Pedia
Pedia
• Definition of Terms
• Respiratory effort
A. Growth: increase in size of a structure. Human • Muscle tone
growth is orderly and predictable, but not even;
it follows a cyclical pattern. • Reflex irritability
B. Development: maturation of physiologic and • Skin color
psychosocial systems to more complex state. 1 minute initial adaptation to extrauterine life
C. Cephalocaudal: head-to-toe progression of 5 minutes overall status
growth and development
APGAR SCORING
GENERAL PRINCIPLES INTERPRETATION
• Chest – Normal
• Genitalia • APD = TD
• Extremities • Slight sternal retractions evident during
inspiration
HEAD – Abnormal
• Asymmetry of the chest
• Eyes
• Depressed sternum
– Normal
• Color gray GENITALIA
• Labia and clitoris usually edematous – Loses 5 to 10% and regain within 10 days
• Urethral meatus behind clitoris – Gain of 28g /day 1 6 months
st
BEHAVIORAL ASSESSMENT
• Period of Reactivity
– 30 minutes after birth
– Awake and active
– VS are increased
– Mother infant bonding breastfeeding
• Resting Period
– 2 to 4 hours
– VS returning to baseline
DEVELOPMENTAL THEORIES 5. Identity vs role confusion
a. 12 - 20 years
Psychosexual model (Freud) b. Significant relations: peer groups, role models
1. Oral c. Psychosocial virtues: fidelity, loyalty
a. 0-18 months d. Maladaptations & malignancies:
b. Pleasure and gratification through mouth fanaticism -- repudiation
c. Behaviors: dependency, eating, crying, biting 6. Intimacy vs isolation
d. Distinguishes between self and mother a. 20 - 25 years
e. Develops body image, aggressive drives b. Significant relations: partners, friends
2. Anal c. Psychosocial virtues: love
a. 18 months - 3 years d. Maladaptations & malignancies:
b. Pleasure through elimination or retention of feces promiscuity -- exclusivity
c. Behaviors: control of holding on or letting go 7. Generativity vs stagnation
d. Develops concept of power, punishment, ambivalence, a. 25 - 45 years
concern with cleanliness or being dirty b. Significant relations: household, workmates
3. Phallic/Oedipal c. Psychosocial virtues: care
a. 3 - 6 years d. Maladaptations & malignancies:
b. Pleasure through genitals overextension -- rejectivity
c. Behaviors: touching of genitals, erotic attachment to 8. Integrity vs despair
parent of opposite sex a. 45 years to end of life
d. Develops fear of punishment by parent of same sex, b. Significant relations: mankind or “my kind”
guilt, sexual identity c. Psychosocial virtues: wisdom
4. Latency d. Maladaptations & malignancies:
a. 6 - 12 years presumption -- despair
b. Energy used to gain new skills in social relationships
and knowledge Interpersonal Model (Sullivan)
c. Behaviors: sense of industry and mastery 1. Infancy
d. Learns control over aggressive, destructive impulses a. 0 - 18 months
e Acquires friends b. Others will satisfy needs
5. Genital 2. Childhood
a. 12 - 20 years a. 18 months - 6 years
b. Sexual pleasure through genitals b. Learn to delay need gratification
c. Behaviors: becomes independent of parents, 3. Juvenile
responsible for self a. 6 - 9 years
d. Develops sexual identity, ability to love and work b. Learn to relate to peers
4. Preadolescence
Psychosocial Model (Erikson) a. 9-12 years
1. Trust vs mistrust b. Learn to relate to friends of same sex
a. 0 - 18 months 5. Early adolescence
b. Significant relations: mother a. 12-14 years
c. Psychosocial virtues: hope, faith b. Learn independence and how to relate to opposite sex
d. Maladaptations & malignancies: 6. Late adolescence
sensory distortion- withdrawal a. 14-21 years
2. Autonomy vs shame and doubt b. Develop intimate relationship with person of opposite
a. 18 months - 3 years s ex
b. Significant relations: parents
c. Psychosocial virtues: will, determination Cognitive Theory (Piaget)
d. Maladaptations & malignancies: A. 0 - 2 years: sensorimotor
impulsivity -- compulsion -reflexes, repetition of acts
3. Initiative vs guilt B. 2 - 4 years: preoperational
a. 3 - 5 years -no cause and effect reasoning; egocentrism; use
b. Significant relations: family of symbols; magical thinking
c. Psychosocial virtues: purpose, courage C. 4 - 7 years: intuitive
d. Maladaptations & malignancies: -beginning of causation
ruthlessness -- inhibition D. 7 - 11 years: concrete operations
4. Industry vs inferiority - uses memory to learn
a. 6 - 12 years - aware of reversibility
b. Significant relations: neighborhood and school E. 11 - 15 years: formal operations
c. Psychosocial virtues: competence -reality, abstract thought
d. Maladaptations & malignancies: -can deal with the past, present and future
narrow virtuosity -- inertia
KOHLBERG’S STAGES OF NEONATAL REFLEXES
MORAL DEVELOPMENT
• Stage 3
• Stimulus: stroking the corner of the mouth,upper or
lower lip
Age : 7-10
• Description:
• Response:moving the tongue, mouth and head
towards the site of stimulus
– "Good boy/girl" • Onset: birth
– Orientation to interpersonal relations of mutuality • Suppression: 4 mos
– A child follows rules because of a need to be a
good person in own eyes and in the eyes of others
• Reflex: palmar grasp
• Stage 4
• Stimulus: pressure or touch on the palm, stretch of
Age : 10-12
finger flexors
• Description:
• Response:flexion of fingers
– Law and Order
• Onset: birth
– Maintenance of social order, fixed rules and • Suppression: 4-6 mos
authority
– Child follows rules of authority figures as well as NEONATAL REFLEXES
parents to keep the system working
POSTCONVENTIONAL LEVEL (level 3) • Reflex: Plantar grasp
– child follows standards of society for the good of • Suppression: 12-18 mos
all people
• Stage 6 • Reflex: Automatic neonatal walking
Age :older than 12 • Stimulus: contact of the sole in vertical position tilting
• Descriptions: the body forward and from side to side
– Principled Conscience • Response: automatic alternating steps
– universal ethical principle orientation • Onset: birth
– child follows internalized standards of conduct • Suppression: 3-4 mos
REFLEXES 2) respirations: 32 - 60 and irregular; neonates are
• Blinking or corneal reflex
abdominal breathers, obligate nose breathers
3) blood pressure: 75/49 mm Hg
• Pupillary reflex e. Motor development
• Doll’s eye fixation develops
1) behavior is reflex controlled
2) flexed extremities
• Sneeze reflex f. Sensory development
• Sucking reflex
1) hearing and touch well developed at birth
2) sight not fully developed until 6 years
• Gag reflex a) differentiates light and dark at birth
• Rooting reflex 3 to 4 months
b) rapidly develops clarity of vision within 1 foot
c) fixates on moving objects
• Extrusion reflex 4 months d) strabismus due to lack of binocular vision
• Cough reflex 2. 1 - 4 months
• Babinski reflex a. Head growth: posterior fontanel closes
• Moro reflex 3 to 4 months
b. Motor development
1) reflexes begin to fade (e.g., Moro, tonic neck)
• Dance or step reflex 3 to 4 weeks 2) gains head control; balances head in sitting
position
NEONATAL SENSES 3) rolls from back to side
4) begins voluntary hand-to-mouth activity
• HEARING: c. Sensory development
– able to hear in the utero 1) begins to be able to coordinate stimuli from
various sense organs
– within hrs after birth, hearing in NB becomes 2) hearing: locates sounds by turning head and
acute visually searching
• VISION: 3) vision: follows objects 180°
3. 5 - 6 months Fears
a. Begins to imitate 1. Separation from parents
b. Can find partially hidden objects a. Searches for parents with eyes.
b. Shows preference for parents.
c. Develops stranger anxiety around 6 months 5. Able to feed self.
(peaks at 8 months). 6. Negativism may interfere with eating.
2. Pain 7. Initial dental examination at 3 years.
•
C - urious
•
I – ron supplement (4 to 6 months), immunization
H – ighly imaginative
•
•
N – o choking hazard
O – bserve for initiative VS guilt
•
•
F – ear of stranger peaks at 8 months
O – ff limits to the kitchen (risk for poisoning and burn)
•
•
A – llow to use a pacifier if NPO
L – oss of body part is a common fear
• N – ote the weight changes
•
PRESCHOOL
T – rust V.S. mistrust
•
•
M - u ti l a ti o n
S – olitary play
• A – associate play, abandonment
•
TODDLER (1 to 3yr)
•
G - uilt
•
T – alk to the child at simple terms
I – nitiative, imaginary playmate, imagination
•
•
O – ffer choices to the child to provide some control
C – urious “Y”
• D – on’t leave alone near the bathtub or swimming
pool SCHOOL AGE ( 6 to 12 yr)
• O – ff limits to vehicles
• P – ush-pull toys (mobile), parallel play (forget
• L – oss of control is a common fear
sharing)
• I – nvolve parents
• D – eath (bogeyman), honesty funerals and burials
• S – eparation anxiety
• I – ndustry VS inferiority (collections)
COMMON ACCIDENTS
• P – eers (own sex)
P – revent further absorption
O – ff, shower or wash off
• L – oss of control hospitalization, encourage
decision making
I - dentify
S - upport • E - xplaination of procedures
O – ngoing safety education
N – otify local poison control center ADOLESCENT (12 to 18 yr)
• R – gression is common
different
•
•
I – dentity – image college or career
E – xplain procedures
•
•
R – ole diffusion
S – ame age group for room assignment
• S – eparation from peers