Principles of Growth and Development PDF

Principles of Growth and Development NCM 107 CHAPTER 28  Principles of Growth and Development Growth is defined as an increase in physical size, including the measurements of height, weight, and head circumference. Obtain and record height and weight on a standard growth chart...

Principles of Growth and Development NCM 107 CHAPTER 28  Principles of Growth and Development Growth is defined as an increase in physical size, including the measurements of height, weight, and head circumference. Obtain and record height and weight on a standard growth chart for children at all well- child visits. Head circumference measurement is obtained for children ages 2 years and younger. Growth charts, which plot growth patterns, are available from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). Principles of Growth and Development Development refers to the progression toward maturity in mental, physical, and social markers. Obtain a developmental health history from caregivers and the child (if age appropriate) including nutritional intake, sleep, elimination, and a description of behaviors that reflect past and current development Principles of Growth and Development Growth describes an increase in physical size (a quantitative change). Growth in weight, for example, is measured in pounds or kilograms; growth in height is measured in inches or centimeters. Development indicates an increase in skill or ability to function (a qualitative change). A child’s development is assessed by observing a child’s ability to perform specific tasks, by recording the parent’s description of a child’s progress, or by using standardized tests. Maturation is a synonym for development. Principles of Growth and Development Psychosocial development refers to Erikson’s stages of personality development. Kohlberg’s theory of moral development refers to the ability to know right from wrong and to apply it to real-life situations. Cognitive development refers to the ability to learn or understand from experience, to acquire and retain knowledge, to respond to a new situation, and to solve problems. It may be assessed by intelligence tests and by observing a child’s ability to function in different environments.  Factors Influencing Growth and Development Social determinants of health greatly influence whether a child achieves their growth and development potential. Prenatal care, access to medical and dental care, adequate nutrition, a safe environment, access to play areas, well-equipped childcare centers and schools, and access to developmentally appropriate play items can affect optimal growth and development GENETICS In utero, the basic genetic makeup of an individual is present. In addition to physical characteristics such as eye color and height potential, a child may inherit a genetic abnormality, which could result in disability or disease. SEX DIFFERENCES RELATED TO PHYSICAL GROWTH On average, females are born weighing less (by an ounce or two) and measuring shorter (by an inch or two) than males. Males tend to keep this height and weight comparison until prepuberty, at which time females begin their puberty growth spurt (typically around 6 months to 1 year earlier than males). By the end of puberty, usually around 14 to 16 years old, males tend to be taller and weigh more than females. TEMPERAMENT Temperament is the reaction pattern of an individual or an individual’s characteristic manner of thinking, behaving, or reacting to environmental stimuli. Temperament is not developed in stages. Understanding that not all children are alike helps parents/caregivers understand why their children are different from one another, and from themselves.  Reaction Patterns Chess and Thomas (1985) identified nine characteristics that define temperament. Each child’s pattern comprises a combination of these individual elements. These are not negative or positive, just different variations. A child’s individual temperaments may lead them to successfully pursue specific activities and careers. Activity Level Activity level describes the overall activity of the child. Is the infant difficult to diaper or dress due to excessive squirming? Is the infant content to sit and quietly watch an activity? Is the child always moving? On the other hand, does the child prefer quiet activities? Highly active children may direct excess energy into success in sports, perform well in high-energy careers, and be able to keep up with many different responsibilities. Rhythmicity Rhythmicity refers to the predictability of biologic functions like appetite and sleep. Does the child get hungry or tired at predictable times? On the other hand, is the child unpredictable in terms of hunger and tiredness? As adults, irregular individuals may do better than others do with traveling as well as be likely to adapt to careers with unusual working hours. Approach Approach refers to a child’s initial response to a new stimulus. When introduced to a new situation, some children approach the challenge with ease. They interact and “talk” to people they do not know, accept a new food eagerly, and explore new toys without apprehension. Other children demonstrate withdrawal rather than approach. They may react fearfully to new situations, crying at the sight of strangers, new toys, and foods. Slow-to-warm-up children tend to think before they act. They may be less likely to act impulsively during adolescence. Adaptability Adaptability is to how easily the child adapts to transitions and changes. Does the child have difficulty with changes in routines, or with transitions from one activity to another? Does the child take a long time to become comfortable in new situations? A slow-to-adapt child is less likely to rush into dangerous situations, and may not be as influenced by peer pressure. Intensity of Reaction A child with a strong intensity of reaction reacts strongly and loudly to stimuli. Does the child show pleasure or become upset strongly and dramatically? On the other hand, does the child just get quiet when upset? Intense children are more likely to have their needs met and may have depth and delight of emotion rarely experienced by others. These children may enjoy dramatic arts. Intense children can be a challenge to parents/caregivers. Distractibility Children with high distractibility can shift their attention to new situations with ease. For example, if they are crying over the loss of a toy, they may be appeased by being offered a different one. Other children may refuse to adapt or change. Does the child take a long time to become comfortable to new situations? A slow-to-adapt child is less likely to rush into dangerous situations and may be less influenced by peer pressure Attention Span and Persistence Attention span includes the ability to maintain interest in an activity. This varies greatly among children, with some playing alone with a toy for several minutes and others focusing on a toy for no more than a few minutes. The degree of persistence varies. Some infants perform activities despite failure, while others stop trying after one unsuccessful attempt. Persistence is the length of time a child continues an activity in the face of obstacles. Attention Span and Persistence Does the child continue to work on a puzzle when having difficulty with it or do they just switch to another activity? Is the child able to wait to have needs met? The highly persistent child may be more likely to succeed in reaching goals. Children with low persistence may develop strong social skills because they realize other people can help. Threshold of Response The threshold of response is the intensity level of stimulation necessary to evoke a reaction. Children with a low threshold react when faced with a minimal level of frustration; those with a high threshold need prolonged frustration before they become upset. Threshold of response applies to how sensitive the child is to physical stimuli. It is the amount of stimulation (sounds, tastes, touch, temperature changes) needed to produce a response in the child. Threshold of Response Does the child react positively or negatively to particular sounds? Does the child startle easily to sounds? Is the child a picky eater or will the child eat almost anything? Does the child respond positively or negatively to the feel of clothing? Highly sensitive individuals may be more artistic and creative. Mood Quality Mood describes the tendency to react to the world primarily in a positive or negative way. Does the child focus on the positive aspects of life? Is the child generally in a happy mood? On the other hand, does the child focus on the negative aspects of life? Is the child generally serious? Serious children tend to be analytic and evaluate situations carefully. CATEGORIES OF TEMPERAMENT The Easy Child Children are regarded as “easy to care for” if they have a predictable rhythmicity, approach, and adapt to new situations readily; have a mild-to-moderate intensity of reaction; and have an overall positive mood quality. Most children are rated by their parents as being in this category. The Intermediate Child Some characteristics of both easy and difficult groups are present. CATEGORIES OF TEMPERAMENT The Difficult Child Children are considered “difficult” if they are irregular in habits, have a negative mood quality, and withdraw rather than approach new situations. Only about 10% of children fall into this category. The Slow-to-Warm-Up Child Children fall into this category if, overall, they are fairly inactive, respond only mildly and adapt slowly to new situations, and have a general negative mood. About 15% of children display this pattern. When discussing this temperament with parents, try to use positive terms such as “ways to find a healthy fit for your child” rather than stressing ways the child is hard to manage. ENVIRONMENT Twenty percent of all U.S. children less than 17 years of age live in poverty and are exposed to a cluster of determinants of health that result in high rates of infant mortality, developmental delays, asthma, ear infections, obesity, and child maltreatment. Social Determinants of Health Their home, school, workplace, neighborhood, and community affect the health of a child. It is determined in part by access to social and economic opportunities; the resources and supports available in the homes, neighborhoods, and community; the quality of the schooling, the safety of the workplaces, the cleanliness of the water, food and air; and the nature of social interactions and relationships. The resources available, or lack thereof, affect the health of children. The Caregiver–Child Relationship Loss of love from a primary caregiver, as might occur with the death of a parent, or interruption of parental contact through hospitalization, imprisonment, or divorce, can have such an effect on a child that it interferes with normal growth and development. Adverse childhood experiences (ACEs) are potentially traumatic events that may occur during childhood that can influence growth and development. These events comprise the three general areas of maltreatment, neglect, and household changes. Sibling Socialization and Relationship Siblings and their position in the family have a role in the socialization and development of self-esteem in each child. It is important that parents prepare siblings for the birth of a child. Jealousy, insecurity, and behavioral regression may occur in the older child with the birth of a sibling. Parents should help siblings develop good relationships with each other, although there will most likely be conflicts. It is important for parents to spend individual time with each child and connect with them about an activity or interest they enjoy. Physical Activity and Health Physical activity is essential for a healthy lifestyle and should begin in infancy and continue through adolescence. Physical activity increases lean body mass, muscle and bone strength, and promotes physical health. It fosters psychological well-being, can increase self-esteem and capacity for learning, and help children and adolescents handle stress. Health problems, such as obesity, which continues to increase in children, can be addressed with a balance of physical activity and healthy eating. It is recommended that children and adolescents get 60 minutes or more of physical activity a day Nutrition Nutritional quality has a major influence on health, weight, and stature. Children may begin to show inadequate physical growth as early as infancy due to poor nutrition. Nutrition plays a vital role in the body’s susceptibility to disease. Poor nutrition limits the body’s ability to resist infection. Lack of calcium could leave a child prone to rickets, a disease that affects growth by causing shortening or bowing of long bones. Lack of vitamins can lead to visual impairments, poor healing, and poor bone growth. Obesity is linked to a variety of comorbidities including type 2 diabetes and heart disease Nutrition Guidelines for a Healthy Diet Caregivers should model healthy eating patterns for their children. Patterns can be tailored to the individual’s social-cultural and personal preferences. Nutritional needs should be met primarily from nutrient-dense foods. Vegetables, fruits, whole grains, and dairy are associated with reduced risk of many chronic diseases and improved health in children. Nutrition Guidelines for a Healthy Diet Differences in recommended calorie intake for males and females start at age 9 years. They range from 1,000 calories a day for a 2-year-old to 2,400 calories a day for an 18-year-old male and 1,800 calories a day for an 18-year-old female. Healthy eating pattern guidelines including: Eat a variety of foods. Choices from all food groups—dairy, protein, fruits, vegetables, and grains— should be included in meals every day. Participate in physical activity to maintain a healthy weight and strong bones. Choose a diet low in saturated fat and trans fats. Fat intake does not need to be restricted for the first 2 years of life because fat is necessary for myelination of spinal nerves. Thereafter, fat intake can be tailored to meet the guidelines of 30% of total intake (saturated fat should be less than 7% of total intake) for both children and adults. Choose a diet low in sodium, salt, and sugar, and high in fiber. Components of a Healthy Diet A balanced diet of proteins, carbohydrates, fats, vitamins, and minerals is important for growth and development Protein Protein is the major component of bones, skin, hair, and muscle and is responsible for a wide variety of essential functions in the body, including growth. Components of a Healthy Diet Carbohydrate Carbohydrates are a main energy source for the body, essential to the functioning of body systems. Carbohydrates are important to infants and toddlers because their brain cells are actively growing. Fat Dietary fat is a second source of energy for the body. It can be an immediate energy source or can be stored if not used, then released when energy is required. Some fat deposits also serve as insulating material for subcutaneous tissues. In infants, fats are necessary to ensure myelination of nerve fibers. Components of a Healthy Diet Vitamins Vitamins are organic compounds essential for specific metabolic actions in cells. For children, fat-soluble vitamins (A, D, K, and E) are mainly supplied by fortified dairy products, cereals, and plant or fish oils. Such vitamins are not absorbed from the gastrointestinal tract by themselves but only if accompanied by fat molecules. Once absorbed, they are used by cells for growth or are stored for later use. Water-soluble vitamins (B complex and C) do not need fat for absorption. They are not stored well in the body, and should be taken daily to maintain effective levels. They are found primarily in fruits and vegetables. Components of a Healthy Diet Minerals Minerals are necessary for building new cells as well as for the regulation of body processes such as fluid and electrolyte balance, nerve transmission, and muscle contractions. Minerals are classified according to the amounts needed daily. If more than 100 mg is needed daily, a mineral is a macronutrient (a major mineral). If the amount needed is less than 100 mg, it is a minor mineral or micronutrient. Trace minerals refer to those needed in only extremely small amounts  Promoting Adequate Nutritional Intake in Vegetarian Diets Five main types of vegetarian diets include: The lacto-ovo-vegetarian diet, which includes dairy products (“lacto”), eggs (“ovo”), and plants (vegetables, fruits, and grains) The ovovegetarian diet, which includes eggs but excludes dairy products The lacto-vegetarian diet, which includes dairy products but excludes eggs The vegan diet, which excludes all animal products and consists of only vegetables, fruits, and grains The macrobiotic diet, which is a primarily vegetarian diet. Its main sources of protein are grains, seeds, and nuts, but small quantities of egg, fish, and wild game can be added.  Theories of Child Development A theory is a systematic statement of principles that provides a framework for explaining a phenomenon. Developmental theories are theories that provide road maps for explaining human development.  Theories of Child Development Developmental tasks are skills or growth responsibilities arising at a particular time in an individual’s life, the achievement of which will provide a foundation for the accomplishment of future tasks. It is not so much chronologic age as the completion of the task that defines whether a child has passed from one developmental stage of childhood to another. For example, children are not toddlers just because they are 1 year plus 1 day old. They become toddlers when they have passed through the developmental stage of infancy.  Theories of Child Development Sociocultural theories are those that stress the importance of environment on growth and development. Learning theory suggests children are like blank pages that can be shaped by learning. Cognitive theorists such as Piaget stress that learning skills are the key to achieving success in life. Epigenetic theories stress that genes are the true basis for growth and development. Erikson is a psychoanalyst who discussed positive aspects necessary for healthy growth and development for a child to become a mentally healthy and productive adult FREUD’S PSYCHOANALYTIC THEORY Sigmund Freud (1856–1939), an Austrian neurologist and the founder of psychoanalysis, offered the first real theory of personality development. The theory, based on Freud’s observations of adults experiencing mental disturbances, described adult behavior as being the result of instinctual drives of a primarily sexual nature (libido). Freud described child development as being a series of psychosexual stages in which a child’s sexual gratification becomes focused on a particular body part at each stage. SUMMARY OF FREUD’S AND ERIKSON’S THEORIES OF PERSONALITY DEVELOPMENT  ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT Erik Erikson (1902–1996) was trained in psychoanalytic theory but later developed his own theory of psychosocial development, a theory that stresses the importance of culture and society in development of the personality. One of the main tenets of his theory, that a person’s social view of self is more important than instinctual drives in determining behavior, allows for a more optimistic view of the possibilities for human growth. Whereas Freud looked at ways mental illnesses develop, Erikson looked at actions that lead to mental health, and describes eight developmental stages covering the entire life span. At each stage, there is a conflict between two opposing forces. The resolution of each conflict, or accomplishment of the developmental task of that stage, allows the individual to go on to the next phase of development. The Infant According to Erikson (1993), the developmental task for infants is learning trust versus mistrust (other terms are “learning confidence” or “learning to love”). When an infant is hungry, a parent feeds and makes the infant comfortable again. When an infant is wet, a parent changes their diaper and the infant is dry again. When an infant is cold, a parent holds the baby closely. By these simple processes, infants learn to trust that when they have a need or are in distress, a parent will come and meet that need. The Infant If care is inconsistent, inadequate, or rejecting, infants learn mistrust; they become fearful and suspicious of people and then of the world. Like a burned child who avoids fire, emotionally burned children shun the potential pain of further emotional involvement. This can cause children to be “stuck” emotionally at this stage, although they continue to grow and develop in other ways. The Infant The problem of trust versus mistrust, for example, is not resolved forever during the first year of life but arises again at each successive stage of development. Children who enter school with a sense of mistrust may come to trust a teacher with whom they form a close relationship; given this second chance, children can overcome early mistrust. Likewise, children who come through infancy with a sense of trust intact may have a sense of mistrust activated at a later stage if their parents divorce under unpleasant circumstances or if the child is maltreated. The Toddler The developmental task of the toddler is to learn autonomy versus shame or doubt. Autonomy (self-governance or independence) arises from a toddler’s new motor and mental abilities. Children not only take pride in the new things they can accomplish but also want to do everything independently, whether it is pulling the wrapper off a piece of candy, selecting a vitamin tablet out of a bottle, flushing the toilet, or replying, “No!” The Toddler Infants appear to have difficulty differentiating between their bodies and those of others; they think of their bodies as extensions of their parents or primary caregivers. When infants approach toddlerhood, they begin to make the differentiation. As they recognize they are separate individuals, toddlers also realize they do not always have to do what others want them to do. From this realization comes the reputation toddlers have for being negativistic, obstinate, and difficult to manage. This reputation probably exists because parents misinterpret children’s cues. For example, children’s refusal to accept help putting on shoes may be seen by a parent as disobedience, whereas children may view this as insisting on performing a task they can do independently—a positive expression of autonomy. The Toddler Children who are constantly told not to try things because they will hurt themselves may be left with a stronger sense of doubt than confidence at the end of the toddler period. Children who are made to feel it is wrong to be independent may leave the toddler period with a stronger sense of shame than autonomy. If caregivers recognize that toddlers need to practice those things they are capable of doing at their own pace and in their own time, their children will develop the ability to control both their muscles and impulses. However, if children leave this stage with less autonomy and more shame or doubt, it can affect their attempts to achieve independence and their confidence in their abilities to achieve, well into adolescence and adulthood The Preschooler The developmental task of the preschool period is learning initiative versus guilt, or learning how to do things such as drawing, building an object from blocks, or playing dress up. Children initiate motor activities of various sorts on their own or no longer merely respond to or imitate the actions of other children or their parents. The same is true for language and fantasy activities. The Preschooler Another word for initiative is creativity. When children have the freedom and opportunity to initiate motor play such as running, bike riding, sliding, and wrestling, or are exposed to such play materials as finger paints, sand, water, and modeling clay, their sense of initiative is reinforced. Initiative is also encouraged when caregivers answer a child’s questions (intellectual initiative) and do not inhibit fantasy or play activity. In contrast, if children are made to feel their motor activity is bad (perhaps in a small apartment or in a hospital), their questions are a nuisance, or their play is silly, they can develop a sense of guilt over self-initiated activities that will persist in later life. Those who do not develop initiative have limited brainstorming and problem- solving skills later in life; instead, they wait for clues or guidance from others before acting The School-Aged Child Erikson (1993) viewed the developmental task of the school-aged period as developing industry versus inferiority, or self-confidence rather than inferiority. During the preschool period, children learned initiative (i.e., how to do things). During school age, children learn how to do things well. A school-aged child, while doing a project, will ask, “Am I doing this right? Is it OK to use blue?” When they are encouraged in their efforts to do practical tasks or make practical things and are praised and rewarded for the finished results, their sense of industry grows. Caregivers who see their children’s efforts at making and doing things as merely “busy work” or who do not show appreciation for their children’s efforts may cause them to develop a sense of inferiority rather than pride and accomplishment. The School-Aged Child During this stage of life, a child’s world grows to include the school and community; success or failure in those settings can have as lasting an impact as experiences at home. Children with an intelligence quotient of 80 or 90 (slightly below average), for example, may have different learning needs that may not always be adequately met in a typical school setting. This can lead to repeated failures in their efforts and reinforce a sense of inferiority, even when their sense of industry has been rewarded and encouraged at home. On the other hand, children whose sense of industry has not been supported at home may have it revitalized at school through the efforts of a committed teacher. The Adolescent The new interpersonal dimension that emerges during adolescence is the development of a sense of identity versus role confusion. To achieve this, adolescents must bring together everything they have learned about themselves as a child, an athlete, a friend, a fast-food cook, a student, a garage band musician, and so on, and integrate these different images into a whole that makes sense. If adolescents cannot do so, they are left with role confusion or are left unsure of what kind of person they are or what kind of person they want to become. It is common in this stage for adolescents to explore and express their identity in different ways The Late Adolescent The developmental crisis of late adolescence is achieving a sense of intimacy versus isolation. Intimacy is the ability to relate well with other people in preparation for developing future relationships. The Late Adolescent A sense of intimacy grows out of earlier developmental tasks because people need a strong sense of identity before they can reach out fully and offer deep friendship or love to others. Because there is always the risk of being rejected or hurt when offering love or friendship, individuals cannot offer it if they do not have confidence that they can cope with rejection or if they did not develop a sense of trust as an infant or autonomy as a toddler. This is important for maternal and child health nursing because parents without a sense of intimacy may have more difficulty than others accepting a pregnancy and beginning to love a new child.  PIAGET’S THEORY OF COGNITIVE DEVELOPMENT Jean Piaget (1896–1980), a Swiss psychologist, introduced concepts of cognitive development, or the way children learn and think. The theory has roots similar to those of both Freud and Erikson, but with differing aspects. Piaget defined four stages of cognitive development, within the stages of growth, then finer units or schemas. progress from one period to the next, children reorganize their thinking processes to bring them closer to adult thinking. PIAGET’S STAGES OF COGNITIVE DEVELOPMENT PIAGET’S STAGES OF COGNITIVE DEVELOPMENT PIAGET’S STAGES OF COGNITIVE DEVELOPMENT The Infant Piaget referred to the infant stage as the first four stages of the sensorimotor stage. Sensorimotor intelligence is practical intelligence because an infant is not yet able to use words and symbols for thinking and problem solving at this early age. At the beginning of life, babies relate to the world through their senses, using only reflex behavior. During this stage, infants learn objects in the environment—their bottle, blocks, their bed, or even a parent—are permanent and continue to exist even though they are out of sight or changed in some way The Infant For example: Infants will search for a block hidden by a blanket, knowing the block still exists. Infants can recognize a parent remains the same person whether dressed in a robe and slippers or pants and a T-shirt. Infants are only ready to play peek-a-boo when they have mastered permanence because only then do they realize the person playing with them exists behind their hands. Infants identify that they are a separate entity from objects. They learn where their body ends and where their bed, plaything, or parent begins. The Infant Infants can identify their parents as different from other adults as early as 4 months of age. The world begins to make sense and the developmental task of achieving trust falls into place when the concept of permanence has been learned (e.g., infants know their parents exist and will return to them). Gaining a concept of permanence also contributes to separation anxiety, which can begin between 8 and 12 months of age. During this stage, infants continue to cry for their parents because they know their parents still exist even when out of sight. The Toddler The toddler period is one of transition as children complete the fifth and sixth stages of the sensorimotor period and begin to develop some cognitive skills of the preoperative period, such as symbolic thought and egocentric thinking. Children use trial and error to discover new characteristics of objects and events. A toddler sitting in a high chair who keeps dropping objects over the edge of the tray is exploring both permanence and the different actions of toys. For example, during these periods, toddlers: Complete their understanding of object permanence. Begin to be able to use symbols to represent objects. Start to draw conclusions only from obvious facts that they see. The Preschooler Preschool children move on to a substage of preoperational thought termed intuitive thinking. During this period, when young children look at an object, they are able to see only one of its characteristics. For example, they see a banana is yellow but do not notice that it is also long. Intuitive thinking is noticeable when children are learning about medicine (they observe it tastes bitter but cannot understand it is also good for them). The Preschooler Intuitive thinking contributes to the preschooler’s lack of conservation (the ability to discern truth, even though physical properties change) or reversibility (ability to retrace steps). For example, if preschoolers see water poured from a short, fat glass into a tall, thin one, they will notice only one changing characteristic. They might say there is now more water in the second glass (because the level has risen) or there is less water in the second glass (because the second glass is thinner). The Preschooler When the water is poured back into the first glass, they still will not understand the amount of water is unchanged, only its appearance. This immature perception leads children to make faulty conclusions as it did during the toddler period. It takes more years of development and practice for children to learn that when thought processes (i.e., knowing the amount of water did not change) and perceptions conflict, thought processes are more trustworthy. The Preschooler Preschool thinking is strongly influenced by role fantasy or how children would like something to turn out. Children use assimilation (taking in information and changing it to fit their existing ideas) as a part of this. For example, because a child wants to go outside and play, the child says the outside is calling them to come and play. Children believe their wishes are as real as facts and dreams are as real as daytime happenings during this stage. They perceive animals and even inanimate objects as being capable of thought and feelings (e.g., a dog took their doll because the dog was feeling sad, a footstool meant to trip them). This phenomenon is often called “magical thinking.” Magical thinking fades as, later on, children learn accommodation (they change their ideas to fit reality rather than the reverse). The School-Aged Child Piaget viewed school age as a period during which concrete operational thought begins because school-aged children can be seen using practical solutions to everyday problems as well as begin to recognize cause-and-effect relationships. A child who understands water does not change in amount just because it is poured from one glass to another has grasped the concept of conservation. Conservation of numbers is learned as early as age 7 years, conservation of quantity at age 7 or 8 years, conservation of weight at age 9 years, and conservation of volume at age 11 years. Reasoning during school age tends to be inductive or proceeds from specific to general: A school-aged child holding a broken toy reasons the toy is made of plastic, and, therefore, all plastic toys break easily The Adolescent Adolescence is the time when cognition achieves its final form or when formal operational thought begins. When this stage is reached, adolescents are capable of thinking in terms of possibility—what could be (abstract thought)—rather than being limited to thinking about what already is (concrete thought). This makes it possible for adolescents to use scientific reasoning. They can use deductive reasoning in addition to the induction reasoning they used during school age or can move from the general to the specific (e.g., plastic toys break easily, the toy they are holding is plastic; therefore, it will break easily).  KOHLBERG’S THEORY OF MORAL DEVELOPMENT One more developmental theory that has relevance to maternal and child health nursing is Kohlberg’s (1927–1987) theory of moral development. A German psychologist, Kohlberg (1984) studied the reasoning ability of males and, based on Piaget’s development stages, developed a theory on the way children gain knowledge of right and wrong or moral reasoning  KOHLBERG’S THEORY OF MORAL DEVELOPMENT Recognizing where a child is developmentally according to these stages can help identify how children may feel about an illness, such as whether they think it is fair that they are ill. Recognizing moral reasoning also helps determine whether children can be depended on to carry out self-care activities such as administering their own medicine or whether children have internalized standards of conduct so they do not cheat when away from external control. Moral stages closely approximate cognitive stages of development because children must be able to think abstractly (conceptualize an idea without a concrete picture) before being able to understand how rules apply even when no one is there to enforce them.