Growth, development, and therapeutic approaches for young children
Assisting in pediatrics
Pediatrics is the medical specialty that deals with the development and care of children and the treatment of childhood diseases. Pediatric patients range in age from newborn to puberty. Some practices continue to see the child until they graduate from high school. Subspecialties within pediatrics include surgery, cardiology, and psychiatry.
Approximately 50% of the patients in a pediatric office are there for well-baby or well-child visits. The roles of the provider and the medical office staff are to supervise and help maintain the health of these patients. The medical assistant can help by encouraging therapeutic communication among the patient, parents, caregivers, and medical staff. The trust that a child develops in these relationships and the consideration the family receives in the provider’s office form the basis of good medical care.
Pediatric care actually starts before the child is born, with good prenatal care. The confidence and enthusiasm of the parents can have a significant impact on an infant’s physical and emotional well-being.
The developmental stages and care
Normal growth and development
The terms growth and development are often used together. They refer to the combination of changes a child goes through as they mature. Growth refers to measurable changes, such as height and weight. The first determinant of these physical characteristics is the genetics inherited from the parents; however, a child’s growth can be influenced by many factors, including nutritional status, environmental factors, and the presence of disease. Development refers to the stages of physical, cognitive, and social growth. A provider looks at how the child is progressing in motor, mental, social, and language skills. A child’s development is determined by a combination of prenatal, environmental, and caregiver factors. Each child has his or her own pattern of growth and development. Pediatric assessments are individualized for each child according to age, developmental level, health condition, family characteristics, and past experiences with healthcare professionals. National standards are used to help pinpoint irregularities in growth and development. The child’s physical, intellectual, and social levels are compared with published national standards. This comparison indicates whether the child is at the appropriate stage of growth and development for his or her chronologic age.
Growth patterns
Physical growth is one of the most visible changes in childhood. The average birth weight is 7 to pounds, and in 6 months, the baby’s birth weight doubles. Growth then slows slightly over the next 6 months and even more over the next couple of years. Between ages 2 and 3, most children slim down so that by the time the third birthday arrives, the pot bellied toddler has become the characteristic preschooler.
By age 4, the child usually has doubled their birth length. During this time, the legs are the fastest-growing part; fatty connective tissue continues to increase slowly until approximately age 7. This same growth rate continues through the school-aged period (6 to 12 years), and as this period of development ends, the child usually is into a growth spurt that indicates impending puberty.
The growth spurt continues for approximately 2 years, and the child then reaches adolescence (ages 12 to 18 years). During this period, the adolescent gains almost half of his or her adult weight, and the skeleton and organs double in size. Weight increases in girls by 20 to 25 pounds and in boys by 15 to 20 pounds. Girls grow 5 to 6 inches, and boys grow 4 to 5 inches. As the growth spurt is completed, the teenager reaches sexual maturity. In girls, sexual maturity is signaled by the onset of the menstrual cycle; in boys, it is determined by the presence of sperm in the semen. The timing of sexual maturity in both genders varies greatly.
Growth patterns
6 months birth weight doubles 1 year birth weight triples, length increased by 50% 2 years gains 6 pounds in 1 year 3 years gains 3–5 pounds in 1 year and grows 2– inches 3–6 years gains 3–5 pounds per year, grows – inches per year
Skeletal growth is complete in girls between 15 and 16 years of age and boys between ages 17 and 18. Skeletal growth is considered complete when the epiphyseal plates (growth plates) of the long bones of the extremities have completely fused.
Growth charts are used to compare the child’s individual growth pattern with national standards. The Centers for Disease Control and Prevention (CDC) has developed growth charts that track growth continuously through the age of 20. The growth charts are gender specific. Length, weight, and head circumference are tracked on the birth to 36 months growth chart. Stature and weight are tracked on the 2 to 20 years growth chart. There are also CDC growth charts used to track body mass index (BMI) in infants and young adults 2 to 20 years of age, giving providers another weapon in the fight against childhood obesity. BMI is a means of assessing the relationship between height and weight. BMI conversion charts are typically available or are calculated automatically in electronic health record (EHR) programs. The actual formula to calculate BMI is as follows:
For adults, the BMI itself is used as the screening tool. In pediatrics, the BMI needs to be plotted on the gender-specific growth chart, and the growth chart percentile is the screening tool. The CDC has developmental patterns
Developmental patterns
General patterns of child development occur rapidly during the first year of life as the infant progresses from reflex activities (e.g., grasping fingers and sucking) to learning to manipulate simple objects (e.g., pulling open drawers or throwing toys out of the crib). In addition to these motor skills, the child learns verbal patterns, progressing from cooing and crying for attention to speaking his or her first words.
By age 3, the child is showing increased autonomy . Now the child can walk, is toilet trained, sits at the table and eats with the family, makes simple sentences, understands the word no, and even imitates the parent by using gestures they have seen them use. The child’s vocabulary consists of up to 900 words.
Therapeutic approaches for infants (newborn to 12 months):
- Crying is normal; use distraction, but do not overstimulate.
- It is important to keep the infant close to the caregiver; either have the parent hold the infant or keep the parent in the child’s line of vision.
- Involve the parent as much as possible, depending on the task and the parent’s level of comfort.
- Place a familiar object near the infant and keep frightening ones out of view.
- An infant’s negative response to strangers usually develops at approximately 8 months; do not take the rejection personally.
- Do not restrain the infant any more than necessary but be ready to use restraint at times (e.g., when giving an injection) to keep the infant safe.
- Encourage the caregiver to cuddle and hug the child after the procedure is complete.
- Unpleasant procedures are associated with other objects, so do not use play areas for treatment, and do not use a favorite toy or object during the procedure; offer it afterward for comfort.
During the preschool stage, the child becomes increasingly independent and initiates activities. Preschoolers have mastered many gross motor skills and are perfecting their fine motor development. Verbal communication has increased to full, simple, and even complex sentences but remains quite literal. For example, if you tell a preschool child that you are going to fly to visit Aunt Sue, the child thinks you are going to flap your arms and fly. Nonverbal communication skills are also being mastered. The vocabulary now includes more than 2000 words. During this period, children need to develop social skills, such as sharing and taking part in peer-group activities.
Therapeutic approaches for toddlers and preschoolers (2 to 6 years):
- Toddlers and preschoolers often fear visits to the doctor; ignore temper tantrums and negative behavior.
- Praise the child as much as possible.
- Perform unpleasant procedures as quickly as possible; the fear of the procedure is worse than the actual discomfort.
- Allow the child to keep on as much clothing as possible for security and comfort.
- Use words familiar to the child, and do not use words the child could misinterpret. For example, “The test uses dye” (the child may think you mean “die”); “The doctor will put you to sleep so that it doesn’t hurt” (the family dog may have been put to sleep).
- Explain a procedure as the child would sense it—what it will look like, how it will smell, how it will feel, and so on.
- Allow the child to handle equipment when possible.
- Do not use the child’s favorite doll or stuffed animal to demonstrate; the child may believe the toy feels pain.
- Explain procedures to the parents away from the child when possible; the child may misinterpret the information.