Growth and Development Test Preparation

The goal of this recording is not to fully describe every concept, but I do hope to explain or at least identify the most commonly tested concepts and the most common areas of confusion. First, growth and development. There are two important patterns in growth and development, cephalocodal, which means from head to toe, and proximal distal, which means from the middle of your body out to the extremities. Those are two very consistent trends you will see all throughout the body, not in terms of just not only in terms of physical growth, but in the way that they develop. We develop our trunk before we develop our arms before we develop movement in our fingers. There are sequential trends. Sequential trends is an incredibly important concept to understand, and sequential trends says that within a given category there's a predictable progression of events that is to say a child may talk before they walk and a child may walk before they talk, but a child will not crawl before they walk and a child will not walk before they run. In the same way, a child will not talk in three word sentences before they talk in one word sentences. It doesn't make sense. They always move in one direction. That's a predictable thing for all children. In terms of physical changes, birth weight doubles at five months, triples at 12 months, quadruples at around two and a half years of age. Birth length should increase by 50% by about 12 months of age, and the anterior fontanel closes at around 18 months of age. Infant and toddler milestones. For infants, it's probably most helpful to memorize those that happen around 12 months of age. And slightly before, for example, in terms of language, their first word is around 10 months of age. In terms of fine motor, they start using their pincer grass, but around nine months of age, they really get good with it at around 11 months of age. Their first step is around 12 months of age. So you can see how a lot of exciting things are happening right at that transition period. Once you've figured out what a 12-month-old looks like, then if you figure out what a six-month-old looks like, you can, for the most part, fill in the blanks in between those enough to answer any test question. One thing to know is that if you do not remember a particular milestone given to you on a test, try to use sequential trends to your advantage. Think about the category of milestone as soon. Is it a gross motor milestone? Is it a fine motor milestone? Is it a language milestone? Once you've identified that, try to bring to mind milestones that you do know within that category and try to think, does this particular milestone that I forgot in the test question asking about, does it come before or after the milestones that I do know? How far before, how far after? That'll give you a good estimate as to which answer you're looking for. For the toddler milestones, most of the interesting ones happen very early on. They start walking independently in around 13 months of age. They start using expressive jargon at that time. They're moving beyond just the words and trying to use grammar, but they don't really know how to do that yet, so they just kind of use the expressions that they copy from parents. Then they'll start using actual grammar at around three years of age, toward the end of toddlerhood. Also, in the beginning of toddlerhood, they build a tower of two cubes, start using their cup and their spoon. They're not super great at anything really, but they're starting to do all the things that we're expecting a full on toddler to do. And around by 18 months of age, they look like what we expect a toddler to look like. They're running, climbing, jumping, having temper tantrums and all that. Theories of development. When it comes to theories of development, there are three important ones that we need to know. Piaget, Eric St. Freud. Your first step will be to memorize the names of each of the stages for each of these theoretical framework. For Piaget's theoretical framework, the two most important ones to study are pre-operational, concrete operational. For the most part, students do pretty well with sensory motor. Very simple. They move their bodies and they sense things. That's really the extent of their cognition. A formal operational thinker is an abstract thinker that there's similar to us. So in those, in that way, those two age groups are fairly easy to understand. But there's a transition period from pre-operational to concrete operational. That can be confusing. The important thing to understand about a pre-operational thinker is that they're trying to make sense of the world, the universe, how things work. But they're really bad at it. They're making a lot of bad logical conclusions and the classic one that you'll see in test questions and in book to describe a pre-operational thinker from a nursing standpoint is a child who believes that they cause their illness or cause your sibling's illness. You may have to assure a child that that was not the case. The fact that they kicked their sibling didn't cause their sibling to get cancer. That doesn't make any sense. In our minds, for pre-operational thinker, they may think that for a concrete operational thinker, you're going to be looking for something that is taking advantage of the fact that they can understand the world actively. But you need to spell it out for them. A diagram, a figurine, something like that. They want to know how things work. And you have to explain it very, very simply trying to avoid abstract language as much as possible. There are also a couple other concepts linked to PiJ theory that aren't really one of the stages. And those two most important ones are probably object permanence and egocentrism. Object permanence is the concept that, just because an object is not visible, it doesn't mean that it no longer exists. This is something that infants first get a sense of and they master around toddlerhood. Ego-centricism is the belief that everything in the world has something to do with them. And you can see how egocentrism is linked to pre-operational thinking. Going back to that example of a pre-operational thinker that believed that it had caused their siblings illness, that is egocentric thinking. They think that all these things in the world somehow are connected to them. Erexan's theory describes psychosocial development. So this is different from PiJ's theory, which describes cognitive development. There's not really a firm line you can draw between these two, of course, cognitive function and social function kind of go together. But when you're faced with an Erexan's theory question, you're going to be looking for something that has a social elevator. It won't only be cognitive in nature. When it comes to these different stages, the most important one that I see most often on the test is autonomy versus shame. This is a difficult life stage because we want children to have a sense of autonomy. This is the goal of the stage for them to have a sense of autonomy according to Erexan. But this is toddlers. Toddlers and autonomy versus shame group. And toddlers don't really know what is best for them. They ask for things that we should not give them. When they're about to get their vaccines, they say, "No, I don't want it," right? When we're asking them what they want for lunch or for dinner, they're going to say hamburgers, hot dogs, right? They're going to say ice cream. They're not going to always tell you, and very unlikely, they're going to tell you things that are actually good for them to eat. And so we need to do. We need to give them a sense of autonomy, giving them choices in things that we. I can't safely give them choices about. Do you want me to first look at your right hand or your left hand? Do you want me to do your blood pressure in your right arm or your left arm? Those are going to be the kind of choices that we are going to give to a child. A choice where both options are valid choices. This is very, very important to understand. One common source of confusion is autonomy as opposed to initiative as opposed to industry. So I get those words from the stages for the toddler preschooler and school age child for toddlers, autonomy versus shame for preschoolers and the school for school age child it is industry versus inferiority. Autonomy, like I just described, is the desire to make decisions for yourself. Initiative is a little different in that children want to initiate new activities. Industry is different in that they want to get good at those activities. So autonomy is choosing for themselves. Initiative is doing new things. Industry is being good at things. There's often a lot of confusion between those three healthy outcomes. When it comes to unhealthy outcomes, there's also a little bit of confusion. There's a little difference between shame and guilt. Guilt is like you've done something wrong. Shame is just feeling ashamed of an inability. And industry, if you're saying, "Freury, if inferiority is almost like a very specific type of shame in that they feel inferior compared to their peers specifically." So when you're thinking about those unhealthy outcomes and those healthy and unhealthy outcomes, I'm trying to make sure that you understand the difference between these three. The last stage of Eric's sins for children identity versus royal confusion is for the most part I'm fairly easy to understand. But when it comes to applying it, sometimes students get tripped up because they'll be faced with four different options that are good for a teenager. But only one will be relevant to Eric's. So a test question might say, "How would you apply Eric's sins theory for a teenage child?" And one of the options might be, "Have the teenager get exercised? Should 18 years get exercised?" Yes, definitely. Is this an application of Eric's sins theory? No, it is not. Freud's theory. So when it comes to Freud's theory, the most important thing is to know when the different stages begin. And the most important stages to know specifically are the oral stage and the anal stage. And for the oral stage, they get gratification through oral stimulation. So sucking, biting, chewing, something like that. For the anal stage, the most important thing, the most important way that toddlers get anal satisfaction is by successfully potty training. So it's very important that we set children up for success. And part of that is to not set yourself up for failure. There are certain situations when it's not the right time to be potty training. For example, if they are going through a very stressful time, if they're hospitalized, they're really sick. That is not the time to try party training. If you try party training during that time, you will actually cause that you may cause that child action to regress. And so in that sense, you'll see that successful party training is a huge is probably the one biggest application of Freud's theory in the annual stage. For the later stages of Freud, they're fairly predictable. There's the applications, things like giving the privacy, I understand that they'll have sexual feelings, things like that. Play. Play is very, very important in children. It's a way that they develop themselves. And in that way, you're going to see that a lot of task questions that are related to play are linked to milestones and linked to just their where they are in their growth and development. Or it may even be linked to injury prevention for that particular age group. For example, children who are beginning to walk and run around, they love playing with push and play push and pull toys. Right. It's developing a skill that they're really that they want to use. For an infant, they may just like colorful toys. Right. That's really what they want because they're in the sensory motor stage. For a preschooler, they may want to do things like dramatic play because they want to use that imagination that they now have and trying new things. Right. And that's kind of related to the initiative versus guild stage for preschoolers. And so you can see how the theoretical framework may get you to understand whether whether a particular type of play is appropriate for a particular child. Sometimes it's by milestones. If it requires them to pick up small objects, then they will need to be able to pick up small objects and they develop the pencil grasp at around nine months of age. So you can see how sometimes you can find out whether a particular type of play is appropriate to a child based on theoretical framework. Sometimes based on their fine growth, more development. The two most commonly confused types of play are associative and cooperative play. Cooperative play is play that is true cooperation. They need to work together in order to do to do the task correctly. A great example would be a board game. Right. If one person doesn't understand the rules to the board game, you can't really play the board game. Of course, you can just play with the pieces and like knock them around. But you're not actually playing the board game. So anything that requires rules and things that require cooperation is cooperative play. Associative play is going to be play that is that does involve several several children, but it doesn't require a set of rules, right? There's no one keeping score in any particular way. So playing house, playing very imaginative games would be an example of associative play. Sleep. When it comes to sleep, children sleep less and less with age as they just get older in general, especially during infancy, they'll sleep less and less. So the two most important milestones when it comes to them sleeping less and less is that they sleep through the night at the end of infancy. So kind of toward the end of the first year, they should sleep through the night. And then at the end of toddler hood, there's no more nap time. So sleeping through the night happens at the end of infancy. nap time gets eliminated kind of toward the end of toddler hood. Developmentally appropriate nursing practice. When it comes to developmentally appropriate nursing practice, the most important thing to remember is to slow down when you're reading the question. Make sure that you're reading what age the child is in the question. And I can't emphasize this enough because many students when they see their test question after they've answered it, looking backward, all of a sudden they just hit their head because they're just so confused just how they could have possibly mistaken a particular question because it'll say something like, you know, what's the best toy for a teenager? And they'll say something like a rattle or a colorful beads or something like that. And they'll think, why did I think that? And it's because they thought that the question was asking about an infant. And so even if you know everything correctly, it's not going to do you any good. If you don't slow down and read this test question, does the number one thing I can tell you about developmentally appropriate nursing practice questions? The next most important thing is to use what you know about PHA and Ericsson. Think about a sensory motor or pre-operational child, a child in those stages of thinking. They're really going to be just interested in how things feel, right? When you're trying to explain this to a child, you're not really going to be able to explain much about how things work. But for a concrete operational child, they are very curious and they definitely want to be told how things work and it'll help to get their, it'll get their cooperation in order to kind of feed their curiosity in that way. One thing that you learn in adult nursing is that you should go from least to most invasive. When it comes to children, you want to modify that a little bit. You want to go from least to most scary. So in general, you're going to want to think about not only what's least most invasive, but look at these options through a child's eyes and what is less scary? What is more scary? For example, it's less scary to talk to the parents than to talk to the child. So you talk to the parents first, then you talk to the child. It's less scary to assess the feet and to assess the head. So you assess the feet first, then you assess the head. For the most part, if you have a good intuition on, does would a child be scared by this? Then you would have a good intuition in terms of answering a lot of these types of questions. So the other part to this is when do you move on to the next more scary thing? And the the hope of this is that as you do things that are less scary, they'll trust you more and they'll be ready for you move on to the next thing. So there are a couple things that children do in order to express that they are ready to move on to other things that they're comfortable around your presence, but the most part it would be pretty easy to understand those things. They're just more comfortable. They begin playing. They start talking to the nurses. They start looking at the nurse. Now, I assume that this child was a young child. For the most part, development to the appropriate nurse practice for a teenager is the same as a doll. It's not very interesting. It's not something that I chose to put in test questions very often. Childhood injuries. It's important to understand that injuries are the most common cause of death and more of vehicle accidents are the most common cause of injury deaths. Part of the reason why children are more at risk is because anatomically, they have very large head and large organs. Cognitively, they have poor judgment and coordination. A lot of things that we can do to try to prevent childhood injuries will become fairly obvious when you think about it as long as you can slow down and think through it. Should you turn the pot handles to the front of the stove or toward the back? You should definitely turn it toward the back so that children don't pull up and grab it. Should you leave children around water unattended? No. Should you put a helmet on a child when they are running a bicycle? Yes, right? So some of these things are pretty simple to understand. Even if you've never studied it before, a lot of times you'll be able to get these questions correct. One exception would be sea safety, car sea safety. Two most important details when it comes to sea safety is that children should be in a rear-facing sea until two years of age and then a booster sea until eight years of age.