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Course: Fundamentals of Nursing�Topic: Care of a Child

The Nurses International Community

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Module Goals

Learners will be able to:

Identify the needs of the child.
Explain how the nurse can address the physiological/emotional/developmental needs of the child.

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Age Appropriate Vital Signs

Within defined limits (WDL) vital signs vary per age range.

It is important to know the different WDL vital signs per age group that you are assessing.

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“Child” Definition

RN.com, 2004

Childhood will be divided into two segments: preschool age child and school aged child.

Preschool age: 3 years to 5 years of age.

School age: 6 years to 12 years of age.

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Preschool Child Developmental Need

Initiative vs Guilt².

Increased play and social interaction with peers.
Child learning assertion, initiative, and interpersonal skills through leading others and making independent decisions.
If initiative is hindered by being overly controlled or criticized, guilt may develop.

Children may feel guilty if they make mistakes or disappoint caregivers¹.
The child seeks praise, encouragement, and rewards for actions and behaviors¹.
Behavioral regressions may occur if injury or illness occurs¹.

Avillion, 2008
McLeod, 2018

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Preschool Child Development Considerations

Avillion, 2008
RN.com, 2004

Playing with other children assists in development².

If able, allow children to play with others similar in their age.

Consider safety and environment.

This creates awareness of others and increase social awareness and cues.

May have imaginary friends¹.
Child may imitate adult behaviors and words¹.

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Growth and Development Considerations

Avillion, 2008
CDC, 2021a

Preschool aged children should grow about 2-3 inches per year and gain 4-5 pounds each year.

For steady growth, consistent calories of about 1200-1800 calories every day¹.

Recommended sleep amounts: 10-13 hours per 24 hours.

This includes nap time (Centers for Disease Control².

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Assessment Considerations

American Academy of Pediatrics, 2009

Understand WDL vital signs for age.
Limited subjective data may enhance assessment.

Vocabulary is expanded, child may answer questions.

Age appropriate developmental skills may be assessed along with physical assessments.

Movement, language, cognitive, social, emotional.

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Special Considerations for Communication

Preschool children are very curious and ask many questions¹.
Be responsive to questions and answer honestly¹.
Preschoolers are literal in thinking¹.

Avoid hypotheticals and abstract thoughts.

Limited attention span¹.
Imaginations are vast².

Explain any procedures or interventions and then assess for their understanding and give further clarification and support if necessary.
May perceive threats from imagination so assurance may be necessary.

Avillion, 2008
RN.com, 2004

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Special Considerations for Care

Beneficial for caregivers to stay with child.

May reduce fear.
Increased confidence in child.
Interpretation of child’s behavior and communication.

If caregivers leave, or if child has to be separated from them, explain to child when they may return².

Visual cues may be of assistance.

Comfort measures for child¹:

Routine and structure.

Similar to at home routines if possible.
Familiar objects and people if able.

Avillion, 2008
RN.com, 2004

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Critical Thinking Question

A caregiver brings a 3 year old into the clinic and mentions during the visit that they are not potty trained yet. The caregiver states that they are not sure how to approach potty training the child. What can the nurse suggest that the parent can incorporate into their potty training endeavor?

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School Age Child Developmental Need

Identity versus Inferiority¹.

Main source of self-esteem is peer group.

May try to gain approval from peers and yearned to be valued by their peers and environment.

Develops pride in their accomplishments.
If encouraged, child feels industrious (competent) and have increased confidence in reaching their goals.
If restricted by parent or teacher, child may feel inferior and have doubt in themselves.

Child wants to be a master of a skill or a problem leading to increased confidence and competence².

McLeod, 2018
RN.com, 2004

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School Aged Child Development Considerations

Learns well through participating in games and activities, while receiving rewards and praises.
Mature process of understanding. Ability to elaborate on what they understand or do not comprehend.

This will direct your education and approach to interactions with the child.

Logic and reasoning are beginning to form beyond concrete and literal thinking.
Enhanced understanding of both past and future
Understands concepts of time
Questioning authority and potential rebellion may occur at this age

Testing boundaries and authority figures

RN.com, 2004

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Growth and Development Considerations

Growth spurts are common¹.
Nutritional assessments (both access to food and nutritional needs) are completed¹.
Education about a healthy diet and nutritional needs should be given¹.
Ensure proper growth is occurring¹.
Encourage activities and active play².

Movement is important to maintain health.
Aim for 1 hour of physical activity a day, at minimum.

RN.com, 2004
CDC, 2021b

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Assessment Considerations

Understanding WDL vital signs for specific age.
Ask questions during the assessment.

Ability to answer questions, provide feedback, and describe any discomfort or pains.

Attempt to use the least invasive approach first.
Respect need for privacy during assessment.
Common fear may be bodily harm or death.

Early childhood understanding of death: separation from parents, more make-believe concept.
Later childhood understanding of death: permanent separation.

RN.com, 2004

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What would the nurse say?

A parent expresses concern that their 10 year old son is upset because he feels excluded from a friend group. How should the nurse respond?

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Cultural Considerations

In some cultures, caregivers may not be able to stay with the client at the hospital.
In some cultures, caregivers may not take part in the care while in the hospital.
Potty training may differ in varying cultures. The following are examples:

Kenya: Infants are assessed for visual cues that they are about to urinate or defecate. The infants are then seated in a position on the mother’s lap that mimics sitting on the toilet. The mother makes a “shhhh” sound while the child is urinating, and the infant is rewarded for urinating to that sound by the age of 4-5 months. No noises were made for defecation, but a reward was made for pooping.

Howard, 2017

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Cultural Considerations

Potty training may differ in varying cultures. The following are examples:

Vietnam: Similarly to the mothers in Kenya, the Vietnamese mothers looked for visual cues as the child was a newborn to know when urination or defecation was occurring. From times when they are very young, the child is held over the toilet during these cues and the mother makes a whistling sound. When the infant reaches approximately 9 months, it is expected for the child to toilet at a planned time when being held over a toilet on the sound of a whistling sound from the caregiver.

Howard, 2017

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Cultural Considerations

Potty training continued :

Iran: A variety of techniques are utilized. Mainly two approaches are done: an intensive approach where the child is put on the toilet at regular intervals when the parents want to initiate training, while the other is a child-oriented approach where the parent initiates toilet training when the child gives cues that they are ready such as interest in the potty or walking. The average age that the child is potty trained in Iran is around 24-27 months. The intensive approach generally begins around 12 months old, and the use of diapers are not utilized anymore at this time.

Howard, 2017

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Cultural Considerations

Potty training continued :

United Kingdom: Training varies in the United Kingdom for potty training. The National Health Service in the United Kingdom recommends utilizing potty training pants, commonly referred to as “pull-ups” when children are being potty trained, bridging the gap between diapers and complete training on the toilet.

Howard, 2017

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Reference:

American Academy of Pediatrics. (2009, November 2). Developmental milestones: 3 to 4 year olds. Healthychildren.org. https://www.healthychildren.org/English/ages-stages/preschool/Pages/Developmental-Milestones-3-to-4-Year-Olds.aspx

Avillion, A. (2008). Evidence-based age-specific care: Training handbook for nurses and clinical care staff. HCPro. Retrieved on 25th of September, 2021 from https://hcmarketplace.com/media/browse/6587_browse.pdf

Centers of Disease Control and Prevention. (2021a, February 22). Preschoolers (3-5). Child Development. https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/preschoolers.html

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Reference:

Centers of Disease Control and Prevention. (2021b, February 22). Middle childhood (6-8 years). Child Development. https://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/middle.htm

Howard, J. (2017, November 8). How the world potty trains. CNN Health. https://www.cnn.com/2017/10/31/health/potty-training-parenting-without-borders-explainer/index.html

McLeod, S. (2018, May 3). Erik erikson’s stages of psychosocial development. Simply Psychology. https://www.simplypsychology.org/Erik-Erikson.html

RN.com. (2004, October 1). Age-specific considerations in patient care. RN.com. https://lms.rn.com/getpdf.php/587.pdf

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