Introduction

Delivering excellent health care services to mothers and children is a goal that is attainable through nursing services. Nurses who want to achieve excellence in the delivery of health care to the mother and the new born should understand how the nursing care is to be provided to children at different stages of development throughout their life span. In this essay, we are going to highlight the importance of health promotion in children of two age groups, namely toddlers and school age (7-12).

Pediatric Profiles

Age Range

Toddlers: Toddlers are children of age group 1 to 3 years. The world of a toddler is always growing rapidly with many changes in it. They become independent at this age. They are still babies and need a lot of love and support. They want freedom but at the same time want to feel safe. They are active and curious; they are starting to learn about themselves and others. They do not understand our reasons, cannot sit still, nor can they share or control their feelings. They need a lot of understanding, encouragement, time, love and patience from the care giver (“Living With Toddler”, n.d.).

School age: The school age children show a slow physical growth. However, their social and developmental growth gets accelerated, and it becomes complex at this age. Their world now expands from family to peers, teachers, and other external influences like coaches and media (television). The child now tries to become increasingly independent and wants to participate in activities outside the home (Montegomery, 2001).

Personality Development

Toddlers: Erikson describes toddlerhood as the stage of autonomy Vs shame and doubt (Lidz & Theodore, 1983). The desire for autonomy results in showing negativism.  The child now uses the words “no” frequently. Temper tantrums and frustration are common (Richardson, 1990).  During this stage, the child's curiosity increases, but his verbal and intellectual abilities lag far behind his motor development.   The bond between caregiver and child becomes strong, and the child shows separation anxiety.  The developmental tasks for this stage are identified as: tolerating separation from the primary caregiver, gaining control of bowl and bladder function, using words to communicate with others, and becoming less dependent on the primary caregiver.

School age: Children of this age move out of their homes into the world. Their self concepts, value systems and cognitive capacities change. Children start interacting with peer groups and get influenced by them (Hoare & Peter, 1993).  The child becomes more communicative with the rapid   physical, cognitive, and social development (Cornell, 1985).   At this stage, the child starts comparing him/her self with class mates or playmates and achieves self esteem.  The developmental tasks of the school age child are: developing the social and physical skills needed for playing games, learning to get along with others, learning behavioural attitudes relevant to one's own sex, learning basic reading, writing, and arithmetic skills, acquiring a conscience and morals, and  developing a good feeling and attitude about oneself.

Cognitive Development
Toddlers: According to Piaget (1969), toddlers move through the sensory motor phase of development through age 1 to 2, which is the first stage of cognitive development. They can use symbols to allow imitation. They can engage in delayed imitation. During the second to third year of toddler development, the toddler passes through the second stage of cognitive development i.e. pre operational stage. According to Ericson (1963), toddlers are in the autonomy Vs shame and doubt stage at the age of 1 to 3. A toddler achieves autonomy and self control, separated from the parent, imitates adults, and spontaneously shows affection,

School age: According to Piaget (1969), the age of 7 to 11 years is the age of concrete operational thoughts. The child is now able to assimilate and co ordinate the information about the world from his own perspective and dimensions. The child can conclude from others point of view and can rethink his own actions. He can recapitulate the stored memories of past experiences and apply them to the current experiences. The child can classify things into different sets and identify their relationships with each other. A nurse may need to intervene by preventing cognitive role strain like school age issues or new sibling in the household when the parent is experiencing role strain.

Physical Development

Toddlers: There is a steady increase in height and weight of a toddler which often is in spurts. A toddler should gain around 3 to 5 pounds in weight and average 3 inches of height per year. Brain growth reaches around 90% of its adult size and myelinization of the nerve cells completes by around the second year. The respiratory structures continue to grow. The heart rate decreases and blood pressure increases. The stomach and small intestine grow in size allowing three regular mills a day. Kidney and bladder function reach the adult level by 24 months. Bones increase in length, muscles mature and become stronger (Ricci & Kyle, 2009).

School age: The height of school age children grows by average 2 inches per year, and weight increases by 3 to 3 kg per year. The differences in girls and boys start becoming more obvious towards the middle school age. The development of secondary sex characteristics starts. The differences in height and weight relationships and changes in development patterns should be explained to the parents and children by the nurse. It should also be made clear that the rapid physical growth is not necessarily associated with emotional maturity. The organ systems development may vary with age and gender (Ricci & Kyle, 2009).  

Milestones of Growth and Development

Toddlers: Establishing autonomy, achieving mobility and language development are the main focuses during toddlerhood. Some toddlers reach the growth and developments milestones earlier than the others. However, all the healthcare visits of the toddlers should focus primarily on attaining the developmental milestones. The nurse must be aware of the changes that take place during the toddlerhood.

School age: The growth mile stones of school age children are listed in Table 1.

Table 1:

Growth and developmental milestones of school age children

Age

Activities

Cognitive

Social

6-7 years

Enjoys many activities and stays busy, likes to paint and draw, may lose first tooth, vision is as sharp as an adult's vision, practices skills in order to become better, jumps rope, rides a bike

Understands the concept of numbers, daytime and night time. Knows right and left hands, can copy complex shapes, tell time, explain objects and their use, can read age-appropriate books

Cooperates and shares, may cheat, if able, jealous of others and siblings, likes to copy adults, likes to play alone, but friends are becoming important. Plays with friends of the same gender, may have temper tantrums, modest about body, likes to play board games

8-9

more graceful with movements and abilities. Jumps, skips, and chases, dresses and grooms self completely, can use tools (i.e., hammer, screwdriver)

can count backwards, knows the date, enjoys reading, understands fractions, understands the concept of space, draws and paints, enjoys collecting objects

likes competition and games, starts to mix friends and play with children of the opposite gender, modest about body, enjoys clubs and groups, becomes interested in boy-girl relationships

10-12

remainder of adult teeth will develop, likes to sew and paint

writes stories, likes to write letters, reads well, enjoys using the telephone

friends are very important; may have a best friend, increased interest in the opposite gender, likes and respects parents.

Play with me

Toddlers: The major socialization of toddlers occurs through play. It is particularly typical of toddlers to play alongside a child (parallel play). The span of attention of toddlers is short and hence they continuously need new and safe toys to play. Toddlers are egocentric, and they do not readily share their toys. Care-givers and nurses play a pivotal role of creating a conducive and convenient environment to support toddlers’ play. Toddlers like music. Physical activity through play is also required for physical development and movement training. The environment must provide opportunities for uninterrupted time, ample space and appropriate materials for free play (Ricci & Kyle, 2009).

School age: The children of school age play together with other children i.e. exhibit co operative play. They engage themselves both in solitary activities and organized cooperative activities. They can participate in co operative activities like playing football, basketball, tennis etc. The child of this age can comprehend that this co operation with others will lead to a unified goal for the team. Additionally, the child also learns the follow disciplines and rules of the game. They also enjoy solitary activities like boards, cards and video games. Children also enjoy the formal education in the school and reading (Hall & Reet, 2000).

 How to Prepare Me for a Procedure

Toddlers: Toddlers can benefit from explanation, training and education prior to a surgical procedure.  The toddlers are usually scared of being left alone, of having to stay in an unknown room, of the painful procedures, of medical equipments and appearance of the doctors. A nurse can prepare a child for the surgery by reading books about going to hospital or performing an interactive play of a surgery. The toddlers would obviously be fussy and cry during the surgical procedure. The caregivers need to stay calm and be patient (“Preparing child for surgery”, n.d.). 

School age: Common stressors about a surgery of a school aged child are fear of being away from school and children, thinking that he/ she is in hospital because she is bad, having a part of body injured, pain, needles and shots, and dying during the surgery. A school aged child needs to be prepared one to two weeks in advance. This can be done by a nurse by touring the surgical facility along with the child, reading books about surgery, explaining the benefits of the surgery, convincing  the child that it is ok to cry and be afraid (“Preparing child for surgery”, n.d.).
Safety Issues

Toddlers: There is a high probability of unintentional injuries in toddlerhood due to curiosity, lack of impulse control and extensive mobility.  Injuries due to drowning, choking, vehicle accidents, falls, burns and poisoning are the most common. While at home, toddlers should be protected from tobacco smoke.  Toddlers are prone to injuries due to falling. A toddler should never be unsupervised outdoors. Materials which are poisonous and unsafe should be kept away from toddlers.  While in hospitals, toddlers should be protected from drugs and medicines. The cribs of the toddlers should always be kept locked (Hall & Reet, 2000).

School age: School children have the highest incidence of pedestrian injury as they often walk to school. Hence, they should be taught safe road and pedestrian practises. Bicycling, scooter riding and skating are the other common causes of injury. Children should be taught to wear helmets while riding in order to reduce the risk of head injuries. School age children are curious about cooking and should be counselled about fire hazards and safety. Nurses should intervene by discussing safety measures needed for biking, cars, scooters, fire, discuss and develop a safety plan, and teach first aid measures to the parents and child (Hall & Reet, 2000).

 Health Promotion

Toddlers: Practising health care routines and rituals helps the toddler to develop a self esteem and a conscience. Routines such as providing avenues for learning are being introduced: time to wake up and go to bed, brushing teeth regularly, toilet training, feeding, dressing, washing and bathing. Routines shall take into consideration cultural and religious differences, family backgrounds etc. Nurses should consult the families regularly on their toddlers’ routines and rituals. Self help skills in feeding, dressing, bathing should be encouraged when the toddler shows readiness.

School age: School age children should choose nutritional foods and snacks that are culturally appropriate. Processed sugars and fats should be restricted. Eating fish and proteins should be promoted. Children between the age of 6-8, 8-10 an 10-12 need 12 hrs, 10 hrs and 8-10 hrs of sleep and sometimes a brief nap after school. Dental caries remain a prevalent problem and proper brushing rituals and the use of fluoride toothpastes are required. Children have different phobias like school phobias, phobia of returning home alone etc. Nurses should continue to educate parents and teachers about these problems and encourage children to remain in their peers (Hall & Reet, 2000).

Health Problems

Toddlers and school children: When the nurse finishes the evaluation of general health status of the toddler or a school going child, she may diagnose one or more of the following   health problems. e.g. delayed growth and development, improper nutrition, interrupted family processes etc. The nurse should assess the feeding schedule, intake, method of feeding if the toddler’s nutrition is imbalanced. She should determine toddler’s ability to drink/ eat from a particular device like a cup or a spoon. She should weigh the toddler regularly. Caregivers should provide at least three nutrient dense meals and two healthy snacks etc. In case of toddlers with delayed growth, the nurse should perform interventions such as prescribed by physical, occupational or speech therapists. The nurse should also support the family of the toddler with the developmental delay (Hall & Reet, 2000).
 Anticipatory Guidance

Toddlers: As a toddler moves quickly, the caregiver must watch the toddler at all times and provide a child-proof environment. The nurse should provide anticipatory guidance to the family members of a toddler on: drowning, hot liquids, poisonings, falls, aspiration and environmental dangers, importance of next EPSDT visit, including immunizations,

diapering, rashes, infant hygiene, delaying toilet training, child proofing home, climbing, car seat use, sun exposure, safety gates, safety plugs, sleep/separation problems, bedtime ritual, developmental milestones, etc (Handbook f healthy kids services, n.d.).

School aged children: The nurse should provide anticipatory guidance on:

1. Safety related to bicycles, seat belts, matches, fires, poison, water safety, skate boards, playing in the street.

2. Developmental needs: Talking out problems with family members, expressing thoughts and feelings, secure home environment, freedom to explore new skill areas.

3. World: need to be reassured there are many ways to do things, appropriate affective verbal

messages, recognition for skills, opportunities for problem-solving, develop a sense of right and wrong, set consistent limits that are reasonable, provide healthy role models, punishment/discipline that fits the wrong-doing.

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