Child and Adolescent Development

Posted by Nurse Linda in Life After Paralysis on April 29, 2019 # Health

Two basic assessments of children and adolescents are growth or how the body is physically enlarging and development which is about the maturation of the physical and psychosocial being. Last month, a review of growth was provided. This month, we will review maturation and development.

Development is assessed at each visit with your healthcare professional. This will include the timely accomplishment of milestones, psychological adjustment, nutrition, activity, and sleep among others. For children and adolescents with spinal cord injury, modifications to the assessment scales will ensure your child is progressing.

Age categories for children are divided into four general sections, infancy, preschool, school-aged, and adolescents. Pediatrics covers a wide time span of development, from 0-20 years. Dividing by sections allows assessments to be able to flow in similar age ranges. The categories break up the vast expanse of years in childhood. You would not expect an infant to behave like an adolescent; the groupings allow for these differences. Within each group, there are subgroups as well for more defined goals.

In infancy, care by the parent is anticipated. This is the same as for babies with spinal cord injury. Depending on the type and level of injury, the typical milestones may not be reached or might need modifications. If the spinal cord injury is from trauma, you would expect a baby to say mama or dada by about one year. If the spinal cord injury is from a medical issue with brain involvement, you might not expect the child to reach that goal according to the milestone. The timeline will need to be modified to fit the uniqueness of your child.

Motor activity is also affected by the type and level of injury. You might see the leg muscle contract when the milestone indicates standing as the goal. The milestone would need to be modified and therapy initiated for mobility issues if it has not yet begun. The distinction is that there is a recognition that the child is initiating the activity as their body allows.

In the preschool years, children start to initiate more activity, give direction to others, and form childhood relationships with peers. Play is very important. Be sure to initiate opportunities for your child to become involved in activities with other children. It can be easy to keep your child safe and sound within your home or just involved with you and your family. This is the time to arrange play dates, go to the park, and explore the world with other children in the same age group. Be sure to include children of all ability levels to let your child experience interactive playtime.

Preschool is the time for learning to use the potty. If your child is using intermittent catheterization, they can still meet this milestone. They might not be able to complete a clean catheterization technique, but the milestone can be adapted. For example, the child can know their body parts and direct the steps to catheterization for an age-appropriate goal. Starting to reach milestone tasks, adapted for the level of your child’s spinal cord injury ability is important to their progression. Set a plan to progressively adapt milestones until they are mature enough to do the activity them by themselves.

School-aged children are on their own for a large part of the day. They will be making choices about food. School cafeterias can be a haven for poor choices. Talk with your child to educate them about good eating habits. You can devise a plan at home to review their choices early in their school years. Setting a good example in the preschool years is helpful as the child grows more independent.

Activity is necessary for the school-aged child with or without a spinal cord injury. Since your child will be away from you for most of the day, work with the school personnel to integrate activity into the school day. This might be therapy, gym class, or range of motion provided by an attendant. The Individual Education Plan (IEP) is a method for school personnel to provide the resources needed for your child to excel academically. If muscles are cramped from spasms or inactivity, learning cannot be accomplished- advocate for your child by including activity as a way for your child to succeed in academia.

Adolescence is a challenge for every parent. This is the time when the transition from child to adult is occurring. It is a time when more independence is being sought. Privacy is valued. It can be a particularly difficult time if you have a spinal cord injury and rely on parental support for the most private care. Some adolescents will want to continue with processes as they are, while others will rebel against any authority. Most will land somewhere in the middle.

Choices are important at this time. However, with spinal cord injury, there are some activities of daily living that are not choices. These include doing pressure releases, catheterization, and bowel programs. Hopefully, you have instilled these processes into your child’s life. If they have the ability to perform these activities on their own, be sure you have allowed them to advance to being independent in completing them. They do these activities in their necessary way. Adapted personal care should be treated as a normal routine for the adolescent.

If you or an attendant is needed to do personal care, try to create as much privacy as possible for your teen. For example, catheterization is usually done showing your face to the individual. The individual then sees your expression of normalcy. In nursing, we say point your toes to their nose, so the individual can see your facial responses, which should be without expression. With a teen, something as simple as pointing your toes to their toes will change your body position so the individual cannot see your face. This can make the catheterization a lot less embarrassing. It seems like such a minor thing, but it can make a world of difference to the adolescent, especially during puberty.

In adolescence, alcohol, smoking, and recreational drug abuse can become an issue. All parents hope this does not happen. Having a teen with a spinal cord injury is just as risky as all children for peer pressure. All teens should be monitored for signs of drug abuse. Signs of drug abuse are typically first presented by dropping grades, personality changes, and inattentiveness. Confront your teen if you suspect any of these behaviors. Seek professional help early. Any drug, alcohol, or nicotine can affect the body and mind which can change the way your teen’s body will respond to general health issues. Nicotine affects skin elasticity. Mixing with drugs can create toxic combinations. Another issue is your teen giving their prescribed medication to others.

Social media is a huge problem in society. All teens spend a great deal of time on devices. For many, this can be a lifeline to interacting with others as well as a great source of recreation. Your child is never too old to be monitored for the sites and sources of their computer interactions. People of all ages can fall victims to scammers and people who will negatively influence your teen. Monitoring of social media is a must for everyone. Parents can fall victim to all sorts of scams as well. Block any connections that make you even just the slightest uncomfortable. Remember, there is no legitimate person with a cure for spinal cord injury that will cost money or the emotional trauma of failure.

As a parent, you have challenges with raising any child, with or without a spinal cord injury. Find the balance between ogre and friend. You are neither of these. You are the parent. There is a delicate balance in providing security for your child as well as support. Knowing your child will provide the needed direction to provide great care. It can be exhausting to be a parent. Find support for yourself either with your spouse or a close friend. The Christopher & Dana Reeve Foundation has peer mentors that can interact with your child as well as other parents as mentors that can support you.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.