Developmental Theories

● Erickson
○ Infant: trust vs mistrust (birth to 1 year)
■ Achievement is based on the quality of the caregiver infant relationship and the
care received by the infant.
■ Trust = meeting the needs
■ Mistrust = needs are inadequately or inconsistently met
○ Toddler: autonomy vs shame/doubt (1 - 3 years)
■ Independence expressed through negative responses
■ Maintaining routines provides a sense of comfort for toddlers
○ Preschooler: initiative vs guilt (3 - 5 years)
■ Preschoolers become energetic learners
■ Guilt can occur when preschoolers believe they have misbehaved
○ School Age: industry vs inferiority (5 - 12 years)
■ Industry is achieve through the development of skills and knowledge that allows
the child to provide meaningful contributions to society.
■ Inferiority complex is created when a child is unable to complete a task and gain
a reward - children should be taught that not everyone will master a task.
○ Adolescent: identity vs role confusion (12 - 18 years)
■ Adolescents develop a sense of personal identity and come to view themselves as
unique individuals
■ Failure to establish a sense of identity within society can lead to role confusion
leading to experimentation.
● Piaget
○ Sensorimotor: 0-2 years
■ Separation: infants learn to separates themselves from other objects in the
environment
■ Object Permanence: infants learn that an object still exists when it is out of view
(9-10 months)
■ Mental Representation: ability to recognize and use symbols
○ Preoperational Thinking
■ 1-3 years
● Toddlers have/demonstrate memories of events related to them.
● Domestic mimicry
● Toddlers can’t understand others viewpoints
● Toddlers can symbolize objects and imitate previously seen activities
■ 4-7 years
● Thoughts move from egocentric to social awareness
● Preschoolers begin to understand the sequence of time
● Magical thinking
○ Concrete Operational Thinking: 7-11 years
■ Masters of conversation
■ Able to classify complex information
■ Able to solve problems and see the perspective of others
 ○ Formal Operational Thinking: 12+ years
■ Able to think through more than two categories of variables concurrently.
■ Highly imaginative and idealistic
■ Capable of using formal logic to make decisions
■ Able to understand how the actions of one individual can influence others
● Social Development
○ Infant → attachment, separation anxiety (4-8 mo), recognition, stranger fear (6-8
mo)
○ Toddler → differentiating themselves from their parents / becoming independent
○ Preschoolers → prolonged separation can cause anxiety / pretend play is healthy and
allows them to determine the difference between fantasy and reality.
○ School Age → same gender peer group play is popular / bullying becomes a problem /
conformity is evident
○ Adolescent → peer relationships develop / best friend relationships are stable and
lasting / parent child relationships change to allow for independence
Stages
● Newborn/Infants
○ General Measurements
■ Head circumference → averages between 33 and 35 cm
■ Chest circumference
■ Abdominal circumference
■ Length
■ Body weight → averages 6 to 9 lbs / normal to lose 10% of birth weight by 3-
4 days / infants gain 1.5 lb per month during first 5 months of life / tripled by
1 yr
■ Dentition → 6-8 teeth should erupt by end of first year
○ Fontanels
■ Posterior → closes 6-8 weeks
■ Anterior → closes 12-18 months
○ Reflexes
■ Sucking & Rooting
● Age: birth to 4 months
● How? Stroking an infant’s cheek or the edge of infants mouth.
● Reaction: infant turns head toward the side which was touched and starts
to suck.
■ Palmar Grasp
● Age: birth to 3 months
● How? Place an object in the infants palm.
● Reaction: the infant grasps the object.
■ Plantar Grasp
● Age: birth to 8 months
 ● How? Touch the sole of the infant’s foot.
● Reaction: infant’s toes curl downward.

■ Moro Reflex
● Age: birth to 4 months
● How? Allowing the infant’s head and trunk to fall from a semi-sitting
position to a 30 degree angle.
● Reaction: the infant will spread their arms out (abduction) and then
unspread their arms (adduction).
■ Startle Reflex
● Age: birth to 4 months
● How? Produce a loud noise near the newborn.
● Reaction: the newborn abducts their arms at the elbows while the hands
are clenched.
■ Tonic Neck
● Age: birth to 4 months
● How? Turning infant’s head to one side.
● Reaction: the infant extends the arm and leg on that side and flexes the
arm and leg on the opposite side.
■ Babinski
● Age: birth to 1 year
● How? Stroking the outer edge of the infant’s foot upward towards the
toes.
● Reaction: the infant’s toes fan upward and out.
■ Stepping
● Age: birth to 4 weeks
● How? Holding the infant upright with his feet touching a flat surface.
● Reaction: The infant should make stepping movements.
○ Nutrition
■ Solids are introduced at 4-6 months of age
■ Vegetables at 6-8 months
● Toddlers
○ Activities
■ Temper tantrums occur when toddlers are frustrated with restrictions on their
independence → create a consistent environment.
■ Toilet training
■ Parallel play
○ Nutrition
■ Physiologic anorexia → toddlers will not eat too much, but what they eat
should be good in calories.
■ 24 - 28 ounces of milk/day
■ Finger foods
○ Injury Prevention
 ■ Aspiration - Motor Vehicle
■ Burns - Poisoning
■ Drowning - Suffocation
■ Falls
● Preschool
○ Language
■ 3-4 word sentences by age 3 / 4-5 word sentences by age 4

○ Nutrition
■ 13 - 19 g/day of protein
■ 5 servings fruits and veggies
○ Injury Prevention
■ Bodily Harm - Drowning
■ Burns - Motor Vehicle Injuries
● School Age
● Adolescence
○ Tanner Stages
○ HEADSS
■ Home
■ Education
■ Activities
■ Drugs/Alcohol
■ Sexuality
■ Suicide and Prevention
■ Safety Issues
○ Consent
○ Emancipation
Pain
● Assessment Scales
○ FLACC (2 months - 7 years)
■ Face / Legs / Activity / Cry / Consolability
○ Faces (3 years and older)
■ Pain rated on a scale of 0 to 5 using a
diagram of six faces
○ Numeric ( 5 years and older)
● Assessment Findings
○ Young Infant
■ Loud cry
■ Rigid body or thrashing
■ Expressions of pain (eyes tightly closed, eyebrows drawn together)
■ Lack of association between stimulus and pain
○ Older Infant
■ Loud cry
■ Deliberate withdrawal from pain
 ■ Facial expression of pain
○ Toddler
■ Screaming - Clinging to significant person
■ Thrashing - Noncooperation
■ Avoiding stimulus
○ School Age
■ Stalling behavior
■ Muscular rigidity
○ Adolescent
■ Verbal expressions with less protest
■ Muscle tension with body control
● Pharmacological Management
○ Two Step Approach
■ Children above 3 months with mild pain = administer a nonopioid (NSAIDs)
■ Moderate or severe pain = administer strong opioid (morphine)
○ Fentanyl
■ Who? 12 years +
■ Onset: 12 - 24 hours
■ Duration: 72 hours
○ Medication Administration
■ Preferred route for children = oral
● Peak effect: 1-2 hours
■ Otic route
● < 3 years = pull pinna down and back
● > 3 years = pull pinna up and back
■ Bolus
● Rapid (5 min)
● Type: morphine / hydromorphone
● Nonpharmacological Management
○ Distraction
■ Tell a joke or story to the child
■ Use play or a game
○ Guided Imagery
■ Assist the child in an imaginary experience
■ Have the child describe the details
○ Behavioral Contracting
■ Use stickers or tokens as rewards
■ Give time limits for the child to cooperate
○ Non Nutritive Sucking
■ Pacifier with sucrose