Herd Immunization
- Though voluntary, compliance rates below 90% tend to create susceptibility in the public.
- Vaccination rates above 90-95% establishes “herd immunization”
- Herd immunization confers protection to an entire community, on the theory that a virus cannot spread effectively when most members are immune to it. (The virus is stopped from spreading to those who don’t have immunity)
Vaccination hesitancy
- While vaccines are known to cause minor, temporary side effects like soreness or fever, there is little, if any, evidence linking vaccination with permanent health problems or death.
- The vast majority of vaccine adverse events are minor and temporary, like a sore arm or mild fever.
- We have seen in health care increasing numbers of families choosing to defer vaccinations for their children, or to decline to vaccinate altogether.
Fears:
-autism rates have been increasing –> the rates of autism increasing have in fact been linked to a variety of other factors –> autism symptoms first become apparent at a specific age due to expected developmental milestones.
- the first signs and symptoms of autism generally appear in individual children around the age that vaccinations such as the MMR shot are given.
- concern about the effect of the mercury Thimerosal being used in vaccines –> Thimerosal has been removed from all childhood vaccines, and multiple studies have shown no link between Thimerosal exposure and autism
How do they give the vaccine?
Most vaccinations are delivered via Intramuscular (IM) Injection.
The Vastus lateralis is the largest part (vastus = large) of the Quadriceps femoris muscle.
IM injection is given to anterolateral aspect of thigh (just to the side of front of thigh) and in middle third of thigh.
This vaccination site used during vaccinations at 2, 4 and 6 months.
The thigh used as may be used for IM injection site for children up to about the age of 18 months (other muscles may not be well enough developed yet). Hip and knee should be flexed as in top picture. (next slide)
Toddler Characteristics
- Age range is 12-15 months to about 3 years
- Growth is steady but slower than infancy
- Mean height at 30 mos. is 36” & weight is 30 lbs
- Gains in height are greater than gains in weight.
- Many children are ambidextrous and don’t show a hand preference until about 3.5 years. Left-handedness associated with higher accident rate.
- You can double girl’s height at 2 years and boy’s height at 2.5 years to gain an estimate of final adult height.
Appearance “Baby fat” lost by about 12-15 mos. Muscle tone improves Has about 16 deciduous (impermanent) teeth by 2 yrs. Limbs grow faster than torso
Separation Responses For Parents
In general, anxiety on separation from mother or father is particularly intense between 18 – 24 months
On long term separation, a grief response may be noticed:
- Protest: lasts few hours or days (seen during short and long separations). Child cries continually, ties to find her, is terrified, fears he or she has been deserted. Clings to mother on her return.
- Despair: a quiet stage, characterized by moaning, sadness, reduced activity, feels abandoned. Does not cry continuously but is in deep mourning. Does not make demands on the environment. May not respond to overtures by others, even those of mother on her return … however, may cling to her when she does return.
- Denial: occurs after prolonged separation. Becomes more involved with environment and others: plays, accepts other adults, can be misinterpreted as recovery. However, anger and disappointment related to prolonged separation are deep, so that child may appear to act as though he or she does not need mother on return … appears to reject mother
Motor Control
Preference for handedness not shown until about 3 ½ years
Tend to be ambidextrous
Gross motor skills characteristically include
Walking up and down stairs while holding rail
Kicking or throwing large ball [with both hands]
Using outstretched arms and body to catch
Balancing on one foot for very brief time
Climbing on and off chairs without assistance
Fine motor skills include
Turning door knobs
Drinking from cup with one hand
Turning pages of a book
Zipping and unzipping large zippers
Buttoning and unbuttoning large buttons
Brushing teeth with help
Putting on and taking off simple articles of clothes
Language Development
- Words begin to replace behaviour, as word storage increases
- Verbal communication becomes more understandable
- Speech increasingly becomes a mechanism to think and explain the world
- Movement from syncretic to telegraphic speech patterns
Cognitive Development
-Primary means of learning is “learning by doing”
-Imitation & helping others are important learning mechanisms
-According to Piaget’s Theory of Cognitive Development, at this stage, toddlers move from the “sensorimotor” stage of development to the “preoperational” stage
-More tools exist to promote learning
(Trial and error, and, greater use of memory & past experiences, Repetition, Experimentation)
-Language is increasingly used for thinking, & the toddler can often arrive at answers mentally
-Thinking is largely concrete and literal
-Thinking also tends to be egocentric
E.g. has difficulty taking the viewpoint of another person when it is different
-Toddler has a greater sense of cause & effect, and of object permanence
Play
- Play is often conceptualized as “the work of the toddler”
- As well as fun, play provides an active means to learn about many things, such as socialization, rules, and the expectations of interactions
Forms of play
- Solitary
- Parallel
Toddler Independence
- newly acquired physical, language, & cognitive skills promote interest in greater autonomy or independence
- toddler is commonly interested in doing things that observes others doing, and doing things for self
- balance for parents is to nurture expressions of independence, but in a safe, appropriate manner
Toilet Training
Children often show signs of readiness between 18 and 24 months, although some may be ready earlier or later than that.
Observe signs from your child that tell you it’s time to start toilet teaching:
-follow simple instructions
-understand words about the toileting process
-regulate the muscles responsible for elimination
-express a need to go
-keep a diaper dry for 2 hours
-get to the potty on her own
-pull down diapers or underpants
(Boys typically start later and take longer to learn to use the potty than girls – but of course not always!)
Summarize Toddlers
- have learned to walk and are substantially more mobile
- have become increasingly more skillful, but fine motor skills are still outstripped by gross motor skills
- are curious and take initiative to act and try new things
- tend to be egocentric and have difficulty taking other points of view
- have increasing, but still relatively short attention spans
- have difficulty deferring gratification
Discipline
-Discipline is a more complete concept than punishment. Punishment may be one form of discipline, but it can also be an action or reaction simply meant to reinforce relationship hierarchies.
-In its ideal, discipline is based on due consideration of the child’s “best interests”. It is a means of guidance that permits the child to effectively differentiate between what is right and what is wrong, or what is acceptable or not acceptable.
-As a general rule, discipline should be applied in a consistent and calm manner. Why?
>Inconsistency can confuse expectations,
>Anger or rage creates the potential for harm, rather than establishing a window of learning, which is ultimately discipline’s intention.
Childhood
The age range of “childhood” is generally accepted as the range between 6-12 years old… Can be divided into
- Middle childhood 6-8
- Late childhood 8-12
Other descriptors may also be used:
- Juvenile period 6-9
- Preadolescence 9 or 10 – 12
Child Labour
-approximately 168 million children between the ages 5 and 17 who are engaged in child labour
-The effects of exploitative child labour can be profound:
Interference with education
-Exposure to workplace hazards and toxins
(notably, many industries that use child labour often exploit the child’s small size or dexterity, such that children perform tasks that are difficult for adults)
-Interference with ‘normal’ social, physical, and mental development
Erickson on Childhood
Industry vs Inferiority: developing sense of self as competent or and wanting to engage in work, versus feeling unable to do so.
This is a time of “reflected appraisals”: self-concept and self-esteem are reflections of the views of others who are significant in the child’s social environment.
Piaget on Childhood
This is a period of Concrete Operations
School aged children learn concepts best by taking part in concrete activities.
During the school aged time, children increasingly learn to organize information logically and systematically . See your textbook for additional descriptions of the following concepts: classification seriation conservation reversibility decentering
The child’s brain at this stage is becoming increasingly effective at learning!
Mental Operations
Mental Operations help us to systematically and logically organize information and make it understandable. They permit us to figure things out.
Classification: enables a child to sort objects according to a variety of attributes or features
Seriation: is a mental operation that permits children to order objects according to an increasing or decreasing measure
Conservation: is a mental operation that enables children to understand the sameness, despite a change in some aspect
Memory
•at age 5 or 6 a child is usually able to remember 2 items or digits, and by adolescence, 6 items or digits
•Children are able to use memory aids (mnemonics) to help retain information
•They also learn to use external aids (e.g. notes, calendars), rehearsal strategies (e.g. repeating a phone number over and over), and information organization strategies (breaking information into smaller bits for memorization)
–>[e.g. instead of 4 bits of information such as 1, 2, 3, 4, can create 2 bits of information to remember: 12 and 34]
Accidents
- Accidents are the leading cause of death in this age group
- boys two times more likely to die due to accident
- car accidents account for 1/2 of childhood accidental deaths
- fires, falls, drowning and poisoning are also prominent
TV/Computers
- On average, Canadian children between 2-11 watch about 18 hrs of TV/week.
- By the end of high school, the average child will have watched 15,000 hrs of TV, the equivalent of about 1 ¾ years.
- In North America, the average TV is turned on for 7 hrs/day.
- A common practice is eating meals or snacking in front of the TV
- Online behaviour is becoming increasingly time-consuming
- The amount of TV time has actually been decreasing.
- The Canadian pediatric society suggests no more than 1 hour per day for preschoolers. American pediatric society recommends no TV watching for children less than two (although surveys show more than 2/3 children less than two watch TV daily).
- Studies show that even 1 – 2 hours per day for school aged children can have a harmful effect on academic performance, particularly reading.
- There is a growing professional consensus that some children may be more susceptible to violent content and messages than others.
- There is a correlation between childhood obesity and TV watching.
Childhood obesity in Canada
-Between 1978/79 and 2004, the combined prevalence of overweight and obesity among those aged two to 17 years increased from 15% to 26%
-Increases were highest among youth, aged 12 to 17 years
-If current trends continue, by 2040, up to 70% of adults aged 40 years will be either overweight or obese.”
-Obese children are more likely to develop a range of health problems, including:
>high blood pressure or heart disease
>type-2 diabetes
>low self-esteem and negative body image
>depression
-Children and teenagers should participate in at least 60 minutes of physical activity per day.
-Childhood obesity is linked to the over-consumption of sugary beverages
Eating Disorders
- We are also seeing a dramatic increase in the prevalence of eating disorders
- This is true of all genders
- young people by far are the most impacted group (especially ages 15-19)
- Children with televisions were 3 times more likely to have an eating disorder.
- some people are susceptible to eating disorders due to combinations of genetics and certain psychological traits. -Exposure to media messages, especially to the so-called thin ideal, or to the male muscular ideal, plays a powerful role in triggering the disorder in those people.
