Adolescence PDF

Care for the adolescent ADOLESCENSE Adolescence is a transition period from childhood to adulthood. Its is based on childhood experiences and accomplishments. It begins with the appearance of secondary sex characteristics and ends when somatic growth is completed and the individua...

Care for the adolescent ADOLESCENSE Adolescence is a transition period from childhood to adulthood. Its is based on childhood experiences and accomplishments. It begins with the appearance of secondary sex characteristics and ends when somatic growth is completed and the individual is psychological mature. ADOLESCENSE Age: 12-18 years old Conflict – Identity vs. Role Confusion Physical development – growth spurts, muscle coordination slows. Development of sexual organs and secondary sexual characteristics (puberty). Secretion of sex hormones leads to the onset of menstruation in girls and the production of sperm and semen in boys. Body shape and form changes. ADOLESCENSE Mental development – most foundations have been set. Development primarily involves an increase in knowledge and sharpening of skills. Learn to make decisions and accept responsibility for actions. Emotional development – emotional development is often stormy and in conflict. Adolescents try to establish their identities and independence. They respond more and ADOLESCENSE Social development – spending less time with family and more time with peer groups. Toward the end of this stage they develop a more mature attitude and develop patterns of behavior that they associate with adult behavior. Need for reassurance, support and understanding. Problems that develop in this stage can be traced to conflict and feelings of inadequacy and insecurity. PHYSICAL GROWTH Weight: Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in boys). Males gains 7 to 30kg, while female gains 7 to 25kg. Height: By the age of 13, the adolescent triples his birth length. Males gains 10 to 30cm in height. Females gains less height than males as they gain 5 to 20cm. Growth in height ceases at 16 or 17 years in females and 18 to 20in males PHYSICAL GROWTH Closure of epiphyseal plates: Females: 16-17 years old Males: 18-20 years old Increased endocrine activity Puberty TANNER SCALE FOR FEMALE Tanner Pubic Hair Breast Stage 1 None Papilla Elevation Minimal coarse, pigmented hair mainly Small breast buds palpable and areolae 2 on labia; Age: 11.2 years (9.0 – 13.4 enlarge. Age: 10.9 years (8.9 – 12.9 years) years) Elevation of breast contour; areolae Darker, begins to curl; Age: 11.9 years 3 enlarge. Age: 11.9 years (9.9 -13.9 (9.6 – 14.1 years) years) Coarse, less curly than adult. Adult Areolae forms secondary mound on the quality. No spread to junction of medial 4 breast. Age: 12.9 years (10.5 – 15.3 thigh with perineum. Age: 12.6 years years) (10.4 -14.8 years) Mature: nipple projects. Adult breast Adult Triangle. Adult distribution of hair. 5 contour. Areola recesses to general Pubic hair spreads to medial thigh. contour of breast. TANNER SCALE FOR FEMALE TANNER SCALE FOR FEMALE FEMALE BREAST AND PUBIC HAIR DEVELOPMENT TANNER SCALE FOR MALE MALE GENITALIA & PUBIC HAIR DEVELOPMENT Secondary sex characteristics in females Increase in transverse diameter of the pelvis. Development of the breasts. Change in the vaginal secretions. Growth of pubic and axillary hair. Menstruation (first menstruation is called menarche, which occurs between 12 to 13 years). Secondary sex characteristics in males Increase in size of genitalia. Swelling of the breast. Growth of pubic, axillary, facial and chest hair. Change in voice. Rapid growth of shoulder breadth. Production of spermatozoa (which is sign of puberty). PHYSIOLOGICAL GROWTH Pulse: Reaches adult value 60–100 beats/min. Respiration: 16–20 C/minute. NB: The sebaceous glands of face, neck and chest become more active. When their secretion accumulates under the skin in face, acne will appear. Developmental milestone Talking as a form of socialization Privacy Independence As teenagers gain independence they begin to challenge values Critical of adult authority Relies on peer relationship Emotional development This period is accompanied usually by changes in emotional control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with periods of quite one. He may become hostile or ready to fight, complain or resist every thing. Early adolescent developmental task: identity versus role confusion Body image Self-esteem Emotional development Early adolescent developmental task: identity versus role confusion—(cont.) Career decisions Emancipation Late adolescent developmental task: intimacy versus isolation Sense of intimacy Socialization Mood swings especially in early adolescents COGNITIVE development Through formal operational thinking, adolescent can deal with a problem. COGNITIVE THEORY (Jean Piaget) 4. Formal Operational (11yr-Adulthood): Teenagers-thinking more rational Our advance cognitive abilities allows us to understand abstract concept such as love & hate, success and failure New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical consequences of behavior. The child applies the scientific method/deductive reasoning in learning; gains appreciation of abstract ideas. Final stage in Cognitive development SOCIAL development He needs to know "who he is" in relation to family and society, i.e., he develops a sense of identity. If the adolescent is unable to formulate a satisfactory identity from the multi- identifications, sense of self-confusion will be developed according to Erikson:- Adolescent shows interest in other sex. He looks for close friendships. Socialization: Self-identity Romantic relationships Identifying with role models Adolescent behavioral problems Anorexia Attention deficit Anger issues Suicide PARENTAL CONCERNS DURING ADOLESCENT YEARS HEALTH PROBLEMS Hypertension Poor posture Body piercing and tattoos Fatigue Menstrual irregularities Acne Obesity PARENTAL CONCERNS DURING ADOLESCENT YEARS SEXUALITY AND SEXUAL ACTIVITY STDs Pregnancy Homosexuality Date rape Stalking HAZING OR BULLYING PARENTAL CONCERNS DURING ADOLESCENT YEARS SUBSTANCE USE DISORDERS DEPRESSION AND SELF-INJURY Risk for Accidents Testing limits Impulsive behavior Sense of being invulnerable Rebelling against adult advice EATING DISORDERS Often develop from an excessive concern for appearance Anorexia nervosa Bulimia More common in females Usually, psychological or psychiatric help is needed to treat these conditions SUBSTANCE ABUSE Using alcohol or other drugs is a common maladaptive attempt to cope with stressors. Use of alcohol or drugs with the development of a physical and/or mental dependence on the chemical Can occur at any life stage, but frequently begins in adolescence Can lead to physical and mental disorders and diseases Treatment towards total rehabilitation REASONS FOR CHEMICAL USE Trying to relieve stress or anxiety Peer pressure Escape from emotional or psychological problems Experimentation Seeking “instant gratification” Hereditary traits or cultural influences EDUCATION ABOUT SUBSTANCE USE DISORDER Whether a drug is inhaled, swallowed, or injected, it still is absorbed, enters the body, and is potentially harmful. Relying on drugs to give courage to solve problems (or to help forget you have problems) prevents you from learning to handle life situations and maturing. EDUCATION ABOUT SUBSTANCE USE DISORDER The bottom line of substance use disorder is that you have the final say: You are the only one who can stop chemical dependency from happening. Despite their social acceptability, alcohol and nicotine are drugs. A short span of daily use of either can make you addicted. SEXUAL BEHAVIORS Teenage pregnancy Sexually transmitted diseases SUICIDE Often, suicide is perceived by the adolescent as the only alternative to an overwhelming situation. One of the leading causes of death in adolescents Permanent solution to temporary problem Impulsive nature of adolescents Most give warning signs Call for attention REASON FOR SUICIDE Depression Grief over a loss or love affair Failure in school Inability to meet expectations Influence of suicidal friends or parents Lack of self-esteem INCREASED RISK FOR SUICIDE Family history of suicide A major loss or disappointment Previous suicide attempts Recent suicide of friends, family, or role models (heroes or idols) INCREASED RISK FOR SUICIDE Family history of suicide A major loss or disappointment Previous suicide attempts Recent suicide of friends, family, or role models (heroes or idols) ADOLESCENT TEACHING Relationships Sexuality – STD’s / AIDS Substance use and abuse Gang activity Driving Access to weapons NURSING IMPLICATIONS The nurse must honor the adolescent’s choice to withhold sensitive information from parents. Adolescents should be treated in a respectful, dignified manner. A nonjudgmental attitude is essential to the establishment of rapport with Thank you! REPRODUCTIVE HEALTH LAW Republic Act No. 10354 WHAT IS RA NO. 10354? “An act providing for a national policy on Responsible Parenthood and Reproductive Health” RH LAW GUARANTEES THE FOLLOWING: 1. Access to services on Reproductive Health and Family Planning 2. Maternal health care services 3. RH and sexuality education for the youth 4. Regular funding RH LAW PROVIDES: Midwives for skilled birth attendance Emergency obstetric care Hospital-based family planning Contraceptives as essential medicines Reproductive health education Employees’ responsibilities Capability building of community-based volunteer workers WHAT DOES THE RH LAW UPHOLD? Section 2 Universal basic human right To equality and nondiscrimination To sustainable human development To health To make decisions Family Gender equality, gender equity and women empowerment Universal access to RH care services Promote openness to life: Provided, that parents bring forth to the world only those children whom they can raise in a truly humane way HOW DOES THE RH LAW INTEND TO IMPROVE PEOPLE’S ACCESS TO RH SERVICES? WHO WILL BENEFIT FROM THE RH LAW? WOMEN CHILDREN - Address unmet need for - Healthier children family planning RH Law beneficiaries PWDs ADOLESCENTS - Section 18 - Sexuality education - Prevent teenage pregnancy - Decrease incidence of HIV  HOW WILL THE RH LAW FACILITATE ACCESS OF THE POOR TO RH AND FP SUPPLIES? SEC 9 National Drug Formulary Essential medicines Hormonal contraceptives Intrauterine device Injectables Safe, legal, non-abortifacient Effective FP product and supplies SEC 11 National Household Targeting System for Poverty Reduction (NHTS-PR) poor and marginalized women Poverty reduction  HOW WILL THE RH LAW FACILITATE ACCESS OF THE POOR TO RH AND FP SUPPLIES? SEC 13 Mobile Health Care Services (MHCS) Transportation appropriate to its terrain Remote communities SEC 17 Pro-bono services for indigent women Poverty Reduction (NHTS-PR) poor and marginalized women (48) Hour annually  HOW WILL RH LAW ENSURE THE RH NEEDS OF THE ADOLESCENTS? SECTION 14 AGE AND DEVELOPMENT APPROPRIATE REPRODUCTIVE HEALTH AND SEXUALITY EDUCATION - Values formation -physical, social and emotional changes in - Knowledge and skills in self-protection adolescents against discrimination -women’s rights -sexual abuse and violence against women/ -children’s rights gender-based violence -responsible teenage behavior -teenage pregnancy -gender and development -responsible parenthood ETHICAL ISSUES Maternal and child health Population control Poverty reduction Family planning services “Anti-life” Thank you!  HEALTH PROMOTION OF THE SCHOOL-AGE CHILD AND FAMILY (6-12 Y.O) LATE CHILDHOOD Age: 6-12 years old Conflict – Industry vs. inferiority Physical development– slow but steady. Muscle coordination is well developed and children can engage in physical activity that require complex motor-sensory coordination Mental development – developing quickly and much of the child’s life centers around school. Reading and writing skills are learned, understand abstract concepts like honesty, loyalty, values and morals LATE CHILDHOOD Emotional development -- the child achieves greater independence and a more distinct personality. Fears are replaced by the ability to cope. Social development – changes from activities by themselves to more group oriented. They are more ready to accept the opinions of others and learn to conform to rules, and standards of behavior. Needs are the same as infancy and early childhood along with the need for reassurance, parental approval, and peer acceptance. BIOLOGIC DEVELOPMENT PHYSICAL GROWTH GETS SLOW Between 6 and 12 years old, children grow an average of 5 cm (2 inches) per year Almost double their weight, increasing 2 to 3 kg (4.4 to 6.6 pounds) per year. The average 6-year-old child is about 116 cm (46 inches) tall and weighs about 21 kg (46 pounds) The average 12-year-old child is about 150 cm (59 inches) tall and weighs approximately 40 kg (88 pounds). BIOLOGIC DEVELOPMENT PHYSICAL GROWTH GETS SLOW During this age, girls and boys differ little in size, although boys tend to be slightly taller and somewhat heavier than girls. Toward the end of the school-age years, both boys and girls begin to increase in size, although most girls begin to surpass boys in both height and weight BIOLOGIC DEVELOPMENT By 9 years old: Lymphatic tissue growth, IgG and IgA in adult level By 10 years old: Complete brain growth, adult vision level, refined motor coordination PHYSICAL CHANGES School-age children are more graceful than they were as preschoolers, and they are steadier on their feet. Their body proportions take on a slimmer look, with longer legs, varying body proportion, and a lower center of gravity. More erect posture PHYSICAL CHANGES Fat gradually diminishes Eruption of Permanent teeth PHYSICAL CHANGES The most pronounced changes that indicate increasing maturity in children are a decrease in head circumference in relation to standing height, a decrease in waist circumference in relation to height, and an increase in leg length in relation to height. Eruption of Permanent teeth MATURATION OF SYSTEMS Preadolescence is the period that begins toward the end of middle childhood and ends with the 13th birthday. Puberty signals the beginning of the development of secondary sex characteristics, and prepubescence, the 2-year period that precedes puberty, typically occurs during preadolescence. SEXUAL MATURATION Puberty onset: 10 -14 years old Females: 12 -18 years old Males: 14 - 20 years old DEVELOPMENT OF SECONDARY SEX CHARACTERISTICS DEVELOPMENTAL MILESTONES Fine Motor: Fine motor is refined 6 years old: able to tie shoe laces 7 years old: “eraser year”; dissatisfaction with work done Writing skills improve DEVELOPMENTAL MILESTONES Fine Motor: Fine motor with more focus: Building: models – legos Sewing Musical instrument Painting Typing skills Technology: computers DEVELOPMENTAL MILESTONES Gross Motor (gender differences) At 6–8 years, the school–age child: Rides a bicycle. Runs Jumps, climbs and hops. Has improved eye-hand coordination. Prints word and learn cursive writing. Can brush and comb hair. DEVELOPMENTAL MILESTONES At 8–10 years, the school–age child: Throws balls skillfully. Uses to participate in organized sports. Uses both hands independently. Handles eating utensils (spoon, fork, knife) skillfully. DEVELOPMENTAL MILESTONES At 10–12 years, the school–age child: Enjoy all physical activities. Continues to improve his motor coordination. 8 to 10 years: team sports Age 10: match sport to the physical and emotional development PLAY Play involves increased physical skill, intellectual ability, and fantasy. Belonging to a group is of vital importance. 7 years old: decline of imaginative play, as symbolized by use of more props by playing Collecting props for sorting 10 years old: Competitive play COGNITIVE DEVELOPMENT At 7-11 years, the child now is in the concrete operational stage of cognitive development.. Greater ability to concentrate and participate in self- initiating quiet activities that challenge cognitive skills, such as reading, playing computer and board games. COGNITIVE DEVELOPMENT (PIAGET) Concrete operational thought When children enter the school years, they begin to acquire the ability to relate a series of events to mental representations that can be expressed both verbally and symbolically. Thinking is now logical and there is an ability to relate external events to each other without being egocentric Children develop an understanding of relationships between things and ideas. SCHOOL PERFORMANCE Ask about favorite subject How they are doing in school Do they like school By parent report: any learning difficulties, attention problems, homework Parental expectations LANGUAGE DEVELOPMENT Ability to tell time, simple math 9 years old: understand dirty jokes, bathroom language 12 years old: development of sense of humor EMOTIONAL DEVELOPMENT Industry vs. Inferiority Problem solving skills: exploration for solutions rather than finding solutions Living well with other; empathy PSYCHOSOCIAL DEVELOPMENT: DEVELOPING A SENSE OF INDUSTRY (ERIKSON) INDUSTRY VS INFERIORITY A sense of industry, or a sense of accomplishment, occurs somewhere between 6 years old and adolescence. Children need to cope with new social and academic demands. When they are successful with this, they feel COMPETENT and achieve INDUSTRY. When they are not successful with handling task, they feel inferior and develops INFERIORITY EGOCENTRISM decreases and importance of RELATIONSHIPS increases. HOW TO DEVELOP INDUSTRY? Children gain satisfaction from independent behavior in exploring and manipulating their environment and from interaction with peers. Reinforcement in the form of grades, material rewards, additional privileges, and recognition provides encouragement and stimulation. A sense of accomplishment also involves the ability to cooperate, to compete with others, and to cope effectively with people. HOW TO DEVELOP INDUSTRY? Middle childhood is the time when children learn the value of doing things with others and the benefits derived from division of labor in the accomplishment of goals. Peer approval is a strong motivating power. Children achieve a sense of industry when they have access to tasks that need to be done and they are able to complete the tasks well PSYCHOSEXUAL STAGE LATENCY 6 Y.O. TO PUBERTY decrease libido less conflict sexual urger are suppress or sublimated into other social activities or channeled into schoolwork, hobbies, friends SOCIAL DEVELOPMENT Peer group identification is an important factor in gaining independence from parents. SOCIAL DEVELOPMENT Conformity is the core of the group structure. Each child must abide by a standard of behavior established by the members. Conforming to the rules provides children with feelings of security and relieves them of the responsibility of making decisions. By merging their identities with those of their peers, children are able to move from the family group to an outside group as a step toward seeking further independence. SOCIAL DEVELOPMENT Bullying is any recurring activity that intends to cause harm, distress, or control towards another in which there is a perceived imbalance of power between the aggressor(s) and the victim Poor relationships with peers and a lack of group identification can contribute to bullying. Cyberbullying involves an electronic medium to harm or bother another individual and can be more harmful than traditional bullying, because the attack can instantly reach a wider audience DEVELOPING A SELF-CONCEPT: BODY IMAGE Physical impairments, such as hearing or visual defects, ears that “stick out,” or birthmarks, assume great importance. Increasing awareness of these differences, especially when accompanied by unkind comments and taunts from others, may cause a child to feel inferior and less desirable. This is especially true if the defect interferes with the child's ability to participate in games and activities. DEVELOPMENT OF SEXUALITY Many children experience some form of sex play during or before preadolescence as a response to normal curiosity, not as a result of love or sexual urges. Any adverse emotional consequences or guilt feelings depend on how the behavior is managed by the parents. SEX EDUCATION An important component of ongoing sex education is effective communication with parents. If parents either repress the child's sexual curiosity or avoid dealing with it, the sexual information that the child receives may be acquired almost entirely from peers. When peers are the primary source of sexual information, it is often transmitted and exchanged in secret conversation and contains misinformation. SEX EDUCATION Reproductive organ function and physiology of reproduction, so children understand what menstruation is and why it occurs. Secondary sexual characteristics, so children will understand what is happening in their bodies Male sexual functioning, including why the production of increased amounts of seminal fluid leads to nocturnal emissions SEX EDUCATION The physiology of pregnancy and the possibility for unintended pregnancies, which will come with sexual maturity Social and moral implications of sexual maturity NURSE'S ROLE IN SEX EDUCATION Nurses should treat sex as a normal part of growth and development. Questions should be answered honestly at the child's level of understanding. Exercises on clarifying values, identifying role models, engaging in problem-solving skills, and practicing responsibility are important to prepare children for early adolescence and puberty. Information about anatomy, pregnancy, contraceptives, and sexually transmitted diseases, including human immunodeficiency virus and human papillomavirus, should be presented in simple, accurate terms. Nurses can be open and available for questions and discussion SCHOOL EXPERIENCE School serves as the agent for transmitting the values of society to each succeeding generation of children and as a setting for many peer relationships. After the family, schools are the second most important socializing agent in the lives of children. Latchkey children is used to describe children in elementary school who are left to care for themselves before or after school without the supervision of an adult. DISHONEST BEHAVIOR Young children may lie to escape punishment or to get out of some difficulty even when their misbehavior is evident. Older children may lie to meet expectations set by others to which they have been unable to measure up. However, most children know that lying and cheating are wrong, and they are concerned when it is observed in their friends. They are quick to tell on others when they detect cheating. DISHONEST BEHAVIOR They find it difficult to lose at a game or contest, so they may cheat to win. This behavior usually disappears as they mature. However, when children observe parental behaviors such as boasting about cheating, they assume this to be appropriate behavior. When parents set examples of honesty, children are more likely to conform to these standards. STEALING Early childhood stealing is best handled without a great deal of emotion. Shoplifting must be taken seriously by parents. Parents should set good examples. VIOLENCE OR TERRORISM Assure children they are safe. Observe for signs of stress. Do not allow children or adolescents to view footage of traumatic events repeatedly. Watch news programs with children; explain the situation portrayed. Prepare a family disaster plan; designate a “rally point” to meet if ever separated. RECREATIONAL USE OF DRUGS Suspect if child regularly appears irritable, inattentive, or drowsy. Counsel against use of steroids; highlight future cardiovascular irregularities, uncontrollable aggressiveness, and possible cancer. Teach to recognize tobacco advertising manipulation; caution against experimenting with smokeless tobacco. Role model excellent nonsmoking health behavior. CAUSES OF STRESS AND FEAR Stress in childhood comes from a variety of sources: conflict within the family parental criminality or psychiatric disorder low socioeconomic status The demands from teachers and parents with school work and standardized proficiency testing Peer pressure, can cause stress on school-age children CAUSES OF STRESS AND FEAR Children in the middle school years are often overcommitted with activities such as dance, music, athletics, and other activities until the cumulative effect is overwhelming. These fears are considered normal for children this age. Encouraging them to “blow off steam” through physical activity reduces tension and anxiety. DENTAL PROBLEMS Limited or inadequate dental care results to: Dental caries, Malocclusion, and Periodontal disease. Dental caries (cavities) is the principal oral problem in children and adolescents. Is a multifactorial disease involving susceptible teeth, cariogenic microflora, and an appropriate oral environment. Intervention Oral inspection is an integral part of the physical assessment of every child DENTAL PROBLEMS Periodontal disease, an inflammatory and degenerative condition involving the gums and tissues supporting the teeth, often begins in childhood and accounts for a significant amount of tooth loss in adulthood. The more common periodontal problems are : Gingivitis (simple inflammation of the gums) Periodontitis (inflammation of the gums and loss of connective tissue and bone in the supporting structures of the teeth) DENTAL PROBLEMS Intervention Management is directed toward prevention by conscientious brushing and flossing, including the use of fluoride. Children should see a dentist at any signs of inflammation or irritation. SAFETY Allow independence if they can follow the rules reliably and can occupy ourselves for an hour’s time. NUTRITION Provide healthy snacks Allow the child to have a say in meals, allow him to help prepare and plan meals. Right time to improve table manners DAILY ACTIVITIES Teach the child regarding care for belongings Debunk beliefs in menstruation/puberty Dental visits twice a year High protein snacks Establish house rules Involve in doing house chores Strengthen child’s sense of accomplishment COMMON CONCERS OF SCHOOL AGE CHILDREN Caries Progressive destruction decalcification of tooth enamel or dentin because of proliferation of acidic microorganisms in acidic oral environment Malocclusion Language development problems Common fears: school beginning, bullying Obesity Sex education (best time) RED FLAGS: SCHOOL AGE School failure Lack of friends Social isolation Aggressive behavior: fights, fire setting, animal abuse The END DEVELOPMENTAL MILESTONES PRESCHOOL: 3 TO 5 YRS. PRESCHOOL 3-5 YEARS OLD Ages 3 to 6 years. Physical growth slows. Psychosocial and cognitive development accelerate. The child’s world begins to expand. The child is better able to communicate. PRESCHOOL 3-5 YEARS OLD Rapid social development Rapid fine motor development Improving coordination Getting ready for school Average yearly increase in height of 2 to 3 inches/year Weight increases 5 lbs./year PRESCHOOL: PHYSICAL GROWTH & DEVELOPMENT Contour change: Endomorph (large), ectomorph (slim) PRESCHOOL: PHYSICAL GROWTH & DEVELOPMENT Handedness becomes evident Ability to learn extended language Tonsils are enlarged IgA and IgG antibody levels increase Physiological splitting of heart sounds and innocent heart murmurs may be assessed due to changing of heart size in reference to the thorax PRESCHOOL: PHYSICAL GROWTH & DEVELOPMENT AP diameter in adult proportions Bladder becomes easily palpable Muscular coordination improves Genu valgus (knock knees) disappear due to increased skeletal growth PRESCHOOL: FINE MOTOR SKILLS Fine motor skills – uses little muscles Holding a pencil or scissors Writing their first names PREPARING FOR Cutting out simple shapes SCHOOL AGE Paste things in paper Complete puzzles with 5 or more pieces Uses spoon and fork Can brush teeth Can dress self; buttoning clothing PRESCHOOL: GROSS MOTOR SKILLS Gross motor skills- requires large muscle group Hopping on one (1) foot standing climbing running jumping Riding tricycles Riding bicycle PRESCHOOL: LANGUAGE DEVELOPMENT 3-5 YEARS OLD: approximately 400 questions daily with approximately 900 vocabulary. Provide simple answers to encourage child’s curiosity, vocabulary building. 4-5 YEARS OLD: child is able to imitate language exactly Involve the child in mealtime conversations LANGUAGE EXPLOSION Able to speak about 2100 words Speak 4-5 word sentences Can correctly name colors, objects and people Tell stories & use fantasies Know their names and address Stammering is normal Reassure the parent Do not rush. Let them finish their words PRESCHOOL: PLAY Child likes imitating other people, ROLE PLAYING Presence of IMAGINARY FRIEND At 5 years old, child like being involved in group games. PRESCHOOL: EMOTIONAL DEVELOPMENT ERIKSON (Initiative vs Guilt) Needs opportunity to try new thing, make decisions, conscience is now developed between what is right and wrong Struggle with trying new things leads to GUILT/ no purpose, often experience disapproval What to do? Encourage play Give freedom to make new things and make choices Encourage when they fail Avoid controlling behavior SENSE OF Development of the superego, or conscience, begins toward the end of the toddler years and is PURPOSE a major task for preschoolers PRESCHOOL: EMOTIONAL DEVELOPMENT OEDIPAL COMPLEX attachment of preschool BOY to his MOTHER distinguishes FATHER as competition ELECTRA COMPLEX attachment of preschool GIRL to his FATHER distinguishes MOTHER as competition RESOLVE by identifying with parent of the same sex PRESCHOOL: EMOTIONAL DEVELOPMENT GENDER ROLES: Versus stereotyping Expose to roles of opposite sex SOCIALIZATION: Expose child to other people/child to help ease him into socialization. PRESCHOOL: COGNITIVE DEVELOPMENT PIAGET THEORY (Pre-operational) 2-7 y.o. Still egocentric like toddlers Magical thinkers – pretends to play and likes to do imaginary playmate Literal thinkers REDUCE SEPARATION ANXIETY Tends to disappear by 4-5 y.o. Tolerates better than toddlers PROTEST- LESS INTENSE (cry quietly) DESPAIR & DETACHMENT- Same as toddler MAGICAL THINKERS- reassure frequently that the mother is coming back but don’t give specific time for return A Belief that one’s own thoughts, wishes or desires can influence the external world PRESCHOOL: MORAL & SPIRITUAL DEVELOPMENT Preconventional or Premoral Level (Kohlberg) They behave because of the freedom or restriction that is placed on actions. In the punishment and obedience orientation, children (about 2 to 4 years old) judge whether an action is good or bad depending on whether it results in a reward or a punishment. If children are punished for it, the action is bad. If they are not punished, the action is good regardless of the meaning of the act. For example, if parents allow hitting, the child will perceive that hitting is good because it is not associated with punishment. INTERVENTIONS FOR HOSPITALIZATION Honesty Use simple terms Medical play Encourage the child and answer questions Do not give specific time for a certain procedure instead give stage Parent should be with the child CHILD SAFETY Supervision despite independence Use of seatbelt when riding cars Have the child sit at the back seat Gun safety Use protective gears such as Bike helmets Swimming Strangers HEALTHY EATING Preschoolers are not as picky eaters as toddlers Plan complete meals with toddlers Less ritualism Willing to eat new foods Small, frequent feedings like in toddlers HEALTHY EATING Avoid snacking too often Sits for meals longer By the beginning of the preschool period, the eruption of the deciduous (primary) teeth is complete. Should have dental visits Watch out for choking, talking with mouth full OUTLINE BEHAVIOR EXPECTATIONS Loss of control Fear/anxiety Aggression (modeling from an aggressive parent) Decrease negativism, less Ritualism Nightmares - imaginative DAILY ACTIVITIES Allow the child to dress himself and choose his own clothes. Fear of the dark: Do not expose the child to frightening stories; provide night light if available. Assist the child in bathing. Let the child to brush teeth independently. Bruxism (teeth grinding) is common. Foster vocabulary development. DISCIPLINE TIME-OUT Child is removed form where the misbehavior happened. Child is away from all things that are fun. Not a punishment. It is a safe and comfortable place for children to manage their emotions. Strategy that can help manage child’s challenging behavior. As many minutes as the child’s age E.g. a 2-year-old would sit time-out for 2 minutes; 3 year old would have a 3-minute time-out. COPING WITH CONCERNS RELATED TO NORMAL GROWTH AND DEVELOPMENT Aggression refers to behavior that attempts to hurt a person or destroy property. Hyperaggressive behavior in preschoolers is characterized by unprovoked physical attacks on other children and adults, destruction of others' property, frequent intense temper tantrums, extreme impulsivity, disrespect, and noncompliance. Aggression is influenced by a complex set of biological, sociocultural, and familial variables. COPING WITH CONCERNS RELATED TO NORMAL GROWTH AND DEVELOPMENT Frustration, or the continual thwarting of self-satisfaction by disapproval, humiliation, punishment, or insults, can lead children to act out against others as a means of release. Especially if they fear their parents, these children will displace their anger on others, particularly peers and other authority figures. This type of aggression often applies to children who are well- behaved at home but have a discipline problem at school or are bullies among their playmates. COPING WITH CONCERNS RELATED TO NORMAL GROWTH AND DEVELOPMENT Modeling, or imitating the behavior of significant others, is a powerful influencing force in preschoolers. Children who see their parents as physically abusive are observing behavior they come to know as acceptable and therefore may exhibit this behavior with others PARENTAL CONCERNS WITH PRESCHOOLERS Infectious diseases as common health problem Common fears: Fear of the dark Fear of mutilation Fear of separation/abandonment SEX EDUCATION Be open to sexual questions. Teach the child that masturbation should be done privately. Instruct the child against sexual abuse. Provide simple, factual answers and use of appropriate terms when asked by preschooler on sexual questions. CHOOSING PRESCHOOL Ensure continuous evaluation of the preschool by the child and the parent Preparing a child for school Child readiness Parental attitude Practice Transportation Following instructions Lunch protocols BATHROOM LANGUAGE Child imitates parents use of swear words. Be unemotional when correcting the child. Avoid speaking swear words upon preschooler’s hearing range. RED FLAGS: PRESCHOOL Inability to perform self-care tasks, hand washing simple dressing, daytime toileting Lack of socialization Unable to play with other children Unable to follow directions during exam  THEORIES ON GROWTH & DEVELOPMENT  Fundamental Concepts of Growth and Development Growth refers to the quantitative changes in physical size of the body and its parts. It can be measured in Kg, pounds, meters, inches, ….. Etc.  Fundamental Concepts of Growth and Development Development refers to behavioral changes and increasing competency in functional abilities and skills. Development refers to a progressive increase in skill and capacity of function. It is a qualitative change in the child’s functioning. It can be measured through observation. By understanding what to expect during each stage of development, parents can easily capture the teachable moments in everyday life to enhance their child's language development, intellectual growth, social development and motor skills.  Four Main Types of Growth and Development Physical: body growth Mental: mind development Emotional: feelings Social: interactions and relationships with others All four types above occur in each stage  Fundamental Concepts of Growth and Development Maturation describes the increasing complexity of a person’s capabilities. Maturation involves biological growth, functional changes, and learning that come with age. Increase in child’s competence and adaptability. It is describing the qualitative change in a structure. The level of maturation depends on child’s heredity.  Principles of Growth and Development Growth is an orderly process, occurring in systematic fashion. Rates and patterns of growth are specific to certain parts of the body. Wide individual differences exist in growth rates. Growth and development are influences by are influences by a multiple factors.  Principles of Growth and Development Development proceeds from the simple to the complex and from the general to the specific. Development occurs in a cephalocaudal and a proximodistal progression. There are critical periods for growth and development.  Principles of Growth and Development Rates in development vary. (↑ periods of GR in early childhood and adolescents & ↓ periods of GR in middle childhood) Not all body parts grow in the same rate at the same time. Each child grows in his/her own unique way. Each stage of G&D is affected by the preceding types of development.  Principles of Growth and Development Growth and development begins at birth and ends at death The pattern of growth and development is continuous, orderly, and predictable. During an entire lifetime, individuals have needs that must be met Growth and development may temporarily be stalled or regress during critical periods “touch points.” Health care workers need to be aware of the various stages and needs of the individual to provide quality health care Growth Pattern Why do Nurses need to Understand Child Development? Importance of G & D for Nurses Knowing what to expect of a particular child at any given age. Gaining better understanding of the reasons behind illnesses. Helping in formulating the plan of care. Helping in parents’ education in order to achieve optimal growth & development at each stage. Importance of G & D for Nurses Early detection of deviation in child’s pattern of development Simple and time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed: cognitive, motor, language, social / behavioral and adaptive Factors Influencing Growth and Development Heredity Health Status Life Experiences Cultural Expectations Environmental Factors Heredity The genetic composition of an individual determines physical characteristics. Determines to a great extent the rate of physical and mental development. Health Status Illness or disability can interfere with the achievement of developmental milestones. Life Experiences A child’s experiences can influence the rate of growth and development. Cultural Expectations The age at which an individual masters a particular task is determined in part by culture. Environmental Prenatal Environment 1. Factors related to mothers during pregnancy: - Nutritional deficiencies - Diabetic mother - Exposure to radiation - Infection with German measles - Smoking - Use of drugs 2. Factors related to mothers during pregnancy: - Malposition - Faulty placental implantation Environmental Postnatal Environment 1. External Environment - socio-economic status of the family - child’s nutrition - climate and season - child’s ordinal position in the family - Number of siblings in the family - Family structure (single parent or extended family … ) Environmental Postnatal Environment 1. Internal Environment - Child’s intelligence - Hormonal influences - Emotions Theoretical Perspective of Human Development Physiologic Cognitive Spiritual Growth Dimension Dimension Psychosocial Moral Dimension Dimension Self Concept Intrapsychic Theory Interpersonal Theory  Theoretical Perspective of Human Development Genetic PHYSIOLOGICAL Predisposition GROWTH of an individual is Maturation CNS influenced primarily by interaction of the following: Endocrine System  Theoretical Perspective of Human Development PSYCHOSOCIAL Subjective Feelings DIMENSION consists of subjective feelings and interpersonal relationships. Interpersonal Relationships  Theoretical Perspective of Human Development SELF CONCEPT is a view of one’s self, and is likely the Body Image most important key to a person’s success and happiness. Self-esteem Ideal Self Characteristics of an Individual with a Positive Self-Concept Self confidence Willingness to take risks Ability to receive Ability to adapt criticism without effectively to stressors defensiveness Innovative problem- solving skills  PSYCHOSOCIAL DIMENSION INTRAPSYCHIC (Psychodynamic) THEORY INTERPERSONAL THEORY INTRAPSYCHIC (Psychodynamic) THEORY Focuses on an individual’s unconscious processes, which are feelings, needs, conflicts, and drives. Sigmund Freud and Erik Erikson are two major intrapsychic theorists. SIGMUND FREUD Viewed the personality as a three-part structure: the id, the ego, and the superego. Believed that personality development was completed in the final stages of adolescence. ERIK ERIKSON Expanded Freud’s concept of developmental stages to a lifelong process. Certain psychosocial tasks must be mastered in each of eight developmental stages. Each stage poses a conflict that can have favorable or unfavorable outcomes. Self-fulfilling cycle in positive self-concept INTERPERSONAL THEORY Relationships with others influence how one’s personality develops. Approval and disapproval from significant others shape the formation of one’s personality. Harry Stack Sullivan is an interpersonal theorist.  Theoretical Perspective of Human Development Perception COGNITIVE DIMENSION Perception, memory, and judgment Memory Develops throughout the life span By JEAN PIAGET Judgment JEAN PIAGET’S COGNITIVE DEVELOPMENT THEORY Observations of children learning to think by playing Intellectual development is characterized by four phases as the child interprets and uses the environment. Sensorimotor Preoperative Concrete Operations Formal Operations The individual learns by interacting with others and the environment through: Assimilation Accommodation Adaptation  Theoretical Perspective of Human Development MORAL DIMENSION Right A person’s value system that helps in differentiating right and wrong. Moral maturity is the ability to independently decide for Wrong one’s self what is “right.” LAWRENCE KOHLBERG Framework for understanding how individuals, over time, develop a moral code to guide their behavior and make moral judgments Theoretical Perspective of Human Development SPIRITUAL DIMENSION Relationships with one’s self, with others, and with a higher power or divine source Characterized by a sense of personal meaning  Stages of Growth and Development (Life Stages) Prenatal Infancy Early Middle Late Childhood Childhood Childhood Embryonic Fetal Stage Neonate Infancy Toddler Preschool School Age Adolescent Conception 8 – 40 or 42 Birth to 1 1 month to 1 – 3 years 3 – 6 years 6 – 12 years 12 – 18 to 8 Weeks Weeks month end of 1 years year  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT *Governed by LIBIDO (instinctual drives, primarily of sexual nature), to bring pleasure to the individual Oral Phase Infant Anal Phase Toddler Phallic Phase Preschool Latency Phase School age Genital Phase Adolescent  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Oral Phase (Infant: Age 0-1) Center of Pleasure: MOUTH Our main pleasure is by: Sucking our mother’s breast or a bottle Eating Putting things in the mouth Requires Oral Stimulation Purpose: enjoyment, relief of tension, pleasure, nourishment (e.g. sucking)  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Oral Phase (Infant: Age 0-1) The conflict occurs from weaning by the primary caregiver. When a baby is weaned of without trauma, he might end up happy and independent adult. If a child is weaned of early than 4 months which is too early suffers from trauma and develops an oral fixation. Compensate by chewing gum all the time. When a baby is neglected and is left alone crying when hungry, he looks for oral stimulation he is denied for and further develops manipulative and addictive behavior.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Anal Phase (Toddler: Age 1-3) Center of Pleasure: ANUS Our main pleasure is by Control over: Elimination, which fosters independence (e.g. toilet training) Defecation Major focus of this age is the control of the bladder and anus; control of body functions is major feature.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Anal Phase (Toddler: Age 1-3) Learns how to use the potty A child is praised well in using the toilet develops a competent personality. A child is forced potty training too early and punished for mistake becomes an over controlling adult. A child is neglected entirely becomes messy, disorganized and rebellious.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Phallic Phase (Preschool: Age 3-6) Center of Pleasure: EXTERNAL GENITALS Our main pleasure is by: Stimulation of external genital organs (e.g. toilet training) Masturbation is performed by males, in particular; e.g. exhibitionism If possible, assign same sex nurse.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Phallic Phase (Preschool: Age 3-6) Oedipus Complex- conflict/rivalry with the father. Boy develops an unconscious infatuation towards his mother, and simultaneously fears his father to be a rival. This happens at an unconscious level. Electra Complex describe a girl's sense of competition with her mother for the affections of her father.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Phallic Phase (Preschool: Age 3-6) A child with the presence of his fathers support during this stage learns to take on a male role and respects both roles A child with no paternal support during this stage fails to develop a sense of manhood Has a mother fixation and isn't sure of the sexuality. Genitals become focus of sexual curiosity; superego (conscience) develops.  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Latency Phase (School age: Age 6-12) Center of Pleasure: DORMANT PLEASURE DERIVATION Focus is on concrete thinking. Privacy is a big issue Same-sex friends Sexual feelings are firmly repressed by the superego; period of relative calm. No real conflict in this stage  FREUD’S STAGES OF PSYCHOSEXUAL DEVELOPMENT Genital Phase (Adolescent: Age 12-18/puberty to Death) Center of Pleasure: GENITALS Our main pleasure is by: New sexual desires Stimulated by increasing hormone levels; sexual energy wells up in full force, resulting in personal and family turmoil. A child with no much trauma succeeds in building a strong ego. Discipline at work and with a fulfilled sex life. ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Erik Erikson was a psychoanalyst who identified eight stages of psychosocial development For each stage a basic conflict or need must be met  Trust vs. Mistrust Infant Autonomy vs. Shame & Doubt Toddler Initiative vs. Guilt Preschool Industry vs. Inferiority School age Identity vs. Role Confusion Adolescent Intimacy vs. Isolation Young Adult Generativity vs. Stagnation Middle Adult Ego Integrity vs. Despair Older Adult  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Trust vs. Mistrust From birth to 12 months of age Virtue: HOPE Addressing infant needs timely fosters a trusting attitude in the child towards the provider of care. Infant ask themselves if they can trust the world. If they can trust someone now, they can trust others in the future. If they develop fear, they will develop doubt & mistrust Mother is the key to development Development of a sense that the self is good and the world is good when consistent, predictable, reliable care is received; characterized by hope.  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Trust vs. Mistrust NURSING CONSIDERATIONS: Provide for infant’s needs. Care should be done routinely/rhythmically. The presence of primary care giver is important. Keep the parents involve for trust. Ensure consistency of actions because it fosters a sense of security towards the child. Visual stimulation is encouraged.  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Autonomy vs. Shame and Doubt Ages 1 to 3 years Virtue: WILL Allow the child to perform activities fostering independence. The child begins to differentiate himself from his primary caregiver; his negativistic character towards his caregiver is a sign of independence. We discover ourselves asking “is it ok to be me?”. if we are allowed to discover ourselves we develop self confidence or if not, we develop shame and doubt Both parents plays a major role Development of sense of control over the self and body functions; exerts self; characterized by will.  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Autonomy vs. Shame and Doubt NURSING CONSIDERATIONS: Provide ways for the child to perform activities involving muscle control and impulses while ensuring his safety. Present opportunities for decision-making. Praise child for exhibiting his independence over reprimanding him for the mistakes he does. Promote exploration Allow the child to do things themselves Self feeding if able Praise them to gain self respect and pride Allow exploration of their body  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Initiative vs. Guilt Ages 3 to 6 years Virtue: PURPOSE Initiative (starting things on his own), in this case, focuses on the child knowing how to do things. We ask “is it ok for me to do what I do?” if we are encourage, we develop interest, if we are held back and told us that we are silly we develop guilt Learning from the entire family Development of a can-do attitude about the self; behavior becomes goal-directed, competitive, and imaginative; initiation into gender role  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Initiative vs. Guilt NURSING CONSIDERATIONS: Encourage creative/free-form play Allow child to have self-initiated activities Anticipate the intellectual initiative/inquisitiveness of the child. Expose the child on activities involving exploration Acknowledge child’s fantasies/magical thinking, but orient him so he can distinguish it from reality. Role-playing is a good means to encourage the child’s imagination. Allow them to create  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Industry vs. Inferiority Ages 6 to 12 years Virtue: COMPETENCE Industry focuses on the ability of the child to do things well. Discover our own interest and realize that we are different from others We ask “Can I make it in this world?”. if we receive recognition from our teachers or peers we become hard-working but if we receive negative feedback we start to feel inferior and we lose motivation Influenced more by neighbor and school characterized by competence. promote achievement Allow them to help if able  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Industry vs. Inferiority NURSING CONSIDERATIONS: Provide opportunities wherein the child could gain a sense of accomplishment Opt for activities that could be completed on a limited period of time. Preference to spend time with peers is a sign of his independence. With the child’s affinity to conformity, structured activities with reward systems are a good means to develop his sense of accomplishment.  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Identity vs. Role Confusion Ages 12 to 18 years Virtue: FIDELITY We learn that we have different social roles. We are friends, students, children and citizen. If are allowed to explore we can find identity but if they push us to comply with their views we feel lost and face role confusion Key to learning are our peers and role models Begins to develop a sense of “I”; this process is lifelong; peers become of paramount importance; child gains independence from parents; characterized by faith in self.  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Identity vs. Role Confusion NURSING CONSIDERATIONS: Identity focuses on the integration of all the roles the child has to play in his daily life. Body changes Value system/beliefs Career Emancipation from parents  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Intimacy vs. Isolation Ages 18 to 40 years Virtue: LOVE We understand who we are We ask if we can love. If we make a lifelong commitment, we are confident and happy but if cannot form intimate relationship we might end up lonely and feel isolated Center to this development is our friends and partners  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Generativity vs. Stagnation Ages 40 to 65 years Virtue: CARE Reach the age of 40 we become comfortable, we use our leisure time creatively and began to contribute to society If we think we can lead the next generation in this world we are happy but if we did not resolve some conflicts early we become pessimistic/negative and experience stagnation People from home and work influences the most  ERIKSON’S 8 STAGES OF PSYCHOSOCIAL DEVELOPMENT Ego Integrity vs. Despair Ages 65 to Death Virtue: WISDOM As we grow older we tend to slow down and began to look back into our lives. We ask “How have I done?” if we think well, we develop feeling of integrity or wholeness, if not we experience despair or lose hope and we become grumpy and bitter JEAN PIAGET’S THEORY Jean Piaget's theory of cognitive development suggests that children move through four different stages of mental development. Her theory focuses not only on understanding how children acquire knowledge, but also on understanding the nature of intelligence. Piaget realize that younger children consistently make types of mistake that older children do not. He concluded that children of different age must think differently.  COGNITIVE THEORY (Jean Piaget) Piaget's stages are: 1. Sensorimotor stage: birth to 2 years TODDLER 2. Preoperational stage: ages 2 to 7 years PRESCHOOL 3. Concrete operational stage: ages 7 to 12 years SCHOOL AGE 4. Formal operational stage: ages 12 and up ADOLESCENT to OLD ADULT COGNITIVE THEORY (Jean Piaget) 1. Sensorimotor Period- Birth to 2 years Transition from neonatal reflexes to integration of learning through the child’s sensory and motor skills. A working memory. In Piaget’s term our realization of object permanence Child is curious in everything Explore more, learns to sit, crawl, stand, walk and even run Egocentric means we can perceive the world only from our own perspective COGNITIVE THEORY (Jean Piaget) 2. Preoperational stage: ages 2 to 7 We have a lot of fantasies and believe that objects are alive Birth of primitive reasoning Piaget calls it “intuitive age” Thinking remains egocentric, becomes magical, and is dominated by perception. COGNITIVE THEORY (Jean Piaget) 2. Preoperational stage: ages 2 to 7 Egocentrism: prioritizing his own needs over others Static Thinking: inability to remember what is initially being talked about; hence, their beginning and ending though are not in line with the other. Assimilation: the child fits the situation/perception of things to his own thoughts. COGNITIVE THEORY (Jean Piaget) 2. Preoperational stage: ages 2 to 7 Centering: failing to put one’s self in another person’s shoes Role Fantasy: the child thinks of how he wants things to turn out. Deferred Imitation: the child remembers an action he’s observed and imitates it later on. COGNITIVE THEORY (Jean Piaget) 3. Concrete operational stage: ages 7 to 11 Discover logic and we develop sorting objects in order Thinking becomes more systematic and logical, but concrete objects and activities are needed. We know that to reverse an object we will do the opposite We learn to put ourselves in someone else shoes COGNITIVE THEORY (Jean Piaget) 3. Concrete operational stage: ages 7 to 11 Involves the child’s ability to provide concrete (tangible) solutions to problems; appreciates the idea of cause and effect Accommodation: the child is able to adapt thought process to fit what is perceived. Conservation: ability to discern truth despite change in physical form of an object. Class inclusion: the child is able to understand that an object can belong in various groups. COGNITIVE THEORY (Jean Piaget) 4. Formal Operational (11yr-Adulthood): Teenagers-thinking more rational Our advance cognitive abilities allows us to understand abstract concept such as love & hate, success and failure New ideas can be created; situations can be analyzed; use of abstract and futuristic thinking; understands logical consequences of behavior. The child applies the scientific method/deductive reasoning in learning; gains appreciation of abstract ideas. Final stage in Cognitive development  KOHLBERG’S STAGES OF MORAL DEVELOPMENT Level 1: Level 2: Level 3: Preconventional Conventional Postconventional (School age) (Adolescence) Stage 1: Stage 2: Stage 3: Stage 4: Stage 5: Stage 6: Universal Punishment- Individualism Nice girl - Nice Social Order Social Contract – Ethical Principle Obedience (Preschool) boy orientation (Toddler) KOHLBERG’S STAGES OF MORAL DEVELOPMENT Premorality or Preconventional Morality, Stage 0 (0-2 year): Naivete and Egocentrism No moral sensitivity; decisions are made on the basis of what pleases the child; infants like or love what helps them and dislike what hurts them; no awareness of the effect of their actions on others. “Good is what I like and want.” Level 1: Preconventional Stage 1 (2-3 year): Punishment-Obedience Orientation Right or wrong is determined by physical consequences: “If I get caught and punished for doing it, it is wrong. If I am not caught or punished, then it must be right.” Parents serve as basis of child’s morality Parents must be clear in giving their instructions and in discerning the right and wrong Level 1: Preconventional Stage 2 (4-7 year): Individualism/ Instrumental Hedonism and Concrete Reciprocity Child conforms to rule out of self-interest: “I’ll do this for you if you do this for me”; behavior is guided by an “eye for an eye” orientation. “If you do something bad to me, then it’s OK if I do something bad to you.” The child prioritizes what is good for him rather than what is good for the majority. Level 2: Conventional Stage 3 (7-10 year): Good-Boy or Good-Girl Orientation Morality is based on avoiding disapproval or disturbing the conscience; child is becoming socially sensitive. The child prioritizes what is good in the eyes of other people for them to be distinguished as good children. Level 2: Conventional Stage 4 (begins at about 10-12 year): Law and Order Orientation/ Social Order Right takes on a religious or metaphysical quality. Child wants to show respect for authority and maintain social order; obeys rules for their own sake. The child relies on following rules and an authority figure, even at the cost of their own safety. Level 3: Postconventional Stage 5: Social Contract Orientation Right is determined by what is best for the majority; exceptions to rules can be made if a person’s welfare is violated; the end no longer justifies the means; laws are for mutual good and mutual cooperation. The person follows the standard of society in terms of morality – what is good for the people. Level 3: Postconventional Stage 6: Personal Principle Orientation Achieved only by the morally mature individual; few people reach this level; these people do what they think is right, regardless of others’ opinions, legal sanctions, or personal sacrifice; actions are guided by internal standards; integrity is of utmost importance; may be willing to die for their beliefs. The person develops his own standard of morality and lives by it. Stage 7: Universal Principle Orientation This stage is achieved by only a rare few; Mother Teresa, Gandhi, and Socrates are examples; these individuals transcend the teachings of organized religion and perceive themselves as part of the cosmic order, understand the reason for their existence, and live for their beliefs. Arigato Gozaimasu Health Promotion of the Infant and Family Promoting Optimal Growth and Development Biologic Development At no other time in life are physical changes and developmental achievements as dramatic as during infancy. All major body systems undergo progressive maturation, and there is concurrent development of skills that increasingly allow infants to respond to and cope with the environment. Acquisition of these fine and gross motor skills occurs in an orderly head-to-toe and center-to- periphery (cephalocaudal- proximodistal) sequence. Definition of Normal Infants It is the period which starts at the end of the first month up to the end of the first year of age. Infant's growth and development during this period are rapid. INFANTS Age: birth to 1 year old Conflict – Trust vs. Mistrust Dramatic and rapid changes Physical development– roll over, crawl, walk, grasp objects Mental development—respond to cold, hunger, and pain by crying. Begin to recognize surroundings and become aware of surroundings and people INFANTS Emotional development – show anger, distrust, happiness, excitement, etc. Social development – self-centeredness concept of the newborn to recognition of others in their environment Infants are dependent on others for all needs B Body changes A Achieving Milestone B Babies Safety I Intervention E Eating plan S Social stimulation/Play BODY CHANGES: PHYSICAL GROWTH Weight -By 6 months old: 2 x birth weight. -By 1 year old: 3 x birth weight During the 1ˢᵗ 6 months: average weight gain is 2 lbs./month During the 2ⁿᵈ 6 months: average weight gain is 1 lb./month BODY CHANGES: PHYSICAL GROWTH Estimated calculation of infant’s weight: Infants from 3 to 12 months Weight = Age in months + 9 2 Example: Wt. of 7 months old infant = 7+9 = 16 = 8 kg 2 2 BODY CHANGES: PHYSICAL GROWTH Height increase follows cephalocaudal patter: On the first 6 months, the trunk grows; On the second 6 months, the legs Height increases by 2.5 cm (1 inch) a month during the first 6 months of life and also slows during the second 6 months. Increases in length occur in sudden spurts, rather than in a slow, gradual pattern. The average height is 65 cm (25.5 inches) at 6 months old and 74 cm (29 inches) at 12 months old. By 1 year old, the birth length has increased by almost 50%. BODY CHANGES: PHYSICAL GROWTH Head growth is also rapid. Head circumference increases approximately 2 cm (0.75 inch) per month for the first 3 months 1 cm (0.4 inch) per month from 4 to 6 months then the rate of growth declines to only 0.5 cm (0.2 inch) monthly during the second 6 months. The average size is 43 cm (17 inches) at 6 months and 46 cm (18 inches) at 12 months. BODY CHANGES: PHYSICAL GROWTH Asymmetry of the head is present when child assumes the side- lying position Position the child in supine when asleep Prone when playing Closure of the cranial sutures occurs Posterior fontanel fusing by 6 to 8 weeks old Anterior fontanel closing by 12 to 18 months old (average, 14 months old). BODY CHANGES: PHYSICAL GROWTH Body Proportion Mandible is more prominent Size is greater than chest and abdominal circumference The abdomen remains protuberant until the child learns to walk well Spinal curves begin to develop. BODY CHANGES: PHYSICAL GROWTH Body Systems Thermoregulation: Impaired thermoregulation is present until 6 months. Hematologic system: Physiologic anemia is present at 2-3 months because of RBC destruction > RBC production. This is caused by hematologic system immaturity. Fetal hemoglobin is replaced by adult hemoglobin at 5-6 months. Respiratory system: Small respiratory tract and decreased mucus production makes the child more prone to URTI. BODY CHANGES: PHYSICAL GROWTH Body Systems Immune system: Becomes functional at 2 months of age IgG and IgM production occurs by 1 year Gastrointestinal system: With an immature liver, inadequate bilirubin conjugation takes place and glucose storage is not as efficient in adults. Eruption of teeth starts by 5–6 months of age. It is called "Milky teeth" or "Deciduous teeth" or "Temporary teeth". Lower central Incisor erupts mostly around 10 months and lost for about 6-7y.o The central incisors of the upper teeth (maxillary teeth) erupt at 8 to 12 months and exfoliate at 6 to 7 years. The lateral incisors of the upper teeth erupt at 9 to 13 months and exfoliate at 7 to 8 years. The canines of the upper teeth erupt at 16 to 22 months and exfoliate at 10 to 12 years. The first molar of the upper teeth erupts at 13 to 19 months and exfoliates at 9 to 11 years. The second molar of the upper teeth erupts at 25 to 33 months and exfoliates at 10 to 12 years. The central incisors of the lower teeth(mandibular teeth) erupt at 6 to 10 months and exfoliate at 6 to 7 years. The lateral incisors of the lower teeth erupt at 10 to 16 months and exfoliate at 7 to 8 years. The canines of the lower teeth erupt at 17 to 23 months and exfoliate at 10 to 12 years. The first molar of the lower teeth erupts at 14 to 18 months and exfoliates at 9 to 11 years. The second molar of the lower teeth erupts at 23 to 31 months and exfoliates at 10 to 12 years. ACHIEVING MILESTONE: Erikson has divided the first year of life Oral– Social stages During the first 3 to 4 months, food intake is the most important social activity in which the infant engages. Social modality involves a mode of reaching out to others through grasping. Grasping is initially reflexive, but even as a reflex, it has a powerful social meaning for the parents. The reciprocal response to the infant's grasping is the parents' holding on and touching. ACHIEVING MILESTONE: GROSS MOTOR DEVELOPMENT VENTRAL SUSPENSION: Infant is held in mid-air on horizontal plane, supported by the hand on the abdomen Assess for presence of head lag Newborn Age 6 months ACHIEVING MILESTONE: GROSS MOTOR DEVELOPMENT PRONE POSITION (with head turn to side for ease of breathing): 1 month Lifts head only & turns it easily to side 2 months Raises head and maintains position 3 months Lifts head and shoulders 4 months Lifts up to chest 5 months Turns over completely; back and front; weight on forearms when prone 6 months Rest weight on extended arms 7 months Creeping (with arms extended and legs bent; knees used for mobility ACHIEVING MILESTONE: GROSS MOTOR DEVELOPMENT SITTING: 1-3 months Head lag progressively improves form 1-3 months. 4 months Head lag disappears 5 months Child sits with support 6 months Child sits momentarily without support 8 months Child sits without support Sitting Up Age 2 months Age 8 months ACHIEVING MILESTONE: GROSS MOTOR DEVELOPMENT STANDING: 1 month Newborn stepping reflex is present 9 months Stands with support 10 months Able to stand self with support 11 months Cruising, walks with support 12 months Stands alone momentarily ACHIEVING MILESTONE: GROSS MOTOR DEVELOPMENT AMBULATION: 9 months Crawls 10 months Creeps 12 months Stand independently form creep and crawl 13 months Walk and toddle quickly 15 months Can run Ambulation 13 month old Nine to 12-months ACHIEVING MILESTONE: FINE MOTOR DEVELOPMENT 1-2 months Grasp reflex 4 months (+) thumbs up position 5 months (-) fisting 6 months Palmar grasp: Uses entire hand to pick up an object 7 months Transfers objects form one hand to another 9 months Pincer grasp: Uses thumb and forefingers to grasp small objects FINE MOTOR 6-month-old 12-month-old ACHIEVING MILESTONE: DEVELOPMENTAL MILESTONE LANGUANGE/SPEECH: 1-2 months Cooing sound; different cries for different needs 2-6 months Laugh and Squeals 4 months Cooing, babbling, gurgling, laughing 5 months Simple sounds 6 months Imitating 9 months 1ˢᵗ word 12 months 4 words (mama, dada, bye-bye, no) ACHIEVING MILESTONE: DEVELOPMENTAL MILESTONE VISION: 1 month Follows objects to midline 2 months Focus improves 3 months Eyes follows past midline 4 months Familiar object recognition 6 months Depth perception 10 months Object permanence ACHIEVING MILESTONE: DEVELOPMENTAL MILESTONE HEARING: Enjoys cooing/minimal sounds BAER hearing test done at birth (Brainstem Auditory Evoked Response) Ability to hear correlates with ability enunciate words properly Always ask about history of otitis media – ear infection, placement of PET (pressure equalizing tubes) – tubes in ear Early referral to MD to assess for possible fluid in ears (effusion) Repeat hearing screening test Speech therapist as needed ACHIEVING MILESTONE: 2 MONTHS 4MONTHS Move head from side to side Begins to play Tract peoples faces/objects Babbling-copying noises Smiles Hold and reach for things Holds head up when on stomach Remember faces Roll over ACHIEVING MILESTONE: 6 MONTHS 8-9 MONTHS 10-12 MONTHS Sits with support Sits without support Begin waking-major milestone Follow very simple commands Stranger anxiety Crawling (come here, give to daddy) Stand with pulling and holding Babble with vowel sounds Knows how to wave or say bye unto the object Respond to their names Princer grasp Puts object in container Having fun looking in the mirror Moves object hand to hand Bangs the object Object permanence Says simple words (mama/papa Separation anxiety ACHIEVING MILESTONE: Erikson has divided the first year of life Oral– Social stages During the first 3 to 4 months, food intake is the most important social activity in which the infant engages. Social modality involves a mode of reaching out to others through grasping. Grasping is initially reflexive, but even as a reflex, it has a powerful social meaning for the parents. The reciprocal response to the infant's grasping is the parents' holding on and touching. RED FLAG IN INFANT DEVELOPMENT Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years. ACHIEVING MILESTONE: EMOTIONAL DEVELOPMENT His emotions are unstable, where it is rapidly changes from crying to laughter. His affection for or love family members appears. 1 ½ months, Social smile (smiles back to anyone smiling at him) 8 months, Peak of stranger anxiety 9 months, Voice tone recognition 10 months, he expresses several beginning recognizable emotions, such as anger, sadness, pleasure, jealousy, anxiety and affection. 12 months of age, these emotions are clearly distinguishable; end of stranger anxiety ACHIEVING MILESTONE: SOCIAL DEVELOPMENT He learns that crying brings attention. The infant smiles in response to smile of others. The infant shows fear of stranger (stranger anxiety). He responds socially to his name. According to Erikson, the infant develops sense of trust. Through the infant's interaction with caregiver (mainly the mother), especially during feeding, he learns to trust others through the relief of basic needs. Separation Anxiety ~ 8 months BABY SAFETY SIDS - SUDDEN INFANT DEATH SYNDROME Sleep position- at the back/supine position Avoid smoking Remove extra linens from the crib Don't overdress the infant Don't sleep in the same bed with the infant BABY SAFETY SHAKE BABY SYNDROME- Baby's brain is very fragile BURN- Infant start to reach anything RISK FOR ASPIRATION- Infant puts anything to the mouth Toys that fit inside toilet paper roll can be aspirated by infants. Do not give popcorn, peanuts, and the like. BABY SAFETY ROLLING OVER- Around 4 months, do not swaddle or wrap the baby anymore because baby becomes more movable and at risk for fall BABY SAFETY FALL PREVENTION: Do not leave the infant unattended on an elevated surface. Ensure that the side rails of the infant’s crib are always raised. Ensure that the infant’s head will not fit the failings of the side rails. Bassinet can be safely used only up to 2 months. CAR SAFETY: Car seats are used until pre-school or until child’s weight reaches 40-60 lbs. BATHING: Never leave the infant unattended when bathing, even when the tub or basin is lower that the infant’s sitting height. BABY SAFETY CHILDPROOFING: With the child teething at 5-6 months, objects that may be swallowed must be kept away from him. Keep hazardous objects away form infant’s reach. Do not leave the infant unattended at any time. Cover the electrical outlets, especially when the child can reach it. INTERVENTIONS 1. Promote achievement of TRUST 2. Discuss age-appropriate recommendations (Ways to calm and sooth baby, wellness visits, immunizations, milestones, support for single parent families) 3. Teach nutrition 4. Sleep patterns 5. Foster attachment (emphasize skin-to-skin contact, kangaroo mother care, breastfeeding) 6. Explore family support systems 7. Safety INTERVENTIONS FOR HOSPITALIZED INFANTS CRY- Respond to crying Identify the cause Investigate the reason (Hungry/in pain) FOR YOUNGER PROVIDE COMFORT INFANTS Rock, swaddle, feeding INTERVENTIONS OLDER INFANT 10-12 MONTH OLD INFANT Keep the caregiver near during the assessment Assign same nurse if possible to avoid stranger anxiety Daily Activities: Diaper care is done every 2-4 hours Teeth eruption by 6 months. Prior to that, gums must be cleaned with soft cloth. If tooth eruption begins, brush with soft cloth/toothbrush. Do this twice daily. EATING PLAN Exclusive breastfeeding 0-6 months Give vitamin D 400 IU Formula Feeding with Iron Avoid cows milk or honey for the 1st year of life Solids @ 4-6 months-iron fortified rice cereal 1ˢᵗ Next veggies, fruit, then meat 8-10months EATING PLAN CRITERIA FOR ASSESSING PREPAREDNESS FOR SOLID FOOD INTAKE: The child nurses vigorously every 3-4 hours and does not seem to be satisfied. The child takes >32 oz (960 ml) of formula in a day and does not seem to be satisfied. EATING PLAN GUIDELINES FOR INTRODUCING NEW FOOD FOR THE INFANT: Introduce one food at a time with 5-7 days interval for each food introduced. Food must be introduced before giving breast/formula milk. Give food in small amounts at a time. Do not place food being introduced with milk in a bottle. Check if extrusion reflex is still present. Respect infant’s food preferences. EATING PLAN SEQUENTIAL INTRODUCTION OF FOOD TO INFANTS: 1ST: Cereals (preferably fortified, with consistency fairly liquid  thick) 2ⁿᵈ:Vegetables (by 5-7 months; preferred over fruits because of high iron content) 3ʳᵈ:Fruits (6-8 months) 4ᵗʰ:Meat, pork , poultry (9 months: red meats preferred to be introduced first because of high iron content) 5ᵗʰ: Egg yolk (10 months; high iron content), then egg white (introduce last because of high protein content; potential for allergies) EATING PLAN WEANING (9 MONTHS): Replace one feeding a day ( not main feeding) when infant is feed using a new method of feeding) SOCIAL STIMULATION 4 MONTH OLD -INDEPENDENT PLAY/solitary play -They observe -Be there with them -Babies love the hear voices PLAY PROGRESSES TO INTERACTION -Holds the rattle, hitting objects/blocks together, PUSH TOYS, HIDING OBJECTS Parten’s 6 Stages of Play 1. Unoccupied Play 2. Solitary Play 3. Onlooker Play 4. Parallel Play 5. Associative Play 6. Cooperative Play Parten’s 6 Stages of Play Unoccupied Play (Birth to 3 months) Sensory activities that lack focus or narrative Key Characteristics: Lack of social interaction Lack of sustained focus No clear story lines during play Language use is non-existent or very limited A child picking up, shaking, then discarding objects in their vicinity A child hitting and giggling at a play mobile in a cot. Parten’s 6 Stages of Play Solitary Play (3 months to 2 ½ years) Involves a child playing alone and with little interest in toys outside of their immediate vicinity. Key Characteristics: Increased focus and sustained attention on toys Emerging play narratives, such as use of symbolic play (using objects to represent a car). Disinterest in other children or adult during play. Unstructured play, lacking clear goals. THE END HEALTH PROMOTION OF THE TODDLER AND FAMILY TODDLER DEVELOPS FINE AND GROSS MOTOR SKILLS DEVELOPMENTAL AWARE OF THEIR ENVIRONMENT MILESTONE WANTS TO TEST EVERYTHING WANTS TO EXPLORE DEVELOPS AUTONOMY I WANT TO BE INDEPENDENT I HAVE MY OWN WILL EARLY CHILDHOOD Age: 1-6 years old Conflict: Toddler 1 to 3 years - Autonomy vs. shame and doubt Preschool 3 to 6 years – Initiative vs. guilt Child becomes more independent. The toddler’s frequent use of the word “no” is an expression of developing autonomy.  BODY CHANGES BY 2 YEARS Height- increases 2-3 inches/year WEIGHT GAIN IS ABOUT 4-6 LBS/YEAR ½ their adult height EXAMPLE: BW-7 LBS X 4 = 28 LBS Average ht-33-34” AVERAGE WT. FOR 2Y.O Head Circumference (1-2 cm larger than the GIRL-26.5 lbs chest circumference) MALE- 27.5 lbs - is equal around 12-24 mos TODDLER PHYSICAL DEVELOPMENT Protuberant abdomen Physiologic Lordosis Complete spinal cord myelination = preparedness for toilet training Temporary teeth complete by 2 ½ - 3 years old Physical development – growth slower than in infancy. Muscle coordination allows the child to run, climb, move freely. Can write, draw, use a fork and knife TODDLER FINE MOTOR SKILLS (LOCOMOTION) THROW A BALL KICK A BALL COLORING/HOLD CRAYONS/PENCILS BUILDING BLOCKS COPY A CIRCLE ON A PAPER JUMPS UP & DOWN FINE MOTOR 1 year old: transfer objects from hand to hand 2 year old: can hold a crayon and color vertical strokes Turn the page of a book Build a tower of six blocks 3 year old: copy a circle and a cross – build using small blocks GROSS MOTOR At 15 months, the toddler can: Walk alone. Creep upstairs. Assume standing position without falling. Hold a cup with all fingers grasped around it. At 18 months: Hold cup with both hands. Transfer objects hand-to hand at will. GROSS MOTOR At 24 months: Go up and down stairs alone with two feet on each step. Hold a cup with one hand. Remove most of own clothes. Drink well from a small glass held in one hand. GROSS MOTOR At 30 months: the toddler can: Jump with both feet. Jump from chair or step. Walk up and downstairs, one foot on a step. Drink without assistance. LANGUAGE DEVELOPMENT FOLLOW SIMPLE DIRECTIONS LINK WORDS TOGETHER BY 2 Y.O VOCABULARY OF 300 WORDS BY 2 Y.O ABLE TO IDENTIFY OBJECTS ABLE TO IDENTIFY BODY PART MENTAL DEVELOPMENT Mental development – verbal growth progresses short attention span at end of stage ask questions recognize letters and some words Up to 2 years, the toddler uses his senses and motor development to differentiate self from objects. The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive development (2-4 years), where he is still egocentric and can not take the point of view of other people. EMOTIONAL DEVELOPMENT Emotional development – develop self-awareness and recognize the effect they have on other people and things. Children feel impatience and frustration as they try to do things beyond their abilities. This lead to temper tantrums (the terrible two’s) AUTONOMY Socialization – to foster independence ISSUES IN PARENTING: EMOTIONAL DEVELOPMENT Stranger anxiety – should dissipate by age 2 ½ to 3 years Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months – most disappear by age 3 Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be prolonged indefinitely Thumb sucking Toilet Training SOCIAL DEVELOPMENT The toddler is very social being but still egocentric. He imitates parents. Notice sex differences and know own sex. According to Erikson, The development of autonomy during this period is centered around toddlers increasing abilities to control their bodies, themselves and their environment i.e., "I can do it myself". SOCIAL DEVELOPMENT Social development – at beginning of stage very self-centered one year old to sociable six year old. Strong attachment to parents. Needs are food, shelter, protection, love and security. PLAY: parallel play (side-to-side); playing beside each other) Child prefers toys he can control, can play by themselves, and require action. Child imitates adult around 2 years old. Parten’s 6 Stages of Play Unoccupied Play Solitary Play Onlooker Play Parallel Play Associative Play Cooperative Play Parten’s 6 Stages of Play Solitary Play (3 months to 2 ½ years) Involves a child playing alone and with little interest in toys outside of their immediate vicinity. Key Characteristics: Increased focus and sustained attention on toys Emerging play narratives, such as use of symbolic play (using objects to represent a car). Disinterest in other children or adult during play. Unstructured play, lacking clear goals. Parten’s 6 Stages of Play Onlooker Play (2 ½ years to 3 ½ years) Children showing interest in the play behaviors of other children Key Characteristics: Children showing interest in other children’s play Withholding from play due to fear, disinterest, or hesitation  T - Temper Tantrums O - On the Move (Safety) D - Diaper to Potty Transition D - Developmental Stage Theory L - Love to Say NO! E - Eating Plan R - Ritualism/Rivalry/Regression TEMPER TANTRUMS They're how young children show that they're upset or frustrated. Tantrums may happen when kids are tired, hungry, or uncomfortable. They can have a meltdown because they can't get something (like a toy or a parent) to do what they want. This is because children’s social and emotional skills are only just starting to develop at this age. Children often don’t have the words to express big emotions. They might be testing out their growing independence. And they’re discovering that the way they behave can influence the way other people behave TEMPER TANTRUMS Autonomy is easily stressed Immature in processing their emotions  How to handle toddler tantrums I when they happen? (IBADES) IGNORE! But don’t leave them and protect them from hurting themselves B Be consistent and calm in your approach. If you sometimes give your child what they want when they have tantrums and you sometimes don’t, the problem could get worse. A Acknowledge your child’s strong feelings. For example, ‘It’s very upsetting when your ice-cream falls out of the cone, isn’t it?’ This can help prevent behaviour getting more out of control and gives your child a chance to reset emotions. D Don’t reason with them because they don’t want to understand. Don't give in. If your child still won’t calm down and you know the tantrum is just a ploy to get your attention, E Educate the parent that this is NORMAL S Stay calm (or pretend to!). Take a moment for yourself if you need to. If you get angry, it’ll make the situation harder for both you and your child. When you speak, keep your voice calm and level, and act deliberately and slowly. Spanking your child is also not a good option, and it will only make the tantrum worse.  Tantrum Prevention Tactics PREPARE THEM Avoid situations in which tantrums are likely to erupt. Try to keep your daily routines as consistent as possible and give your child a five-minute warning before changing activities. COMMUNICATE Tell them the plan for the day and stick to your routine to minimize surprises. FEED AND REST Make sure your child is well rested and fed before you go out so they don't blow up at the slightest provocation. CHOICES- Give your toddler a little bit of control. Let your child choose which book to bring in the car or whether they want grilled cheese or peanut butter and jelly for lunch. These little choices won't make much of a difference to you, but they'll make your child feel as though they have at least some control over their own life.  Tantrum Prevention Tactics PICK YOUR BATTLES. Sometimes you can give in a little, especially when it comes to small things. Would you rather let your child watch 15 extra minutes of television or listen them scream for 30 minutes? DISTRACT. A young child's attention is fleeting and easy to divert. When your child's face starts to crinkle and redden in that telltale way, open a book or offer to go on a walk to the park before it can escalate into a full-blown tantrum. Sometimes, humor is the best way to distract. Make a funny face, tell a joke, or start a pillow fight to get your child's mind off what's upsetting them. TEACH your child other ways of dealing with frustration. Children who are old enough to talk can be reminded to use their words instead of screaming. PRAISE THEM- praise them for good behavior  ON THE MOVE (SAFETY) D DROWNING ( DON’T LEAVE A BATHTUB UNSUPERVISED) A AUTOMOBILE ACCIDENTS (CAR SEAT SAFETY) N NOSE DIVES (FALLS) PUT GATES ON THE TOP AND BOTTOM OF THE STAIRS G GETTING BURNED E EATING TOXINS R REVOLVERS/RIFLES (UNSECURED FIREARMS) S SUFFOCATE/CHOKE DIAPER TO POTTY TRANSITION Toddler needs to be physically and mentally ready Anal and urethral sphincters are controlled between 18-24 mos Praise for doing good in the potty training to develop confidence DEVELOPMENTAL STAGE THEORY SENSORIMOTOR BIRTH – 2 YEARS PIAGET PREOPERATIONAL 2-7 Y.O Child is curious in everything Explore more, learns to sit, crawl, stand, walk and even run Egocentric means we can perceive the world only from our own perspective Thinking remains becomes magical and is dominated by perception. (Like playing with a stick imagining that it is a sword) SYMBOLIC THINKING AND PLAY Parallel play Is when two or more toddlers play near one another or next to one another, but without interacting directly Observe others playing they love building blocks love push and pull objects Pretending sets like cooking sets Benefit Language development.... Gross and fine motor skill development.... Freedom to express their desires and feelings.... Understanding social interactions and learning about boundaries.... Learning to share.  Erikson- Autonomy vs Shame/guilt Result to confidence FeelingINTERVENTIONS of independence Major task is Toilet PROVIDE food choices PROVIDE POSITIVE FEEDBACKS training AVOID PUNISHING THEM SEPARATION ANXIETY Protest- scream, cry, hard to calm Despair – quiet but depress; withdrawn Reassure the child that the parent is coming back Detachment- rare to get into this stage Maintain routines like is it can affect parent-child relationship time for reading books, watching tv, or coloring books Talk about their parent LOVE TO SAY NO! Negativism Negativism is doing the opposite of what others want and is closely related to autonomy: the toddler wants to do things by herself/himself. Because a toddler is going through a time of wanting independence, he/she becomes negative toward anyone who attempts to take away his/her independence. How to avoid No answers? Maintain firm and reasonable limits, even though your child objects. Riding in a car seat is good example Give them opportunities to make choices on their own. Give them options Example: it’s time for you to take your medicine. Would you like to put it in a red or blue cup? Avoid giving choices when “no” is not an option Accept no sometimes.  EATING PLAN Dental carries- avoid sugary, processed items USE FULL FAT MILK UNTIL 2Y.O avoid nighttime bottles Iron deficiency anemia – is common visit the dentist as early as the teeth erupts due to lack of iron in foods helps teeth brushing ask is fluoride is added in the water Introduce- iron fortified cereals Picky eaters- offer appealing foods/how the food looks red meats don’t mix the foods. Toddlers don’t like their foods mixed up fish not the best time to try something new use fun/colorful cups or plates (imaginative) beans WATCH OUT FOR FOODS THAT CAN CAUSE CHOKING DO NOT USE FOOD AS A REWARD RITUALISM Do things in the same way why? Predictable, comfortable, promotes learning, less stress Do routines RIVALRY (Sibling/Dethronement) loss of sole parental attention attention is diverted to the younger child How to Avoid? Educate the parent to include them in the care Watch out for Jealousy REGRESSION Regression can vary, but in general, it is acting in a younger or needier way. You may see more temper tantrums, difficulty with sleeping or eating or reverting to more immature ways of talking. If a child has achieved something like getting dressed by herself, you may see a loss of some of those skills. Reverts back to infant type skills Example: They’re on to feeding themselves but now they want to bottle Talking like a baby, wants a pacifier Common causes of regression in young children include: Change in the child-care routine—for example, a new sitter, or starting a child-care or preschool program. The mother's pregnancy or the birth of a new sibling. A major illness on the part of the child or a family member. Do to help? Do not punish them Identify stress to alleviate it Praise them for doing well Daily activities: Foster independence by allowing child to dress himself and complimenting him for accomplishing the task before correcting dressing mistakes. Sneakers are preferred for arch support and firmness against rough surfaces. Ensure routine in daily activities to provide sense of security. Offer food high in protein for snacks against dental caries formation. PARENTAL CONCERNS with TODDLERS TOILET TRAINING Parameters for preparedness for toilet training: 1. control of urethral sphincter 2. walks well 3. understanding that it means to hold urine/stool