Maternal and Child Health Nursing Growth and Development Module

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Maternal and Child Health Nursing- Growth and Development

Module
Nursing (Western Mindanao State University)
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NCM 107 A (CARE OF MOTHER, CHILD AND ADOLESCENTS (WELL CLIENT)
GROWTH AND DEVELOPMENT
Desdimona C. Sakandal, RN, RM, MN
Course Facilitator

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Table of Contents
A. Theoretical approaches to the growth and development of children.
B. Nursing process for promotion of normal growth and development.
1. The family with an infant
2. The family with a toddler
3. The family with a preschooler.
4. The family with a school aged child.
5. The family with an adult adolescent.
LESSON 1 : Principles and Theoretical Approaches to the Growth and Development of Children.
INTRODUCTION :
Growth and development is a lifelong process. It is a continuum that

involves the different concepts and theories which applies to the child’s growth and
development pattern. It highlights the psychosocial, cognitive and moral aspects as well
as the physical growth and maturation in various stages from newborn to adolescence. It
provides relevant information which will guide us in understanding the different changes
that occurs as the child moves along the life stages and specific nursing implications in
dealing with these changes.
OBJECTIVES : At the end of this module, you should be able to;
1. Differentiate growth from development.

2. Explain the general principles of growth and development.
3. Describe the different theoretical approaches
of the child’s psychosocial, cognitive and moral
development across stages.
4. Apply these theoretical approaches in the care of the child in various
stages of growth and development

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Try this!
Read and understand the following statements. Indicate which of the general principles of
growth and development best describe the statements.
5. Growth is from small to big and follows a certain sequence or order.

➢ Growth and development proceeds in an orderly sequence
6. Development begins with the head ending with the tail.
➢ Development is cephalocaudal.
7. Systems of the body vary in their period of development and
functioning.
➢ All body systems do not develop at the same rate.
8. Tasks are learned at the appropriate time.
➢ There is an optimum time for initiation of experience or learning.
9. New skills are learned and new cell grow continuously.
➢ Growth and development are continuous processes from conception until death.
10. A child learns to hold before he/she can write.
➢ Development proceeds from gross to refined skills.
11. Two children may both learn to walk at different time range.
➢ Children pass through the predictable stages at different rates.
12. A child learns to hold things once the grasp reflex disappears.
➢ Neonatal reflexes must be lost before development can proceed.
13. A child attempts to take a few steps, walk and may fall several times in
order to accomplish the skill of walking.
➢ A great deal of skill and behavior is learned by practice.

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Think ahead!
A. Think of at least three (3) factors which may influence a child’s growth and development and
support your answer by providing an example.
FACTORS EXAMPLES
1. GENETICS ➢ In my case, my father is tall while my mother is short. I

ended up splitting the difference by having an average
height.
➢ I got my father’s light brown eyes since the dominant
light brown eye gene was from my father and my mother
handed down a recessive russet brown eye gene, the
dominant gene will win out.
➢ Other genetic abnormalities and diseases such as Down
syndrome also influence how a child grow and develop.
2. GENDER ➢ Girls like me usually undergo puberty earlier than boys

but are shorter and lighter in weight than boys as
puberty ends due to their biological difference.
3. ENVIRONMENT ➢ Enriching and stimulating home environment is

conducive to growth and development by providing a
child with love, emotional support, and opportunities for
learning and exploration. However, for children from
families with low socio – economic status or orphans
without parents often have limited economic and
emotional resources which affects the growth and
development of a child.
B. Complete the table below by indicating the appropriate answers based on Freud’s and Erikson’s
Theories of Personality Development.
STAGE DEVELOPMENTAL TASK PSYCHOSEXUAL STAGE
Infant Trust vs. Mistrust Oral Stage
Toddler Autonomy vs. Shame and Doubt Anal Stage
Preschooler Initiative vs. Guilt Phallic

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School-Age Child Industry vs. Inferiority Latency
Adolescent Identity vs. Role Confusion Genital
C. Identify the appropriate moral development based on Kohlberg’s Theory being described in the
following sentences.
Level II: Conformity and Interpersonal Accord 1. The focus of behavior is not what is right or wrong but
what is “nice”.
Level III: Universal Principles 2. Internalizes standards of conduct, doing what he or she thinks is right
regardless of an existing social rule.
Level I: Self-Interest 3. The child tries to imitate doing gestures or behaviors only for gestures in return.
Level I: Obedience/Punishment 4. Punishment-obedience orientation, easily governed by parental

authority.
D. Matching Type: Match Column A (Piaget’s Stages of Development) with Column B (description
of Piaget’s Stages), write the letter corresponding to your answer on the space provided.
COLUMN A COLUMN B
C. 1. Sensorimotor A. Thinking in terms of what could be than

what currently exist
E. 2. Preoperational thought B. Inductive reasoning, from specific to

general
_ _D__ 3. Intuitive thought C. Development of the concept of

permanence and goal-directed behavior
__ B _ _ 4. Concrete operational thought D. Object viewed as having only one

characteristics
__A __ 5. Formal operational thought E. Symbolic thought, egocentric and static

thinking

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Read and Ponder
• Growth – refers to a quantitative change; an increase in height and weight. Process of physical
maturation resulting to an increase in body size and various organs.
• Development – denotes a qualitative change; one’s maturation or skills development; an
increase in one’s ability to perform tasks.
GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT :
1. Growth and development are continuous processes from conception until death.
2. Growth and development proceeds in an orderly sequence.
3. Children pass through the predictable stages at different rates.
4. All body systems do not develop at the same rate.
5. Development is cephalocaudal.
6. Development proceeds from proximal to distal body parts.
7. Development proceeds from gross to refined skills.
8. There is an optimum time for initiation of experience or learning.9. Neonatal reflexes must be lost
before development can proceed.
10. A great deal of skill and behavior is learned by practice.
Factors Influencing Growth and Development:
1. Genetics – eye color and height potential are determined in one’s genetic make-up upon conception.
This may also include disabilities and diseases.
2. Gender – There are differences in height and weight patterns among boys and girls.
e.g. girls are shorter and lighter in weight than boys as puberty ends.
3. Health – illnesses may interfere with the child’s growth and development process.
4. Intelligence – Children with high intelligence tend to grow and develop their physical skills slower
since they spend much of their time reading or with mind games.
5. Temperament – how a child responds to his environment or situation is innate or congenital.
Categories of Temperament :

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A. The EASY child – has predictable rhythmicity, approach and adapts to new situations readily,
have a mild to moderate intensity of reaction and have an overall positive mood quality.
B. The Intermediate Child – some characteristics of both easy and difficult groups are present C.
The Difficult Child – irregular in habits, have a negative mood quality, and withdraw rather than
approach new sitations.
D. The Slow-to-Warm-Up Child – fairly inactive, respond only mildly and adapts slowly to new situations,
and have a general negative mood
6. Environment – Child’s growth and development can be influenced by the following;

A. Socio-economic level
B. Parent-Child relationship
C. Ordinal position in the family
D. Health
E. Nutrition
Theoretical Approaches to Growth and Development of Children:
• Theory – a systematic statement of principle that provides a framework for explaining a

phenomenon.
• Developmental Theories – provides road maps for explaining human development.
• Developmental Tasks – are skill or a growth responsibility arising at a particular time in an
individual’s life, in which achievement will provide a foundation for the accomplishment of
future tasks.
BASIC DIVISION OF CHILDHOOD :

STAGE AGE PERIOD
Neonate First 28 days of life
Infant 1 month to 1 year
Toddler 1-3 years
Preschooler 3-5 years
School-Age child 6-12 years
Adolescent 13-17 years
Late Adolescent 18-21 years
1. FREUD’S PSYCHOANALYTIC THEORY
• Sigmund Freud (1856-1939) – an Austrian neurologist and founder of psychoanalysis.

• Described adult behavior as being the result of instinctual drives of a primarily sexual nature
(libido)

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• Child development is a series of psychosexual stages in which a child’s sexual gratification

becomes focused on a particular body part at each stage.
https://it3psychproject.wordpress.com/2014/07/19/part-1-1-reaction-on-freuds-theory/
Nursing Implications :
1. Infant – provide oral stimulation by giving pacifiers; do not discourage thumb sucking
2. Toddler – help children achieve bowel and bladder control without undue emphasis on its
importance.
3. Preschooler – Accepts children sexual interest such as fondling his or her own genitalia, as a normal
area for exploration
4. School-age Child – help children have positive experiences with learning so their self-esteem continue
to grow.
5. Adolescent – Provide appropriate opportunity for the child to relate with opposite and own sex
relationship.
2. ERIKSON’S THEORY OF PSYCHOSOCIAL DEVELOPMENT :
• Erik Erikson (1902-1996)

• Stresses the importance of culture and society in development of the personality.
• The person’s social view of self is more important than instinctual drives in determining
behavior.
• Described eight (8) developmental stages across life span which are conflicting or opposing to
each other, wherein resolution of each conflict will allow the individual to progress to the next
phase.

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1. Infant - provide a primary caregiver and experiences that add to security.
2. Toddler – provide opportunities for independent decision-making, such as choosing own clothes.
3. Preschooler – provide opportunities for exploring new places or activities. Allow free-form play
4. School-age Child – provide opportunities such as allowing child to assemble and complete a short
project.
5. Adolescent – provide opportunities to discuss feelings about events important to him or her. Offer
support and praise for decision-making.
3. PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
• Jean Piaget (1896 – 1980), a Swiss psychologist,

• Introduced how children learn and think
• Defined four (4) stages where children progress from one period to the next; children reorganize
their thinking process to bring them closer to adult thinking.

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https://philocyclevl.wordpress.com/13th-lesson-211-stages-in-personality-development/
A. Birth to 2 years
1 month - stimuli are assimilated into beginning mental images; entirely reflexive
1 – 4 months – hand-mouth and ear-eye coordination develop; rattle or tape of parents voice
4 – 8 months – infant learns to initiate, recognize and repeat pleasurable experiences from
environment; good toy-mirror; good play – peek-a-boo
8 – 12 months – infant can play activities to attain specific goals; good toy – nesting toys (e.g. colored
boxes)
12 – 18 months – Child is able to experiment to discover new properties of objects and events; good
game-throw and retrieve
18 – 24 months – Transitional phase to the preoperational thought period; good toys – things with
several uses ( blocks or colored plastic rings)
B. Preoperational Thought
• Thought becomes more symbolic; can arrive at answer mentally instead of through physical
attempt.
• Centering or focusing on a single aspect of an object causes distorted reasoning
• No awareness of reversibility (for every action there is an opposite action) is present
• Unable to state cause and effect relationships, categories or abstraction
• Good toy – items that require imagination (e.g. modeling clay)
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C. Concrete Operational Thought

• Systematic reasoning; uses memory to learn broad concepts (fruits) and subgroups (apple,
banana)
• Classification involves sorting objects according to attributes (e.g. color), seriation (increasing or
decreasing measures like weight) and multiplication.
• Awareness of reversibility (retraces steps); understands conservation (able to discern truth, even
though physical properties change)
• Good activity – collecting and classifying natural objects (e.g.native plants or sea shells)
• Expose child to other view points by asking questions ( e.g. “How do you think you’d feel if you
are a nurse and had to tell a boy to stay in bed?”)
D. Formal Operational Thought

• Can solve hypothetical problems with scientific reasoning
• Good activity – “talk time” to sort through attitudes and opinions
4. KOHLBERG’S THEORY OF MORAL DEVELOPMENT
• Lawrence Kohlberg (1927 – 1987), a German psychologist

• Developed the theory on the way children gain knowledge of right or wrong and moral
reasoning.
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2 – 3 years old – child needs help to determine what are right actions; give clear instructions to avoid
confusion.
4 – 7 years old – child is unable to recognize that like situations require like actions; unable to take
responsibility for self-care because it interferes with meeting own needs.
7 – 10 years old – child enjoys helping others because this is nice behavior; praise for desired behavior
and allow in helping with activities (e.g. house chores).
10 – 12 years old – child often ask what the rules are and if something is right; may have difficulty
modifying a procedure because one method may not be right. Follows self-care measures only if
someone is there to enforce them.
Older than 12 – adolescents can be responsible for self-care because they view this as a standard of
adult behavior
Adulthood – universal ethical principle orientation; many adults do not reach this level of moral
development.
The Metro Manila Developmental Screening Test (MMDST)

- a screening test to note for normalcy of the child’s development and to determine any delays as
well in children 6 ½ years old and below.
- Modified and standardized by Dr. Phoebe Williams from the original Denver Developmental
Screening Test (DDST) by Dr. William K. Frankenburg
MMDST evaluates 4 sectors of development:
• Personal-Social – tasks which indicate the child’s ability to get along with people and to take
care of himself
• Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick up
objects and to draw
• Language – tasks which indicate the child’s ability to hear, follow directions and to speak •
Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump
Explaining the Procedure :
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✓ It has to be emphasized that this is not a diagnostic test but rather a screening test only
✓ When conducting the test, the parents or caregivers of the child under study should be informed
that it is not an IQ test as it may be misinterpreted by them.
✓ The nurse should also establish rapport with the parent and the child to ensure cooperation.
Considerations :
• Manner in which each test is administered must be exactly the same as stated in the manual,
words or direction may not be changed
• If the child is premature, subtract the number of weeks of prematurity. But if the child is more
than 2 years of age during the test, subtracting may not be necessary
• If the child is shy or uncooperative, the caregiver may be asked to administer the test provided
that the examiner instructs the caregiver to administer it exactly as directed in the manual
• If the child is very shy or uncooperative, the test may be deferred
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See if you can do this!
A. Complete the concept map of “I, Me and Myself”
JANELLIE C. RAYMUNDO
"Ambivert"
20 years old
Intimacy vs.
Genital Stage
Isolation
Formal operational Level II: Authority and

This involves an increase in Social Order I started to explore and form
logic, the ability to use Laws and social order relationships with other people
deductive reasoning, an reign supreme. Rules other than my family. I also
understanding of abstract and regulations are to share myself more intimately
ideas to think of potential be followed and with them more often to have
solutions to problems, and obeyed. long-term commitments.
think more scientifically.
B. Case Study:
You are providing care to a 3-year-old child who is admitted due to diarrhea with mild
dehydration and requires an intravenous therapy.
1. Give a description of the typical characteristics of your client’s psychosocial development.
3 years old children like my client are typically full of curiosity, physical exploration, questions and high
energy. They are enthusiastic and intrusive learners. They can balance well (stand on one foot), climb,
explore independently. Their primary drive is to explore the environment in a communicative sense.
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Develop confidence that their worldly enquiries will be met. New emotion of guilt, when actions don't
achieve the desired response.
2. Based on Piaget’s Cognitive development, what would you expect to observe from your client?
The client is expected to be egocentric, which means they have difficulty thinking outside of their own
viewpoints and their thinking is mostly based on intuition rather than logical reasoning. He is also expected
to represent things using words and images. 3 years old children like him usually cannot yet grasp more
complex concepts such as cause and effect, time, and comparison.
LESSON II : Nursing Process for Promotion of Normal Growth and Development
INTRODUCTION :
Physical growth and maturation is an essential concept to allow better understanding of

the normal physiologic and psychological processes from newborn to adolescent stage. Emphasis is placed
on specific parameters and milestones as basis for assessment and planning of appropriate nursing
interventions. The nursing interventions will be aimed towards family support and anticipatory guidance.
OBJECTIVES: At the end of this module, you should be able to;
1. Describe the normal growth and development pattern of the following age group/ stages;
A. Newborn
B. Infant
C. Toddler
D. Preschooler
E. School-Age Child
F. Adolescent
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2. Assess a child for normal growth and development milestones.
3. Integrate knowledge of growth and development with the nursing process to promote efficient and
quality child health nursing care.
Try this!
MATCHING TYPE : Match the terms in Column A with the descriptions in Column B. Write the letter
corresponding to your answer.
TODDLER
COLUMN A COLUMN B
A. Universal fear that begins at about 6

__B__ 1. Deferred imitation months of age and persist throughout the
preschool period
B. Remembering an action to mimic at a later
__D__ 2. Negativism time
C. A forward curve of the spine at the sacral
__A__ 3. Separation anxiety area
D. A positive stage where the toddler see
__C__ 4. Lordosis himself/herself as a separate individual
with separate needs
E. Major period of cognitive development
__F__ 5. Discipline that usually occurs at the end of the
toddler period
F. Setting rules to teach children what is
__E__ 6. Preoperational thought expected of them
FILL IN THE BLANKS: Supplement the missing answer or information.
1. An infant’s immune system becomes functional at age ___2-3___ months.
2. The first tooth eruption is expected at age ___6___ months.
3. Thumb opposition is beginning around the age of 9-10 months.
4. A 2-month old infant smiles in return to an interested person’s smiling. This is termed to as social__
smile.
5. Attachment refers to a strong emotional attachment of a preschool boy to his mother.
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6. The repetition and/or prolongation of sounds, syllables and words is termed as stuttering_
7. As seminal fluid is produced, boys begin to notice ejaculation during sleep, termed as __nocturnal
emissions__
Think ahead
Briefly discuss/ provide an example on the following.
1. Cognitive development of school-age children as follows;
a. Decentering:
Decentering (also known as Decentration) refers to the ability to consider multiple aspects of a
situation. In Piaget's theory of cognitive development, the third stage is called Concrete Operational
stage, where a child age 7-12 shows increased use of logic. For example, when asked to choose
between two lollipops, a child might choose based on how one flavor is better than the other even
though the other is the same size and color.
b. Accommodation:
Accommodation refers to the part of the adaptation process. The process of accommodation involves
altering one's existing schemas, or ideas, as a result of new information or new experiences. New
schemas may also be developed during this process. For example, when our infant comes across
another object again - say a beach ball - he will try his old schema of grab and thrust.
c. Conservation:
Conservation refers to a logical thinking ability that allows a person to determine that a certain
quantity will remain the same despite adjustment of the container, shape, or apparent size,
according to the psychologist Jean Piaget. For example, when kids understand that if you break a
candy bar up into smaller pieces it is still the same amount at when the candy was whole.
d. Class inclusion:
Piaget stated that class inclusion is an ability of a child to understand that objects can belong to more
than one classification, either class or sub-class. It is not until he can decentre that he can
simultaneously compare both the whole and the parts, which make up the whole. The child can then
understand the relationship between class and sub-class. For example, a child is shown four red
flowers and two white ones and is asked 'are there more red flowers or more flowers?' A typical five-
year-old would say 'more red ones'.
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2. Oedipus and Electra complexes:
The Oedipus complex is a term used in the psychosexual stages of development theory by Sigmund
Freud. The concept, first proposed by Freud in 1899 and not formally used until 1910, refers to a male
child’s attraction to their parent of the opposite sex (mother) and jealousy of their parent of the same
sex (father). For example, a boy who acts possessive of his mother and tells the father not to touch her
or a child who insists on sleeping between parents.
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 subconsciously sexually attached to her father and increasingly
hostile toward her mother. Carl Jung developed the theory in 1913. For example, when a girl who
declares she wants to marry her father when she grows up.
Read and Ponder
Newborn stage :
• is the first 4 weeks or first month of life. It is a transitional period from

intrauterine life to extra uterine environment.
• Physical Growth :
✓ Weight = 2.700 – 4 kg
✓ Wt gain by 10th day of life
✓ Gain ¾ kg by the end of the 1st month
✓ Wt loss 5% -10% by 3-4 days after birth due to :
• Withdrawal of hormones from mother.
• Loss of excessive extra cellular fluid.
• Passage of meconium (feces) and urine. Limited food intake.
Height :
• Boys average Ht = 50 cm
• Girls average Ht = 49 cm
• Normal range for both (47.5- 53.75 cm)
Head Circumference :
• 33-35 cm
• Head is ¼ total body length
• Skull has 2 fontanels (anterior & posterior)
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Anterior Fontanel
• Diamond in shape
• The junction of the sagittal, corneal and frontal sutures forms it
• Between 2 frontal & 2 parietal bones
• 3-4 cm in length and 2-3 cm width
• It closes at 12-18 months of age
Posterior Fontanel
• Triangular
• Located between occipital & 2 parietal bones
• Closes by the end of the 1st month of age
Vital Signs :
- Temperature : (36.3 to37.2 C )
- Pulse : ( 120 to 160 b/min )
- Respiration : ( 35 to 50/min)
- BP (at birth) : Average 75/42 mmHg; systolic 60 to 80 mmHg; Diastolic 40 – 50 mmHg APGAR SCORE :
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http://pennmedicine.adam.com/content.aspx?productid=14&pid=14&gid=000129
https://brooksidepress.org/ob_newborn_care_2/?page_id=191
NEWBORN SENSES :
1. Touch
• It is the most highly developed sense
• It is mostly at lips, tongue, ears, and forehead
• The newborn is usually comfortable with touch
2. Vision
• Pupils react to light
• Bright lights appear to be unpleasant to newborn infant.
• Follow objects in line of vision
3. Hearing
• The newborn infant usually makes some response to sound from birth
• Ordinary sounds are heard well before 10 days of life
• The newborn infant responds to sounds with either cry or eye movement, cessation of activity
and / or startle reaction
4. Taste
Well developed as bitter and sour fluids are resisted while sweet fluids are accepted
5. Smell
• Only evident in newborn infant’s search for the nipple, as he smell breast milk MOTOR
DEVELOPMENT :
Gross Motor development
• The newborn's movement are random, diffuse and uncoordinated. Reflexes carry out bodily
functions and responses to external stimuli.
Fine Motor Development

• Holds hand in fist
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• When crying, he draws arms and legs to body
Emotional Development :
• The newborn infant expresses his emotion just through cry for hunger, pain or discomfort
sensation
Cognitive Development :
• difficult to understand or observe
REFLEXES :
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Read and Ponder

INFANCY
• It is the period which starts at the end of the first month up to the end of the first year of age.
• Infant's growth and development during this period are rapid.
Physical Growth of Normal Infant :

• The infant will double his birth weight by 4-6 months and triple it by 1 year of age.
• First 6 months - average of 2 lb./month
• Second 6 months – 1 lb/month
• Infants from 3 to 12 months
Calculating Infant’s Weight :
Weight = Age in months + 9

2
e.g. Weight of a 7 months old infant
= 7+9 /2
= 16/2
= 8 kg
Height :
• Length increases about 3 cm /month during the 1st 3 months of age,

• then it increases 2 cm /month at age of 4-6 months, • It increases during the first year by 50%
https://www.slideshare.net/rdhaker2011/growth-and-developmentppt
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Head Circumference :
• It increases about 2 cm /month during the 1st 3 months,

• Then, ½ cm/month during the 2nd 9 months of age
• Posterior fontanel closes by 6-8 weeks of age
• Anterior fontanel closes by 12-18 months of age
• The brain already reaches 2/3 of its adult size by the end of the first year
Chest Circumference :
• By the end of the 1st year, it will be equal to head circumference.
Vital Signs :
Pulse : 100-120 b/min

Respiration : 35 ± 10 b/min
• Breaths through nose or obligatory nose breathers Blood pressure: 80/50 ± 20/10 mmHg
BODY SYSTEMS :
• Infants are prone to develop a physiologic anemia at 2-3 months of age
• Hemoglobin in an infant becomes totally converted from fetal to adult hemoglobin at 56
months of age
• May experience a decrease in serum iron levels at 6-9 months
• GIT is immature in its ability to digest food and mechanically move it; it gradually
matures
• Can independently drink from a cup by age 8 or 10 months
• Lipase is decreased in amount during the first year
• Liver remains immature
• Kidneys remain immature and not efficient in eliminating body waste as in adult
• Endocrine system is immature in response to pituitary stimulation – infant may not be
able to respond to stress effectively
• Immune system becomes functional by at least 2 months of age
• Ability to adjust to cold is mature by age 6 months – infant can shiver in response to
cold and has developed additional adipose tissue to serve as insulation
• ECF (extracellular fluid) 35% of infant’s body weight; ICF (intracellular fluid) 40% -
increases an infant’s susceptibility to dehydration from illnesses (loss of ECF could result
in loss of over a third of an infant’s body fluid)
Dentition :
• Eruption of teeth starts by 5–6 months of age. It is called "Milk teeth" or "Deciduous teeth" or
"Temporary teeth".
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MOTOR DEVELOPMENT :
• At 2 months
Hold head erect in mid-position.
Turn from side back
• At 3 months, the infant can Hold head erect and steady

Open or close hand loosely
Hold object put in hand
Landau reflex develops (not evident on infants with motor weakness, cerebral palsy and
neuromuscular deficits)
Landau Reflex : Head Control :
https://www.dnatube.com/video/30281/Postural-and-landau-reflex-clinical-examination-on-a-6-months-infant
https://www.madeformums.com/baby/when-will-my-baby-be-able-to-hold-their-head-up/
At 4 months, the infant can :

• Sit with adequate support
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• Roll over from front to back

• Hold head erect and steady while in sitting position
• Bring hands together in midline and plays with fingers. “thumb opposition” begins
• Grasp objects with both hands. Palmar and plantar grasp have disappeared
• Neck-righting reflex – rolls sideways when lifting head in prone position

• Balance head well when sitting
• Sit with slight support
• Pull feet up to mouth when supine
• Grasp objects with whole hand (Rt. or Lt.)
• Hold one object while looking at another
• Turn completely over - front to back and back to front
• Persistent fisting suggest delay in motor development; unilateral – hemiparesis

• Sit alone briefly
• Lift chest and upper abdomen when prone
• Hold own bottle/ objects in one hand
• Moro, palmar grasp and tonic neck reflexes have completely faded – persistence suggest
neurologic disease

• Sit alone
• Hold cup
• Imitate simple acts of others
• Transfer toys from one hand to the other

• Sit alone steadily
• Drink from cup with assistance
• Eat finger food that can be held in one hand

• Rise to sitting position alone
• Creep (i.e., abdomen is off the floor and moves one hand and one leg and then the other hand
and leg)-using knees to locomote
• Hold one bottle with good hand-mouth coordination
• Can stand holding onto a table
• Can pull themselves to a standing position holding onto the side of a low table or playpen
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• Walk but with help

• Bring the hands together
• Pincer grasp
• Point to objects
At 11 months , the infant can:

• Walk or “cruise” holding on furniture
• Stand erect with minimal support
At 12 months , the infant can :

• Stand-alone for variable length of time
• Sit down from standing position alone
• Walk in few steps with help or alone (hands held at shoulder height for balance)
• Pick up small bits of food and transfers them to his mouth
• Holds crayon well enough to draw a semi-straight line
✓ A child has until about 22 months of age to walk and still be within the normal limit
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Emotional Development :
• His emotions are instable, where it is rapidly changes from crying to laughter.
• His affection for or love family members appears.
• By 6 weeks “Social Smile”
• By 8 months – stranger anxiety
• By 10 months, he expresses several beginning recognizable emotions, such as anger, sadness,
pleasure, jealousy, anxiety and affection.
• By 12 months of age, these emotions are clearly distinguishable; joins in family activities
Social Development :
• He learns that crying brings attention
• The infant smiles in response to smile of others
• The infant shows fear of stranger (stranger anxiety)
• He responds socially to his name
• According to Erikson, the infant develops sense of trust. Through the infant's interaction with
caregiver (mainly the mother), especially during feeding, he learns to trust others through the
relief of basic needs
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Cognitive Development :
Sensorimotor Stage
• practical intelligence; babies relate to the world through their senses, using only reflex behavior.
Learns only objects in the environment.
• Concept of “permanence” in relation to “trust” and “separation anxiety”
Play :
❑ Solitary – purpose is to stimulate sensorimotor development.
❑ Toys: safe, simple, stimulating, easily handled, washable
❑ Types: mobiles, musical, rattles, squeeze & sponge toys
❑ 9-12 months: activity box, balls, blocks, pots & pans
❑ Games: peek-a-boo
• 1 – 2 months old : musical mobile

• 3 month old : small blocks or small rattles
• 4 month old : playpen, sheet spread
• 5 month old : variety of objects to handle that are light and NOT small enough to swallow
• 6 month old : bath tub toys; teething ring
• 7 month old : colorful toys like balls that can be rolled or transferred
• 8 month old : toys with different texture (stuffed)
• 9 month old : stacking toys
• 10 month old : peek-a-boo, patty cake (clapping)
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• 11- 12 month old : cruises around; put thing in and out of containers
Speech Milestones :
• 1-2 months: coos
• 2-6 months: laughs and squeals
• 8-9 months babbles: mama/dada as sounds
• 10-12 months: “mama/dada specific; can say 2 words
• 18-20 months: 20 to 30 words – 50% understood by strangers
• 22-24 months: two word sentences, >50 words, 75% understood by strangers • 30-36 months:
almost all speech understood by strangers
Nutrition: breast milk – 0-6 months

◼ Caloric needs: NB needs 400 kcal/day; 1 year needs 1,200 kcal/day.
◼ Cereals/solids: introduced at 4-6 months; then at 6-7 months strained fruits and
vegetables.
Note: does not need solid food before 4 months
✓ Extrusion reflex lasts until 3-4 months and chewing movement begin at 7-9 months.
✓ Ground/pureed meat: given at 8-9 months, chewable finger foods introduced when teething
begins.
✓ Egg yolks: delay egg whites until 12 months due to allergies.
✓ At 10 months, baby can drink independently from a cup.
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Potential Unintended Injuries of Infants :

• Aspiration
• Falls
• Motor vehicle
• Suffocation
• Drowning
• Animal bites
• Poisoning
• Burns
Infant :Promoting Development in Daily Activities

• Bathing – not needed on a daily basis; scalp care if w/ seborrhea (cradle cap)
• Diaper-area care – every 2-4 hours
• Dental Care – toothbrushing can begin even before tooth erupts (use soft cloth)
• Dressing-easy to laundry and simply constructed; soft-soled shoes
• Sleep – 10-12 hours at night; sleep on his back
• Exercise – early morning outing and sunlight exposure; safe space to crawl and walk
• Teething – rub gum line with soft cloth; cold teething rings
• Thumb sucking – sucking begins at 3 months through first years of life; sucking reflex peaks at 6-
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8 months; thumb sucking peaks at 18 months

• Use of pacifiers – benefits: comforting, pain relief and decreased risk od SIDS;
Risk : negative impact on breastfeeding, acute otitis media and dental malocclusion.
Wean from pacifier after 3 months
• Head banging
• Sleep concern – common to breastfed infants; delay night sleep to 1 hour and shorten nap time
• Constipation – common to formula-fed infants; offer more fluids and bulk-forming foods (if
weaning babies)
• Loose stool – determine for celiac disease (inability to process gluten)-referral is needed;
dehydration should be prevented
• Colic – due to overfeeding or swallowing too much air while feeding; manage by small, frequent
feeding and burping
• Obesity – weight greater than 90th to 95th percentile on a standard ht/wt chart
• Gen. Rule : DO NOT give infant more that 32 oz of milk/day or breastfeed more often than
every 2 hours
Hearing :
• hearing test done at birth
• Ability to hear correlates with ability to enunciate words properly
• Always ask about history of otitis media – ear aiding devices.
• Early referral to MD to assess for possible fluid in ears (effusion)
• Repeat hearing screening test
• Speech therapist as needed
Red Flags in Infant Development :

• Unable to sit alone by age 9 months
• Unable to transfer objects from hand to hand by age 1 year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.
Read and Ponder
TODDLER (1 – 3 years old)
• During this period, growth slows considerably
Physical Growth :
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Weight
• The toddler's average weight gain is 1.8 to 2.7 kg/year

• Formula to calculate normal weight of children over 1 year of age is Age in years X 2+8 = ___
kg.
e.g., The weight of a child aging 4 years
= 4 X 2 + 8 = 16 kg
Height
• During 1–2 years, the child's height increases by 1cm/month

• The toddler's height increases about 10 to 12.5cm/year
• Formula to calculate normal height Age in years X 5 + 80 = _____cm.
e.g., the length of 2 years old child
= 2 X 5 + 80 = 90cm
Head and Chest Circumference :

• The head increases 10 cm only from the age of 1 year to adult age
• During toddler years, chest circumference continues to increase in size and exceeds head
circumference
Teething :
• By 2 years of age, the toddler has 16 temporary teeth.
• By the age of 30 months (2.5 years), the toddler has 20 teeth
PHYSIOLOGIC GROWTH :
Pulse: 80–130 beats/min (average 110/min).
Respiration: 20–30 b/min; mainly abdominal
BP – increases to about 100/60 mmHg
Brain develops to about 90% of its adult size
Bowel and bladder control:
• Daytime control of bladder and bowel control by 24–30 months
Fine Motor Development :

• 1 year old: transfer objects from hand to hand
• 2 year old: can hold a crayon and color vertical strokes
Turn the page of a book
Build a tower of six blocks
• 3 year old: copy a circle and a cross – build using small blocks
Gross Motor Development :

At 15 months, the toddler :
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• Walks alone
• Creeps upstairs
• Assumes standing position without falling
• Holds a cup with all fingers grasped around it
At 18 months:
• Holds cup with both hands
• Transfers objects hand-to hand at will
At 24 months:
• Goes up and down stairs alone with two feet on each step
• Holds a cup with one hand
• Removes most of own clothes
• Drinks well from a small glass held in one hand
At 30 months:
• Jumps with both feet
• Jumps from chair or step
• Walks up and downstairs, one foot on a step
• Drinks without assistance
EMOTIONAL DEVELOPMENT :
• Stranger anxiety – should dissipate by age 2 ½ to 3 years
• Temper tantrums: occur in 50 to 80% of children – peak incidence 18 months – most disappear
by age 3
• Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years but may be
prolonged indefinitely
• Thumb sucking
• Toilet Training
Toileting Practices – learning bowel & bladder control is one of the major tasks of
toddlerhood. Uses toileting activities to control self & others.
◼ 18 months – has bowel control
◼ 2 to 3 years – has day time bladder control
◼ 3 to 4 years – has night time bladder control
• Ritualistic behavior – “their” own stuff again and again

• Negativism – establishing their identities as separate individuals; their reply to every request is
“NO”; limit number of questions
✓ Discipline vs. Punishment – “Time-out” (to help children learn that actions have consequences)
– 1 minute/ year of age
• Parents need to be consistent
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• Rules are learned best if correct behavior is praised rather than wrong behavior punished
• Separation anxiety
Cognitive development:
• Up to 2 years, the toddler uses his senses and motor development to differentiate self from
objects
• The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive development (2-4
years), where he is still egocentric and cannot take the point of view of other people
• The toddler is very social being but still egocentric.
• He imitates parents.
• Notice sex differences and know own sex.
• Parallel Play – play side by side and NOT with other children
• According to Erikson,
The development of autonomy during this period is centered around toddlers increasing abilities
to control their bodies, themselves and their environment i.e., "I can do it myself".
Play (parallel)
◼ Child will play beside but not with another child.
◼ Purpose: stimulate motor development and help make transition from solitary to
cooperative play.
◼ Types: should allow for self-play and be action-oriented. Ex: Push & pull toys, blocks,
balls, dolls, stuffed toys, clay, paints, crayons, coloring, wood puzzles.
◼ Games: “rough and tumble play”, like to throw and retrieve objects.
Nutrition: needs an average of 1,300 kcal/day
◼ Has “physiological anorexia” – eats a great deal one day & little the next. Growth slows,
has ritualistic food preferences like finger foods.
◼ Prone to Iron Deficiency Anemia (IDA), dehydration, Upper Respiratory Infection (URI),
tonsillitis & Otitis media.
◼ Guide to parents: recognize ritualistic needs (same utensils, chair); don’t force child to
eat; don’t give bottle as a substitute for solid foods.
Potential Unintended Injury :

• Motor vehicles
• Falls
• Aspiration
• Drowning
• Animal bites
• Poisoning
• Burns
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Read and Ponder
PRE-SCHOOLER (3-6 YEARS)
The growth during this period is relatively slow.
Psychosocial development
◼ A period of curiosity, discovery, imaginary friends, fears and fantasies
◼ Child learns to do things, derives satisfaction from activities.
◼ Imitates role models; has active imagination; may have imaginary friends;
has exaggerated fears
Physical G & D
◼ Gains 4-5 Ibs/year; approximately 1.8- 2 kg/year
◼ He doubles birth length by 4–5 years of age; 2 - 3.5 in a year on average
◼ Generally, have all 20 of their deciduous teeth by 3 years of age
◼ Vital Signs :
Pulse: 80–120 beats/min. (average 100/min).
Respiration: 20–30 b/min.
Blood Pressure: 100/67+24/25.
◼ Thinner, taller, more erect

◼ Becomes apparent in Preschool age
- Ectomorphic body build ( slim)
- Endomorphic body build (large)
- “genu valgus” (knock-knee) is exhibited but disappears with increased skeletal growth
Genu Valgus
https://www.medicalnewstoday.com/articles/319894
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Stuttering
◼ Is fairly common among toddlers and pre-schooler.
◼ Parents should ignore stuttering so that the child does not become anxious.
Sleep
◼ Requires 9 to 12 hours sleep each night.
◼ Sleep problems are most common.
◼ Child may awaken with nightmares and may have fears of the dark.
Fine Motor Skills

• Buttoning clothing
• Holding a pencil
• Building with small blocks
• Using scissors
• Playing a board game
• Have child draw picture of himself
• 3 year old: copy a circle and a cross – build using small blocks
• 4 year old: use scissors, color within the borders
• 5 year old: write some letters and draw a person with body parts
Gross Motor Skills

3 y/o :Runs, alternate feet on stairs, rides tricycle, stands on one foot
4 y/o :Constantly in motion, jumps, skips5 y/o :Throws overhand
Language
3 y/o : vocabulary of 900 words
4 y/o :Vocabulary of 1,500 words
5 y/o : Vocabulary of 2,100 words
• Avoid broken fluency when communicating with them
Emotional Development
• Initiative is well developed if a child likes to explore because new learning is fun.
• Fears the dark and mutilation
• Tends to be impatient and selfish
• Expresses agression through physical and verbal behaviors.
• Shows signs of jealousy of siblings
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Social Development
• Egocentric
• Tolerates short separation
• Less dependent on parents
• May have dreams & nightmares
• Attachment to opposite sex parent
• More cooperative in play
Play (cooperative)
◼ Purpose – help child to share and play in small groups; learns simple games & rules,
language concepts & social roles. Play maybe creative, imitative and dramatic
◼ Types: dolls, dress-up clothes, housekeeping toys, wagons, tricycle, picture books,
jigsaw puzzles, materials for cutting, pasting and painting.
Nutrition
◼ Needs an average 1700 kcal/day.
◼ A slow growth period, appetite remains decreased; has definite food preferences.
Sexuality
◼ Knows sex differences by 3 years
◼ Imitates feminine or masculine behavior
◼ Gender identity well established by 6 years
◼ Masturbation is normal – may increase in frequency when under stress.
Guidelines for Caregivers

◼ Answer questions – simple, honestly and matter of fact
◼ For masturbation – redirect child’s attention w/out punishing or verbally reprimanding.
Unintentional Injuries
• Motor vehicles
• Falls
• Drowning
• Animal bites
• Poisoning
• Burns
• Community – DO NOT talk to strangers
Red Flags for Preschool Stage :

• Inability to perform self-care tasks, hand washing simple dressing, daytime toileting
• Lack of socialization
• Unable to play with other children
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• Unable to follow directions during exam

P – lay is associative/cooperative
R – gression is common
E – xplain procedures
S – ame age group for room assignment
C - urious
H – ighly imaginative
O – bserve for initiative VS guilt
O – ff limits to the kitchen (risk for poisoning and burn)
L – oss of body part is a common fear
M - utilation
A – associate play, abandonment
G - uilt
I – nitiative, imaginary playmate, imagination
C – urious → “Y”
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Read and
Ponder
SCHOOL AGE (6 TO 12 YEARS)
The child's growth and development is characterized by gradual growth.
A. Psychosocial Development
◼ develops a sense of competency and esteem academically, physically & socially;
assumes more responsibility. Gains competency in mastering new skills and
tasks.
◼ More responsive to peers; has best friends; desire for accomplishment so strong
that young school child may try to change rules of game to win.
◼ School phobias may occur as a result of increased competition and desire to
succeed.
B. Physical Growth
• By 10 y/o, brain growth is complete
• Fine motor coordination refined
• Adult vision level is achieved
• Immune globulins reach adult levels
• Appendix is lined with lymphatic tissue
Weight:
• School–age child gains about 3-6 lb (1.3 – 2.7 kg)/year.
• Boys tend to gain slightly more weight through 12 years.
• Weight Formula for 7 - 12 yrs
= (age in yrs x 7 )– 5
2
Height : 1-2 in ( 2.5 – 5 cm)/ year); Females usually taller than males.
Vital Signs :
Pulse rate decreases to 70-80 beats/min
• B/P : average of 112/60 mmHg
Sexual maturation : PUBERTY ( 8-14 y/o)
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• Length of time it takes to pass puberty until it is COMPLETE :

Girls – 12 and 18 y/o
Boys – 14 and 20 y/o
Pubertal Concerns :
Girls
✓ prepubertal girls are taller by about 2 in or more than preadolescent boys
✓ Changes in pelvic contour and breast development
✓ Early preparation for menstruation – reassure that they can bathe, shower, swim
✓ Vaginal secretions will be present
✓ Menstrual irregularity during the first 2 years after menarche
Boys :
✓ Breast development : hypertrophy of breast tissue (gynecomastia)
✓ Increasing genital size
✓ “nocturnal emissions” – increased seminal fluid
Dentition :
• Deciduous teeth are lost and permanent teeth erupt

• 28 teeth between 6-12 y/o
Fine Motor Skills
• Writing skills improve

• Fine motor is refined
• 7 y/o : “eraser” year – not contented with output
• Fine motor with more focus
Tie shoelaces
Building: models – logos
Sewing
Musical instrument
Painting
Typing skills
Technology: computers
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Motor Development
At 6–8 years, the school–age child:

• Rides a bicycle.
• Runs Jumps, climbs and hops.
• Has improved eye-hand coordination.
• Prints word and learn cursive writing.
• Can brush and comb hair.
• Throws balls skillfully.
• Uses to participate in organized sports.
• Uses both hands independently.
• Handles eating utensils (spoon, fork, knife) skillfully

• Enjoy all physical activities.
• Continues to improve his motor coordination
Play (cooperative)
Team, rule-governed; same sex together
• 6 y/o : rough and tumble
• 7 y/o : require “props” – decline in imaginative play
• 8 y/o : collecting, sorting, cataloging; baking; table games
• 9 y/o : hard play; music lessons; art lessons
• 10 y/o : boys and girls play separately; interested in rules and fairness
• 11-12 y/o : dancing to popular music; table games
• 8 to 10 years: team sports
• Age 10 : match sport to the physical and emotional development
✓ Purpose – learn to cooperate, compromise, develop logical reasoning abilities, to bargain and
increase social skills.
✓ Types – entertainment, play figures, trains, model kits, games and jigsaw puzzles, storybooks,
adventure-mystery, riding a bike, sports, music, dancing lessons.
Language
• Talk in full sentences easily and with meaning
• Know months in a year
• Mathematical ability increases – can make simple purchases
• Uses swear words
• Short period of intense fascination with “Bathroom language”
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• By 12 years can carry on adult conversation

New Concepts
• Decentering – ability to project one’s self into other people’s situation
• Accommodation – ability to adapt thought processes to fit what is perceived

• Conservation – ability to appreciate that a change in shape does not necessarily mean a change
in size
• Class Inclusion – ability to understand that objects can belong to more than one classification
Nutrition
◼ needs an average of 2,400 cal/day. Appetite increases
◼ Breakfast is important for school performance and more likely to eat junk foods.
Emotional Development
The school–age child:
• Fears injury to body and fear of dark.
• Jealous of siblings (especially 6–8 years old child).
• Curious about everything.
• Has short bursts of anger by age of 10 years but able to control anger by 12 years.
Sense of Initiative
• Learning how to do things “well”
• “how?”
• If prevented or not recognized – results to inferiority or not convinced they can do things well
(unable to envision success in life )
Prevent Unintentional Injuries

• Motor vehicle
• Bicycle
• Community : sexual maltreatment (stranger, family members, new friends-internet)
• Burns
• Falls
• Sports injuries
• Drowning
• Drugs
• Firearms
Concerns of a School-Age Child

• Beginning grade school
• Bullying
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• Violence or terrorism
• Recreational drugs
• Stealing
• Long-term illness
• Overweight or obesity
Red Flags for School-Age Child

• School failure
• Lack of friends
• Social isolation
• Aggressive behavior: fights, fire setting, animal abuse
S – ame sex stage

C – ompetitive play
H – eroworship
O – bserve for industry VS inferiority
O – ff limits to vehicles
L – oss of control is a common fear
E – xplain procedurse
R – egression is common
D – eath (bogeyman), honesty → funerals and burials

I – ndustry VS inferiority (collections)
M – odesty (privacy)
P – eers (own sex)
L – oss of control → hospitalization, encourage decision making
E - xplaination of procedures
Read and Ponder
ADOLESCENT (12-20 YEARS OLD)

◼ Begins at puberty and ends when physical maturity is achieved.
◼ It is an essential period in sexual development and formation of personality.
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◼ Asks, “Who am I?” “What do I want to do with life?”
Physical Growth:
Weight:
• Growth spurt begins earlier in girls (10–14 years, while it is 12–16 in boys)
• Males gains 7 to 30kg, while female gains 7 to 25kg.
• Growth stops with the closure of epiphyseal lines of the long bones
• Females : 16-17 y/o
• Males : 18-20 y/o
Height :
• By the age of 13, the adolescent triples his birth length.
• Males gains 10 to 30cm in height.
• Females gains less height than males as they gain 5 to 20cm.
• Growth in height ceases at 16 or 17 years in females and 18 to 20 in males
Pulse: Reaches adult value 60–80 beats/min.

Respiration: 16–20 breaths/minute.
NB: The sebaceous glands of face, neck and chest become more active. When their secretion
accumulates under the skin in face, acne will appear.
• He needs to know "who he is" in relation to family and society, i.e., he develops a sense of
identity. If the adolescent is unable to formulate a satisfactory identity from the
multiidentifications, sense of self-confusion will be developed according to Erikson
• As teenagers gain independence they begin to challenge values
• Critical of adult authority
• Relies on peer relationship
• Mood swings especially among early adolescents
Emotional development:
This period is accompanied usually by changes in emotional control. Adolescent exhibits
alternating and recurrent episodes of disturbed behavior with periods of quiet one. He may become
hostile or ready to fight, complain or resist everything.
4 Main Areas to be Gained to Achieve Identity

1. Accepting their changed body image
2. Establishing a value system – what kind of person they want to be
3. Making a career decision
4. Becoming emancipated from parents
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Adolescent behavioral problems

• Anorexia
• Attention deficit
• Anger issues
• Suicide
Adolescent Teaching
• Relationships
• Sexuality – STD’s / AIDS
• Substance use and abuse
• Gang activity
• Driving
• Access to weapons
Common Health Problems of Adolescents

• Hypertension
• Poor posture
• Body piercing, tattoos
• Fatigue
• Menstrual irregularities
• Acne
• Obesity
Nutrition
◼ Girls need 2,200 cal/day. Boys need 2,700 cal/day
◼ Appetite increases with rapid growth; increased need for protein, iron, calcium & zinc
◼ Eating habits are easily influenced by peer group
◼ Intake of junk foods, fad diets can lead to obesity, bulimia, anorexia nervosa, iron
deficiency anemia.
P – eer group → activities, peer pressure

A – ltered body image
I – dentity – image → college or career
R – ole confusion
S – eparation from peers
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Read and Ponder
YOUNG AND MIDDLE ADULTHOOD

◼ Developmental state and function characterized by self-sufficiency in pursuit or
occupation/vocation and defined interpersonal relationships.
◼ Physical/cognitive
◼ Stabilized growth rate (weight is variable) and functioning
◼ Refines formal operational abilities
◼ Undergoes menopause
◼ Begins physical degeneration
◼ Psychosocial
◼ Develops self-sufficiency
◼ Pursues vocation/occupation
◼ Has intense interpersonal relationships (most frequently marriage and children)
LATE ADULTHOOD
Physical / cognitive
◼ Has general slowing of physical and cognitive functioning
Psychosocial
◼ Needs to establish highest degree of independence (self-sufficiency) physically possible
by adopting environment to ability.
◼ Reflects on life accomplishments, events and experiences
◼ Continues interpersonal relationships despite changes and loss.
PROMOTING HEALTHY GROWTH & DEVELOPMENT :

Ensuring the health of the child, the growing years is accomplished in the following ways:
◼ Providing adequate nutrition
◼ Providing for dental health
◼ Meeting basic emotional needs
◼ Immunizing against infectious diseases
◼ Protecting from harmful accidents
◼ Giving continuous health supervision
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See if you can do this!
My Journal : Write a 2-page journal of your growth and development pattern following these guide.
A. Interview your parents or care provider who raised you and ask about significant changes you
underwent during your growing up years.
B. Present a thorough growth and development of your childhood years highlighting significant
milestones based on the following theories:
1. Sigmund Freud Psychoanalytic Theory

2. Eric Erikson Psychosocial Theory
3. 3.Jean Piaget Cognitive Theory
1. Motor development: Gross and Fine
Fine motor skills are small movements made by a baby and involve relatively smaller muscles of
your baby’s body. While Gross motor skills are those movements made by a baby which are larger and
involve the movements of the larger muscles of your baby’s body. My mother said that she cannot forget
the moment I move my little fingers to reach for her hands when I was 3 months old. She also said that at
that point, I like to grab things and put them in my mouth. When I reached 9 months, I can already sit
alone without any assistance from my mother and I was also able to hold my bottle filled with milk or eat
using my hands. This was also the time where I started to learn to crawl well and stand while holding
something for balance. I was able to stand alone and walk in few steps without my mother’s help when I
was 1 year old. At 2 years old, using my hands to do simple tasks like holding things with one or both
hands and removing my clothes was also easy for me to do independently. I was also able to walk and
walk on stairs alone. Around 3-5 years old, I started to write and draw things using pencils or colors. I was
also very hyper and was constantly jumping and running all around. I started to go to school when I was
6-8 years old and my writing skills improved and gained friends in school. I also learned how to ride a
bicycle and how to use a cellphone or computer. Around 12 years old and until my present age, I am more
independent in doing my own stuff.
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2. Language development
During infancy, my speaking skills were limited to coos, laughs, and squeals. However, at 9
months, I started saying “mama” and “kaka”. After reaching toddler age, 1 year old, I can already speak
several words but not all of them are fully comprehensible. The words and sentences I utter became
comprehensible when I was already 2 years old. At 3-5 years old, I can understand basic instructions or
recite stories on my own, communicate easily with other children and adults, and my vocabulary also
increased by reading books. At school age of 6-12 years old, I can talk constantly, ask innumerable
questions, and use correct grammar. By reading more books, I also continuously increase my vocabulary
and reading comprehension to understand figurative word meanings. From adolescence to present age.
I can talk in full sentences easily and speak in an adult manner while constantly gaining language maturity.
3. Personal/Social
During infancy, my mother said that I only smile and react positively to familiar figures like her.
My moods also change easily, from crying to laughing. I tend to be hostile and anxious when interacting
around strangers. I always cry when I am hungry and when I want to poop. I always smile in response to
smile of others. My mother said that I always cry whenever I cannot see her around or when my baby
titter or bottle is missing. I was also very sensitive because I would cry whenever other people would take
me from her. Around 1-3 years old, I was independently attending my toilet needs and has more control
with urination and bowel movements. During this point, I was egocentric and hard-headed and cries when
I don’t get what I want. I would only stop when punished by my mother or my brother. My mother also
told me that I copy what she does and I always want to do things on my own. By ages 3-6, I began exploring
more independently. Expressing my emotions and cooperating with others were much easier. I became
less dependent and tolerates short separation with my mother. However, I tend to be anxious before an
upcoming event. My mother said that I was often impatient and would throw tantrums at certain times.
At school age, since I was at school more often, I thrive on having more friends and want to please my
friends all the time. I was afraid of bullies so I act strong and intimidating to avoid being bullied by others.
I also want to impress my family by studying hard and earn high grades. At adolescence until present age,
I show more independence from my mother. I also have a good relationship with my peers and wants to
continue building more intimate relationships. However, I think I am still in the state of confusion that is
why I am doing my best to develop my self-identity as early as possible to avoid stagnation.
48

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Maternal and Child Health Nursing- Growth and Development

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NCM 107 A (CARE OF MOTHER, CHILD AND ADOLESCENTS (WELL CLIENT)

GROWTH AND DEVELOPMENT

Desdimona C. Sakandal, RN, RM, MN

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A. Theoretical approaches to the growth and development of children.

B. Nursing process for promotion of normal growth and development.

1. The family with an infant

2. The family with a toddler

3. The family with a preschooler.

4. The family with a school aged child.

5. The family with an adult adolescent.

Growth and development is a lifelong process. It is a continuum that

OBJECTIVES : At the end of this module, you should be able to;

1. Differentiate growth from development.

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5. Growth is from small to big and follows a certain sequence or order.

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1. GENETICS ➢ In my case, my father is tall while my mother is short. I

2. GENDER ➢ Girls like me usually undergo puberty earlier than boys

3. ENVIRONMENT ➢ Enriching and stimulating home environment is

Infant Trust vs. Mistrust Oral Stage

Toddler Autonomy vs. Shame and Doubt Anal Stage

Preschooler Initiative vs. Guilt Phallic

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School-Age Child Industry vs. Inferiority Latency

Adolescent Identity vs. Role Confusion Genital

Level I: Obedience/Punishment 4. Punishment-obedience orientation, easily governed by parental

C. 1. Sensorimotor A. Thinking in terms of what could be than

E. 2. Preoperational thought B. Inductive reasoning, from specific to

_ _D__ 3. Intuitive thought C. Development of the concept of

__ B _ _ 4. Concrete operational thought D. Object viewed as having only one

__A __ 5. Formal operational thought E. Symbolic thought, egocentric and static

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Read and Ponder

GENERAL PRINCIPLES OF GROWTH AND DEVELOPMENT :

Factors Influencing Growth and Development:

5. Temperament – how a child responds to his environment or situation is innate or congenital.

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6. Environment – Child’s growth and development can be influenced by the following;

Theoretical Approaches to Growth and Development of Children:

• Theory – a systematic statement of principle that provides a framework for explaining a

BASIC DIVISION OF CHILDHOOD :

• Sigmund Freud (1856-1939) – an Austrian neurologist and founder of psychoanalysis.

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• Child development is a series of psychosexual stages in which a child’s sexual gratification

• Erik Erikson (1902-1996)

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1. Infant - provide a primary caregiver and experiences that add to security.

3. PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

• Jean Piaget (1896 – 1980), a Swiss psychologist,

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C. Concrete Operational Thought

D. Formal Operational Thought

4. KOHLBERG’S THEORY OF MORAL DEVELOPMENT

• Lawrence Kohlberg (1927 – 1987), a German psychologist

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The Metro Manila Developmental Screening Test (MMDST)

MMDST evaluates 4 sectors of development:

Explaining the Procedure :

A 5. Formal operational thought E. Symbolic thought, egocentric and static

1. An infant’s immune system becomes functional at age _2-3_ months.

2. The first tooth eruption is expected at age _6_ months.