0133427269 Module25 Development LectureOutline

Module 25: Development I. The Concept of Development Normal development Growth refers to physical change, increase in size Development increase in complexity of function, skill progression, capacity and skill of a person to adapt to the environment Continuous, orderly, sequential processes influenced by maturational, environmental, genetic factors All humans follow same pattern of growth and development Sequence of each stage predictable Learning helps or hinders maturational process, depending on what is learned Each developmental stage has own characteristics Growth and development occur in a cephalocaudal direction Growth and development occur in proximodistal direction Development proceeds from simple to complex Development becomes increasingly differentiated Certain stages of growth and development more critical than others Pace of growth and development is uneven See Table 25–1 STAGES OF GROWTH AND DEVELOPMENT, p. 1649 Theories of Growth and Development Psychosocial theories Freud Unconscious mind Id Ego Defense mechanisms Adaptive mechanisms Superego Libido Must meet needs of each developmental stage to move successfully to next becomes fixated at that stage See Table 25–2 FREUD’S FIVE STAGES OF DEVELOPMENT, p. 1650 Erikson Life is a sequence of developmental stages or levels of achievement Positive and negative aspects of critical life periods Environment highly influential See Table 25–3 ERIKSON’S EIGHT STAGES OF DEVELOPMENT, p. 1651 Havighurst Developmental tasks to be learned at each stage of growth and development Provide framework broad See Table 25–4 HAVIGHURST’S AGE PERIODS AND DEVELOPMENTAL TASKS, p. 1652 Peck Physical capabilities, functions decrease with old age, mental and social capacities tend to increase in latter part of life Three developmental tasks in old age Ego differentiation versus work-role preoccupation Body transcendence versus body preoccupation Ego transcendence versus ego preoccupation Gould Transformation central theme during adulthood Stages Stage 1 (ages 16–18 part of family rather than individuals; want to separate from parents Stage 2 (ages 18–22) have established autonomy, feel it is in jeopardy Stage 3 (ages 22–28) individuals feel established as adults, autonomous from families Stage 4 (ages 29–34) marriage, careers well established Stage 5 (ages 35–43) period of self-reflection Stage 6 (ages 43–50) personalities seen as set; time accepted as finite Stage 7 (ages 50–60) period of transformation realization of mortality, concern for health Continuity theory Successful aging involves maintaining or continuing previous values, habits, preferences, family ties, and all other linkages Piaget’s Theory of Cognitive Development Cognitive development manner in which people learn to think, reason, use language Orderly, sequential process in which variety of new experiences must exist before intellectual abilities can develop Person develops through each of phases Each phase has person use three primary abilities Assimilation process through which humans encounter, react to new situations by using mechanisms they already possess Accommodation process of change where cognitive processes mature sufficiently to allow person to solve problems that were unsolvable before Adaptation ability to handle the demands made by the environment See Table 25–5 PIAGET’S PHASES OF COGNITIVE DEVELOPMENT, p. 1654 Behaviorism Learning take place when individual’s reaction is either positively or negatively reinforced Skinner Social learning theory Social learning theory Children learn attitudes, beliefs, customs, and values through their social contacts with adults and other children Bandura Children can choose how they act Self-efficacy expectation that someone can produce a desired outcome See EVIDENCE-BASED PRACTICE: Self-Efficacy, p. 1655 Temperament theory Chess and Thomas Child as individual who influences, is influenced by the environment Parameters of response to daily events Personality characteristics displayed during infancy often consistent with those seen in later life See Box 25–1 PATTERNS OF TEMPERAMENT-CHESS AND THOMAS, p. 1655 Resiliency theory Resilience ability to function with healthy responses, even when experiencing stress Protective factors provide strength, assistance in dealing with crises Risk factors promote, contribute to challenges Confronted with crisis Adjustment phase disorganization, unsuccessful attempts at meeting crisis Adaptation phase child, family meet challenge, use resources to deal with crisis Ecological theory Nature genetic or hereditary capability of individual Nurture effects of environment on person’s performance Emphasizes presence of mutual interactions between child and close, remote settings Five systems Microsystem daily, consistent close relationships—home, childcare, school, friends, neighbors Mesosystem relationships of microsystems with one another Exosystem settings that influence child even though child not in close daily contact with system—parents’ jobs Macrosystem includes beliefs, values, behaviors expressed in child’s environment Chronosystem perspective of time to previous settings Moral theories Involves learning what one should and should not do Moral means relating to right and wrong Morality refers to requirements necessary for people to live together in society Moral behavior way person perceives, responds to those requirements Moral development pattern of change in moral behavior with age Kohlberg 3 levels, 6 stages Premoral or preconventional children responsive to cultural rules, labels of good, bad, right, wrong Conventional concerned about maintaining expectations of family, group, nation; sees this as right Postconventional, autonomous, principled people make an effort to define valid values, principles, without regard to outside authority, expectations of others See Table 25–6 KOHLBERG’S STAGES OF MORAL DEVELOPMENT, p. 1658 Gilligan Reported women often consider the dilemmas Kohlberg used in his research to be irrelevant Moral development proceeds through three levels, two transitions Stage 1: Caring for oneself Stage 2: Caring for others Stage 3: Caring for self and others Women often see morality in integrity of relationships, caring; moral problems they encounter are different from those of men Both viewpoints blend Spiritual theories Fowler Development of faith as force that gives meaning to life Faith is relational phenomenon Interactive process between individual and his/her environment Westerhoff Faith as way of being, behaving that evolves from an experienced faith to an owned faith that is internalized and serves as directive for personal action See Table 25–7 WESTERHOFF’S FOUR STAGES OF FAITH, p. 1659 Genetic considerations Temperament Sex chromosomes Autosomal chromosomes Carry messages that encode for characteristics, diseases Family history may be present Growth and Development Through the Life Span See Figure 25–5 BODY PROPORTIONS AT VARIOUS AGES, p. 159 Infant (birth to 1 year) Physical growth and development Rapid change Weight doubles by 5 months, triples by end of first year Height increases by approximately 1 foot Teeth erupt by about 6 months Body organs, systems maturing Milestones (see Table 25–8 GROWTH AND DEVELOPMENT MILESTONES DURING INFANCY, p. 1660) Cognitive development Brain continues to increase in complexity Psychosocial development Play primarily solitary play Cognitive ability reflected in manipulation of blocks to create different sound Manipulative behavior looks at toys, touches, puts in mouth See Table 25–9 PSYCHOSOCIAL DEVELOPMENT DURING INFANCY, p. 1661 Personality and temperament Differences in responses to environment believed to be inborn characteristics of temperament Nursing assessment identifies personality characteristics of infant that nurse can share with parents Communication Express comfort by soft sounds, cuddling, eye contact Nonverbal methods Nurses assess communication to identify abnormalities, developmental delays Denver II Developmental Test Receptive speech Expressive speech Toddler (1 to 3 years) Physical growth and development Rate of growth slows during second year of life Gross motor activity develops rapidly Milestones (see Table 25–10 GROWTH AND DEVELOPMENT MILESTONES DURING TODDLERHOOD, p. 1662) Cognitive development Moves from sensorimotor to preoperational stage Early language Rudimentary problem solving Psychosocial development Motor skills changing Play parallel play Physical skills push, pull objects, climb in and out, up, down Enables toddler to manipulate objects, learn about qualities See Table 25–11 PSYCHOSOCIAL DEVELOPMENT DURING TODDLERHOOD, p. 1663 Personality and temperament May demonstrate some changes Increasing independence Communication Capacity for language skill development greatest during toddler period Receptive speech far outpaces expressive speech 3-year-old has vocabulary of almost 1,000 words Expressive jargon Tantrums Parents promote communication speaking frequently naming objects, expressing feelings Preschool child (3 to 6 years) Physical growth and development Growth is steady, slow Physical skills continue to develop Runs Holds a bat Throws balls of various types Writing ability increases Preschooler enjoys drawing, learning Begin to brush teeth Milestones See Table 25–12 GROWTH AND DEVELOPMENT MILESTONES DURING THE PRESCHOOL YEARS, p. 1664 Cognitive development Preoperational thought symbols, words used to represent objects See Table 25–13 CHARACTERISTICS OF THOUGHT IDENTIFIED BY PIAGET, p. 1665 Psychosocial development More independent in establishing relationships Interacts closely with children and adults Plans and carries out activities Play Interacts with others during play Associative play Large motor activities Fine motor activities Dramatic play See Table 25–14 PSYCHOSOCIAL DEVELOPMENT DURING PRESCHOOL YEARS, p. 1666 Personality and temperament Characteristics observed in infancy tend to persist May need assistance as characteristics expressed in new situations Encourage parents to see their children as individuals who may not all learn in the same way Communication Vocabulary increases to more than 2,000 words Complete sentences of several words Sophisticated speech grasp of meaning usually literal “Dye” might be interpreted as “die” Concrete visual aids enhance teaching by meeting child’s developmental needs Allow time for child to integrate explanations Verbalize frequently to the child Use drawings, stories to explain care Use accurate names for bodily functions Allow choices Good time to introduce concepts related to problem solving, conflict resolution School-age child (6 to 12 years) Physical growth and development Boys and girls close in size, body proportions Fat gives way to muscle Rapid increases in size Nutritional needs increase dramatically Loss of deciduous teeth 22–26 permanent teeth by age 12 Milestones (see Table 25–15 GROWTH AND DEVELOPMENT MILESTONES DURING THE SCHOOL-AGE YEARS, p. 1667) Cognitive development Concrete operational thought at about 7 years Learns concept of conservation Understands that healing will occur Psychosocial development Play Understands everyone on team has a role Cooperates Eager to learn rules Cooperative play Increasing desire to spend time with friends Separation from playmates (e.g., hospitalization) can lead to feelings of sadness See Table 25–16 PSYCHOSOCIAL DEVELOPMENT DURING THE SCHOOL-AGE YEARS, p. 1667 Personality and temperament Enduring aspects of temperament continue Child classified as “difficult” may have difficulty in classroom Quiet setting, reward child for concentration Communication Learns how to correct lingering pronunciation, grammatical errors Communication strategies Provide concrete examples of pictures, materials to accompany verbal descriptions Assess knowledge before planning instruction Allow child to select rewards following procedures Teach techniques such as counting, visualization to manage difficult situations Include child in discussions and history with parent Sexuality Need information about bodily changes Interested in sexual issues Friends, media common sources of erroneous ideas Appropriate, inappropriate touch Encourage child to go to more than one person if episode of inappropriate touch Adolescent (12 to 18 years) Physical growth and development Puberty Growth spurt Secondary sex characteristics Stronger, more muscular Male, female patterns of fat distribution Sweating, distinct odor to perspiration Body organs fully mature adult doses of medications Milestones (see Table 25–17 GROWTH AND DEVELOPMENT MILESTONE DURING ADOLESCENCE, p. 1669) Cognitive development Formal operational thought Develops ability to reason abstractly Thinks, acts independently rebels against parental authority Psychosocial development Activities Drive, ride buses, bike independently Participation in sports, extracurricular activities Hanging out Peers important Same-sex interactions predominate boy–girl relationships more common than earlier Personality and temperament Characteristics manifested in childhood remain stable Inform parents of different personality types, help support teen’s uniqueness Communication All parts of speech used, understood Increasingly leaves home base, establishes close ties with peers Has need to leave past, be different Breaks rules Privacy to be ensured during taking of health history, interventions Should be given opportunity to ask questions alone Given choice about parental presence Teen rooms in hospitals Peer support Freedom of choice for bathing, clothes, treatments Guidelines Provide written and verbal explanations Direct history and explanations to teen alone, then include parent Allow for safe exploration of topics by suggesting that the teen is similar to other teens Arrange meetings for discussions with other teens Sexuality Maturation of body, increased secretion of hormones sexual maturity Growing interactions with members of opposite sex Needs information about body, emerging sexuality Clear information about sexuality Alternatives, support for decisions Sexual minority groups Provide information Open communication, active listening Adults Young adults 18–25, peak of physical development Psychosocial stressors choices about education, occupation, relationships, independence, lifestyles Physical assessment Height, weight, BP, vision History Substance use Sexual activity, concerns Exercise Eating habits Menstrual history, patterns Coping mechanisms Familial chronic illness, family changes See Table 25–18 PHYSICAL STATUS AND CHANGES IN THE YOUNG ADULT YEARS, p. 1670 Middle adults 40–65 similar physical status, function of young adult Physical assessment All body systems Monitoring for risks, onset of cancer symptoms History Food intake Exercise habits Substance abuse Sexual concerns Changes in reproductive system Coping mechanisms Family history of chronic illnesses See Table 25–19, PHYSICAL CHANGES IN THE MIDDLE ADULT YEARS, p. 1671 Older adults Further divided Young-old (65–74) Middle-old (75–84) Old-old (85+) Physical assessment All body systems History Dietary patterns Elimination Exercise and rest Use of alcohol, nicotine, over-the-counter (OTC) medications, prescriptions Sexual concerns Financial concerns Support systems See Table 25–20, PHYSICAL CHANGES IN THE OLDER ADULT YEARS, p. 1673 See MULTISYSTEM EFFECTS OF AGING, p. 1672 Alterations from normal Developmental disabilities cluster of conditions that occur as a result of impairment in physical function, language development, behavioral patterns, or learning ability Nurses must be knowledgeable about normal development in order to recognize development delays Alterations and manifestations Certain alterations have a single manifestation, but the alteration can stem from may etiologies Other alterations manifest in an array of signs and symptoms The exemplars explore four common developmental disabilities: ADHD, autism spectrum disorders, cerebral palsy, and failure to thrive Prevalence Approximately 1 in 6 children in the U.S. is impaired by one or more developmental disability or delay 9.5% of children have ADHD 1 in 88 children is diagnosed with autism spectrum disorder 1 in 303 8-year-olds has cerebral palsy 5 - 10% of children in primary care settings are diagnosed with failure to thrive Genetic considerations and nonmodifiable risk factors Some developmental delays are due to genetic abnormalities Chromosomal disorders caused by an array of factors In all cases, early identification and intervention help clients achieve highest possible functioning See CONCEPTS RELATED TO DEVELOPMENT, p. 1674 See ALTERATIONS AND THERAPIES: Development, p. 1675 Case Study: Part 1 Ms. Lacy Galleret, 30 years old, arrives at the nurse practitioner’s office with her 5-month-old daughter Annabelle…, p. 1676 Prevention Modifiable risk factors Prenatal considerations Nutrition and general state of health Use of prescription and OTC drugs Maternal illness Maternal depression or distress Environmental factors Family characteristics Adequate nutrition Living conditions Socioeconomic status Climate Community Screenings Well-child visits Developmental assessments are done in clinical, home, school, and community settings Assessment Nursing assessment Use information on developmental milestones to assess children Compare expected findings with assessment results Lifespan and cultural considerations Culture influences development in many ways All cultures have rules regarding social interaction Genetic traits are common in certain ethnic or cultural groups Diagnostic tests Laboratory tests generally not used Observational tools, questionnaires, and screening tests are used Case Study: Part 2 When Annabelle Galleret is 9 months old, her mother brings her to the clinic for a wellness exam…, p. 1678 Interventions and therapies Independent Safety is highest priority educate families and caregivers about creating a safe home environment Facilitate connections for clients and families with support groups and community resources Collaborative Team members may include physical therapists, occupational therapists, speech and language therapists, psychologists, psychiatrists, social workers, nutritionists Pharmacologic therapy Available for some disorders such as ADHD and CP Review: The Concept of Development Relate: Link the Concepts Ready: Go to Companion Skills Manual Refer: Go to Nursing Student Resources Reflect: Case Study: Part 3 Exemplar 25.1 Attention-Deficit/Hyperactivity Disorder Overview Attention-deficit disorder (ADD) developmentally inappropriate behaviors involving inattention Attention-deficit/hyperactivity disorder (ADHD) hyperactivity, impulsivity accompany inattention Not strictly childhood condition Pathophysiology and etiology Etiology May result from several mechanisms involving interaction of genetic, biologic, and environmental factors Risk factors Genetic factors are implicated in development of ADHD Occurs commonly within families Prenatal exposures No single gene located at this time Family stress, poverty, and poor nutrition contribute Clinical manifestations Decreased attention span Impulsiveness And/or increased motor activity See CLINICAL MANIFESTATIONS AND THERAPIES: ADHD, p. 1681 Collaboration Diagnostic tests History Family history Birth history Growth and developmental milestones Behaviors Sleep, eating patterns Progression, behaviors in school Social, environmental conditions Reports from parents, teachers See Table 25–21 SCREENING TESTS FOR ADHD, p. 1683 Specific diagnostic criteria Desired outcomes Frequently diagnosed after beginning school Interfering with daily functioning of teachers or parents See Box 25–2 DSM-5 DIAGNOSTIC CRITERIA FOR ATTENTION-DEFICIT/HYPERACTIVETYDISORDER, p. 1682 Pharmacologic therapy Moderate to severe treated with pharmacotherapy See MEDICATIONS: ADHD p. 1683 Nonpharmacologic therapy Environmental supports Decreasing stimulation Orderly environment Behavior therapy Reward child for desired behaviors Applying consequences for undesirable behaviors Nursing process Assessment Family and birth history Developmental testing Observe child Diagnosis Impaired Verbal Communication Impaired Social Interaction Chronic Low Self-Esteem Risk for Injury Risk for Caregiver Role Strain Planning Prevention discouraging regular television for young children from 1 to 3 years Hospitalized child Administering medications Manage environment Implementing behavioral management plan Emotional support Promoting self-esteem Ensuring ongoing care Implementation Administer pharmacologic treatments Stimulant medications Nonstimulant medications Minimize environmental distractions Equipment out of reach Shade to darken room during naps, bedtime Implement behavioral management plans Behavior modification programs Rewards daily, weekly, monthly Punishment Withdrawal of privilege quickly following offense Provide emotional support Parents Family Child Promote self-esteem Assist child with social skills Help child to understand disorder at appropriate developmental level Emphasize positive Educate families Stable environment at home and school Nurse as liaison to teachers, school personnel Reinforce importance of providing structured environment free from unnecessary external stimuli Provide information about treatments, complementary, alternative therapies Provide explanations about disorder, techniques that will assist in dealing with problems See Box 25–3 OPTIMIZING THE EDUCATIONAL EXPERIENCE FOR THE CHILD WITH ADHD Evaluation Parents, child demonstrate understanding of disorder Family accurately, safely manages medication administration Child demonstrates increased inattentiveness, decreasing hyperactivity, impulsivity, sleep disturbance Child displays formation of positive self-image Child manifests formation of healthy social interactions with peers, family Child achieves educational performance to maximum potential Review: ADHD Relate: Link the Concepts and Exemplars Refer: Go to Nursing Student Resources Reflect: Case Study Exemplar 25.2 Autism Spectrum Disorders Overview Autistic spectrum disorders (ASDs) Demonstrate Impaired communication and social interaction, and Repetitive, restrictive, and stereotyped behaviors Range across spectrum from mild to severe Pathophysiology and etiology Etiology Etiology is unknown Believed to be associated with a complex interplay between genetic, immunologic, and environmental factors Risk factors Maternal age over 40 or paternal age over 50 Maternal smoking, or use of alcohol, valproic acid, or misoprostol during pregnancy increases risk Children with fragile X syndrome, , Down syndrome, tuberous sclerosis, congenital rubella syndrome, and neurofibromatosis higher than normal incidence Prevention No way to prevent autism Modifiable factors include good maternal health while pregnant Clinical manifestations Essential features apparent by age 3 Impairments in social interactions Communication difficulties Difficulty adapting to new situations Problems with attention span and ability to organize responses to situations See CLINICAL MANIFESTATIONS AND THERAPIES: Autistic spectrum disorder, p. 1690 See LIFESPAN CONSIDERATIONS: Adults with ASD, p. 1690 Collaboration Interdisciplinary task force, team in community, public schools Diagnostic tests Based on presence of specific criteria See Table 25–22 SCREENING TESTS FOR AUTISM SPECTRUM DISORDERS, p. 1691 Pharmacologic therapy Medications used to manage manifestations and associated behaviors stimulants, SSRIs, mood stabilizers Nonpharmacologic therapies Early intervention assists in maximizing potential Complementary and alternative therapy Dietary therapy Help parents evaluate studies Nursing process Assessment No babbling or communication gestures by 12 months No single word by 16 months No spontaneous two words by 24 months Loss of language or social skills previously achieved History Birth history Neonatal exposures Ask about behaviors Diagnosis Impaired Verbal Communication Impaired Social Interaction related to developmental disability Risk for Injury Risk for Caregiver Role Strain related to the chronic demands of child’s condition Compromised Family Coping Planning Child will remain free of injury Child will acquire communications strategies that enable communication with others Child will be able to perform self-care to maximum potential Child will demonstrate consistent developmental progress Child will participate in small groups of family members, peers Child’s symptoms will be managed successfully Implementation Prevent injury Monitor children at all times, including bath and bedtime Use helmets on children who head bang Provide anticipatory guidance Encourage parents to promote child’s development through behavior modification and specialized education programs Goal is to provide child with the guidance, education, and support for optimal functioning Stabilize environmental stimuli Interpret and respond to environment differently than others Orient child to new settings Provide supportive care Adjust communication techniques, teach to child’s level May need assistance with ADLs Identify rituals, patterns Challenges with onset of emotional, hormonal changes of adolescence Enhance communication Utilizing, improving communication with child Short, direct sentences Speech, language therapy Facilitate community-based care Families need support to cope with challenges May need specialized transportation services, social support IEP Genetic counseling Immunization education Evaluation Discuss child’s progress with parents Review: Autism Spectrum Disorders Relate: Link the Concepts and Exemplars Refer: Go to Nursing Student Resources Reflect: Case Study Exemplar 25.3 Cerebral Palsy Overview Group of chronic conditions affecting body movement, coordination posture nonprogressive abnormality of immature brain Common chronic disorder of childhood Four types of motor dysfunction Spastic Dyskinetic Ataxic Mixed Pathophysiology and etiology Exact insult may not be identifiable Alters muscle tone Muscle stretch reflexes Postural reactions Primitive reflexes May result in Seizures Mental retardation Hearing problems Multifactorial Etiology Congenital, hypoxic, ischemic, infectious intrauterine insults to CNS Rate of cerebral palsy (CP) increases with decreasing gestational age Risk factors Increased with advanced or young maternal age Young paternal age African American ethnicity Multiple births Prevention Infection prevention in pregnant women Keeping current vaccinations Injury prevention Risk reduction for preterm labor Clinical manifestations Variety of symptoms Abnormal muscle tone, lack of coordination, spasticity in majority of cases Developmental delays Back arching, little spontaneous movement Visual defects Feeding difficulties See Table 25–23 CLINICAL CHARACTERISTICS OF CEREBRAL PALSY, p. 1696 See CLINICAL MANIFESTATIONS AND THERAPIES: Cerebral Palsy, p. 1697 Collaboration Collaborative care team Lifelong condition that requires special consideration Diagnostic tests Based on clinical findings Surgery Improve function Pharmacologic therapy Seizure control, control spasms, minimize GI side effects Baclofen Nonpharmacologic therapy May show gradual improvement in function Focus on developing to maximum level of independence Physical, occupational, and speech/language therapy Special education Braces, splints, serial casting, positioning devices Early intervention programs Prognosis depends on level of physical involvement Nursing process Assessment Assess at each healthcare visit for developmental delays Diagnosis Risk for Injury Impaired Mobility Risk for Constipation Impaired Tissue Integrity Impaired Verbal Communication Impaired Home Maintenance Chronic Pain Delayed Growth and Development Caregiver Role Strain Planning Client will remain free from injury Client will demonstrate appropriate growth and development Client will maintain an appropriate diet to meet nutritional needs Client and family will monitor bony prominences to avoid altered skin integrity Implementation Prevent injury Ensure that client receives degree of assistance required for safe ambulation Maintain safe environment without obstacles and with good lighting Use safety belts, helmets, etc Provide adequate nutrition High-calorie diets, supplements Maintain skin integrity Protect bony prominences Monitor skin integrity Maintain body alignment Promote physical mobility Range-of-motion exercises Adaptive, assistive technology Promote growth and development Not necessarily intellectually disabled Foster parental knowledge Teach about disorder Provide emotional support Parents require emotional support to help them cope with the diagnosis Evaluation Client’s growth is appropriate for age Client meets developmental milestones appropriate for age Client’s nutritional status adequate for age and energy needs Review: Cerebral Palsy Relate: Link Concepts and Exemplars Ready: Go to Companion Skills Manual Refer: Go to Nursing Student Resources Reflect: Case Study 25.4 Failure to Thrive Overview Syndrome in which infant falls below fifth percentile for weight, height on standard growth chart Falling in percentiles on a growth chart Geriatric failure to thrive is a similar disorder seen in adults Pathophysiology and etiology Etiology Can be organic Congenital AIDS, inborn errors of metabolism, neurological disease, esophageal reflux Most are nonorganic Feeding disorder of infancy or early childhood Risk factors Infants deprived of mothering Parental depression, substance abuse, mental retardation, psychosis, history of abuse Prevention Educating caregivers regarding infants’ dietary and nutritional needs Home nursing visits Clinical manifestations Persistent failure to eat adequately with no weight gain or with weight loss in a child under 6 years of age Infants may have erratic sleep patterns, are irritable and difficult to soothe, fall well under expected growth patterns, and are often developmentally delayed Collaboration Thorough history and physical exam required to rule out any chronic illnss Goals of treatment provide adequate caloric and nutritional intake, promote normal growth and development, assist parents in developing feeding routines and responding to infant’s cues Diagnostic tests Laboratory testing is not recommended Surgery Varies based on physiological impairment Possible interventions include repairing cleft palate or alleviating bowel obstruction Pharmacologic therapy No medications are available for primary treatment Resolve barriers to obtaining and absorping adequate caloric intake and providing nutritional supplementation Nonpharmacologic therapy Education for caregivers Nursing process Assessment Physical assessment Measurements, percentiles History Stressors in parents’ lives Questions about pregnancy, birth Diagnosis Imbalanced Nutrition Delayed Growth and Development Risk for Impaired Parenting Fatigue Planning Child will attain adequate growth in normal development Parent–child relationship will improve Parental understanding of child’s nutritional vitamins will improve Complications associated with poor nutrition will be prevented Implementation Thorough history, physical assessment Observing parent-child interactions Parental involvement in feeding child Refer parents to early childhood intervention agency to continue monitoring situation Evaluation Growth and development of the child improves Parent voices specific action plan to improve, maintain appropriate growth of child Child experiences no long-term complications as a result of FTT Review: Failure to Thrive Relate: Link Concepts and Exemplars Ready: Go to Companion Skills Manual Refer: Go to Nursing Student Resources Reflect: Case Study