Psychosocial Achievements and Normal Growth and Development:

• Builds motor skills, such as grasping, rolling, sitting, crawling, standing, walking
• Reflexive behaviors gradually replaced by voluntary movements
• Develops trust and a sense of being loved and cared for
• Simple communication such as crying and babbling
• Birth weight triples during 1^st year of life
• Fears loss of support, loud noises, bright lights, sudden movements, strangers

Psychosocial Achievements and Normal Growth and Development:

• Gains less than 5 pounds/year; grows 2-2.5 inches/year
• Begins to lose baby teeth
• Develops coordination (e.g., runs, hops, throws, uses scissors)
• Can dress self
• Learns to use utensils, tie shoe laces, ride bike; can write name and copy letters of alphabet
• Speech becomes more intelligible, speaks in sentences, vocabulary increases
• Curious, imaginative and asks lots of question
• Develops sense of privacy
• Becomes aware of others' feelings
• Develops sense of time
• Active fantasy life
• Fear of separation and the supernatural (monsters, ghosts, animals, the dark)

Health Concerns:

• Communicable diseases of childhood
• Accidents
• Dental health
• Poisoning
• Hospitalization/illness may lead to regression
• Nutritional Balance

Unique Challenges:

• Maintaining a safe environment for child
• Promoting close contact between caregiver(s) and child
• Maintaining a healthy diet. Children often have specific likes and dislikes at this age.

Age Specific Considerations for the Healthcare Professional:

• Reassure child that
• illness and/or treatment are not punishment for misbehavior
• Assess for developmental milestones
• Monitor for abuse/neglect: report when indicated
• Remind primary caregiver(s) regarding checkups, screening, and immunizations
• Praise good behavior and offer small token rewards such as stickers
• Encourage parental involvement and presence during hospitalization
• Use clear, concise explanations that child can understand being attentive to vocabulary choices (e.g.. a child might believe they will be “stretched” if they have to go on a stretcher)
• Give appropriate choices whenever possible (e.g. injection site)
• Be alert to pediatric medication doses (usually based on child's weight)
• Use appropriately sized equipment (pediatric BP cuff, electrodes, catheters, etc.)
• Allow child some independence (self care, dressing, feeding) when appropriate
• Use pediatric pain assessment tool

Psychosocial Achievements and Normal Growth and Development:

• Gains 4-7 pounds/year, height increases at age 9, arms long in proportion to body
• Girls may begin menstruation and develop secondary sex characteristics
• Has 10-26 permanent teeth
• Improved balance and muscular strength, improved hand-eye coordination
• Can read, write, do math, and memorize
• Logical and deductive reasoning develop, understands past, present/future, can understand death and dying
• Assumes responsibility for chores and school related tasks
• Begins to understand anatomy, bodily functions and illness
• Can articulate some degree of discomfort, but may be reluctant to ask questions
• Need to develop a sense of adequacy about abilities involving social interaction and learning
• Sex segregated “play” with peers (athletics), development of personal interests/hobbies
• Coping skills include doing nothing, acting impulsively, problem solving
• Other adults beginning to have significant impact on behavior (teachers, coaches), but parents still considered primary adult authority

Health Concerns:

• Communicable childhood diseases
• Accidents
• Dental health
• Behavior disorders
• Nutrition
• Vulnerable regarding drugs, alcohol, and sexual activity

Unique Challenges:

• Peer pressure may lead to poor judgment
• Prefers fast food dining with friends
• Concerned with peer acceptance and appearance

Age Specific Considerations for the Healthcare Professional:

• Remind primary caregiver(s) regarding checkups, screening, and immunizations
• Continue to assess for developmental milestones
• Monitor for abuse/neglect; report when indicated
• Educate patient and caregiver(s), and promote parental involvement
• Use age appropriate teaching materials and language. Be direct, use correct terminology, and encourage child to ask questions, participate in care, and make own decisions regarding care when appropriate
• Be supportive of need for control and privacy
• Support coping mechanisms and independence (e.g. “Your job is to hold very still while I put these drops in your eye. It's OK if you're scared and want to grab your pillow”)
• Address fears, such as loss of control, failure in school, and death
• Provide for continued schooling
• Educate in safe behaviors regarding drugs, alcohol, and sexual activity

Psychosocial Achievements and Normal Growth and Development:

• Secondary sex
• characteristics develop
• Adult weight is achieved, some awkwardness may occur because of rapid growth
• Variable appetite
• Dentition complete, many adolescents have wisdom teeth extracted
• Gross and fine motor control increases
• Heightened emotionality because of hormonal changes
• Capacity for abstract, symbolic, deductive and analytical thinking.
• Beginning thoughts of career options
• Critical of appearance and mood changes

Health Concerns:

• Accidents
• Eating disorders
• Depression
• Substance abuse
• Acne
• Reproductive system problems
• Adolescent pregnancy
• STDs

Unique Challenges:

• May participate in
• impulsive and risk-taking behaviors
• Is heavily influenced by peer opinion and judgments.
• Attempts to identify factors necessary for self-growth
• Identity, achievement, and autonomy

�Age Specific Considerations for the Healthcare Professional:

• Emphasize the
• continued need for checkups, screenings, and immunizations
• Provide privacy for teaching and procedures
• Provide increasingly more detailed information with the use of correct medical terminology
• Know the age at which an adolescent can legally authorize own treatment.
• Involve patient in treatment decisions and care
• Encourage contact with family and friends while hospitalized
• Reinforce knowledge of safe behaviors regarding drugs, alcohol, and sexual activity
• Monitor for abuse
• Assess for depression and encourage use of stress reduction
• Refer to appropriate youth support groups, if needed
• Provide for continued schooling

Psychosocial Achievements and Normal Growth and Development:

• Physical and motor development complete
• At peak physical strength and prime reproductive capacity
• Continued development of intellectual abilities
• Develops intimate, long-term relationships
• Struggles to form commitment without losing identity
• Evaluates new information in terms of own experience

Health Concerns:

• Pregnancy and childbirth
• Infertility
• STDs
• Accidents
• Stress-related illness
• Substance abuse

Unique Challenges:

• Fears the loss of work and social relationships
• Most significant relationships are with spouse, children, and coworkers
• Most stressors include career, establishing family, balancing numerous roles and responsibilities at home, work, school, community, and child rearing
• Choice of alternative lifestyle (e.g., homosexuality)

Age Specific Considerations for the Healthcare Professional:

• Assess for physical and mental health, self-esteem, family roles, support system
• Emphasize the continued need for checkups, screenings, and immunizations
• Use teaching methods that won't challenge self-concept
• Explain the importance of compliance by relating to patient's life
• Encourage family participation in patient care and education
• Encourage expression of feelings and concerns
• Educate in accident prevention and healthy lifestyle (e.g. weight control, exercise, nutrition, stress reduction) and explain benefits
• Monitor for abuse

Psychosocial Achievements and Normal Growth and Development:

• Slow decline in body functions
• Degenerative changes (hair loss, eyesight, bearing), atrophy of reproductive system
• Menopause
• Develops concern for next generation
• May seek further education or career change
• Reflects on life and accomplishments

Health Concerns:

• Chronic disease such as cardiovascular disease, arthritis, osteoporosis, diabetes, hypertension, lung disease
• Cancer
• Obesity may occur secondary to reduced metabolic rate
• Depression
• Substance abuse

Unique Challenges:

• Making adjustments to middle age's physical changes
• Maintaining satisfactory employment, then preparing for retirement and leisure activities
• Maintaining satisfying relationships, social and civic responsibilities
• Maybe caring for aging parents as well as children
• Empty nest issues
• Adjusting to being a grandparent

Age Specific Considerations for the Healthcare Professional:

• Physical and mental health assessment to include physical changes/loss, family and social roles, career, self esteem
• Continued monitoring for abuse
• Encourage checkups, screenings, and immunizations
• Promote as much self-care as possible and include significant other family in education and care when appropriate
• Begin teaching about advance medical directives
• Allow time to verbalize fears and concerns
• Educate in accident prevention and healthy lifestyle (e.g. weight control, exercise, nutrition, stress reduction).
• Educate on the safe use of medications
• Assist in finding resources to meet healthcare needs and costs

Psychosocial Achievements and Normal Growth and Development:

• Require more sleep
• May feel isolated or upset by loss (friends, family, sensory abilities or financial)
• Need for acceptance of their worth and satisfaction with accomplishments
• May have reduced attention span and memory

Health Concerns

• Decreased mobility, joint pain, brittle bones
• Greater risk for poor nutrition, dehydration, infections
• Changes in skin, muscles, and sensory abilities
• Recovery from illness takes longer
• Despair/depression
• Chronic diseases as mentioned previously, but also including Alzheimer's, glaucoma, cataracts, benign prostatic hypertrophy, and fractures
• More prone to adverse drug reactions
• May present with atypical or vague symptoms making diagnosis difficult

Unique Challenges:

• May lose self-confidence as abilities decline
• Increased need for safety because of decreased cognition and mobility
• May need smaller, more frequent meals
• Maintaining leisure activities and social relationships
• Coming to terms with death

Age Specific Considerations for the Healthcare Professional:

• Physical and mental health assessment to include screening for abuse and neglect, physical changes of aging, financial stability, loss & role changes, support system
• May need to present information in a slower manner, in smaller segments, repeat a number of times, and avoid distractions
• Use large print materials, simple pictures and medication dose calendars/aids
• Ask questions to determine level of comprehension don't assume understanding
• Involve family in education and care
• Encourage checkups, screenings and immunizations
• Ensure safety
• Encourage physical and social activity and reminiscing
• Encourage self-care and decisions