Growth & Development + Preventive Care

Growth and Development (Erikson, Piaget, Developmental Milestones)

16.1 Erikson’s Psychosocial Development Theory

• General Idea: Every life stage involves a challenge that shapes a person’s emotional and social development. Successfully working through each challenge supports healthy psychological growth.
• Stages Overview:

1. Trust vs. Mistrust (Newborn–1 year):
   • Babies begin to rely on caregivers if their needs are predictably met. Inconsistent or neglectful care may lead to suspicion and lack of trust.
2. Autonomy vs. Shame and Doubt (1–3 years):
   • Young children try to do things independently, like dressing themselves. If constantly corrected or restricted, they may start to feel insecure about their choices.
3. Initiative vs. Guilt (3–6 years):
   • Children initiate play and interact socially. If they’re overly controlled or made to feel their actions are wrong, they may develop guilt.
4. Industry vs. Inferiority (6–12 years):
   • At this age, children want to achieve and feel accomplished, especially in school and group settings. Repeated discouragement can cause feelings of inadequacy.
5. Identity vs. Role Confusion (12–20 years):
   • Teens try to figure out who they are and where they belong. If they struggle to form a strong sense of self, they may feel lost or unsure.
6. Intimacy vs. Isolation (Early adulthood):
   • Adults work on forming meaningful emotional bonds. Struggles in building relationships can lead to loneliness or emotional withdrawal.
7. Generativity vs. Stagnation (Middle adulthood):
   • Individuals aim to guide others and be productive in life. Feeling disconnected or unproductive can result in a sense of stagnation.
8. Integrity vs. Despair (Older adulthood):
   • Seniors reflect on their life’s journey. A sense of accomplishment brings peace; unresolved regrets may lead to despair.

16.2 Piaget’s Cognitive Development Theory

• Sensorimotor Stage (Birth–2 years):
  • Infants understand their world through movements and senses. They learn that objects still exist even when they can’t see them.
• Preoperational Stage (2–7 years):
  • Children use imagination and symbols in play but struggle with logic and seeing things from others’ viewpoints. They don’t yet understand that changing an object’s appearance doesn’t change its amount.
• Concrete Operational Stage (7–11 years):
  • Children begin applying logical thinking to tangible situations. They grasp concepts like conservation and can categorize and arrange objects.
• Formal Operational Stage (11 years–adulthood):
  • Individuals can think in complex, abstract ways. They use logic to form hypotheses and explore possibilities.

16.3 Key Developmental Milestones by Age

• Infant (0–12 months):
  • Gains motor skills such as rolling over, sitting, crawling, and standing with support. Begins simple communication like babbling and responding to familiar voices.
• Toddler (1–3 years):
  • Walks steadily, runs, starts using short phrases, begins understanding toilet use, and engages in play near others without direct interaction.
• Preschooler (3–5 years):
  • Demonstrates fine motor skills like using scissors and drawing, shows interest in social games, and begins learning basic academic concepts.
• School-Aged Child (6–12 years):
  • Develops physical coordination through sports, improves academic skills, follows rules, and begins to think more logically.
• Adolescent (12–18 years):
  • Experiences rapid physical growth, becomes more socially aware, reasons more abstractly, and focuses on self-identity.

Overview of Piaget’s Stages of Cognitive Development

Stage	Age Range	Key Features	Milestones
Sensorimotor	0–2 years	Learns through physical interaction and senses	Develops object permanence, begins to show fear of strangers
Preoperational	2–7 years	Thinks symbolically, focused on self-perspective	Engages in pretend play, vocabulary expands quickly
Concrete Operational	7–11 years	Begins to reason logically with real-world items	Understands conservation and can sort/group objects
Formal Operational	11+ years	Can apply abstract and logical thinking	Uses deductive reasoning, can hypothesize and plan

Normal Pregnancy, Prenatal Care, and Fetal Development

17.1 Pregnancy Basics

• Pregnancy is categorized into three stages, lasting about 9 months in total.
• Early recognition of pregnancy and regular prenatal checkups are essential for promoting the well-being of both the mother and baby.

17.2 Trimester Breakdown and Notable Events

• First Trimester (Weeks 1–13):
  • Critical phase of early development when organs begin to form.
  • Pregnant individuals often experience fatigue, morning sickness, and breast changes.
  • Healthcare appointments are commonly scheduled every month during this time.
• Second Trimester (Weeks 14–26):
  • Marked by noticeable fetal development; the baby begins to move and grow quickly.
  • Nausea usually lessens, and energy often improves. However, discomforts like heartburn or back pain may start.
• Third Trimester (Weeks 27–40):
  • The fetus gains weight and matures in preparation for birth.
  • Increased physical discomforts may include irregular uterine contractions, more frequent urination, and difficulty breathing.
  • Prenatal check-ins become more frequent—every two weeks, then weekly as due date approaches.

Essential Aspects of Prenatal Care

• First Appointment:
  • A full review of medical and pregnancy background (including GTPAL: total pregnancies, full-term births, premature deliveries, pregnancy losses, and current living children), physical checkup, and routine lab work (e.g., complete blood count, blood group, infection screening).
• Follow-Up Appointments:
  • Routine tracking of maternal weight, vital signs, and uterus size.
  • Monitoring baby’s heartbeat and activity.
  • Regular urine checks for protein or sugar levels.
  • Scheduled testing includes glucose tolerance between weeks 24–28 and GBS screening closer to term (35–37 weeks).

17.4 Key Points in Fetal Development

• A heartbeat can usually be detected via ultrasound around 6 weeks and with a handheld Doppler around 10–12 weeks.
• By the end of the first trimester, all essential organ systems have started to form.
• Fetal survival outside the womb becomes possible around 23–24 weeks with advanced medical care, though risks remain high at this stage.

Newborn Care (APGAR, Reflexes, Feeding, Jaundice, Thermoregulation)

18.1 APGAR Score

• Purpose: A brief evaluation performed at 1 and 5 minutes after birth to assess how well the newborn is adapting.
• Five Categories: Skin color, pulse rate, response to stimulation, muscle activity, and breathing effort.
• Scoring System: Each item is rated 0–2 points, with a maximum of 10. Scores between 7 and 10 typically suggest the baby is adjusting well.

18.2 Common Newborn Reflexes

• Rooting: When the infant’s cheek is stroked, they instinctively turn in that direction, searching for a feeding source.
• Sucking: Touching the roof of the mouth triggers a rhythmic sucking motion to help with feeding.
• Moro Reflex: A sudden movement or noise causes the baby to extend the arms outward before pulling them back in, as a survival response.
• Palmar Grasp: Newborns tightly curl their fingers around an object placed in their hand.
• Babinski Sign: Stroking the bottom of the foot causes the toes to extend and fan outward—normal in newborns but concerning if seen in older children.

18.3 Infant Nutrition and Feeding Practices

• Breastfeeding: The AAP advises feeding solely with breast milk for about the first 6 months. It helps support immunity and is easily tolerated by infants.
• Formula Feeding: A suitable option for caregivers who opt out of or are unable to breastfeed; it must be mixed and stored according to provided guidelines.
• Feeding Schedule: Most newborns need to eat about every 2 to 3 hours, resulting in roughly 8 to 12 feedings in a day.

18.4 Understanding Jaundice in Newborns

• Definition: A yellowing of the skin and eyes caused by the buildup of bilirubin, which the baby’s immature liver may not yet process efficiently.
• Categories: Physiologic jaundice appears after the first day of life and is often benign; pathologic jaundice begins within 24 hours and may signal an underlying issue.
• Treatment: Encouraging frequent feeding, using phototherapy if levels are high, and, in severe cases, considering procedures like exchange transfusion.

18.5 Newborn Temperature Regulation

• Infants are vulnerable to losing body heat quickly because they have a relatively large surface area and thin fat layers.
• Heat Loss Mechanisms: Includes transfer through air (convection), to surrounding objects (radiation), through moisture on skin (evaporation), and direct contact (conduction).
• Interventions: Immediately drying the newborn, covering with warm blankets or clothing, holding baby skin-to-skin, and controlling ambient temperature in care areas help minimize heat loss.

Immunizations (CDC Schedule and Safety Considerations)

19.1 Purpose of Vaccines

• Vaccines help the immune system prepare defenses against certain infections by mimicking exposure—without causing the actual illness.

19.2 CDC Childhood Immunization Schedule (Key Points)

• At Birth: First dose of Hepatitis B.
• At 2 Months: Start of core vaccines like DTaP, Hib, IPV, PCV, Rotavirus, and the second Hep B dose.
• At 4 Months: Repeat doses of the same series begun at 2 months (excluding Hep B).
• At 6 Months: Continuing vaccine series; first flu shot can be given now, repeated yearly afterward.
• At 12–15 Months: Measles, mumps, rubella (MMR), chickenpox (Varicella), Hepatitis A (2-dose series starts), and additional booster doses.
• At 4–6 Years: Final primary doses of DTaP, IPV, MMR, and Varicella.

19.3 Key Vaccines for Adults

• Adults should receive a Tdap booster every decade, an annual flu shot, and—depending on age or health—pneumonia and shingles vaccines (especially for those 50 or older).

19.4 When Vaccines Should Be Delayed or Avoided

• Absolute Contraindications: Individuals with a known life-threatening allergy to a vaccine ingredient (like eggs or gelatin) should not receive that vaccine.
• Temporary Precautions: Vaccinations are often delayed if someone is moderately or severely ill to ensure optimal immune response.
• Pregnancy Consideration: Live-virus vaccines are avoided during pregnancy because they may pose a risk to the developing baby.

Typical Pediatric Immunizations and Their Delivery Methods

Vaccine	Route	Typical Schedule	Notes
Hepatitis B (HepB)	IM (thigh/arm)	Given at birth, 1–2 months, and between 6–18 months	Avoid if allergic to yeast
DTaP	IM (thigh/arm)	Administered at 2, 4, 6 months; 15–18 months; 4–6 years	Tdap booster at 11–12 years, then every decade
Hib	IM (thigh/arm)	2, 4, possibly 6 months (brand-dependent); 12–15 months	Protects against serious H. influenzae type b infections
Polio (IPV)	SubQ or IM	2, 4 months; 6–18 months; 4–6 years	Oral version no longer recommended in the U.S.
MMR	SubQ (arm)	12–15 months; 4–6 years	Contains live virus; should not be given during pregnancy
Varicella	SubQ (arm)	12–15 months; 4–6 years	Live vaccine; not safe for pregnant individuals

Health Screening Guidelines (BP, Lipids, Cancer, Glucose Monitoring)

20.1 Monitoring Blood Pressure

• Routine Screening:
  • Adults with readings below 120/80 mmHg can have blood pressure assessed every other year.
  • Those with systolic readings between 120–129 mmHg and diastolic under 80 mmHg should undergo yearly checks.
  • Individuals with known hypertension or risk factors like excess weight or diabetes may need closer surveillance.
• Why It Matters: Detecting elevated blood pressure early helps avoid serious health outcomes like stroke, heart or kidney complications.

20.2 Lipid Profile Evaluation (Cholesterol)

• When to Test:
  • Starting at age 20, adults should undergo a fasting cholesterol panel (total cholesterol, HDL, LDL, and triglycerides) at least once every 5 years.
  • More frequent monitoring may be necessary for those with a personal or family history of lipid disorders, metabolic conditions, or elevated BMI.
• Target Values:
  • Aim for LDL levels under 100 mg/dL (or under 70 mg/dL in those with significant cardiovascular risk).
  • HDL should exceed 40 mg/dL for men and 50 mg/dL for women.
  • Keeping total cholesterol below 200 mg/dL is considered optimal.

20.3 Cancer Detection Strategies

• Breast Cancer:
  • Women are encouraged to start screening mammograms between ages 40 and 50, with repeat imaging every 1–2 years depending on clinical judgment and personal risk.
• Cervical Cancer:
  • Women ages 21–29 should receive Pap tests every 3 years.
  • From ages 30 to 65, screening may involve both a Pap smear and HPV testing every 5 years—or Pap testing alone every 3 years.
• Colorectal Cancer:
  • Screening starts around age 45–50 and may include colonoscopy every 10 years or alternative tests like annual stool-based testing or sigmoidoscopy every 5 years.
• Prostate Cancer:
  • Men, especially those at higher risk (e.g., African American men or those with a strong family history), may begin PSA blood tests or digital rectal exams around age 50—or earlier if clinically indicated.

20.4 Blood Sugar Screening (Diabetes)

• Who Needs Testing:
  • Adults with a BMI of 25 or higher, along with another risk factor (e.g., sedentary lifestyle, elevated blood pressure, or family history), should be screened.
  • Everyone aged 35 and up should be tested every three years, provided results are within the normal range.
• Testing Methods:
  • Screening tools include HbA1c (average glucose over time), fasting glucose levels, or a glucose tolerance test.
• Why Screen Early: Identifying high blood sugar early can prevent progression to complications such as vision loss, nerve damage, kidney problems, or heart disease.

Overview of Routine Health Screening Guidelines

Screening	Age/Interval	Additional Notes
Cholesterol	Begin at age 20; repeat every 5 years	Test sooner or more often for those with increased cardiovascular risk
Cervical Cancer	Every 3 years with Pap test, or every 5 with HPV	Depends on age group and prior screening outcomes
Blood Pressure	Minimum of once every 2 years	Annual checks advised if readings are near the high range
Breast Cancer	Annually or every 2 years starting at 40–50	Screening recommendations differ; personal/family history matters
Colon Cancer	Colonoscopy every 10 years from age 45–50	Other methods include FIT, stool DNA test, or flexible sigmoidoscopy
Diabetes	Start screening at 35, repeat every 3 years	Begin earlier if overweight, sedentary, or family history exists

Lifestyle Interventions (Quitting Smoking, Nutrition, Physical Activity, Mental Wellness)

21.1 Quitting Tobacco Use

• Health Consequences of Tobacco:
  • Tobacco use is linked to a higher chance of heart disease, strokes, various types of cancer (including lung and bladder), and respiratory illnesses.
• Approaches to Quitting:
  • Behavioral techniques such as one-on-one therapy or peer groups.
  • Nicotine substitutes (gum, lozenges, transdermal patches).
  • Medications like varenicline or bupropion may assist with withdrawal.
  • Learning to avoid smoking triggers and developing healthier habits for stress.

21.2 Nutrition and Balanced Eating

• Core Recommendations:
  • Focus on nutrient-rich foods including leafy greens, lean meats, legumes, dairy alternatives, and whole grains.
  • Reduce intake of harmful fats, salt, and sugary items.
  • Maintain hydration appropriate for individual lifestyle and climate.
• Targeted Diet Plans:
  • DASH diet for managing hypertension.
  • Mediterranean-style meals to support heart health.
  • Regulated carbohydrate intake to maintain steady blood sugar in diabetes.

21.3 Staying Active

• Exercise Guidelines:
  • Adults should aim for about 2.5 hours of moderate aerobic activity weekly (e.g., cycling, brisk walking), or 75 minutes of more intense activity like cardio.
  • Add strength-building workouts on 2 or more days a week (e.g., lifting, resistance bands).
• Why It Matters:
  • Promotes healthy weight, strengthens the heart and lungs, enhances blood sugar regulation, and alleviates anxiety and tension.

21.4 Coping with Stress

• Helpful Practices:
  • Use calming techniques like guided breathing or muscle relaxation.
  • Engage in mindfulness or movement-based therapies like yoga.
  • Ensure adequate nightly rest (around 7–9 hours for most adults).
  • Organize tasks to reduce overwhelming responsibilities.
• When to Seek Help:
  • Utilize professional counseling, support groups, or therapeutic tools when stress interferes with daily life.

STI Awareness and Protection

22.1 Frequently Diagnosed STIs

• Examples Include:
  • Conditions such as syphilis, gonorrhea, HPV, HSV, HIV, and chlamydia are prevalent.
• Potential Consequences:
  • If untreated, STIs may lead to issues like infertility, chronic pelvic discomfort, cancers, or systemic infections.

22.2 How to Prevent Infection

• Protective Measures:
  • Using condoms correctly and limiting the number of partners can reduce transmission.
  • Establishing monogamous relationships with tested, uninfected partners offers additional protection.
• Immunization:
  • Vaccines like HPV (recommended around ages 11–12) and hepatitis B provide critical prevention.
• Testing Routine:
  • Those who are sexually active—especially with new or multiple partners—should get tested yearly.
• Knowledge and Compliance:
  • Teach early warning signs, promote medication adherence, and emphasize the importance of partner testing.

22.3 Key Teaching Points

• Common Signs:
  • Genital sores, pain when urinating, abnormal discharge, or rash may indicate infection.
• Treatments:
  • Typically involve antibiotics or antivirals; full course must be completed to be effective.
• Partner Treatment:
  • Recent partners also need testing and possibly treatment to break the cycle of reinfection.

Birth Control and Family Planning

23.1 Purpose of Family Planning

• Intentions:
  • Helps individuals prevent or prepare for pregnancy based on personal or medical needs.
• Method Differences:
  • Options differ in terms of reliability, side effects, user preference, and affordability.

23.2 Hormone-Based Contraceptives

• Combined Pills (Estrogen + Progestin):
  • Suppress ovulation and must be taken consistently at the same hour daily.
  • May cause nausea or slight weight gain and raise the risk for blood clots.
• Mini-Pill (Progestin-Only):
  • Often chosen by breastfeeding individuals or those sensitive to estrogen.
  • Requires strict timing to maintain effectiveness.
• Injections (e.g., Depo-Provera):
  • Given every 12 weeks; may lead to irregular cycles or decreased bone strength over time.
• Implants (e.g., Nexplanon):
  • Placed under the skin in the upper arm and effective for multiple years.

23.3 IUDs (Intrauterine Devices)

• Copper IUD:
  • Hormone-free and usable for up to 10 years; periods may become heavier or more painful.
• Hormonal IUD:
  • Releases progestin and can remain effective for 3–7 years depending on type; may reduce menstrual flow.

23.4 Barrier Protection

• Male Condoms:
  • Effective at reducing STI risk and pregnancy when used properly each time.
• Female Condoms:
  • Placed inside the vagina and offer a barrier against infections and pregnancy.
• Diaphragm/Cervical Cap:
  • Requires professional fitting and used along with spermicidal gel to block sperm entry.

23.5 Natural Contraceptive Methods (Fertility Tracking)

• Relies on observing physical fertility signs such as daily temperature patterns, vaginal discharge consistency, or cycle timing to estimate fertile windows.
• Most reliable when followed closely and used by individuals with consistent menstrual cycles.

23.6 Irreversible Birth Control Options

• Vasectomy (Male Procedure):
  • A quick outpatient procedure that interrupts the pathway for sperm, making fertilization highly unlikely.
• Tubal Procedure (Female Sterilization):
  • Involves closing off or cutting the fallopian tubes surgically to keep eggs from meeting sperm inside the reproductive system.

Guide to Comparing Contraceptive Options

Method	Typical Use Failure Rate	Advantages	Disadvantages
Oral Contraceptives	Around 7% with regular use	Helps with cycle control, may reduce acne breakouts	Requires daily consistency, possible risk of blood clots
Male Condom	About 13%	Protects against STIs, easy to obtain	May tear or fall off, needs proper use every time
Copper IUD	Less than 1%	Non-hormonal and effective for many years	May lead to heavier periods and more cramps
Levonorgestrel IUD	Less than 1%	Provides extended protection, may reduce menstrual flow	Must be inserted/removed by clinician, may cause hormonal side effects
Implant (Nexplanon)	Less than 1%	Effective for 3–5 years without daily attention	Can cause spotting; requires medical insertion and removal
Depo-Provera (injection)	Approximately 6%	Given every 3 months, low maintenance	May cause weight changes, affect bones, and delay fertility return