HEALTH CARE ETHICS

MODULE 5

GROWTH AND DEVELOPMENT

DEFINITION OF TERMS
 GROWTH – increase in number & size of cells, resulting in increased size or
weight of a part or whole; quantitative
 DEVELOPMENT – gradual advancement from lower to more advanced stage of
complexity; increase in skill/ability (physical, mental, personal, social, etc.);
qualitative
 MATURATION – increased competence & adaptability; to function at a higher
level
 DIFFERENTIATION – process by which early cells & structures are systemically
modified to achieve specific & characteristic physical & chemical properties,
thereby allowing a more specific function

PRINCIPLES OF GROWTH & DEVELOPMENT

 Growth and development occur in a regular direction reflecting a definite and
predictable patterns or trends
A. DIRECTIONAL TRENDS – occur in regular directions that reflect the
development of neuromuscular functions. These apply to the physical,
mental, social and emotional developments
1. CEPHALO – CAUDAL: “head to tail”
‒ Occurs along body’s long axis in which control over head, mouth
and eye movements precede control over upper body, torso and
legs
2. PROXIMO – DISTAL:
‒ From center of the body to extremities
‒ e.g. baby uses whole arm in crawling then hand pincers
3. SYMMETRICAL:
‒ Each side of the body develop on the same direction at the same
time and rate
4. MASS – SPECIFIC (DIFFERENTIATION):
‒ The child learns from simple operations before complex functions
or move from a broad general pattern of behavior to a more
refined pattern (e.g. crying, hunger, thirst or pain until the child can
use words for milk, etc.)
B. SEQUENTIAL TRENDS – involve a predictable sequence of growth and
development to which the child normally passes; these involve locomotion,
language and social skills
C. SECULAR TRENDS – refer to the worldwide trend of maturing earlier and
growing larger as compared to preceding generations
 BEHAVIOR is the most comprehensive indicator of developmental
status.
 PLAY is the universal language of the child.
 A great deal of skill and behavior is learned by PRACTICE.
 There is n optimum time for initiation of experience or learning.
 Neonatal reflexes must be lost first before development can proceed
e.g. spitting/extrusion reflex must be overcome before infant can be
fed with solid foods
REFLEXES:
 Different involuntary reactions to specific forms of stimulation
 For neonate’s survival
‒ Feeding reflexes: rooting, sucking, swallowing
‒ Protective reflexes: blink, gag, cough, Moro
‒ Reflects how well CNS is functioning
‒ Forms the basis for later, more sophisticated behaviour
 BLINK
‒ Rapid eyelid closure when strong light is shown to protect the eyes;
disappears at death
 PALMAR GRASP
‒ When a solid object is placed in the palm, the baby will grasp the object
1. To cling to the mother for safety
2. Beginning ability to hold then release objects
3. Disappears at 6 weeks to 3-4 months
 STEP-IN/WALK-IN PLACE
‒ Neonate is placed on a vertical position with feet touching a hard surface;
baby will tale few quick alternating steps in this position
1. Present at birth
2. Disappears at 1 month
 PLACING
‒ Almost the same with step-in place reflex only that the examiner touches the
anterior surface of a neonate’s leg
1. NORMAL RESPONSE
‒ Flex hip and knee
‒ Place stimulated foot on top of the table
2. ABNORMAL RESPONSE
‒ No response
‒ Consider paralysis if born in breech presentation
‒ Disappears at 6 weeks
 PLANTAR GRASP
‒ When an object touches the sole of the neonate’s foot at the base of the toes;
the toes grasp in the same manner as the fingers do
‒ Disappears at 8-9 months I preparation for walking
 TONIC-NECK/BOXER/FENCING
‒ When the neonate is in supine, with head turned to one side, the arm and
the leg on the side to which the head turns extend, and the apposite arm and
leg contract.
‒ Disappears within 3-4 months
 MORO/STARTLE
‒ Test for neurological integrity
1. Upon jarring of the crib or exposure to loud voice, the baby will assume
the “letter C” position, throws arms forward and draws legs up
2. Abnormal response – asymmetrical response
3. To protect the baby from attacker
4. Present at 36 weeks age of gestation (AOG)
5. Disappears at 4-5 months when the baby can roll over
 MAGNET
‒ When there is pressure at the sole of the foot, the baby pushes back against
the pressure
 CROSSED EXTENSION
‒ Test for spinal nerve integrity; when sole of foot is stimulated by a sharp
object, that foot flexes and the other foot extends
 TRUNK INCURVATION/GALANT
‒ While in prone, when the paravertical area is stimulated, the trunk flexes and
the pelvis swings towards the touch
 LANDAU
‒ Test for muscle tone; while in the prone, with the examiner’s hands
supporting the baby’s trunk, the baby exhibits some muscle tone
1. Abnormal response: collapse of the baby in limp, concave position
2. Present at 3 months
 PARACHUTE REACTION
‒ While on ventral suspension, sudden change in equilibrium causes
extension of arms and legs
1. Abnormal response: collapse of the baby in limp, concave position
2. Present at 6-9 months
 BABINSKI
‒ Sole of foot stimulated by a blunt object in an inverted J motion
fanning/dorsiflexion of all toes
1. Abnormal response: fanning of great toe only
2. Present due to immature central nervous system (CNS); myelinization is
not yet complete
3. Disappears at 2 months to 2 years

TYPES OF GROWTH AND DEVELOPMENT:

1. Physical
2. Mental
3. Social
4. Emotional
5. Spiritual
FACTORS AFFECTING GROWTH AND DEVELOPMENT:
A. GENETIC INFLUENCES.
 A “map” is formed upon conception
B. GENDER
 Weight, height, pubertal differences.
 For example: girls enter puberty first before boys; girls are born lighter and
shorter than boys.
C. HEALTH AND DISEASES
 A child who inherits a genetically transmitted disease may not grow as rapidly
or develop as fully as a healthy child depending on the type of illness and the
therapy or care available for the disease.
D. INTELLIGENCE
 Children with high intelligence do not generally grow faster physically than
other children, but they do tend to advance faster in skills.
E. TEMPERAMENT
 Is a usual reaction pattern of an individual or an individual’s characteristic
manner of thinking, behaving or reacting to stimuli in the environment.
F. ENVIRONMENT
 Although children cannot grow taller than their genetically programmed height
potential allows, their adult height can be considerably less than their genetic
potential if their environment hinders their growth.
 Example: A child could receive inadequate nutrition because of a low family
socio-economic status; a parent could lack childcare skills or not give a child
enough attention or stimulation.
G. SOCIO-ECONOMIC LEVEL
H. PARENT-CHILD RELATIONSHIP
I. ORDINAL POSITION IN THE FAMILY
 Only child or oldest child generally excels in language development because
conversations are mainly with adults.
 Middle child is very competitive
 Youngest child develop language more slowly but has faster motor
development and accomplishes toilet training fast and writing at an early age.

THEORIES OF GROWTH AND DEVELOPMENT

SIGMUND FREUD’S THEORIES

 SIGMUND FREUD – Father of Psycho Analysis
 FREUD’S THEORY OF INSTINCT – PSYCHOSEXUAL/PSYCHOANALYTIC
THEORY (by Sigmund Freud) or Psychoanalytic Theory
 LIBIDO (sexual energy) goes to one part of the body to another where it is
responsible for survival
 INSTINCT – a psychic energy man uses to think, learn and perform
‒ a psychodynamic force which Freud believed to be present in every
individual which he uses to satisfy his basic urges
‒ a representation in the mind of a stimuli that originates within the body and
drives the individual into action
‒ sometimes called MOTIVES
  CATEGORIES:
1. LIFE INSTINCT - Eros ( for survival) - sum of all instincts for self-
preservation
2. SEX INSTINCT – includes not only those that refer to things that are erotic
but includes all pleasurable thoughts and behaviors
3. DEATH INSTINCT – Thanatos - a set of destructive forces present in
human beings; the drive that compels us to destroy

Freud believed that Eros is stronger than Thanatos but if Thanatos reaches a critical
point, death instinct will be manifested.

 FREUD’S STRUCTURE OF PERSONALITY

1. ID
 Core of being; oldest of personality structures; present at birth; Source
of all drives and the reservoir of instincts
 Obeys the pleasure principle by seeking immediate gratification
without regard for preservation of life and irrespective of
considerations of danger
2. EGO
 Emerges because the needs wishes and demands of the id requires
appropriate exchanges with the outside world
 Executive of personality
 Reality oriented
 Emerges when:
‒ the desires of the ID are not met or immediately gratified
‒ diversion of psychic energy to important cognitive processes
‒ Tension develops when the needs of the ID are not immediately
gratified thus the ego, to relieve itself of this anxiety develops
defense mechanism
3. SUPEREGO
 Represents what is ideal
 Judicial branch of personality
 Person’s moral arbiter
 Strives for perfection rather than reality
 Ormed from internalization of moral standards set by parents and
develops as personal guidelines

 FIVE STAGES OF FREUD’S PSYCHOSEXUAL THEORY

1. ORAL (0-18 months): Infant
 Mouth – site of gratification
 Activity: biting, sucking, crying (for enjoyment and release of tension)
‒ Never discourage thumb sucking
‒ Offer pacifier when on NPO status
 Id – source of all drives; present at birth; striving for gratification of
needs
 Ego – for reality testing and problem solving; develops at 4-5 months,
when infant begins to see self separate from mother (development of
sense of self)
 Focus on the mothering one
 Primary conflict : WEANING

2. ANAL (18 months – 3 years): Toddler

 Anus – site of gratification on where elimination takes place
 Principles in Toilet Training:
 ‒ "Holding on”: child wins; becomes stubborn or antisocial
‒ “Letting go”: mother wins; child becomes obedient, kind,
perfectionist, obsessive-compulsive
 Primary conflict : TOILET TRAINING
3. PHALLIC (3-6 years): Preschooler
 Genitalia – site of gratification
 Focus on the genitals and finds pleasure in masturbation and
exploration of the genitals
 There is increase knowledge on 2 sexes; exhibitionism is normal
‒ Accept child’s fondling of his/her genitalia as a normal area of
exploration
‒ Answer child’s questions directly
 Superego is a necessary part of socialization that develops at 3-6
years; includes
‒ Internalization of values, ideas, moral standards of parents and
society; and
‒ Development of CONSCIENCE
 OEDIPUS AND ELECTRA COMPLEX – the condition where the child
loves the parent of the opposite sex and hates the parent of the same
sex
 PENIS ENVY –usually happens to girls wondering her lack of a penis
and the consequent hurt to her own self-esteem
 CASTRATION FEAR – usually happening to boys seeing a girl's
genitalia will falsely assume that the girl must have had her penis
removed, probably as punishment for some misbehavior, and will be
anxious lest the same happen to him

4. LATENT (6-12 years): School Age

 Period of suppression, no obvious development
 Dormant sexual drives because of focus on same sex peers, learning
skills and activities needed to cope with environment
 Focus is on the ability to relate with others outside of home
 Help child achieve positive experiences so that he/she will become
ready to face the conflicts of adolescence

5. GENITAL (12 years): Adolescent

 Focused on sexuality
 Focus is back on the genitals which is the major source of sexual
tension and pleasures
 Developing sexual maturity; learning how to establish a satisfactory
relationship with opposite sex
 Give opportunity to relate with peers of opposite sex
 ERIK ERICKSON’S PSYCHOSOCIAL THEORY
 ERIK ERICKSON - a Freudian psychologist however focuses more on man and
society
 DEVELOPMENTAL TASK – a skill or growth responsibility arising at a particular
time in the individual’s life. The successful achievement of which will provide a
foundation for the accomplishment of the future tasks.
‒ Focuses on psychosocial tasks that are accomplished throughout the life
cycle
‒ Stresses the importance of culture and society to the development of one’s
personality
‒ Unsuccessful resolution of psychosocial crisis leaves the individual
emotionally-handicapped
 PRINCIPLES
1. There Is A Natural, Predetermined Order To Development.
2. Personality growth follows a sequence of inner, predetermined laws.
3. Each person develops through a sequence of stages that emerge in
accordance with this preset plan.
4. At each stage a person is confronted with a CRISIS that must be resolved.
5. Each crisis is represented by a healthy versus an unhealthy resolution that
can be represented as polar opposites on a straight line. Trust---Mistrust
6. A person’s social environment has an extremely important effect on how
each crisis is resolved, but it does not determine the order in which stages
emerge!
7. The stages are sequential but they are NOT HIERARCHICAL.
8. Each new stage emerges according to the predetermined biological plan
irrespective of how successful the resolution of the previous stage was.

However, the unhealthy resolution of a stage negatively affects the resolution of all
subsequent stages.
 8 STAGES
1. TRUST VS MISTRUST (0-18 months): Infants
 Major Developmental Factor: FEEDING
 Foundation of all psychosocial tasks
 Psychosocial theme: “To give is to receive”
 Developed by
‒ Satisfying needs at all times: feed upon demand (because the
stomach capacity is low and baby easily gets hungry)
‒ Parental caring must be consistent and adequate
‒ Giving an experience that will add to security (e.g. touch, hugs and
kisses, eye-to-eye contact, soft music)
2. AUTONOMY VS SHAME AND DOUBT (18 months – 3 years): Toddler
 Major Developmental Factor: TOILET TRAINING
 If everything is planned or done for the child, autonomy is not developed
 Developed by
‒ Giving opportunity for decision-making, offering choices
‒ Setting limits is the parents’ moral obligation
3. INITIATIVE vs GUILT (3-6 years): Preschooler
 Major Developmental Factor: DOING BASIC THINGS
‒ Guilt: anger turned inward
‒ Sees play as work and takes it seriously; cries so much if child
fails in play
‒ Developed by
‒ Giving opportunity to explore new places and events
‒ Providing activities that can enhance imagination, creativity
and fine motor skills (e.g., modelling clay, finger painting,
blowing bubbles)
‒ If child fails in a play, do not say “It’s just a game”, instead
encourage child to accept defeat and to do his/her best next
time
4. INDUSTRY VS INFERIORITY (6-12 years): School age
 Major Developmental Factor: SCHOOL COMPETENCE
‒ Learns how to do things well
‒ Developed by
‒ Giving opportunity on short assignments and projects
5. IDENTITY VS ROLE CONFUSION (12-20 years): Adolescent
 Major Developmental Factors: PEERS
‒ Learns who he/she is, what kind of person will he/she become by
adjusting to new body image
‒ Emancipation from parents: liberation/freedom
‒ Ego-identity crisis
‒ Identity (Ego-Identity) = strong sense of self
‒ Role Confusion (Identity-Crisis) = failure to achieve ego-identity –
feeling like you don’t belong, don’t know who you are or what you
want to do
6. INTIMACY VS ISOLATION (20-25 years): Young Adult
 Major Developmental Factor: LOVE
‒ Looking for lifetime partners, career-focused
 ‒ Intimacy = the ability to merge your identity with someone else’s
without losing your own sense of identity in the process
‒ Isolation = inability to establish intimacy
7. GENERATIVITY VS STAGNATION (25-45 up to 60-65 years): Middle Adult
 Major Developmental Factor: PARENTING CARE

‒ Generativity = becoming a mentor or teacher to guide younger

people
‒ Stagnation = inability to (or choice not to) take part in generativity
8. EGO INTEGRITY VS DESPAIR (65 years): Late Adult
 Major Developmental Factor: REFLECTION, WISDOM

‒ Ego integrity = looking back on life with a sense of fulfillment &

satisfaction
‒ Despair = view life with sense of frustration and regret
‒ leads one to feel disgusted with self and bitter with others

JEAN PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

 JEAN PIAGET – Swiss psychologist
 COGNITIVE ACTS – ways in which the mind organizes and adapts to its
environment
 SCHEMA – individual’s framework of thought acquired from past experiences
 REQUIRED FOR ADAPTATION OR LEARNING:
1. ASSIMILATION – absorbing information into existing schema
2. ACCOMMODATION – schemata is revised to include new information
‒ needed to maintain equilibrium
 4 STAGES:
1. SENSORIMOTOR (birth to 2 years): “Practical Intelligence”; words and
symbols are not yet available
 Use of reflexes (birth to 1 month)
‒ use of crying, sucking, rooting, etc.
‒ experiences begin the understanding of cause-&-effect relationship
(eg. cry = feed = stop crying)
‒ assimilation begins
Schema Head Behavior
Neonatal Reflex/Stimulus 1 month All reflexes
Response
Primary Circular Reaction 1-4 months Activities related to body, discover
persons, no object permanence,
repetition of behavior
Secondary Circular 4-8 months Activities not related to body, object
Reaction permanence, memory traces present,
anticipate familiar events
Coordination of 8-12 months Exhibit goal-directed activities,
Secondary Circular increasing sense of permanence
Reaction
Tertiary Circular Reaction 12-18 months Use trial and error in discovering places
and events, space and time perception
Intervention of new means 18-24 months Invent new means by active
thru mental combination experimentation, transitional phase to
preoperational period

2. PRE-OPERATIONAL (2-7 years)

‒ 2.1 Pre-conceptual (2-4 years)
‒ 2.2 Intuitive (4-7 years)
‒ CHARACTERISTICS OF THIS STAGE:
 a. EGOCENTRISM – inability to envision situations from perspectives
other that one’s own
‒ child can’t imagine being in other’s shoes
‒ instead of saying “don’t spank because it hurts”, focus on ”don’t
spank because it hurts”
b. TRANSDUCTIVE REASONING – eg: child refuses to go near a
nurse because of a previous injection scare
c. CENTRATION – focusing on one aspect rather than considering all
possible alternatives; eg: won’t eat because of bad color, although
taste & smell are okay
d. ANIMISM – inanimate objects have life-like qualities
‒ eg. scolds a tree after falling
e. IRREVERSIBILITY
‒ eg. a wound will not heal
f. MAGICAL THINKING – thoughts are all-powerful & can cause
events
g. INABILITY TO CONSERVE- inability to understand the idea that a
mass can be changed in size, shape, volume & length without losing
or adding to the original mass
‒ eg. water poured into a tall thin glass = more than the same
amount of water poured into a wide short one
Schema Age Behaviour
Pre-conceptual 2-4 years Thinking in basically complete, literal
and static
Concept of time: NOW
Concept of distance: what can be seen
ANIMISM – inanimate objects has life
SYMBOLIC PLAY
Irreversibility of thinking
Intuitive 4-7 years Beginning of causation (“WHY”)
Egocentric in play, thought and behavior
Undimensional classification (texture,
color, length one at a time)

3. CONCRETE OPERATIONS (7-12 years)

‒ Find solution to everyday problems with systematic reasoning
‒ Concept of REVERSIBILITY
‒ Concept of CONSERVATION
‒ Cooperative interaction-relates own point of view with others
‒ Activity: Collecting
‒ Multidimensional classification
‒ can reason logically, organize thoughts
‒ concepts of conservation, reversibility achieved
‒ can classify according to object’s different attributes, enjoy
collections
‒ egocentrism & rest of earlier pre-operational activities disappear
‒ acquires ability to read
4. FORMAL OPERATIONS (12 years & up)
‒ Cognitive achieves its final from
‒ Solve hypothetical problems with scientific reasoning
‒ Abstract thinking and mature thought
‒ Concept of time: past, present and future
‒ Activity: Talk time – sorting out of opinions and current events
 ‒ scientific & inductive reasoning
‒ abstract & hypothetical thinking
‒ capable of inductive & deductive reasoning

LAWRENCE KOHLBERG’S THEORY OF MORAL DEVELOPMENT

 LAWRENCE KOHLBERG – a Harvard professor based his theory on the
cognitive developmental theory (Piaget)
‒ Closely approximates cognitive stages of development
‒ Not all persons may reach all stages; may be fixated in one stage

Age (year) Stage Description

0-2 Infant Premoral/Amoral or Not concerned with what is right or
Pre-religious wrong
PUNISHMENT & OBEDIENCE
2-3 Pre-conventional ORIENTATION (2-3 years)
Toddler (Level I) - begins to know right & wrong, but
1 only according to what
authority/parents tell them
- something is right because parents
approve of action
- child does right to avoid punishment
INDIVIDUALISM.
- Instrumental purpose and exchange.
4-7 -Carries out action to satisfy own
Pre-schooler Pre-conventional needs rather society.
(Level I) -Will do something for another if that
2 person will do something for the child
Motto :“Do for me and I do for you”
Conventional Orientation to interpersonal relations of
7-10 (Level II) mutuality. Child follows rules because
School age 3 of a need to be a “good” person in own
eyes and the eyes of others (“Good
boy, nice girl social concept”)

GOOD BOY, GOOD GIRL

- “good boy, good girl” image
- child does good because this is “nice”
behavior & wants to please others
- looks at traits & motives of actions,
labels “good” or “bad” person
- motto: “I behave so I may please you”

Maintenance of social order, fixed rules

10-12 Conventional and authority. Child finds following
School age (Level II) rules satisfying. Follows rules of
4 authority figures as well as parents in
an effort to keep the “system” working
(“Law and Order Orientation”)

LAW & ORDER (10-12 years)

- social order; child follows rules of the
land, authority, church
- may have difficulty modifying a
 procedure even if needed if not stated
in rules
- motto: “I behave because it’s the right
thing to do”

Post Social contract, utilitarian law-making

12 years and up Conventional perspectives. Follows standards of
Adolescent (Level III) society for the GOOD OF ALL people
5

SOCIAL CONTRACT (12 & up)

-follows standards of society for the
good of all people
-particular with people’s rights,
principles & values
-can acknowledge a conflict between 2
socially accepted standards.

Universal ethical principle orientation.

12 years and up Post Follows INTERNALIZED STANDARDS
Adolescent Conventional of conduct
(Level III)
6 UNIVERSAL ETHICAL PRINCIPLE
follows internalized standards of
conduct; love, respect, justice
analyzing from each party’s
perspective
principled conscience
many do not reach this level

HARRY STACK SULLIVAN INTERPERSONAL THEORY OF DEVELOPMENT

 HARRY STACK SULLIVAN – American (New Yorker) psychologist
‒ First worked with schizophrenics before coming up with theory
‒ His Interpersonal Theory is based on the belief that people's interactions
with other people, especially significant others, determine their sense of
security, sense of self, and the dynamisms that motivate their behavior.
‒ Stack-Sullivan’s theory states that the purpose of behavior is for the patient
to have his or her needs met through interpersonal interactions, as well as
decrease or avoid anxiety.
‒ In the Interpersonal Theory, each stage prepared the personality for the next
stage, and failure to successfully achieve stage activities limited personality
development opportunities for a successful life.

 SOURCES OF MOTIVATION:
‒ The pursuit of satisfaction
‒ Similar to Freud’s homeostatic hunch that, human beings want to
maximize pleasure and minimize displeasure.
 ‒ The pursuit of security
‒ Main motive is the avoidance of anxiety.
‒ Desire to minimize insecurity that arises from cultural and social needs.

 STAGES OF INTERPERSONAL DEVELOPMENT

1. STAGE 1: INFANCY (birth to 18 months)
‒ The main characteristic of this stage is the gratification of needs.
‒ Primary task: learning to rely on others, especially the primary caregiver
to gratify the physiologic needs.
‒ If needs are not met, a fear-like state occurs, manifested by excessive
cryiong or difficulties eating and sleeping.
‒ Self-image emerge in accordance on how the infant perceives the
mother-infant relationship.
‒ “Good me” feelings occur when acceptance is sensed.
‒ “ Bad me” feelings occur when infant experiences anxiety while
interacting with caregivers. This leads to feelings of inferiority and
depression.
2. STAGE 2. EARLY CHILDHOOD (18 months to 6 years)
‒ Children are able to communicate well with others, thereby facilitating
interpersonal relationships.
‒ Excess parental disapproval may cause children to view themselves and
the world negative and hostile.
3. STAGE 3 LATE CHILDHOOD/JUVENILE ERA ( 6 to 9 years old)
‒ from grammar school years to needing a close relationship with another
& development of sexual identity
‒ living with peers
‒ learns to pay attention to other’s wishes, from satisfying relations with
peers of both genders, and sometimes oppose rules
4. STAGE 4: PRE ADOLESCENCE (9 to 12 years)
‒ need to develop a close relationship with a peer
- “chums” are very important to test trust, develop feelings of worthiness &
likeability. This special friend or “chum” allows participation in genuine
love relationship with another, furthers self-identity and help develops
concern for others.
- most important stage, because a child learns to establish relationships
without the presence of lust (which Sullivan believes is self-satisfying)
5. STAGE 5: EARLY ADOLESCENCE (12 to 15 years)
‒ several “chums”
‒ need for sexual expression. Self-worth is almost synonymous with
sexual attractiveness & acceptance of the opposite sex
‒ rebellion, dependence, cooperation and collaboration are exhin=bited
when early adolescents become more independent.
6. STAGE 6: LATE ADOLESCENCE (15 to 19 years)
‒ friendship combines with sexual relationship
‒ Initial feeling of love to opposite sex emerges

7. STAGE 7: ADULTHOOD (19 years old and above)

‒ able to establish relationships of love for another, wherein the other
person is as significant (or nearly as significant) as one’s self
 B. F. SKINNER OPERANT CONDITIONING THEORY
 Involves behavioural changes due to negative (punishment) or positive
(reinforcers) consequences rather than just the occurrence of a stimulus.
 Positive reinforcement: friendly smiles, praise or special treats/privileges.
 Punishment : criticisms. A frown, or withdrawal of privileges.
 If behaviour is rewarded, the likelihood of it reoccurring increases: if behaviour is
punished, chances are it will not reoccur.
 DEVELOPMENTAL MILESTONES
A. INFANCY (0-12 months)
‒ PLAY:Solitary, non-interactive (begins at 4 months)
‒ BEST TOYS: mobiles, teethers, music box, rattles
‒ FEAR: Stranger anxiety
‒ Begins at 6-7 months
‒ Peaks at 8 months
‒ Fades at 9 months
B. NEONATE (0-28 days)
‒ Largely reflexes
‒ Complete fisted
‒ Cries without tears
‒ Visual fixation for human face
C. 1 MONTH
‒ Looks at mobiles
‒ Prefers checker boards with angles and not pastel colors with contours
‒ Hang at least 8 in. (20 cm) from head
D. 2 MONTHS
‒ Holds head up when in prone
‒ (+) Head lag when pulled to sitting position
‒ (+) Social smile
‒ Cries with tears
‒ Closure of posterior fontanel (2-3 months)
E. 3 MONTHS
‒ Holds head and chest up when in prone
‒ Follows object past midline
‒ Palmar grasp and tonic neck reflexes are fading
‒ (+) Hand regard
‒ Coos, babbles
F. 4 MONTHS
‒ Turns from stomach to back, needs space to turn
‒ Complete head control when pulled to sitting position
‒ Solitary play begins
‒ Laughs aloud
‒ Recognizes mother
‒ Rooting reflex disappear
G. 5 MONTHS
‒ Assumes crawling stance
‒ Places objects in mouth (give teething rings)
‒ Handles rattle well
‒ Moro reflex disappears (4-5 months)
‒ Reaches out to be held
‒ Cries when toy is removed
H. 6 MONTHS
‒ Rolls from back to stomach
‒ Sits with support
 ‒ Starts to move from crawling stance
‒ Handles bottle well
‒ Says vowel sounds “ah”
‒ Eruption of first temporary teeth then a tooth every month thereafter
(first two lower central incisors)
‒ Exhibits stranger anxiety
‒ Doubles birth weight
‒ Object permanence
I. 7 MONTHS
‒ Rocks from crawling stance
‒ Transfers object from hand to hand
‒ Likes object that is good in size
‒ Bites aggressively
‒ Resist unwanted food/object
‒ Cries when mother leaves
J. 8 MONTHS
‒ Sits without support
‒ Uses pincer grasp
‒ Peak of stranger anxiety
‒ Responds to often used words
‒ Plantar grasp (8-9 months) and Babinski disappear
K. 9 MONTHS
‒ Creeps and crawls extensively
‒ (+) Neat pincer grasp
‒ Combines 2 syllables (Mama, Dada, Yaya)
L. 10 MONTHS
‒ Pulls self to stand, holding on to furniture
‒ Understands the word “no” and simple commands; aware of approval
and
‒ Disapproval
‒ Responds to own name
‒ Play peak-a-boo, pat-a-cake
M. 11 MONTHS
‒ Stands with assistance
‒ Cruising
‒ Ability to push toys
N. 12 MONTHS
‒ Stands alone
‒ Walk with support
‒ Triples birth weight
O. 15 MONTHS
‒ Walks without support
‒ Grasp spoon
‒ Learns by repetitive experience and by trial and error
P. 18 MONTHS
‒ Walks upstairs with one hand held
‒ Able to remove shoes and socks, tries to put shoes on
‒ Drinks from cup without spilling
Q. 24 MONTHS
‒ Walks up and down stairs 1 step at a time
‒ Rides bicycle
‒ Draws vertical strokes egocentric thinking evident in speech and play
R. 30 – 35 MONTHS
‒ Jumps on both feet
‒ Complete set of 20 deciduoud teeth
 ‒ Brushes teeth
‒ Temper tantrums, negativism and dawdling behaviors subsides
‒ Separation fears

OTHER SALIENT POINTS:

 POT BELLIED – appearance of this feature is due to lack of abdominal
development.
 RITUALISM – the need to maintain sameness. If rituals are disrupted the child
experiences stress.
 FOOD JAGS – eating the same food for a period of time. Example: eating
chicken for breakfast, lunch and dinner.
 DAWDLING – indicates ambivalence. Having difficulty deciding on how to
respond to their conflicting wishes.
 NEGATIVISM/TEMPER TANTRUMS – expression of toddler’s search for
autonomy.
‒ Caregivers are advised to ignore the behaviour unless safety is
compromised.
‒ Reduce the opportunity to say “no”.
 TOILET TRAINING – major task in toddlerhood.

ASSESSMENT FOR TOILET TRAINING READINESS

Physical Readiness o Voluntary control of anal and urethral sphincter
o Ability to stay dry for 2 hours
o Regular bowel movements
o Motor skills of sitting, walking and squatting
o Fine motor skills to remove clothing
Mental Readiness o Recognizes urge to defecate and urinate
o Verbal and non verbal cues
o Cognitive skills to imitate appropriate behaviour and
follow directions
Psychologic o Expresses willingness to please parents
readiness o Able to sit in toilet for 5 to 10 minutes without fussing
or getting off
o Curiosity about adults or older sibling’s toilet habits
o Impatience with wet or soiled diapers;desire to be
changed immediately
Parental readiness o Recognizes child’s level of readiness
o Willing to invest the time required for toilet training
o Absence of family stress or change such as moving;
new sibling or imminent vacation.

HEALTH PROMOTION AND MAINTENANCE IN INFANCY

NUTRITION AND INFANT FEEDING

Breastfeeding
o Promotes mother-infant bonding
o Convenient
o Easily digestible for the infant
o Have immunoglobulin and
antibodies
o Cost effective
o Nurse at least 10-15 minutes on
each side of the breast
Bottle feeding
o Less demanding to the mother
o Allows father to participate in
infant care
o Digested slowly
o Formula should be iron-fortifies.
o Be sure formula is diluted
 o Do not use soap or alcohol on
breast or nipples. Clean with
water during showering or
bathing.
o Baby’s urine should be yellow
with soft yellow stools.
o Burp baby between and at the
end of each feeding.
correctly if in concentrated or
powder form. Never add more or
less water to the formula than is
recommended by the
manufacturer because this can be
dangerous to the newborn.
o Do not allow the newborn to drink
from a bottle for long periods,
especially when sleeping.
“Nursing bottle syndrome”

INTRODUCTION OF SOLID FOODS

 Earliest time to introduce food is 4 months.
 Guide for Introduction of solid foods
Age Food group Foods to include
4-6 months Cereal Rice, oatmeal
6-8 months Strained/mashed squash, sweet
Vegetables potato, green bean, carrots

Strained/mashed applesauce,
Fruits bananas, pears, peaches

Juices
8-10 months Meals Strained/pureed lamb, beef, veal,
liver, turkey, chicken
10 months Egg yolks
8-12 months Finger foods Rule of thumb: pieces should be
the size of the infants thumb

INFANT SAFETY AND INJURY PREVENTION

Type of injury Safety measures
Falls o Keep crib rails up at all times
o Never leave infant unattended on high surface
Drowning o Never leave infant unattended in bath tub, pool,
yard, or playground
o Never leave unattended in the bathroom
Burns o Keep infant away from hot water
o Always check bathwater temperature
o Do not hold or drink hot liquids when holding infant
o Avoid extended hours of sun exposure
o Protect child from electrical sources
Strangulation o Do not tie anything to crib
o Keep infant’s crib away from curtain or blind cords
o Do not tie any string around infant’s neck
Motor Vehicle accident o Use only an approved infant-restraint system in the
car
o Do not leave infant unsecured in car seat
o Always put car seat in the back seat facing rear.
Choking o Keep small object out of reach
o Never leave infant unattended on the floor
o Use caution when introducing solid foods
Suffocation o Do not use large pillows on the infant’s bed
o Keep plastic bags/wrap out of reach
 HEALTH PROMOTION AND MAINTENANCE IN TODDLERHOOD
 NUTRITION
‒ Toddler’s ability to chew and swallow, as well as use utensils also improves
during this time.
‒ Food jags occur
‒ Offer small amount of food initially. Toddler will ask for more if still hungry.
‒ Nurse should teach the mother to be reminded of the child’s ritualistic
behaviour.
 DENTAL CARE
‒ 2 years old is the best time to start dentist visits (Jaques, 1993)
‒ Supervision is needed when toodlers are learning to brush their teeth.

SAFETY PROMOTION AND INJURY PREVENTION

Types of injury Safety measures
Motor vehicular o Teach to stay off streets
accidents o Use appropriate car seat and do not allow child in
front of vehicle with air bags
o Provide fence play area
Falls o Don’t run with anything protruding in the mouth
o Use gates in stairways
o Remove scattered rags and toys
o Teach child to wear bike helmet when riding a
tricycle
Aspiration o Check all toys for small, removable parts
o Avoid popcorn, nuts, hard candy
Burns o Keep iron and electrical sockets and wires away
from child’s reach
Ingestion/poisoning o Store poisonous substances on original containers
and out of reach.
o Do not refer to medications as candy
o Keep phone number of poison control available at
all times
Drowning o Provide close supervision around water

HEALTH PROMOTION AND MAINTENANCE IN PRESCHOOLER

 NUTRITION:
‒ At age 3, the child should be eating table foods
 PREPARATION FOR SCHOOL
‒ Practice school type activities
‒ Stay with the child on the first day of school.

KEY POINTS:
 Provide a safe, clear space for kids.
 A million toys aren't necessary.
 Make the play area the child's domain.
 Childproof the area to allow maximum exploration without restrictions.
 Store building blocks or little cars in shoeboxes on a shelf at the child's height for
easy access and cleanup.
 Rotate toys to keep children from getting bored with the selection.
 Building blocks allow a child to build anything he chooses. (simple to complex)
 Avoid toys that do a child's imaginary work for him. Scaled-down adult objects
are often the best toys for kids. Small hammers, screwdrivers, pots, pans, or
telephones intrigue toddlers because they are "just like Mom's and Dad's."
 Play with children, especially during their early years. Create a playful
atmosphere.
 Avoid over stimulating children, particularly babies. Babies will signal when
they've had enough stimulation by crying or looking away.
 Be sure to choose playthings according to your child's age and abilities. Your
child will feel helpless rather than challenged if you provide toys designed for an
older and bigger child.
 Value your child's play. "I like the way you play."

Age group Recommended Safety concerns Other salient

appropriate toys points
Infancy Large, colorful Choking hazards Sensory
(Solitary play) mobiles stimulation
Musical toys
Toddler Requires movements Poison/hazardous Negativistic
(Parallel play) Musical/noise substances possessive
tricycles Electrical/fire hazards temper tantrums
fairy tales separation
anxiety
rituals
parallel play
pets ( e.g.
turtles)
Pre-school Trick or treat Same as toddlers Engage in
(Associative Dressing-up fantasies
play) Costume parties very curious
fairy tales Are very
coloring and writing physical &
materials unaware of their
strength
Group play
School age Art materials and all Fractures Teacher and
(Cooperative those that enhance friends as
play) skills important people
Adolescence Collections Vehicular accidents Friends as the
All activities geared Drugs most influential
towards search for Sexual concerns On matters of
identity money