This is one of four courses dealing with Age Specific Criteria.  The four courses are for Children, Adolescents, Adults and Geriatrics.  It is advised that each of these be reviewed when possible.

INTRODUCTION:

Each patient is an individual. However, developmental similarities can be recognized and used to assist us in caring for these patients at a specific time in their growth and development. Growth occurs proximodistally from the center out and development refers to the acquisition of skills and abilities that take place throughout life. As we grow and mature, most of us will pass through similar growth and developmental stages.

The best way to care for patients will differ as people pass through the different growth and development stages. The way you care for an infant will differ from your care for and communication with children, teenagers adults and the geriatric population.

At each level, you will learn:

1. "Normal" and common "problems" associated with each developmental stage.

2. How to care for and communicate effectively with each stage of growth and development.

AGE GROUP DIVISION.

Although, this is a general division of age groups, it is important to recognize that this is not a specific universal division and that people may pass in and out of these developmental stages as they grow and develop.

CHILD:

There are three stages to child-hood.

Infant is defined as birth to one year of age.

Toddler / Preschooler is defined as one year to five years of age.

School age child is defined as six years to 12 years of age.

ADOLESCENT:

Adolescents are defined as Thirteen years to 19 years of age.

ADULT:

Adult is defined as 19 to 64 years of age.

GERIATRIC:

Geriatric is defined at 64 years of age to death.

CHILDHOOD

INFANT: BIRTH TO 1 YEAR OF AGE.

Infancy is the period from birth to 1 year. It is a time of very rapid unparalleled growth and development. Weight gain and growth are rapid. By age one, the infants weight will triple. The infant will progress from reflex activity through simple repetitive behaviors to imitative behaviors. The child will begin to learn problem solving through trial and error. He will learn from his environment by exploration, experimentation. He will learn to distinguish between himself and his environment.

HEALTH CARE PROFESSIONAL CONSIDERATIONS:

1. Infants are born helpless and tiny with poor eye sight and muscle control.

Weight gain and growth are more rapid at this stage then in any other.

Infants are unable to communicate with words.

Increased metabolism causes faster heart and respiratory rates than in adults. Normal heart rate 70 – 190/per minute, Normal Respiratory rate 30 – 80/min

RISKS:

Increased risk for loss of body temperature.

Increased risk for infection, as organs and body systems are not fully developed.

Increased risk for dehydration and malnutrition.

Increased risk for fall, injury and poisoning.

INTERVENTION / PREVENTION:

Increased Metabolic Rate and Increased rate for loss of body temperature requires the infant need to be clothed or maintained in a controlled environment such as a heated incubator.

Increased Metabolic Rate with Undeveloped Organ system requires frequent feedings of an appropriate formula or Mothers Milk and plenty of undisturbed sleep.

UN-developed organ systems require protection from exposure to illness and infection.

COMMUNICATION NEEDS:

Infants need appropriate stimulation in order to thrive. It is important as healthcare workers respond to these needs. By assessing each baby’s stimulation needs and to provide for them.

Communication is essential to fostering the child’s ability to interact and achieve intellectual and emotional growth and to establishing social skills. It is imperative that infants are talked to and responded to when they make sounds or try to interact with their environment.

Infants are unable to communicate with the world through verbal communication. At birth infants have poor eyesight. Therefore, it is imperative that the caregiver communicates with the infant through tactile and auditory stimulation. Frequent touching talking and singing to baby will communicate well being and safety to baby. As eyesight improves, baby will begin to recognize individual faces and facial expression. Maintaining good eye contact with the infant is also necessary for effective communication. Although baby can not verbally communicate with their caregivers, the baby will communicate through crying and facial expressions including smiles, startle or surprise and crying.

SPEECH AND LANGUAGE:

Before a child can speak, the following conditions must be met:

The child must be able to hear sounds correctly.

The child must be able to coordinate his tongue and lower mandible.

The respiratory system must be functioning properly to provide tonal quality and volume.

The palate must be intact.

Areas of the brain involved in speech manipulation must be functional.

SAFETY AND INTERVENTIONS:

Most injuries and deaths to children occur by automobile and recreational accidents, drowning, fire choking and poisoning. Due to the limited mobility, the infant has prior to six months, most injuries and deaths are limited. Precautionary measures should not be excluded. Close supervision whenever the baby is placed on a high surface and keeping small objects out of reach of all infants and children. Keep in mind, that as children grow mobility increases. Therefore, as mobility increases the potential for injury and death increase,

Consideration for the Child’s developmental stage and implemented teachings to parents, caregivers and co-workers can prevent serious injury and or death.

Always encourage Parents and Caregivers to correctly use approved safety restraint devices while riding in automobiles.

Poisonings account for 5% of all accidental deaths in children less than 5 years of age.

Muscle Coordination and control at birth is very uncontrolled. As the infant grows and strengthens, muscles and coordination of movement are improved.

As infants grow and develop, exploration of their surroundings increase from verbal and tactile stimuli from their caregivers to feeling, touching and tasting on their own.

Every thing an infant can touch he/she will put, drag or pull into their mouths

KEEP ALL MEDICINE SUPPLIES AND EQUIPMENT OUT OF BABY’S REACH!

A GOOD RULE IS THE "TOILET PAPER TUBE RULE" ANY ITEM THAT CAN FIT IN A TOILET PAPER TUBE IS A CHOKING HAZARD FOR BABY.

As infants continue to grow, they begin to wiggle, scoot and crawl. Turning your back on a baby for even a second can cause baby to fall. Head Trauma, Bone Fractures, Internal Injuries and or DEATH can occur.

NEVER LEAVE BABY UNATTENDED.

COMMUNICATION INTERVENTION:

Babies show stress and pain in several ways. Two of the most obvious are crying and regression of development. Observation of behavior is the primary assessment tool for the non-verbal infant. Observation and documentation of behavior associated with distress such as withdrawal, immobility, irritability, lethargy, continuous crying and disturbed sleep patterns. Spend some time with the primary caregiver asking appropriate questions of the caregiver to determine sleeping and eating patterns normal and abnormal behavior of the infant etc.

As babies grow and develop, they recognize their primary caregivers. Having Mom / Dad close by during examinations and procedures will help decrease anxiety for both the baby and the caregiver.

Observation of baby is paramount to their care. Remember, baby can’t tell you what is wrong so we must look and listen for signs and symptoms of distress.

SIGNS AND SYMPTOMS OF SERIOUS LIFE THREATENING DISTRESS:

Observation of baby’s nail beds for changes in color (cyanosis or pallor) are good indications of impending cardiac / respiratory distress. As infant systems become distressed, peripheral capillaries will constrict shunting blood to the brain and major organs. A decrease in heart rate and or respiratory rate indicates a baby that has been in distress for a prolonged period.

Skin pallor and Cyanosis will follow changes in nail bed appearance.

PREVENTION:

Teaching parents and caregivers to prevent injury and illness is the first line of defense for a well baby.

Teach parents and caregivers to "Child Proof" the baby’s environment. Get down to the same level of the child (adult of hands and knees) and remove all potential for danger and injury.

Use of approved electrical cover outlets, cabinet and toilet seat locks, as well as covering and or removing sharp corners, glass tables and any objects that the baby may be able to pull down on them causing injury.

Remove small items from the child’s access. Using the "Toilet paper tube rule."

Reinforce to parents, child care workers, health care professionals that baby must never be left UN-attended.

TODDLER: 1 YEAR TO 3 YEARS OF AGE

INTRODUCTION:

The Toddler years are marked by increased awareness of self and environment. Most accidental injuries and poisonings in the home occur during this developmental sage. As toddler’s coordination and strength have improved, they are now able to climb, reach higher, walk and run faster. Exploration and Curiosity of their environment combined with increased mobility puts the child at a greater risk for injury and death. This developmental stage is also known as the Preoperational Stage. This period is marked by egocentricity. The child cannot comprehend any point of view different from his own. He values people, objects, and events for the interest or usefulness they hold for him. This is also a time for magical thinking or preoccupation with dreams and fantasy. The toddler engages in parallel play at this stage. Interaction and cooperative play with other children are minimal. Playtime and fantasy are very important to the toddler, as it will help him/her to associate ideas and internalize concepts that are more complicated.

The child learns autonomy by imitating others. If he is not allowed independence or is belittled for his efforts, he will develop a sense of shame and self-doubt. Praise and acceptance for the toddlers efforts are fundamentally important at this stage.

MAJOR PHYSICAL DEVELOPMENT:

The child learns control of his bodily functions between the ages of one and three.

Toddlers learn to walk and feed self.

Cooperate with dressing self.

Attention span remains short.

Attempt to assert independence while learning constraints from parents/caregivers.

Understand right from wrong, fair, and unfair.

Favorite word is "NO."

Growth and metabolic rates remain higher. Normal heart rate 80-120/min, Normal Respiratory rates 20-40/min.

Nutrition requirements remain high for protein, calcium and vitamins.

SAFETY RISK:

Toddlers can climb and reach higher.

Increased ability to walk and run.

Choking and poisonings remain a risk.

HEALTH CARE PROFESSIONAL CONSIDERATIONS:

Secure side-rails of beds, cabinets doors, toilet bowels.

Never leave buckets of water in same room or access to child (drowning risk).

Toddler can understand simple instructions. Fantasy and Play-acting are helpful for demonstration of procedures and exams.

Toddlers recognize and depend of parents/caregivers. They may feel abandoned if parent or caregiver is not allowed to remain with toddler during exams or procedure. Allowing the parent or caregiver to remain with the toddler will decrease anxiety for both the toddler and the caregiver.

Never ever, leave a toddler unsecured alone in a room or on an exam table.

Assess child’s immunization status with parents/caregivers. All children should be immunized by age two.

COMMUNICATION:

Communication skills have improved. However, regression is common in the toddler who is experiencing stress or illness. The toddler may communicate stress, illness, discomfort and fear in a regressed manner of the previous stage of behavior such as crying, temper tantrums, throwing things, biting, hitting and general acting out. Keep in mind that hospitalization interferes with the normal development of the sense of self, and the preschooler reacts to it differently.

Protest: Screaming and crying is a normal healthy display as it is a refusal by the preschooler to surrender and attempt to hold on to his/her own reality.

Despair: Refusal of the preschooler to interact with health care providers who approach them. If the parent is present the child may cry and cling to the parent. This reaction is normally characterized by withdrawal.

Denial: During prolonged hospitalizations, the preschooler may progress to a stage of denial in which the child surrenders all hope. He/she can no longer cope with the loss of parents and denies all need for them. A child who suddenly becomes cooperative and friendly after a prolonged period of hospitalization by be signaling that a deeper psychological trauma has occurred.

HEALTH CARE PROFESSIONAL CONSIDERATIONS FOR COMMUNICATION:

Remain calm and reassuring.

Remove any obstacles toddler may use to injure himself or others.

Restrain the toddler if necessary to prevent injury to self and others.

Toddlers love to be the center of attention, do not reward the tantrum, ignoring it is best if the child is not in any danger of injury to self or others.

Establish trust with the child.

Never tell him or her that it won’t hurt if it does.

Ask toddler, parent/caregiver to participate in care.

HEALTH CARE PROFESSIONAL OBSERVATIONS:

Observe toddler for cause of stress.

Illness

Not enough sleep.

Multiple stimuli in the hospital invading the child’s environment.

 

PRESCHOOLER: AGES THREE TO FIVE.

INTRODUCTION:

This period of development is marked by the preschoolers increasing ability to engage in cooperative play with other children. He/she continues to engage in fantasy and play-acting. However, he/she will engage in this type of fantasy and play-acting cooperatively with other children. He/she has an increased understanding of rules and expectations. Inquisitive behavior and exploration of the environment outside the home and his surroundings is expanding. The preschooler will challenge parents/caregivers rules and regulations as an attempt at gaining independence. He/she will demand answers and endless explanations. Favorite word is "why".

MAJOR GROWTH AND DEVELOPMENT ACHIEVEMENTS:

Metabolic rate and growth have slowed from infancy and toddler stages. However, the preschooler continues to need higher amounts of protein vitamins, minerals, and calories than adults do.

Increased physical activity and play.

Increased development in fine motor skills. They can begin to color and draw and paint rather than scribble.

Increased ability to understand and follow rules and regulations.

Ability to understand that other people and animals have needs and feelings is increasing. However, cooperation from the preschooler emanates from the desire of the child to please his parents or caregiver.

Praise and acceptance for the preschoolers attempts and achievements are paramount to the child’s sense of well being and psychological development.

SAFETY / RISK:

Remain the same as in Toddler. It is important to remember that the toddler can reach and climb higher and they can move much faster. Therefore, it is imperative to increase the area of child proofing the child’s environment.

COMMUNICATION CONSIDERATIONS:

Child has increased ability to communicate with others and understand and follow instructions has improved.

Use of fantasy and play- acting will assist the child in understanding and cooperation during exams and procedures.

Regression is common in the preschooler during times of stress and illness.

Praise for the child’s accomplishments and cooperation will assist to decrease anxiety.

SCHOOL AGE CHILD: SIX TO TWELVE YEARS OF AGE.

INTRODUCTION:

Between the ages of six and twelve, the child’s thought processes become more logical and coherent. By age seven, he/she begins to reason intuitively and starts o understands time, size, weight and length. He / she can think and reason independently. He/she collects things and masters facts. He/she can deal with several aspects of a situation simultaneously and uses inductive reasoning to solve problems, though he still cannot think abstractly. Opinions, wants and desires are strong and more easily expressed. This developmental stage reflects a child who has become less selfish and self-centered. He can now understand viewpoints different from his own. Friends and pears have greater importance to the school age child. However, the parent/caregiver remain the predominant influence on the child’s behavior and view from right and wrong. The child enjoys projects and working with others and tends to follow rules. During this stage, competitions with others are keen, and forming social relationships takes on great importance. The child may have feelings of inferiority if unrealistic expectations (or if he feels they are unrealistic) are placed upon him. If he is able to develop a sense of accomplishment, he will feel competent t meet life’s expectations.

SAFETY / RISKS:

Increased independence from the parent/caregiver and home.

Increased activity on bikes, organized sports and team playing.

HEALTH CARE PROFESSIONAL CONSIDERATIONS:

Teach parents/caregivers to use appropriate safety equipment during sports and team activities.

Encourage parental supervision during out door play and sports activities.

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