Growth & Development PDF

GROWTH & DEVELOPMENT  DEFINITION Growth = is the increase in physical size of a structure or whole as by product of cell division - ( cm, kg) - ( quantitative change ) Parameters of Growth: 1. WEIGHT – is the most sensitive indicator of growth especially low birth weigh...

GROWTH & DEVELOPMENT  DEFINITION Growth = is the increase in physical size of a structure or whole as by product of cell division - ( cm, kg) - ( quantitative change ) Parameters of Growth: 1. WEIGHT – is the most sensitive indicator of growth especially low birth weight ( LBW). It is measured in grams, kilograms, or pounds = Doubles by 5-6 months = Triples by 12 mos ( 1 yr) = Quadruples by 2-21/2 yrs Height – is measured in inches , feet, or centimeters = increases by 1 inch per month in the first 6 mos & by ½ inch per mo from age 7-12 mos Average increase in height during the 1st year of life is 50% Maturation- is used synonymously with development also known as readiness. - skills and competencies Development – is the increase in the skills or capacity to function ( Qualitative change) How to measure Development: 1. By directly observing the child’s performance 2. By noting parent’s description of the child’s progress 3. By DDST ( Denver Developmental Screening Test) MMDST) **4 Main Rated Categories of DDST: 1. Language: ability to communicate 2. Personal Social: ability to interact 3. Fine Motor Adaptive: ability to use hand movements 4. Gross Motor Skills: ability to use large body movement - Cognitive Development – increase in abilities to solve problems, to understand and apply learning experience, to accommodate knowledge & adapt to practical settings, & dexterity to handle new situations. - IQ test – tool used to test cognitive development - Formula Mental Age/ x Chronological age X 100 = IQ  Stages of G & D A.First Stage – pre-natal begins from conception to birth. B. Second stage – from birth to 12 months 1. neonatal – first 28 days, first 4 weeks. 2. Infancy – 1 to 12 months C. Third Stage – Early Childhood( 1-6 y/o) 1. Toddler – 1-3 y/o 2. Pre- school – 4-6 y/o D. Fourth Stage – Middle Childhood 1. School age – 7-12 y/o 2. Adolescence – 13 – 18 y/o E. Late Childhood - Preadolescence – 11 to 13 years - Adolescence – 12 to 18 yrs  Principles of Growth & Development ** G & D is a continuous process that begins from conception that begins from conception & ends in death – principle of “Womb to Tomb” ** Not all parts of the body grow at once, at the same time , & at the same rate. G&D grows occurs in a regular direction reflecting definite & predictable patterns or trends. ** Trends or pattern can be: A. Directional Trends – reflects the direction of development of neuromuscular functions; seen in physical , social & emotional development. 1.Cephalocaudal – ( head to tail) pattern of development that proceeds along the long axis of the body from the head, down the spinal column, then to the toes. 2. Proximodistal –( centro-distal) pattern of development that proceeds from the midline of the body to the extremities ( arm movement development before fine motor finger ability )  3. Symmetrical – each side of the body develops in the same direction at the same time & with the same rate. 4. Mass to specific (differentiation ) – ** child masters simple operation before complex operation. ** moves from a broad general pattern of behavior to a refined pattern. B. Sequential trend – predictable sequence: G&D proceeds thru a normal & known chain of events or stages. Locomotion: ( crawls > creeps> stands> walk> run ) Language :.& social skills - crying, > coos > vowel sounds > full words Secular = refers to the worldwide trend of maturing earlier & growing larger as compared to succeeding generations. ** Behavior is the best gauge of normal development. ** PLAY is the universal language of a child. ** Perfect practice makes perfect learning. ** A right time for initiation of learning & experience is waiting for every individual. ** Primitive neonatal reflexes are lost first for the next development to occur.  Rates of Growth: - rapid – fetal, infancy, adolescence - alternating rapid & slow – toddler, pre- school - slow – school age (growth gap years). THEORIES OF GROWTH AND DEVELOPMENT  Developmental theorists 1. Sigmund Freud – is an Austrian neurologist , Father of Psychoanalysis, & the first person to offer the theory of personality development.  Freud’s Phases of Psychosexual Theory 1. Oral phase –Infancy ( 0- 18 mos) -site of gratification : mouth ( oral stimulation for nutrition, enjoyment and release of tension) Activity: biting, crying, sucking NI: provide oral stimulation even if baby is placed on NPO – pacifiers, breastfeeding, never discourage thumbsucking 2. Anal Phase - toddlerhood ( 18 mos – 3 yrs old) - site of gratification : Anal region Activity: Toilet training; ( elimination or retention of feces or urine is a way of discovery and exerting independence NI: Help the child achieve bowel and bladder control even if hospitalized. The period when obsessive compulsive behaviour originates.( because of strict toilet training) 11/2 yo – start of toilet training ** The main cause of failure in toilet training is the unreadiness of the toddler.  Cues for Toilet Training Readiness: 1. Can stand , squat & walk alone 2. Can communicate toilet needs 3. Can maintain himself or herself dry at an interval of 2 hrs.  3. Phallic – Preschool ( 4-6 y/o) Site of Gratification: Genitalia Activity: The child may show exhibitionism & increased knowledge on both sexes. May perform masturbation. NI: accept sexual interest and answer questions about birth or sexual difference ** accept the child fondling his or her genitalia as a normal area of exploration. In case of masturbation, explain to the child that things like this must be done in private. OEDIPUS COMPLEX – attachment of a son to the mother ELECTRA COMPLEX – attachment of a daughter to a father 4. Latent - School age ( 7 to 12 y/o) - “ Age of Suppression ““because of no obvious development - libido diverted to school NI: help child achieve positive experiences to promote self esteem & so that he/she will be ready to face the conflict of adolescence 5. Genital – Adolescence ( 12- 18 y/o) - site of gratification: Genitalia Activity : learns to establish satisfactory relationship with the opposite sex. - establish sexual aims and finding new love objects NI: give opportunities to relate w/ opposite sex;  Developmental tasks = are skills or growth responsibilities or challenges arising at a particular time in an individual’s life that a person must resolve at a right time as a requirement for accomplishment of future tasks. The successful mastery of each task can result in the development of a “virtue” or personality strength. - ERIK ERICKSON – a student of Sigmund Freud , stressed the importance of culture & society to the development of one’s personality.  Erik Erickson’s Stages Theory of Psychosocial Development 1. Trust vs Mistrust –infancy ( 0-12 mos) Trust – is the foundation of all psychosocial tasks. Trust: safe environment; dependable people; satisfy needs on time; care must be consistent & adequate - Give an experience that will add to security ( hugs & kisses , touch, eye to eye contact & soft music) Mistrust : suspicious, fearful, shun emotional involvement NI: provide primary caregiver and visual stimulation T= developmental task of an infant is to form a sense of trust..when an infant is hungry, a parent feeds & makes him comfortable again. When he is wet, the parent changes her so she is dry again. When she is cold, a parent warms her..  trust vs. mistrust (oral-sensory, birth – 2 years) Existential Question: Can I Trust the World? The first stage of Erik Erikson's theory centers around the infant's basic needs being met by the parents and this interaction leading to trust or mistrust. Trust as defined by Erikson is "an essential truthfulness of others as well as a fundamental sense of one's own trustworthiness." The infant depends on the parents, especially the mother, for sustenance and comfort. The child's relative understanding of world and society come from the parents and their interaction with the child. A child's first trust is always with the parent or caregiver; whomever that might be; however, even the caregiver is secondary where as the parents are primary in the eyes of the child. If the parents expose the child to warmth, regularity, and dependable affection, the infant's view of the world will be one of trust. Should the parents fail to provide a secure environment and to meet the child's basic needs; a sense of mistrust will result. Development of mistrust can lead to feelings of frustration, suspicion, withdrawal, and a lack of confidence. According to Erik Erikson, the major developmental task in infancy is to learn whether or not other people, especially primary caregivers, regularly satisfy basic needs. If caregivers are consistent sources of food, comfort, and affection, an infant learns trust- that others are dependable and reliable. If they are neglectful, or perhaps even abusive, the infant instead learns mistrust- that the world is an undependable, unpredictable, and possibly a dangerous place. While negative, having some experience with mistrust allows the infant to gain an understanding of what constitutes dangerous situations later in life, yet being at the stage of infant or toddler; it is a good idea not to put them in situations of mistrust, the child's number one needs are to feel safe, comforted, and well cared for. 2. Autonomy vs Shame and Doubt – toddlerhood ( 18 mos – 3 y/o) Developmental Task : Autonomy or Independence How to develop Autonomy: 1. Give an opportunity for decision making such as offering choices 2. Encourage the child to make decisions rather than judge Autonomy: build on new motor and mental abilities, take pride in accomplishments Shame : doubt and stop trying NI: provide opportunities for decision making and give praises  Autonomy vs. shame and doubt (muscular-anal, 2–4 years) Existential Question: Is It OK to Be Me? As the child gains control over eliminative functions and motor abilities, they begin to explore their surroundings. The parents still provide a strong base of a security from which the child can venture out to assert their will. The parents' patience and encouragement helps foster autonomy in the child. Children at this age like to explore the world around them and they are constantly learning about their environment. Caution must be taken at this age while children may explore things that are dangerous to their health and safety. At this age children develop their first interests. For example, a child who enjoys music may like to play with the radio. Children who enjoy the outdoors may be interested in animals and plants. Highly restrictive parents, however, are more likely to instill in the child a sense of doubt, and reluctance to attempt new challenges. As they gain increased muscular coordination and mobility, toddlers become capable of satisfying some of their own needs. They begin to feed themselves, wash and dress themselves, and use the bathroom. If caregivers encourage self-sufficient behavior, toddlers develop a sense of autonomy—a sense of being able to handle many problems on their own. But if caregivers demand too much too soon, refuse to let children perform tasks of which they are capable, or ridicule early attempts at self-sufficiency, children may instead develop shame and doubt about their ability to handle problems. 3. Initiative vs Guilt – Preschool age ( 4-6 y/o) Developmental Task: Initiative as the child learns how to do basic things How to develop Initiative: 1. Give an opportunity to explore new places & events such as bringing the child to an amusement park Activity: finger painting & modelling clay- enhances their imagination , creativity & fine motor development. Guilt : limited brainstorming and problem-solving skills NI: provide opportunities for exploration, answer questions and do not inhibit fantasy Purpose: initiative vs. guilt (locomotor-genital, preschool, 4–5 years) Existential Question: Is it OK for Me to Do, Move, and Act? Initiative adds to autonomy the quality of undertaking, planning and attacking a task for the sake of just being active and on the move. The child is learning to master the world around them, learning basic skills and principles of physics. Things fall down, not up. Round things roll. They learn how to zip and tie, count and speak with ease. At this stage, the child wants to begin and complete their own actions for a purpose. Guilt is a confusing new emotion. They may feel guilty over things that logically should not cause guilt. They may feel guilt when this initiative does not produce desired results. The development of courage and independence are what set preschoolers, ages three to six years of age, apart from other age groups. Young children in this category face the challenge of initiative versus guilt. As described in Bee and Boyd (2004), the child during this stage faces the complexities of planning and developing a sense of judgment. During this stage, the child learns to take initiative and prepare for leadership and goal achievement roles. Activities sought out by a child in this stage may include risk-taking behaviors, such as crossing a street alone or riding a bike without a helmet; both these examples involve self-limits. Within instances requiring initiative, the child may also develop negative behaviors. These behaviors are a result of the child developing a sense of frustration for not being able to achieve a goal as planned and may engage in behaviors that seem aggressive, ruthless, and overly assertive to parents. Aggressive behaviors, such as throwing objects, hitting, or yelling, are examples of observable behaviors during this stage. ** Preschoolers are increasingly able to accomplish tasks on their own, and can start new things. With this growing independence comes many choices about activities to be pursued. Sometimes children take on projects they can readily accomplish, but at other times they undertake projects that are beyond their capabilities or that interfere with other people's plans and activities. If parents and preschool teachers encourage and support children's efforts, while also helping them make realistic and appropriate choices, children develop initiative- independence in planning and undertaking activities. But if, instead, adults discourage the pursuit of independent activities or dismiss them as silly and bothersome, children develop guilt about their needs and desires. 4. Industry vs Inferiority - School age ( 7 to 12 y/o) Developmental Task: Industry as the child learns how to do things well How to develop industry: 1. Give short assignments & projects Inferiority: always worried about poor or incorrect performance NI: provide opportunities for completing short projects, give praise and rewards Competence: industry vs. inferiority (latency, 5–12 years) Existential Question: Can I Make it in the World of People and Things? The aim to bring a productive situation to completion gradually supersedes the whims and wishes of play. The fundamentals of technology are developed. The failure to master trust, autonomy, and industrious skills may cause the child to doubt his or her future, leading to shame, guilt, and the experience of defeat and inferiority. "Children at this age are becoming more aware of themselves as individuals." They work hard at "being responsible, being good and doing it right." They are now more reasonable to share and cooperate. Allen and Marotz (2003)also list some perceptual cognitive developmental traits specific for this age group. Children grasp the concepts of space. and time in more logical, practical ways. They gain a better understanding of cause and effect, and of calendar time. At this stage, children are eager to learn and accomplish more complex skills: reading, writing, telling time. They also get to form moral values, recognize cultural and individual differences and are able to manage most of their personal needs and grooming with minimal assistance. At this stage, children might express their independence by talking back and being disobedient and rebellious. Erikson viewed the elementary school years as critical for the development of self-confidence. Ideally, elementary school provides many opportunities for children to achieve the recognition of teachers, parents and peers by producing things- drawing pictures, solving addition problems, writing sentences, and so on. If children are encouraged to make and do things and are then praised for their accomplishments, they begin to demonstrate industry by being diligent, persevering at tasks until completed, and putting work before pleasure. If children are instead ridiculed or punished for their efforts or if they find they are incapable of meeting their teachers' and parents' expectations, they develop feelings of inferiority about their capabilities. At this age, children start recognizing their special talents and continue to discover interests as their education improves. They may begin to choose to do more activities to pursue that interest, such as joining a sport if they know they have athletic ability, or joining the band if they are good at music. If not allowed to discover their own talents in their own time, they will develop a sense of lack of motivation, low self-esteem, and lethargy. They may become "couch potatoes" if they are not allowed to develop interests. After age 12 though, economy becomes part of identity, "Do I want to be employed and have a paying job; or do I want to take advantage of the system and live off the dole." 5. Role Identity vs Role Confusion – adolescence ( 12-18 y/o) Developmental Task: = Identity as the adolescent adjusts to changes in his/her body & seeks freedom from parents to learn who she/he will be in the future Role Confusion: unsure of who they are or who they can become, may rebel NI: help the person accept himself/herself & provide opportunities to discuss feelings and support and praise for decision-making Fidelity: identity vs. role confusion (adolescence, 13–19 years) Existential Question: Who Am I and What Can I Be? The adolescent is newly concerned with how they appear to others. Superego identity is the accrued confidence that the outer sameness and continuity prepared in the future are matched by the sameness and continuity of one's meaning for oneself, as evidenced in the promise of a career. The ability to settle on a school or occupational identity is pleasant. In later stages of Adolescence, the child develops a sense of sexual identity. As they make the transition from childhood to adulthood, adolescents ponder the roles they will play in the adult world. Initially, they are apt to experience some role confusion—mixed ideas and feelings about the specific ways in which they will fit into society—and may experiment with a variety of behaviors and activities (e.g. tinkering with cars, baby-sitting for neighbors, affiliating with certain political or religious groups). Eventually, Erikson proposed, most adolescents achieve a sense of identity regarding who they are and where their lives are headed. Erikson is credited with coining the term "Identitys." Each stage that came before and that follows has its own 'crisis', but even more so now, for this marks the transition from childhood to adulthood. This passage is necessary because "Throughout infancy and childhood, a person forms many identifications. But the need for identity in youth is not met by these." This turning point in human development seems to be the reconciliation between 'the person one has come to be' and 'the person society expects one to become'. This emerging sense of self will be established by 'forging' past experiences with anticipations of the future. In relation to the eight life stages as a whole, the fifth stage corresponds to the crossroads: What is unique about the stage of Identity is that it is a special sort of synthesis of earlier stages and a special sort of anticipation of later ones. Youth has a certain unique quality in a person's life; it is a bridge between childhood and adulthood. Youth is a time of radical change—the great body changes accompanying puberty, the ability of the mind to search one's own intentions and the intentions of others, the suddenly sharpened awareness of the roles society has offered for later life. 12]  Adolescents "are confronted by the need to re-establish [boundaries] for themselves and to do this in the face of an often potentially hostile world." This is often challenging since commitments are being asked for before particular identity roles have formed. At this point, one is in a state of 'identity confusion', but society normally makes allowances for youth to "find themselves," and this state is called 'the moratorium': The problem of adolescence is one of role confusion—a reluctance to commit which may haunt a person into his mature years. Given the right conditions—and Erikson believes these are essentially having enough space and time, a psychosocial moratorium, when a person can freely experiment and explore— what may emerge is a firm sense of identity, an emotional and deep awareness of who he or she is.[  6. INTIMACY VS ISOLATION – Early Adulthood ( 18- 25/30 y/o Developmental task : young adult seeks companionship & love with another person that results the ability to give & receive love. NI: Encourage a mutual relationship & responsible sexual behaviour. Love: intimacy vs. isolation (young adulthood, 20–24, or 20–39 years) Existential Question: Can I Love? The Intimacy vs. Isolation conflict is emphasized around the age of 30. At the start of this stage, identity vs. role confusion is coming to an end, though it still lingers at the foundation of the stage (Erikson, 1950). Young adults are still eager to blend their identities with friends. They want to fit in. Erikson believes we are sometimes isolated due to intimacy. We are afraid of rejections such as being turned down or our partners breaking up with us. We are familiar with pain and to some of us rejection is so painful that our egos cannot bear it. Erikson also argues that "Intimacy has a counterpart: Distantiation: the readiness to isolate and if necessary, to destroy those forces and people whose essence seems dangerous to our own, and whose territory seems to encroach on the extent of one's intimate relations" (1950). Once people have established their identities, they are ready to make long-term commitments to others. They become capable of forming intimate, reciprocal relationships (e.g. through close friendships or marriage) and willingly make the sacrifices and compromises that such relationships require. If people cannot form these intimate relationships – perhaps because of their own needs – a sense of isolation may result; arousing feelings of darkness and angst  7. Generativity vs, Stagnation – Middle Adults ( 30-45/65 y/o) Developmental Task: Generativity: middle age-adults contribute to the next generation by performing meanigful work as they extend their concern to the community & the world. NI: Encourage them to be an active member of the community Generativity vs. Stagnation (middle adulthood, 25–64, or 40–64 years) Existential Question: Can I Make My Life Count? Generativity is the concern of guiding the next generation. Socially- valued work and disciplines are expressions of generativity. The adult stage of generativity has broad application to family, relationships, work, and society. “Generativity, then is primarily the concern in establishing and guiding the next generation... the concept is meant to include... productivity and creativity." During middle age the primary developmental task is one of contributing to society and helping to guide future generations. When a person makes a contribution during this period, perhaps by raising a family or working toward the betterment of society, a sense of generativity- a sense of productivity and accomplishment- results. In contrast, a person who is self-centered and unable or unwilling to help society move forward develops a feeling of stagnation- a dissatisfaction with the relative lack of productivity. Central tasks of middle adulthood: Express love through more than sexual contacts. Maintain healthy life patterns. Develop a sense of unity with mate. Help growing and grown children to be responsible adults. Relinquish central role in lives of grown children. Accept children's mates and friends. Create a comfortable home. Be proud of accomplishments of self and mate/spouse. Reverse roles with aging parents. Achieve mature, civic and social responsibility. Adjust to physical changes of middle age. Use leisure time creatively.  8. EGO INTEGRITY vs. DESPAIR ( Late Adulthood ( 65 y/o & above) Developmental Task: Integrity = older adults try to make sense out of their lives as they have feelings of self acceptance , dignity, worth & importance NI: Accept their body limitations but encourage them to share their wisdom & explore the philosophy of life & death. Wisdom: ego integrity vs. despair (late adulthood, 65 – death) Existential Question: Is it OK to Have Been Me? As we grow older and become senior citizens we tend to slow down our productivity and explore life as a retired person. It is during this time that we contemplate our accomplishments and are able to develop integrity if we see ourselves as leading a successful life. If we see our life as unproductive, or feel that we did not accomplish our life goals, we become dissatisfied with life and develop despair, often leading to depression and hopelessness. The final developmental task is retrospection: people look back on their lives and accomplishments. They develop feelings of contentment and integrity if they believe that they have led a happy, productive life. They may instead develop a sense of despair if they look back on a life of disappointments and unachieved goals. This stage can occur out of the sequence when an individual feels they are near the end of their life (such as when receiving a terminal disease diagnosis).  ERICKSON’S PSYCHOSOCIAL THEORY OF HUMAN DEVELOPMENT STAGES DEVELOPMENTAL TASK Oral –sensory ( birth to 18 TRUST VS. MISTRUST mos) Musculo-anaL ( 18mos – 3 AUTONOMY VS. SHAME & DOUBT years) Locomotor – phallic ( 3-5 yrs) INITIATIVE VS. GUILT Latency ( 6-11 yrs) INDUSTRY VS. INFERIORITY Adolescence (12-18 yrs) ROLE IDENTITY VS. ROLE CONFUSION Young adulthood (19-35 yrs) INTIMACY VS. ISOLATION Adulthood (35- 65 yrs) GENERATIVITY VS. STAGNATION Maturity ( 65+ years) EGO INTEGRITY VS. DESPAIR  Piaget’s Theory of Cognitive development Jean Piaget – a Swiss psychologist & founder of the theory of Cognitive Development Cognitive Development means how children think, explore and figure things out. It is the development of knowledge skills, problem solving and dispositions. Stages of Cognitive Development: A. Sensorimotor – 1 mo-24 mo “ Infancy Practical Intelligence” - relate through senses & reflexes because the child cannot use words & symbols yet.  B. Preoperational Thought – 2-7 yo A. Preconceptual 1. Age: 2-4 2. Their thinking is basically literal & static. They are egocentric ( unable to view other’s viewpoint) 3. Their concept of time is only now & their concept of distance is only as far as the eyes can see. 4. They have the concept of animism ( considers inanimate objects as alive) 5. They are not aware of the concept of reversibility or cause & effect B. Intuitive 1. Ages 5-7 2. beginning of causation C. Concrete Operational Thought – 7-12 yo 1. Can find solution to everyday problems with systematic reasoning 2. Aware of the concept of reversibility 3. Aware of the concept of conservation ( constancy despite of transformation) Activity: Collecting & classifying Reversibility – ability to recognize that things that have been changed can be returned to their original state. Ex. Water can be frozen & then thawed to become liquid again. But eggs cannot be unscrambled. Arithmetic can be reversible as well: 2+3 = 5 and 5-3 = 2. D. Formal Operational Thought – 12 yo & above 1. The period where cognition achieves its final form 2. Can solve hypothetical problems with scientific reasoning 3. Can deal with the past, present & future 4. They are capable of abstract & formal thought 5. How to develop: talk time that will sort out opinions on current events.  JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT-Development proceeds from reflex activity to SENSORIMOTOR ( 0 – 2 YEARS) representation & sensorimotor solutions to problems PRE- Problems solved through REPRESENTATION, language OPERATIONAL development; (2-4 yrs); thoughts & language both ( 2 – 7 YEARS) EGOCENTRIC, can’t solve conservation problems CONCRETE REVERSIBILITY attained; can solve conservation problems; OPEARATIONAL LOGICAL OPERATION developed & applied to CONCRETE ( 7- 11 years) problems, cannot solve complex verbal problems FORMAL LOGICALLY SOLVES all types of problems; thinks OPERATIONAL SCIENTIFICALLY; solves COMPLEX problems; COGNITIVE ( 12 YRS TO structures mature ADULTHOOD)  Lawrence Kohlberg’s Theorist of Moral development Moral development is considered to closely approximate cognitive stages of development. Stages of Moral Development Infancy – premoral, amoral ore pre-religious  Lawrence Kohlberg’s Theory of Moral Development Preconventional (Level I) Stage 1 - 2-3 yo “mother or father says so” punishment obedience orientation - Child does what is right to avoid punishment or to obey what their parents tell them. Give clear instructions to avoid confusion about what the right actions are. Stage 2 - 4-7 yo “mother says it’s wrong” individualism/egocentrism - Actions are directed towards satisfying own needs rather than the needs of society & will do things for others only in return of something. Remind the child that things are done for him as trade off actions.  Kohlberg’s Theory of Moral Development Conventional (Level II) Stage 3 – 7-10 yo “nice girl, nice boy” Orientation to interpersonal relations of mutuality. A child follows rules to be “nice”. Allow actions that give the child an image of “nice boy nice girl” , or to be good in his own eyes. Stage 4 – 10-12 yo following rules is satisfying “Law and Order” Maintenance of social order , fixed rules and authority. Finds satisfaction by following rules of authority figures in an effort the keep the “system” working. Child often asks what is “right” or “what are the rules” but only follows rules in the presence of an enforcing authority.  Kohlberg’s Theory of Moral Development Postconventional (level III) older than 12 yo Stage 5 following standards for everyone’s good “Social Contract”, utilitarian law making perspectives. Responsibly follows standards of the society for the good of all people Stage 6 Universal ethical “Principled conscience” Follows internalized standard of conduct not reached by most adults.  DEVELOPMENTAL Milestones Growth and Developmental Milestones = are major markers of growth & development that serves as the basis of assessing developmental delay or advancement. INFANCY – 0-1 yo  * INFANCY (28 DAYS TO ONE YEAR) I- PSYCHOSEXUAL STAGE ( FREUD): ORAL II –PSYCHOSOCIAL STAGE ( ERICKSON): TRUST VS. MISTRUST A. CENTRAL PERSON: PRIMARY CAREGIVER B. BEHAVIORAL INDICATORS: a. CRYING IS THE ONLY MEANS OF COMMUNICATING NEEDS. III– COGNITIVE STAGE( PIAGET) : SENSORIMOTOR ( 0-2 YRS) PLAY : SOLITARY (THEY PLAY WITH THEIR OWN BODY) 1. TO PRACTICE MOTOR SKILLS 2. TO GAIN COORDINATION 3. TO RELATE TO OBJECTS & PEOPLE *infants usually do not seek out the company of other infants to “play”. This does not mean that the infant should be left alone with toys; however, social stimulation from parents, older siblings  Age appropriate toys: Nursing Alert: In choosing a toy , the priority is safety & iy must be age appropriate. Toys should stimulate all senses & be bright & multi-colored. 1. mobiles 5. teething rings 2. rattles 6. textured balls 3. musical box 7. large, soft cuddly toys 4. squeeze toys 8. brightly colored pictures Best color: red Auditory stimulation: sing & talk to the Tactile stimulation: 1. Hold, pat, touch, cuddle, swaddle/keep warm; rub body with lotion, powder. Toys: various textures; nesting & stacking, plastic milk bottle with blocks to dump in & out. Kinetic stimulation: 1. Cradle, stroller, carriage, infant seat, car rides, wind-up infant seat, walker Toys : cradle gym, push-pull 1V – Greatest Fear – Stranger anxiety ( starts at 6 months and peaks at 8 months)- normal – indicates attachment of infant to caregiver. “Nurse Alert” – Most common accident during the first twelve months is the aspiration of foreign bodies. V. PHYSICAL GROWTH: 1.Height ( length) – 50% increase by first birthday 2. Weight = Doubles by 6 months ( gains 5- 7 oz./wk in 1st 6 mos.; gains 3-5 oz/wk in 2nd month) ** Best color for neonates: black & white ** Best color for infants: red **Use CAR SEATS for children according to “Rule of 4’s” when traveling = 4 years or younger = 40 lbs or less = 40 in. tall or shorter  Neonate:birth to 1 month A.) Largely reflex B. Complete head lag C. Cry without tears D. Hands fisted E. Visual fixation on human face 1 month: Dance reflex disappear Looks at mobile  GROWTH & DEVELOPMENT 2 months Gross: 45 degree head control; Holds head up when in prone position Fine : EYES midline (3 mos: HAND RECOGNITION) Social : SOCIAL SMILE Language: CRYING Baby coos Rooting reflex diminishes Posterior fontanel closes Immune System matures (immunization starts)  3 Months: a. Holds head & chest up when in prone position B. Hand regard C. Grasp & tonic neck reflexes disappear D. Follows object past midline GROWTH & DEVELOPMENT 4 months G : lifts head and chest when prone F: brings hands together L: COOS/GURGLES/ SQUEALS , moves head to sound S: plays with rattles, enjoys social interaction (-) PALMAR/STEPPING (-) EXTRUSION- supplemental feeding starts  5 Months: A. Turns both ways ( roll over) B. Teething rings C. Moro reflex disappear ( 4-5 mos) S: smiles to mirror when he/ she sees self D. Handles rattles well GROWTH & DEVLOPMENT 6 months G: rolls over from supine to prone, good head control *HEADBANGING F: holds object in 1 hand and reaches out for another object Sits with support L: simple vowel sounds S: recognizes familiar faces start of *STRANGER ANXIETY P: Eruption of the first temporary teeth (lower central incisors ) 2X Birthweight, (-) MORO/SUCKING *Bruxism  7 months = Beginning of fear of strangers ( 6-7 months) = Transfers object from hand to hand GROWTH & DEVELOPMENT 8 months G: sits without support, CRAWLS (9 mos: CREEPS, PULLs SELF TO STANDING POSITION) F: hand to hand transfer of objects, waves BYE-BYE S: peak of STRANGER ANXIETY  9 Months A. Creeps & Crawls B. Combine 2 syllables “ma-ma or da-da” C. Needs space for creeping Neat pincer grasp reflex starts looking for objects and persons ( object of permanence) GROWTH & DEVELOPMENT 10 months G: CRUISES Pulls self to stand Understands the word NO Responds to own name stands with support S: responds to NAME when called, enjoys nursery games (peek-a-boo) L: mama, dada  11 months Stands with support Cruises One word plus mama dada  GROWTH & DEVELOPMENT 12 months G: stands alone, walks with assistance F: throws toys, attempts at 2 tower blocks, attempts to use SPOON L: one word other than mama, dada S: shows jealousy and affection P: weaning off from bottle to CUP *BABY BOTTLE SYNDROME 3X Birthweight 2X Birth length  PLAY – solitary play 1-3 mos 7-9 mos Balloon mobiles Block play Mirror play Splashing bath Stuffed animals toys Cloth textured Rattles being toys held Large balls 4-6 mos Squeeze toys 10-12 mos Picture books Busy boxes Large blocks Play gyms Nesting cups  PLAY Peek-a-boo Rocking Singing games Squeaky toys Pat-a-cake Feet & toes games Fingers & hand games Listening to stories Making faces Calories: 100-115 kcal/kg/day 0-3 mos - breastmilk 4-6 mos - semi-solid food ** Introduce solid food one at a time to determine allergies Start with small quantities: 1.Cereals, 2. strained vegetables, 3. meat 7-9 mos - Finger food, fluids 10-12 mos – 3 meals w/ snacks Water – 125-150 ml/k/day from 0-6 mos - 135 ml/kg/day from 6-12 mos - bathing DAILY CARE - diaper care - care of teeth - dressing - sleep – 16-20hrs/day; - 6 mos- 1-2 naps, with 12h at night - 12 mos old; 1 nap with 12h at night - exercise  Concerns - Constipation /Loose - sleep problems – Stools breastfed infants - Teething – cleanliness wake up sooner - COLIC –paroxysmal - Thumb sucking – until abdominal pain school age - DIAPER - pacifiers – wean after 3 DERMATITIS months - MILIARIA - OBESITY - spitting up  REACTION TO NURSING CARE ILLNESS Soothing Discomfort and pain stimulation Lack of stimulation Toys from home Separation anxiety Human contact Disruption of routine Provide/Anticipate needs TODDLER – 1 –3 yo  TODDLER ( 1-3 YEARS OLD) I – PSYCHOSEXUAL STAGE ( FREUD): ANAL - LEARNING MUSCLE CONTROL FOR TOILET TRAINING. - SOURCE OF ENJOYMENT /GRATIFICATION IS THE ACT OF RELEASING CONTENTS OF BOWEL & BLADDER. - NEGATIVISM – ASSERTION OF INDEPENDENCE II – CENTRAL FIGURE: PARENTS III – PSYCHOSOCIAL STAGE:( ERICKSON): CENTRAL TASK: AUTONOMY VS. SHAME & DOUBT 1. AUTONOMY- SENSE OF INDEPENDENCE IS DEVELOPED BY ALLOWING THE CHILD TO EXPLORE UNDER SUPERVISION IN A CONTROLLED ENVIRONMENT. - SIGNS OF INDEPENDENCE: ** TEMPER TANTRUMS ** SAYS “NO”( THEY LEARN TO SAY “NO” ** INSISTS ON PUTTING ON THEIR OWN CLOTHES & GET THEIR FEET ON THE WRONG SHOES. ** INSISTS ON WINDING A TOY & BREAKING IT. 2. GAIN CONTROL OF BODY FUNCTION: ** SELF-FEEDING, DRESSING, UNDRESSING, & HYGIENE 3. TOILET TRAINING – BEGIN TRAINING WHEN READY: ** CAN STAND ALONE & WALK STEADILY  ** IS ABLE TO SAY WEEWEE OR POOPOO ** DESIRES TO PLEASE PRIMARY CARETAKER GUIDELINES: 1.REWARD POSITIVE BEHAVIOR WITH PRAISE & AFFECTION. 2. MAINTAIN RELAXED & NON-PUNITIVE ATTITUDE 3. DISCIPLINE CONSISTENTLY, IMMEDIATELY, & APPROPRIATELY 4. USE CORPORAL PUNISHMENT, SPARINGLY LIKE SPANKING, NEVER IN ANGER FOR THE CHILD’S SAFETY. 5. DO NOT BRING FAVORITE TOY DURING TRAINING 6. PUT ON TRAINER FOR 10 MOS; DO NOT LEAVE ALONE. ** BOWEL CONTROL AT 18 MOS; DAYTIME BLADDER CONTROL AT 2 TO 2 ½ YEARS & NIGHTIME BLADDER CONTROL AT 3 YEARS IV – COGNITIVE STAGE: ( PIAGET): STAGE 1 ( PRECONCEPTUAL STAGE) OF THE PREOPERATIONAL THOUGHT PERIOD (2- 4 YRS) = CHARACTERIZED BY EGOCENTRICITY EXPRESSED IN RELATING EVERYTHING TO SELF. V MORAL (KOHLBERG) PRECONVENTIONAL LEVEL 1 STAGE 1 VI – PLAY = PARALLEL VII – GREATEST FEAR: SEPARATION ANXIETY ( begins at 9 mos most acute at 2- 2 ½ years of age)  3 Phases of Separation Anxiety 1. Protest = characterized by anger , may scream & call the mother to come back 2. Despair = characterized by being withdrawn & does not want to talk. 3. Denial = exhibited by ignoring the parents. ** How to prevent separation anxiety : Do not prolong the goodbyes & say goodbye firmly. Parallel Play –two toddlers play next to but not necessarily with each other. They are engaged in separate activities , do not have shared rules & have no apparent organization.  TODDLER Slowed growth Wt gain 5-6 lbs (2.5 kg) 5 in (12 cm) Baby fat disappears brain 90 % adult size Baby fat disappears CC > HC; inc by 2 cm HR 90 bpm BP 99/64  TODDLER Protruberant abdomen Stomach capacity increases Control of urinary and anal sphincters 20 deciduous teeth ( milk teeth)  MILESTONES 15 mos –Plateau Stage ; walks alone well - seats self on chair - Creeps upstairs - vocalizes wants - 3 words other than dada, mama - imitates housework 18 mos – bowel control achieved - run and jump in place - walk up & down stairs holding on to railing - height of possessiveness - walks up & down stairs w/ both feet same step, same time - 7 to 20 words ; can name one body part  24 Months: - terrible two’s - can open door by turning door knobs - 5 to 200 words ( 2 word sentence) - Daytime bladder control achieved 30 Months: - Makes simple lines & strokes or crosses with pencil - knows full name - Copies a circle 2 ½ yo – tiptoes - Temporary teeth complete – 20 deciduous teeth ( last to erupt – posterior molar)  36 Months: - Trusting threes - can do toothbrushing with little supervision - Unbuttons buttons - Draws a cross - Learns how to share - Night time bladder control achieved 3 yo - speaks fluently using longer sentences - tells stories, plurals - - toilet trained by day (2-3 yrs old) - 3 yo - throws balls, rides tricycles - stands on 1 foot momentarily  NUTRITION Decrease in appetite Picky eaters 1, 300 kcal/day Allow self feeding Allow choice between 2 types of food Offer finger food Risk of aspiration  PLAY – parallel play Babbling and talking Making music and noise Ball games Push and Pull toys Clay Puppet play Listening to music Scribbling Listening to stories Stack-and-dump toys  DAILY CARE - dressing – can put on socks, underpants, undershirt - sleep – 12-14H/night w/ 1 nap - dependency on security object (transitional toy) - may ask to sleep with bottle - may rebel against going to sleep - bathing - care of teeth-since all 20 deciduous teeth are out by 2 ½ yrs, start teaching brushing of teeth; first dental check up shld be bet. 12-18 mos.  Negativism – they are slowly moving out of infancy & are more closely defining their own independent activity. Temper Tantrums-in order to control self & others. Mx: IGNORE THE BEHAVIOR or direct them to activities they can master.( When things are rearranged or are strange; or when persons or places are unfamiliar) Accidents because they are , naturally active, mobile & curious –(set limits & exert external control. LOVE & CONSISTENCY are the 2 most important concepts in child rearing. Rituals- rigid, repetitive & steroetyped.  EGOCENTRIC – uses “ MINE “ for everything.  Sibling rivalry Discipline Separation anxiety  DAILY CARE - dressing – can put on socks, underpants, undershirt - sleep – 8 hours sleep w/ 1 nap - bathing - care of teeth  CONCERNS Toilet Training bowel control – 18 mos daytime bladder ctrl – 2-3 yo nighttime bladder ctrl – 3-4 yo CONDITIONS: 1. control of sphincters 2. cognitive understanding 3. delay immediate gratification 4. mature nervous system  REACTION TO ILLNESS and NURSING INTERVENTIONS fear of separation - Assure of parents return Regressive behaviors - reassurance Nutrition – allow finger food Dressing changes – allow to pull off tape Medication – allow choices of “chaser” after oral medication “CHASER”  Hygiene – allow choice of bathtime toy, allow to put toothpaste Pain – allow to express pain Stimulation Elimination – continue potty training Rest – allow choice of toy at bedtime NOTES: 1.Accidents are the chief cause of death in toddlers. Most accidental deaths in children under age 3 years are related to MOTOR VEHICLE ACCIDENTS. 2. When caring for a toddler in the hospital, the nurse should prevent SEPARATION ANXIETY by encouraging rooming-in. To help the toddler deal with frustration & loss of autonomy, the nurse should provide the toddler with a POUNDING BOARD or PUNCHING BAG. 3. SECURITY OBJECT – something a toddler becomes strongly attached to like doll, stuffed animal, pillow or blanket; if separated from the security object, the toddler usually reacts with extreme frustration & anxiety. 4. The DENVER DEVELOPMENT SCREENING TEST is used to screen the development of toddlers. ( ex. Most toddlers can remove their own clothes between 12 & 18 mos. And put their own clothes between 19-24 mos. 5. Turn pot handles in when on stove top.  ** Consider every non food substance a hazard and place out of child’s sight/ reach. ** Keep all medications, cleaning materials etc. in clearly marked containers in locked cabinets. ** provide barrier on open windows to prevent falls.  PEDIATRIC NURSING HEALTH ASSESSMENT A. General considerations 1. child - maintain eye contact, bend to child’s level - use appropriate language - Allow child some warm up time - Respect child’s response, need for privacy - Incorporate play 2. Family Considerations - encourage parents participation - choose quiet environment for teaching and assessment - ask open ended questions - focus on information needed or problem - listen attentively, respect response, provide feedback - encourage questions  Age related interview techniques a. Infant: speak softly, allow infant to identify you w/ a parent, use touch b. Toddler: allow toddler to stay close to parent, focus on favorite toy or unique characteristics of child c. Preschooler: use simple questions and words, allow child to manipulate equipment, use puppets and play  Age related interview techniques a. School age: offer explanations, teach about health, provide demonstrations e. Adolescents: maintain confidentiality, facilitate trust, open and honest communication, nonjudgmental  Physical Assessment - complete less threatening and less intrusive procedure first to secure child’s trust - Explain actions, what child should expect and let child manipulate equipment - IPPA ins,palpation, percussion, auscultation - IAPP – inspection, auscultation, percussion, palpation Developmental Approaches a. Infant: allow infant to sit on parent’s lap, encourage parents to hold infant, use distraction, enlist parent’s help a. Toddler: allow toddler to sit on parent’s lap, enlist parent’s assistance, use play, praise cooperation Developmental Approaches c. Preschooler: use storytelling, doll, puppet d. School age: maintain privacy, explain procedure and teach child about body e. Adolescent: provide privacy and confidentiality, provide options