Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2007 by Pearson Education, Inc. Upper...

Bledsoe et al., Essentials of Paramedic Care: Division 1© 2007 by Pearson Education, Inc. Upper Saddle River, NJ

Division 1Introduction to Advanced

Prehospital Care


Chapter 5Life-Span Development


Topics

Infancy

Toddler

Preschooler

School age

Adolescent

Early Adult

Middle-aged Adult

Late-aged Adult

Characteristics of the following life stages:


Normal Vital Signs


Infancy


Physiological Development

The younger the child, the more rapid the pulse and respirations.

Blood pressure is related to age and weight.


Weight

Normal birth weight is 3.0–3.5 kg.

Weight drops within first week due to excretion of extracellular fluid.

First month infants grow approximately 30 grams per day.

Infant’s head is equal to 25% of the total body weight.


Infants double their weight by 4 to 6 months old and triple it by

9 to 12 months.

© Michal Heron


Cardiovascular System

Several changes occur to transition the infant from fetal to pulmonary circulation:– The ductus venosus constricts.– The foramen ovale closes.– The ductus arteriosus constricts.


Pulmonary System

Infant’s airway is shorter, narrower, less stable, and more easily obstructed than at any other time.

Infants are obligate nose breathers.

Lung tissue is fragile.

Accessory muscles are immature.

Chest wall is less rigid; ribs are horizontal, causing diaphragmatic breathing.


Renal System

Kidneys are unable to produceconcentrated urine, so infants are much more easily dehydrated.


Immune System

The fetus acquires some of the mother’s immunity which may remain active for six months to a year after birth.


Nervous System (1 of 2)

Infants lack ability to localize pain.

Infants have several reflexes that disappear over time:– Moro reflex (startle)– Palmar grasp– Rooting reflex– Sucking reflex


Nervous System (2 of 2)

Fontanelles allow for compression of head during childbirth and allow for rapid growth of brain.

Newborns sleep 16–18 hours daily, evenly distributed over a 24-hour period.

Sleep decreases to 14–16 hours, with a 9–10 hour period at night.


Musculoskeletal System

Extremities grow from growth plates.

Epiphyseal plates are secondary growth centers.


Other Characteristics (1 of 3)

Two MonthsRecognizes familiar faces and objects

Three MonthsMoves objects to mouth, displays primary emotion

Four MonthsReaches out to people

Five Months

Sleeps through the night, differentiates between family and strangers



Six MonthsSits upright, makes single syllable sounds

Seven MonthsExhibits fear of strangers

Eight MonthsResponds to the word "no," sits alone, plays "peek-a-boo"

Nine Months

Pulls up to standing position, explores objects by mouthing, sucking, chewing, and biting them



Ten Months Pays attention to name, crawls well

Eleven Months

Attempts to walk without assistance, shows frustration about restrictions

Twelve Months Can walk without help, knows name


Psychosocial Development


Family Processes andReciprocal Socialization

Crying

Attachment

Trust vs. mistrust


Crying

Crying is an infant’s only means of communication.

Mothers quickly learn to distinguish the differences between cries.


AttachmentSecure attachment– Infant learns that caregivers will be

responsive and helpful when needed.

Anxious resistant attachment– Infant learns to be uncertain about

whether or not caregivers will be responsive.

Anxious avoidant attachment– Infant learns that caregivers will not be

responsive or helpful when needed.


Trust vs. Mistrust

Infant wants the world to be an orderly place where causes and effects can be anticipated.

Infant develops trust when he or she can count on consistent parental care.

Mistrust develops if he or she cannot count on parental care.


Scaffolding is a teaching/learningmethod whereby the infant builds on

what he or she already knows.


Temperament

Easy child:– Regular body functions– Low or moderate intensity of reactions– Accepts new situations

Difficult child:– Irregular body functions– Intense reactions– Withdrawal from new situations

Slow-to-warm-up child:– Low intensity of reactions and

somewhat negative mood


Parental Separation Stages

Protest

Despair

Detachment or withdrawal


Toddler and Preschool Age


A toddler beginning to stand and walk on his own

© Michal Heron


Body System Changes (1 of 3)

Cardiovascular:– Capillary beds better developed

and assist in thermoregulation.– Hemoglobin levels approach

normal adult levels.

Pulmonary:– Alveoli increase in number.– Chest muscles still immature.



Renal:– Kidneys well developed.– Urine characteristics similar to adult.

Immune:– Passivity immunity is lost and child is

susceptible to minor respiratory and GI infections.

Nervous:– Brain at 90% of adult weight.– Myelination has increased.– Fine motor skills developing.



Musculoskeletal:– Muscle mass and bone density increase.

Dental:– All primary teeth have erupted by the age

of 36 months.

Senses:– Visual acuity is 20/30 during toddler

years.– Hearing reaches maturity at 3 to 4 years

old.


In the preschool-age child, exploratory behavior accelerates.

© Michal Heron


Psychosocial Development (1 of 2)

Cognition:– Starts to grasp meaning of words at 1

year.– By 3 or 4, has mastered basics of

language.– Between 18 and 24 months, begins to

understand cause and effect.– By 24 to 36 months, develops magical

thinking and engages in play-acting.

Play:– Able to play simple games and follow

basic rules.


Psychosocial Development (2 of 2)

Sibling relationships:– Sibling rivalry may occur.

Peer group functions:– Provide source of information about other

families and the outside world.


Parenting Styles

Authoritarian parents are demanding and desire instant obedience.

Authoritative parents believe both they and the children have rights and try to maintain a balance.

Permissive parents take a tolerant, accepting view of a child’s behavior.


Divorce and Child Development

Children express feelings of shock, depression, and fear that their parents no longer love them.

May feel abandoned.

Cannot see the divorce from the parent’s perspective.


Television and Modeling

Television:– TV violence increases aggression.– Increases passive acceptance of use of

aggression by others.

Modeling:– Begin to recognize sexual differences

and begin to incorporate gender-specific behaviors of parents, siblings, and peers.


School Age

Ages 6 to 12 Years Old


School-age children are allowed more self-regulation and independence

as they grow older.

© Michal Heron



Average child gains 3 kg per year.

Vital signs reach adult levels.

Lymph tissues are proportionately larger than those of an adult.

Brain function increases in both hemispheres.

Primary teeth are being replaced by permanent ones.



Development of self-concept.

Begin to develop self-esteem.

Moral development begins:– Pre-conventional reasoning– Conventional reasoning– Post-conventional reasoning


Adolescence



Children reach reproductive maturity during adolescence.

Index Stock Imagery, Inc.



Usually experience a rapid two- to three-year growth spurt.

Both males and females reachreproductive maturity.

Muscle mass and bone growth are complete.


Psychosocial DevelopmentFamily conflict may occur as the adolescent strives for autonomy and parents strive for continued control.Privacy and modesty become important.There is a need to be treated as an adult.There is increased idealism, which leads to disappointment.Depression and suicide are more common at this age than any other.


Ethical Development

Development of logical, analytical, and abstract thinking occurs.

A personal code of ethics develops.


Early Adulthood



Peak physical conditions occur in early adulthood.


Physiological Development (1 of 2)

The body begins its slowing process.

Spinal discs settle, leading to decreased height.

Fatty tissue increases, leading to weight gain.

Childbirth is common in this stage.



Muscle strength decreases.

Accidents are the leading cause of death.

The highest levels of job stress occur.

Love develops.


Middle Adulthood

Ages 41 to 60


People in middle adulthood still function at a high level.



Hearing and visual changes occur.

Cardiac output decreases andcholesterol levels increase.

Cancer often strikes this age group.

Weight control is more difficult.



For women in their late 40s and early 50s, menopause commences.

Offspring have left home, and “empty-nest syndrome” may occur.

Often there are financial commitments to elderly parents and young adult children.


Late Adulthood

Ages 61 and Older


The ability to learn and adjust continues throughout life.


Cardiovascular System

Vessel walls thicken.Increased peripheral vascular resistance, and reduced blood flow to organs.Decreased baroreceptor sensitivity.Decreased vessel elasticity.Heart starts showing disease.Functional blood volume decreases, as well as red blood cells.


Respiratory System

Trachea and large airways increase in diameter.

Decreased surface area of lungs as well as decreased elasticity in the lungs.

Coughing is less effective due to weakened chest wall and bone structures.


Endocrine System

Glucose metabolism and insulin production decrease.

The thyroid shows diminished triiodothyronine production.

Cortisol is diminished by 25%.

The pituitary is 20% less effective.

The reproductive organs atrophy in women.


Gastrointestinal System (1 of 2)

Tooth loss can lead to dietary changes, increased chance of malnutrition, vitamin and mineral deficiency.

The swallowing mechanism changes.

Peristalsis is decreased and the gastric sphincter is less effective.


Gastrointestinal System (2 of 2)

Stomach secretions decrease.

Intestines atrophy.

Metabolism and absorption change.


Renal System

Reduced kidney function leads to decreased clearance of some drugs and decreased elimination.

The kidneys’ hormonal response to dehydration is reduced.

The kidneys are less able to modify vitamin D to a more active form.


The Senses

Taste buds diminish.

Smell declines, and parts of the brain involved in smell degenerate.

Response to pain is diminished.

Ability to sense movement diminishes.

Visual acuity decreases, and reaction times increase.

Hearing decreases.


The Nervous System

Neurotransmitters are decreased.

Loss of coordination and memory.

Sleep problems may occur.



The terminal drop hypothesis states that death is preceded by a five-year period of decreasing cognitive function.


Challenges

Housing becomes a challenge.

Maintaining a sense of self-worth becomes a problem as it is harder to care for themselves.

Finances become stressful with retirement and the decreased ability to work.


Dying Companions or Death

Because of the death or impending death of companions, fear and grief are present.

People must go through the stages of the grieving process.


Summary

Infancy

Toddler

Preschooler

School age

Adolescent

Early Adult

Middle-aged Adult

Late-aged Adult

Characteristics of the following life stages:

Bledsoe et al., Essentials of Paramedic Care: Division 1 © 2007 by Pearson Education, Inc. Upper...

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