HESI – Pediatrics Review
Growth and Development
Description: Growth and development follow an orderly yet
individual pattern. Nurses should assess growth and the
emergence of developmental skills in all pediatric clients.
Knowledge of cognitive abilities allows a nurse to adapt teaching
to the level of the child. Knowledge of appropriate toys and
interests of children at different ages enables the nurse to use
play to facilitate the child's development and minimize problems
caused by the hospitalization.
I. Infant (Birth to 1 Year)
A. Developmental milestones
1. Birth weight doubles by 6 months, triples by 12 months.
2. Birth length increases by 50 at 12 months.
3. Posterior fontanel closes by 8 weeks.
4. Social smile occurs at 2 months.
5. Head turns to locate sounds at 3 months.
6. Moro reflex disappears around 4 months.
7. Steady head control is achieved at 4 months.
8. Rolls from abdomen to back and back to abdomen at 5 to 6
months.
9. Plays peek–a–boo after 6 months.
10. Transfers objects from hand to hand at 7 months.
11. Develops stranger anxiety at 7 to 9 months.
12. Sits unsupported at 8 months.
13. Crawls at 10 months.
14. Fine pincer grasp appears at 10 to 12 months.
15. Waves bye-bye at 10 months.
16. Walks with assistance at 10 to 12 months.
,17. Says a few words in addition to "mama" or "dada" at 12
months.
18. Explores environment by motor and oral means.
B. Erickson's theory: Developing a sense of trust (trust versus
mistrust)
C. Nursing implications
1. During hospitalization, the infant's emerging skills may
disappear.
2. If the parents are not able to be with the infant the baby may
be inconsolable due to separation anxiety.
3. The nurse should plan to have the parents be part of the
infant's care and should encourage them to do so.
4. Respect the infant's schedule at home by assessing and
implementing components as possible.
5. Preparation and teaching should be directed to the family.
However, the nurse should always speak to the infant and
console the infant, especially while performing painful or
stressful procedures.
6. Toys for hospitalized infants include mobiles rattles, squeaking
toys, picture books, balls, colored blocks, and activity boxes.
II. Toddler (1 to 3 Years)
A. Developmental milestones
1. Birth weight quadruples by 30 months.
2. Achieves 50 of adult height by 2 years.
3. Growth velocity slows.
4. Appears to be bowlegged and potbellied.
5. All primary teeth (20) are present.
6. Anterior fontanel closes by 12 to 18 months.
7. Throws a ball overhand at 18 months.
8. Kicks a ball at 24 months.
, 9. Feeds self with spoon and cup at 2 years.
10. Daytime toilet training can usually be started around 2 years.
11. Two– to three–word sentences are spoken by 2 years.
12. Three– to four–word sentences are spoken by 3 years.
13. Own first and last name can be stated by 2 1/2 to 3 years.
14. Temper tantrums are common.
B. Erikson's theory: Developing a sense of autonomy (autonomy
versus doubt and shame)
C. Nursing implications
1. Give simple, brief explanations before procedures, keeping in
mind that a l-year-old does not benefit from the same explanation
as that given to a 3–year–old.
2. During hospitalization, enforced separation from parents is the
greatest threat to the toddler's psychological and emotional
integrity.
3. Security objects or favorite toys from home should be provided
for a toddler.
4. Teach parents to explain their plans to the child (e.g., "I will
be back after your nap").
5. Respect the child's routine and implement when possible.
6. Expect regression (e.g., bed–wetting).
7. Toys for the hospitalized toddler include board and mallet,
push-pull toys, toy telephones, stuffed animals, and storybooks
with pictures, depending on the reason for hospitalization.
8. Toddlers benefit from being taken to the hospital playroom
when able, because mobility is very important to their
development.
9. Toddlers are learning to name body parts and are concerned
about their bodies.
10. Very basic explanations should be given to toddlers about
procedures.
11. Autonomy should be supported by providing guided choices
when appropriate.
Growth and Development
Description: Growth and development follow an orderly yet
individual pattern. Nurses should assess growth and the
emergence of developmental skills in all pediatric clients.
Knowledge of cognitive abilities allows a nurse to adapt teaching
to the level of the child. Knowledge of appropriate toys and
interests of children at different ages enables the nurse to use
play to facilitate the child's development and minimize problems
caused by the hospitalization.
I. Infant (Birth to 1 Year)
A. Developmental milestones
1. Birth weight doubles by 6 months, triples by 12 months.
2. Birth length increases by 50 at 12 months.
3. Posterior fontanel closes by 8 weeks.
4. Social smile occurs at 2 months.
5. Head turns to locate sounds at 3 months.
6. Moro reflex disappears around 4 months.
7. Steady head control is achieved at 4 months.
8. Rolls from abdomen to back and back to abdomen at 5 to 6
months.
9. Plays peek–a–boo after 6 months.
10. Transfers objects from hand to hand at 7 months.
11. Develops stranger anxiety at 7 to 9 months.
12. Sits unsupported at 8 months.
13. Crawls at 10 months.
14. Fine pincer grasp appears at 10 to 12 months.
15. Waves bye-bye at 10 months.
16. Walks with assistance at 10 to 12 months.
,17. Says a few words in addition to "mama" or "dada" at 12
months.
18. Explores environment by motor and oral means.
B. Erickson's theory: Developing a sense of trust (trust versus
mistrust)
C. Nursing implications
1. During hospitalization, the infant's emerging skills may
disappear.
2. If the parents are not able to be with the infant the baby may
be inconsolable due to separation anxiety.
3. The nurse should plan to have the parents be part of the
infant's care and should encourage them to do so.
4. Respect the infant's schedule at home by assessing and
implementing components as possible.
5. Preparation and teaching should be directed to the family.
However, the nurse should always speak to the infant and
console the infant, especially while performing painful or
stressful procedures.
6. Toys for hospitalized infants include mobiles rattles, squeaking
toys, picture books, balls, colored blocks, and activity boxes.
II. Toddler (1 to 3 Years)
A. Developmental milestones
1. Birth weight quadruples by 30 months.
2. Achieves 50 of adult height by 2 years.
3. Growth velocity slows.
4. Appears to be bowlegged and potbellied.
5. All primary teeth (20) are present.
6. Anterior fontanel closes by 12 to 18 months.
7. Throws a ball overhand at 18 months.
8. Kicks a ball at 24 months.
, 9. Feeds self with spoon and cup at 2 years.
10. Daytime toilet training can usually be started around 2 years.
11. Two– to three–word sentences are spoken by 2 years.
12. Three– to four–word sentences are spoken by 3 years.
13. Own first and last name can be stated by 2 1/2 to 3 years.
14. Temper tantrums are common.
B. Erikson's theory: Developing a sense of autonomy (autonomy
versus doubt and shame)
C. Nursing implications
1. Give simple, brief explanations before procedures, keeping in
mind that a l-year-old does not benefit from the same explanation
as that given to a 3–year–old.
2. During hospitalization, enforced separation from parents is the
greatest threat to the toddler's psychological and emotional
integrity.
3. Security objects or favorite toys from home should be provided
for a toddler.
4. Teach parents to explain their plans to the child (e.g., "I will
be back after your nap").
5. Respect the child's routine and implement when possible.
6. Expect regression (e.g., bed–wetting).
7. Toys for the hospitalized toddler include board and mallet,
push-pull toys, toy telephones, stuffed animals, and storybooks
with pictures, depending on the reason for hospitalization.
8. Toddlers benefit from being taken to the hospital playroom
when able, because mobility is very important to their
development.
9. Toddlers are learning to name body parts and are concerned
about their bodies.
10. Very basic explanations should be given to toddlers about
procedures.
11. Autonomy should be supported by providing guided choices
when appropriate.
