Development proceeds from the head downward. This is the cephalocaudal principle. It describes the direction of growth and development. The child gains control of the head first, then the arms, and then the legs. Infants develop control of the head and face movements within the first two months after birth. In the next few months, they are able to lift themselves up by using their arms. By 6 to 12 months of age, infants start to gain leg control and may be able to crawl, stand, or walk. Coordination of arms always precedes coordination of legs. Proximodistal

Development proceeds from the center of the body outward. This is the principle of proximodistal development that also describes the direction of development. This means that the spinal cord develops before outer parts of the body. The child's arms develop before the hands and the hands and feet develop before the fingers and toes. Finger and toe muscles (used in fine motor dexterity) are the last to develop in physical development. Gross Fine Motor A motor skill is an action that involves the movement of muscles in your body. Gross motor skills are larger movements involving the arm, leg, or feet muscles or the entire body things like crawling, running, and jumping are gross motor skills. Fine motor skills are those smaller actions like picking things up between thumb and finger or using the toes to wriggle into sand or the lips and tongue to taste and feel objects. Gross motor and fine motor skills develop in tandem because many activities depend on the coordination of both sorts of skills. At 3 months you may notice your baby bringing his hands together over his chest as he lies on his back (a gross motor skill) and then playing with his hands (a fine motor skill). Even filling a shape sorter box, at about 18 months, for example, requires that your baby be able to use gross motor skills to hold his body steady enough to grasp the shapes firmly and fine motor skills to twist or turn each shape so that it fits into its appropriate hole.

Freud’s stage of development The first stage that we encounter is the oral stage. This stage occurs during the first two years of life. The mouth is the principal erogenous zone. An erogenous zone according to Freud was a

particular part of the body where we seek and gain pleasure from. For example, according to Freud an infant’s greatest source of gratification is sucking. It is often common to see an infant between the ages of one to two to be constantly putting objects in his or her mouth. Oral Stage This stage occurs during the first two years of life. The mouth is the principal erogenous zone. An erogenous zone according to Freud was a particular part of the body where we seek and gain pleasure from. For example, according to Freud an infant’s greatest source of gratification is sucking. It is often common to see an infant between the ages of one to two to be constantly putting objects in his or her mouth Anal Stage The anal stage occurs from age two to three. The membranes of the anal region provide the major source of pleasurable stimulation. Toilet-training is a major issue in this time frame of a child’s life. Phalic Stage The phallic stage occurs from ages three to six. It focuses on self-manipulation of the genitals as providing the major source of pleasurable stimulation. The latency stage occurs from age six to twelve. In this stage, sexual motivations recede in importance. At this stage a child is more preoccupied with developing skills and other activities. The genital stage is the final stage of development. It occurs after puberty and extends into adulthood. The deepest feelings of pleasure come from sexual relationships with other adults.

Freud’s psychoanalytic theory Freud offered dynamic and psychosocial explanations for human behavior. He conceptualized what we call the psychosexual stages of development. Freud believed that there are specific stages in which an individual has a specific need, and if needs are left unfulfilled or over stimulated, according to Freud there are dramatic effects on an individual’s behavior. Freud’s explanation of these developmental stages provided early psychosocial explanations for an individual’s deviance or abnormal behavior. Freud outlined five stages of development: the oral stage, the anal stage, the phallic stage, the latency stage, and the genital stage What is psychosocial development?

Erik Erikson’s theory of psychosocial development is one of the best-known theories of personality in psychology. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud’s theory of psychosexual stages, Erikson’s theory describes the impact of social experience across the whole lifespan.

Psychosocial stage 1 – trust vs mistrust. - The first stage of Erikson’s theory of psychosocial development occurs between birth and one year of age and is the most fundamental stage in life.2 - Because an infant is utterly dependent, the development of trust is based on the dependability and quality of the child’s caregivers. - If a child successfully develops trust, he or she will feel safe and secure in the world. Caregivers who are inconsistent, emotionally unavailable, or rejecting contribute to feelings of mistrust in the children they care for. Failure to develop trust will result in fear and a belief that the world is inconsistent and unpredictable Stage 2 autonomy vs shame and doubt

v The second stage of Erikson's theory of psychosocial development takes place during early childhood and is focused on children developing a greater sense of personal control.2 v Like Freud, Erikson believed that toilet training was a vital part of this process. However, Erikson's reasoning was quite different then that of Freud's. Erikson believe that learning to control one’s body functions leads to a feeling of control and a sense of independence. v Other important events include gaining more control over food choices, toy preferences, and clothing selection. v Children who successfully complete this stage feel secure and confident, while those who do not are left with a sense of inadequacy and self-doubt. Stage 3 Initiative vs guilt v During the preschool years, children begin to assert their power and control over the world through directing play and other social interaction. v Children who are successful at this stage feel capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative. Stage 4 Industry vs Inferiority


This stage covers the early school years from approximately age 5 to 11.

î Through social interactions, children begin to develop a sense of pride in their accomplishments and abilities. î Children who are encouraged and commended by parents and teachers develop a feeling of competence and belief in their skills. Those who receive little or no encouragement from parents, teachers, or peers will doubt their ability to be successful. Stage 5 Identity vs Confusion v During adolescence, children are exploring their independence and developing a sense of self. v Those who receive proper encouragement and reinforcement through personal exploration will emerge from this stage with a strong sense of self and a feeling of independence and control. Those who remain unsure of their beliefs and desires will insecure and confused about themselves and the future. The Sensimotor stage The Sensorimotor Stage is the first stage Piaget uses to define cognitive development. During this period, infants are busy discovering relationships between their bodies and the environment. Researchers have discovered that infants have relatively well developed sensory abilities. The child relies on seeing, touching, sucking, feeling, and using their senses to le In the preoperational stage a child will react to all similar objects as though they are identical (Lefrancois, 1995). At this time all women are 'Mummy' and all men 'Daddy'. Most preoperational thinking is self-centred, or Egocentric. According to Piaget, a preoperational child has difficulty understanding life from any other perspective than his own. In this time, the child is very me, myself, and I oriented. CONCRETE OPERATIONAL STAGE During this stage, children begin to reason logically, and organize thoughts coherently. However, they can only think about actual physical objects, and cannot handle abstract reasoning. They have difficulty understanding abstract or hypothetical concepts. Stage of Moral Development Level 1. Preconventional Morality Stage 1 - Obedience and Punishment Obeying the rules is important because it is a means to avoid punishment. Stage 2 - Individualism and Exchange At this stage of moral development, children account for individual points of view and judge actions based on how they serve individual needs. I Reciprocity is possible, but only if it serves one's own interests. Level 2. Conventional Morality Stage 3 - Interpersonal Relationships

Often referred to as the "good boy-good girl" orientation, this stage of moral development is focused on living up to social expectations and roles. There is an emphasis on conformity, being "nice," and consideration of how choices influence relationships. Stage 4 - Maintaining Social Order At this stage of moral development, people begin to consider society as a whole when making judgments. The focus is on maintaining law and order by following the rules, doing one’s duty, and respecting authority. Level 3. Post conventional Morality Stage 5 - Social Contract and Individual Rights At this stage, people begin to account for the differing values, opinions, and beliefs of other people. Rules of law are important for maintaining a society, but members of the society should agree upon these standards. Stage 6 - Universal Principles Kohlberg's final level of moral reasoning is based upon universal ethical principles and abstract reasoning. At this stage, people follow these internalized principles of justice, even if they conflict with laws and rules.

Temperament v refers to those aspects of an individual's personality, such as introversion or extroversion, that are often regarded as innate rather than learnt. v Extroverts tend to enjoy human interactions and to be enthusiastic, talkative and assertive. They take pleasure in activities that involve large social gatherings, such as v Introverts tend to be more reserved and less assertive in social situations. They often take pleasure in solitary activities such as reading, writing, drawing, playing musical instruments or using computers.

4 Temperament types Ø Sanguine v A person who is sanguine is generally light-hearted, fun loving, a people person, loves to entertain, spontaneous, and confident. However they can be arrogant, cocky, and indulgent. He/She can be day-dreamy and off-task to the point of not accomplishing anything and can be impulsive, possibly acting on whims in an unpredictable fashion. The humor of Sanguine was once commonly treated with leeches. Ø Choleric v A person who is choleric is a doer. They have a lot of ambition, energy, and passion, and try to instill it in others. They can dominate people of other temperaments, especially phlegmatic types. Many great charismatic military and political figures were choleric. On the negative side, they are easily angered or bad-tempered. Melancholic

v A person who is a thoughtful ponderer has a melancholic disposition. Often very kind and considerate, melancholic's can be highly creative – as in poetry and art - but also can become overly pre-occupied with the tragedy and cruelty in the world, thus becoming depressed. A melancholic is also often a perfectionist, being very particular about what they want and how they want it in some cases. This often results in being dissatisfied with one's own artistic or creative works and always pointing out to themselves what could and should be improved. They are often loners and most times choose to stay alone and reflect. Ø Phlegmatic v While phlegmatic are generally self-content and kind, their shy personality can often inhibit enthusiasm in others and make themselves lazy and resistant to change. They are very consistent, relaxed, rational, curious, and observant, making them good administrators and diplomats. Like the sanguine personality, the phlegmatic has many friends. However the phlegmatic is more reliable and compassionate; these characteristics typically make the phlegmatic a more dependable friend. v Phlegmatic along with the other 3 temperaments should be looked at not just his psychological statements but in view of physiology and how they would relate to attention deficit disorders, dyslexia, etc. Health Assessment , n an evaluation of the health status of an individual by performing a physical examination after obtaining a health history. Various laboratory and functional tests may also be ordered to confirm a clinical impression or to screen for possible disease involvement. complete health history, a health history that includes a history of the chief complaint, present illness, past and present health history, social history, occupational history, sexual history, and family health history. Chief Concern v Obtaining information about the chief concern puts the parents observation in proper perspective there are six aspects of voicing chief concern. v v v v v v Duration Intensity Frequency Description Associated symptoms Actions taken

Chief Complaint A medical evaluation of a person begins with an interview about the patient's major or "chief " complaint. The physician begins the process by asking specific questions about the complaint. if the patient presents with chest pain, the physician will inquire about the character, location, severity and duration of the pain. What brought it on? What relieved it? Did it move to the shoulder, arms, jaw, back or other parts of the body? Were there associated symptoms like shortness of breath, sweating, dizziness, weakness, nausea, vomiting, etc.? When did it first start? How often does it occur? If it was initially brought on by exertion, is the pattern changing? Is it brought on by lesser amounts of exertion? Is it becoming more frequent with time? Are the symptoms lasting longer? Do they appear at rest or has it awakened the patient from a sound sleep? Answers to these questions are analyzed by the physician and help him or her determine the cause of the pain and the seriousness of the problem. Each of the symptoms given by the patients will prompt a series of specific questions that will help the physician arrive at a preliminary single diagnosis, or a group of different diagnoses. The latter is known as a "differential diagnosis" A HISTORY obtained by a physician is similar to a detective interviewing a victim. The goal is to identify the criminal (disease) that is responsible for the victim's (patient's) problem. Past History After obtaining information about the chief complaint, the physician will inquire about the past history. This will include questions about diseases such as diabetes, high blood pressure, elevated cholesterol levels, prior surgery, asthma, stroke, cancer, allergies, etc. This information may also strengthen a suspected diagnosis. For example, the presence of diabetes, high blood pressure and high cholesterol is known to increase the risk of heart disease. Family History Certain cardiac illnesses such as coronary artery disease and high blood pressure may occur in more than one member of a family. Therefore, the physician will inquire about the health of the patient's parents, brothers, sisters and children. Similarly, risk factors for coronary artery disease, such as diabetes, high cholesterol, etc., may be prevalent in the same family. Review Of Systems This is a "laundry list" of symptoms related to various organs of the body. A series of questions are designed to seek out information that the patient may have neglected to provide the physician. A history of asthma during childhood, for example, may be discovered this way and keep the physician from prescribing certain heart medicines that may provoke an asthmatic attack. The history dictates whether or not the patient needs further work-up or testing, and the urgency with which they should be carried out. Should the patient be hospitalized because there is a threat of an impending heart attack? Is the likelihood of disease low enough that testing can be obtained at a more leisurely pace? Subsequent testing helps to identify the patient's problem, or exclude different parts of the differential diagnosis.

Pregnancy History Are there physical factors that could have interfered with pregnancy bonding such as painful varicose veins or gestational diabetes? Are there psychosocial factors such as an unwelcome move or loss of an important support person? Ask the woman to describe her labor and birth at a home visit, both to determine whether any complications are present and to evaluate her reaction to the event.

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