Revision

As of 2015 –
•196 countries
•Although having signed the convention the United States has not yet ratified the convention

Two or more individuals who are joined together by marriage, birth or adoption and live together in the same
household. (US census Bureau 2013 in Ball, Bindler & Coewn, 2015)
•A family is what an individual considers it to be (Hokenberry, Wilson & Rodgers 2015)

Nuclear family
•Blended Family
•Extended family
•Single Parent Family
•Heterosexual cohabiting Family
•Binuclear family
•Polygamous Family
•Communal Family
•LGBT Family
Protect – from harm (physical, psychological etc.)
•Provide – for basic needs (food, shelter, clothing, etc)
•Nurture – socialize as to accepted norms and values of the family, community and society as a whole
•Discipline – as relates to rewards, correction and punishment
•Support – growth and development ( physical, psychological, cognitive, emotional, spiritual etc.)

The family is a constant in the child’s life & partner in the child’s health care
•The family, child and health professionals work together in partnership ( collaborative)
•Communication is ongoing and therapeutic
•The racial, ethnic, cultural and socioeconomic background of the family is respected and honoured
•Health information/ education must be available

Goal- Improve the quality of life by improved quality of healthcare

For children and their families

•Educate- health promotion& maintenance

•Advocacy- Protect rights (Non malifecence)
•Care-giver
. EPI
•Dental services
•Pediatric clinics
Human trafficking
•Violence and abuse
•Obesity
•Addiction
•Child labour

STAGE TASKS

Navigating how to live together.

Married couple without children Adjusting relationships with families-of-origin and social networks to
include a partner.
 STAGE TASKS

Preparing and adjusting the family system to accommodate children.

Childbearing families with the oldest child
Developing roles as parents.
between birth and 30 months.
Redefining roles with extended families.

Socializing, educating and guiding children.

Families with preschool children. Assessing and adjusting parenting roles as children age and more
children join the family.

Providing guidance to children while collaborating with outside

Families with school-age children.
resources (e.g., school, extracurricular activities).

Adjusting parent-child relationships with adolescents to provide more

Families with adolescents. independence with safe limits.
Tending to parents’ midlife relationship and career issues.

Navigating adult-to-adult relationships with children.

Launching families (first to last child is
Resolving midlife issues.
leaving home).
Caring for aging family members.

Middle-age families (“empty/spacious Adjusting to being a couple without children living at home.
nest” to retirement). Caring for aging family members.

Aging families (retirement to death of both Learning new roles related to retirement, becoming grandparents,
spouses). losing a partner, and health-related changes.

 Duvall’s theory is based on the traditional, nuclear, intact family.

 Families will move through each stage in order across time.
  A family will move from one stage to the next after all members successfully master the tasks within a
stage.


Family system theory- wholeness & interaction

•Family Stress theory- reaction and adaptation to stress

•Family developmental theory – change over time
HEALTH PROMOTION STRATEGIES IN CHLDREN

Divisions of childhood
•Neonate ‒ birth-28 days
•Infant ‒ 29 days-1 year
•Toddler ‒ 2-3 years
•Pre-school child ‒ 4-5 years
•School child ‒ 6-12 years
•Adolescent ‒ 13-18 years

Health Promotion strategies for Neonate -Play

•• Tactile stimulation
•• Visual stimulation
•• Use of sound
•• Education (caregiver)

NEONATE- Bonding
•• Wanted/Unwanted child
•• Relationship between infant & parents/family
•• Family support

NEONATE-
Psychosocial/economic status
•• Rooming-in
•• Breast feeding
•• Child/parent (s) dynamics
NEONATE - NUTRITION

•• Breast feeding
•• Alternative to breast milk
•• Weight gain
•• Nutrition education

NEONATE- EXERCISE

•• Freedom of movement
•• Positioning
School Aged & Adolescent
•Growth & Development – learning about their bodies
•Nutrition – independence and formation of habits that influence future
•Physical activity- crucial in the development of lifelong exercise habits
•Oral health
•Mental & spiritual health- self concept & self esteem
•Sleep & rest
•Disease Prevention
•Injury Prevention

Functions of Play
•Natural medium for expression and communication
•Aids in physical growth and development
•Educational
•Recreational- releases surplus energy
•Aids in social & emotional development
•Therapeutic - reduces stress

Types of play
•Onlooker play
 •Solitary
•Parallel

•Associative

•Co Operative

Freud's 5 Psychosexual Stages

Oral Stage (Birth to 1 year)
Anal Stage (1 to 3 years)
Phallic Stage (3 to 6 years)
Latency Stage (6 to puberty)
Genital Stage (puberty to adult)

Freud also believed that all tension was due to the build-up of libido (sexual energy) and that all pleasure came from its
discharge.

Psychosexual Stages of Development

Erik Erikson's Stages of Psychosocial Development

Stage Psychosocial Crisis Basic Virtue Age

1. Trust vs. Mistrust Hope 0 - 1½
2. Autonomy vs. Shame Will 1½ - 3
3. Initiative vs. Guilt Purpose 3-5
4. Industry vs. Inferiority Competency 5 - 12
5. Identity vs. Role Confusion Fidelity 12 - 18
6. Intimacy vs. Isolation Love 18 - 40
7. Generativity vs. Stagnation Care 40 - 65
8. Ego Integrity vs. Despair Wisdom 65
Piaget's Stages of Cognitive Development

Jean Piaget's theory of cognitive development suggests that intelligence changes as children grow. A child's cognitive
development is not just about acquiring knowledge, the child has to develop or construct a mental model of the world.
Cognitive development occurs through the interaction of innate capacities and environmental events, and children pass
through a series of stages.

Piaget's theory of cognitive development proposes 4 stages of development.

 Sensorimotor stage: birth to 2 years
 Preoperational stage: 2 to 7 years
 Concrete operational stage: 7 to 11 years
 Formal operational stage: ages 12 and up

Piaget’s Four Stages

Stage Age Goal

Sensorimotor Birth to 18-24 months Object permanence
Preoperational 2 to 7 years old Symbolic thought
Concrete operational Ages 7 to 11 years Logical thought
Formal operational Adolescence to adulthood Scientific reasoning

Kohlberg's Theory of Moral Development

Kohlberg's theory proposes that there are three levels of moral development, with each level split into two stages. Kohlberg
suggested that people move through these stages in a fixed order, and that moral understanding is linked to cognitive
development. The three levels of moral reasoning include preconventional, conventional, and postconventional.

Stages of Moral Development

Preconventional morality is the first stage of moral development, and lasts until approximately age 9. At the preconventional
level children don’t have a personal code of morality, and instead moral decisions are shaped by the standards of adults and
the consequences of following or breaking their rules.
Stage 1. Obedience and Punishment Orientation. The child/individual is good in order to avoid being punished. If a
person is punished, they must have done wrong.
• Stage 2. Individualism and Exchange. At this stage, children recognize that there is not just one right view that is handed
down by the authorities. Different individuals have different viewpoints.

Level 2 - Conventional morality

Conventional morality is the second stage of moral development, and is characterized by an acceptance of social rules
concerning right and wrong. At the conventional level (most adolescents and adults), we begin to internalize the moral
standards of valued adult role models.
Authority is internalized but not questioned, and reasoning is based on the norms of the group to which the person belongs.
A social system that stresses the responsibilities of relationships as well as social order is seen as desirable and must,
therefore, influence our view of what is right and wrong.

• Stage 3. Good Interpersonal Relationships. The child/individual is good in order to be seen as being a good person by
others. Therefore, answers relate to the approval of others.
• Stage 4. Maintaining the Social Order. The child/individual becomes aware of the wider rules of society, so judgments
concern obeying the rules in order to uphold the law and to avoid guilt.

Level 3 - Postconventional morality

Postconventional morality is the third stage of moral development, and is characterized by an individuals’ understanding of
universal ethical principles. These are abstract and ill-defined, but might include: the preservation of life at all costs, and the
importance of human dignity.
Individual judgment is based on self-chosen principles, and moral reasoning is based on individual rights and justice.
According to Kohlberg this level of moral reasoning is as far as most people get.
Only 10-15% are capable of the kind of abstract thinking necessary for stage 5 or 6 (post-conventional morality). That is to
say, most people take their moral views from those around them and only a minority think through ethical principles for
themselves.

Stage 5. Social Contract and Individual Rights. The child/individual becomes aware that while rules/laws might exist for
the good of the greatest number, there are times when they will work against the interest of particular individuals.
The issues are not always clear-cut. For example, in Heinz’s dilemma, the protection of life is more important than breaking
the law against stealing.
• Stage 6. Universal Principles. People at this stage have developed their own set of moral guidelines which may or may
not fit the law. The principles apply to everyone.
E.g., human rights, justice, and equality. The person will be prepared to act to defend these principles even if it means going
against the rest of society in the process and having to pay the consequences of disapproval and or imprisonment. Kohlberg
doubted few people reached this stage.

Cancer in children differ from cancer in

adults
•They arise from mesodermal
and neuroectodermal tissue
•Results in leukemias, lymphomas,
sarcomas or CNS tumors
•Adult cancers arise mostly from
epithelial cells
Warning signs
•Mostly related to changes in blood cell
production or as a result of
compression, infiltration or obstruction
caused by a tumor
COMMON MANIFESTATIONS
•Pain
•Cachexia
•Anaemia
•Infection
•Bruising
•Neurologic symptoms
•Palpable mass

CACHEXIA
•A syndrome characterized by
anorexia, weight loss, anemia,
asthenia (weakness) and early
satiety.
TYPES OF CHILDHOOD CANCER
•NEUROBLASTOMA
•WILM’S TUMOR
•OSTEOSARCOMA
•EWINGS SARCOMA
•LEUKEMIA
•HODGKIN DISEASE
•RABDOMYOSARCOMA
•RETINOBLASTOMA

NEUROBLASTOMA
•Tumor occurring outside the
cranium
•15% cancer deaths in children
•A smooth hard non tender mass
along the sympathetic nervous
system chain
•Found in abdomen, adrenal,
thoracic and cervical areas
•Cause unknown

NURSING MANAGEMENT
•Assessby observation and
inspection, palpation is contraindicated
•Monitor vital signs and bowel function
•Observe gait and coordination
•Monitor weight and height and compare to
previous readings