NCM 101- Growth and Development

DEFINITION OF TERMS:
Growth - refers to the increase in the physical size
- quantitative change Ex: increase in height and weight
- measured by some units of measurements like kilograms or cm.
Development - an increase in capability or function
- Increase in skills or ability to function e.g. how child performs a
specific skill
- Qualitative change
Maturation - development of traits carried through the genes.
- Synonymous for development

FACTORS INFLUENCING GROWTH AND DEVELOPMENT

Generally, there are 2 primary factors that determine how each child grows and mature;
genetic inheritance and environmental influences. For the sake of discussion, genetically related
and common environmental factors are enumerated:
1. Heredity/Genetic
- the genetic make-up each is determined from the moment of conception: gender,
intelligence, health, reaction, patterns
- there are certain gender related characteristics that will influence G&D like race,
health, intelligence, temperament.
a. Health
b. Intelligence- children with high intelligence do not generally grow physically
( motor skills) than other children.
c. Temperament

 manner of thinking, behaving or reacting to stimuli- these reaction patterns

can be identified thru the 9 separate characteristics
 it is not developed by stages but is an inborn characteristic
d. Sex

 on the average, girls are born lighter and shorter than boys
 boys keep their height and weight advantage until prepuberty

2. Environment
- Several factors seem to interpolate/ interrelate and become the cause or effect of other
factors
- Physical environment, physical facilities safely, people influencing the child-
financial worries and concern about space and material needs
a.Socio-Economic Status
- health care and good nutrition cost money or sufficient income

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 b. Race
-children of some races and nationalities tend to be taller/shorter
 Sickle-cell anemia-occurs mainly in African Americans
 Thalasemia-occurs in children of Mediterranean countries
 Skin cancer- increase incidence in caucasians
c.Family
-cultural norms within a family, presence or absence (death of parent, imprisonment,
divorce, lack of parental love) of love from primary caregivers
--parent-child relationship-children who are loved thrive better quality of time spent
-family size, multiple births, family structure( single parent, nuclear,extended,etc.)
-ordinal position in the family

PRINCIPLES OF GROWTH AND DEVELOPMENT

1. Growth and Development are continuous( at all times a person is growing new cells and
learning new skills), orderly, sequential processes( follows a pattern: smaller to longer)
-cephalocaudal- head to toe development
-proximodistal- center to periphery
-gross to refined- related to proximodistal, once child is able to control distal body parts ,
he is able to perform fine motor skills
-general to specific- can hold bigger objects then smaller ( large crayons to fine pen) Ex:
from crying to complete sentence
-imitates sounds (8 months) says “mama” specific(12 months), other words(16 months)

2. Each child grows at his own rate passing through predictable stages and different body
parts have asynchronous growth.- sit then stand then walk then run; some may pass thru it
so quickly while others do not show little growth until puberty
-certain body tissues mature more rapidly than others Ex: neurologic tissues grow rapidly
the first 2 years while reproductive organs show little growth until puberty
-Child 1 may begin walking at 9 months; C2 may start it at 12 months
3. Each developmental stage has its own characteristics and it is continuous throughout life.
Ex. Infancy-reflexes; toddlerhood-“NO” stage; preschool- fear of the dark secondary to
vivid imagination
4. There is an optimum time for initiation of learning and new skills tend to predominate.
5. Learning can either help or hinder maturational process, depending on what is learned.
6. There are critical periods of Growth and Development
7. Children resemble ( changes that occur in each stage are similar from child to child) one
another but each child is unique (due to influence of nature and nurture)
8. The many factors influencing growth and development are interrelated. They act upon
and react with one another extensively and inseparably.

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 MEASUREMENT TOOLS FOR GROWTH AND DEVELOPMENT
- Some aspects have standardized measurements derived from studies to keep track
of the progress of growth and development

1. Chronologic Age- using the birth date as reference, developmental tasks related to
certain age group is assessed( make use of different developmental theories)
2. Assessment of Cognitive Development-Mental Age- measured by a variety ( at
least 2 separate testing sessions)
3. DDST/MMDST- Denver Developmental Screening Test

4. Growth Parameters- Ex. Measurement of height and weight and compared against
acceptable norms ( growth chart) , bone age thru x-ray to determine degree of
ossification

THEORIES OF GROWTH AND DEVELOPMENT

1. Sigmund Freud- psychosexual

2. Erik Erikson- Psychosocial
3. Jean Piaget- Cognitive
4. Havighurst- Theory of developmental task
5. Kohlberg- moral development

Developmental Task- skill or learning process that an individual must accomplish at a particular
time in his life.

Theory- a systematic statement of principles that provide a framework for explaining some
phenomena.

I. Sigmund ( Australian neurologist who formulated the first real theory of personality
development ) Freud’s theory of PSYCHOSEXUAL DEVELOPMENT

- believes that early childhood experiences from the unconscious motivation for actions in later
life.- adult behavior is the result of instinctual drives that have a primarily sexual nature (libido)

-personality develops in five (5) overlapping stages from birth to adulthood; sexual energy is
centered in specific parts of the body at certain stage.

-unresolved conflict and unmet needs at a certain stage lead to a fixation(inability of the
personality to proceed to the next stage) of development at that stage.

Freud’s Five Stages of Psychosexual Development- child development is a series

of psychosexual stages in which a child’s sexual gratification becomes focused on a

particular body part

Stage AGE CENTER OF PLEASURE/GRATIFICATION

Oral Phase 0-1 yr.(infant) Mouth( infants are so interested in oral
(smokers, stimulation or pleasure; infants suck for
alcoholics) enjoyment, relief of tension, nourishment)

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Anal Phase 1-3 yrs. Anal region (children’s interest focus on
(homosexual) (toddlerhood) the anal region as they begin toilet
training. Children find pleasure in both
retention of feces and defecation. It is a
part of toddler’s self-discovery.
Phallic 3-6 (preschool) Genitalia (child’s pleasure zone shifts from
(exhibitionist, anal to genital- masturbation,
rapist) exhibitionism. They are hopeful that this
will increase their knowledge about sexes.
Latency 6-12 (school age) Sexual impulse is repressed( because
libido is divided into concrete thinking-
entrance to school)
Genital 12 and Full sexual maturity( establishment of new
after(adolescence) sexual aims and finding of new love
objects)

Nursing Implications:

1. The nurse must be aware of meeting the needs of each stage in order to move
successfully into future developmental stages.
2. The nurse should strive to meet an ill child’s needs.
a. The importance of sucking in infancy should alert the nurse to provide a pacifier
when needed.
b. The preschool’s concern for sexuality should guide the nurse to provide privacy and
clear expectations during any procedure involving the genital area.
c. It may be necessary to teach parents that masturbation ( private matter) by the young
child is normal and to help them deal with it.
d. The nurse should/may question about significant friends during history taking with an
adolescent.

Fixation – immobilization or the inability of the personality to proceed to the next stage due to
anxiety.

II. Erik Erikson’s (psychoanalyst who developed his own theory which stresses the importance
of culture and society in the development of personality ) theory of PSYCHOSOCIAL
DEVELOPMENT

- establishes eight (8) psychosocial stages in an individual’s life span

- each stage signals a task that must be achieved; the greater the achievement, the healthier
the personality of the individual.
- developmental tasks ( skill or growth responsibility arising at a particular time in an
individual’s life) are viewed as series of crises (maturational social needs); successful
resolution is supportive to (and allows the individual to go on next phase) the ego while
failure to resolve the task is damaging to the ego ( needs are not met, unhealthy outcome
which will influence future relationships).
- failure to achieve a task influences the individual’s ability to achieve the next task.

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Erikson’s Eight Stages of Psychosocial Development

Indicators
Stage/developmental
Age Of Positive Of Negative Resolution
task or crisis
Resolution
Trust vs. Mistrust 1.1 yr. *trusting others *mistrust (when care is
(+)resolution(-) (learning (infancy) *views the world as inconsistent ,inadequate
confidence) safe place and people or rejecting) ,withdrawal,
as helpful and estrangement
dependable  *fearful,
suspicious
Autonomy(self- 1-3 yrs. *self-control( they take *compulsive self-
governance/independence (toddlerhood) pride in new restraint or compliance
) vs. Shame and Doubt accomplishments and *willfulness and defiance
Signs of independence: want to do everything
temper tantrums, says independently) without
“NO”, insists on putting loss of self-esteem
own clothes and get feet *ability to cooperate
on wrong shoes, insists on and express self( let the
winding a toy and break decide)
it)
Initiative ( learning how 3-6 yrs. *beginning ability to *lacks self-confidence
to do things and that it is (pre-school) evaluate own behavior *pessimistic
desirable) vs. Guilt *learning how to do *overcontrol and
things and child overrestriction of own
initiates new activities activity
*considers new ideas
Industry vs. inferiority 6-12 yrs. *beginning to create, *loss of hope
( learn how to do things develop and *sense of mediocre
well, praise the when manipulate *withdrawal from school
they do good things and *sense of competence and peers (when parents
reward for finished and perseverance do not show appreciation
projects) since a child *develops new interest for their children’s effort)
world’s grow to include and involvement in
the school and the activities
community
environment, a sense of
industry may be
encouraged or sense of
inferiority may be
reinforced)
Identity vs. role 12-18 yrs. *coherent sense of self *feelings of confusion,
confusion (adolescence) (must be able to (if adolescent can not
integrate everything integrate everything that
that have learned about have learned they will be
self as a son or left unsure or uncertain
daughter, friend, of what kind of person
student, etc.) they are. They can seek
negative identity than
having no identity at all)
indecisiveness, and
possible antisocial
behavior
Intimacy vs. isolation 18-25 yrs. *intimate relationship *impersonal relationships
(young with another *avoidance of
adulthood) person( able to relate relationship, career or
well with others and lifestyle commitment

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 with one’s own sex to
form long, lasting
relationships)
*commitment to work
and relationship
Generativity 25-60 yrs. *extends concern to *self-absorbed
vs. stagnation (middle community(they *unable to cope with
adulthood) participate in change ( can not/ have
community affairs and difficulty assuming
able to juggle their multiple roles)
various lives, becomes
politically active
*self-confident
*able to assume
various roles
Integrity vs. despair 60 years *feels good about *wishes life could turn
onwards his/her life choices out differently( wishes
(old life could start all over
adulthood) again and turn out
differently)

Nursing Implications:

1. Nurse should be aware of indicators of positive and negative resolution of each stage.
2. Nurse can assist the family in providing opportunities and encouragement to the
child/person for enhancement of a positive resolution.
3. Nurse should help the person develop coping skills relative to the crises experienced at a
specific level of development.
4. The nurse should be aware that the environment is highly influential in personality
development.

III. Jean Piaget’s (Swiss Psychologist) Theory of COGNITIVE DEVELOPMENT

- the way children learn to think, reason, and use language
- defined four (4) phases of development and each phase consists of sub-units with their
own characteristics
- as child advances from one phase to the next, thinking process is recognized until become
closer to adult thinking

Three (3) Primary Abilities:

1. ASSIMILATION- the process of changing a situation or one’s perception of it to fit

one’s thoughts/ideas
- Because children believe that their wishes are as real as facts or they dream as real as
daytime happenings
2. ACCOMODATION- the process of change whereby cognitive processes mature,
sufficiently to allow the person to solve those that are unsolvable before. Changing ideas
to fit reality.

3. ADAPTATION- the ability to handle the demands made by the environment.

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Piaget’s Four (4) Stages of Cognitive Development

Stage Age Child Activity/Behavior

1. SENSORIMOTOR(0-2
years)practical intelligence
and infant relate to the
world thru his senses using
his reflex behavior
Substages:
1.1 Neonatal Reflexes 0-1 mo. - Entirely reflexive, use of senses
1.2 Primary( activities are 1-4 mos. - Beginning intention of behavior
related to own body) is present (realizes that self is
Circular separate from other people and
Reaction(repetition of objects – spends time looking at
behavior) objects ; put hands to mouth for
Good toy: rattle the purpose of sucking ‘ finds it
pleasurable to repeat it.

1.3 Secondary ( activities 4-8 mos. - Begins to be aware of the

are separate from environment as the infant begins
child’s body)Circular to connect cause and effect
Reaction
Good toy: mirror, peek-
a-boo

1.4 Coordination of 8-12 mos.

Secondary Schemes

- Can plan activities to attain

1.5 Tertiary Circular
Reactions
specific goals
- Object Permanence – the
knowledge that something
continues to exist even when
out of sight, begins when the
infant remembers where a
hidden object is likely to be
found; it is no longer “out of
sight, out of mind.
- Recognizes shapes and sizes,
imitates others.
- Increased sense of separateness
12-18 mos. - Experimentation( they use trial
(1-1/2 years) and error to discover new
Starts to walk character of objects and events
and explore
the
environment

1.6 Mental 18-24 mos. - Object permanence now

Combination(invention FULLY DEVELOPED
of new means thru
mental combination)
Transitional phase to

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 the preoperational
thought

-Language provides a new tool

for the toddler to use in
understanding the world
- Uses memory and imitation to
act
- Initiates when model is out of
sight
- Can solve basic problems
II. PRECONCEPTUAL 2-7 yrs. - Vocabulary(single word
PREOPERATIONAL THOUGHT Assimilation progresses to phrases then
They derive sentences) and comprehension
conclusion increase greatly but child is
from obvious egocentric( unable to see the
facts EX: 1. viewpoint of another)
mama puts
make up
therefore she
is going to
work because
yesterday she
put on make
up then went
to work 2.
Nurse on
white-
injection
- Thinking is basically concrete
and literal ( distorted reasoning)
- Static thinking

- Concept of time is now, concept

of distance is as far as he/she
can see
II. 1. INTUITIVE 4-7 yrs. - Child relies on transductive
THOUGHT reasoning ( lacks the insight to
put self in another’s place; lacks
conservation or the ability to
discern truth even though
physical properties change
-----faulty conclusions
- Thinks of one idea at a time
(centering)
- Words express thought
III. CONCRETE 7-11 yrs. - Concept of “conservation” is
OPERATIONAL learned

-Child can reason quite well if

concrete objects are used in
teaching or experimentation

- Aware of reversibility and

decentering
- Begins to understand

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 relationships
IV. FORMAL 11 yrs. - Adult like thinking/scientific
OPERATIONAL thinking
Cognition achieves its final form
-Fully mature intellectual
thought is attained
- Uses rational thinking

Nursing Implication:

It is essential to the pediatric nurse that she must understand a child’s thought to design
stimulating activities and meaningful, appropriate teaching plans.

IV. Lawrence Kohlberg’s ( psychologist who studied reasoning ability of children and
developed his theory of moral reasoning)Theory of MORAL DEVELOPMENT

- Focuses on the way children gain knowledge of right and wrong

- Moral development progresses through three levels and six stages

Level Stage Age

I. PRECONVENTIONAL
- Externally established
rules determine right or
wrong actions
- Egocentric focus(
individualism- carry out
activities to satisfy own
needs rather than society.”
I will obey if you give me
something in return”
1. Punishment and Obedience 2-3 yrs.
Orientation
-Look up to parent’s
authority and may not
obey requests from others
-It is right because mama
says so and not because of
societal norms
-fear of punishment is reason
for conformity or behavior

2. Instrumental Relativist 4-7 yrs.

Orientation
- Conformity is based on
egocentric and narcissistic
needs
- Instrumental purpose and
exchange( I give that you
may give)

II. CONVENTIONAL 3. Interpersonal Concordance 7-10 yrs.

- Concerns with Orientation
maintaining expectations - Behavior is based on
and rules of family, group concerns about other’s
or society reactions
- Societal focus - Follows rules because of
the need to be “good”- self
interest to be good
- Child enjoys helping 10-12 yrs.
others because this is a
“nice” behavior. Allow
child to help with simple

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 tasks

4. Law-and-Order Orientation
- Maintenance of social
order, fixed rules and
authority
- Child finds following
rules and authority
because it is nice or fair
- Child often asks what are
the rules and is something
right

III. POSTCONVENTIONA 5. Social Contract Logistic Older than 12

L Orientation
- Lives autonomously and
defines moral values and
principles that are distinct
from personal
identification with group
values
- Universal focus
- Believes a higher moral
principle applies and not Adolescent can
only social rules be responsible
for self care
6. Universal Ethical Principle because he
Orientation views this as a
- Decision and behaviors standard adult
are based on internalized behavior
rules and on self-chosen
ethical and abstract
principles that are
universal, consistent, and
comprehensive

Nursing Implications:

1. Emphasize the importance of helping children determine what are right actions.
2. Allow child to help in simple activities and praise for the desired behavior

V. Robert Havighurst’s Theory of DEVELOPMENTAL TASK

- theorizes that LEARNING is essential to life and that human being continues to LEARN
throughout life.

AGE PERIOD TASKS

1. Infancy and Early Childhood - Learn to walk, to take solid food,
control elimination of body wastes, sex
difference, sexual modesty, relate
emotionally to parents, siblings and
others, to distinguish right from wrong
(develop conscience); achieve
physiological stability, from physical
and social concepts of reality.
2. Middle Childhood - Learn physical skills necessary for
ordinary games, to get along with age
mates’ appropriate masculine and
feminine social role; develop

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 wholesome attitude toward self, skills
in reading, writing, calculating concepts
necessary for everyday living, morality,
values, personal independence
3. Adolescence - Achieve mature relationship with peers
of both sexes, masculine/feminine
social role, acceptance of one’s body
image, emotional independence of
parents and others adults economic
independence, selection and preparation
for marriage and family life, intellectual
skills and concepts necessary for civic
competence, socially responsible
behavior, set of values and an ethical
system.
4. Early adulthood - Select a mate; learn to live with
significant others; start family; rear
children; manage a home; begin
occupation; assume civic responsibility;
identify with a social group.
5. Middle age - Achieve adult civic and social
responsibility; establish and maintain
an economic standard of living, assist
children to become responsible; happy
adults; develop leisure activities; relate
to spouse on a more intense basis;
accept and adjust to physiological
changes of middle age; adjust to accept
own aging parents.
6. Later Maturity - Accept and adjust to decrease physical
strength and health; adjust to
retirement; lower income; aging and
inevitable death of self and spouse;
establish affiliation with age group;
meet social and civic obligations; live
in satisfactory physical environment.

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PROVERB 22:6
“Train up a child in the way he should go, and when he is old, he will not depart from it.”

THE INFANT
 Infant undergoes rapid development [both in size (growth) and ability to perform tasks] and
because of the growth and learning potential that occurs, this period is a crucial one.
Emphasize to parents the importance of infant health care visits because it makes HCP to
assess potential problems; help parents verbalize their concerns about the progress of their
child; and provide anticipatory guidance for parents.

Weight
- Average weight: 2.7 – 3.8 kgs.
– Gains 1-2 lb/month during the first 6 months
– Gains ¾ - 1 lb/month during the 2nd half of infancy (2nd 6 mos.)
– Birth weight doubles at 6 months (4-6 mos.)
– Birth weight triples at 12 months (I year)

Length
- Average height: 50 cm.
– With 50% increase by one year or grows from the average birth length of 20-30
inches
o 1st six months – infant growth is more apparent in the trunk
o 2nd half – more apparent as lengthening of legs in preparation for walking

Head Circumference
- Average head circumference: 35 cm.
- Birth – 6 mos: .6” / month
- 6mos. – 1 y/o: .2 / month
– Head is greater than chest at birth
– 9 – 10 mos.: head and chest are equal
– 1 y/o and above: chest becomes larger

 Some infants’ heads appear asymmetric – always being placed in one position, causing skull
bones to flatten on that side
o Suggest parents to vary infant’s position

Teething (baby teeth/deciduous/temporary)

– 6-7 months lower central incisor
– at 12 months, an average of 8 teeth have erupted
 Pattern can vary greatly among children

Body Systems
 CVS
o HR slows from 120-160 to 100-120
o By the end of 1st year, heart is becoming more efficient

 RR
o Slows from 30-60 to 20-30 breaths/min
o Mucus production by the respiratory tract is still inefficient and tract
remain small – URTI

 Liver
o Remains immature – inadequate conjugation of drugs

 Kidney

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 o Remains immature
o
 Immune system
o Becomes functional at 2 months
o Ig G and Ig M are actively produced by 1 year
o Ig E and Ig D – not plentiful until preschool
 Ability to adjust t cold is mature at 6 months
o Can shiver and develop additional adipose tissues

Play
– Solitary

Toys
– Musical mobiles
– Small rattles
o For two months
 Also spend great time watching parent’s face – “favorite toy”
– teething rings (6 months)
– squeeze toys (5 months)
o Should be small enough so infant can lift it but also big so not to be swallowed
– soft, cuddly toys (8 months)
o Because they are sensitive to difference in texture (velvet, fur, smooth, rough)

Greatest Fear
– Stranger Anxiety (7-8 months)
o Eight Month Anxiety

Other specific behavior:

Gross Motor Development

1.1 Month: Largely reflexes

a. Sucking reflex
b. Rooting reflex: feeding reflex elicited by touching the baby’s cheek, causing baby’s head to turn
to the side that was touched and disappears after 4 months
c. Palmar grasp: disappears after 3 months
d. Plantar reflex: disappears after 8 months
e. Tonic neck reflex/fencing reflex: postural reflex elicited by turning the head of the baby at the
right side for example, the left side of the body shows a flexing of the left arm and the left leg. It
disappears during after 4 months.
f. Moro reflex: use to estimate the maturity of the CNS. Sudden noise, change of position, abrupt
jarring of the crib elicits this reflex. Disappears after 4 months
g. Babinski reflex: J stroke sole of the foot, big toe rises and other toes fan out. Disappears before 1
year old.

2months
- holds head up when prone
- shed tears

3 months
- Lifts head and shoulder when prone

4 months
- No head lag: lift head and chest
- Tonic and moro reflex are fading
- Attempts to roll back

5 months

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 - Turns from back to abdomen

6 months
- turns both ways

7 months
- sits with support

8 months
- sits without support

9 months
- creeps or crawls

10 months
- pulls self to standing

11 months
- cruises (walks with support)

12 months
- stands alone and some infants takes first step

Fine Motor Development

0 month: keeps hand fisted

5 months: raking grasp

6 months: palmar grasp

7 months: crude pincer grasp

9 months: neat pincer grasp

12 months: holds cup and spoon well

Socialization and Language

2 months: social smile, makes cooing sounds, differentiates cry

3 months: squeal with pleasure

4 months: laugh out loud

5 months: simple vowel sounds

7 months: oh-oh,ah-ah,oo-oo

8 months: fear of stranger

9 months: dada, mama

10 months: bye-bye, no

12 months: 2 words besides mama and dada

Health Maintenance

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– caloric requirement = 1,200 calories/day
o From breast milk (1st 6 months) – 110-120 cal/kg of BW per day at birth to 100/kg at the
end of 1st year.
– introduction of solid foods = 6 months

Requirements to readiness for solid foods

– extrusion (3-4 mos.) and sucking (6-10 mos.) reflexes are fading
– can sit with support
– salivary glands, intestinal enzymes are developed and present
– there is a nutritional need to be met

Rules to Follow when Introducing Supplementary Foods

– one food at a time
– Small amount each feeding (1 tsp.)
– have an interval of 4-7 days between new foods
– feed only when the baby is hungry
– do not force, bribe, plead or threaten the child

 Learn infant’s cues to distinguish taste preference from inadequate management of solid food

Sequence of Introducing Solids

1. Cereals
o Fortified with Fe or Vit. B complex
2. Vegetables – 7 mos.
 Higher Fe content
3. Fruits – 8 mos.

 Good source of vitamins; add new textures and favors to diet

4. Meats – 9 mos.
5. Egg yolk – 10 mos.
 Egg white - protein
6. fish
7. whole egg at one year

Promoting Infant Safety

1. Fall
 No infant should be left unattended on a raised surface
 Side rails of cribs should have narrow spaces in between so child cannot put his
or her hand between them
 Place gate at top/bottom of stairways, avoid use of infant walker
 Do not allow infant to walk with sharp objects in hands

2. Suffocation
 No plastic bags within infant’s reach
 No large pillows in a crib
 Unused appliances with doors should be removed
 Remove constricting clothing at bedtime

3. Drowning
 Do not leave infant alone in bath tub or unsupervised near water

4. Poisoning
 Never present medications as candy
 Meds in containers with safety caps
 Place meds/poisons in locked containers

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  No lead paints

5. Motor vehicles
 Use infant car seat in the back seat of the car
 Do not leave infant unattended in a parked car
 Don’t get distracted by an infant while driving

6.
 Test temperature of water and food before feeding
 Do not smoke/drink hot liquids while holding infants
 Limit child’s sun exposure to less than 30 mins. at a time
 Turn handle of pans toward back of the stove
 Keep screens in front of fireplace or heater
 Keep electrical outlets covered with safety plugs
 Keep matches, lighted candles out of reach

Immunizations
– At birth = Hepa B and BCG
– 2 months = DPT, OPV, Hepa B (3 doses at one month interval)
– 9 months = anti measles

THE TODDLER

Freud: Anal phase

Erickson: Autonomy vs. Shame and doubt
Piaget: End of sensorimotor to early part of pre operational
Kohlberg: Punishment & obedience

Weight
– Gains 5-10 lb/2-3 kg. during the period
– Prominent belly or lordotic appearance
Length
– doubles by age 2
– boys slightly taller than girls, gains more in proportion to weight

Head Circumference
– equal to chest by 1-2 years

Fontanelles
– Anterior – closes at 12-18 mos.

Teething
– Completion of 20 primary or deciduous teeth by 2 ½ - 3 yr.

MAJOR CONCERNS IN TODDLERS:

1. Toddlerhood is the critical period for toilet training.

Pre-requisites:
a. physiologic readiness
 rectal and urethral sphincter control
 recognizes the urge and with the ability to stand and walk to bathroom
 manages clothing himself
b. psychological readiness

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  understands the act of elimination
 ability to use words or gestures regarding toileting needs
c. desire to please the primary caretaker

Schedules of Toilet Training

15-18 mos. - start of training
18-24 mos. - bowel control
2-3 yr. - Daytime bladder control
3-4 yr. - Nighttime bladder control

Tips on How to Toilet Train a Toddler

1.Use uncomplicated garments so child can undress quickly enough

2. Potty chair can be purchased because it is potentially less frightening to a child
3. Put your child on the potty chair/ toilet at regular intervals
4. Praise child if he does urinate or defecate. Remind to wash hands.
5. Do not allow a child to use the potty chair to eat or as a play table to avoid
confusion as to purpose
6. If child is not successful, return to diaper for a short period but do not show
that, it means he has failed. Do not pressure child to accomplish things.

2. Toddlers are headstrong and negativistic, naturally active, mobile and curious.
- “NO” is a favorite word, with negativistic behavior
 May mean refusing a task, they d not understand it, or just practicing it because they
know they have a potent effect on those around them
 They are asserting their independence
o By giving him choices, you can help him feel more in control without having to
directly challenge your authority
- If he does not talk, should be referred for it can indicate any of the ff.:
a. mental retardation
b. deafness
c. emotional deprivation
- do not “baby talk”; expose to conversation at meals to encourage language development and
learn other words
 Always answer child’s questions simply and briefly
 Pint to objects and name them

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 DEVELOPMENTAL MILESTONE OF THE TODDLER
Age Gross Motor Skills Fine Motor Skills Language Development Psychosocial Skills Cognitive Skills Play
(Parallel Play)

15-18 mo. - walks alone Holds cup with spills - 10-20 words, uses words - resistant to sit in laps - continues to - stacks of boxes
- climbs, creeps upstairs, Takes shoes and socks off over and over repeatedly and being cuddled experiment on object or balls that fit
on furniture Drinks with cup but meaningfully - imitator (dust or permanence each other
- with sphincter control, Trying to eat with spills - gestures, points to desired sweeps) - tertiary circular - push and pull
- throws a ball objects - parallel play (plays reaction toys
- says “NO” to all requests beside the child next to - attained object - manipulate toys
(NEGATIVISTIC) them but permanence - toys that allow
- can name one body part not with them) - points at body parts him to do
- magical thinking something with
begins (18 mos. to 2 them
years)
- egocentric
- begins sense of time

2 years - runs without falling - uses one hand for a glass or cup - 30 words; 2 words in one - parallel play increased - Pre-operational - imitates adult
- jumps with both feet in - no spilling with spoon sentence in intensity though, uses action in his play
place - can undress self almost totally - parents should see that assimilation (not able (wrap up a doll
- walks upstairs with one - can open doors by turning door if two are playing that to change his thought and put it to bed)
foot after the other knobs they have the same toys to fit as a situation;
- balances on one foot therefore he has to  Household
- still have wide based change a situation to chores- dusting,
 unsteady walk fit his thoughts) laundrying, etc.

2 ½ -3 yrs - rides a tricycle - pours with spills
- stands on one foot - holds crayons
- jump off one step - begins drawing, copies circles
- draws recognizable circles
- puts raisins into narrow neck
bottles
- sentence of 2-3 words - notices sex differences
- knows full name and points to children
- names one color - he plays and say “boy”
or “girl”
3. Toddlers are rigid, repetitive, ritualistic and stereotyped in behavior. When things are
rearranged, are strange, or when places and persons are unfamiliar, they go into
temper tantrums.

Temper Tantrums - characterized by the child’s kicking, screaming, stamping of feet and
shouting “NO!”, child lies on the floor, hails his arms and legs, hold
his breath until he becomes cyanotic and slumps to the floor.

4. Discipline and Setting Limits – setting of rules and external control whenever necessary to
the child so that he knows what is expected of him.
 It is instill early in life because it involves setting safety limits and protecting others or property
 Arises from day to day experience
 Setting rules or road signs so that children know what is expected of them

Punishment – consequence that results from a breakdown of discipline; from the child’s
breaking the rules he has learned.

Principles of Good Discipline:

1. Immediately after a wrong doing
2. consistent and firm
3. positive approach
4. allow the child to explain your reason of disciplining
5. observe safety
6. provide physical care after so that DOUBT is erased and AUTONOMY reinforced

 Give one warning, if a child repeats the behavior, discipline

Forms of Disciplining
1. Redirect the child’s attention
 Let child choose (distract)
2. Timeout

Effects of Good Punishment

1. security
2. self-control
3. socially appropriate and acceptable behavior
 Because he can now control himself

5. Separation Anxiety
- most acute at 2 – 2 ½ years old
 Toddlers have difficulty accepting being separated from primary care givers
- May begin at 6 months
- parents need to say good-bye firmly, give reassurance that you are coming back
- prolonged good-byes will only lead to more crying
- sneaking-out – produces no crying and so eases the parent’s guilt. Parents need to
have a fair warning about the separation and who will take care of them

6. Health Maintenance
a. Nutrition
caloric requirement – 1,300 calories/day
physiological anorexia – voracious appetite on one day then nothing the next day

effects: a. prone to iron deficiency anemia

b. refusal to eat

management: - do not force the child to eat

- let the child feed himself
- allow the child to join others at the table
 Imitation
- let the child decide for the order of food
- recognize ritualistic behavior

20
  Use same spoon, same chair, same place in the table, same plate,
etc.
 They don’t want to eat unless these are followed
- give small portions
- do not give bottle as a substitute for solids, give solids before
or with milk
- do not use food as reward (contributes to obesity)
- “Nutritious finger foods”

b. Accident Prevention
1. falls - leading cause of death
- use stair guards and bed rails
- windows and doors screened
- supervise play
- floors must not be slippery

2. poisoning - keep cabinets locked

- do not place medicines on places where children can reach
- give medicines as drugs NOT as candies

3. burns - cover electrical outlets

- keep electrical wires out of reach
- teach child what “HOT’ means
- check bath water temperature

4. cuts and stabs - place knives and sharps on safe areas

5. drowning - do not leave the child unattended

THE PRE-SCHOOLER

Weight
– gains 5 lb/year
– Slimmer and taller, child-like in figure
– Slower growth rate-thinner than the toddler

Height
– 2-2 ½ inches/year
– With erect posture, looks tall but thin
– Increase in size is seen in elongation of legs vs. trunk

 There is a prominent change in body contour; Future body type becomes apparent
 Handedness becomes obvious.

Teething
– have all 20 deciduous teeth by 3 years old
– No new teeth erupts
– Loss of primary teeth starts at 5-7 years old

Fears
– castration complex – anxiety about the genitalia specially of the boys
– Fear of mutilation
 Small cut in finger is very big issue to them
- Fear of the dark – universal fear of the age group
Play
– associative or cooperative
 Form in groups; capable o f sharing
– allows education, teaching on social roles; sharing and playing in small groups,
simple games and rules

 Children who are exposed to playmates have an easier time learning to relate to people

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Behavior Traits
– imitate adult behaviors
o playing house and pretend to be teacher, store clerks, etc
– favorite word: Why and how
– age of sibling rivalry
– Oedipal/electra complex
o Oedipal Complex – strong emotional attachment of young boys t their mother
o Electra complex – Strong emotional attachment of young girls to father
– masturbation may be seen in some

 Sense of Initiative: Assist parents in separating those tasks a preschooler can accomplish
independently from those that require home adult supervision so they can set sensible limits
o Dressing self

Physical Development
three - walks backward
- pedals strike
- uses scissors
- climbs stairs
four - climbs and jumps well
- brushes teeth
- throws ball overhead
five - jumps rope
- ties shoelace with ribbon
- skips and balances on 1 foot 8 sec

THE SCHOOL AGE CHILD

Weight
– Doubles (1-2 kg/year)
Height
– grows 2 inches/year
– 9 years old – boys and girls are of the same height/size
– 12 years old – girls are taller and bigger than boys

 Sexual Maturation
o Onset: 10-14
o Girls: 12-18
o Boys: 14-20
 Sexual and Physical Concerns
o Changes in physical appearance that comes with puberty can lead to
worries
o School age is the time for parents to discuss with children the physical
changes that will occur and the sexual responsibility these changes
require.
 Acne
 Vasomotor instability – blushing
 Increased perspiration
 Concerns of Girls
o Maybe taller than boys
o Change in pelvic contour and may misinterpret as weight gain
o Breast development – may hide with loose clothing
o Menstruation
 Early preparation is important
 Explain god hygiene; reassure that they can bathe, shower,
ADL
o Presence of vaginal secretions must be explained
o Menstrual irregularities
 Concerns of Boys
o Increase in genital size
o Nocturnal emission (ejaculation during sleep)

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Teething
– age of dental caries
– 5-7 years old – loss of deciduous teeth, average is at 6 years old
– 12 years old – all permanent teeth (1st and 2nd molars) erupts
– 32 permanent teeth (upper and central incisor – first to disappear)

Nutrition
 Are generally good eaters/ have good appetite but influenced by the child’s activity
o Full day of activities – increased appetite
o Had a poor mark in school – decreased appetite

– calories needed – 2,100 – 2,400 calories/day

o Late school year, boys needed greater calories and nutrients
– More likely to eat junk foods and carbonated beverages
o Because of lack f elementary facts of nutrition
 Packed sandwich is traded for candy or sweets at school
 NI: Nutrition education at health maintenance visits
– Display good table manners
o Enjoys helping in preparing foods to foster industry
 Instruct parents to prepare healthy foods
 Avoid--- foods because it may dull the child’s appetite for dinner

Fears
– fear of displacement or replacement in school
– fear of body injury
– fear of death
– Anxiety r/t beginning school

Safety
– motor vehicle accidents
– Supervised during sports activity
– Teach respect for fire and its danger
– Do not go with strangers, say no to anyone who touches them if they do not wish
it

 Latch Key Children – school children without adult supervision for port of each weekday

Play
– Competitive, Cooperative (team and rules governed)
– Number of play activities decreases while amount of time spent on a particular
activity increases
– beginning of school year (6-7 years)
– boys and girls together but gradually separates into sex oriented type of activities
o Best time to talk about sex education
– team play – rules and rituals dominates play; evades/eliminates individuals not
tolerated by peers
o Girl games: dressing dolls
o Boy games: Video games; Pretending t bandits, pirates, etc.
– types of play/games:
 quiet games – painting, collections, reading, viewing television, listening on
the radio
 athletic activities – swimming, hiking, cycling
6-9 yrs/old – housekeeping toys, dolls, accessories, needle works, collection
hobbies
9-12 yrs/old – handicrafts, science toys, chess, scrabble, model kits, video games,
radio/record, books, comic books, joke books

 Follow rules, promises must be kept because they view them as definite
commitments (7 y/o)
– AUTONOMOUS MORALITY develops after 9 yr – recognizes differing points
of view. (decentering)

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DEVELOPMENTAL MILESTONES

Age Gross Motors Fine Motors Specific Behaviors

(Influenced by friends)
6 Jumps, skips (hops well) Can print but may reverse
Prints letters
Tie shoelaces well Cuts and paste well
Can easily tie shoelaces

7 Rides a bicycle With full developed eyes Withdrawn and moody

Can read regular size Prefers to be alone
letters Vision matures, 20/20
Enjoys reading with
pleasure
Enjoys card games
 “Eraser year” –
never quite content with
what they have due to
high standard they set
on themselves.

8 Write rather than print Write rather than print Onset of secondary sex
More graceful movement characteristics
Increase smoothness and Prefers playmates of own
speed since arms and sex
legs begins to grow,  Best friends develop
may stumble on  Homosexual best
furniture or spill his friends
milk at the table Collects objects

9 “On the go” constantly Writings begin to look More interested in friends
Fully developed hand-eye more mature and less than family
coordination awkward  “Gang age” – all
Enjoys baseball and activities done with
basketball gang
 “Spite clubs” Lying and
stealing may become a
problem
 They concentrate on
something as right
because its good for
them and not
because right for
humanity
Worry and complain a
great deal
 Because of high
expectations on self

10 More active in perfecting With smoothness and Peer-oriented

athletic skills speed in fine motor With secret language
skills (because brain Enjoys privacy
development is complete,
fine motor skill becomes
refined)

11 In constant motion Hero worship

Drumming fingers is  A film star, a doctor,
common a cartoon hero or
Tapping pencils or feet role model whom

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 they want to grow up
to be like
Beginning interest in the
opposite sex

LANGUAGE DEVELOPMENT
1. rapid expanding vocabulary
2. likes name calling, word games
3. with passwords and secret languages
 Whispers among themselves for “Spite clubs”
4. with sense of humor; giggles and laughs a lot
5. enjoys dirty jokes

 Favorite words are those that reflect curiosity such as how, why, what?
o Is this the way to do it?
o Is this good?
 Common problem is articulation

PSYCHOLOGICAL SKILLS
1. school occupies half of his waking hours
- friends and classmates are more important than family
- teacher becomes parent-substitute
- school phobia may result to psychosomatic disorders and complaints
2. increasing social activities
 They may forget household chores or may do them sloppily so they can join their friends and
have more time with them
3. more cooperative and with improved manners
4. capable of a good deal of responsibilities

 Begins to learn compassion and thoughtfulness

5. modest and enjoys privacy (starts at 10 yr. Old)

6. with hero worshipping

COGNITIVE SKILLS
 Concrete Operational

1. period of industry
 Simple chores that could be completed quickly
 Book with many short chapters
 Because they have learned new concepts such as:
– likes to explore, produce, accomplish to have adventure
2. develops confidence
3. with logical thinking
4. acquires use of reason and understanding of rules; allows greater use of language
 Conformity is vital in children at this age
5. names months and years, right and left and can tell time
6. Capable of simple problem solving
 Parent should encourage this skill to develop the attitude of optimism

THE ADOLESCENT

Adolescence
- Transition between childhood and adulthood
- it is the period of social and behavioral maturation from the beginning of
pubescence to beyond the time of reproductive maturity
- behavioral indicators:
a. rapid bodily changes
 Androgen stimulates sebaceous glands --- acne

25
  Apocrine sweat glands form and produce strong odor
b. wants to be exactly like peers
c. much interest in opposite sex
d. formation of personality
e. concerned with lie after school
f. moves from dependency of childhood to independence of
adulthood
g. transition period: no longer a child, not quite an adult

Puberty
– period of full reproductive maturity
 11-14 years

GIRLS – begins with menarche; most young girls are not fertile for about 1-2yr. after
menarche
BOYS – at or near first ejaculation
 Begins to produce spermatozoa

Weight
- with pubertal spurt
- Female: 10-14 y/o - gains 38 lb.
Male: 12-16 y/o - gains 52 lb.

Height
Female: 10-14 y/o - 20.5 cm gain; 95% of the mature height is achieved
by the onset of the first menarche (within 3 years
from menarche, may reach adult height)
Male: 12-16 y/o - 27.5 cm gain; 95% of mature height is achieved at
15.

Physical Growth
– rapid increase in weight and height, alteration in body shape:
GIRLS - forms becomes smoother because of the fat deposition
- pelvis broadens
- breast development is the first overt sign of beginning of reproductive
maturation

BOYS - increase in the size of the testes and scrotum and later the penis
- leaner chest and shoulders broadens

 Secondary sex changes that distinguish the sexes from each other
o Growth of pubic hair
o Voice changes
o Facial acne
Fears
– fear related to body image (secondary sex characteristics)
o Immaterialized hopes
– body injury
o Overuse injuries from athletics because they can not recognize their limits yet (early
adolescent)
– death

Teething
– 12-13 y/o – 2nd molars
14-15 y/o – 3rd molars or wisdom teeth; can extend up to 18-21 yrs.

Play
– recreational and leisure activities:
o Sports where team loyalty is intense
Girls: - social functions
- romantic TV shows

26
 - telephone use for a long time
- cooking and sewing
- outings and movies
- art and poetry
- daydreaming
Boys - group activities
- sports activities are important
- part-time employment
- mechanical and electrical devices

 Most adolescents spend a great deal of time just talking with peers as social interaction. Some
parents consider it as a waste of time but for adolescents, it is their way of discovering the world and
develop value system.

Safety and Accidents:

1. leading cause of death, with motor accidents and sports injuries
2. drugs and alcohol are serious problems
3. suicides as secondary causes of death
4. drowning is also common
Psychosocial Patterns
 The periods are defined not so much on chronological age but on the psychologic and sociologic
factors
1. Early Adolescence (12-14) 13-14
a. physical and body changes can result to altered self concept leading to
fear of rejection
b. early and late developers may also have anxiety regarding fear of
rejection
c. may have mood swings
d. with fantasy and daydreaming
e. needs consistent discipline, limits and behavior

2. Middle Adolescence (F: 13-16; M: 13-17) 15-16

a. emancipated from parents
 May become an issue for parents for two reasons
o Parents are not ready for their child to be independent
o Adolescents are not sure they want to be on their own
 Fight over battle of staying late at night
 Start to look for part-time jobs t earn money
o It teaches them how to work with others, accept responsibilities and handle
money wisely
b. identifies own values
c. finds increasing interest in heterosexual relationships; may find a mate
or form ‘love’ relationships
d. with peer group
- one of the strongest motivating forces of behavior
- finds importance to be part of the group and be like everyone else, conforms to
values and fads of the group
- clique formation- may be determined by race, social class and special interest
e. sex education is complete at this period

3. Late Adolescence (F: 18-21: M: 17-21)

a. physically and financially independent from parents
b. finds a mate
 Ready to work on achieving intimacy which is strongly correlated with sense of trust
c. finds identity
d. develops morality
e. increasing social and moral interest; participate in society
 Engage in charitable endeavors
o Learn that they are strong and capable enough not only to take care of themselves but
also to help less fortunate.
f. completes physical and emotional maturity

27
  That relationship is not solely based or learn on physical appearance but on inner
qualities

Health Maintenance
– calories: 2200 in girls, 2700 in boys
– appetite increases with rapid growth
– increase in CHON, Ca, Fe & Zinc needs for sexual maturation
– increase in nutritional requirement because of sports activities
– eating habits – influences by peer group, usually with feeding
problems

ADULTHOOD AND MATURITY

Adulthood – age at which a person is considered adult depends on how it is described

 In terms of maturity in physical/mental aspect.
 Different culture may view it differently, some may have earlier adulthood

YOUNG ADULTS (18-25y/o)

Physical Development:
- at height of bodily vigor
- maximum level of strength, muscular development, cardiac and respiratory capacity
- peak for sexual activity

Psychosocial Development:
- developing an intimate, lasting relationship with another person correlated with sense of
trust
 Basic strength that evolves from the relationship is love, empathy, compassion and not
egocentrism

- develops fuller understanding of own authority and maturity

- outcome of negative resolution is exclusivity (isolation)
- faces new experiences and changes in life style as one progresses maturity
- choices must be made about education, employment, marriage, singlehood, starting a
home, rear children, forming new friendships, assuming community activities
 Engaged in reproductive work

Cognitive Development:
- maximum ability to solve problems and learn new skills
 Cognitive structures are complete during the formal operations period
- egocentrism continues to decline
- capable of forming new concepts and shifting their thinking in order to solve problems
 Critical thinking and problem-solving abilities are developed

Moral Development:
- able to separate self from the expectations and rules of others (peers, friends)
 Mastering the post conventional period
- one is able to define morality in terms of personal principles

Spiritual Development:
- person focuses on reality
- one enters the individuating-reflective period after 18 years old
 Assumes responsibility for own beliefs
 Nursing Implication:
1. Encourage use of spiritual support system
- religious teaching that the person has as a child and may now be accepted or redefined

28
Health Promotion and Protection
- interested in meeting their health needs
- needs annual physical examinations
female: breast exams male: testicular self exam
papanicolaou
- safety
- nutrition
- health problems - anemia - HPN risk
- obesity - cardiovascular disease
- exercise
- sexual concerns
- work and career stress
- divorce and separation
- battered/ abused woman
- substance abuse
- violent death and injuries

MIDDLE ADULT (25- 60 y/o )

General Characteristics
- years of stability and consolidation

Physical Development:
- gradual decline in biologic function:
musculoskeletal decline in muscle strength, loss of reserve capacity
cardiovascular loss of elasticity of blood vessels
respiratory decrease lung capacity
skin/appendages graying of hair, balding, wrinkling of skin
senses failing eyesight, gradual hearing loss, gradual loss of sense
of smell, decreased sense of taste
GIT decrease in tone of large intestines
urinary system nephron units are lost, GFR decreases
sexuality hormonal changes takes place in both sexes
menopause – menstruation ceases
andropause - sexual activity decreases
- fat depositions on the abdominal area
- stooped posture

Psychosocial Development

Generativity Stagnation

- establishing and guiding the next Boredom

generation: Impoverishment
*providing for the welfare of Difficult to accept aging bodies
human kind that is equal to Withdrawn, isolated, preoccupied with
the concern of providing for self, unable to give to others
self
* altruistic
* concepts to service to others
love, compassion gain
prominence
* more time for companionship
and recreation

Cognitive Development:
- takes longer to memorize
- cognitive processes includes : recreation time, memory, perception, learning
problem solving, creativity
- able to carry out all strategies described in Formal Operation by PIAGET

29
Moral Development
- adult can move beyond the conventional level to post-conventional level
- few achieves the highest level of moral reasoning (KOHLBERG )

Health Promotion and Protection

– Assessment: visual and hearing changes
Cessation of menstruation
Satisfaction with work
Social activities
Children and family relationships
Usual patterns and changes in eating, elimination and exercise
Chronic illness
– safety – changing physiologic factors
– nutrition- eating healthy diet : CHON, Ca: limit cholesterol and
calorie intake, vitamin supplements according to prescription
– exercise- to delay aging process
– self concept- diminished: encourage to do the new thing, support in
accepting the changes and adjusting to them

LATE ADULTHOOD (above 60 y/o )

The Young Old – 60-79 years old

The Old Old – 80 years and above

Aging
 is a normal process that occurs throughout the life span causing progressive
decrease in functional capabilities
 This process is not just physical but psychological and social as well

Ego integrity vs. despair (Erickson)

(+) – Accepts own life as having been meaningful nad appropriate
(-) - Time is too short

Theories on Aging:

A. Physiologic Theory
 Related to physiologic changes occurring in aging

B. Psychosocial Theory
 Sense of worth is derived from helping others

C. Disengagement Theory
 Inevitable mutual withdrawal of the person and society from each other

D. Activity Theory
 Activities continue; if roles are relinquished, the person will substitute new roles
E. Continuity Theory
 As a person grows older, he or she is likely to maintain continuity in habits, preferences,
commitment
 Implies that there are many possible adaptations to aging

Physical Changes
- decreased sebaceous gland activity, inability to retain fluids
- less of hair color- decreased number of functioning pigment producing cells
- body temperature lower due to decreased BMR

30
 - neuromusculoskeletal changes – gradual reduction/speed and power of voluntary
muscle contraction
- cardiopulmonary changes - respiratory efficiency reduced, heart capacity
decreased, dyspnea experienced
- sensory/perceptual changes - sunken appearance of the eyes, decreased blink
reflex, loss of visual acuity, decreased power of adaptation to darkness/dim light,
decreased accommodation to near and far objects, peripheral vision, discrimination to
colors
- digestion changes - decreased digestive enzymes, number of absorbing cells,
muscle tones, decreased gastric pH – decreased absorption rate of drugs and nutrients
- urinary elimination changes - decreased excretory functions, decreased blood
flow due to arteriosclerosis, loss of muscle tone and sphincter control
- sexual activity and reproductive organ changes – sexual drives persist into the
70’s, 80’s and 90’s provided that health is good and an interested partner is available

Cognitive Development:
– there is minimal changes in intellectual capacity of the healthy
aging person
– crystallized intelligence more stable
– better memory for the past
– must maintain verbal and mental activity

Psychosocial Development
– intensified feelings of aging and mortality
– retirement years
– provides moral support
– may be preoccupied with bodily complaints

Spiritual Development:
– with mature religious outlook strives to incorporate views of theology and
religious action into thinking
– knowledge becomes wisdom
– with strong religious convictions
– continues to attend church services
– some enters the 8th stage UNIVERSALIZING – they think and act in a way that
exemplifies love and justice

Health Promotion and Protection

– Assessment – usual dietary patterns
 problems with bowel and urinary elimination
 activity/exercise and sleep/rest patterns
 family and social activities and interests
 any problem with reading, writing or problem solving
 adjustment to retirement or loss of partner
– safety
– nutrition
– elimination
– activity/exercise
– rest and sleep
– older abuse
– drug use and misuse
– alcoholism
– chronic illnesses

31
ROLE PLAY
 Last week of September

Reminders:

Maximum of 20 minutes each

 15-20 minutes including preparation

Grading System

40% completeness and adequacy of info presented – able to present all the
characteristics of the child

20% Clarity of presentation - presentor’s ability to organize the play, smooth flowing,
no dead air, no gaps

20% Presentor’s mastery of role – member able to deliver role spontaneously and
naturally

10% Consciousness of time – follow prescribed duration of presentation

10% Evidence of creativity/ showmanship – use of props, costumes, audience impact

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NURSING PROCESS IN G&D:
- determining a child’s developmental stage is often their focus of a health
interview

1. Assessment
- measure and plot height and weight on standard growth chart perform PA
- take health hx and observe what specific activities the child can accomplish to
establish whether developmental milestones (major markers of normal
development) are being met
-recall hx for nutritional intake, sleep, school, and play behavior

2. Nursing Diagnosis
-risk for delayed G&D related to lack of age-appropriate toys and activities
-delayed G&D RT prolonged illness
-readiness for enhanced family coping related to parent’s seeking information
about child’s G&D
-imbalanced nutrition, less than body requirements RT to parental knowledge
deficit regarding child’s protein/caloric needs

3. Planning
-consider all aspects of child’s health- physical, emotional, mental, spiritual,
social-remembering that each child’s developmental progress is unique and
influenced by genetic and environmental factors.
-through anticipatory guidance, child can be encouraged to reach maximum
developmental potential
-include child’s family
-assist family in acceptance of developmental delays, otherwise, plans may have
to be delayed

4. Implementation
-encourage age appropriate self-care
-suggest age-appropriate toys or activities to parents
-role modeling is an important on-going intervention with both child and family

33