Week 13 Growth and Development PDF

1ST SEMESTER A.Y. 2022-2023 NCMA217-FINALS WEEK 13: GROWTH AND DEVELOPMENT continue, the 5-yr-old child, r...

1ST SEMESTER A.Y. 2022-2023 NCMA217-FINALS WEEK 13: GROWTH AND DEVELOPMENT continue, the 5-yr-old child, ready to begin school, would INTRODUCTION TO GROWTH AND weigh 1600 lb and be 12 ft 6 in DEVELOPMENT tall. Growth and development Growth in height occurs in only Abraham Jacobi (1870) known as Father of Pediatrics. proceed in an orderly one se- quence—from smaller He was awarded the first pediatric professorship in the sequence. to larger. Development also proceeds in a predictable order. US. He was able to promote establishments of pediatric For example, the majority of departments in hospitals in New York City to promote children sit before they creep, comprehensive care to children. creep before they stand, stand o 1889 – Open the first milk distribution center before they walk, and walk providing pasteurized milk. before they run. Occasionally, a child will skip a stage (or pass PRINCIPLES OF GROWTH AND DEVELOPMENT through it so quickly that the Growing up is a complex phenomenon because of the many par- ents do not observe the interrelated facets involved. Children do not merely grow taller and stage). Occasionally, a child will heavier as they get older; maturing also involves growth in their progress in a different order, but ability to perform skills, to think, to relate to people, and to trust or most children follow a have confidence in themselves. predictable sequence of growth Growth is generally used to denote an increase in and development. physical size or a quantitative change. Growth in weight is Different children pass All stages of develop- ment measured in pounds or kilograms; growth in height is through the predictable have a range of time rather than measured in inches or centimeters. stages at different rates. a certain point at which they are o Growth an increase in number and size of cells usually accomplished. Two which result in increased height and weight of children may pass through the the body or body part. motor sequence at such Development is used to indicate an increase in skill or the different rates, for example, that ability to function (a qualitative change). Development one begins walking at 9 mo, can be measured by observing a child’s ability to perform another only at 14 mo. Both are specific tasks such as how well a child picks up small developing normally. They are objects such as raisins, by recording the parent’s both following the predictable description of a child’s progress, or by using standardized sequence; they are merely tests such as the Denver II. developing at different rates. Maturation is a synonym for development. All body systems do not Certain body tissues mature develop at the same rate. more rapidly than oth- ers. For 1. Psychosexual development is a specific type of example, neurologic tissue development that refers to developing instincts or sensual experiences its peak growth pleasure (Freudian theory). Psychosocial development during the first year of life, refers to Erikson’s stages of personality development. whereas genital tissue grows Moral development is the ability to know right from wrong little until puberty. and to apply these to real-life situations. Kohlberg is a Development is Cephalo is a Greek word theorist who studied this. cephalocaudal. meaning “head”; caudal means 2. Cognitive development refers to the ability to learn or “tail.” Development proceeds understand from experience, to acquire and retain from head to tail. Newborns can knowledge, to respond to a new situation, and to solve lift only their head off the bed problems (see the section below on Piaget’s theory of when they lie in a prone cognitive development). It is measured by intelligence position. By age 2 mo, infants tests and by observing children’s ability to function can lift both the head and chest effectively in their environment. off the bed; by 4 mo, the head, chest, and part of the abdomen; FACTORS INFLUENCING GROWTH AND by 5 mo, infants have enough control to turn over; by 9 mo, DEVELOPMENT they can control legs enough to crawl; and by 1 yr, children can Genetic inheritance, or whether a child receives healthy genes or stand upright and perhaps walk. genes that will lead to an illness, and environmental influences, such Motor development has as whether the family a child is born into has sufficient funds to proceeded in a cephalocaudal supply adequate food, are two primary factors that determine a order—from the child’s pattern of growth and development. head to the lower extremities. Development proceeds from This principle is closely related Temperament (the typical way a child reacts to situations) is an proximal to distal body parts. to cephalo- caudal example of genetic influence. development. It can best be illustrated by tracing the BOX 28.2 PRINCIPLES OF GROWTH AND DEVELOPMENT progress of upper extremity Growth and development are Although there are highs and development. A newborn makes continuous processes from lows in terms of the rate at little use of the arms or hands. conception until death. which growth and development Any movement, except to put a proceed, at all times a child is thumb in the mouth, is a flailing growing new cells and learning motion. By age 3 or 4 mo, the new skills. An ex- ample of how infant has enough arm control to the rate of growth changes is a support the upper body weight com- parison between that of on the forearms, and the infant the first year and later in life. An can coordinate the hand to infant triples birth weight and scoop up objects. By 10 mo, the increases height by 50% during infant can coordinate the arm the first year of life. If this and thumb and index fingers tremendous growth rate were to sufficiently well to use a 1st Semester | NCMA 217 (LECTURE) pincer-like grasp or be able to for example, many children with type 1 diabetes pick up an object as fine as a mel- litus died in early childhood; those who piece of breakfast ce- real on a lived were left physically challenged. Currently, highchair tray. with good health supervi- sion and insulin Development proceeds from This principle parallels the therapy, the effects of type 1 disease can be gross to refined skills. preceding one. Once children minimized so that children with diabetes both are able to control distal body thrive and grow. Diabetes is still a major factor in parts such as fin- gers, they are the health of children, however. As more and able to perform fine motor skills more children in developed countries become (a 3-yr- old colors best with a obese, type 2 diabetes now has begun to occur large crayon; a 12-yr-old can in children as young as school-age (Hussain et write with a fine pen). al., 2007). There is an optimum time for Children cannot learn tasks until 3. Intelligence initiation of experiences or their nervous system is mature Children with high intelligence do not generally learning. enough to allow that particular grow faster physically than other children, but learning. A child cannot learn to they do tend to advance faster in skills. sit, for ex- ample, no matter how Occasionally, children of high intelligence fall much the child’s parents have behind in physical skills because they spend him or her practice, until the their time with books or mental games rather nervous system has matured than with games that develop motor skills and enough to allow back control. so do not receive practice in these areas. Children who are not given the opportunity to learn TEMPERAMENT developmental tasks at the Temperament is the usual reaction pattern of an individual, or an appropriate or “target” times for individual’s characteristic manner of thinking, behav- ing, or reacting that task may have more to stimuli in the environment (Chess & Thomas, 1995). Unlike difficulty than the usual child cognitive or moral development, temperament is not developed by learn- ing the task later on. A stages but is an inborn char- acteristic set at birth. Understanding child who is confined to a body that children are not all alike—some adapt quickly to new situations cast at 12 mo, the time the child and others adapt slowly, and some react intensely and some would normally learn to walk, passively—can help parents better understand why their children are may take a long time to learn differ- ent from each other and help them care for each child more this skill once free of the cast at, constructively. say, age 2 yr. The child has passed the time of optimal 1. Reaction Patterns learning for that particular skill. Chess and Thomas (1995) identified nine separate Neonatal reflexes must be lost An infant cannot grasp with skill characteristics that define temperament or how children react to before development until the grasp reflex has faded situations. Each child’s pattern is made up of a combination of these nor stand steadily until the individual elements. walking reflex has faded. Activity Level. The level of activity among children differs Neonatal reflexes are replaced widely. Some babies are constantly on the go and rarely by purposeful movements. quiet. They wiggle and squirm in their crib as early as 2 A great deal of skill and Infants practice over and over weeks of age. Parents put such children to sleep in one behavior is learned by taking a first step before they end of a crib and find them in the other end an hour later; practice. accomplish this securely. If such children will not stay seated in bathtubs and refuse to children fall behind in growth be confined in playpens. Other babies, by contrast, move and development because of ill- little, stay where they are placed, and appear to take in ness, they are capable of their environment in a quieter, more docile way. Both “catch-up” growth to bring them patterns are normal; they merely reflect two extremes of equal again with their age motor activity, one characteris- tic of temperament. group. Rhythmicity. A child who has rhythmicity manifests a regu- lar rhythm in physiologic functions. Even as infants, GENETICS such children tend to wake up at the same time each morning, are hungry at regular 4-hour periods, nap at the from the moment of conception when a sperm and ovum fuse, the same time every day, and have a bowel movement at the basic genetic makeup of an individual is cast. Although each child is same time every day. They are predictable and easy to unique, certain gender-related characteristics will influence growth care for because their par- ents learn early on what to and development. In addition to physical characteristics such as eye expect from them. On the other end of the scale are color and height potential, inheritance determines other infants with an irregular rhythmicity. They rarely awaken at characteristics such as learning style and temperament. An the same time 2 days in a row. They may go a long time individual may also inherit a genetic abnormality, which could result without eating one day and the next day appear hungry in disability or illness at birth or later in life. almost immediately after feeding. Such children may be 1. Gender more difficult to care for because it is difficult to plan a On average, girls are born lighter (by an ounce schedule for them. Parents must constantly adapt their or two) and shorter (by an inch or two) than own routine to the child’s routine. boys. Boys tend to keep this height and weight Approach. Approach refers to a child’s response on initial advantage until prepuberty, at which time girls contact with a new stimulus. Some children approach new surge ahead because they begin their puberty situations in an unruffled manner. They smile and “talk” to growth spurt 6 months to 1 year earlier than strangers and accept a first feeding or a new food without boys. By the end of pu-berty (14 to 16 years), spitting up or fussing. They explore new toys without boys again tend to be taller and heavier than appre- hension. Other children demonstrate withdrawal girls. This difference in growth patterns is rather than approach to new situations. They cry at the reflected in the different growth charts used for sight of strangers, new toys, and new foods; they fuss the boys and girls (see Appendix E). first time they are placed in a bathtub. They are difficult to 2. Health take on vacation or to meet a new childcare provider A child who inherits a genetically transmitted because they react so fearfully to new situations. disease may not grow as rapidly or develop as Adaptability. Adaptability is the ability to change one’s fully as a healthy child, depending on the type of reaction to stimuli over time. Infants who are adaptable illness and the therapy or care available for the can change their first reaction to a situation without disease. Before insulin was discovered in 1922, exhibiting extreme distress. The first time such children  are placed in a bathtub they might protest loudly, for The Difficult Child Children are “difficult” if they are example, but by the third time they sit splashing happily. irregular in habits, have a This is in contrast to infants who cry for months whenever negative mood quality, and they are put into a bathtub or who cannot seem to withdraw rather than approach accustom themselves to a new bed, new car seat, or new new situations. Only about 10% caregiver. of children fall into this category. Intensity of Reaction. Some children react to situations Slow-to-Warm-Up Child Children fall into this category if with their whole being. They cry loudly, thrash their arms, they are overall fairly inactive; and begin temper tantrums when their diapers are wet, respond only mildly and adapt when they are hungry, and when their parents leave them. slowly to new situations, and Others rarely demonstrate such overt symptoms of anger have a general negative mood. or have a mild or low-intensity reaction to stress. About 15% of children display Distractibility. Children who are easily distracted or who this pattern. When discussing can easily shift their attention to a new situation this temperament with parents, (distractibility) are easy to care for. If they are crying over try to use positive terms such as the loss of a toy, they can be appeased by the offer of a “ways to find a healthy fit for different one. Other children cannot be distracted in this your child” rather than stressing way; their parents may describe them as stubborn, willful, ways the child is hard to or unwilling to compro- mise because they persistently manage. return to an activity or refuse to adapt or change. Attention Span and Persistence. Attention span is the Bringing these characteristics to parents’ attention helps ability to remain interested in a project or activity. Like them better understand their child and lays the foundation other aspects of temperament, this varies among children. for beginning to accept and respect the child as an individ- Some play by themselves with one toy for an hour; others ual. It is essential for successful child rearing (Foley, spend no more than 1 or 2 minutes with each toy. The 2007). degree of persistence also varies. Some infants keep Noticing children’s temperamental characteristics as they trying to perform an activity even when they fail time after are admitted to a hospital can help you anticipate time; others stop try- ing after one unsuccessful attempt. children’s probable reactions to procedures or pain. For Threshold of Response. The threshold of response is the example, a child with a mild reactivity pattern may not in- tensity level of stimulation that is necessary to evoke a show a great deal of response to even acute pain, but a reaction. Children with a low threshold need little child with an intense pattern may react as strongly to stimulation; those with a high threshold need intense minor discomfort as to major pain, making it difficult to stimulation before they become upset over a situation. evaluate the true level of pain the child is experiencing. Mood Quality. A child who is always happy and laughing One instrument that is helpful in evaluating temperament has a positive mood quality. Obviously, this can make a is the Carey-McDevitt Infant Temperament Questionnaire major difference in the parents’ enjoyment of a child. (Carey & McDevitt, 1978). This consists of 95 responses Parents are bound to spend more time with a child who is and can be answered by a parent in approximately 25 always happy than with a child who has a negative mood min- utes. General categories center on the child’s quality. responses to feeding, sleeping, soiling and wetting, dressing, bathing, and diapering, as well as to people and Nursing Implications Regarding Temperament new situations. Three categories of temperament are shown in Box 28.3. Parents fill out the questionnaire when their infant is be- Children who have a normal activity level and regular tween 4 and 8 months of age (before this, temperament is rhyth- micity, who approach and adapt to new situations not developed enough to be evident). The parent reads easily, and who have a long attention span, a high level of each behavioral description and then selects the option persis- tence, and a positive mood quality are “ideal” or that most accurately describes the child. If an item does “easy” chil- dren to care for, from a parent’s point of view. not apply at all, the parent crosses it out. Finally, parents Highly active infants are much more difficult for parents to are asked to describe general impressions of the child’s care for, especially if they demonstrate irregular temperament, activity level, positive and negative moods, physiologic rhythms, withdrawal rather than approach, and and distractibility. little ability to adapt. Such children require more planning Although individual children show characteristics from all and creative distraction measures.It is useful to talk to groups, most children can be categorized into one of four parents about their child’s reactivity patterns at health groups: maintenance visits because these patterns tend to persist: ○ Difficult: arrhythmic, withdrawing, low in the way a child will react in the future de- pends a great adaptability, intense, and negative in mood deal on the way a child reacts today. ○ Slow to warm up: inactive, low in approach and A child who withdraws from rather than approaches a first adapt- ability, and negative in mood toy, for example, may react the same way to toilet training ○ Intermediate: some characteristics of both or start- ing day care. The parents of such a child will need groups to focus on extra preparation for new activities more than ○ Easy: rhythmic, approaching, adaptable, mild, the parents of a child who approaches new situations and positive in mood easily. Parents who are aware their baby shies away from new experiences such as baths and new foods will be able ENVIRONMENT to take it in stride when their child is slow to adapt to a Head Start program at age 4; they will know it is simply Although children cannot grow taller than their genetically their child’s method of coping. programmed height potential allows, their adult height may be considerably less than genetic potential if their environ- ment hinders their growth in some way. For example, a child could receive BOX 28.3 CATEGORIES OF TEMPERAMENT inadequate nutrition because of a family’s low socioeconomic status; The Easy Child Children are rated as “easy to a parent could lack childcare skills or not give a child enough care for” if they have a attention; or a child could have a chronic illness (O’Shea et al., predictable rhythmicity, 2007). Many illnesses lower children’s appetite; others, such as approach and adapt to new certain endocrine disorders, directly alter their growth rate. Having a situations readily, have a mild to parent who abuses alcohol or other substances can cause such moderate in- tensity of reaction, inconsistency in care it affects mental health (Fitzgerald & Das and have an overall positive Edien, 2007; Motz, Leslie, & DeMarchi, 2007). mood quality. Most children are Environmental influences, however, are not always detri- mental rated by their par- ents as being (Dooley & Stewart, 2007). For example, children with in this category. phenylketonuria, an inherited metabolic disease, can achieve normal Maria Alyssa Jimenez | 3 1st Semester | NCMA 217 (LECTURE) growth and development in spite of their genetic makeup if their diet Children whose diets lack essential nutrients show inadequate (a part of the environment) is properly regulated. The following physical growth. A lack of energy and stamina prevents children environmental influences are those most likely to affect growth and from learning at their best intellectual level. In some communities, as development. many as 50% of American children are obese today (Kline, 2008). 1. Socioeconomic Level Children who eat too many carbohydrates and be- come obese may Because health care and good nutrition both develop motor skills more slowly than other children because cost money, children born into families of low physical movement is more tiring for them. Obese children are socioeconomic means may not receive sometimes taunted by their playmates and may become loners or adequate health supervision or good nutrition. have difficulty relating to their peers because of behavior problems Poor health supervision can leave them without or depression about their weight. immunization against measles or other childhood illnesses and therefore vulnerable to Nutrition also plays a vital role in the body’s susceptibility to disease diseases that could cause permanent neurologic because poor nutrition limits the body’s ability to resist infection. damage if complications occur (Demicheli et al., Lack of calcium could leave a child prone to rickets, a disease that 2009). Poor nutrition can also leave them affects growth by causing shortening or bowing of long bones. Lack vulnerable to disease as antibody formation of vitamins can lead to visual impairments, poor healing, and poor depends on a good protein intake (Rolfes, bone growth (Ondrak & Morgan, 2007). Pinna, & Whitney, 2009). 2. Parent–Child Relationship Poor nutrition also plays a major role in the development of chronic Cultural norms within a family play a role in illness. Of the eight leading causes of death in adults, six have been determining when a child is expected to achieve linked to dietary excesses: heart disease, cancer, cerebrovascular particular developmental milestones. Children disease, diabetes mellitus, cirrhosis, and arteriosclerosis. It is clear, who are loved thrive better than those who are too, that dietary habits have a cumulative effect; for instance, not. Either parent or a non parent caregiver may although heart disease is not one of the top causes of death in serve as the primary caregiver or form a primary children, the arterial changes that cause cardiovascular disease parent–child love relationship. It is the quality of begin in childhood. Increased consumption of food and alcohol, time spent with children, not the amount of time, decreased levels of exercise, and smoking all lead to a greater that is important. Loss of love from a primary incidence of these diet-related diseases in adult life. Establishing caregiver, as might occur with the death of a healthy eating patterns early in life, therefore, can contribute to bet- par- ent, or interruption of parental contact ter health in adult years. through hospitaliza-tion, imprisonment, divorce, or inadequate parental love, can interfere with a THEORIES OF DEVELOPMENT child’s desire to eat, improve, and advance. Helping parents feel involved in their child’s care A theory is a systematic statement of principles that is important in both healthcare and childcare provides a framework for explaining some phenomenon. settings (Knitzer, 2008). Developmental theories provide road maps for explaining 3. Ordinal Position in the Family human development. The position of a child in the family (first-born A developmental task is a skill or a growth responsibility child, middle child, youngest child, only child) arising at a particular time in an individual’s life, the and the size of the fam- ily have some bearing achievement of which will provide a foundation for the on a child’s growth and development. An only accomplishment of future tasks. It is not so much child or the oldest child in a family, for example, chronologic age as the completion of developmental tasks generally excels in language development that de- fines whether a child has passed from one because conversations are mainly with adults. developmental stage of childhood to another. For Youngest children may develop language more example, children are not toddlers just because they are 1 slowly, especially if older children talk “baby talk” year plus 1 day old; they become toddlers when they have with them. Children learn by watching other passed through the developmental stage of infancy. children, however, so a youngest child who has many examples to watch may excel in other TABLE 28.4 BASIC DIVISIONS OF CHILDHOOD skills, such as toilet training at an early age. 4. Health STAGE AGE PERIOD Diseases that come from environmental sources Neonate First 28 days of life can have as strong an influence on growth and Infant 1 month – 1 yr development as genetically inherited diseases. Toddler 1-3 yr Infants cared for in neonatal intensive care Preschooler 3-5 yr units, for example, may develop some decrease School-age child 6-12 yr in hearing because of the overstimulation of Adolescent 13-21 yr sound, an example of health being directly influenced by the environment (Thomas & Uran, 2007). Children who have residual heart FREUD’S PSYCHOANALYTIC THEORY impairment as a result of contracting rheumatic Sigmund Freud (1856–1939), an Austrian neurologist fever might be limited in their ability to play an and the founder of psychoanalysis, offered the first real active sport. The eventual degree of disability theory of personality development (Edmundson, 2007). will depend not only on the damage caused by Freud based his theory on his observations of mentally the actual disease but also on the attitudes of disturbed adults. He described adult behavior as being the the people around the child—how disabled they result of instinctual drives that have a primarily sexual believe the child to be (Ulrich, 2007). nature (libido) that arise from within the person and the Treating children as if they were sick or conflicts that develop be- tween these instincts vulnerable to sick- ness is referred to as (represented in the individual as the id ), reality (the ego), “vulnerable child syndrome” (Green & Solnit, and society (the superego). He described child 1964). Fortunately, if an illness does not last long, most children achieve “catch-up” growth development as being a series of psychosexual stages in afterward. which a child’s sexual gratification becomes focused on a NUTRITION particular body part. 1. INFANT In the past 20 years, nutrition has become a major focus of health promotion and disease prevention in the United States because the Freud termed the infant period the “oral phase” because quality of a child’s nutrition during the growing years (including infants are so interested in oral stimulation or pleasure prenatally) has a major influence on health and stature (Rolfes, during this time. According to this theory, infants suck for Pinna, & Whitney, 2009). Poor maternal nutrition may limit the enjoyment or relief of tension, as well as for nourishment. growth and intelligence potential of a child from the moment of birth. 2. TODDLER Freud described the toddler period as an “anal phase” because during this time, children’s interests focus on the anal region as they begin toilet training. Elimination takes on new importance for them. Children find pleasure in both the retention of feces and defecation. This anal interest is part of toddlers’ self-discovery, a way of exerting independence, and probably accounts for some of the difficulties parents may experience in toilet-training children of this age. 3. PRESCHOOLER During the preschool period, children’s pleasure zone appears to shift from the anal to the genital area. Freud called this period the “phallic phase.” Masturbation is common during this phase. Children may also show exhibitionism, suggesting they hope this will lead to increased knowledge of the two sexes. 4. SCHOOL-AGE CHILD Freud saw the school-age period as a “latent phase,” a time in which children’s libido appears to be diverted into concrete thinking. He saw no developments as obvious as those in earlier periods appearing during this time. 5. ADOLESCENT Freud termed the adolescent period the “genital phase.” Freudian theory considers the main events of this period to be the establishment of new sexual aims and the finding of new love objects. 1. The Infant According to Erikson, the developmental task for infants is learning trust versus mistrust (other terms are “learning confidence” or “learning to love”). Infants whose needs are met when those needs arise, whose discomforts are quickly removed, who are cuddled, played with, and talked to, come to view the world as a safe place and people as helpful and dependable. However, when their care is inconsistent, inadequate, or rejecting, this fosters a basic mistrust: infants become fearful and suspicious of the world and of people. Like a burned child who avoids fire, emotionally burned children may shun the potential pain of further emotional involvement and carry this attitude through later stages of development. Such children can be “stuck” emotionally at this stage, although they continue to grow and develop in other ways. 2. The Toddler Erikson defines the developmental task of the toddler age as learning autonomy versus shame or doubt. Autonomy ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT (self-government or independence) builds on children’s new motor Erik Erikson (1902–1996) was trained in psychoanalytic and mental abilities. theory but later developed his own theory of psychosocial Children take pride in new accomplishments and want to development, a theory that stresses the importance of do everything independently, whether it is pulling the culture and society in development of personality (Erikson, wrapper off a piece of candy, selecting a vitamin tablet out 1993). One of the main tenets of his theory, that a person’s of the bottle, flushing the toilet, or replying, “No!” If parents social view of self is more important than instinctual drives recognize toddlers need to do what they are capable of in determining behavior, allows for a more optimistic view doing, at their own pace and in their own time, then of the possibilities for human growth. While Freud looked children develop a sense of being able to control their at ways mental illness develops, Erikson looked at actions muscles and impulses during this time. that lead to mental health. Erikson describes eight When caregivers are impatient and do everything for developmental stages covering the entire life span. At them, this enforces a sense of shame and doubt. If each stage, there is a conflict between two opposing children are never allowed to do things they want to do, forces. The resolution of each conflict, or accomplishment they will eventually doubt their ability to do them; they will of the developmental task of that stage, allows the stop trying and cannot do them. If children leave this stage individual to go on to the next phase of development. with less autonomy than shame or doubt, they can be disabled in their attempts to achieve in- dependence and may lack confidence in their abilities to achieve well into adolescence and adulthood Maria Alyssa Jimenez | 5 1st Semester | NCMA 217 (LECTURE) 3. The Preschooler rejection or if they did not develop a sense of trust as an The developmental task of the preschool period is learning initiative infant. versus guilt. Learning initiative is learning how to do things. Parents without a sense of intimacy may have more Children can initiate motor activities of various sorts on their own and difficulty than others accepting a pregnancy and beginning no longer merely respond to or imitate the actions of other children to love a newborn child. or of their parents. The same is true for language and fantasy 7. The Middle-Aged Adult activities. The developmental task of middle age is to establish a sense of Whether children leave this stage with a sense of initiative generativity versus stagnation. People extend their concern from outweighing a sense of guilt depends largely on how just themselves and their families to the community and the world. parents respond to self-initiated activities. They may become politically active, work to solve environmental When children are given much freedom and opportunity to problems, or participate in far-reaching community or world-based initiate motor play such as running, bike riding, sliding, and decisions. wrestling or are exposed to such play materials as finger People with a sense of generativity are self-confident and paints, sand, water, and modeling clay, their sense of better able to juggle their various lives (mother, soccer initiative is reinforced. Initiative is also encouraged when coach, church member, teacher, political party parents answer a child’s questions (intellectual initiative) chairperson, gourmet cook). and do not inhibit fantasy or play activity. People without this sense become stagnated or self- If children are made to feel their motor activity is bad, their absorbed. Those who have devoted themselves to only questions are a nuisance, or their play is silly and stupid, one role are more likely to find themselves at the end of they may develop a sense of guilt over self-initiated middle age with a narrow perspective and lack of ability to activities that will persist in later life. Those who do not cope with change. develop initiative may later have limited brainstorming and Women without a sense of generativity may have more problem-solving skills; they wait for clues or guidance from difficulty than others accepting a late-in-life pregnancy and others before acting. a new role of childbearing and childrearing. 4. The School-Age Child 8. The Older Adult Erikson viewed the developmental task of the school-age period as Older adults play a role in child rearing today because many of them developing industry versus inferiority, or accomplishment rather give childcare to young children while parents work. The than inferiority. developmental task of older adults is integrity versus despair. Older During the preschool period, children learned adults with integrity feel good about the life choices they have made; initiative—how to do something. During school age, those with a feeling of despair wish life could begin over again so children learn how to do things well. A school-age child, that things could turn out differently. A sense of integrity is helpful in while doing a project will ask, “Am I doing a good job? Am a grandparent who provides childcare, as it helps children develop a I doing this right?” sense of trust and learn initiative (Bernal & Anuncibay, 2008). 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. Parents 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. During the elementary school years, a child’s world grows to include the school and community environment, and success or failure in those settings can have a lasting impact. 5. The Adolescent Erikson believed the new interpersonal dimension that emerges during adolescence is a sense of identity versus role confusion. To achieve this, adolescents must bring together everything they have learned about themselves as a son or daughter, an athlete, a TABLE 28.5 SUMMARY OF FREUD’S AND ERIKSON’S THEORY friend, a fast-food cook, a student, a garage band musician, and so OF PERSONALITY DEVELOPMENT on, and integrate these different images into a whole that makes FREUD’S STAGES OF CHILDHOOD sense. If adolescent’s can- not do so, they are left with role Psychosexual Stage Nursing Implications confusion; that is, they are left unsure of what kind of person they are and are uncertain what they can do or Infant Oral stage: Child Provide oral stimulation by what kind of person they can become. explores the world by giving pacifiers; do not Some adolescents seek a negative identity: being using mouth, especially discourage thumb-sucking. identified as a drug abuser or runaway may be preferable the tongue. Breastfeeding may provide to having no identity at all. Body piercing and tattooing can more stimulation than help establish identity as they are outward expressions of formula feeding because it who adolescents think they are. requires the infant to 6. The Young Adult expend more energy. The developmental crisis of the young adult is achieving a sense of Toddler Anal stage: Child learns Help children achieve intimacy versus isolation. Intimacy is the ability to relate well with to control urination and bowel and bladder control other people, not only with members of the opposite sex but also defecation. without undue emphasis on with one’s own sex to form long-lasting friendships. its importance. If at all A sense of intimacy grows out of earlier developmental possible, continue bowel and bladder training while tasks, because people need a strong sense of identity child is hospitalized. before they can reach out fully and offer deep friendship or Preschooler Phallic stage: Child Accepts children’s sexual love. Because there is always the risk of being rejected or learns sexual identity interest, such as fondling hurt when offering love or friendship, individuals cannot through awareness of their own genitals, as offer it if they do not have confidence they can cope with genital area. normal area of exploration. Helps parents answer  child’s questions about to THE SENSORIMOTOR STAGES birth or sexual differences. Ages: Birth to 2 Years School-age Latent stage: Child’s Help children have positive child personality development experiences with learning Major Characteristics and Developmental Changes: appears to be non-active so their self-esteem The infant learns about the world through their senses and or dormant. continues to grow and they through their actions (moving around and exploring its can prepare for the environment). conflicts of adolescence. During the sensorimotor stage a range of cognitive Adolescent Genital stage: Provide appropriate abilities develop. These include: object permanence; Adolescent develops opportunities for the child to sexual maturity and relate with opposite sex; self-recognition; deferred imitation; and learns to establish allow child to verbalize representational play. satisfactory relationships feelings about new They relate to the emergence of the general symbolic with the opposite sex. relationships function, which is the capacity to represent the world ERIKSON’S STAGES OF CHILDHOOD mentally At about 8 months the infant will understand the Developmental Task Nursing Implications permanence of objects and that they will still exist even if they can’t see them and the infant will search for them Infant Developmental task is to Provide a primary when they disappear. form a sense of trust caregiver. Provide During this stage the infant lives in the present. It does not versus mistrust. Child experiences that add to yet have a mental picture of the world stored in its memory learns to love and be security, such as soft therefore it does not have a sense of object permanence. loved. sounds and touch. Provide If it cannot see something then it does not exist. This is visual stimulation for active why you can hide a toy from an infant, while it watches, child involvement. but it will not search for the object once it has gone out of Toddler Developmental task is to Provide opportunities for sight. form a sense of decision making, such as The main achievement during this stage is object autonomy versus offering choices of clothes shame. Child learns to to wear or toys to play with. permanence - knowing that an object still exists, even if it be independent and Praise for the ability to is hidden. It requires the ability to form a mental make decisions for self. make decisions rather than representation (i.e., a schema) of the object. judging the correctness of Towards the end of this stage the general symbolic any one decision. function begins to appear where children show in their Preschooler Developmental task is to Provide opportunities for play that they can use one object to stand for another. form a sense of initiative exploring new places or Language starts to appear because they realize that versus guilt. Child learns activities involving water, words can be used to represent objects and feelings. how to do things (basic clay, (for modeling), or The child begins to be able to store information that it problem solving) and finger paint. knows about the world, recall it and label it. that doing things is desirable. SIX SUB-STAGES OF THE SENSORIMOTOR PERIOD School-age Developmental task is to Provide opportunities such Neonatal Reflex Occurs from birth to Development of child form a sense of industry as allowing the child to 6 weeks reflexes. versus inferiority. Child assemble and complete a learns how to do things short project so that the Stimuli are well. child feels rewarded for assimilated into accomplishment. beginning mental Adolescent Developmental task is to Provide opportunities for an images. form a sense of identity adolescent to discuss versus role confusion. feelings about events Adaptation to their Adolescents learn who important to him or her. surroundings they are and what kind Offer support and praise for through assimilation of person they will be by decision making. and accommodation adjusting to a new body begins in this stage. image, seeking Primary Circular Occurs from 6 Hand-mouth and emancipation from Motion weeks to 4 months ear-eye coordination parents, choosing a develop. vocation, and Infants spend much determining a value time looking at system. objects and separating self from PIAGET’S THEORY OF COGNITIVE DEVELOPMENT them. Jean Piaget (1896–1980), a Swiss psychologist, introduced concepts of cognitive development or the way Beginning intention of behavior is children learn and think that have roots similar to those of present (the infant both Freud and Erikson and yet separate from each brings a thumb to (Wadsworth, 2003). Piaget defined four stages of cognitive mouth for a development; within each stage are finer units or purpose: to suck in.) schemas. Each period is an advance over the previous Secondary Circular Occurs from 4 to 8 Infants learn to one. To progress from one period to the next, children Motion months initiate, recognize, reorganize their thinking processes to bring them closer to and repeat adult thinking. pleasurable Piaget discovered that children think and reason differently experiences from at different periods in their lives. the environment. Memory traces are present; infants Maria Alyssa Jimenez | 7 1st Semester | NCMA 217 (LECTURE) anticipate familiar ○ Symbolic functioning - characterized by the events (a parent use of mental symbols, words, or pictures, coming near him will which the child uses to represent something pick him up.) which is not physically present. Coordination of Occurs from 8 to 12 Infants can plan ○ Centration- characterized by a child focusing Secondary months activities to attain or attending to only one aspect of a stimulus or Motions specific goals. situation. ○ Intuitive thought - occurs when the child is Perceives that able to believe in something without knowing others can cause why she or he believes it. activity and that ○ Displays static thinking (inability to remember activities of one's what he or she started to talk about so that at own body are the end of a sentence the child is talking about separate from another topic.) activity of objects. ○ Egocentrism—a version of centration, this denotes a tendency of a child to only think from Can search for and her or his own point of view. retrieve toys from ○ Animism—The child believes that inanimate view. objects have "lifelike" qualities and are capable of action.Concept of time is now, and concept Recognizes shapes of distance is only as far as he or she can see. and sizes of familiar ○ Unable to state cause-effect relationships, objects. categories, or abstractions. Experiences THE CONCRETE OPERATIONAL STAGE separation anxiety. Ages: 7 - 11 Years Tertiary Circular Occurs from 12 to Child is able to Motion 18 months (toddler) experiment to Major Characteristics and Developmental Changes: discover new During this stage, children begin to think logically about properties of objects and events. concrete events. Children begin to understand the concept of conservation; Capable of space understanding that, although things may change in perception and time appearance, certain properties remain the same. perception as well During this stage, children can mentally reverse things as permanence. (e.g. picture a ball of plasticine returning to its original shape). Objects outside self During this stage, children also become less egocentric are understood as and begin to think about how other people might think and causes of actions. feel. Invention of New Occurs from 18-24 Uses memory and The stage is called concrete because children can think Means through months imitation to act. logically much more successfully if they can manipulate Mental real (concrete) materials or pictures of them. Combinations Can solve basic problems, foresee Piaget considered the concrete stage a major turning point maneuvers that will in the child's cognitive development because it marks the succeed or fail. beginning of logical or operational thought. This means the child can work things out internally in their head (rather THE PREOPERATIONAL STAGE than physically try things out in the real world). Ages: 2 - 7 Years Children can conserve number (age 6), mass (age 7), and weight (age 9). Conservation is the understanding that Major Characteristics and Developmental Changes: something stays the same in quantity even though its Toddlers and young children acquire the ability to internally appearance changes. represent the world through language and mental imagery. But operational thought is only effective here if a child is During this stage, young children can think about things asked to reason about materials that are physically symbolically. This is the ability to make one thing, such as present. Children at this stage will tend to make mistakes a word or an object, stand for something other than itself. or be overwhelmed when asked to reason about abstract A child’s thinking is dominated by how the world looks, not or hypothetical problems. how the world is. It is not yet capable of logical (problem solving) type of thought. CONCRETE OPERATIONAL THOUGHT is the third of the four stages. (School Age) Infants at this stage also demonstrate animism. This is the Occurs from 7 to 12 years tendency for the child to think that non-living objects (such appropriate use of logic. as toys) have life and feelings like a person’s. It includes the following processes: By 2 years, children have made some progress towards ○ Seriation—the ability to arrange objects in an detaching their thought from the physical world. However, order according to size, shape, or any other they have not yet developed logical (or 'operational') characteristic. thought characteristic of later stages. ○ Classification—the ability to name and identify Thinking is still intuitive (based on subjective judgements sets of objects according to appearance, size or about situations) and egocentric (centered on the child's other characteristic, including the idea that one own view of the world). set of objects can include another.Decentering—where the child takes PREOPERATIONAL THOUGHT into account multiple aspects of a problem to is the second stage of the four stages. solve it. (PRE-SCHOOLER) ○ Reversibility—where the child understands By observing sequences of play, Piaget was able to that numbers or objects can be changed, then demonstrate that towards the end of the second year a returned to their original state. qualitatively new kind of psychological functioning occurs. ○ Conservation—understanding that quantity, It includes the following processes: length or number of items is unrelated to the  arrangement or appearance of the object or succeed or fail. Good toys for this items. period: those with several uses, ○ Elimination of Egocentrism—the ability to such as blocks, colored plastic view things from another's perspective (even if rings. they think incorrectly). PREOPERATIONAL 2-7 Thought becomes more symbolic; THOUGHT year can arrive at answers mentally THE FORMAL OPERATIONAL STAGE instead of through physical Ages: 12 and Over attempt. Comprehends simple abstractions but thinking is basically concrete and literal. Major Characteristics and Developmental Changes: Child is egocentric (unable to see Concrete operations are carried out on things whereas the viewpoint of another). formal operations are carried out on ideas. Formal Displays static thinking (inability operational thought is entirely freed from physical and to remember what they started to perceptual constraints. talk about so that at the end of a During this stage, adolescents can deal with abstract sentence children are talking ideas (e.g. no longer needing to think about slicing up about another topic). Concept of cakes or sharing sweets to understand division and time is now, and the concept of fractions). distance is only as far as they can They can follow the form of an argument without having to see. Centering or focusing on a think in terms of specific examples. single aspect of an object causes distorted reasoning. No Adolescents can deal with hypothetical problems with awareness of reversibility (for many possible solutions. E.g. if asked ‘What would every action there is an opposite happen if money were abolished in one hour’s time? they action) is present. Unable to state could speculate about many possible consequences. cause–effect relationships, From about 12 years of age children can follow the form of categories, or abstractions. Good a logical argument without reference to its content. During toy for this period: items that this time, people develop the ability to think about abstract require imagination, such as concepts, and logically test hypotheses. modeling clay. This stage sees emergence of scientific thinking, Concrete 7-12 Concrete operations include formulating abstract theories and hypotheses when faced operational thought year systematic reasoning. Uses with a problem. memory to learn broad concepts (fruit) and subgroups of concepts FORMAL OPERATIONAL THOUGHT (apples, oranges). Classifications is the fourth and the final of the periods in Piaget’s theory. involve sorting objects according Occurs from 12 years old to adulthood to attributes such as color; Can solve hypothetical problems with scientific reasoning; seriation, in which objects are understands causality and can deal with the past, ordered according to increasing present, and future. or decreasing measures such as Adult or mature thoughts. weight; multiplication, in which The young adult is able to understand such things as objects are simultaneously love, "shades of gray", logical proofs, and values. classified and serrated using weight. Child is aware of reversibility, an opposite operation TABLE 28.6 PIAGET’S STAGES OF COGNITIVE DEVELOPMENT or continuation of reasoning back STAGE OF AGE NURSING IMPLICATIONS to a starting point (follows a route DEVELOPMENT SPAN through a maze and then SENSORIMOTOR reverses steps). Understands Neonatal Reflex 1 Stimuli are assimilated into conservation, sees constancy month beginning mental images. despite transformation (mass or Behavior entirely reflexive. quantity remains the same even if Primary circular 1-4 Hand-mouth and ear-eye it changes shape or position). reaction month coordination develop. Infant Good activity for this period: spends much time looking at collecting and classifying natural objects and separating self from objects such as native plants, sea them. Beginning intention of shells, etc. Expose children to behavior is present (the infant other viewpoints by asking brings a thumb to mouth for a questions such as, “How do you purpose: to suck it). Enjoyable think you’d feel if you were a activity for this period: a rattle or nurse and had to tell a boy to stay tape of parent’s voice. in bed?” Coordination of 8-12 Infant can plan activities Formal operational 12 Can solve hypothetical problems secondary reactions month thought year with scientific reasoning; Tertiary circular 12-18 Child is able to experiment to understands causality and can reaction month discover new properties of deal with the past, present, and objects and events. Capable of future. Adult or mature thought. space perception and time Good activity for this period: “talk perception as well as time” to sort through attitudes and permanence. Objects outside self opinions. are understood as causes of actions. Good game for this period: throw and retrieve. Invention of new 18-24 Transitional phase to the means through month preoperational thought period. mental combinations Uses memory and imitation to act. Can solve basic problems, foresee maneuvers that will Maria Alyssa Jimenez | 9 1st Semester | NCMA 217 (LECTURE) DEVELOPMENTAL MILESTONE A developmental milestone is a skill that a child acquires within a specific time frame. Milestones develop in a sequential fashion. Children develop skills in five main areas of development: Cognitive Development - ability to learn and solve problems Social and Emotional Development - ability to interact with others, including helping themselves and self-control Speech and Language Development - ability to both understand and use language Fine Motor Skill Development KOHLBERG’S THEORY OF MORAL DEVELOPMENT - ability to use small muscles, specifically their hands Lawrence Kohlberg (1927–1987), a psychologist, studied and fingers the reasoning ability of boys and, based on Piaget’s Motor Skill Development development stages, developed a theory on the way - ability to use large muscles. children gain knowledge of right and wrong or moral reasoning. PAHINGA MUNA, FUTURE RN! Recognizing where a child is at according to these stages can help identify how children may feel about an illness such as whether children 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 (be able to conceptualize an idea without a concrete picture) before being able to understand how rules apply even when no one is there to enforce them. CHILDHOOD DEVELOPMENT 1ST, 6 WEEKS - newborns are totally dependent on us for their basic needs WHAT WHAT WHAT HOW HOW HOW BABY BABY BABY BABY BABY BABY CAN CAN CAN EATS MOVES COMMUNI SEE HEAR FEEL CATES vision is already Babies only need a cry is her not fully recogniz enjoy tolerate lot of way of develop es his gentle liquids support communic ed mother's massag to hold ating her voice es his head needs. enjoy when he up seeing is born When baby TABLE 28.7 KOHLBERG’S STAGES OF MORAL bright makes eye DEVELOPMENT colors or changes contact large in your with you, black baby's he is and body communic white moveme ating his pictures nts interest when there baby may are new pull back or loud from you to sounds show that around he needs a him. break.