JAYSON, CRISTINA L.

BSN 4B

HEALTH TEACHING PLAN FOR INFANTS, TODDLERS, PRESCHOOLERS, SCHOOLERS, AND ADOLESCENTS BASED ON THE FOLLOWING:
GENERAL HEALTH TEACHING 1. INFANT a. NUTRITION SPECIFIC HEALTH TEACHINGS a. First 6 months Breast Feeding This is the most desirable complete diet for first half of the year. Recommended supplement of oral vitamin D (200 IU per day). Formula Iron fortified commercial formula is a complete food for the first half of the year. Other health teachings:

Exclusive breast feeding is recommended for the first 6 months. All the necessary nutrients, vitamins, minerals, and water are provided by human milk for the first 6 months of life, with exception of vitamin K ( 1 mg intramuscularly is administered at birth); vitamin D ( 200 IU of oral vitamin D drops is administered daily bekginning during the first 2 months of life if there is limited sunlight exposure); vitamin B12 if the mother is a strict vegetarian and takes no B12 supplement; and fluoride, but only if this is not included in the water supply (Thilo & Rosenberg, 2008). With exclusive breastfeeding, an infant is fed only breastmilk. The infant is given no other food or liquid, not even water (WHO, 2008). Infants who are exclusively breastfed may still receive vitamin and mineral supplements or medicines, in the form of drops or syrups. They may be given oral rehydration solution, if needed (WHO 2008). Exclusive breastfeeding to six months of age is associated with continued protection for the infant against gastrointestinal infections and illness

(Kramer et al., 2003; Kramer & Kakuma, 2002) as well as respiratory tract infections (Chantry, Howard, & Auinger, 2006). The breastfeeding mother also benefits from exclusively breastfeeding her infant to six months. Her weight loss is more rapid after birth and there may be a delayed return of menses (Kramer & Kakuma, 2002). How long to continue breastfeed is an individual choice, although it is recommended through the entire first year

b. Second 6 months Introduce solid foods while still continuing breastfeeding The entire first year of life is one of extremely rapid growth, so a high protein, high calorie intake is necessary. Early weaning from breast feeding can lead to an increased incidence of obesity. For infants whose mothers choose not to breastfeed, a commercial iron fortified formula will supply adequate nutrition. Supplementation is unnecessary with iron fortified commercial formula unless the water supply does not contain fluoride. c.

Selection and Preparation of Solid Foods/Quantities & Types of Food 5 6 months: Iron fortified infant cereal mixed with breast milk, orange juice, or formula. Rationale: Aids in preventing iron deficiency anemia; the least allergenic type of food; an easily digested food 7 months: Vegetables Rationale: Good source of vitamin A; adds new texture and flavors to diet 8 months: Fruit Rationale: Best source of vitamin , good source of vitamin ; adds new texture and flavors to diet 9 months: Meat Rationale: Good source of protein, iron, and B vitamins 10 months: Egg yolk Rationale: Good source of iron

d. Introduction of Solid foods Delaying solid food until this 4 to 6 months helps prevent overwhelming an

infants kidneys with a heavy solute load that can occur when protein is ingested. Infants are physiologically ready for solid food when they are nursing vigorously every 3 to 4 hours and do not seem satisfied or taking more than 32 oz (960 mL) of formula a day and do not seem satisfied. Introduce one food at a time, waiting 5 to 7 days between new items. Introduce the food before formula or breastfeeding when an infant is hungry. Introduce small amounts of new food (1 or 2 tsp) at a time. Respect infant food preferences; a child cannot be expected to like all new tastes equally well. Use only minimal to no salt and sugar on solid foods to minimize the number of additives. Remember that the extrusion reflex is present for the first 4 to 6 months of life, so any food placed on an infants tongue will be pushed forward. To prevent aspiration, do not place food in bottles with formula. Introduce foods with a positive, Youll like this attitude.

e. Weaning To wean from formula or breast milk, choose one feeding a day and then begin offering fluid by the new method at that feeding Choose a time of day that is not an infants fussy period After 3 days to 1 week, when an infant has become acclimated to the one change, change a second feeding Should an illness such as an upper respiratory infection occur or should the child have teething setbacks, so no set number of weeks should be prescribed to complete weaning Infants usually need more fluid during hot weather than cold weather because of increased perspiration this may make it more difficult to begin weaning during summer. f. Self-feeding Can be started at approximately 6 months of age There is great deal of spilling during feeding due to underdeveloped coordination Spread newspapers, a plastic tablecloth, or a towel on the floor around a high

chair to catch most of the dropped food, and then let the child practice. Let the child take in charge of the feeding When infants no longer attempt to feed themselves at a meal but merely begin to play with their food by squeezing it through their fingers or dabbing it in their hair, it is time to end the meal. This behavior indicates that they have had enough.

b. SLEEP AND ACTIVITY

Sleep Problems Nighttime Feeding Increase daytime feeding intervals to 4 hr or more (may need to be done gradually). Offer last feeding as late as possible at night; may need to gradually reduce amount of formula or length of breast feeding. Offer no bottles in bed. Put to bed awake. When child is crying, check at progressively longer intervals each night; reassure child but do not hold, rock, take to parents bed, or give bottle or pacifier. Developmental Night Crying Reassure parents that this phase is temporary. Enter room immediately to check on child but keep reassurances brief. Avoid feeding, rocking, taking to parents bed, or any other routine that may initiate trained night crying. Refusal To Go To Sleep Evaluate if hour of sleep is too early (child may resist sleep of not tired). Assist parents in establishing consistent before bedtime routine and enforcing consistent limits regarding childs bedtime behavior. If child persists in leaving bedroom, close door for progressively longer periods. Use reward system with child to provide motivation. Trained Night Crying (Inappropriate Sleep Associations) Put child in own bed awake. If possible, arrange sleeping area separate from other family members.

When child is crying, check at progressively longer intervals each night; reassure child but do not resume usual routine.

Nighttime Fears Evaluate if hour of sleep is too early (child may fantasize when nothing to do but think in dark room). Calmly reassure frightened child; keeping night light on may be helpful. Use reward system with child to provide motivation to deal with fears. Avoid patterns that can lead to additional problems (e.g., sleeping with child or taking child to parents room). If childs fear is overwhelming, consider desensitization (e.g., progressively spending longer time alone; consult professional help for protracted fears). Distinguish between nightmares and sleep terrors (confused partial arousals). c. DENTAL HEALTH a. Oral Hygiene Once the primary teeth erupt, cleaning should begin. The teeth and gums are initially cleaned by wiping with a damp cloth; tooth brushing is too harsh for the tender gingiva. Oral hygiene can be made pleasant by singing or talking to the infant. Infants should have an oral health examination by 6 months of age from a qualified pediatric health practitioner. Infants at high risk for dental caries should be seen by a dentist between 6 months and 1 year of age. Use small, soft bristled tooth brush as more teeth erupt and the infant adjusts to the routine of cleaning. Fluoride is needed beginning at 6 months of age if the infant does not receive water with adequate fluoride content. b. Diet Avoid propping the milk bottle or giving the milk bottle in the bed Avoid fruit juices in a bottle, especially before 6 months of age Foods with concentrated sugar (sucrose) are used sparingly (if at all) in the infants diet. The practice of coating pacifiers with honey or using commercially available hard candy pacifiers is discouraged. Besides being cariogenic, honey also may cause infant botulism, and parts of

the candy pacifier can be aspirated.

d. INJURY PREVENTION

a. Aspiration of Foreign Objects Birth to 4 months Never shake baby powder directly on infant; place powder in hand and then on infants skin; store container closed and out of infants reach. Hold infant for feeding; do not prop bottle. Know emergency procedures for choking. Use pacifier with one piece construction and loop handle. 4 to 7 months Keep buttons, beads, syringe caps, and other small objects out of infants reach. Keep floor free of any small objects. Do not feed infant hard candy, nuts, food with pits or seeds, or whole or circular pieces of hot dog. Exercise caution when giving teething biscuits, since large chunks may be broken off and aspirated. Do not feed infant while he or she is lying down. Inspect toys for removable parts. Keep baby powder, if used, out of reach. 8 to 12 months Keep lint and small objects off floor, off furniture, and out of reach of children. Take care in feeding solid table food to give very small pieces. Do not use beanbag toys or allow child to play with dried beans. b. Suffocation Birth to 4 months Keep all plastic bags stored out of infants reach; discard large plastic garment bags after tying in a knot. Do not cover mattress with plastic Use firm mattress and loose blankets; no pillows Make certain crib design follows federal regulations and mattress fits snugly cribs slats 6 cm (2.375 inches) apart Position crib away from other furniture and away from radiators. Do not tie pacifier on a string around infants neck.

Remove bibs at bedtime. 4 to 7 months Keep all latex balloons out of reach. Remove all crib toys that are strung across crib or playpen when child begins to push up on hands or knees or is 5 months old. 8 to 12 months Keep doors of ovens, dishwashers, refrigerators, coolers, and front loading clothes washers and dryers closed at all times. If storing an unused appliance, such as a refrigerator, remove the door. Supervise contact with inflated balloons, immediately discard popped balloons, and keep uninflated balloons out of reach.

c. Motor Vehicle injuries/Car Safety Transport infant in federally approved, rear facing car seat, preferably in back seat. Do not place infant on seat of car or in lap. Do not place child in a carriage or stroller behind a parked car. Do not place infant or child in front passenger seat with an air bag unless air bag is deactivated. d. Falls Birth to 4 months Always raise crib rails. Never leave infant on a raised, unguarded surface. When in doubt as to where to place child, use floor. Restrain child in infant seat and never leave child unattended while the seat is resting on a raised surface. Avoid using a high chair until child can sit well with support. 4 to 7 months Restrain in a high chair. Keep crib rails raised to full height. 8 to 12 months Avoid walkers, especially near stairs. Ensure that furniture is sturdy enough for child to pull self to standing position and cruise. Fence stairways at top and bottom if child has access to either end. Dress infant in safe shoes and clothing (soles that do not catch on floor,

tied shoelaces, pant legs that do not touch floor). e. Poisoning Birth to 4 months This is not as great danger to this age group, but begin practicing safeguards early (see under 4 to 7 months). 4 to 7 months Make sure that paint for furniture or toys does not contain lead. Place toxic substances on a high shelf or in locked cabinet. Keep medication vials and bottles locked in a secure place. Hang plants or place on high surface rather than on floor. Avoid storing large quantities of cleaning fluid, paints, pesticides, and other toxic substances. Discard used containers of poisonous substances. Do not store toxic substances in food containers. Keep cosmetic and personal products out of childs reach. Discard used button size batteries; store new batteries in safe area. Know telephone number of local poison control center (usually listed in front of telephone directory). 8 to 12 months Administer medications as a drug, not as a candy. Do not administer medications unless prescribed by a practitioner. Replace medications and poisons immediately after use; replace caps properly if a child protector cap is used. Have syrup of ipecac in home; use only if advised. Keep phone number for poison control center readily available. f. Burns Birth to 4 months Install smoke detectors in home. Use caution when warming formula in microwave oven; always check temperature of liquid before feeding. Check bath water. Do not pour hot liquids when infant is close by, such as sitting on lap. Beware of cigarette ashes that may fall on infant. Do not leave infant in sun for more than a few minutes; keep exposed areas covered. Wash flame retardant clothes according to label directions.

Use cool mist vaporizers. Do not leave child in parked car. Check surface heat of car restraint before placing child in seat. 4 to 7 months Keep faucets out of reach. Place hot objects (cigarettes, candles, incense) on high surface. Limit exposure to sun; apply sunscreen. 8 to 12 months Place guards in front of or around any heating appliance, fireplace, or furnace. Keep electrical wires hidden or out of reach. Place plastic guards over electrical outlets; place furniture in front of outlets. Keep hanging tablecloths out of reach (child may pull down hot liquids or heavy or sharp objects). g. Drowning/Bathing and Swimming Safety Never leave infant alone in bath. Fence swimming pools. Always supervise when near any source of water, such as cleaning buckets, drainage areas, or toilets. Keep bathroom doors closed. Eliminate unnecessary pools of water. Keep one hand on child at all times when in tub. h. Bodily Damage Birth to 4 months Keep sharp, jagged objects out of childs reach. Keep diaper pins closed and away from infant. 4 to 7 months Give toys that are smooth and rounded, preferably made of wood or plastic. Avoid long, pointed objects as toys. Avoid toys that are excessively loud. Keep sharp objects out of infants reach.

2. TODDLER a. NUTRITION

a. Nutritional Counseling Meal times should be enjoyable rather than times for discipline or family arguments.

b. SLEEP AND ACTIVITY

c. DENTAL HEALTH

Call toddlers 15 minutes before mealtime to allow them ample opportunity to get ready for eating while settling down their active minds and bodies. Offer less than toddlers may eat and let the child ask for more. Provide frequent, nutritious, planned snacks Use plastic dishes and cups Introduce at least three items from the groups in the MyPyramid guide at each meal to help develop a variety of taste preferences and well balanced habits. For snacks, several small pieces of food (carrot sticks, cheese blocks, raisins, crackers, sliced cold meat, apple slices) can be placed in an ice cube tray for a pick-and-choose menu. Fruit juices should not be offered as a replacement for fruit snacks or for daily requirement of fruits. The American Academy of Pediatrics recommends that fruit juice intake not exceed 4 to 6 oz/day. a. Sleep Problems Bedtime rituals (same hour of sleep, snack, quiet activity) are helpful. Provide transitional objects such as favorite stuffed animal or blanket a. Regular Dental Examination/Tooth Care The American Academy of Pediatrics, Section on Pediatric Dentistry (2003a), now recommends that every child have an oral health examination by a practitioner by 6 months of age. If the child is in a high risk category for caries, an initial visit to a dentist or pedodontist (pediatric dentist) by age 6 months or within 6 months of the eruption of the first tooth is recommended. b. Removal of Plaques The most effective method for plaque removal are brushing and flossing. One that is suitable for cleaning the primary teeth is the scrub method. The tips of the bristles are placed firmly at a 45 degree angle against the teeth and gums and are moved back and forth in a vibratory motion. The ends of the bristles should be moving gently to avoid damaging the gums and enamel. The most effective cleaning is done by parents. Several positions facilitate access to the mouth and help stabilize the head for comfort: Stand with childs back toward adult. Sit on a couch or bed with childs head resting in adults lap.

Sit on the floor or a stool with childs head resting between adults thighs. With all positions, use one hand to cup the chin and the other to brush the teeth. For easier access to back teeth, hold the mouth partially open. For effective cleaning, a small toothbrush with soft, rounded, multitufted nylon bristles that are short and uniform in length is recommended. Toothbrushes should be replaced every 3 months or as soon as the bristles are frayed or bent. When using toothpaste, children should select the flavor they like to encourage brushing habit. c. Fluoride Base recommendation on the fluoride concentration in childs drinking water, including bottled water, filtered and well water, and processed food. If water is fluoridated, use tap water for drinking and for preparation of formula (except soy formula, which has twice the fluoride of regular formula), frozen concentrated juices, powdered mixes, soups, ice, and gelatin. If the water is nonfluoridated or contains less than 0.3 ppm (ages 6 months to 3 years) or less than 0.6 ppm (ages 3 to 6 years) fluoride, or if child refuses to drink tap water or refuses drinks or foods made with tap water, consider fluoride supplements. If the water, such as water from some wells or springs, has a concentration of fluoride above the recommended level, encourage use of bottled nonfluoridated water for drinking. Encourage supervision of toddler when brushing teeth or using a fluoridated mouth rinse to prevent overingestion of fluoridated topical supplement. Use fluoridated toothpaste. Consider other sources of fluoride from diet, such as tea. d. Diet Encourage a low cariogenic diet such as raw, fresh fruits and vegetables Natural foods, including honey, molasses, corn syrup, and dried fruits such as raisins, are highly cariogenic. Complex carbohydrates, such as breads, potatoes, and pasta, also contribute to caries because they lower the plaque pH. Eliminate bedtime bottle completely. Feed the last bottle before bedtime

d. DRESSING AND BATHING

e. INJURY PREVENTION/TODDLER SAFETY

Substitute a bottle of water for sweet liquids Do not use the bottle as a pacifier Never coat pacifiers in sweet substances a. Guidelines When toddlers dress themselves, they invariably put shoes on the wrong feet and shirt and pants backward. Parents should give up perfection for the benefit of the childs developing sense of autonomy. If children end up with underpants or shirt on backward, in most instances it does not make that much difference, and toddlers are not likely to feel independent and confident if their attempts at dressing are criticized. If parents feel they must change the childs clothes, they should begin with a positive statement, such as You did a good job, before making the switch. As soon as children are up on their feet and walking, they need shoe soles that are firm enough to provide protection from rough surfaces. However, toddlers do not need extremely firm or ankle high shoes. Because a toddlers arches are still developing, it is better for their arches to provide foot support rather than having it provided by shoes. Sneakers are an ideal toddler shoe because the soles are hard enough for rough surfaces and arch support is limited. The time for a toddlers bath should depend on the parents and the childs wishes and schedule. Toddlers usually enjoy bath time, and parents should make an effort to make it fun by providing a toy, such as a rubber duck, boat, or plastic fish. Although toddlers can sit well in bathtub, it is still not safe to leave them alone unsupervised. They might slip and get their head under water or reach and turn on the hot water faucet and scald themselves. a. Motor Vehicle injuries Use federally approved car restraint; if restraint not available, use lap belt. Supervise child while playing outside. Do not allow child to play on curb or behind a parked car. Do not permit child to play in pile of leaves, snow, or large cardboard container in trafficked area. Supervise tricycle riding; have child wear helmet. Limit playing in driveways with parked cars or provide physical barriers limiting access. Lock fences and doors if not directly supervising children.

Teach child to obey pedestrian safety rules: - Obey traffic regulations; cross only at crosswalks and only when traffic signal indicates it is safe. - Stand back a step from the curb until it is time to cross. - Look left, right, and left again and check for turning cars before crossing street. - Use sidewalks; when there is no sidewalk, walk on left, facing traffic. - Wear light colors at night and attach fluorescent material to clothing. b. Drowning Supervise closely when near any source of water, including buckets. Never, under any circumstance, leave unsupervised in bathtub or around bathtub filled with water. Keep bathroom doors closed and lid down on toilet. Have fence around swimming pool and lock gate Teach swimming and water safety. c. Burns Turn pot handles toward back of stove. Place electric appliances, such as coffee maker and popcorn machine, toward back of counter. Keep electric curling irons out of childs reach. Place guardrails in front of radiators, fireplaces, or other heating elements. Store matches and cigarette lighters in locked or inaccessible area; discard carefully. Place burning candles, incense, hot foods, and cigarettes out of reach. Do not let tablecloth hang within childs reach. Do not let electric cord from iron or other appliance hang within childs reach. Cover electrical outlets with protective plastic caps. Keep electrical wires hidden or out of reach. Install smoke and carbon monoxide alarms; change batteries every 4 mo. Develop fire escape plan for the entire family and have drills. Do not allow child to play with electrical appliance, wires, or butane lighters. Stress danger of open flames; teach what hot means. Always check bathwater temperature; adjust water heater temperature to 49C (120F) or lower; do not allow children to play with faucets. Never leave young children unattended in or around bathtub they can climb in tub as well.

Apply a sunscreen when child is exposed to sunlight (all year round). d. Poisoning/Lead Screening Place all potentially toxic agents out of reach or in a locked cabinet, including cosmetics, personal care items, cleaning products, pesticides, medications. Caution against eating nonedible items, such as plants and personal cosmetic products. Immediately put away medications or poisons; replace child guard caps properly. Administer medications as a drug, not as a candy. Do not store large surplus of toxic agents. Promptly discard empty poison containers; never reuse to store food item or other poison. Never remove labels from containers of toxic substances. Know number of nearest poison control center. Post number near phone or on refrigerator. e. Falls Use window guards do not rely on screens to stop falls from windows. Place gates at top and bottom of stairs. Keep doors locked or use childproof doorknob covers at entry to stairs, high porch, or other elevated area, including laundry chute. Ensure safe and effective barriers on porches, balconies, bleachers, decks. Apply nonskid decals in bathtub or shower. Keep crib rails fully raised and mattress at lowest level. Place carpeting under crib and in bathroom. Keep large toys and bumper pads out of crib or playpen (child can use these as stairs to climb out), then move to youth bed when child is able to climb out of crib. Keep child restrained in vehicle; never leave unattended in vehicle, shopping cart, or high chair. f. Aspiration and Suffocation Avoid large, round chunks of meat, such as whole hot dogs (slice lengthwise into short pieces). Avoid fruit with pits, fish with bones, dried beans, hard candy, chewing gum, nuts, popcorn, grapes, marshmallows. Choose large, sturdy toys without sharp edges or small removable parts. Discard old refrigerators, ovens, and so on; if storing an old appliance,

remove the door. Keep automatic garage door transmitter in inaccessible place. Select safe toy boxes or chests without heavy, hinged lids. Keep window covering cords out of childs reach or use straight cords without loops. g. Bodily Damage Avoid giving sharp or pointed objects such as knives, scissors, or toothpicks, especially when walking or running. Do not allow lollipops or similar objects in mouth when walking or running. Teach safety precautions (e.g., to carry knife or scissors with pointed end away from face). Store all dangerous tools, garden equipment, and firearms in locked cabinet. Be alert to danger of supervised animals and household pets. Use safety glass on large glassed areas, such as sliding glass doors. 3. PRESCHOOL

a. NUTRITION

a. Promoting Nutritional Health Offer small servings of food Ensure that children are not snacking so frequently so that they will not miss out on planned meals For snacks, offer foods such as fruit, cheese, or milk rather than cookies and a soft drink Make mealtime a happy and enjoyable part of the day for everyone. Allow a child to prepare simple foods, such as making a sandwich or spreading jelly on toast. b. Diet Foods should be based on food pyramid groups, making sure to offer a variety. Additional vitamins are probably unnecessary if child is eating foods from all pyramid food groups and meets the criteria for a healthy child such as being alert and active, with height and weight within normal averages. If parents do give vitamins, a child will undoubtedly view a vitamin as candy rather than medicine because of the attractive shapes and colors of preschool vitamins, so they must be stored out of reach. Do not give more vitamins than the recommended daily amount, because

poisoning from high doses of fat soluble vitamins or iron can result.

b. SLEEP AND ACTIVITY

c. DENTAL HEALTH

d. DRESSING

a. Sleep Problems Preschoolers may need a night light during sleep Screen out frightening stories or television watching just prior to bedtime Continue familiar bedtime routines b. Exercise Rough housing is a good way of getting rid of tension and should be allowed as long as it does not become destructive. Promote love time honored games such as ring-around-the-rosy, London Bridge, or other more structured games. Reduce television watching. a. Care of Teeth A child should continue to drink fluoridated water or receive a prescribed oral fluoride supplement if fluoride is not provided in the water supply. One good toothbrushing period a day is often more effective than more frequent half hearted brushings. Check that all tooth surfaces are cleaned. Ensure that the child floss the teeth well. Supervise children when using an electric toothbrush and teach not to use it or any other electrical appliance near a basin of water. Encourage children to eat apples, carrots, celery, chicken, or cheese for snacks rather than candy or sweets to prevent tooth decay. 1/2 Children should have made a first visit to a dentist by 2 years of age for evaluation of tooth formation. a. Guidelines Preschoolers prefer bright colors or prints and so may select items that do not match. Children need the experience of choosing their own clothes. One way for parents to solve the problem of mismatching is to fold together matching shirts and pants so a child sees them as a set rather than individual pieces. If children insist on wearing mismatched clothes, parents should make no apologies for their appearance. A simple statement such as Mark chose his own clothes today explains the situation.

b. HYGIENE

c. INJURY PREVENTION/PRESCHOOLER SAFETY

a. Guidelines Preschoolers can wash and dry their hands adequately if the faucet is regulated for them so they do not scald themselves with hot water. Parents should turn down the temperature of the water heater in their home to under 120 F to help prevent scalds. Preschoolers do not clean their fingernails very well, so these often need touching up by a parent or older sibling. Hang a mobile over the tub so they have a reason to look up for rinsing and use a nonirritating shampoo Although preschoolers may sit well in bathtubs, they should still not be left unsupervised at bath time. Do not use bubble bath with preschoolers as some girls develop vulvar irritation (and perhaps bladder infections) from exposure to such products. a. Keeping Children Safe, Strong, and Free Warn a child never to talk with or accept a ride from a stranger Teach a child how to call for help in an emergency (yelling or running to a designated neighbor's house if outside, or dialing 911 if near a telephone) Describe what police officers look like and explain that police officers can help in an emergency situation Explain that if children or adults ask them to keep secrets about anything that has made them uncomfortable, they should tell their parents or another trusted adult, even if they have promised to keep the secret Explain that bullying behavior from other children is not to be tolerated and should be reported so they can receive help managing it b. Motor Vehicle and Bicycle Safety Safely buckle preschoolers into car seats in the back seat Stress the important role of seat belts in preventing injury in accidents and should make it a rule that the car does not move until seatbelts are fastened. Check the position of the shoulder harness so it does not go across a child's face or throat. Promote bicycle safety; provide a safety helmet approved for children their age and size. Demonstrate safe riding habits by wearing helmets as well.

4. SCHOOLER

a. NUTRITION

a. Establishing Healthy Eating Patterns Have young children collect pictures of healthy foods and make a poster for display in the school cafeteria. Make healthy foods (fruits, vegetables, whole grains, low fat snacks) available in school vending machines and at school sporting events. Discourage the use of high fat foods (candy bars) as part of school fund raising projects. Avoid the use of food as rewards for behavior; use verbal praise and token gifts to reinforce healthy eating and physical activity. Ask each child to keep a diary of foods eaten in 1 day; using the Food Guide Pyramid, evaluate these foods. b. Diet Choose a diet with plenty of grain products, vegetables, and fruits. Choose a diet low in fat, saturated fat, and cholesterol. Eat a variety of foods. Choose a diet moderate in salt and sodium. Choose a diet moderate in sugars. a. Guidelines Sleep needs vary among individual children. Younger school age children typically require 10 to 12 hours of sleep each night, and older ones require about 8 to 10 hours. Most 6 year olds are too old for naps but do require a quiet time after school to get them through the remainder of the day. During school years, many children enjoy a quiet talk or a reading time at bedtime. At about age 9, when friends become more important, children generally are ready to give up pre bedtime talks with parents in preference to calling or text messaging a friend. a. Sports Common activities for school - age children include baseball, soccer, gymnastics, and swimming. Equipment must be maintained in safe condition, and protective apparatus should be worn to prevent serious injury During puberty stage, it is usually recommended that girls compete only against other girls because at this stage boys become larger and have more

c. SLEEP AND REST

d. EXERCISE AND ACTIVITY

muscle mass Activities should include both practice sessions and unstructured play; the actual game or event should be managed in a manner that stresses mastery of the sport and enhancement of self - image rather than winning or pleasing others. All children should have an opportunity to participate, and special ceremonies should recognize all participants, not just individuals who excel in sports or athletics. b. Acquisition of Skills With the tools of language and reading, children create poems, stories, and plays. With more advanced fine motor skills, they are able to master an unlimited variety of handicrafts, such as ceramics, needlework, woodworking, and beadwork. School - age children are capable of assuming responsibility for their own needs, although their distaste for soap and water and "dress" clothes is legendary. School - age children can and want to assume their share of household tasks, which usually are related to the male and female roles that have been defined by their culture. Many children also assume responsibility for tasks outside the home, such as babysitting, mowing lawns, or paper routes. c. Exercise Exercise can come from neighborhood games, walking with parents or a dog, or bicycle riding. As children enter preadolescence, those with poor coordination may become reluctant to exercise. Urge them to participate in some daily exercise, or else obesity, or osteoporosis later in life, can result. One hour or more of moderate and vigorous physical activity on most or all days. Participate in several bouts of physical activity of 15 minutes or more each day. Avoid periods of inactivity of 2 hours or more.

e. DENTAL HEALTH

a. Dental Problems Dental Caries Dental caries are largely preventable with proper brushing and use of fluoridated water or fluoride application. When carries do occur, it is important they be treated quickly and the childs dental hygiene practices to be evaluated and improved if necessary. Most important, children must believe they have a stake in the health or disease of their teeth so they willingly undertake the self care measures necessary to ensure healthy teeth, with parental support rather than parental command. Malocclusion Children with malocclusion should be evaluated by an orthodontist to see if orthodontic braces or other therapy is necessary. The time to begin correction varies with the extent of the malocclusion and the jaw size. Braces are expensive and painful when they are first applied and at periodic visits when they are tightened to maintain pressure for further straightening. Some children develop mild, shallow ulcerations (canker sores) on the buccal membrane from friction of metal wires. Rubbing the offending wire with dental wax dulls the surface and gives relief. Oral acetaminophen or an agent such as Ora-Jel (an over-the-counter drug) rubbed on the ulceration also gives relief. Children who wear braces need to have their teeth assessed frequently to see they are brushing properly around the braces and that they are using dental floss to remove plaque around wires. After removal of braces, many children must wear retainers to maintain the correction the braces achieved. Show appropriate sympathy and help children problem solve if they are bothered by the appearance of braces or wearing a retainer. b. Care of Teeth School age children should visit a dentist at least twice yearly for a checkup, cleaning, and possibly a fluoride treatment to strengthen and harden the tooth enamel.

Children who tend to develop caries (cavities) might be encouraged to visit a

pedodontist if one is available and affordable.

School age children have to be reminded to brush their teeth daily. For effective brushing, a child should use a soft toothbrush, fluoride based toothpaste, and dental floss to clean between teeth to help remove plaque. Snacks are best limited to high protein foods such as chicken and cheese rather than candy. Fruits, vegetables, and cereals fortified with minerals and vitamins can all be fun afterschool snacks for school age children. If the child does eat candy, a type that is eaten quickly and dissolves quickly is better than slowly dissolving or sticky candy, which stays in contact with the teeth longer.

f. DRESS

g. INJURY PREVENTION

a. Hygiene Children of 6 or 7 years of age still need help in regulating bath water temperature and in cleaning their ears and fingernails. By age 8, children are generally capable of bathing themselves but may not do it well because they are too busy to take the time or because they do not find bathing as important as do their parents. Both boys and girls become interested a. Promoting School-age Safety

5. ADOLESCENT

a. NUTRITION

a. Eating habits and behavior b. Diet

b. SLEEP AND REST

a. Guidelines

c. EXERCISE AND ACTIVITY

a.Guidelines

b. DENTAL HEALTH

a. Care of Teeth

b. PERSONAL CARE

a. Dress and Hygiene

b. STRESS REDUCTION

a. Guidelines

c. SEXUALITY EDUCATION AND GUIDANCE d. INJURY PREVENTION

a. Guidelines

a. Adolescent Safety

3.

CREATE A HEALTH TEACHING PLAN FOR AN EXPECTANT MOTHER. MUST BE MORE THAN 5 SPECIFIC HEALTH TEACHING GENERAL HEALTH TEACHING 1. EXERCISE 2. NUTRITION 3. SLEEP AND REST SPECIFIC HEALTH TEACHING

4. HYGIENE 5. TRAVEL