PEDIATRIC NURSING

STAGES OF DEVELOPMENT   The process of maturation 

Infant
 Age: 1-12 months
 Psyche (Sigmund Freud): up to 18 months old
 Freud: oral stage (gratify mouth)
o Via breastfeeding by the mother
 Erickson: trust vs. mistrust
o Will feel consistency when needs are met
therefore achieving trust
 Neonate: 0-28 days old
 Key concept (observable during infancy):
 Fastest
o Growth pattern
o Development  
GROWTH
Changes:
 Size:
 Weight:
o Filipino Child (N): 2500g - 3500g or 2.5kg - 3.5kg
o >3500 grams: LGA/Macrosomia d/t GDM
 ↑Sugar→ placenta→ fetus (consumes
excessive sugar of the mother) → macrosomia
(hypoglycemic baby)
 PRIORITY: monitor blood sugar
 Blood is collected at the corner of the
heel of the baby
 Normal adult blood sugar: 70-110 mg/dl
 Normal newborn blood sugar: 40-60
mg/dl
 d/t size and body mass
 ↑Sugar during pregnancy→ delivery→ fetus is
removed from hyperglycemic environment→
hypoglycemia (dangerous)
 Sugar is used for heat production
 ↓Sugar→ ↓heat production→
hypothermia (fatal effect)
o <2500 grams: SGA/Microsomia d/t Smoking
(**PIH, Alcoholism)
 Nicotine→ vasoconstriction of the blood
vessels
 Nutrients and oxygen come from the maternal
blood→ placenta→ umbilical cord
 Umbilical cord: 3 blood vessels (2
arteries, 1 vein - AVA)
 Small diameter blood vessel -
umbilical arteries
 Large diameter blood vessel -
umbilical vein
 Larger because the umbilical
vein carries the oxygenated
blood during pregnancy
 Secondhand smoking can also lead to SGA
 Length:
o Proper positioning for accurate measurement:
SUPINE
o Tape measure is used (cm)
o Normal birth length: 45-55 cm
 Other Name:
 Quantitative Changes (measurable)
 Parameters:
 Criteria to determine the growth
 Weight:
o More important & most sensitive
o Operation Timbang
o To consider in drug dosages
o Males are expected to be heavier at birth because
of larger body mass
 Height:
o “Vertical or linear growth”
o Males are expected to be lengthier at birth because
of larger body mass
DEVELOPMENT
Changes:
 Skills or capabilities of the child
 Ability to sit, stand, walk
 Language
 Every child is unique in skills
Other name:
 Qualitative changes (measurable) 
 Assessment Tool for foreigners: DDST (Denver
Developmental Screening Test) - set of exams to
evaluate the development of a foreigner child 
 Assessment Tool for Filipinos: MMDST (Metro
Manila Developmental Screening Test) - designed for
pattern of development of Filipino children
Consider the environment of the child in utilizing the
assessment tool
 Genetic factor is used as a basis for assessment tool
Parameters:
 Gross motor skills
 Fine motor skills
 Language
 Social Skills
 Prone to have Autism if not developed
o First born Male  
 Second born children regardless of gender, have a risk
for developing schizophrenia d/t criticisms,
comparisons :<<
Gross Motor Development
 Cephalo-caudal development (head to toe)
 0-1 month: head lag
 Head and neck muscles are not well developed.
Supporting the head is a must
 (+) head lag 2 months: abnormal
o d/t fluid accumulation (hydrocephalus)
 2 months: lift the head (prone position)
 4 months: lift the chest
 SIDS (sudden infant death syndrome): d/t improper
positioning of the baby 
o Prone position causes suffocation→ sudden
death
 Decreased risk for SIDS at 4 months
 5 months: roll over (prone to supine)
 WOF: Risk for fall
 6 months: sit with support
 Provide chair for stability 
 7 months: bouncing 
 Bouncing foot towards the mouth→ sucking
 Benefit: strengthen the muscle→ preparation for
standing and walking (stretch muscles of the leg)
 8 months: sit without support (sit alone)
  Balance in the upper and lower body
 9 months: crawl 
 10 months: stand with support
 11 months: cruising
 Cruising - hold two arms of the baby
 Walk with support - hold one arm of the baby
 12 months: 
 Stand without support (stand alone)
 Walk with support 
 15 months: walk without support (walk alone)
 18 months: jump
 3 years old: run
 Appropriate bike: tri-bike 
Fine Motor Development
 Proximo-distal development (hands)
 1-3 months: close fist
 5 months: close and open hands / hold
 Toy: Rattle (sensory development)
o Colorful stimulating sense of sight
o Creates sound developing sense of hearing
 7 months: ability to transfer object from one hand to  This is good, because providing options
another enhances the sense of autonomy of the
 Skill: Crude Pincer Grasp child 
 9 months: Neat Pincer Grasp  Toilet training
 Thumb and pointing finger are controlled o Anal stage (Freud): gratify anal area
 Pick tiny objects  Toilet training will become a ritualistic
 Oral stage of development: sinusubo; risk for behavior
choking, aspiration, poisoning (WOF) o Start at: 18 months and above 
 12 months:  Maturation of the sphincters 
 Throwing the ball  Bowel control first then bladder control 
o Benefit: promote walking  1. Daytime bladder control
2. Nighttime bladder control
 Hold spoon
o Toothbrushing 
 2 years old: draw lines (vertical and horizontal)
 Ritualistic behavior that will be taken up until the
 3 years old: draw circle, curve, cross toddler grow 
 4 years old: draw square, rectangle (4-sided objects)  Start at: 30 months old
 5 years old: draw triangle, diamond, star (has pointed  Deciduous teeth
parts/apex)  Other name: milk teeth/ temporary teeth
 6 years old: draw all shapes o Adult permanent teeth = 32 teeth
 Complete set: 20 milk teeth 
Language Development
o Upper portion: 10 milk teeth
 First language: cry
o Lower portion: 10 milk teeth
 Determine hunger, wet diaper (basic needs)
o Observed at 30 months
 Characteristics:
 Toothbrushing
o Loud/vigorous/strong cry - NORMAL 
 Provide pear if the toddler refuses to
o High pitched cry – ABNORMAL
brush their teeth 
 Indicates: IICP d/t hydrocephalus   Contains tiny fibers that brushes the
 1-2 months: cry (open mouth) teeth when bitten
 Produce loud cry  Apple causes staining of the teeth 
 3 months: cooing sounds  Given to children with asthma
 4 months: vowel sounds d/t hypoallergenic effect 
 5 months: consonant sounds   Dental check up 
 7 months: mmm cry (close mouth; humming)  First eruption: 6 months
1-7 months: more on sounds language o Solid foods are offered 
o 2 lower central incisors
 9 months: 2 words o Common discomforts:
 Mama: for PNLE  Fever  
 Dada/papa: for NCLEX   Provide Tepid Sponge Bath
 12 months: 4 words  Paracetamol/antipyretic every 4 hours
 Mama  Pain 
 Dada/papa   Cold Teether for anesthetic effect 
 The additional 2 words depending on the child’s  Diarrhea 
environment (what they hear)  At risk for dehydration
 2 years old: 50 words  Continue breastfeeding (enough to
 Prolonged exposure to gadgets delay social provide hydration)
development and may lead to autism  Second eruption: 7 months
 3 years old: 100 words o Upper central incisors 
 4 years old: 200-300 words  Third eruption: 9 months
o Upper lateral incisor 
TODDLER  Start to loosen: 6-7 years old
 Age: 1-3 years old  o d/t sugar (formula milk - high sugar content)
 Freud: Anal stage o Delayed (bad assessment) causes crooked teeth 
 Erickson: psychosocial (autonomy vs shame & doubt) o Maximum of 2 milk teeth per day can be
 Key concept (observable): RENTT removed to prevent bleeding
 Ritualistic behavior (habitual activities)  Natal teeth - teeth present at birth d/t excessive
o Has favorite toy, pillow calcium intake of the mother during pregnancy (rapid
o Security objects  bone & teeth development of the fetus)
o Temper tantrums o 1-2 can be observed
 Will act out frustrations when favorite o Lower central incisors 
toy/pillow has been misplaced o Management: check if the teeth is loosen
 Language is not well developed (cannot  Dangerous if loosen d/t risk of aspiration 
verbalize frustrations, emotions)  Needs to be extracted
 Management: 
1. Ensure safety (priority) PRESCHOOLER
 Provide helmet/pillow for  Age: 4-6 years old 
protection of the head (head  3+ (e.g., 3 years and 1 month): preschooler 
banging)  Key concept (observable): MISY
2. Ignore the behavior   Magical Thinking: Imaginary friend (normal until 6
 Temper tantrums are done to gain years old ONLY)
attention o Exaggerated imagination 
 Egocentric: self centered o Fear: body mutilation 
o Possessive (mine)  Cover wounds 
o Parallel play   Imitative behavior 
 Negativism o Role play
o They always reply with “No”  Sharing (good boy/good girl)
o Management: o Cooperative/associative play 
 Provide options/choices  Y (why?)
o 200-300 question per day (Pilliteri)