a) List the difference between growth and development

b) Explain the physical, psychosocial, psychosexual, intellectual and language development of a school
age child.

Growth: concept and definition

Growth refers to physical increase in some quantity over time. It includes changes in terms of height, weight,
body proportions and general physical appearance.

In encyclopedia Britannica, growth is defined as “an increase in size or the amount of an entity”. It means
growth involves all those structural and physiological changes that take place within individual during the
process of maturation. For example, growth of a child means the increase in weight, height and different
organs of the child‟s body.

Hurlock has defined growth as “change in size, in proportion, disappearance of old features and acquisition
of new ones”.

Growth refers to structural and physiological changes (crow and crow, 1962). Thus, growth refers to an
increase in physical size of whole or any of its part and can be measured.

Development: concept and definition

Development refers to the qualitative changes in the organism as whole. Development is a continuous
process through which physical, emotional and intellectual changes occur. It is a more wider and
comprehensive term than growth. It is also possible without growth.

In Webster’s dictionary development is defined as “the series of changes which an organism undergoes in
passing from an embryonic stage to maturity.”

In encyclopedia Britannica is the term development defined as “the progressive change in size, shape and
function during the life of an organism by which its genetic potential are translated into functioning adult
system.” So, development includes all those psychological changes that take in the functions and activities of
different organs of an organism.

Development is continuous and gradual process (skinner). According to crow and crow (1965) development
is concerned with growth as well as those changes in behavior which results from environmental situation.”
Thus, development is a process of change in growth and capability over time due to function of both
maturation and interaction with the environment.
1. Development refers to overall changes in the
1. Growth refers to physiological changes.
individual. It involves changes in an orderly and
coherent type towards the goal of maturity.
2. A change in the quantitative respect is 2. Development changes in the quality along with
termed as growth. quantitative aspect.
3. Growth does not continue throughout life. 3. Development continues throughout life.
4. Growth stops after maturation. 4. Development is progressive.
5. Growth occurs due to the multiplication of
5. Development occurs due to both maturation and
cells.
interaction with the environment.
6. Growth is cellular. 6. Development is organizational.
7. Growth is one of the part of the
developmental process. 7. Development is a wider and comprehensive term.

8. Growth may be referred to describe the

8. Development describes the changes in the
changes in particular aspects of the body
organism as a whole.
and behavior of the organism

9. Development brings qualitative changes which

9. The changes produced by growth are
are difficult to measure directly. They are
subjects of measurements. They may be
assessed through keen observation of behavior in
quantified and observable in nature.
different situations.

10. Growth may or may not bring

10. Development is possible without growth.
development.
 Physical development
 Middle childhood spans the years between early childhood and adolescence.
 Children are approximately 6 to 11 years old.
 These children come in all shapes and sizes: height, weight, abilities, and disabilities.
 Physical growth rates are generally slow and steady during these years.
 Growth spurts do occur during middle to late childhood
 Typically, a child will gain about 5-7 pounds a year and grow about 2 inches per year.
 They also tend to slim down and gain muscle strength.
 As bones lengthen and broaden and muscles strengthen, many children want to engage in strenuous physical
activity and can participate for longer periods of time.
 The rate of growth for the extremities is faster than for the trunk, which results in more adult-like
proportions.
 Long-bone growth stretches muscles and ligaments, which results in many children experiencing growing
pains, at night, in particular.
 Children between ages 6 and 9, show significant improvement in their abilities to perform motor skills.
 This growth allows children to gain greater control over the movement of their bodies, mastering many
gross and fine motor skills that were beyond that of the younger child.
 Riding a bike that is bigger or running longer and further is a big improvement in gross motor skills.
 Eye-hand coordination and fine motor skills allow for children to become better at writing and cutting.
Sports and extracurricular activities may become a part of the lives of children during middle childhood due
to their physical growth and capabilities.
 Girls and boys differ very little in size.
 Boys tend to be slightly taller and heavier than girls.
 Slimmer body proportions and longer legs
 Posture improves to facilitate locomotion and efficiency in using the arms and trunk
 Perform Climbing, bicycle riding and other activities easier.
 Fat gradually diminishes.
 Thinner appearance.
 Skeletal lengthening.
 Stomach upsets due to maturity of the gastrointestinal tract.
 Increased stomach capacity.
 Better maintenance of blood glucose levels.
 Bladder capacity greater in girls than boys.
 Heart grows more slowly related to rest of the body.
 Immune systems become more competent.
 Bones continue to ossify.

Intellectual development
Piaget’s theory of cognitive development: Concrete Operational thought
 As children continue into elementary school, they develop the ability to represent ideas and events more
flexibly and logically.
 Their rules of thinking still seem very basic by adult standards and usually operate unconsciously, but they
allow children to solve problems more systematically than before, and therefore to be successful with many
academic tasks.
 In the concrete operational stage, for example, a child may unconsciously follow the rule: “If nothing is added
or taken away, then the amount of something stays the same.” This simple principle helps children to
understand certain arithmetic tasks, such as in adding or subtracting zero from a number, as well as to do
certain classroom science experiments, such as ones involving judgments of the amounts of liquids when
mixed. Piaget called this period the concrete operational stage because children mentally “operate” on
concrete objects and events.
 The concrete operational stage is defined as the third in Piaget's theory of cognitive development. This stage
takes place around 6 years old to 12 years of age, and is characterized by the development of organized and
rational thinking.
 Piaget considered the concrete stage a major turning point in the child's cognitive development, because it
marks the beginning of logical or operational thought.
 The child is now mature enough to use logical thought or operations (i.e. rules) but can only apply logic to
physical objects (hence concrete operational). Children gain the abilities of conservation (number, area,
volume, orientation) and reversibility.
 Seriation: Arranging items along a quantitative dimension, such as length or weight, in a methodical way is
now demonstrated by the concrete operational child. For example, they can methodically arrange a series of
different-sized sticks in order by length, while younger children approach a similar task in a haphazard way.
 Classification: As children's experiences and vocabularies grow, they build schema and are able to organize
objects in many different ways. They also understand classification hierarchies and can arrange objects into
a variety of classes and subclasses.
 Reversibility: The child learns that some things that have been changed can be returned to their original
state. Water can be frozen and then thawed to become liquid again. But eggs cannot be unscrambled.
Arithmetic operations are reversible as well: 2 + 3 = 5 and 5 – 3 = 2. Many of these cognitive skills are
incorporated into the school's curriculum through mathematical problems and in worksheets about which
situations are reversible or irreversible.
 Conservation: An example of the preoperational child’s thinking; if you were to fill a tall beaker with 8
ounces of water this child would think that it was "more" than a short, wide bowl filled with 8 ounces of
water? Concrete operational children can understand the concept of conservation, which means that
changing one quality (in this example, height or water level) can be compensated for by changes in another
quality (width). Consequently, there is the same amount of water in each container, although one is taller
and narrower and the other is shorter and wider.
 Decentration: Concrete operational children no longer focus on only one dimension of any object (such as
the height of the glass) and instead consider the changes in other dimensions too (such as the width of the
glass). This allows for conservation to occur.
 Identity: One feature of concrete operational thought is the understanding that objects have qualities that
do not change even if the object is altered in some way. For instance, mass of an object does not change by
rearranging it. A piece of chalk is still chalk even when the piece is broken in two.
 Transitivity: Being able to understand how objects are related to one another is referred to as transitivity,
or transitive inference. This means that if one understands that a dog is a mammal, and that a boxer is a dog,
then a boxer must be a mammal.

Language Development
 Makes few grammatical errors while speaking
 Understands opposites
 May begin to stutter when excited or tired (typically only temporary)
 Uses and understands prepositions (in, out, over, under, etc.) And personal pronouns (i, me, myself, etc.)
 Understands analogies
 Uses simple comprehension in family, social environments and school
 Begins to experiment with tongue twisters
 Communicates effectively in social settings (school, playground, and classroom)
 Knows similarities and opposites
 Able to communicate efficiently with peers and adults
 Understands and uses more complex grammar
 Understands within the classroom
 Enjoys riddles and telling jokes
During this stage, school age children have an increased awareness of vocabulary and words which they
continue to extend as they learn new words. Conversations are a lot more detailed and can be sustained for a
longer period of time, than previously. Overall at this point, a school age child will develop a wider
vocabulary and will seek meaning and use of new words learnt. This is definitely the time to extend upon
language development by introducing new and exciting words that they can use in the future.
2. a) Define growth and development.
b) Explain the physical, psychosocial, cognitive and language development of an infant.

Growth is defined as “an increase in size or the amount of an entity”. It means growth involves all those
structural and physiological changes that take place within individual during the process of maturation.

Development is defined as “the progressive change in size, shape and function during the life of an organism by
which its genetic potential are translated into functioning adult system.”

Physical development
 At no other time in life are physical changes and developmental achievements as dramatic as during infancy.
 All major body systems undergo progressive maturation, and there is concurrent development of skills that
increasingly allow infants to respond to and cope with the environment.
 Acquisition of these fine and gross motor skills occurs in an orderly head-to-toe and center-to-periphery
(cephalocaudalproximodistal) sequence.
 During the first year of life, especially the initial 6 months, growth is very rapid.
 Infants gain 150 to 210 g weekly until approximately age 5 to 6 months, when the birth weight has at least
doubled.
 An average weight for a 6-month-old child is 7.3 kg (16 pounds).
 Weight gain slows during the second 6 months.
 By 1 year of age, the infant’s birth weight has tripled, for an average weight of 9.75 kg (21.5 pounds).
 Infants who are breastfed beyond 4 to 6 months of age typically gain less weight than those who are bottle fed,
yet their head circumference is more than adequate.
 Height increases by 2.5 cm (1 inch) a month during the first 6 months of life and also slows during the second 6
months. Increases in length occur in sudden spurts, rather than in a slow, gradual pattern. Average height is 65
cm (25.5 inches) at 6 months and 74 cm (29 inches) at 12 months. By 1 year of age, the birth length has increased
by almost 50%. This increase occurs mainly in the trunk rather than in the legs and contributes to the
characteristic physique of the infant.
 Head growth is also rapid. During the first 6 months, head circumference increases approximately 1.5 cm (0.6
inch) per month, but the rate of growth declines to only 0.5 cm (0.2 inch) monthly during the second 6 months.
The average size is 43 cm (17 inches) at 6 months and 46 cm (18 inches) at 12 months. By 1 year, head size has
increased by almost 33%. Closure of the cranial sutures occurs, with the posterior fontanel fusing by 6 to 8
weeks of age and the anterior fontanel closing by 12 to 18 months of age (average, 14 months). Expanding head
size reflects the growth and differentiation of the nervous system. By the end of the first year, the brain has
increased in weight about 2.5 times. Maturation of the brain is exhibited in the dramatic developmental
achievements of infancy. Primitive reflexes are replaced by voluntary, purposeful movement, and new reflexes
that influence motor development appear.
 The chest assumes a more adult contour, with the lateral diameter becoming larger than the anteroposterior
diameter. The chest circumference approximately equals the head circumference by the end of the first year. The
heart grows less rapidly than does the rest of the body. Its weight is usually doubled by 1 year of age in
comparison with body weight, which triples during the same period. The size of the heart is still large in relation
to the chest cavity; its width is approximately 55% of the chest.

Gross Motor Skills

Voluntary movements involve the use of large muscle groups and are typically large movements of the arms,
legs, head, and torso. They are referred to as gross motor skills (or large motor skills). These skills begin to
develop first. Examples include moving to bring the chin up when lying on the stomach, moving the chest up,
rocking back and forth on hands and knees, and then crawling. But it also includes exploring an object with one’s
feet as many babies do as early as 8 weeks of age if seated in a carrier or other device that frees the hips. This
may be easier than reaching for an object with the hands, which requires much more practice. And sometimes an
infant will try to move toward an object while crawling and surprisingly move backward because of the greater
amount of strength in the arms than in the legs. This also tends to lead infants to pulling up on furniture, usually
with the goal of reaching a desired object. Usually this will also lead to taking steps and eventually walking.
2 months Can hold head up and begins to push up when lying on tummy
Makes smoother movements with arms and legs
4 months Holds head steady, unsupported
Pushes down on legs when feet are on a hard surface
May be able to roll over from tummy to back
Brings hands to mouth
When lying on stomach, pushes up to elbows
6 months Rolls over in both directions (front to back, back to front)
Begins to sit without support
When standing, supports weight on legs and might bounce
Rocks back and forth, sometimes crawling backward before moving forward
9 months Stands, holding on
Can get into sitting position
Sits without support
Pulls to stand
Crawls
12months Gets to a sitting position without help
Pulls up to stand, walks holding on to furniture (“cruising”)
May take a few steps without holding on
May stand alone

Fine Motor Skills

More exact movements of the feet, toes, hands, and fingers are referred to as fine motor skills (or small motor
skills). These include the ability to reach and grasp an object in coordination with vision. Newborns cannot grasp
objects voluntarily but do wave their arms toward objects of interest. At about 4 months of age, the infant is able
to reach for an object, first with both arms and within a few weeks, with only one arm. Grasping an object involves
the use of the fingers and palm, but no thumbs.
Use of the thumb comes at about 9 months of age when the infant is able to grasp an object using the forefinger
and thumb. This is known as the pincer grip. This ability greatly enhances the ability to control and manipulate
an object and infants take great delight in this newfound ability. They may spend hours picking up small objects
from the floor and placing them in containers. And as those objects will often next go into the mouth, caregivers
must be vigilant about keeping items small enough to be choking hazards out of reach of little fingers. By 9
months, an infant can also watch a moving object, reach for it as it approaches and grab it. This is quite a
complicated set of actions if we remember how difficult this would have been just a few months earlier.

2 months Grasps reflexively

Does not reach for objects
Holds hands in fist
4 months Brings hands to mouth
Uses hands and eyes together, such as seeing a toy and reaching for it
Follows moving things with eyes from side to side
Can hold a toy with whole hand (palmar grasp) and shake it and swing at dangling toys
6 months Reaches with both arms
Brings things to mouth
Begins to pass things from one hand to the other
9 months Puts things in mouth
Moves things smoothly from one hand to the other
Picks up things between thumb and index finger (pincer grip)
1 year Reaches with one hand
Bangs two things together
Puts things in a container, takes things out of a container
Lets things go without help
Pokes with index (pointer) finger

Psychosocial development: Erikson- Trust vs. Mistrust

Erikson was in agreement on the importance of a secure base, arguing that the most important goal of infancy the
development of a basic sense of trust in one’s caregivers. Consequently, the first stage, trust vs. mistrust,
highlights the importance of attachment. Erikson maintained that the first year to year and a half of life involves
the establishment of a sense of trust (Erikson, 1982). Infants are dependent and must rely on others to meet their
basic physical needs as well as their needs for stimulation and comfort. A caregiver who consistently meets these
needs instills a sense of trust or the belief that the world is a trustworthy place. The caregiver should not worry
about overly indulging a child’s need for comfort, contact or stimulation.
Problems Establishing Trust: Erikson (1982) believed that mistrust could contaminate all aspects of one’s life
and deprive the individual of love and fellowship with others. Consider the implications for establishing trust if a
 caregiver is unavailable or is upset and ill-prepared to care for a child. Or if a child is born prematurely, is
unwanted, or has physical problems that make him or her more challenging to parent. Under these circumstances,
we cannot assume that the parent is going to provide the child with a feeling of trust.

Cognitive development: Piaget and Sensorimotor Intelligence

Piaget describes intelligence in infancy as sensorimotor or based on direct, physical contact. Infants taste, feel,
pound, push, hear, and move in order to experience the world. Let’s explore the transition infants make from
responding to the external world reflexively as newborns to solving problems using mental strategies as two
years old.

Sub stage one: Birth to 1 This active learning begins with automatic movements or reflexes. A ball comes
Simple Reflexes month into contact with an infant’s cheek and is automatically sucked on and licked.
Sub stage Two: 1 to 4 months The infant begins to discriminate between objects and adjust responses
Primary Circular accordingly as reflexes are replaced with voluntary movements. An infant may
Reactions accidentally engage in a behavior and find it interesting such as making a
vocalization. This interest motivates trying to do it again and helps the infant
learn a new behavior that originally occurred by chance. At first, most actions
have to do with the body, but in months to come, will be directed more toward
objects.
Sub stage Three: 4 to 8 months The infant becomes more and more actively engaged in the outside world and
Secondary takes delight in being able to make things happen. Repeated motion brings
Circular particular interest as the infant is able to bang two lids together from the
Reactions cupboard when seated on the kitchen floor.
Sub stage Four: 8 to 12 months The infant can engage in behaviors that others perform and anticipate upcoming
Coordination of events. Perhaps because of continued maturation of the prefrontal cortex, the
circular infant becomes capable of having a thought and carrying out a planned, goal-
reactions directed activity such as seeking a toy that has rolled under the couch. The object
continues to exist in the infant’s mind even when out of sight and the infant now
is capable of making attempts to retrieve it.

2 months Pays attention to faces

Begins to follow things with eyes and recognize people at a distance
Begins to act bored (cries, fussy) if activity doesn’t change
4 months Lets you know if she is happy or sad
Responds to affection
Reaches for toy with one hand
Uses hands and eyes together, such as seeing a toy and reaching for it
Follows moving things with eyes from side to side
Watches faces closely
Recognizes familiar people and things at a distance
6 months Looks around at things nearby
Brings things to mouth
Shows curiosity about things and tries to get things that are out of reach
Begins to pass things from one hand to the other
9 months Watches the path of something as it falls
Looks for things he sees you hide
Plays peek-a-boo
Puts things in mouth
Moves things smoothly from one hand to the other
Picks up things like cereal o’s between thumb and index finger
1year Explores things in different ways, like shaking, banging, throwing
Finds hidden things easily
Looks at the right picture or thing when it’s named
Copies gestures
Starts to use things correctly; for example, drinks from a cup, brushes hair
Bangs two things together
Puts things in a container, takes things out of a container
Let’s things go without help
Pokes with index (pointer) finger
Follows simple directions like “pick up the toy”

Language Development
Infants do not communicate with the use of language. Instead, they communicate their thoughts and needs with body
posture (being relaxed or still), gestures, cries, and facial expressions. A person who spends adequate time with an
 infant can learn which cries indicate pain and which ones indicate hunger, discomfort, or frustration as well as
translate their vocalizations, movements, gestures and facial expressions.

Stages of Language Development

1. Intentional Vocalizations: Cooing and taking turns: Infants begin to vocalize and repeat vocalizations within the
first couple of months of life. That gurgling, musical vocalization called cooing can serve as a source of entertainment
to an infant who has been laid down for a nap or seated in a carrier on a car ride. Cooing serves as practice for
vocalization as well as the infant hears the sound of his or her own voice and tries to repeat sounds that are
entertaining. Infants also begin to learn the pace and pause of conversation as they alternate their vocalization with
that of someone else and then take their turn again when the other person’s vocalization has stopped. Cooing initially
involves making vowel sounds lik e “oooo”. Later, consonants are added to vocalizations such as “nananananana”.

2. Babbling and gesturing: At about four to six months of age, infants begin making even more elaborate
vocalizations that include the sounds required for any language. Guttural sounds, clicks, consonants, and vowel sounds
stand ready to equip the child with the ability to repeat whatever sounds are characteristic of the language heard.
Eventually, these sounds will no longer be used as the infant grows more accustomed to a particular language. Deaf
babies also use gestures to communicate wants, reactions, and feelings. Because gesturing seems to be easier than
vocalization for some toddlers, sign language is sometimes taught to enhance one’s ability to communicate by making
use of the ease of gesturing. The rhythm and pattern of language is used when deaf babies sign just as it is when
hearing babies babble.

3. Understanding: At around ten months of age, the infant can understand more than he or she can say. You may have
experienced this phenomenon as well if you have ever tried to learn a second language. You may have been able to
follow a conversation more easily than to contribute to it.

4. Holophrastic speech: Children begin using their first words at about 12 or 13 months of age and may use partial
words to convey thoughts at even younger ages. These one word expressions are referred to as holophrastic speech.
For example, the child may say “ju” for the word “juice” and use this sound when referring to a bottle. The listener
must interpret the meaning of the holophrase and when this is someone who has spent time with the child,
interpretation is not too difficult. They know that “ju” means “juice” which means the baby wants some milk! But,
someone who has not been around the child will have trouble knowing what is meant. Imagine the parent who to a
friend exclaims, “Ezra’s talking all the time now!” The friend hears only “ju da ga” which, the parent explains, means “I
want some milk when I go with Daddy.

5. Under extension: A child who learns that a word stands for an object may initially think that the word can be used
for only that particular object. Only the family’s Irish Setter is a “doggie”. This is referred to as underextension. More
often, however, a child may think that a label applies to all objects that are similar to the original object. In
overextension all animals become “doggies”, for example.

6. First words and cultural influences: First words if the child is using English tend to be nouns. The child labels
objects such as cup or ball. In a verb-friendly language such as Chinese, however, children may learn more verbs. This
may also be due to the different emphasis given to objects based on culture. Chinese children may be taught to notice
action and relationship between objects while children from the United States may be taught to name an object and its
qualities (color, texture, size, etc.). These differences can be seen when comparing interpretations of art by older
students from China and the United States.

7. Vocabulary growth spurt: One year olds typically have a vocabulary of about 50 words. But by the time they
become toddlers, they have a vocabulary of about 200 words and begin putting those words together in telegraphic
speech (I think of it now as 'text message' speech because texting is more common and is similar in that text messages
typically only include the minimal amount of words to convey the message).

8. Two word sentences and telegraphic speech: Words are soon combined and 18 month old toddlers can express
themselves further by using expressions such as “baby bye-bye” or “doggie pretty”. Words needed to convey messages
are used, but the articles and other parts of speech necessary for grammatical correctness are not yet used. These
expressions sound like a telegraph (or perhaps a better analogy today would be that they read like a text message)
where unnecessary words are not used. “Give baby ball” is used rather than “Give the baby the ball.” Or a text message
of “Send money now!” rather than “Dear Mother. I really need some money to take care of my expenses.”
2 months Coos, makes gurgling sounds
Turns head toward sounds
4 months Begins to babble
Babbles with expression and copies sounds he hears
Cries in different ways to show hunger, pain, or being tired
6 months Responds to sounds by making sounds
Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while
making sounds
 Responds to own name
Makes sounds to show joy and displeasure
Begins to say consonant sounds (jabbering with “m,” “b”)
9 months Understands “no”
Makes a lot of different sounds like “mamamama” and “bababababa”
Copies sounds and gestures of others
Uses fingers to point at things
1 year Responds to simple spoken requests
Uses simple gestures, like shaking head “no” or waving “bye-bye”
Makes sounds with changes in tone (sounds more like speech)
Says “mama” and “dada” and exclamations like “uh-oh!”
Tries to say words you say

3. Describe the growth and development of an adolescent under the following heading:
a. List the biological growth
b. Explain psychosocial and psychosexual development.
c. Describe the common health problems of an adolescent.

a) Biological growth:
Physical Growth
 The adolescent growth spurt is a rapid increase in an individual’s height and weight during puberty resulting
from the simultaneous release of growth hormones, thyroid hormones, and androgens.
 Males experience their growth spurt about two years later than females.
 The accelerated growth in various body parts happens at different times, but for all adolescents it has a fairly
regular sequence.
 The first places to grow are the extremities (head, hands, and feet), followed by the arms and legs, and later the
torso and shoulders. This non-uniform growth is one reason why an adolescent body may seem out of proportion.
During puberty, bones become harder and more brittle.
 Before puberty, there are nearly no differences between males and females in the distribution of fat and muscle.
During puberty, males grow muscle much faster than females, and females experience a higher increase in body
fat.
 An adolescent’s heart and lungs increase in both size and capacity during puberty; these changes contribute to
increased strength and tolerance for exercise.
 For both boys and girls, these changes include a growth spurt in height, growth of pubic and underarm hair, and
skin changes (e.g., pimples). Hormones drive these pubescent changes, particularly the increase in testosterone
for boys and estrogen for girls

Sequence of maturational changes

Girls
 Breast changes
 Rapid increase in height and weight
 Growth of pubic hair
 Appearance of axillary hair
 Menstruation (usually begins 2 years after first signs)
 Abrupt deceleration of linear growth
Boys
 Enlargement of testicles
 Growth of pubic hair, axillary hair, hair on upper lip, hair on face and elsewhere on body (facial hair usually
appears about 2 years after appearance eof pubic hair)
 Rapid increase in height
 Changes in the larynx and consequently the voice (usually take place alongwith growth of penis)
 Nocturnal emissions
 Abrupt deceleration of linear growth

Brain Growth
 Brain Growth continues into the early 20s.
 The development of the frontal lobe, in particular, is important during this stage.
 Adolescents often engage in increased risk-taking behaviors and experience heightened emotions during puberty;
this may be due to the fact that the frontal lobes of their brains—which are responsible for judgment, impulse
control, and planning—are still maturing until early adulthood.
 The brain undergoes dramatic changes during adolescence. Although it does not get larger, it matures by
becoming more interconnected and specialized.
  The myelination and development of connections between neurons continues. This results in an increase in the
white matter of the brain, and allows the adolescent to make significant improvements in their thinking and
processing skills.
 Different brain areas become myelinated at different times. For example, the brain’s language areas undergo
myelination during the first 13 years. Completed insulation of the axons consolidates these language skills but
makes it more difficult to learn a second language. With greater myelination, however, comes diminished
plasticity as a myelin coating inhibits the growth of new connections.

b). Psychosocial and Psychosexual development.

Erik Erikson – Theory of Psychosocial Development
Erikson proposed that each period of life has a unique challenge or crisis that a person must face. This is referred
to as a psychosocial development. According to Erikson, successful development involves dealing with and
resolving the goals and demands of each of these crises in a positive way. These crises are usually called stages,
although that is not the term Erikson used. If a person does not resolve a crisis successfully, it may hinder their
ability to deal with later crises.
Identity vs. Role Confusion
Identity vs. Role Confusion is a major stage of development where the child has to learn the roles he will occupy
as an adult. In adolescence, children (ages 12–18) face the task of identity vs. role confusion. Success in this stage
will lead to the virtue of fidelity. Fidelity involves being able to commit one's self to others on the basis of
accepting others, even when there may be ideological differences.
According to Erikson, an adolescent’s main task is developing a sense of self. Adolescents struggle with questions
such as “Who am I?” and “What do I want to do with my life?” Along the way, most adolescents try on many
different selves to see which ones fit; they explore various roles and ideas, set goals, and attempt to discover their
“adult” selves. Adolescents who are successful at this stage have a strong sense of identity and are able to remain
true to their beliefs and values in the face of problems and other people’s perspectives. When adolescents are
apathetic, do not make a conscious search for identity, or are pressured to conform to their parents’ ideas for the
future, they may develop a weak sense of self and experience role confusion. They will be unsure of their identity
and confused about the future. Teenagers who struggle to adopt a positive role will likely struggle to “find”
themselves as adults.
Erikson saw this as a period of confusion and experimentation regarding identity and how one navigates along
life’s path. During adolescence, we experience psychological moratorium, where teens put their current identity
on hold while they explore their options for identity. The culmination of this exploration is a more coherent view
of oneself. Those who are unsuccessful at resolving this stage may either withdraw further into social isolation or
become lost in the crowd. However, more recent research suggests, that few leave this age period with identity
achievement, and that most identity formation occurs during young adulthood.

Psychosexual development:
Genital Stage (puberty to adult): The genital stage is the last stage of Freud's psychosexual theory of personality
development, and begins in puberty. During puberty, secondary characteristics appear in both sexes with
maturation of the reproductive system and production of sex hormone.  It is a time of adolescent sexual
experimentation, the successful resolution of which is settling down in a loving one-to-one relationship with
another person in our 20's.
Sexual instinct is directed to heterosexual pleasure, rather than self-pleasure like during the phallic stage. For
Freud, the proper outlet of the sexual instinct in adults was through heterosexual intercourse.  Fixation and
conflict may prevent this with the consequence that sexual perversions may develop. 

c). Common health problems of an adolescent.

Injuries
Drowning
Teenage pregnancy
Sexually Transmitted Diseases
Obesity
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Drug and Substance abuse
Psychiatric disorder
Self-harm/injury
Suicidal behavior

INJURY PREVENTION DURING ADOLESCENCE

Developmental Abilities Related to Risk of Injury
Need for independence and freedom
Testing independence
Age permitted to drive a motor vehicle (varies from state to state)
Inclination for risk taking
Feeling of indestructibility
Need for discharging energy, often at expense of logical thinking and other control mechanisms
Strong need for peer approval
Attempting hazardous maneuvers
Peak incidence for practice and participation in sports
Access to more complex tools, objects, and locations
Can assume responsibility for own actions

Injury Prevention
Motor or Non motor Vehicles
Pedestrian
Emphasize and encourage safe pedestrian behavior.
• At night, walk with a friend.
• If someone is following you, go to nearest place with people.
• Do not walk in secluded areas; take well-traveled walkways.
Passenger
Promote appropriate behavior while riding in a motor vehicle. Refuse to ride with an impaired person or one who
is driving recklessly.
Driver
Provide competent driver education; encourage judicious use of vehicle; discourage drag racing or playing
chicken; maintain vehicle in proper condition (e.g., brakes, tires).
Teach and promote safety and maintenance of two- and three-wheeled vehicles.
Promote and encourage wearing of safety apparel such as a helmet and long trousers.
Reinforce the dangers of drugs, including alcohol, when operating a motor vehicle.
Discourage distractions while driving—cell phone talking or texting, eating, smoking, or reading.
Drowning
Teach non swimmers to swim.
Teach basic rules of water safety.
• Judicious selection of places to swim
• Sufficient water depth for diving
• Swimming with a companion
• No alcohol with water sports
Burns
Reinforce proper behavior in areas with burn hazards (gasoline, electric wires, and fires).
Advise regarding excessive exposure to natural or artificial sunlight (ultraviolet burn).
Discourage smoking.
Encourage use of sunscreen.
Poisoning
Educate in hazards of drug use, including alcohol.
Falls
Teach and encourage general safety measures in all activities.
Bodily Damage
Promote acquisition of proper instruction in sports and use of sports equipment.
Instruct in safe use of and respect for firearms and other devices with potential danger (e.g., power tools,
firecrackers).
Provide and encourage use of protective equipment when using potentially hazardous devices.
Promote access to or provision of safe sports and recreational facilities.
Be alert for signs of depression (potential suicide).
Discourage use of hazardous sports equipment (e.g., trampoline, surfboards).
Instruct regarding proper use of corrective devices (e.g., glasses, contact lenses, hearing aids).
Encourage and foster judicious application of safety principles and prevention.
Consequences of Adolescent Pregnancy
After a child is born life can be difficult for a teenage mother. Only 40% of teenagers who have children before age 18
graduate from high school. Without a high school degree, her job prospects are limited and economic independence is
difficult. Teen mothers are more likely to live in poverty and more than 75% of all unmarried teen mothers receive
public assistance within 5 years of the birth of their first child. Approximately, 64% of children born to an unmarried
teenage high-school dropout live in poverty. Further, a child born to a teenage mother is 50% more likely to repeat a
grade in school and is more likely to perform poorly on standardized tests and drop out before finishing high school.

Sexually Transmitted Infections

Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) or venereal diseases
(VDs), are illnesses that have a significant probability of transmission by means of sexual behavior, including vaginal
intercourse, anal sex, and oral sex. It’s important to mention that some STIs can also be contracted by sharing
intravenous drug needles with an infected person, through childbirth, or breastfeeding. Common STIs include:
Chlamydia;
Herpes (HSV-1 and HSV-2);
Human papillomavirus (HPV);
Gonorrhea;
Syphilis;
Trichomoniasis;
HIV (human immunodeficiency virus) and AIDS (acquired immunodeficiency syndrome).
The most effective way to prevent transmission of STIs is to practice abstinence, (not participating in sexual
intercourse), safe sex, and to avoid direct contact of skin or fluids which can lead to transfer with an infected partner.
Proper use of safe-sex supplies (such as male condoms, female condoms, gloves, or dental dams) reduces contact and
risk and can be effective in limiting exposure; however, some disease transmission may occur even with these
barriers.
Practicing safe sex is important to one’s physical health.

Obesity
Children need adequate caloric intake for growth, and it is important not to impose highly restrictive diets. However,
exceeding caloric requirements on a regular basis can lead to childhood obesity.
There are a number of reasons behind the problem of obesity, including:
Larger portion sizes
Limited access to nutrient-rich foods
Increased access to fast foods and vending machines
Lack of breastfeeding support
Declining physical education programs in schools
Insufficient physical activity and a sedentary lifestyle
Media messages encouraging the consumption of unhealthy foods
Obesity has a profound effect on self-esteem, energy, and activity level. Even more importantly, it is a major risk factor
for a number of diseases later in life, including cardiovascular disease, Type 2 diabetes, stroke, hypertension, and
certain cancers.
A percentile for body mass index (BMI) specific to age and sex is used to determine if a child is overweight or obese. If
a child gains weight inappropriate to growth, parents and caregivers should limit energy-dense, nutrient-poor snack
foods. In addition, it is extremely beneficial to increase a child’s physical activity and limit sedentary activities, such as
watching television, playing video games, or surfing the Internet. Programs to address childhood obesity can include
behavior modification, exercise counseling, psychological support or therapy, family counseling, and family meal-
planning advice.
 Eating disorder
Eating Disorder Description
Anorexia Nervosa Restriction of energy intake leading to a significantly low body weight
Intense fear of gaining weight
Disturbance in one’s self-evaluation regarding body weight
Bulimia Nervosa Recurrent episodes of binge eating
Recurrent inappropriate compensatory behaviors to prevent weight gain, including purging,
laxatives, fasting or excessive exercise
Self-evaluation is unduly affected by body shape and weight
Binge-Eating Recurrent episodes of binge eating
Disorder Marked distress regarding binge eating
The binge eating is not associated with the recurrent use of inappropriate compensatory
behavior
Health Consequences of Eating Disorders
For those suffering from anorexia, health consequences include an abnormally slow heart rate and low blood
pressure, which increases the risk for heart failure. Additionally, there is a reduction in bone density
(osteoporosis), muscle loss and weakness, severe dehydration, fainting, fatigue, and overall weakness. Individuals
with this disorder may die from complications associated with Anorexia nervosa, which has the highest mortality
rate of any psychiatric disorder.
The binge and purging cycle of bulimia can affect the digestives system and lead to electrolyte and chemical
imbalances that can affect the heart and other major organs. Frequent vomiting can cause inflammation and
possible rupture of the esophagus, as well as tooth decay and staining from stomach acids. Lastly, binge eating
disorder results in similar health risks to obesity, including high blood pressure, high cholesterol levels, heart
disease, Type II diabetes, and gall bladder disease.
Eating Disorders Treatment
The foundations of treatment for eating disorders include adequate nutrition and discontinuing destructive
behaviors, such as purging. Treatment plans are tailored to individual needs and include medical care, nutritional
counseling, medications (such as antidepressants), and individual, group, and/or family psychotherapy

Substance Abuse
Many drugs create tolerance: an increase in the dose required to produce the same effect, which makes it
necessary for the user to increase the dosage or the number of times per day that the drug is taken. As the use of
the drug increases, the user may develop dependence, defined as a need to use a drug or other substance
regularly. Dependence can be psychological, in which the drug is desired and has become part of the everyday life
of the user, but no serious physical effects result if the drug is not obtained; or physical, in which serious physical
and mental effects appear when the drug is withdrawn. Cigarette smokers who try to quit, for example, experience
physical withdrawal symptoms, such as becoming tired and irritable, as well as extreme psychological cravings to
enjoy a cigarette in particular situations, such as after a meal or when they are with friends. Users may wish to
stop using the drug, but when they reduce their dosage they experience withdrawal—negative experiences that
accompany reducing or stopping drug use, including physical pain and other symptoms. When the user powerfully
craves the drug and is driven to seek it out, over and over again, no matter what the physical, social, financial, and
legal cost, we say that he or she has developed an addiction to the drug.
It is a common belief that addiction is an overwhelming, irresistibly powerful force, and that withdrawal from
drugs is always an unbearably painful experience. But the reality is more complicated and in many cases less
extreme. For one, even drugs that we do not generally think of as being addictive, such as caffeine, nicotine, and
alcohol, can be very difficult to quit using, at least for some people. On the other hand, drugs that are normally
associated with addiction, including amphetamines, cocaine, and heroin, do not immediately create addiction in
their users. Even for a highly addictive drug like cocaine, only about 15% of users become addicted.

Psychiatric disorders
Disorder/Syndrome Description
Anxiety Disorders Psychological disturbances marked by irrational fears, often of
everyday objects and situations. They include generalized anxiety
disorder (GAD), panic disorder, phobia, obsessive-compulsive
disorder (OCD), and posttraumatic stress disorder (PTSD). Anxiety
disorders affect about 57 million Americans every year.
Dissociative Disorders Conditions that involve disruptions or breakdowns of memory,
awareness, and identity. They include dissociative amnesia,
dissociative fugue, and dissociative identity disorder.
Mood Disorders Psychological disorders in which the person’s mood negatively
influences his or her physical, perceptual, social, and cognitive
processes. They include dysthymia, major depressive disorder, and
bipolar disorder. Mood disorders affect about 30 million Americans
every year.
Schizophrenia A serious psychological disorder marked by delusions,
 hallucinations, loss of contact with reality, inappropriate affect,
disorganized speech, social withdrawal, and deterioration of
adaptive behavior. About 3 million Americans have schizophrenia.
Personality Disorder A long-lasting but frequently less severe disorder characterized by
inflexible patterns of thinking, feeling, or relating to others that
causes problems in personal, social, and work situations. They are
characterized by odd or eccentric behavior, by dramatic or erratic
behavior, or by anxious or inhibited behavior. Two of the most
important personality disorders are borderline personality
disorder (BPD) and antisocial personality disorder (APD).
Somatization Disorder A psychological disorder in which a person experiences numerous
long-lasting but seemingly unrelated physical ailments that have no
identifiable physical cause. Somatization disorders include
conversion disorder, body dysmorphic disorder (BDD), and
hypochondriasis.
Factitious Disorder When patients fake physical symptoms in large part because they
enjoy the attention and treatment that they receive in the hospital.
Sexual Disorders A variety of problems revolving around performing or enjoying sex.
Sexual dysfunctions include problems relating to loss of sexual
desire, sexual response or orgasm, and pain during sex.
Paraphilia Sexual deviations where sexual arousal is obtained from a
consistent pattern of inappropriate responses to objects or people,
and in which the behaviors associated with the feelings are
distressing and dysfunctional.
When symptoms cause serious distress and negatively influence
physical, perceptual, social, and cognitive processes. Teens with
depression were often dismissed as being moody or difficult. About
11 percent of adolescents have a depressive disorder by age 18
according to the National Comorbidity Survey-Adolescent
Supplement (NCS-A). Depressed teens with coexisting (comorbid)
disorders such as substance abuse problems are less likely to
respond to treatment for depression. Studies focusing on conditions
that frequently co-occur and how they affect one another may lead
to more targeted screening tools and interventions. With
medication, psychotherapy, or combined treatment, most youth
with depression can be effectively treated. Youth are more likely to
respond to treatment if they receive it early in the course of their
illness.

Self-Harm or Self-Injury
Adolescents struggling with their mental health may engage in self-harm, or thinking about harming oneself.
They may be distressed and have difficult feelings as well as the urge to hurt themselves. Some unhealthy ways
people may try to relieve emotional pain include cutting, burning, or hitting themselves. These self-harm
behaviors can be difficult to detect and are usually kept a secret by covering the wounds with clothing or jewelry.
Self-injury is a sign that someone is struggling. People who are anxious, depressed, or have an eating disorder are
also more likely to turn to self-injuring behaviors.
Indicators of self-harm include:
Frequent unexplained injuries
Clues like bandages in trash cans.
Clothing inappropriate for the weather (long pants or sleeves when it’s hot)
It’s important when someone confides in self-harm to try to be as nonreactive and nonjudgmental as possible. At
this time there are no medications for treating self-injuring behaviors. But some medications can help treat mental
disorders that the person may be dealing with, like depression or anxiety. Mental health counselling or therapy
can also help

Suicidal Behavior
Adolescence who feel like there is no possible resolution to their mental health struggles may consider, attempt,
or commit suicide. Suicidal behavior causes immeasurable pain, suffering, and loss to individuals, families, and
communities nationwide. But suicide is preventable.
Warning Signs of Suicide
If someone is showing one or more of the following behaviors, he or she may be thinking about suicide. The
following warning signs should not be ignored. Help should be sought immediately.
Talking about wanting to die or to kill oneself
Looking for a way to kill oneself
Talking about feeling hopeless or having no reason to live
Talking about feeling trapped or in unbearable pain
Talking about being a burden to others
Increasing the use of alcohol or drugs
Acting anxious or agitated
Behaving recklessly
Sleeping too little or too much
Withdrawing or feeling isolated
Showing rage or talking about seeking revenge
Displaying extreme mood swings
4. A 1 year 6 months child came to paediatric OPD for immunization. Describe the growth and development under
the following headings:
a. Identify the development stage of this child
b. Explain the physical growth and psychosocial development
c. Describe the parental guidance on promotion of optimum health of this child.

The development stage of the child approximately 12 to 36 months old is called Toddler.

Physical and motor skills

A typical one-year-old toddler's body proportions

 Triple the birth weight

 Grow to a height of 50% over birth length
 Have a head circumference equal to that of the chest
 Have one to eight teeth
 Pull to stand
 Walk with help or alone
 Sit down without help
 Bang two blocks together
 Turn through the pages of a book by flipping many pages at a time
 Have a pincer grasp
 Sleep 8–10 hours a night and take one to two naps

Proportional Changes
Physical growth slows considerably during toddlerhood. The average weight gain is 1.8 to 2.7 kg (4–6 pounds) per year.
The average weight at 2 years is 12 kg (26.5 pounds). The birth weight is quadrupled by 2 years of age. The rate of
increase in height also slows. The usual increment is an addition of 7.5 cm (3 inches) per year and occurs mainly in
elongation of the legs rather than the trunk. The average height of a 2-year-old child is 86.6 cm (34 inches). In general,
adult height is about twice the 2-year-old child’s height. Accurate measurement of height and weight during the toddler
years should reveal a steady growth curve that is step like in nature rather than linear (straight), which is characteristic of
the growth spurts during the early childhood years. The rate of increase in head circumference slows somewhat by the end
of infancy, and head circumference is usually equal to chest circumference by 1 to 2 years of age. The usual total increase
in head circumference during the second year is 2.5 cm (1 inch).
Chest circumference continues to increase in size and exceeds head circumference during the toddler years. The chest’s
shape also changes as the transverse, or lateral, diameter exceeds the anteroposterior diameter. After the second year, the
chest circumference exceeds the abdominal measurement, which, in addition to the growth of the lower extremities,
makes the child appear taller and leaner. However, toddlers retain a squat, “pot-bellied” appearance because of their less
developed abdominal musculature and short legs. The legs retain a slightly bowed or curved appearance during the
second year from the weight of the relatively large trunk.
Sensory Changes
Visual acuity of 20/40 is considered acceptable during the toddler years. Full binocular vision is well developed, and any
evidence of persistent strabismus requires professional attention as early as possible to prevent amblyopia. Depth
perception continues to develop, but because of toddlers’ lack of motor coordination, falls from heights continue to be a
persistent danger. The senses of hearing, smell, taste, and touch become increasingly well developed, coordinated with
each other, and associated with other experiences. All of the senses are used to explore the environment.
Toddlers visually inspect an object by turning it over; they may taste it, smell it, and touch it several times before they are
satisfied with their investigation. They shake it to see if it makes noise and vigorously test its durability.
Gross and Fine Motor Development
The major gross motor skill during the toddler years is the development of locomotion. By 12 to 13 months of age, toddlers
walk alone using a wide stance for extra balance, and by 18 months, they try to run but fall easily. Between 2 and 3 years of
age, refinement of the upright, biped position is evident in improved coordination and equilibrium.
At age 2 years, toddlers can walk up and down stairs, and by age 2 years, they can jump using both feet, stand on one foot
for a second or two, and manage a few steps on tiptoe. By the end of the second year, they can stand on one foot, walk on
tiptoe, and climb stairs with alternate footing.
Fine motor development is demonstrated in increasingly skillful manual dexterity. For example, by age 12 months,
toddlers are able to grasp a very small object but are unable to release it at will. At 15 months, they can drop a raisin into a
narrow-necked bottle. Casting or throwing objects and retrieving them become almost obsessive activities at about 15
months. By 18 months of age, toddlers can throw a ball overhand without losing their balance. By 2 years of age, toddlers
use their hands to build towers, and by 3 years of age, they draw circles on paper.
Mastery of gross and fine motor skills is evident in all phases of toddlers’ activity, such as play, dressing, language
comprehension, and response to discipline, social interaction, and propensity for injuries.
Activities occur less in isolation and more in conjunction with other physical and mental abilities to produce a purposeful
result. For example, the toddler walks to reach a new location, releases a toy to pick it up or to choose a new one, and
scribbles to look at the image produced. The possibilities of the exploration, investigation, and manipulation of the
environment—and its hazards—are endless.
PSYCHOSOCIAL DEVELOPMENT
Toddlers are faced with the mastery of several important tasks. If the need for basic trust has been satisfied, they are ready
to give up dependence for control, independence, and autonomy. Some of the specific tasks to be dealt with include:
• Differentiation of self from others, particularly the mother
• Toleration of separation from parent
• Ability to withstand delayed gratification
• Control over bodily functions
• Acquisition of socially acceptable behavior
• Verbal means of communication
• Ability to interact with others in a less egocentric manner
Mastery of these goals is only begun during late infancy and the toddler years; tasks such as developing interpersonal
relationships with others may not be completed until adolescence. However, crucial foundations for successful completion
of such developmental tasks are laid during these early formative years.

Developing a Sense of Autonomy (Erikson)

According to Erikson (1963), the developmental task of toddlerhood is acquiring a sense of autonomy while overcoming a
sense of doubt and shame. As infants gain trust in the predictability and reliability of their parents, environment, and
interactions with others, they begin to discover that their behavior is their own and that it has a predictable, reliable effect
on others. Although they realize their will and control over others, they are confronted with the conflict of exerting
autonomy and relinquishing the much-enjoyed dependence on others. Whereas exerting their will has definite negative
consequences, retaining dependent, submissive behavior is generally rewarded with affection and approval. However,
continued dependence creates a sense of doubt regarding their potential capacity to control their actions. This doubt is
compounded by a sense of shame for feeling this urge to revolt against others’ will and a fear that they will exceed their
own capacity for manipulating the environment. Skillful monitoring and balance of controls by parents allows a growing
rate of realistic successes and the emergence of autonomy.

ANTICIPATORY GUIDANCE—CARE OF FAMILIES

Understanding toddlers is fundamental to successful childrearing.
Nurses, particularly those in ambulatory or child health centers, are in a favorable position to assist parents in facilitating
the tasks and meeting the needs of children in this age group. Prevention yields better results than treatment. Anticipatory
guidance is paramount if one wishes to prevent future problems. Advice is sometimes not the sole answer. Actual
assistance, such as being available for home visiting or telephone consulting, should be part of the nurse’s flexible
repertoire of interventions. Whether parents are experiencing the dilemmas of rearing a first or a subsequent child, they
benefit from sharing their feelings, frustrations, and satisfactions. They need adult companionship, freedom from
childrearing responsibilities, and periodic separations from their children. Part of a nurse’s responsibility is to provide
opportunities for parents to express their feelings and to meet their physical, mental, and spiritual needs.

a. Mention the importance of growth and development in child care.

b. Explain the physical, psychosocial, intellectual and language development of a preschool age child.

a. Differentiate between growth and development.

Growth refers to physiological changes.
A change in the quantitative respect is termed
as growth.
Growth does not continue throughout life.
Growth stops after maturation.
Growth occurs due to the multiplication of
cells.
Growth is cellular.
Growth is one of the part of the developmental
process.
Development refers to overall changes in the
individual. It involves changes in an orderly and
coherent type towards the goal of maturity.
Development changes in the quality along with
quantitative aspect.
Development continues throughout life.
Development is progressive.
Development occurs due to both maturation and
interaction with the environment.
Development is organizational.
Development is a wider and comprehensive term.

Growth may be referred to describe the

Development describes the changes in the organism
changes in particular aspects of the body and
as a whole.
behavior of the organism

The changes produced by growth are subjects Development brings qualitative changes which are
of measurements. They may be quantified and difficult to measure directly. They are assessed
observable in nature. through keen observation of behavior in different
situations.
 Growth may or may not bring development. Development is possible without growth.

b. Explain the principles of growth and development with suitable examples.

Principles of Growth and Development
Developmental psychologists believe that knowledge of an accurate pattern of development is fundamental to an
understanding of children. There are several basic principles that characterizes the pattern and process of growth and
development. These principles describe typical development as a predictable and orderly process. Even though there are
individual differences in children’s personalities, attitudes, behaviour and timing of development, the principles and
characteristics of development are universal patterns.
1. Development involves change: - The human being is undergoing changes from the moment of conception to the time
of death. There are different types of change occur such as, changes in size, proportions, disappearance of old features and
acquisition of new features etc. The goal of these developmental changes is self-realization, which Abraham Maslow has
labelled as self-actualization. Each individual is equipped with certain abilities and potentialities at birth. By utilizing the
innate or inborn abilities one tries to realize and strive for self actualization during the total life period. Children‟s attitude
toward change are generally determined by his knowledge about these changes, social attitudes toward this change and
the way people of society treats to children when these changes take place.
2. Development is a continuous process: - Development continues throughout the life of an individual. This process
takes place in interaction with the environment in which a person lives. One stage of development is the basic framework
for the next stage of development. A child has limited knowledge and experiences about his environment. But as he
develops, he acquires more information through explorations and adds to the skills already acquired and the new skills
become the basis for further achievement and mastery of skills. For example, the child is able to write and draw; he must
have developed a hand control to hold a pencil and crayon. Thus, a person has vast experiences and knowledge as he
grows up.
3. Development follows a direction and uniform pattern in an orderly manner: -
(i) Development proceeds from the center of the body outward. This is the principle of proximodistal development that
describes the direction of development (from nearer to far apart). It means that the spinal cord develops before outer
parts of the body. The child‟s arms develop before the hands and the hands and feet develop before the fingers and toes.
(ii) Development proceeds from the head downwards. This is called the cephalocaudal principle. According to this
principle, development occurs from head to tail. The child gains control of the head first, then the arms and then the legs.
4. Individual Differences in the Development Process: - Even though the pattern of development is similar for all
children but the rate of development varies among children. Each child develops as per his abilities and perception of his
environment. Children differ from each other both genetically and environmentally. So, both biological factor and
environmental situations have their impact on individual‟s development which leads to individual differences in
development. Understanding this fact of individual differences in rates of development should aware us to be careful about
using and relying on age and stage characteristics to label children.
5. Development depends on maturation and learning:- Maturation refers to the sequential characteristic of biological
growth and development. The biological changes occur in sequential order and give children new abilities. Changes in the
brain and nervous system account largely for maturation. These changes in the brain and nervous system account largely
for maturation. The child‟s environment and the learning that occurs as a result of the child‟s experiences largely
determine whether the child will reach optimal development. An enriched environment and varied experiences help the
child to develop his/her potential.
6. Development is predictable:- Human development is predictable during the life span. Although this development is
influenced by both genetic and environmental factors, however, it takes place in a pre-defined manner. Specific areas of
development, such as: different aspects of motor development, emotional behavior, speech, social behavior, concept
development, goals, intellectual development etc. follow predictable patterns. For example, the growth of the child in
height and weight etc. continue up to a certain age. In general, it is also found that all children follow a commonality in the
development periods of life. All children generally grow following the periods like prenatal period and postnatal period.
The postnatal period includes infancy, babyhood, childhood, puberty and so on.
7. Early development is more critical than later development: - Milton writes “The childhood shows the man, as
morning shows the day.” Similarly, Erikson views “childhood is the scene of man‟s beginning as man.” He explains that if
parents gratify the needs of the child for food, attention and love etc. , his perception towards people and situation remains
positive throughout his life. He develops positive attitudes, feels secure, emotionally stable and adjust well with the
environment. If negative experiences occur during early life of the child, maladjustments may take place. Glueck concludes
that delinquents can be identified as early as 2-3 years of age. Different researchers view that the preschool years age are
most important years of development as basic foundation is laid down during this period which is difficult to change.
8. Development involves Social expectations:- In every society there are certain rules, standards and traditions which
everyone is expected to follow. Development is determined by social norms and expectations of behaviors form the
individuals. Children learn customs, traditions and values of the society and also what behaviors are expected from them.
They realize from the approval or disapproval of their behavior. Social expectations are otherwise known as
“developmental tasks”. Havinghurst defines developmental task as a “task which arises at or about a certain period in the
life of an individual. Developmental tasks arise mainly
(a) As a result of physical maturation,
(b) Form the cultural pressures of society,
(c) Out of the personal values and aspirations of the individual. The developmental tasks remain the same from one
generation after another in a particular culture. As societies are evolving, changing traditions and cultural patterns of a
society are learned automatically by children during their development process. These developmental tasks help in
motivating children to learn as well as help parents to guide their children.
9. Development has potential hazards:- Development may be hampered by various hazards. Hazards may be of physical,
environmental or psychological type. These hazards may be originated from the environment in which the child grows or
due to hereditary factors. They have negative impact on physical as well as sociopsychological development of the child.
The growth of the child may be retarded, he may be an aggressive person or he may encounter adjustment problems. For
example, if a child is slurring or stammering and parents neglect the child, the child may continue with this problem.
10. Happiness varies at different periods of development: - Happiness varies at different periods in the development
process. Childhood is the happiest period of life and puberty is the most unhappy. The patterns of happiness vary from
child to child and it is influenced by the rearing process of the child. Paul B. Baltes stated six principles of development of
life span approach. The six principles of development are mentioned below:
1. Development is a lifelong process- Development is a process which continues throughout life. It begins at birth and
ends in death of an individual.
2. Development includes both gain and loss during life span. The child may develop in one area and lose in another area.
3. Development is influenced by the biological factor and environmental situations- The human development is
influenced by biological and environmental factors. For example, the body strength of the child develops in the early
period but may deteriorate during old age.
4. Development involves changing allocation of resources. It states that during different developmental periods,
resources such as; time, money, social support etc. are used differently. For example, during old age people require
more money to maintain their proper health.
5. Development can be modified- This principle reveals that through proper training development can be modified. For
example, an individual can maintain his proper health by doing different exercises even in old age.
6. Development is based upon historical and cultural environment- The child grows, develops, and acquires knowledge
about the traditions, rules, and regulations of society according to his historical and cultural environment.

Explain the growth and development of a healthy infant

Explain the growth and development of an adolescent.
a. Describe the factors affecting the growth and development
b. List the stages of Erikson’s psychosocial development from infancy to adolescence.
Psychosocial Theory of Erikson
Psychosocial theory on the stages of child development was proposed by Erikson. He stresses upon Epigenetic principle,
according to which the development of new properties which are not contained in the original situation develop us result
of environmental influences and the interaction between the former (original situation) and the latter (environment
factors).
According to Erikson the stages of development are categorized into eight phases marked by specific development
characteristics. The stages are as follows.
1. Birth to 1st year Trust vs Mistrust
2. 1 to 2 years Autonomy vs shame, doubt.
3. 3 to 5 years Initiative vs Guilt
4. 6 to 12 years Industry vs Inferiority
5. Adolescence Identity vs Identity diffusion or Role confusion

Stage I: A sense of trust vs mistrust.

This stage begins from birth and is continued to eighteen months of age. The first and formal task of an infant is to develop
the basic sense of trust in himself and his environment. For the fulfillment of his basic needs he completely depends on
others. Due to dissatisfaction of his needs he gradually loses his sense of faith in the world around him. The sense of faith
may laid down during this period.

Stage II: A sense of autonomy versus a sense of shame. In this stage, child develops a sense of autonomy. He does not
want help from others. He likes to do things in his own way. Parents should be careful about their autonomy. There should
have balance between firmness and permissiveness to make a healthy sense of autonomy.

Stage III: A sense of initiative versus guilt. The third stage of psycho-social development between three to six years of
age is characterized by the crisis of initiative versus guilt. Equipped with the sense of trust and autonomy the child now
begins to take initiative in interacting with his environment. Therefore, these is need to resolve the crisis of initiative vs
guilt at this stage of psycho-social development and it can be property done if we allow the child to experiment with his
initiative by properly supervising and guiding him activities and encouraging him to develop a habit of self-evaluation of
the results of his initiative.

Stage IV: Period of industry vs. inferiority. Generally, by this age children begin to attend to school where they are made
to learn various skills and the teachers as well as the school environment generate pressures on them to work hard in
order to perform well. Parents also now begin to make demands upon the children to lend their hand with household
duties or some cases put them with occupational responsibilities. Therefore, the teachers and the school environment thus
play a very significant role in helping the child out of the industry versus inferiority crisis.
Stage V: The period of identity vs role confusion: This stage, beginning with the advent of puberty, is marked with the
crisis of identity vs role confusion. Adolescents begin to search for their own personal identity equipped with the sense of
trust, initiative and industry. The sudden changes in their bodies and mental functioning and the altered demands of
society compel them to ask questions of themselves like, who am I? What have I become? Am I the some person I used to
be? What am I supposed to do and in which manner am I to behave. There is return of heterosexual interests. Adolescents
are concerned about their future role and status.

a. Explain the special needs of a toddler for optimum growth and development.
Promoting optimal health during toddlerhood
Nutrition
During the period from 12 to 18 months of age, the growth rate slows, decreasing the child’s need for calories, protein, and
fluid. However, the protein (13 g/day) and energy requirements are still relatively high to meet the demands for muscle
tissue growth and high activity level.
The need for minerals such as iron, calcium, and phosphorus may be difficult to meet, considering the characteristic food
habits of children in this age group. Parents may be tempted to rely on vitamin supplementation, rather than a well-
balanced diet, to meet these requirements.
Toddlers usually require three meals and two snacks per day; however, the portions consumed are generally smaller
compared with those of older children.
At approximately 18 months of age, most toddlers manifest this decreased nutritional need with a decreased appetite, a
phenomenon known as physiologic anorexia. They become picky, fussy eaters with strong taste preferences. They may eat
large amounts one day and almost nothing the next. Toddlers are increasingly aware of the nonnutritive function of food—
the pleasure of eating, the social aspect of mealtime, and the control of refusing food. They are influenced by factors other
than taste when choosing food. If a family member refuses to eat something, toddlers are likely to imitate that response. If
the plate is overfilled, they are likely to push it away, overwhelmed by its size. If food does not appear or smell appetizing,
they will probably not agree to try it. In essence, mealtime is more closely associated with psychologic components than
with nutritional ones.

Complementary and alternative medicine

There are four complementary and alternative medicines —biologically based practices, which include herbs, vitamins,
and foods.

Sleep and activity

Total sleep decreases only slightly during the second year and averages about 11 to 12 hours a day. Most children take one
nap a day but may relinquish this habit by the end of the second or third year. Children reach an adult pattern of sleep by 3
years of age.

Fluoride
Fluoride supplementation should be considered for any child older than the age of 6 months whose drinking water is
deficient in fluoride. Supplementation based on fluoride concentration of water supply less than 0.3 ppm (parts per
million) is 0.25 mg for a child 6 months to 3 years of age and 0.5 mg for a child 3 to 6 years of age

Safety promotion and injury prevention

Non accidental trauma is a term used to denote child physical abuse, whether the etiology is suspected or confirmed,
without the stigma of the term child abuse. Toddlers are at particular risk for nonaccidental trauma because of their
tendency to be mobile and curious yet clumsy and uncoordinated; the toddlers’ inability to control emotions at times and
the tendency toward negativism further place them at high risk for nonaccidental trauma.

Motor Vehicle Safety

Motor vehicle injuries cause more accidental deaths in all pediatric age groups after age 1 year than any other type of
injury or disease and are responsible for almost half of all accidental deaths among children ages 1 to 4 years. Many of the
deaths are caused by injuries within the car when restraints have not been used or have been used improperly.
Unrestrained children riding in the vehicle’s front seat are at highest risk for injury. Approved restraints properly installed
and applied can prevent many fatalities and injuries. Motor vehicle back-over injuries and deaths, along with deaths or
serious injury resulting from heat stroke when left in a car, account for a large number of motor vehicle–related injuries in
children

b. Explain the parental guidance in prevention of accidents among toddlers.

Motor Vehicles
Walks, runs, and climbs
Able to open doors and gates
Can ride tricycle
Can throw ball and other objects
Use federally approved car restraint per manufacturer’s recommendations for weight and height.
Supervise child while playing outside.
Do not allow child to play on curb or behind a parked car.
Do not permit child to play in pile of leaves, snow, or large cardboard container in trafficked area.
Supervise tricycle riding; have child wear helmet.
Limit playing in driveways with parked cars or provide physical barriers limiting access.
Lock fences and doors if not directly supervising children.
Teach child to obey pedestrian safety rules:
Obey traffic regulations; cross only at crosswalks and only when traffic signal indicates it is safe.
Stand back a step from the curb until it is time to cross.
Look left, right, and left again and check for turning cars before crossing street.
Use sidewalks; when there is no sidewalk, walk on the left, facing traffic.
Wear light colors at night and attach fluorescent material to clothing.
Drowning
Able to explore if left unsupervised
Has great curiosity
Helpless in water; unaware of its danger;
depth of water has no significance
Supervise closely when near any source of water, including buckets.
Never, under any circumstance, leave unsupervised in bathtub.
Keep bathroom doors closed and lid down on toilet.
Have fence around swimming pool and lock gate.*
Burns
Able to reach heights by climbing, stretching, and standing on toes
Pulls objects
Explores any holes or opening
Can open drawers and closets
Unaware of potential sources of heat or fire
Plays with mechanical objects
Turn pot handles toward back of stove.
Place electric appliances, such as coffee maker and popcorn machine, toward back of counter.
Place guardrails in front of radiators, fireplaces, and other heating elements.
Store matches and cigarette lighters in locked or inaccessible area; discard carefully.
Place burning candles, incense, hot foods, and cigarettes out of reach.
Do not let tablecloth hang within child’s reach.
Do not let electric cord from iron or other appliance hang within child’s reach.
Cover electrical outlets with protective plastic caps.
Keep electrical wires hidden or out of reach.
Do not allow child to play with electrical appliance, wires, or lighters.
Stress danger of open flames; teach what “hot” means.
Always check bathwater temperature; adjust water heater temperature to 49° C (120° F) or lower; do not allow children to
play with faucets.
Apply a sunscreen when child is exposed to sunlight (all year round).
Accidental Poisoning
Explores by putting objects in mouth
Can open drawers, closets, and most containers
Climbs
Cannot read labels
Does not know safe dose or amount
Place all potentially toxic agents, including cosmetics, personal care items, cleaning products, pesticides, and medications,
out of reach or in a locked cabinet.
Caution against eating nonedible items, such as plants.
Replace medications or poisons immediately in locked cabinet; replace child-guard caps promptly.
Administer medications as a drug, not as a candy.
Do not store large surplus of toxic agents.
Promptly discard empty poison containers; never reuse to store a food item or other poison.
Teach child not to play in trash containers.
Never remove labels from containers of toxic substances.
Know number of nearest poison control center
Falls
Able to open doors and some windows
Goes up and down stairs
Depth perception unrefined
Use window guards; do not rely on screens to stop falls.
Place gates at top and bottom of stairs.
Keep doors locked or use childproof doorknob covers at entry to stairs, high porch, or other elevated area, including
laundry chute.
 Ensure safe and effective barriers on porches, balconies, decks.
Remove unsecured or scatter rugs.
Apply nonskid decals in bathtub or shower.
Keep crib rails fully raised and mattress at lowest level.
Place carpeting under crib and in bathroom.
Keep large toys and bumper pads out of crib or play yard (child can use these as “stairs” to climb out) and then move to
youth bed when child is able to climb out of crib.
Avoid using mobile walker, especially near stairs.
Dress in safe clothing (soles that do not “catch” on floor, tied shoelaces, pant legs that do not touch floor).
Keep child restrained in vehicle; never leave unattended in vehicle or shopping cart.
Never leave child unattended in high chair.
Supervise at playgrounds; select play areas with soft ground cover and safe equipment.
Choking and Suffocation
Puts things in mouth
May swallow hard or inedible pieces of food
Avoid large, round chunks of meat, such as whole hot dogs (slice lengthwise into short pieces).
Avoid fruit with pits, fish with bones, hard candy, chewing gum, nuts, popcorn, grapes, and marshmallows.
Choose large, sturdy toys without sharp edges or small removable parts.
Discard old refrigerators, ovens, and so on, and remove the door.
Install smoke and carbon monoxide alarms; change batteries every 6 months.
Develop a fire escape plan for the entire family and have drills.
Keep automatic garage door transmitter in an inaccessible place.
Select safe toy boxes or chests without heavy, hinged lids.
Keep venetian blind cords out of child’s reach.
Remove drawstrings from clothing; shorten essential drawstrings to 15.24 cm (6 inches) or less.
Avoid contact with round, hollow, semi rigid plastic items such as half of a plastic ball.
Bodily Injury
Still clumsy in many skills
Easily distracted from tasks
Unaware of potential danger from strangers or other people
Avoid giving sharp or pointed objects (e.g., knives, scissors, or toothpicks) especially when walking or running.
Do not allow lollipops or similar objects in mouth when walking or running.
Teach safety precautions (e.g., to carry knife or scissors with pointed end away from face).
Store all dangerous tools, garden equipment, and firearms in locked cabinet.
Be alert to danger of unsupervised animals and household pets.
Use safety glass on large glassed areas, such as sliding glass doors.
Teach child name, address, and phone number and to ask for help from appropriate people (cashier, security guard, and
policeman) if lost; have identification on child (sewn in clothes, inside shoe).
Teach stranger safety:
Avoid personalized clothing in public places.
Never go with a stranger.
Tell parents if anyone makes child feel uncomfortable in any way.
Always listen to child’s concerns regarding others’ behavior.
Teach child to say “no” when confronted with uncomfortable situations.

1. Write in detail regarding physiological, psychosocial, sexual and moral development of a toddler.
2. Describe the developmental milestone of adolescence and the psychosocial development in detail.
3. Describe the developmental milestone of an infant.
4. Explain the parental guidance for preparing a preschool child for schooling
5. Explain the nutritional needs of adolescents.
6. Describe the concept of baby friendly hospital initiative
7. Explain the Freud’s psychosexual development stages from infancy to adolescence.
Stages of Development: According to Freud, a child passes through five major stages of psychosexual development.
Each stage is characterized by certain behavioural changes. The stages are given below:
1. The oral stage: The focus of pleasure at the oral stage is mouth. The child's love object is his mother's breast which
he sucks to satisfy his hunger. The child's development starts with the act of nursing by his mother.
2. The anal stage: It refers to the stages when the focus of pleasure shifts from mouth to the anus. The child takes
interest in the activities pertaining to known and pleasure is drawn from activities like urinating and defecating.
3. Phallic stage: This stage is confined with the ages between three to six years. The sexual pleasure shifts from anus to
sexual organ. Oedipus complex is developed during this period. The male child desires his mother and wants to destroy
his rival, the father but perceives his father as a powerful rival and is afraid of being hermed by castrating him. The
primitive fear of physical herm is called "castration anxiety." Gradually this conflict is resolved by repressing his desire
for his mother and identifying with his father. The female child likes her father, and hates her mother. This is called
‘‘Electra Complex’’. About the oedipus and Electra phases, Freud says that these are the results of the sexual attraction
or pleasure of that children experience in the company of the parent of the opposite sex.
 4. The latency stage: This is the fourth developmental stage where in girls starts from 6 years and boys 7 to 8 years.
They like to play with their own sex and neglect or hate members of the opposite sex.
5. The genital stage: Puberty is the onset of the genital stage. The children at this stage have very strange feeling, as
they have strong sensation in their genitals and gets attracted towards the opposite sex. At this stage they may fall in
love with themself, takes interest in beautifying themselves and even go to the extent of sexual relation.
8. Describe the psychosocial and psychosexual development of adolescent.
9. Explain National Immunization schedule for children.
10. Explain the parental guidance for promotion of optimum health of a preschool child
11. Explain the benefits of breast feeding.
12. Explain principles for complementary feeding.
1. Mention the types of play in children.
Play
Freud saw play as a means for children to release pent-up emotions and to deal with emotionally distressing
situations in a more secure environment. Vygotsky and Piaget saw play as a way of children developing their
intellectual abilities. Piaget created stages of play that correspond with his stages of cognitive development.
Piaget’s Stages of Play
Stage Description
Functional Play Exploring, inspecting, and learning through repetitive physical
activity.
Symbolic Play The ability to use objects, actions, or ideas to represent other
objects, actions, or ideas and may include taking on roles.
Constructive Play Involves experimenting with objects to build things; learning
things that were previously unknown with hands on
manipulations of materials.
Games with Rules Imposes rules that must be followed by everyone that is playing;
the logic and order involved forms that the foundations for
developing game playing strategy

Mildred Parten observed two to five year-old children and noted six types of play. Three types she labelled as non-
social (unoccupied, solitary, and onlooker) and three types were categorized as social play (parallel, associative,
and cooperative). Younger children engage in non-social play more than those who are older; by age five
associative and cooperative play are the most common forms of play
Parten’s Classification of Types of Play
Category Description
Unoccupied Play Children’s behavior seems more random and without a specific
goal. This is the least common form of play.
Solitary Play Children play by themselves, do not interact with others, nor are
they engaging in similar activities as the children around them.
Onlooker Play Children are observing other children playing. They may
comment on the activities and even make suggestions, but will
not directly join the play.
Parallel Play Children play alongside each other, using similar toys, but do not
directly act with each other
Associative Play Children will interact with each other and share toys, but are not
working toward a common goal.
Cooperative Play Children are interacting to achieve a common goal. Children may
take on different tasks to reach that goal.

2. List importance of anthropometric assessment

Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue
used to assess the composition of the body. The core elements of anthropometry are height, weight, body mass
index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness.
These measurements are important because they represent diagnostic criteria for many more abnormalities.
There is utility as a measure of nutritional status in children.
Anthropometric measurements can be used as a baseline for physical fitness and to measure the progress of
fitness. 
Anthropometric values provide information about the distribution of body fat and skeletal muscle mass, and over
time, identify nutritional deficiencies or excesses in calorie and protein reserves compared with standardized
percentiles

3. List the advantages of breast feeding.

Protection against infection and deficiency states.
Vitamin D promotes bone growth, protects the baby against rickets
Leukocytes, lactoperoxidase prevents growth of infective agents
Lysozyme, lactoferrin, interferon protect against infection
Long-chain omega-3 fatty acids essential for neurological development
Immunoglobulins IgA (secretory), IgM, IgG protect against infection
Supply of nutrients and vitamins.
Breast milk is a readily available food to the newborn at body temperature and without any cost.
Breastfeeding acts as a natural contraception to the mother
It has laxative action
No risk of allergy
Psychological benefit of mother-child bonding
Helps involution of the uterus
 Lessens the incidence of sore buttocks, gastrointestinal infection and atopic eczema.
The incidence of scurvy and rickets is significantly reduced.

4. List the types of breast milk.

Breast milk has three different and distinct stages: Colostrum, transitional milk, and mature milk.
Colostrum is the first stage of breast milk. It occurs during pregnancy and lasts for several days after the birth of
the baby. It is either yellowish or creamy in color. It is also much thicker than the milk that is produced later in
breastfeeding. Colostrum is high in protein, fat-soluble vitamins, minerals, and immunoglobulins.
Immunoglobulins are antibodies that pass from the mother to the baby and provide passive immunity for the
baby. Passive immunity protects the baby from a wide variety of bacterial and viral illnesses. Two to four days
after birth, colostrum will be replaced by transitional milk.
Transitional milk occurs after colostrum and lasts for approximately two weeks. The content of transitional milk
includes high levels of fat, lactose, and water-soluble vitamins.  It contains more calories than colostrum.
Mature milk is the final milk that is produced. 90% of it is water, which is necessary to keep the infant hydrated.
The other 10% is comprised of carbohydrates, proteins, and fats which are necessary for both growth and energy.
There are two types of mature milk: Fore-milk: This type of milk is found during the beginning of the feeding
and contains water, vitamins, and protein. Hind-milk: This type of milk occurs after the initial release of milk. It
contains higher levels of fat and is necessary for weight gain. Both fore-milk and hind-milk are necessary when
breastfeeding to ensure the baby is receiving adequate nutrition to grow and develop properly.

5. What is cold chain?

Delivering vaccines to all corners of the world is a complex undertaking. It takes a chain of precisely coordinated
events in temperature-controlled environments to store, manage and transport these life-saving products. This is
called a cold chain. Vaccines must be continuously stored in a limited temperature range – from the time they are
manufactured until the moment of vaccination. This is because temperatures that are too high or too low can
cause the vaccine to lose its potency (its ability to protect against disease). Once a vaccine loses its potency, it
cannot be regained or restored.

6. Mention the problems associated with artificial feeding

Acute otitis media (ear infections).
Asthma (a condition of the lungs that causes problems with breathing).
Diabetes – type 1 and 2 (a problem in controlling the body’s sugar levels).
Eczema (an itchy condition of the skin).
Lower respiratory tract (lung) infections (including increased risk of admission to the hospital).
Obesity (being overweight).

7. What is Oedipus complex?

The Oedipus complex is a theory of Sigmund Freud, and occurs during the Phallic stage of psychosexual
development. It involves a boy, aged between 3 and 6, becoming unconsciously sexually attached to his mother
and hostile towards his father (who he views as a rival). In the young boy, the Oedipus complex or more correctly,
conflict, arises because the boy develops unconscious sexual (pleasurable) desires for his mother. Envy and
Jealous are aimed at the father, the object of the mother's affection and attention. These feelings for the mother
and rivalry toward the father lead to fantasies of getting rid of his father and taking his place with the mother. The
hostile feelings towards the father lead to castration anxiety, an irrational fear that the father will castrate
(remove his penis) him as punishment.
To cope with this anxiety, the son identifies with the father. This means the son adopts / internalizes the attitudes,
characteristics and values that his father holds (e.g. personality, gender role, masculine dad-type behaviors etc.).

8. What is Pentavalent vaccine?

Pentavalent vaccine protects against five major diseases:
Diphtheria,
Tetanus,
Pertussis (whooping cough),
Hepatitis B and
Haemophilus influenzae type b (DTP-hepB-Hib)

9. What is anal stage?

The Anal Stage (1 to 3 Years): The toddler period, the second and third years of life, the greatest amount of
sensual pleasure is obtained from the anal and urethral areas by defecating and urinating. At this stage the climate
surrounding toilet training

10. What is weaning?

It is the process during which the baby gets accustomed to food other than its mother’s milk.
 This period extends from 6th month to 1 year. The infant requires—110–125 calories/kg body weight per day and
its fluid requirement is about 150–175 mL/kg body weight per day. During the period of 3–4 months, the baby
may weigh as much as 5–5.5 kg and as such, its demand is more. The breast milk cannot supply the necessary
baby’s need and as such additional foods are required by 6 months of age. Semi-solid foods such as rice, dal, boiled
fish, and egg are gradually incorporated in the tropical countries. These also prevent the baby from becoming
anaemic. Breastfeeding supports the development of neurological and immunological system up to 4–6 years of
age.
The dangers of the weaning period are:
(a) Nutritional disturbances,
(b) Weaning diarrhoea due to altered composition of the food or contaminated with pathogens, and
(c) Psychological trauma to the baby when weaning is abrupt.

11. Write the Vitamin A prophylaxis schedule and dose.

Vitamin A is an important micronutrient for maintaining normal growth, regulating cellular proliferation and
differentiation, controlling development, and maintaining visual and reproductive functions. Diet surveys have
shown that the intake of Vitamin A is significantly lower than the recommended daily allowance in young children,
adolescent girls and pregnant women. Prevalence of clinical and sub clinical vitamin A deficiency in India is among
the highest in the world
Prophylactic Vitamin A as per the following dosage schedule:
100000 IU at 9 months with measles immunization
200000 IU at 16-18 months, with DPT booster
200000 IU every 6 months, up to the age of 5 years.
Thus, a total of 9 mega doses are to be given from 9 months of age up to 5 years.

12. List the common accidents in toddlers.

Motor Vehicles
Walks, runs, and climbs
Able to open doors and gates
Can ride tricycle
Can throw ball and other objects
Drowning
Able to explore if left unsupervised
Has great curiosity
Helpless in water; unaware of its danger; depth of water has no significance
Burns
Able to reach heights by climbing, stretching, and standing on toes
Pulls objects
Explores any holes or opening
Can open drawers and closets
Unaware of potential sources of heat or fire
Plays with mechanical objects
Accidental Poisoning
Explores by putting objects in mouth
Can open drawers, closets, and most containers
Climbs
Cannot read labels
Does not know safe dose or amount
Falls
Able to open doors and some windows
Goes up and down stairs
Depth perception unrefined
Choking and Suffocation
Puts things in mouth
May swallow hard or inedible pieces of food
Bodily Injury
Still clumsy in many skills
Easily distracted from tasks
Unaware of potential danger from strangers or other people

13. List any four optional vaccine recommended for children.

Optional vaccines used in the private sector. These vaccines are rarely used routinely and are obviously not
included in the national immunisation schedule.
Typhoid
HiB
Varicella
 Hepatitis A.
Pneumococcal
Meningococcal and
Influenza

14. Mention any two measures to manage temper tantrums.

The best approach toward tapering temper tantrums requires parental consistency and developmentally
appropriate expectations and rewards. Ensuring consistency among all caregivers in expectations, prioritizing
what rules are important, and developing consequences that are reasonable for the child’s level of development
help manage the behavior. For example, a popular time for a tantrum is before bed. Active toddlers often have
trouble slowing down and, when placed in bed, resist staying there. Parents can reinforce consistency and
expectations by stating, “After this story, it is bedtime.” Starting at18 months, time-outs work well for managing
temper tantrums. During tantrums, parents should ignore the behavior, provided the behavior is not injurious to
the child, such as violently banging the head on the floor. They should continue to be present to provide a feeling
of control and security to the child when the tantrum has subsided. At this time, a toy or a favorite activity can be
substituted for the request. During periods of no tantrums, parents can practice developmentally appropriate
positive reinforcement.
Other suggestions for handling tantrums include the following
• Offering the child options instead of an “all or none” position
• Picking one’s battles carefully and ignoring small skirmishes (arguments) over unimportant issues
• Giving comfort when the child is able to control his or her emotions but not giving in to the original request
• Praising the child for positive behavior when he or she is not having a tantrum.
 Avoid teasing and laughing at the child.
Temper tantrums are common during the toddler years and essentially represent normal development a
behaviors. However, temper tantrums can be signs of serious problems. Nurses should be alert to situations that
require further evaluation.

15. What is sibling rivalry?

Children have a natural jealousy and resentment toward a new child in the family or toward other children in the
family when a parent turns his or her attention from them and interacts with their brother or sister; this is
referred to as sibling rivalry. The arrival of a new infant represents a crisis for even the best prepared toddlers.
They do not hate or resent the infant; rather, they hate the changes that this additional sibling produces, especially
the separation from mother during the birth. The parents now share their love and attention with someone else,
the usual routine is disrupted, and toddlers may lose their crib or room—all at a time when they thought they
were in control of their world. Sibling rivalry tends to be most pronounced in firstborn children, who experience
dethronement (loss of sole parental attention). It also seems to be most difficult for young children, particularly in
terms of mother–child interaction. Preparation of children for the birth of a sibling is individual but is dictated to
some extent by age. For toddlers, time is a vague concept. Preparing children too soon for the birth may lessen
their interest by the time the event occurs. A good time to start talking about the baby is when toddlers become
aware of the pregnancy and the changes taking place in the home in anticipation of the new member.

16. Mention the importance of growth chart monitoring.

A growth chart is a size for age chart that is used to decide whether the size of a child falls within the normal
(average) range or whether the child is larger or smaller than normal.
Educational tool: For mothers
Diagnostic tool: For identifying the high risk children
Tool for action: Helps the health worker for type of intervention to be taken
For planning and policy making: Provides objective basis for the programmes.
Evaluative tool: Evaluation of the effectiveness of corrective measures and impact of the various programmes.

17. What is pulse polio immunization?

Pulse Polio is an immunisation campaign established by the government of India to eliminate poliomyelitis (polio)
in India by vaccinating all children under the age of five years against the polio virus. The project fights polio
through a large-scale, pulse vaccination programme and monitoring for poliomyelitis cases.
India committed to resolution passed by World Health Assembly for global polio eradication in 1988. National
Immunization Day (NID) commonly known as Pulse Polio Immunization programme was launched in India in
1995, and is conducted twice in early part of each year.

18. What is exclusive breast feeding?

"Exclusive breastfeeding" is defined as no other food or drink, not even water, except breast milk (including milk
expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups
(vitamins, minerals and medicines).
Exclusive breastfeeding is defined as feeding infants only breast milk, be it directly from breast or expressed.

19. Mention the importance of child guidance clinic

 Child Guidance Clinic provides comprehensive, intensive mental health services for children and their families.
Child guidance clinic provides help and cares for children with behavioural problems like pica, bed-wetting, sleep
disorders, learning difficulties, mental retardation and eating disorders.
Assessment – through this process, a psychologist will work with your child to evaluate their behavior,
personality and capabilities. This can include interviews, observations, questionnaires and psychological testing to
develop a complete picture of your child or adolescent.
Trauma-focused cognitive behavior therapy – evidence-based treatment that helps reduce symptoms of
anxiety, depression, post-traumatic stress disorder and other child behavior issues. It includes therapy with both
child and child family; regular meetings to learn social, coping and parenting skills; and development of a
treatment plan.
Evaluation – this involves a discussion of behaviors and symptoms, a psychiatric interview, personal and family
history, a complete medical history and, if necessary, laboratory tests to determine if medications are necessary.
Medication management – comprehensive process used to determine if the use of medications would improve
child’s outcomes. Key elements include a review of current prescriptions and development of a medication
treatment plan.
Individual and family therapy – therapy services specifically designed to address childhood matters and help
support juveniles and their families. Throughout this process, staff will work with parents to describe key
findings, explain treatment options and answer any questions.

20. Name the psychosexual stage of adolescent.

Psychosexual development :( Freud’s theory)
1. The Oral Stage (Birth to 1 Year): During this period, the sensory area of the mouth provides the highest
sensual satisfaction for an infant by doing sucking, biting, chewing and vocalizing.
2. The Anal Stage (1to 3 Years): The toddler period, the second and third years of life, the greatest amount of
sensual pleasure is obtained from the anal and urethral areas by defecating. At this stage the climate surrounding
toilet training.
3. The Phallic Stage (3 to 6 Years): During this stage, children become more interested about the genitalia and
sensitive area of the body. They recognize difference between the sexes and become curious about dissimilarities.
The oedipal stage occurs in the later part of phallic stage, during this time the child loves the parent of opposite
sex as the provider of satisfaction.
4. The Latency Stage (6 Years to Puberty): During this stage, children elaborate on previously acquired traits
and skills and also form close relationship with others of their own age and sex.
5. The Genital Stage (Puberty to Death): During puberty, secondary characteristics appear in both sexes with
maturation of the reproductive system and production of sex hormone.

21. What is Electra complex?

The Electra complex is a term used to describe the female version of the Oedipus complex. It involves a girl, aged
between 3 and 6, becoming unconsciously sexually attached to her father and increasingly hostile toward her
mother. For girls, the Electra complex begins with the belief that she’s already been castrated. She blames her
mother for this and experiences penis envy. For girls to develop their superego and female sex role, they need to
identify with the mother. But the girl’s motivation for giving up her father as a love-object in order to move back to
her mother is much less obvious than the boy’s for identifying with his father. As a consequence, girls’
identification with their mothers is less complete than boys’ with their fathers. In turn, this makes the female
superego weaker and their identity as separate, independent persons is less well developed.

22. Define growth and development

Growth is defined as “an increase in size or the amount of an entity”. It means growth involves all those structural
and physiological changes that take place within individual during the process of maturation. For example, growth
of a child means the increase in weight, height and different organs of the child‟s body.

Development is defined as “the progressive change in size, shape and function during the life of an organism by
which its genetic potential are translated into functioning adult system.” So, development includes all those
psychological changes that take in the functions and activities of different organs of an organism.

23. List the Developmental problems of a preschooler.

Language or speech problem(A problem with the muscles controlling speech -- a disorder called dysarthria)
Vision problem
Movement -- motor skills
Social and emotional skills
Thinking -- cognitive skills
Speech problems ( Dyslalia- difficulty to articulate words)

24. List four purposes or reasons for under-five clinics/Well baby clinics.
Under five clinic is a centre, where preventive, promotive, curative, referral and educational services are provided
in a package manner to under five children under one roof.
 Care in illness: Children are treated for acute and chronic illnesses and ailments of growth and development at
these clinic. Nurse can play an important role in taking care of sick children.
Growth monitoring: This is one of the most important function of the clinic. The child is weighed periodically-
every month during the first year, every 2 monthly from 1 to 3 years of age and every 3 monthly in 4th and 5th
years. Besides weighing, measuring height, mid arm circumference can also be carried out depending upon the
availability of trained manpower and equipments. The growth is plotted in the growth chart then growth curve is
prepared to monitor the growth of the child.
Preventive care: This includes Timely physical examination of the children, Immunization, Nutritional care, Oral
rehydration therapy.
Family planning: Family planning is a central to any program directed towards women and children. The
mothers are more receptive to family planning during early puerperium and lactation. Mother is counselled on the
various options available, their merits and demerits so that she can make choice.
Health education: This clinic is used to educate the mother about child

25. List any four principles of growth & development

Principles of Human Growth and Development:
1. Growth and development has direction trends(cephalo-caudal and proximo-distal)
2. Development is Continuous
3. Development is Gradual
4. Development is Sequential
5. Rate of Development Varies Person to Person
6. Development Proceeds from General to Specific
7. Most Traits are Correlated in Development
8. Growth and Development is a Product of Both Heredity and Environment
9. Development is Predictable
10. There is a Constant Interaction Between All Factors of Development

26. Name the causative organisms for four vaccine preventable diseases
Causative organism Diseases
Mycobacterium tuberculi Tuberculosis
Corynebacterium diptheriae Diphtheria
Clostridium tetani Tetanus
Bordetella pertussis Whooping cough

27. Name four psychosocial problems faced by a toddler.

1. Sibling rivalry: Children have a natural jealousy and resentment toward a new child in the family or toward other
children in the family when a parent turns his or her attention from them and interacts with their brother or
sister; this is referred to as sibling rivalry.
2. Negativism: “no” response to every request. The negativism is not an expression of being stubborn or insolent but
necessary assertion of self-control. Children test limits to gain understanding of the world and to learn to modify
their behavior to fit the expectations of society. Negativism begins to subside as most children prepare to enter
kindergarten. One method of dealing with the negativism is to reduce the opportunities for a “no” answer. Asking
the child, “Do you want to go to sleep now?” is an example of a question that will almost certainly be answered
with an emphatic “no.” Instead, tell the child that it is time to go to sleep and proceed accordingly.
3. Temper tantrums: Temper tantrums are nearly universal during toddlerhood as independence is established
and more complex tasks are attempted that may overwhelm the child emotionally. Toddlers may assert their
independence by violently objecting to discipline. They may lie down on the floor, kick their feet, and scream at
the top of their lungs. Some have learned the effectiveness of holding their breath until the parent relents.
Although holding one’s breath may cause fainting from the lack of oxygen, the accumulation of carbon dioxide will
stimulate the respiratory control center, resulting in no physical harm. Rarely, breath holding spells can involve
symmetric tonic-clonic movements, which can be frightening to parents; the child recovers quickly when the
spells over, and there is no residual damage. Tantrums are an indication of the child’s inability to control
emotions; toddlers are particularly prone to tantrums because their strong drive for mastery and autonomy is
frustrated by adult figures or lack of motor and cognitive skills
4. Regression: The retreat from one’s present pattern of functioning to past levels of behavior is referred to as
regression. It usually occurs in instances of discomfort or stress when one attempts to conserve psychic energy
by reverting to patterns of behavior that were successful in earlier stages of development. Regression is common
in toddlers because almost any additional stress hinders their ability to master present developmental tasks. Any
threat to their autonomy, such as illness, hospitalization, separation from a parent, disruption of established
routines, or adjustment to a new sibling, represents a need to revert to earlier forms of behavior, such as
increased dependency; refusal to use the potty chair; temper tantrums; demand for the bottle or pacifier; and loss
of newly learned motor, language, social, and cognitive skills.

28. What is meant by Parallel play?

 Parallel play is a form of play in which children play adjacent to each other, but do not try to influence one
another's behavior. Children usually play alone during parallel play but are interested in what other children are
doing.

29. What is meant by Primary dentition?

This is the first stage of tooth development in children. The term refers to the arrival of 20 deciduous teeth that
erupt during the infant years, including four incisor teeth, two canines and four molars in each jaw.
In humans, the deciduous dentition consists of 20 total teeth, with the dental formula 2102 (or 2102/2102),
indicating two incisors, one canine, zero premolars, and two molars in each quadrant.

30. What is meant by Thumb sucking?

Thumb Sucking is a natural habit of infants and young children. They do it to soothe themselves. Children most
Often suck their thumb when they are hungry or tired. When older children continue to suck their thumb, it could
mean they are bored or feel insecure.

31. Define Supplementary feeding.

Supplementary feeding, defined as the provision of meals, drinks, or snacks to children or families additional to
their normal diets, in comparison to either normal diet or placebo (e.g., low energy drinks). Community-based
interventions where the child could eat at home or at a supervised feeding centre were included.
'Supplementary feeding' describes programmes that provide additional food to children to prevent
undernutrition. The focus is usually on increasing the amount of energy a child receives, but supplementary foods
can also contain micronutrients (vitamins and minerals).

32. List the Precautions taken while introducing weaning diet in infants.
Continue to give the baby breast milk or formula. This will be the baby's main source of calories and nutrition
until their first birthday, and if we eliminate it too soon your baby will be at risk of nutrient deficiencies and
delayed development.
Avoid giving cow's milk until they are 1 year. Only breast milk and infant formula are recommended..
Baby does not need any water before 6 months, and they won't need a lot of water even when they begin to eat
solids. They will get most of their hydration from breast milk or formula. We can offer a small amount of water in
a sippy cup at mealtimes, but not too much until they're fully weaned.
Don’t avoid giving foods that are common allergy culprits, just monitor them closely the first few times they try
them.
It’s important to introduce one new food at a time and wait for 3 – 5 days to observe for allergic reactions such as
rashes, difficulty breathing, diarrhoea or vomiting.
Foods to keep an eye on include peanuts and other nuts, eggs and shellfish.
If you suspect the baby is having an allergic reaction to something they eat, take them to the doctor.
Parents should work with a doctor or dietitian to identify the specific food allergen.

33. What is meant by Sense of industry Vs inferiority?

Industry vsInferiority (6 to 12 Years): Children in this age group have a strong sense of duty. They want to
engage in tasks in their social world that they can carry out successfully, and they want their success to be
recognized by adults and by peers. The danger of this period is the development of a sense of inferiority if the
parents or the school expect a level of achievement that children are unable to attain. The ego quality
development from a sense of industry is competence

34. Write a note on Phallic stage.

The Phallic Stage (3 to 6 Years): During this stage, children become more interested about the genitalia and
sensitive area of the body. They recognize difference between the sexes and become curious about dissimilarities.
The oedipal stage occurs in the later part of phallic stage, during this time the child loves the parent of opposite
sex as the provider of satisfaction
.
35. Write about the Concept of growth
Growth: concept and definition
Growth refers to physical increase in some quantity over time. It includes changes in terms of height, weight, body
proportions and general physical appearance.
In encyclopedia Britannica, growth is defined as “an increase in size or the amount of an entity”. It means growth
involves all those structural and physiological changes that take place within individual during the process of
maturation. For example, growth of a child means the increase in weight, height and different organs of the child‟s
body.
Hurlock has defined growth as “change in size, in proportion, disappearance of old features and acquisition of new
ones”.
Growth refers to structural and physiological changes (crow and crow, 1962). Thus, growth refers to an increase
in physical size of whole or any of its part and can be measured.

36. Write about the Concept of development

 Development: concept and definition
Development refers to the qualitative changes in the organism as whole. Development is a continuous process
through which physical, emotional and intellectual changes occur. It is a more wider and comprehensive term
than growth. It is also possible without growth.
In Webster’s dictionary development is defined as “the series of changes which an organism undergoes in passing
from an embryonic stage to maturity.”
In encyclopedia Britannica is the term development defined as “the progressive change in size, shape and function
during the life of an organism by which its genetic potential are translated into functioning adult system.” So,
development includes all those psychological changes that take in the functions and activities of different organs
of an organism.
Development is continuous and gradual process (skinner). According to crow and crow (1965) development is
concerned with growth as well as those changes in behavior which results from environmental situation.” Thus,
development is a process of change in growth and capability over time due to function of both maturation and
interaction with the environment.

37. Describe teething in toddlers.

38. List the changes occurring in adolescents before puberty

Pre-Puberty Changes: A number of other changes occur during middle childhood
Children become stronger as their muscle mass increases.
Motor skills—in both strength and coordination—improve.
A school-age child's hair may become a little darker.
The texture and appearance of a child's skin gradually changes, becoming more like that of an adult.

First Signs of Puberty

Girls
Breast budding in girls starts around age ten, with some girls starting as early as eight and others not starting
until thirteen.
The peak growth period (in height, weight, muscle mass, and the like) in girls occurs about one year after puberty
has begun.
Menstruation usually starts about 18 months to two years after the onset of puberty. On average, the first menses
occur just before girls turn thirteen.
Boys
Boys enter puberty about one year later than girls. The first sign is enlargement of the testes and a thinning and
reddening of the scrotum, which happens at an average age of eleven but may occur anytime between nine to
fourteen years.

39. What is Embryo?

An embryo is the early stage of development of a multicellular organism. In general, in organisms that reproduce
sexually, embryonic development is the part of the life cycle that begins just after fertilization and continues
through the formation of body structures, such as tissues and organs. Each embryo starts development as a
zygote, a single cell resulting from the fusion of gametes (i.e. fertilization of a female egg cell by a male sperm cell).
In the first stages of embryonic development, a single-celled zygote undergoes many rapid cell divisions, called
cleavage, to form a blastula, which looks similar to a ball of cells. Next, the cells in a blastula-stage embryo start
rearranging themselves into layers in a process called gastrulation. These layers will each give rise to different
parts of the developing multicellular organism, such as the nervous system, connective tissue, and organs.

40. Draw the Symbol of under- five clinic.

41. Explain the principles to be followed during introduction of weaning diet in infants.
Weaning food should be palatable.
Easily digestible.
Offers variety of foods.
Should begin between 3 – 6 months
Premature introduction of solids is not advisable
Foods given without added salts and sugar.
Skimmed or semi skimmed milk are not suitable.
Breast milk should be continued throughout the first year.
Watch the sugar content in the fruit juices and give well diluted.

42. List the common accidents among the preschooler.

43. List the components of prenatal preventive paediatrics

Immunizations
Hygiene
Nutrition
Family wellness
Antenatal care
Community support
Family readiness (eg Concerns and resources)
Infant behaviors (eg sleep, calming)
Breast Feeding
Oral rehydration
Safety (eg car safety seats, tobacco smoke)
Routine baby care (eg infant supplies, skin care, illness prevention, introduction to future visits)
Iodized salts

44. List the four factors affecting growth and development.

1. Heredity. Heredity is the transmission of physical characteristics from parents to children through their genes.
2. Environment
3. Sex.
4. Exercise and Health.
5. Hormones.
6. Nutrition.
7. Familial Influence.
8. Geographical Influences
9. Socio-economic status.
10. Learning and reinforcement
45. List the rules for selection of play material
Simplicity
Versatility: satisfy the need of growing muscles to push, climb, run, bend and lift
Functionality: toys really should work.
Safety: corners, edges should be well rounded.
Durability
Generosity: fulfil children’s intentions in play.
Creativity
Compact and comprehend.
Cost effective
Well designed
Encourage cooperative play

46. List the adverse effect of artificial feeding

Acute otitis media (ear infections).
Asthma (a condition of the lungs that causes problems with breathing).
Diabetes – type 1 and 2 (a problem in controlling the body’s sugar levels).
Eczema (an itchy condition of the skin).
Lower respiratory tract (lung) infections (including increased risk of admission to the hospital).
Obesity (being overweight).

47. List the Scope of services in Integrated Child Development Scheme.

A wide range of services encompassing supplementary nutrition; immunization services; health check-ups for
children less than six years of age; antenatal care of expectant mothers and postnatal care of nursing mothers;
referral services to the beneficiaries who are in the need of prompt medical attention; non-formal pre-school
education for children in the 3-6 years age group; and nutrition & health education especially for the women in
the 15-45 years age group are provided to the beneficiaries
Pre-school non-formal education
Supplementary Nutrition
Nutrition & health education
Immunization
Health check-up and
Referral services