Pediatric Nursing Notes: Day 1 1

Chapter 1: Introduction to Child Health and Pediatric Nursing

Definitions of Health
o Past definition
Absence of disease
Measured by monitoring mortality and morbidity
o Current definition
Shift in focus
Disease prevention
Health promotion
Wellness
World Health Organization Definition of Health
o A state of complete physical, mental, and social well-being, and not merely the absence of disease or
infirmity.
History of Child Health and Child Health Care
o Past centuries
Children were viewed as commodities
Their role was to increase population and help with workload
o Public schools were established
Court viewed children as minors
Child health care received more attention
o End of 19th century
Better understanding of source of illness
Milk pasteurization
Compulsory vaccination programs
o 19th and 20th centuries
Urban public health improvements
New knowledge of nutrition, sanitation, bacteriology, pharmacology, and psychology
o End of 20th century
Technological advances significantly affected health care
Trends led to increased survival rates in children
Significant increase in chronic vs. acute illness as cause of
hospitalization and mortality
Focus of National and International Organizations to Protect Child Rights
o Violence and abuse
o Child labor and soldiering
o Juvenile justice
o Child immigrants and orphaned children
o Abandoned or homeless children
Milestones in Federal Programs in Support of Childrens Health
Evolution of Pediatric Nursing
o 1870: First pediatric professorship awarded to Abraham Jacobi
o Early 1900s: Henry Street Settlement House established by Lillian
Wald
o 1902: Lina Rogers appointed as first full-time school nurse
o 1960s: Nurse practitioner role developed
o 1970s: Federal government cost-control systems in place
o 1980s: Maternalchild health standards developed by ANA
Measurement of Childrens Health Status
o 1979 U.S. Surgeon Generals Report, Healthy People
Provided agenda that identified most significant
preventable threats to health
o Healthy People 2020: The Road Ahead
Pediatric Nursing Notes: Day 1 2

Comprehensive health promotion and disease prevention agenda working to improve quantity and
quality of life for Americans
Goals of Healthy People 2020
o Eliminate preventable disease, disability, and injury and premature death
o Achieve health equity
o Eliminate disparities and improve the health of all groups
o Create physical and social environments that promote good health
o Promote healthy development and behaviors across every stage of life
Mortality vs. Morbidity
o Mortality
Number of individuals who have died over a specific period
Presented in rates per 100,000 population
o Morbidity
Measure of prevalence of a specific illness in a population at a particular time
Presented in rates per 1,000 population
Infant and Neonatal Mortality from 1940 to 2007
Causes of Hospitalization in Children, 2005-2006





Philosophy of Pediatric Nursing
o Focusing on the family
Providing family-centered care
o Providing atraumatic therapeutic care
Minimizing physical and psychological stress for children
o Using evidence-based practices
Using research findings to establish a plan of care
Characteristics of Pediatric Care
o Continuous
o Comprehensive
o Coordinated
o Family centered
o Compassionate
Pediatric Nursing Notes: Day 1 3

Roles of the Pediatric Nurse
o Providing direct nursing care to children and their families
o Being an advocate, educator, and manager
o Serving as a collaborator, care coordinator, and consultant
Role of the Nurse in Relationship to Morbidity and Mortality in Children
o Education
Usual causes of deaths
Types of childhood illnesses
Symptoms requiring health care
o Goal
Raise awareness of and provide guidance and counseling to prevent unnecessary deaths/illnesses in
children
Five Steps of the Nursing Process
o Assessment
o Nursing diagnosis
o Planning and expected outcomes
o Implementation
o Evaluation
National Association of Pediatric Nurse Practitioners, Society
of Pediatric Nurses, American Nurses Association Scope and
Standards of Nursing Practice
Ethical Principles
o Autonomy
o Beneficence
o Nonmaleficence
o Justice
o Veracity
o Fidelity
Balancing Ethical Components for Families of Different
Cultures and Religions
o Identify the problem
o Gather information about the problem
o Weigh risks against benefits
o Choose solution
o Implement solution
o Evaluate outcome of situation
Nurses Responsibility Related to Informed Consent
o Determine whether parent or legal guardian understands what they are signing by asking pertinent questions
o Ensure the consent form is completed with signatures for parents or legal guardians
o Serve as a witness to the signature process
Key Elements of Informed Consent
Special Considerations Related to Informed Consent (Table 1.3)
HIPAA Regulations/Maintaining Confidentiality With Electronic Records
o Always maintain security of personal log-in information
o Always log off when leaving computer
o Do not leave childs information visible on computer
o Use safeguards when using alternate communication

Pediatric Nursing Notes: Day 1 4



Chapter 2: Factors Influencing Child Health
Genetic Influences on Child Health
o Gender
o Race
o Temperament
o Genetically linked diseases
Effect of Race and Temperament on Child Health
o Race
Membership in particular group of humans who have biological traits transmitted by descent
Skin color, bone structure, blood type
o Temperament
Manner in which a child interacts with the environment
Easy, difficult, slow to warm up
Temperament Theory: 9 Parameters of Temperament
o Activity level
o Rhythmicity
o Approach and withdrawal
o Adaptability
o Threshold of responsiveness
o Intensity of reaction
o Quality of mood
o Distractibility
o Attention span and persistence
Lifestyle Influences on Child Health
o Patterns of eating
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o Exercise
o Use of tobacco
o Drugs
o Alcohol
o Methods of coping with stress
Biological Influences on Health
o Genetics
o In utero exposure to teratogens
o Postpartum illness
o Exposure to hazardous substances
o Maturation
Protective Factors Promoting Resiliency
o Internal
Having ability to take control and be proactive
Having responsibility for own decisions
Understanding and accepting own limits and
abilities
Being goal directed and knowing when to continue
or stop
o External
Having caring relationships
Having a positive learning environment and
positive influences in the community
Barriers to Health Care
o Financial
o Ethnic
o Sociocultural
o Health care delivery system
Family
o Considered a basic social unit
o Defined by U.S. Census Bureau as a group of two or
more persons related by birth, marriage, or adoption
and living together
o Many believe it should be defined as whatever the child
or family says it is
o Traditional nuclear family is no longer considered the
dominant family structure
Summary of Major Theories Related to Family
Types of Family Structures
Special Family Situations
o Divorced family
o Single-parent family
o Blended family
o Adopted family
o Foster care family
Typical Parental Roles
o Nurturer
o Provider
o Decision maker
o Financial manager
o Problem solver
o Health manager
o Gatekeeper
Pediatric Nursing Notes: Day 1 6

Four Major Parenting Styles
o Authoritarian
o Authoritative
o Permissive
o Rejecting-neglecting
Discipline Strategies
o Maintain a positive, supportive, nurturing caregiverchild relationship.
o Use positive reinforcement to increase desirable behaviors.
o Remove positive reinforcements.
o Use punishment to reduce or eliminate undesirable behaviors.
Components of Cultural Competence
Beliefs of Practices of Selected Cultural Groups

Distinguishing Factors of Ethnic Groups

o Customs
o Characteristics
o Language
o Family structures
o Food preferences
o Moral codes
o Health care practices


Elements of a Childs Community
o Affects many aspects of a childs health, development, and general welfare
o Consists of the family, school, neighborhood, youth organizations, and other peer groups
Social Capital
o Refers to the bonds between individuals that assist communities to achieve a variety of goals, including child
health care
o Requires norms of reciprocity, mutual assistance, and trust (Putnam & Feldstein, 2003)
o It is a mechanism by which the resources of a community can be mobilized by and from the people, not for
them (Looman & Lindeke, 2005)
o Common interests and relationships propel neighborhoods and communities toward engagement
Types of Violence Affecting Child Health
o School violence (bullying)
o Domestic violence
o Suicide
o Violent crimes
Major Components of Society Influencing Child Health
o Social roles
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o Socioeconomic status
o The media
o Expanding global nature of society
UNICEF Identified Major Problems for Global Child Health
o Malnutrition, including micronutrient deficiency
o HIV/AIDS
o Acute respiratory infections, such as pneumonia
o Diarrhea related to lack of clean water and sanitation
o Vaccine-preventable diseases such as measles
o Malaria
o Poor health care of pregnant and nursing mothers
Chapter 3: Growth and Development of the Newborn and Infant
Developmental Changes in the Newborn and Infant
o Growth
Increase in physical size
Average newborn weights 7lbs 8oz at birth and lose up to 10% of body weight in first 5 days which
then regains to their birth weight by 10 to 14 days .
Most infant double their birth weight by 4 to 6 months of age and triple birth weight by 1 year.
Average newborn is 19-21 inches at birth, during first 6 months length increases by 1 inch per month
then by about half inch per month in the second 6 months.
o Development
Sequential process by which infants and children gain various skills and functions
o Maturation
Increase in functionality of various body systems or developmental skills
Assessing Newborns and Infants for Developmental Milestones
o The nurse may ask the parent if the skill is present or the infant may demonstrate the skill during the
interview.
o The nurse may elicit the skill from the infant.
o Screening tools may be used to assess development.
Denver II Developmental Screening Test
Prescreening Developmental Questionnaire (PDQ II)
Ages and Stages Questionnaire (ASQ)
Infant Toddler Checklist for Language and Communication
Infant Development Inventory
Assessing Growth and Development of a Premature Infant
o Use the infants adjusted age to determine expected outcomes.
o Subtract the number of weeks that the infant was premature from the infants chronological age.
o Plot growth parameters and assess developmental milestones based on adjusted age.
Pediatric Nursing Notes: Day 1 8

Average Measurements of Infants at Birth and 6 and 12 Months


Infant Organ System Maturation
o Neurologic system
o Cardiovascular system- Heart doubles in size in 1
st
year of life. Pulse decreases to about 100 and BP increases
to about 100/50
o Respiratory system- slows from 30-60 breaths in newborn to about 20-30 breaths in 12 month old- doesnt
develop to maturity of adult until 7 years of age.
o Gastrointestinal (digestive) system- Teeth normally erupt between ages of 6-8 months (Deciduous) 12 month
old normally has 4-8 teeth
o Renal system
o Hematopoietic system
o Immunologic system
o Integumentary system
Newborn States of Consciousness
o Deep sleep: infant lies quietly without movement.
o Light sleep: infant may move a little while sleeping and startle to noises.
o Drowsiness: eyes may close; the infant may be dozing.
o Quiet alert state: infants eyes are open wide and body is calm.
o Active alert state: infants face and body move actively.
o Crying: infant cries; body moves in disorganized fashion.
Newborn Primitive Reflexes
o Moro- with sudden extension of the head, the arms abduct and move upward and the hands form a C
Disappears at 4 months
o Root- When infants cheek is stroked the infant turns to that side, searching with mouth- Disappears at 3
months
o Suck- Reflexive sucking when nipple or finger is placed in infants mouth-disappears at 2-5 months
o Asymmetric tonic neck- while lying supine extremities are extended on the side of the body to which the head
is turned and opposite extremities are flexed (fencing position) disappears at 4 months
o Plantar and palmar grasp- grasp when palm is touched- disappears 4-6 months (Palmar) 9 months(plantar)
o Step- with one foot on flat surface the infant puts the other foot down as to step-disappears at 4-8 weeks
o Babinski- Disappears around 1 year stroking along the lateral aspect of the sole an across the plantar surface
results in fanning and hyperextension of the toes (Should disappear when child starts walking)
Respiratory System of the Infant vs. Adult
o The nasal passages are narrower.
o The trachea and chest wall are more compliant.
Pediatric Nursing Notes: Day 1 9

o The bronchi and bronchioles are shorter and narrower.
o The larynx is more funnel shaped.
o The tongue is larger.
o There are significantly fewer alveoli.
Maturation of the Cardiovascular System of
the Infant in the First Year of Life
o The heart doubles in size.
o The average pulse rate decreases from
120 to 140 in the newborn to about
100 in the 1-year-old.
o Blood pressure steadily increases,
from an average of 60/40 in the newborn to 100/50 in the 12-
month-old.

o The peripheral capillaries are closer to the surface of
the skin, making the newborn and young infant more susceptible to
heat loss.
o Thermoregulation becomes more effective.
Immunologic System of the Infant
o Newborns receive large amounts of immunoglobulin
G (IgG) through the placenta from their mothers.
This confers immunity during the first 3 to 6
months of life for antigens to which the mother was previously exposed.
Infants then synthesize their own IgG, reaching approximately 40% of adult levels at age 12 months.
o Immunoglobulin M (IgM) is produced in significant amounts after birth, reaching adult levels by 9 months of
age.
o Immunoglobulin A (IgA), immunoglobulin D (IgD), and immunoglobulin E (IgE) production increases very
gradually, maturing in early childhood.
Developmental Theories
Jean Piagets Theory of Cognitive Development
o Sensorimotor stage: birth to 2 years
o Four stages
Reflexes
Primary circular reaction
Secondary circular reaction
Coordination of secondary schemes
Development of Gross Motor Skills in Infancy

Pediatric Nursing Notes: Day 1 10

Development of Gross and Fine Motor Skills in Infants





Warning Signs Indicating Problems with Sensory Development
o Young infant does not respond to loud noises.
o Child does not focus on a near object.
o Infant does not start to make sounds or babble by 4 months of
age.
o Infant does not turn to locate sound at age 4 months.
o Infant crosses eyes most of the time at age 6 months.
Warning Signs Indicating Problems with Language Development
o Infant does not make sounds at 4 months of age.
o Infant does not laugh or squeal by 6 months of age.
o Infant does not babble by 8 months of age; infant does not use single words with meaning at 12 months of
age (mama, dada).
Social and Emotional Development of the Infant
o Stranger anxiety
Indicates infant recognizes self as separate from others
o Separation anxiety
Infant becomes distressed when parent leaves
o Temperament
Ranges from low to moderately active, regular, and predictable, to
highly active, more intense, and less adaptable

Exceptions to Recommended Breastfeeding
o Infants with galactosemia
o Maternal use of illicit drugs and a few prescription medications
o Maternal untreated active tuberculosis
o Maternal HIV infection in developed countries
Benefits of Breastfeeding
Common Developmental Concerns in Infancy
o Colic
o Spitting up
o Thumb sucking, pacifiers, security items
o Teething



Chapter 4: Growth and Development of the Toddler
Physical Growth of the Toddler
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o Height and weight increase steadily in spurts at a slower rate than the infant.
Generally reach half adult height by age 2
Average weight gain is 3 to 5 lbs per year.
Height increases an average of 3 inches per year.
o Fontanels close by 18 months.
o Head size more proportional to body by age 3
Organ System Maturation
o Neurologic system
Brain reaches about 90% of size by age 2.
o Respiratory system
Alveoli increase in number until age 7; trachea and airways small compared to adult
o Cardiovascular system
Heart rate decreases; blood pressure increases.
o Gastrointestinal system
Stomach increases in size; small intestine grows in length; stool passage decreases.
o Genitourinary system
Bladder and kidney reach adult function by 16 to 24 months; bladder capacity increases; urethra
remains short.
o Musculoskeletal system
Bones increase in length; muscle matures; swayback and pot belly appear due to weak muscles until 3
years old.
Developmental Theories








Motor Skill Development (Toddler)
o Gross motor skills
Include running, climbing, jumping, pushing or pulling a toy, throwing a ball, and pedaling a tricycle
o Fine motor skills
Progress from holding and pinching to the ability to manage utensils, hold a crayon, string a bead,
and use a computer
Speech Development
o Receptive language development: the ability to
understand what is being said or asked
Typically far more advanced than expressive
language development (ability to
communicate desires and feelings)
o Common occurrences
Echolalia: repetition of words and phrases
without understanding
Telegraphic speech: speech that contains only
the essential words to get the point across
Emotional and Social Development of the Toddler
o Focus
Separation
Seeing oneself as separate from the
parent
o Individuation
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Forming a sense of self and learning to
control ones environment leads to
emotional lability.
o Egocentrism
Focus on self
Typical Behaviors of the Toddler
o May rely on a security item
o Becomes aware of gender differences
o May display aggressive behaviors
o May show fear of loss of parents and of strangers
o Becomes more self-aware; does not have clear
body boundaries
Separation anxiety may reoccur.
May resist invasive procedures
Age-Appropriate Developmental Tasks for the Hospitalized Toddler
Promoting Growth and Development of the Toddler Through Play
o Play is the major socializing medium for toddlers.
o Toddlers need 30 minutes of structured physical activity and 1 to 3 hours of unstructured physical activity per
day.
o Parents should limit television and encourage creative and physical play instead.
o Toddlers engage in parallel play (playing alongside another child) instead of cooperative play.
o Toddlers are egocentric and do not like to share.
o The short attention span of toddlers will make them change toys frequently.
o Toddlers do not need expensive toys.
Promoting Safety for the Toddler
o Provide a childproof environment.
o Use a safe car seat in back of car.
o Provide a safe home environment.
Avoid exposure to tobacco smoke.
Prevent injury.
Prevent poisoning.
Sleep Requirements for the Toddler
o 18-month-old: 13.5 hours of sleep per day
o 24-month-old: 13 hours of sleep per day
o 3-year-old: 12 hours of sleep per day
o A typical toddler should sleep through the night and take one daytime nap.
o Most children discontinue daytime napping at around 3 years of age.
Toddler Safety During Mealtime
Key Nutrients Provided by Fruits and Vegetables
Promoting Self-Feeding in Toddlers
o Use a child-sized spoon and fork with dull tines.
o Seat the toddler in a high chair or at a comfortable height in a secure chair
o Never leave the toddler unattended while eating.
o Minimize distractions during mealtime.
Common Developmental Concerns of the Toddler
o Toilet teaching
o Negativism
o Temper tantrums
o Thumb sucking and pacifiers
o Sibling rivalry
o Aggression
Signs a Toddler is Ready for Toilet Teaching
o Regular bowel movement
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o Expresses knowledge of need to defecate or urinate
o The diaper is not always wet.
o The toddler is willing to follow instructions.
o The toddler walks well alone and can pull down pants.
o The toddler follows caregiver to bathroom.
o The toddler climbs onto potty chair or toilet.
Teaching Strategies to Minimize Issues with Sibling Rivalry
o Attempt to keep the toddlers routine as close to normal as possible.
o Spend individual time with the toddler on a daily basis.
o Involve the toddler in the care of the baby.
Focus of Discipline for the Toddler
o Limit setting
o Negotiation
o Techniques to assist the toddler to learn problem solving
Guidelines for Choosing a Preschool for a Toddler
o Parents agree with goals and an overall philosophy.
o Teachers and assistants are trained in early childhood development as well as CPR.
o Classes are small with an appropriate adult-to-child ratio.
o Disciplinary procedures are consistent with the parents values.
o Parents are able to visit at any time.
o School is childproofed inside and out.
o Appropriate hygiene procedures are in place.
Chapter 5: Growth and Development of the Preschooler
Physical Growth Developments of the Preschooler
o Average growth of 2.5 to 3 inches per year
o Average weight gain around 5 pounds per year
o Loss of baby fat and growth of muscle
o Length of skull increases slightly; lower jaw more pronounced; upper jaw widens
Motor Skill Development



Maturation of the Organ System (Preschooler)
o Myelination of the spinal cord allows for bowel and bladder control to be complete; small intestine grows in
length.
o Respiratory structures continue to grow in size; number of alveoli increase.
o Eustachian tubes remain short and straight.
o Heart rate decreases; blood pressure
increases slightly; innocent heart
murmur may be heard.
o 20 deciduous teeth should be present.
o Urethra remains short in children,
making them susceptible to urinary tract
infections.
o Bones increase in length and muscles
strengthen and mature.
Psychosocial Development of the Preschooler
o In Eriksons stage of development:
Initiative vs. Guilt
Pediatric Nursing Notes: Day 1 14

Preschooler is an inquisitive and enthusiastic learner.
Feels sense of accomplishment by succeeding in activities
Feeling pride in accomplishment stimulates initiative
Overextending self can result in sense of guilt
o Superego (conscious development) is completed and is basis for
moral development.
Social Skills Developed by the Preschooler
o Cooperation
o Sharing (of things and feelings)
o Kindness
o Generosity
o Affection display
o Conversation
o Expression of feelings
o Helping others
o Making friends
Emotional and Social Development of the Preschooler
o Friendships
Preschoolers learn how to make and keep a friend.
Temperament
Indicator of parents expectation of childs behavior
Determines childs task orientation, social flexibility, and
reactivity
o Fears
Preschoolers exhibit variety of fears
Parents should acknowledge childs fears.
Cognitive Development of the Preschooler
o Magical thinking
Believes thoughts are all-powerful
o Imaginary friend
Creative way to sample activities and behaviors and practice conversation skills
o Transduction
Extrapolates from one situation to another
o Animism
Attributes life-like qualities to inanimate objects
Communication Skills in the Preschool Child



Sample Nursing Diagnoses for Issues Related to Growth
and Development
o Delayed growth and development
o Imbalanced nutrition, less than body
requirements
o Interrupted family processes
o Readiness for enhanced parenting
o Risk for caregiver role strain
o Risk for delayed development
o Risk for disproportionate growth
o Risk for injury
Issues Involved in Promoting Growth and Development
of the Preschooler
Pediatric Nursing Notes: Day 1 15

o Building self-esteem
o Maintaining routine and ritual
o Setting limits and remaining consistent with them
o Knowing signs of developmental delay
Signs of Developmental Delay
Focus of Nursing Care Plan to Promote Growth and Development of Preschooler
o Promoting growth through play
o Promoting early learning
o Promoting language development
o Choosing a preschool/starting kindergarten
o Promoting safety
o Promoting nutrition
o Promoting healthy sleep and rest
o Promoting appropriate discipline
Daily Nutritional Requirements of the Preschooler
o 500 to 800 mg calcium
o 10 mg iron
o 19 mg fiber
o Fat intake no less than 20% and no more than 30% daily calories
o Saturated fats less than 10%
o Diet high in nutrient-rich foods
o Limited amounts of poor, high-calorie foods
Risks of Overweight and Obesity
o Hypertension
o Hyperlipidemia
o Insulin resistance
Developmental Issues for Preschoolers
o Lying
o Sex education
o Masturbation
Focus of Health Care Visits Throughout Childhood
o Expected growth and development
o Anticipatory guidance
o Preparation for school entry



Chapter 6: Growth and Development of the School-Age Child
Physiologic Growth of the School-Age Child
o Grow an average of 2 inches per year
o Increase in height by at least 1 foot
o Increase weight by 4 to 6 pounds
o Secondary sexual characteristics appear.
Organ System Maturation (School-Age Child)
o Neurologic system: brain and skull grow very slowly; shape of head is longer; growth of facial bones changes
facial proportions.
o Respiratory system: continues to mature with development of lungs and alveoli; respiratory rates increase;
respirations diaphragmatic in nature
o Cardiovascular system: blood pressure increases and pulse rate decreases.
Pediatric Nursing Notes: Day 1 16

o Immune system: matures to adult level around 10 years old; fewer infections experienced
o Gastrointestinal system: deciduous teeth replaced by permanent teeth; fewer gastrointestinal upsets; stomach
capacity increases; caloric needs are lower.
o Genitourinary system: bladder capacity increases (age in years + 2 ounces); prepubescence occurs.
o Musculoskeletal system: greater coordination and strength; muscle still immature and can easily be injured
Piagets Stage of Cognitive Development of Concrete Operational Thoughts (7-11 Years)
o Assimilates and coordinates information about the world from different dimensions
o Sees things from another persons point of view
o Thinks through an action, anticipates consequences and the possibility of having to rethink the action
o Stores memories of past experiences to evaluate present situations
o Divides things into different sets and identifies relationships to each other
o Understands the principle of conservation: matter does not change when its form changes
Developmental Theories
Benefits of Physical Activity for the School-Age Child
o Cardiovascular fitness
o Weight control
o Emotional tension release
o Development of leadership and following skills
Language and Communication Skills (School-Age Child)
o Vocabulary expands to 8,000 to 14,000 words.
o Culturally specific words are used.
o Reading efficiency improves language skills.
o More complex grammatical forms are used.
o Development of metalinguistic awareness
occurs.
o Metaphors are beginning to be understood.
Emotional and Social Developmental Issues (School-
Age Child)
o Temperament
o Self-esteem development
o Body image
o School-age fears
o Peer relationships
o Teacher and school influences
o Family influences
Social Activities Such as Rehearsing for a Play Promote
Development of the School-Age Child
Development of Fine Motor Skills (School-Age Child)
o Hand usage improves.
o Eyehand coordination and balance improve.
o Can write, print words, sew, or build models
o Takes pride in activities requiring dexterity and fine motor skills, such as playing musical instruments
Sensory Development of the School-Age Child
o All senses are mature.
o Typical child has 20/20 vision acuity.
o Ocular muscular control, peripheral vision, and color discrimination are developed by age 7.
Vision Problems Frequently Identified in School-Age Children
o Amblyopia (lazy eye)
Causes
Cross-eyed
Nearsightedness
Farsightedness
Astigmatism
Pediatric Nursing Notes: Day 1 17

o Uncorrected refractive errors or other eye defects
o Malalignment of the eyes (strabismus)
Cultural Influences on Growth and Development (School-Age Child)
o Habits
o Beliefs
o Language
o Values
Safety Issues for the School-Age Child
o Car safety
o Pedestrian safety
o Bicycle and sport safety
o Fire safety
o Water safety
o Abuse in children
Dietary Questions
Nutritional Needs of the Average-Weight (20 to 35 kg) School-Age Child
o 70 calories per kilogram daily (1,400 to 2,100 calories/day)
o 1,800 to 2,100 mL of water per day
o 28 grams protein
o 800 mg calcium
Promoting Appropriate Discipline (School-Age Child)
o Children learn the natural and logical consequences of
discipline.
o Parents should teach children rules established by the family,
values, and social rules of conduct.
o Discipline should focus on the development of the child.
o Parents should discipline with praise.
Factors Determining Type and Amount of Discipline
o Developmental level of both the child and the parents
o Severity of the misbehavior
o Established rules of the family
o Temperament of the child
o Response of the child to rewards
Developmental Concerns (School-Age Child)
o Television and video games
o School phobia
o Latchkey children
o Stealing, lying, cheating
o Bullying
Promoting Sleep and Rest (School-Age Child)
o 12 hours of sleep required
o Should have bedtime expectations and wake-up times
o Night terrors and sleepwalking may occur but should resolve
by age 8 to 10 years

Chapter 7: Growth and Development of the Adolescent
Physiologic Growth and Development (Adolescent)
o Rapid growth occurs with dramatic changes in body size and proportions second only to growth in infancy.
o Sexual characteristics and reproductive maturity occur.
o Puberty begins in girls around 9 to 10 years old and in boys around 10 to 11 years old.
o Adolescents represent varying levels of identity formation.
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Physiologic Changes of Adolescence
Physiologic Changes in Adolescence
o Secretion of estrogen in girls and testosterone in boys
stimulates physical sexual changes.
o Physical development, hormonal changes, and sexual
maturation occur during puberty.
o Peak height velocity occurs at about 12 years of age in girls
and 14 years of age in boys.
o Muscle mass increases in boys and fat deposits increase in
girls.
Organ System Maturation (Adolescent)
o Neurologic system: growth of myelin sheath enables faster
neural processing.
o Respiratory system: increase in diameter and length of the
lungs; respiratory volume and vital capacity increase.
o Cardiovascular system: size and strength of heart increases;
systolic blood pressure and heart rate increase.
o Gastrointestinal system: full set of permanent
teeth; liver, spleen, kidneys, and digestive tract
enlarge.
o Musculoskeletal system: ossification of skeletal
system is incomplete until late adolescence in
boys and occurs earlier in girls; shoulder,
chest, and hip breadth increase.
o Integumentary system: skin is thick and tough;
sebaceous glands are more active; sweat
glands function at adult level.
Use of Computers Has Increased Adolescents Fine
Motor Skills
Developmental Theories





Ways to Improve Communication with
Teens
Influence of Peers During Adolescence
o Play essential role in identity
of the adolescent
o Provide opportunities to learn
negotiation of differences
o Provide recreation,
companionship, and someone
to share problems with
o Teach peer loyalty
o Create stability in times of
stress or transition
Pediatric Nursing Notes: Day 1 19

o Serve as credible sources of information and social reinforcement
o Can have positive or negative influences on each other
Safety Concerns for Adolescents
o Unintentional injuries
o Motor vehicle safety
o Firearm safety
o Water safety
Factors Influencing the Adolescents Diet
Information Included in Nutritional Assessment for and Adolescent
o Evaluation of foods from the different food groups that the adolescent eats each day
o The number of times that fast foods, snacks, and other junk food are eaten per week
This assessment will help the nurse to guide the adolescent in making better food choices at home and
in fast-food establishments.
Risks of Being Involved in an Unhealthy Romantic Relationship
o Dating violence
o Risky sexual activity (STIs)
o Premature pregnancy
Areas of Focus to Encourage Growth and Development in the
Adolescent
o Sports and physical fitness
o Learning and participation in school activities
o Safety issues
o Proper nutrition and healthy eating habits
o Healthy sleep and rest
o Personal care
o Healthy sexual life
o Appropriate discipline
Promoting Proper Hygiene for Adolescents
o Encourage frequent bathing and deodorant use.
o Encourage washing face two to three times a day.
o Discourage squeezing acne lesions and vigorous scrubbing of face.
o Encourage frequent shampooing of hair.
o Teach care for body piercings and tattoos.
o Discourage suntanning.
Caring for the Hospitalized Adolescent
o Provide opportunities for adolescent to maintain independence.
o Allow adolescent to participate in decisions.
o Encourage socialization with friends through phone, e-mail, and visits when possible.
Developmental Concerns for the Adolescent
o Violence
o Suicide
o Homicide
o Substance use
Factors Contributing to Adolescent Violence
Risk Factors for Suicide in Adolescents
Common Substances Abused by Children and Adolescents
o Alcohol and prescribed medications
o Hallucinogens, sedatives, analgesics
o Anxiolytics
o Steroids
o Inhalants (inhaling fumes of common household products)
o Stimulants, opiates
o Various club drugs such as ecstasy, GHB, and LSD
Pediatric Nursing Notes: Day 1 20

Topics for Discussion to Discourage Substance Abuse
o Short- and long-term effects of alcohol, tobacco, and
drugs on health
o Risk factors and implications for unintentional injuries
and sexual activity
o The how and why of chemical dependency
o Impact of substance abuse on society
o Importance of maintaining a healthy lifestyle
o Importance of resisting peer pressure to use drugs and
alcohol
o Importance of having confidence in teens own
judgment