C section scar is ought PREGNANCY Estimation of Gestational Age 1. Naegels Rule used to determine the expected date of delivery by determining the LMP of the mother PREGNANCY Estimation of Gestational Age 2. Mc Donalds Rule used to determine the age of gestation FORMULA a. Length of fundus in cm x 8/7 = AOG in weeks b. Length of fundus in cm x 2/7 = AOG in months PREGNANCY Estimation of Gestational Age 3. Bartholomews Rule to determine age of gestation by fundic location PREGNANCY Frequency of Prenatal Visits PREGNANCY Danger Signs of Pregnancy (SCABS) 1. Swelling or Edema of the upper extremities PREECLAMPSIA 2. Chills and Fever signs of infection Cerebral disturbances: headache sign of preeclampsia

Abdominal pain epigastric pain is an aura of an impending convulsion 4. Board-like abdominal abruptio placenta 5. Sudden gush flush premature rupture of membranes (PROM) PREGNANCY Exercise to strengthen muscles that will be used during the delivery process; done in moderation and must be individualized 1. Walking best form of exercise 2. Squatting to strengthen perineal muscles and increase circulation to perineum (feet FLAT on floor). Do not stand abruptly, it leads to postural hypotension, hence, raise buttocks first before the head 3. Tailor Sitting same purpose as squatting; done by placing 1 leg in front of the other PREGNANCY Exercise to strengthen muscles that will be used during the delivery process; done in moderation and must be individualized 4. Kegels Exercise strengthen pubococcygeal muscle 5. Abdominal Exercise strengthen muscles of abdomen 6. Shoulder Circling strengthen muscle of chest 7. Pelvic Rocking or Pelvic Tilt relieves low back pain and maintains good posture PREGNANCY Childbirth Preparation TYPES A. Psychophysical Bradley Method by Dr. Robert Bradley Principles is based on imitations of nature Advocates active participation of husband during delivery and encourages him to serve as a coach Requirements: o Darkly lighted room o Quiet environment PREGNANCY Childbirth Preparation TYPES A. Psychophysical Bradley Method by Dr. Robert Bradley Requirements: o Relaxation technique o Closed eyes or appearance of sleep Grantly Dick Read Method Principle: Fear causes tension and tension produces pain

3.

Features: abdominal breathing exercise and relaxation techniques PREGNANCY Childbirth Preparation TYPES B. Psychosexual Kitzinger Method by Dr. Sheila Kitzinger Pregnancy, labor, birth and the care of the newborn is an important point in a womans life cycle Features: Mother should go with the flow of contraction rather than struggle with it PREGNANCY Childbirth Preparation TYPE C. Pscyhoprophylaxis (prevention of pain through mind) Lamaze by Dr. Ferdinand Lamaze Features: involves discipline, conditioning, concentration with the help of the husband to serve as a coach PREGNANCY Childbirth Preparation TYPE C. Pscyhoprophylaxis (prevention of pain through mind) Lamaze by Dr. Ferdinand Lamaze Requirements: o Conscious relaxation o Cleansing breath (inhaling through the nose and exhaling through the mouth) o Effleurage gentle circular massage over the abdomen to relieve pain o Imaging sensate focus PREGNANCY Different Method of Delivery 1. Birthing Chair: Semi-Fowlers position 2. Birthing Bed: Dorsal Recumbent 3. Squatting Position: Facilitate descent and relieves low back pain MAJOR DEVELOPMENTAL TASKS INFANCY (1 month to 1 year) Developing a sense of trust and belonging from a relationship with mother and father Differentiating self from environment MAJOR DEVELOPMENTAL TASKS INFANCY (1 month to 1 year) Learning Eat solid food Walk Explore Communicate

Tolerates progressive diet from liquid to solid Develops grows motor skills Learns to speak Learns to imitate MAJOR DEVELOPMENTAL TASKS TODDLER (1 to 3 years) Developing Will power Develops a sense of autonomy (Independence) Learning Exploring environment Masters elimination skills Learns to use symbols Learns to behave appropriately in social situations MAJOR DEVELOPMENTAL TASKS TODDLER (1 to 3 years) Learning Feed self Run Communicate verbally Control urination MAJOR DEVELOPMENTAL TASKS PRESCHOOL (3 to 6 years) Developing Sexual identity Sense of initiative Learns to define objects according to their purpose Distinguishes right or wrong Develop moral judgment Adapts to new situations MAJOR DEVELOPMENTAL TASKS PRESCHOOL (3 to 6 years) Working on Autonomy Dressing self Washing MAJOR DEVELOPMENTAL TASKS PRESCHOOL (3 to 6 years) Developing sense of Time Space Distance MAJOR DEVELOPMENTAL TASKS PRESCHOOL (3 to 6 years) Developing sense of Imagination MAJOR DEVELOPMENTAL TASKS SCHOOL-AGE (6 to puberty) Developing

Sense of work Planning and carrying out projects MAJOR DEVELOPMENTAL TASKS SCHOOL-AGE (6 to puberty) Learning the skills for survival in the childs culture Developing modesty Playing cooperatively MAJOR DEVELOPMENTAL TASKS SCHOOL-AGE (6 to puberty) Learning Read Calculate Learns to cooperate and compete MAJOR DEVELOPMENTAL TASKS SCHOOL-AGE (6 to puberty) Developing neuromuscular coordination Learning to control emotions Identifies with members of opposite sex MAJOR DEVELOPMENTAL TASKS ADOLESCENT (13 to 18 years) Developing Physical maturity Autonomy from home and family Self-identity Coping with body images MAJOR DEVELOPMENTAL TASKS EARLY ADULTHOOD (19 to 35 years) Establishment of enduring close physical and emotional relationships Child bearing Child rearing MAJOR DEVELOPMENTAL TASKS EARLY ADULTHOOD (19 to 35 years) Establishing financial security Community responsibility Social interaction with peers MAJOR DEVELOPMENTAL TASKS MIDDLE ADULTHOOD (35 to 65 years) Separation from children Establishment in a job Adapt to aged parents MAJOR DEVELOPMENTAL TASKS MIDDLE ADULTHOOD (35 TO 65 years) Adapt to physiological changes of aging Adjustment to altered relationship with spouse MAJOR DEVELOPMENTAL TASKS LATER ADULTHOOD (65 TO death) Acceptance of own life as valuable and appropriate

Adaptation to reduced physical health and strength Possible death of spouse MAJOR DEVELOPMENTAL TASKS LATER ADULTHOOD (65 TO death) Adjustment to retirement income Development of relationship with new family members Adaptation to change in living location and style MAJOR DEVELOPMENTAL TASKS Development proceeds in orderly and predictable pattern Thorough knowledge of normal behavior is required to detect abnormalities in development Comparison of Developmental Stages Comparison of Developmental Stages Comparison of Developmental Stages MAJOR DEVELOPMENTAL TASKS BEHAVIOR An expression of complex interaction Four fields Motor behavior Adaptive behavior Language development Personal social behavior MAJOR DEVELOPMENTAL TASKS BEHAVIOR MOTOR BEHAVIOR GROSS MOTOR Involves posturing of the head, trunk and extremities Necessitates movement of all or much of the body MAJOR DEVELOPMENTAL TASKS BEHAVIOR MOTOR BEHAVIOR FINE MOTOR Illustrated by well-coordinated movements of small muscles Fingers MAJOR DEVELOPMENTAL TASKS BEHAVIOR ADAPTIVE BEHAVIOR Most significant Most closely related to intelligence Involves Ability to utilize and manipulate objects Motor and sensory coordination in the

solution of practical problems Resourcefulness in using past experience in adjusting to new situations MAJOR DEVELOPMENTAL TASKS BEHAVIOR LANGUAGE DEVELOPMENT Ability to understand another person and to be able to make oneself understood Reflex sounds and feeble gestures rd (3 week) Crying Cooing rd th Babbling (3 to 8 month) Ma-ma, da-da th Gestures (starts at the 4 month) Word usage MAJOR DEVELOPMENTAL TASKS BEHAVIOR PERSONAL SOCIAL BEHAVIOR Affected by environment and culture Includes Habits affecting feeding, bowel and bladder control Ability to get along with other people REFLEXES OF THE NEWBORN REFLEXES OF THE NEWBORN REFLEXES OF THE NEWBORN IMMEDIATE CARE FOR NEONATE 1. Establish Patent Airway Top priority in the immediate care for newborn Never stimulate to cry unless secretions have been drained out Measures to promote patent air passageways a. Position head lower than the rest of the body b. Suctioning mouth before nose c. Oxygenation IMMEDIATE CARE FOR NEONATE 2. Maintain body temperature 0 Body temperature is about 37.3 C COLD STRESS due to large losses of heat (evaporation, conduction, convection, radiation) To prevent heat loss: a. Dry the newborn immediately b. Wrap the baby c. Put the baby under a droplight

 Initial temperature of the baby must be taken through rectum to detect congenital problem imperforate anus IMMEDIATE CARE FOR NEONATE 3. ID the Newborn Properly To be assure that a mother is never given a wrong infant ID bands and bracelets or by taking foot prints IMMEDIATE CARE FOR NEONATE IMMEDIATE CARE FOR NEONATE SCORE INTERPRETATION 0 3 Resuscitation ASAP! 4 6 Guarded continue monitoring and suctioning 7 10 Best possible condition/ needs normal care IMMEDIATE CARE FOR NEONATE GESTATIONAL AGE ASSESSMENT IMMEDIATE CARE FOR NEONATE 5. Anthropometric Measurement Head Circumference = 33-35 cm (13-14 inch) Chest Circumference = 31-33 cm (level of the nipples) Abdominal Circumference = 31-33 cm (level of umbilicus) Height/Length = 47.5 53.75 (19-21 inch) IMMEDIATE CARE FOR NEONATE 6. Skin Normally ruddy because of increased RBC concentration and decreased amount of subcutaneous fats Acrocyanosis (normal in 24-48 hrs); Harlequin sign Desquamation (drying of skin) Abnormal skin findings a. Pallor excessive blood loss; blood incompatibility; decreased iron stores b. Gray infection c. Yellow jaundice decrease glucoronyl transferase IMMEDIATE CARE FOR NEONATE Common Skin Marks IMMEDIATE CARE FOR NEONATE 7. Credes Prophylaxis or Eye Care Apply ointment to treat against opthamia neonatorium (gonorrheal conjunctivitis) Tearless due to immature lacrimal ducts Cornea is round Pupil is dark Temporary cross-eyed (strabismus) IMMEDIATE CARE FOR NEONATE

8. Cord Dressing To prevent tetanus neonatorium Check the presence of AVA 9. Vitamin K administration Give .1 mL to prevent bleeding in the newborn by improving blood coagulation Weigh the newborn 10. Daipering 11. Mummying or Swalding 12. Feeding tummy to tummy ; football hold 13. Burping ROUTINE CARE OF THE NEWBORN 1. Give initial oil bath to cleanse the baby of blood, mucus and vernix 2. Dress umbilical cord (70% alcohol or PNSS) 3. Credes prophylaxis 4. Vitamin K administration 5. Feeding 6. Bathing Recommended Schedule For Active Immunization Growth and Development of Infant WEIGHT birth weight doubles at 4-6 months of age Birth weight triples at 12 months Weight gain is approximately 1 lb/month for the 1st 6 months; slightly less for the next 6 months Ave weight: Male: 10 kg (22lbs) Female: 9.5 kg (21 lbs Formula: Age in months + 4/2 Growth and Development of Infant HEIGHT a reliable criterion for growth since this is not affected by excess fat or fluid reflects growth failure and chronic undernutrition 50% increase of the birth length during the st 1 year Ave weight: 30 inches (76.2 cm) at 1 year old summary of height pattern: 0-3 mons 9 cm;3-6 mos 8 cm; 6-9 mons 5 cm; 9-12 mons - 3 cm Growth and Development of Infant HEAD CIRCUMFERENCE a reflection of rapid brain growth st At the end of 1 year, brain has already reached 2/3 of adult size Head may have some asymmetry due to persistent position for sleep st Pattern growth: 1 4 mons inch per month; next 8 mons inch per month

Growth and Development of Infant BODY PROPORTION mandible (lower jaw) becomes more prominent head circumference becomes equal to chest circumference at 6 months Abdomen still protuberant start of development of vertebral curves (cervical, thoracic, lumbar) there is lengthening of lower extremities during the last 6 months which readies the child for walking Growth and Development of Infant BODY SYSTEMS Cardiovascular system HR = 100-120 beats/minute BP = 80 - 100 mmHg/40 60 Respiratory system RR = 20-30 cycles/minute tubal cavity of the respiratory tract is till small and mucous production still inefficient Thoracic index (transverse: anteroposterior diameter) = 1.25 Growth and Development of Infant BODY SYSTEMS GI system Digestion of CHON is adequate rd Low amylase (until 3 month) Low lipase (until 12 month) Liver function is immature a. decreased conjugation of drugs b. decreased storage of CHO, CHON and

vitamins Swallowing coordination is not developed until about 6 months Extrusion reflex disappear at 3-4 months Drinking from cup rather from the breast or bottle at 8-10 mons. Growth and Development of Infant BODY SYSTEMS Immune system functional at 2 months produce IgG and IgM by 12 months IgA, IgD, IgE are not plentiful even until preschool period Other Systems Kidneys remain immature and not as efficient in eliminating body wastes Endocrine system remains immaturenot able to react to stress efficiently Growth and Development of Infant DENTITION

1 tooth erupts at 6 months (LOWER CENTRAL INCISORS) Slightly earlier in girls than in boys RULE: No. of teeth = (age in months) 6 Some newborns may be born with teeth called (NATAL TEETH) or have teeth erupt in st the 1 4 weeks of life called (NEONATAL TEETH), which occurs in 1:2000 infants If tooth is fixed firmly, it might as well not be removed; if loose, it must be removed to prevent aspiration INFANTS DAILY ACTIVITIES BATHING An infant does not need a daily bath except in very hot weather Bath serves many functions To promote cleanliness To provide opportunity for the baby to exercise and kick To give parents time to talk, touch and communicate with the baby To give the baby the opportunity to learn different textures and sensations INFANTS DAILY ACTIVITIES DIAPER-AREA CARE Good diaper-area hygiene means not allow an infant to wear soiled diapers for a lengthy time Diapers should be changed frequently Skin should be washed thoroughly with water and mild soap Petroleum jelly or A and D ointment may be used as prophylaxis INFANTS DAILY ACTIVITIES CARE OF THE TEETH Fluoride is important in proper tooth development and prevention of tooth decay. Water level should have 1 ppm Fluoride to protect the tooth enamel Teach parents to begin brushing even before teeth erupt by rubbing a piece of gauze over the gum pads Toothpaste is not necessary INFANTS DAILY ACTIVITIES DRESSING Clothes should be easy to launder and simply constructed Type of clothing should suit infants activity level INFANTS DAILY ACTIVITIES SLEEP Infants need 10-12 hours of sleep a night and once or several naps during the day

st

Caution parents not to place pillows to avoid possibility of suffocation INFANTS DAILY ACTIVITIES EXERCISE The infant benefits from outings in a carriage or stroller, as sunlight provides a natural source of vitamin D. Early mornings and late afternoon are the best times for the infant to be outside Use of infant walkers must be closely supervised Parental Concerns and Problems Related To Infancy Teething Thumb Sucking Use of Pacifiers Head Banging Sleep Problems Constipation Loose Stools Colic Spitting up Diaper Dermatitis Miliaria Seborrhea Baby-Bottle Syndrome Accident Prevention Measures for Infants GENERAL Know the whereabouts of the infant Be aware that the frequency of accidents is increased when parents are under stress Take special precaution at all times Choose babysitters carefully, explain all and enforce all precaution when sitters are in charge Accident Prevention Measures for Infants ASPIRATION Be certain any object than an infant can grasp and bring to the mouth is either safe to eat or too bring to fit in the mouth Do not feed infant with popcorn or peanuts, because these are easily aspirated Store baby products such as powder out of infants reach; powder is high risk in aspiration Inspect toys and pacifiers that could be aspirated if broken Accident Prevention Measures for Infants FALLS Never leave the infant alone do not allow infant to walk with sharp or pointed object

Raise crib rails and make sure they are locked before walking away from crib Do not leave a child unattended in a high chair Avoid using an infant walker Accident Prevention Measures for Infants MOTOR VEHICLE Never transport unless the infant is buckled up into an infant car seat in the back seat of the car Do not place an infant in the front passenger seat if car has an air bag. Do not be distracted by the infant while driving Never leave infant unattended inside a car alone Accident Prevention Measures for Infants SUFFOCATION Allow no plastic bags within infants reach Do not use a pillow in a crib Buy a crib that is approved for safety (spacing of rails not over 2 & 3/8 inches [6 cm] apart) Remove constricting clothes such as a bibs when not in use or bed time Accident Prevention Measures for Infants DROWNING Do not leave infants alone in the bathtub or unsupervised near water (even buckets of cleaning water) ANIMAL BITES Do not allow infant to approach a strange animal Supervise play with family pets Accident Prevention Measures for Infants POISONING Never present medication as candy Buy medication container with safety caps, put away immediately after use Never take medication in front of infants Never leave medications in a pocket or handbags Use no lead-based paint in any area of the home Hang bags or place on high surfaces Post phone number of the poison control Accident Prevention Measures for Infants BURNS Test warmth of formula and food before feeding Do not smoke or drink hot liquids while holding or caring infant Buy flame retardant clothing for infants

Use a sun-screen on a child over 6 months when out in direct or indirect sunlight limit the child exposure to less than hour at a time Turn handles of pan toward back of stove Monitor infants carefully near candles Keep electric wires and chords out of reach; cover electrical outlets Infant Nutrition 0-3 MONTHS Feeding only breast milk or formula for first year Always holding infant when feeding and never propping bottle when feeding Limiting water intake to oz to1 oz at a time Avoiding use of honey or corn syrup Allowing non-nutritive sucking Infant Nutrition 4-6 MONTHS introducing solid foods w/o added salt or sugar and iron-fortified cereal, one food at a time Avoid use of juice or sweetened drinks Feeding from spoon only Infant Nutrition 7-9 MONTHS Introducing finger foods and cup when infant is able to sit up Having infant join family at mealtime Allowing self-feeding, with observation to prevent chocking Introducing limited amounts of diluted juice in a cap Avoiding sugary desserts and soda Infant Nutrition 10-12 MONTHS offering 3 meals and healthy snacks Beginning to wean from bottle and beginning table food Avoiding fruit drinks and flavored milk Allowing infant to feed self with spoon Introduction of Solid Food TOODLER Considered as the age from 1-3 years A period in which enormous changes take place in the child and in the family The largely immobile and preverbal child now becomes a walking, talking child with sense of independence TOODLER Physical Growth WEIGHT

o o o o o o o o

gains only about 5-6 lbs. (2.5 kg) decreased weight gain due to increase activity HEIGHT gains on 5 inches (12 cm) a year during toddler period subcutaneous fat baby fat begins to disappear estimate adult height: multiply by 2 at 2 years TOODLER Physical Growth HEAD HC = CC at 6 months to 1 year CC> HC at 2 years HC increases only about 2 cm during the nd 2 year compared to about 12 cm during st the 1 year Anterior fontanel (bregma) closes at 12-18 months TOODLER Physical Growth BODY CONTOUR prominent abdomen (LORDOSIS) with wide-stanced gait BODY SYSTEM Respiratory system respiration slows slightly but remains to be abdominal TOODLER Physical Growth BODY SYSTEM Cardiovascular system HR slow from 110 to 90 beats/min BP increases to about 99/64 mmHg Nervous system Brain develops to about 90% of adult size Complete myelination of spinal cord causes urinary and anal sphincter control TOODLER Physical Growth BODY SYSTEM GI system stomach capacity increases to the point that the child can eat 3 meals a day Stomach secretions become more acid GI infections are less common TOODLER Physical Growth BODY SYSTEM Immune system IgG and IgM antibody production becomes mature at 2 years of age

o o o o o o o o o o

The passive immunity effects from intrauterine life are no longer oparative TOODLER Physical Growth BODY SYSTEM Dentition 8 new teeth The canines and the first nd molars) erupt during the 2 year All 20 deciduous teeth are generally present by 2 to 3 years of age TOODLER Physical Growth lower/upper Central incisor = 6 to 10; 8 to 12 months Lateral incisor = 10 to 16; 9 to 13 months Cuspid = 17 to 23; 16 to 22 months First molar = 14-18; 13 to 19 months Second molar = 23 to 31; 22 to 33 months Special Needs: TOODLER A. Sense of Autonomy Favorite word NO Child learns to be independent Understanding love for the child is shown by: Giving him all freedom he can safely use Giving him all the love and help needs to keep him safe in an environment beyond his control Giving him guidance in avoiding hazards in the changing social situation in which he feels to be the focal point Special Needs: TOODLER B. Graded Independence/Negativism Give the child opportunity to make choices Independence may be denied for possible painful experience which may hinder a child to try new skills because of fear Special Needs: TOODLER C. Love and Security Love enables the toddler to grew up and reach out for more mature goals because he feels secure Love for the mother decreases; attachment to a loving father increases Security object (e.g. diaper, blanket, toy, etc) Specific Areas for Guidance: TOODLER A. Toilet Training The child begin accepting the reality principle (giving up an immediate pleasure in order to gain another pleasure later)

o o o

o o o o o

Toddler must give up the pleasure of excreting where and when he wishes in order to gain his mothers approval Specific Areas for Guidance: TOODLER Requisites for Toilet Training Physiologic Readiness Sphincter control myelination of nerve tract occurs at around 15-18 months of age (most important requirement) Recognizes the urge and with ability to stand and walk to the bathroom and manage clothing Specific Areas for Guidance: TOODLER Requisites for Toilet Training Psychologic Readiness Understand the act of elimination Ability to verbally communicate need to defecate or urinate Mother or caretaker must be able to recognize verbal behaviors Desire to please the mother Specific Areas for Guidance: TOODLER Schedule/Timing of Training Specific Areas for Guidance: TOODLER Principles of Toilet Training Bowel training should started before bladder training Training should not be accomplished during illness Firm but not strict training should be done (<10 minutes) Positive maternal attitude when successful, the child should be praised and cuddled; if not show any disapproval Child should feel secure when seated on the chair or toilet bowl. NEVER FLUSH TOILET BOWL WHILE CHILD IS SITTING ON IT Child should not be given food or toys during training as it distracts him Specific Areas for Guidance: TOODLER B. Delayed Speech A normal child will begin to speak by 15 months of age If by 2 years, he is not able to speak, causes of the delay must be investigated Specific Areas for Guidance: TOODLER B. Delayed Speech Causes of delayed speech Intelligence level Social and cultural environment Illness Poor models Negativism

Deafness Sex (females speak earlier than males) Learning two languages at the same time Specific Areas for Guidance: TOODLER C. Ritualistic Behavior Common between ages of 2 to 4 years Done to master skills Intervention Adults should recognize these rituals in such phases as: a. Bathing use a face towel b. eating use bib, own utensils c. sleeping taking a favorite toy or blanket to bed with him o Show other ways of doing things Specific Areas for Guidance: TOODLER D. Temper Tantrums Occur when a child cannot integrate his interval impulses and the demands of reality He is frustrated and reacts in the only way knows by violent body activity and crying Specific Areas for Guidance: TOODLER D. Temper Tantrums Causes o In the hospital fear of the unknown o Adult refuses to grant a request o When the child is tired, before bedtime or naptime or during a tiring trip or visit o When mother says, NO too frequently with regard to getting dirty, using a spoon, running, etc o When the child under pressure such as toilet training Specific Areas for Guidance: TOODLER D. Temper Tantrums Interventions o Remove him from immediate cause of tantrum with the adult whom he knows loves him o Be calm and be patient. Do not force attention upon him, until he indicates he is ready for the comfort of knowing he is loved o He should not be given extra attention but should be observed from self-injury or anything in the environment which may be a source of injury to him o Avoid restraining the child Specific Areas for Guidance: TOODLER D. Temper Tantrums Care after a Tantrum o Make few comments of his behavior

o o o o

o o o o

He should not be punished Wash face and hands if he cooperates Give a toy to divert attention Specific Areas for Guidance: TOODLER D. Temper Tantrums Prevention of Tantrum The mother should try to show him better ways of solving his problems o Provide more socially acceptable outlet for his anger and frustrations o He should be helped to release his tension in a socially approved way such as physical exercise going outdoors, gardening, etc. Specific Areas for Guidance: TOODLER E. Dawdling Slowness in carrying out request the child is gradually learning the difference between right or wrong. He cannot decide which of the two actions to take Occurs when: a. The tasks being given is too difficult for him b. He tries to avoid a task he knows will end in failure Handle this problem by giving a specific instructions Specific Areas for Guidance: TOODLER F. Discipline Goal: Establish self-control Forms of Discipline 1. Ignoring (Best for Temper Tantrum) 2. Redirecting childs attention 3. Time-out 4. Corporal punishment (controversial) 5. Explain and reasoning, reprimand and loss of privileges for older children Specific Areas for Guidance: TOODLER F. Discipline Principles: 1. Immediately after a wrong doing 2. Consistency and firmness 3. Disapproval of the behavior and NOT of the child 4. Positive approach 5. Allow child to explain; the reason for your disciplining him 6. Safety disciplining and Never say NO to child too often 7. Provide physical care after do that DOUBT will be erased 8. Withdraw privileges and NOT BASIC NEEDS ( not sending child to sleep without dinner) Specific Areas for Guidance: TOODLER

 1. 2. 3.

F. Discipline Effects of good discipline (3S): Security Self-control Socially appropriate behavior Basic Needs of the TOODLER A. Bathing Time depends on the mother and the childs wishes May be given before and evening meal, at bed time because it relaxes child and helps him to sleep Toddlers enjoy bath time so the mother must proved toy during the bath Basic Needs of the TOODLER B. Clothing Need clothing that can be changed quickly because they cant stand for long C. Dental Care Brush and floss daily (with help) 2x daily Proper oral hygiene and adequate diet (sweets) 2 - 3 years; as soon as all the deciduous teeth are out, he can have his FIRST DENTAL VISIT Basic Needs of the TOODLER C. Dental Care If water is not fluoridated, give supplements: 0.25 to 0.5 mg/day Limit concentrated sweets Do not allow the child to carry a bottle of milk or juice to bed 3 years: instruct to brush teeth after eating and at bedtime Basic Needs of the TOODLER D. Sleep and Exercise Depends on age, health, emotional tension, and activity during the day 12-14 hours at night and 1-2 hours of daytime/afternoon nap Usually outgrows bedtime rituals by 3 years old Basic Needs of the TOODLER E. Play The toddlers work; language of the child PARALLEL PLAY Games: likes throwing and retrieving games; selfish, possessive of toys (lack interest in toys: DANGER SIGN) Basic Needs of the TOODLER Purposes of Play Physical development Social development

o o o o o o o o o o o o o o o o

Therapeutic value Educational Moral values formation Basic Needs of the TOODLER Selection of Play Materials Based on like/dislikes No sharp edges No small removable parts No beads, marbles, coins No flammable toys painted with lead (BRAIN DAMAGE) Basic Needs of the TOODLER F. Nutrition Calorie requirements: 1,300 calories/day; 100cal/kg/day PHYSIOLOGIC ANOREXIA Basic Needs of the TOODLER F. Nutrition Eating Behavior of a Toddler The child may develop food preference He may even refuse food for a short time Maybe demanding in what he wants to eat and dishes he uses and way food is served He is slow and clumsy but he enjoys feeding himself He may wander away from the table Basic Needs of the TOODLER F. Nutrition Development of Eating Skills Basic Needs of the TOODLER F. Nutrition Specific Suggestions for Feeding At 1 to 2 years, child can eat table food and 3 meals a day Serve food in small portions Chop or cut the food in small pieces The diet each day should be well balanced (16 oz of milk should be given daily) Basic Needs of the TOODLER F. Nutrition Specific Suggestions for Feeding Satisfy the childs appetite with nutritious foods Avoid sweets Give vitamins Do not force him to eat Allow the child to join others at the table Recognize ritualistic behavior Do not use food as reward (may cause obesity) Basic Needs of the TOODLER G. Accident Prevention

 o o o o o o o o o o o o o o o o o o o o

of

Accidents are the leading cause of deaths 1-5 years of age Poisoning is a leading cause of morbidity Basic Needs of the TOODLER G. Accident Prevention FALLS Use stair guards; crib rails always up Windows and door always screened Supervise at playgrounds Keep clothes properly cared for and fitted Avoid slippery floors Basic Needs of the TOODLER G. Accident Prevention POISONING Make sure you dont give medications as candies Keep medications out of reach Basic Needs of the TOODLER G. Accident Prevention BURNS Cover electrical outlets Turn pot handles toward back of stove Do not leave unattended in bathtub, near stoves Keep electrical wires out of reach Teach child what hot means Check bath water temperature Basic Needs of the TOODLER G. Accident Prevention DROWNING Teach swimming pool and water safety Do not leave child unsupervised near water or bathtub Have swimming pool fence and gates with childproof locks Basic Needs of the TOODLER G. Accident Prevention CUTS and STABS Keep knives out of reach Teach safety with sharp objects Lock up guns and powder tools Keep scissors away TOODLER MNEMONICS FOR TODDLER P ush-pull Toys/Parallel Play R itualistic Behavior/Regression A utonomy vs Shame and Doubt I nvolve Parents S eparation Anxiety E limination (Toilet Training)/Exploration Environment PRESCHOOL

Traditionally defined to include 3 to 6 years of age Physical growth slows considerably during the period but personally and cognitive growth are substantial PRESCHOOL Physical Growth There is definite change in the body contour during the preschool years The wide-legged gait, prominent lordosis, and protuberant abdomen of the toddler change into a slimmer, taller and much more childlike proportions major step found is the childs ability to learn extended language, which is affected not only by motor but by cognitive development PRESCHOOL Physical Growth Future body type becomes, apparent: PRESCHOOL Physical Growth A. WEIGHT gains 4.5 lbs/year slow growth Appetite remains as it was during the toddler years B. HEIGHT only minimal gain is noticed about 2-3.5 a year on the average PRESCHOOL Physical Growth C. HEAD CIRCUMFERENCE Not routinely measured over 2 years of age D. BODY SYSTEMS D.1 Nervous System o Handedness is beginning to be obvious o There is relative ease in learning language because of the increased cognitive ability PRESCHOOL Physical Growth D. BODY SYSTEM D.2 Lymphatic System o Lymphatic tissue begins to grow (tonsils) o IgG and IgA increase o Illness becomes more localized (an URI remains localized in the nose without systemic fever) PRESCHOOL Physical Growth D. BODY SYSTEM D.3 Cardiovascular System

o o o o o o

o o o o o o o o o

Physiologic splitting or innocent murmurs may be heard on auscultation (due to changing size of the heart in reference to the thorax) PR = decreases to about 85 bpm BP = 100/60 mmHg PRESCHOOL Physical Growth D. BODY SYSTEM D.4 Urinary System Bladder remains to be palpable above the symphysis pubis Voiding becomes frequent (9-10x a day) PRESCHOOL Physical Growth D. BODY SYSTEM D.5 Muscular System Muscles are noticeably stronger Many children exhibit genu valgus (knock knees) which disappears with skeletal growth PRESCHOOL Accident Prevention FALLS Use stairs guards; crib rails always up Windows and door always screened Supervise at playgrounds Keep clothes properly cared for and fitted Avoid slippery floors PRESCHOOL Accident Prevention POISONING Make sure you dont give medications as candies Keep medications out of reach PRESCHOOL Accident Prevention BURNS Cover electrical outlets Turn pot handles toward back of stove Do not leave unattended in bathtub, near stoves Keep electrical wires out of reach Teach child what hot means Check bath water temperature PRESCHOOL Accident Prevention DROWNING Teach swimming pool and water safety Do not leave child unsupervised near water or bathtub Have swimming pool fence and gates with childproof locks

o o o o o o o o

PRESCHOOL Accident Prevention CUTS and STABS Keep knives out of reach Teach safety with sharp objects Lock up guns and powder tools Keep scissors away Common Fears of the PRESCHOOLER A. Fear of the Dark Due to vivid imagination and undue stress A stuffed toy by day becomes a monster in the dark Monitor possible stimuli for such fear Burn a dim night light Reassure the child he is safe No sleep medication please Common Fears of the PRESCHOOLER B. Fear of Mutilation Child has intense reaction to injury He cries not from the pain only but also from the sight of the injury Avoid threatening the child about mutilation in order to discipline him POSTPONE SURGICAL PROCEDURES, UNLESS EMERGENCY Common Fears of the PRESCHOOLER C. Fear of Separation or Abandonment Sense of time is distorted Sense of distance is limited Common causes: hospitalization and going to new school Behavior Problems of the PRESCHOOLER A. Telling Tall Tales Arises from the childs overactive imagination Help the child separate fact from fiction B. Imaginary Friends Make sure that child has exposure to real playmates Regression related to STRESS Ignore behavior and investigate the cause of stress Behavior Problems of the PRESCHOOLER D. Bruxism Night grinding A way of letting go to release tensions and allows falling asleep Identify and relieve source of anxiety If intense, crown of teeth becomes abraded Behavior Problems of the PRESCHOOLER E. Broken Fluency Secondary Stuttering

 o o o o o o 1.

2. 3. 4.

Repeated words/syllables 2 to 6 years of age may typically have some speech difficulty Correction should not be emotional Behavior Problems of the PRESCHOOLER Broken Fluency Principles: Do not label the child as stutter Listen with patience what the child is saying Talk to the child in a calm, simple way Protect space for him to talk if there are other children in the family Do not force the child to speak if he doesnt want to Do not reward for fluent speech or punish him for non-fluent speech Play for the PRESCHOOLER Importance of Play: The child learns to express feelings The child develops concern for his playmates By play, the adult gains a view into the childs world Play for the PRESCHOOLER Kinds of Play (ASSOCIATIVE PLAY): From solitary and parallel play, it shifts to simple forms of: Cooperative play when the child begins to exchange ideas with other children and gradually interact with them Loosely organized play activity which is continuous but membership changes Social play child plays with other children Organized play emerges at latter part of the preschool period Play for the PRESCHOOLER TOYS Special Needs of the PRESCHOOLER A. Development of Initiative encourages his plans and the use of his imagination limit punishment to those acts encourage the childs efforts to cooperate and let him share in the decisions and responsibilities of family living Special Needs of the PRESCHOOLER B. Security and Independence Parents must shoe love, teach, and guide him toward maturity he must learn how to express himself so that he can communicate with others on verbal level

at home, he learns to assume more responsibility and more independence Child must gain from parents the knowledge he needs to grow up with Special Needs of the PRESCHOOLER C. Guidance Limits to the childs behavior must be set and consistently maintained Suggestions, not commands, must be done in a positive manner A choice of action may be given him only when he actually may decide which of two lines of behavior he may take Adults should not make the mistake of playing for the child. He is helped to make his own activities He is allowed freely to create his own work Special Needs of the PRESCHOOLER D. Sex Information should be given in response to the childs interest in the subject but never as facts, which has no connection to the family life source of information is sincere and loving parents Parents should answer the childs questions directly and honesty Information should be given promptly, frankly and unemotionally Special Needs of the PRESCHOOLER E. Religious Development in answering questions, parents must have genuine understanding, be subjective and kind Child cannot be kept spiritually neutral The child does not follow any religious because he understand it rather; he accepts it because it is expected of him to do Special Problems of the PRESCHOOLER A. Thumb sucking Causes May have had too little sucking pleasure Maybe a sign that the child feels unloved It may be an expression of dissatisfaction in life When pressure is exerted upon him to give up an activity Special Problems of the PRESCHOOLER A. Thumb sucking Approaches observed the child and provide a happier childhood experience for him

At the time the child sucks his thumb, the parents should provide more love and security Find the basis of the problem Special Problems of the PRESCHOOLER B. Food Likes and Dislikes Approaches Preschoolers are influenced by example and expectation of parents in eating Children should not be coaxed, bribed, or forced to eat The child should be allowed sufficient time to eat distraction should be avoided The child should allowed to eat with the family Mid-morning and afternoon snacks may be given Special Problems of the PRESCHOOLER C. Enuresis (Bedwetting) Causes: lack of toilet training Too early, to severe or over training Stress Environmental factors Special Problems of the PRESCHOOLER C. Enuresis (Bedwetting) Approaches: Adults should not make an issue of bedwetting. Do not use bribes or punishment, or threaten the child Give less fluid at night Develop confidence in his ability to control urination, help the child achieve positive attitude toward enuresis Physician and parents should analyze the situation to determine the cause Special Problems of the PRESCHOOLER D. Encopresis Uncontrolled stool passages beyond the time when bowel control is expected Causes: rigid training, stress, emotional problems or pathologic conditions Special Problems of the PRESCHOOLER E. Selfishness Approaches: Adults can help the child to learn to share with others if they let him have a possession which both the adult and he recognize as his He can be allowed to decide whether to give or refuse to give his toy to another

Help the child to enjoy playing with other children Expose the child to group play since it encourages habit of sharing Special Problems of the PRESCHOOLER E. Bad Language Approaches: Adults should feel relaxed and not be worried or shocked Substitute the bad word with more difficult word In nursery school the teacher may suggest other words, use distraction or playing with others Special Problems of the PRESCHOOLER F. Hurting Others Causes: He may be jealous or frustrated His behavior results from his mental state Special Problems of the PRESCHOOLER F. Hurting Others Approaches: He may be jealous or frustrated Should not be punished by having the same injury inflicted in him Should not be forced to apologize to the child whom he hurt Must not be made feel rejected by the adult Special Problems of the PRESCHOOLER G. Masturbation Approaches: Should not be punished, help to solve the problem that is causing it. should be given ample opportunity to find another more socially acceptable pleasure outside his body Parents should answer all questions about sex Special Problems of the PRESCHOOLER H. Sleep The child should have a room or a portion of divided room of his own He needs a place to store his treasured possessions Sleep of a 3 years old is disturbed at night because of frightening dreams due to his real or imaginary daytime fears He may sleep beside the room of a brother BY 5 years he now may sleep quietly and peacefully but may still have nightmares Special Problems of the PRESCHOOLER I. Safety Measures Causes of Accidents:

Increased initiative and desire to initiate the behavior of the adult which lead the children into situations hazardous for them They may play with matches They may turn on hot water Increased freedom may result in playing around motor vehicles, or swimming Special Problems of the PRESCHOOLER I. Safety Measures Approaches: Parents should emphasize safety measures in terms they can understand Teachers in the nursery school must provide a safe environment for the preschoolers Special Problems of the PRESCHOOLER J. Health Supervision complete physical examination advise mother on safety factors appropriate immunization Dental care teeth is brushed after eating Nutrition: 1700 cal/day; 90 Kcal/kg/day PRESCHOOL MNEMONICS FOR PRESCHOOL M utilation (fear) A ssociative Play/Abandonment G uilt I nitiative C urious about sexual differences SCHOOL AGE Refers to children between the ages of 6 to 12 years This usually the first time that children are making truly independent judgments The child of school is more influenced by the attitudes of his friends SCHOOL AGE Physical Growth School age children mature slowly but steadily WEIGHT Annual average weight gain is approximately 3-5 lbs Major weight gains occur at 10-12 yrs for boys; 9-12 yrs for girls Girls are usually heavier SCHOOL AGE Physical Growth HEIGHT At 6 years, both boys and girls are about the same height Before puberty, children of both sexes have a growth spurt, girls between 10-12 yrs; and boys between 12-14 years

Girls well be taller than boys Posture becomes erect SCHOOL AGE Physical Growth NERVOUS SYSTEM Brain growth is complete Fine motor coordination becomes refined Eye reaches its final shape at this time The adult vision (20/20) level is achieved SCHOOL AGE Physical Growth LYMPHATIC SYSTEM IgG and IgA reach adult levels Lymphatic tissue continues to grow in size up until about 9 age SCHOOL AGE Physical Growth CARDIOVASCULAR SYSTEM Left ventricular of the heart enlarges so as to be strong enough to pump blood to the growing body Innocent murmurs may become apparent owing to the extra blood crossing heart valves PR = decreased to 70 to 80 bpm BP = increase to about 112/60 mmHg SCHOOL AGE Physical Growth DENTITION Deciduous teeth are lost at 5-7 years (Average 6 years) and permanent teeth erupt The average child gains 28 teeth between 612 years of age (central and lateral incisors; st nd st nd cuspids, 1 , and 2 bicuspid, 1 and 2 molars). At 12 all permanent teeth except the final molars SCHOOL AGE UPPER Central Incisor = 7-8 years Lateral Incisor = 8-9 years Cuspid = 11-12 years st 1 bicuspid = 10-11 years nd 2 bicuspid = 10-12 years st 1 molar = 6-7 years nd 2 molar = 12-13 years rd 3 molar = 17-21 years LOWER Central Incisor = 6-7years Lateral Incisor = 7-8 years Cuspid = 9-10 years st 1 bicuspid = 10-12 years

1. 2. 3. 4. 5.

2 bicuspid = 11-12 years st 1 molar = 6-7 years nd 2 molar = 11-13 years rd 3 molar = 17-21 years SCHOOL AGE Sexual Maturation Timing of this maturity varies widely, between 10 14 years of age At a set point in brain maturity, the hypothalamus transmits an enzyme to the anterior pituitary gland to begin production of gonadotropic hormones, which activates changes in the testes and ovaries SCHOOL AGE Sexual Maturation Concerns of Girls conscious of breast development breast development is usually NOT symmetric Hips become broader As part of preparation for menstruation, girls should be told that vaginal secretions will appear Some girls already menstruate (MENARCHE) SCHOOL AGE Sexual Maturation Concerns of Boys increased genital size, testicular development precedes penis growth males measures their manliness by penis size, which can make a male who develops late feel inferior Hypertrophy of breast tissue (GYNECOMASTIA) occurs often in stocky or heavy boys They have to be reassured that pubic hair growth comes first before appearance of chest hair and beard AS seminal fluid is produced, boys may begin to notice ejaculation during sleep called NOCTURNAL EMISSIONS SCHOOL AGE Prepubertal Changes (BOYS) Testes and scrotum increase in size The skin over the scrotum changes color; it becomes reddened and stippled The breasts may enlarge slightly, but this growth disappears in a few months Sparse, downy pubic hair grows at the base of the penis The penis gradually becomes wider and longer

nd

6. 7. 1. 2.

3. 4. 5.

1.

2.

1. 2. 3. 4. 1. family

The boy grows taller and his shoulders widen Axillary sweating begins SCHOOL AGE Prepubertal Changes (GIRLS) The pelvis and hips broaden The breast tissues develop and may be st tender. At 1 , the nipple is slightly elevated, at 7 - 8 years of age. The areolae become somewhat protuberant and enlarged between the ages of 9 and 11 years Axillary sweating begins The initial growth of pubic hair occurs at 814 years Vaginal secretions become milky and change from an alkaline to an acid pH, and vaginal flora change from mixed to Doderleins lactic acid-producing bacilli SCHOOL AGE Gross and Fine Motor Skills There is increased strength and physical ability, very energetic, develop greater coordination and stamina Bone growth is faster than muscular and ligament growth; susceptible to fractures; looks lanky SCHOOL AGE Language Development With rapidly expanding vocabulary Likes name-calling, word games With password/secret languages With sense of humors; giggles a lot; laughs a great deal; enjoys dirty jokes SCHOOL AGE Psychological Skills School occupies half of his waking hours a. friends/classmates more important than

b. teacher becomes parent-substitute c. school phobia difficulty coping with school demand 2. Increasing social sensitivity 3. More cooperative, with improved manners 4. Capable of good deal of responsibility 5. Modest; enjoys privacy (starting at 10 years) 6. With hero-worshipping SCHOOL AGE Cognitive Skills 5. Develops confidence 6. With concrete, logical thinking

7.

o o o o o o

o 1. 2. 3. 4. 5. 6. o o o o

Names moths and years, right and left, can tell SCHOOL AGE Morality morality develops in the school before age 9 After 9 years old, autonomous morality develops; recognizes differing points; may see gray areas SCHOOL AGE Concept on Death 6 9 years understand that death is final Believes own death can be avoided Associates death with aggression or violence Believes wishes or unrelated actions can be responsible for death SCHOOL AGE Concept on Death 9-12 years Understand that death as the inevitable end of life Begins to understand own morality, expressed as interest in afterlife or as fear of death Expresses ideas about death gathered from parents and other adults SCHOOL AGE Health Promotion Nutrition Calories = 2100-2400 cal/day Breakfast is the most important meal More likely to eat junk foods and take zerocalorie foods (soft drinks) To make the child take the needed calories: WELL PLANNED SNACKS Tends to choose own foods Display good table manners SCHOOL AGE Health Promotion Safety Concerns Safety education is essential; accept increasing responsibility for own safety Motor vehicle accidents leading causes of accidents Provide supervision during sports activities Teach on prevention of sexual abuse. Private Parts are those parts of the body covered by a bathing suit SCHOOL AGE Health Promotion Dressing This is the right age to teach children the important of caring for their own belongings

School age children have definite opinions about style or clothing, often based on the likes of their friends rather than the preference of their parents SCHOOL AGE Health Promotion Sleep and Exercise o 10-12 hours of sleep a night o This need not involve organized sports SCHOOL AGE Common Health Problem 1. Anxiety Related to Beginning School st o The biggest task of the 1 year of formal school is learning to read o Urge parents to spend some time with the child after school or in the evening, so that he or she continues to feel secure in the family SCHOOL AGE Common Health Problem 2. School Phobia o Refers to fear of attending school o Child may develop physical signs of illness a. anxiety of separation from home b. teacher factor c. particular school related activities o Parents should treat the situation matterof-factly o Requires coordination among the school, health care provider who diagnose the problem SCHOOL AGE Common Health Problem 3. Latchkey Children o Refers to school children who are without adults supervision for a part of each weekday. The term alludes to the fact that they generally carry a key so they can let themselves into their homes after school o A major concern is that these children feel lonely and have an increased tendency to have accidents, delinquent behavior and decreased school performance from lack of homework supervision SCHOOL AGE Common Health Problem 4. Stealing o 7 years of age they discover importance of money o If stealing persists beyond 9 years of age counseling may be required SCHOOL AGE MNEMONIC FOR SCHOOL AGE D eath Finality

I ndustry vs Inferiority M odesty P eers (same sex) L oss of control/Latchkey children E explanation of Procedures S tealing/School Phobia ADOLESCENCE The period between 12-18 years old which serves as a transition period between childhood and adulthood The whole period can be divided into: Early adolescence = 12 -14 years Middle adolescence = F: 13-16 yrs; M:13-17 yrs Late adolescence = F: 16-21 yrs; M: 71-21 yrs Period of storm and stress Second rapid growth period ADOLESCENCE TERMS 1. PUBESCENCE - the time span during which reproductive functions begin to mature; ends with the attainment of full maturity or reproductive capacity and characterized by: a. Full growth of the body b. full genital development c. Sexual awareness ADOLESCENCE TERMS 2. PUBERTY period of full reproductive maturity a. GIRLS before, this period was believed to be heralded by the first menses (Menarche); studies: NOT FERTILE for about 1-2 yrs after menarche b. BOYS puberty approaches at or near the first ejaculation. TRUE reproductive maturity is attained when viable sperms appear in the semen ADOLESCENCE TERMS 3. ADOLESCENCE social and behavioral maturation from the beginning of pubescence to beyond the time of reproductive maturity NOTE: Pubescence and Puberty deal with the physical/biological aspects of development of the young boy or girl ADOLESCENCE PHYSICAL GROWTH the major milestones of development in the adolescence period are the onset of puberty and cessation of body growth physiologic growth is rapid and the development of adult coordination is slow

Growth stops with closure of epiphyseal lines of long bones (F: 16-18 yrs; M: 18-21 yrs) ADOLESCENCE PHYSICAL GROWTH WEIGHT with pubertal growth spurt Females: 38 lbs mean weight gain (10-14 yrs) Males: 52 lbs mean weight gain (12-16 yrs) ADOLESCENCE PHYSICAL GROWTH HEIGHT with pubertal growth spurt Females: 20.5 cm mean height gain (10-14 yrs) 95% of mature height is achieved by the onset of menarche Males: 27.5 cm mean height gain (12-16 yrs) 95% of mature height is achieved by skeletal age of 15 yrs ADOLESCENCE PHYSICAL GROWTH BODY SYSTEMS 1. Skeletal System st 1 , gain is mostly in weight, leading to stocky, slightly obese appearance, then the tin appearance of late adolescence Skeletal system grows faster than the muscles They appear long-legged and awkward because extremities elongate first followed by trunk growth ADOLESCENCE PHYSICAL GROWTH BODY SYSTEMS 2. Cardiovascular and Respiratory System Heart and lungs increase in size more slowly than the rest of the body PR = 70 bpm RR = 20 cpm BP = 120/70 mmHg (reaches adult levels at late adolescence (Note: M > BP than F BP) due to large body mass in males ADOLESCENCE PHYSICAL GROWTH BODY SYSTEMS 3. Endocrine System Androgen stimulates sebaceous glands to extreme activity ACNE The formation of apocrine sweat glands (glands present in the axilla and genital

area) occurs shortly after puberty STRONG BODY ODOR ADOLESCENCE PHYSICAL GROWTH DENTITION nd 2 molars: 12-13 yrs (Upper); 11-13 yrs (Lower) rd 3 molar (Wisdom teeth): 17-21 yrs but may erupt as early as 14-15 yrs ADOLESCENCE PSYCOLOGICAL PATTERN A. Early Adolescence Physical body changes can result to altered self-concept FEAR OF REJECTION Early and late developers anxiety regarding FEAR OF REJECTION May have mood swings With fantasy and daydreaming Needs consistent discipline LIMIT BEHAVIOR ADOLESCENCE PSYCOLOGICAL PATTERN B. Middle Adolescence Emancipated from parents (except financially) Identification own values Finds increasing interest in heterosexual relationship; may find a mate or form love relationship With peer group a. One of the strongest motivating forces of behavior b. Clique formation (barkada) ADOLESCENCE PSYCOLOGICAL PATTERN C. Late Adolescence Physically and financially independent from parents Finds identity Finds a mate Develops morality Increasing social and moral interest; participates in society Completes physical and emotional maturity ADOLESCENCE Health Promotion A. Nutrition o Female: 2,200 calories; Male: 2,700 calories o Appetite increases with rapid growth o Increased need for CHON, Ca, Fe, Zn for sexual maturation; WATER is the most important element in the diet of ALL AGES

Sports activities increase nutritional requirements o Overeating and decreased activity OBESITY o Fat diets and false dieting ANOREXIA NERVOSA and BULIMIA ADOLESCENCE Health Promotion B. Dress and Hygiene o Capable of Self-care o Overly conscientious about appearance and personal hygiene o Money is usually spent for clothing C. Care of the Teeth o Individual with braces must extremely conscientious in tooth brushing to prevent plaque buildup on tooth surfaces ADOLESCENCE Health Promotion D. Sleep o Need an average of 8 hours sleep o Growth spurts happen during sleep CHON synthesis and release of somatotropic hormone happen when a person sleeps E. Exercise o Needed to maintain muscle tone and to provide an outlet for tension ADOLESCENCE Health Promotion F. Safety Measures o Accidents are the leading cause of death o Drugs and alcohol becomes serious problems in this stage o Suicide may also be a cause of death o Counsel against swimming alone and other risky behaviors ADOLESCENCE Common Health Problems A. Hypertension Causative factors 1. Obesity 2. Black race 3. Diet high in salt and fat 4. Family history of HPN BP should be taken routinely in children over 3 yrs of age ADOLESCENCE Common Health Problems A. Hypertension Causative factors 1. Obesity 2. Black race

Diet high in salt and fat Family history of HPN BP should be taken routinely in children over 3 yrs of age ADOLESCENCE Common Health Problems B. Poor Posture Detect difference between normal posture and the beginning of scoliosis C. Fatigue Diet, sleep patterns and activity schedules must be assessed May be a sign of boredom Anemia or other related illnesses ADOLESCENCE Common Health Problems D. Menstrual Irregularities Check ups with an OB-Gynecologist should be done if irregularities persists E. Acne Pimples A common skin disorder More common in boys than girls Peak ages: F: 14-17 years; M: 16-19 years ADOLESCENCE Common Health Problems E. Acne Pimples Caused by abnormal keratinization, obstruction of ducts and trapping of sebum Proprionibacterium acnes cause papular lesions Locations: face, neck, back, upper arms and chest ADOLESCENCE Common Health Problems E. Acne Pimples Categories: 1. Mild comedones 2. Moderate papules and pustules 3. Severe cysts Causes of flare-ups: 1. Humidity 5. Irregular sleep pattern 2. Emotional stress 3. Menstrual period 4. Greasy hair creams/make-ups ADOLESCENCE Common Health Problems E. Acne Pimples No relationship to food intake Treatment goals: a. decrease sebum production b. prevent comedone formation c. control bacterial priliferation

3. 4.

ADOLESCENCE Common Health Problems F. Substance Abuse Use of chemicals to improve mental state or induce euphoria Substance commonly abused: a. cigarettes e. amphetamines b. alcohol f. cocaine c. anabolic steroid g. hallucinogens d. marijuana h. opiates ADOLESCENCE Common Health Problems G. Suicide A deliberate self-injury with the intent to end ones life More frequent in males than females (Ratio 8:1) rd Ranks as 3 cause of mortality among adolescents Cause: LOSS OF A LOVED OBJECT ADOLESCENCE MNEMONIC FOR ADOLESCENCE P eer group/Painful love A ltered Body Image/Acne/Ambivalence I dentity R ole confusion/Rejection (fear)/Running away S - uicide MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES NEWBORN Tonic neck reflex position when supine Fisted hands Complete head lag Dolls eye movement Startles (Moro reflex) MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 1 MONTH Legs more extended Raises head slightly from prone position Watches person, follows moving object Smiles, diminishes activity when talked to MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 2 MONTHS Symmetrical position Head control up to 45 from prone position Hands no longer fisted

 Change in activity when spoken to Vocalizes (small throaty sounds) MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 3 MONTHS Moves head towards sound (90 degree) Holds rattle temporarily Alert Hand together MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 4 MONTHS Rolls over, chest up with hand support Can follow moving objects with eyes Both hands activate towards toy Takes toy in hand to mouth Moves head towards sound MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 5 MONTHS Good head control Laughs loudly Reaches for objects Turns to sound MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 6 MONTHS No head lag Chews Sits with support Rolls over Indicates likes and dislikes MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 7 MONTHS Plays with rattle Bounces Recognizes familiar faces Can sits with support and bears some weight on legs Rakes at small objects Says Mam when crying Feeds self recognizes familiar faces MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 8 MONTHS Transfers objects from hand to hand Sits without support/bounces Imitates hand movement (close open hand movement) Can transfer objects from hand to hand Says Mama, Dada MAJOR DEVELOPMENTAL TASKS

DEVELOPMENTAL MILESTONES 9 MONTHS Sits well Holds bottle when feeding index finger approach Stands holding on creeps Imitates sounds Shy with strangers, waves bye-bye MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 10 MONTHS Pulls self to stand Uses thumb and index finger to hold small objects Understands gestures Does nursery games MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 11 MONTHS Stands with support Does nursery games (peek-a-boo) Repetitive consonant sounds (mama) Two words with meaning Responds to sound of name MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 12 MONTHS Stands alone Cruises or walks holding to furniture Attempts to use a spoon Obeys commands or requests Cooperates in dressing Throws toys MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 15 MONTHS Walks alone, crawls up stairs Feeds self with spoon Builds tower of 2 cubes Jargon, four to five words Hugs parents MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 18 MONTHS Seats self in childs chair Creeps up stairs Builds tower of 3 cubes Imitates a vertical stroke Plays ball Has 10 words MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 24 MONTHS

 Runs well Can go up and down the stairs Uses a fork Combines 2 or 3 words in a sentence Toilet-trained during the day MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 2 YEARS Runs well Can go up and down the stairs Uses a fork Combines 2 or 3 words in a sentence Toilet-trained during the day MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 2 YEARS Jumps Builds tower of 6 cubes Imitates a circle Dry by night MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 3 YEARS Stands on one leg Builds tower of 10 cubes Knows sex and full name Dresses self except for buttons and tying shoes MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 3 YEARS Rides tricycle Dresses self except for buttons and tying shoes Counts to 3 or more MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 4 YEARS Walks up and downstairs alternating feet Imitates a cross Recognizes 2 or more colors Cleans oneself, combs hair and brushes teeth MAJOR DEVELOPMENTAL TASKS DEVELOPMENTAL MILESTONES 6 YEARS Can write fairly well Draws a complete person with clothes Adds and subtracts Distinguishes between left and right Dresses self completely