Growth & Development: Mary Lourdes Nacel G. Celeste, RN, MD Ellen H. Tinio, RN, MD

Growth &
Mary Lourdes Nacel G. Celeste, RN, MD

Development
Ellen H. Tinio, RN, MD
PEDIATRIC NURSING
Growth & development are occasionally
used interchangeably but they are totally
different .
Growth : generally used to denote an increase
in physical size (quantitative change)
wt--- kg ht ---cm
Development : used to denote an increased in

skill or the ability to function (qualitative change)
measured by
1. observing child’s ability to perform tasks
2. recording parents’ description
3. using standard tests
Two Parameters of Growth
 Weight – most sensitive measure of growth

 2x ----- 6 mos
 3x-------1 yr
 4x--------2-2 ½ yr
 Height- increases by 1”/mo during 1st 6 mos

 ave. increase in Ht- 1st yr = 50 %
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Development
 Increase in skills or capability to function

 How to measure development
 Observe child doing specific task
 Role description of child’s progress
 DDST- Denver development screening test
o Language communication
o Personal/ social interaction
o Fine motor adaptive- hand movement
o Gross motor skills- large body movement
 MMDST – Metro Manila developmental
screening test ( Phil version)
PEDIATRIC NURSING
 Denver II TEST
(Denver developmental screening test II)
125 easily administered developmental test
items, with age norm, presented in a
convenient one-page format
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Principles of Growth & Development
1. G & D is a continuous process
- continuous process from conception until death
- proceeds in an orderly sequence
2. Not all parts of the body grow at the same time or

at the same rate
- All body systems do not develop at the same rate
• Renal / digestive / circulatory /

musculoskeletal = grow rapidly during
childhood
• CNS, brain , Spinal cord = grow rapidly 1-2
yrs. Adult proportion by 5 yrs old
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3. Each child is unique.
- Different children pass through the predictable stages at
different rates.
- There is an optimum time for initiation of experiences or learning.
4. Occurs in regular direction reflecting a definitive

and predictable pattern
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G & D follows a trend or pattern:
I. Directional Trends – occur in regular direction
reflecting the development of neuromuscular
function. This apply to physical, mental, social &
emotional development and includes:
a. Cephalocaudal
b. Proximodistal - proceeds from proximal to
distal body parts
c. Symmetrical
d. Mass to specific differentiation – child learns
from simple operation before complex function
- from gross to refined skills
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G & D follows a trend or pattern:
I. Directional Trends
II. Sequential trend – predictable sequence:
A. Locomotion- ( crawls > creeps >

stands > walks > runs )
B. Socio-language skills – solitary games
> parallel
III. Secular- worldwide trend of maturing earlier

and growing larger as compared to succeeding
generations
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Principles of Growth & Development
5. Behavior - most comprehensive indicator of

developmental status
6. Play – universal language of child
7. Skills & behavior are learned by practice
8. Neonatal reflexes must be lost before
development can proceed.
e.g :
 Plantar reflex should disappear before
walking.
 Moro reflex disappears before infant could
roll. PEDIATRIC NURSING
Stages
A. First Stage – pre-natal begins from conception to birth
B. Second stage – from birth to 12 months

1. neonatal – first 28 days, first 4 weeks.
2. Infancy – 1 to 12 months
C. Third Stage – Early Childhood ( 1-6 y/o)

1. Toddler – 1-3 y/o
2. Pre- school – 4-6 y/o
D. Fourth Stage – Middle Childhood

1. School age – 6-12 y/o
2. Adolescence – 13 – 18 y/o
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RATES OF DEVELOPMENT
 Infancy & adolescence = fast growth periods
 Toddler & Preschool =alternating rapid & slow
 School age = slow growth period
 Fetal period- infancy = head and

neurologic tissue grow faster than the
other tissues
 Toddler & Preschool/ adolescence= trunks
grow rapidly than other tissues.
 School age period = limbs grow most
PEDIATRIC NURSING
 Types of development
 psychosexual development
 psychosocial development
 moral development
 cognitive development
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1.Psychosexual development- specific type of development
that refers to developing instinct or sensual pleasure
(Freud)
2.Psychosocial development- refers to stages of personality

development (Erikson)
3.Moral development- is the ability to know right from wrong

and to apply this to real life situation (Kohlberg)
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4. Cognitive development- refers to the ability to learn or
understand from experience, to acquire and retain
knowledge, to respond to new situation, to solve
problem (Piaget)
 measured by intelligence tests, and by observing a
child’s ability to function effectively in his/her
environment
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Theories of Growth & development
 Freud, Sigmund PSYCHOSEXUAL
 Piaget, Jean COGNITIVE
 Erikson, Erik PSYCHOSOCIAL
 Kohlberg, Lawrence MORAL
FPEK
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Summary of Theories
THEORY Infancy Toddler Preschool School age Adolescence

(0-1y) (1-3y) (3-6y) (6-12) (12-20y)
Freud ORAL Anal Phallic Latency Genital

psychosexual Oedipal
Piaget Sensori- Sensori- Preoperational Concrete Formal

motor motor operation
cognitive
Erikson Trust Autonomy Initiative vs. guilt Industry vs. Identity vs.
VS vs. inferiority role
psychosocial
mistrust Shame & confusion
doubt
Conventional/ Postconventional/
Kohlberg Pre- Pre- Pre-conventional Concrete Formal operation
(intuitive phase)
convention conventio Operational (deductive and
moral al nal (inductive abstract
reasoning, Thinking)
(Sensorimotor) (preconceptual
beginning logical
phase)
thinking)
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Sigmund Freud
 Oral phase ( 0-18 months)

 Mouth is the site of gratification
 Development of id
 Activity of infant : biting, sucking , crying
 Reason for sucking : enjoyment & release
tension
 N.I : provide oral stimulation even if NPO
 Pacifier
 Never discourage thumb sucking
 Breastfeeding
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Sigmund Freud
 Anal ( 18 months-3 years old)

 Anus is the site of gratification
 Activity of infant : elimination, retention or
defecation of feces
 Principle of holding on or letting go
 1 ½ y – 3 yrs : toilet training (toddlers)
 N.I : help child achieve bowel and bladder
control even if child is hospitalized
 elimination is a way of discovery and
exerting independence
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Sigmund Freud
 Phallic phase ( 3y-6y)
 Genitals : site of gratification
 Masturbation & fantasy of life
 Activity of infant : shows exhibitionism
 Love of opposite sex (Parents oedipal complex/ electra
complex)
 increased knowledge of sex
 Ego development
 Reason for sucking : enjoyment & release tension
 N.I : Accept child fondling his/her own genitalia as
normal exploration
o Accept sexual interest and answer questions about birth or
sexual difference
o Answer child question directly
o Resolved conflict : child identifies with the parents of same
sex
 PRESCHOOL : right age to introduce sexuality
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Sigmund Freud ( Psychosexual)
 Latent ( 7-12 y)
 Sexual drive depresses
 Period of suppression
 Child libido or energy is diverted to more
concrete type of thinking; libido diverted to
school
 Superego and morality development

 N.I : help the child achieve positive
experience to promote self esteem
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Sigmund Freud
 Genital ( 12-20y)
 His/her BODY is the site of gratification
 Develops satisfying sexual and emotional
relationships with members of the opposite
sex
 Achieves sexual maturity
 Individual plans life goals & gain a strong
sense of personal identity.
NI: provide opportunities to relate w/
opposite sex; verbalization about new
feelings
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OVERVIEW OF ERIKSON’S DEVELOPMENTAL TASKS THROUGHOUT THE
LIFESPAN
Age Stage Erikson’s Positive Outcome Negative Outcome
Task
Birth to Infancy Trust vs. Trusts self and others Demonstrates an
18 mos Mistrust inability to trust;
withdrawal, isolation
18 mos Toddler Autonomy Exercises self-control and Demonstrates defiance
to 1 y vs. Shame influences the and negativism
and Doubt environment directly
3 to 6 y Preschool Initiative vs. Begins to evaluate own Demonstrates fearful,
Guilt behavior; learns limits on pessimistic behaviors;
influence in the lacks self-confidence
environment
6 to 12 y School age Industry vs. Develops a sense of Demonstrates feelings
Inferiority confidence; uses of inadequacy,
creative energies to mediocrity, and self-
influence the doubt
environment
12 to 20 Adolescenc Identity vs. Develops a coherent Demonstrates inability
y e Role sense of self; plans for a to develop personal
confusion future of work/education and vocational identity
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Erik Erikson ( Psychosocial)
 Trust vs. Mistrust ( 0-18 months ) infant

 Foundation of all psychosocial tasks
 To give or to receive
T: appreciate environment as safe and people as
dependable
M: suspicious, fearful, shun emotional involvement
 N.I. provide primary caregiver and visual stimulation

o Satisfy needs on time (breastfeeding)
o Care must be consistent and adequate
o Touch, eye to eye contact, soft music – add to security
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 Autonomy vs. Shame & Doubt -
( 18 mos-3 y) toddler
A: build on new motor and mental abilities, take
pride in accomplishments
S: doubt and stop trying
 N.I : provide opportunities for decision making and

give praises
o Give an opportunity of decision making like offer

choices
o Encourage to make decision rather than judge
o Set limits
PEDIATRIC NURSING
 Initiative vs. Guilt ( 4-6 y ) preschool
I: how to do things
G: limited brainstorming and problem-solving skills
 N.I. provide opportunities for exploration, answer

questions and do not inhibit fantasy
o Learn how to do basic things
o Let explore new places & events
o Recommended Activities : molding clay, finger
painting will enhance imagination and creativity and
facilitate fine motor dev’t
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 Industry vs. Inferiority ( 7-12 y) school age
 Child learns how to do things well

 Give short assignment & projects
Ind: how to do things well

Inf: always worried about poor or incorrect
performance
NI: provide opportunities for completing short
projects, give praise and rewards
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 Identity vs. role confusion ( 12-20y )

adolescent
 Learn who he/she is or what kind of person
he will become by adjusting to a new body
image
 Freedom from parent
I: integrate image into a whole

R: unsure of who they are or who they can
become, may rebel
NI: provide opportunities to discuss feelings
and support and praise for decision-making
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JEAN PIAGET
PEDIATRIC NURSING
Stages of Cognitive
 Sensory Motor ( 0-2 y )
 Children experience the world through

movement and senses and learn object
permanence.
 Children are extremely egocentric, meaning
they cannot perceive the world from others’
viewpoints and explore using senses.
PEDIATRIC NURSING
Stages of Cognitive
 Preoperational (2-7 y )
 Magical thinking predominates.

 Acquisition of motor skills
 Children are still egocentric and cannot
conserve or use logical thinking
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Stages of Cognitive
 Concrete ( 7-12 y )
 The child is able to classify, order, and sort

fact.
 Child moves from prelogical thought to
solving concrete problems through logic .
 Children begin to think logically but are very
concrete in their thinking.
 Children can now conserve and think
logically but only with practical aids.
 They are no longer egocentric .
PEDIATRIC NURSING
Stages of Cognitive
 Formal operational ( 12-20 y )

 Able to think abstractly and logically
 Solving abstract and concrete problem
 Development of abstract reasoning
 Children develop abstract thought and can
easily conserve and think logically in their
mind.
 Can solve hypothetical problems, causality,
time
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LAWRENCE KOHLBERG
PEDIATRIC NURSING
 Level 1 (Pre-Conventional)
 1. Obedience and punishment orientation (2-3Y)
(How can I avoid punishment?)
 2. Self-interest orientation (4-7Y)
(What's in it for me?)
 Level 2 (Conventional)
 3. Interpersonal accord and conformity (7-10Y)
(The good boy/good girl attitude)
 4. Authority and social-order maintaining orientation ( 10-12Y)
(Law and order morality)
 Level 3 (Post-Conventional) (>12Y)
 5. Social contract orientation
 6. Universal ethical principles
(Principled conscience)
PEDIATRIC NURSING
UNDERSTANDING THEM!
INFANT (0-12 MOS)

TODDLERS (1-3 Y)
PRESCHOOL (3-6 Y)
SCHOOL AGE (6-12 Y)
ADOLESCENCE (12-20 Y)
PEDIATRIC NURSING
Stages of Growth and Development
 Infancy  Middle Childhood

 Neonate  School age
o Birth to 1 month
 6 to 12 years
 Infancy  Late Childhood
o 1 month to 1 year
 Early Childhood  Adolescent
 Toddler  13 years to
o 1-3 years approximately 18
 Preschool years
o 3-6 years
PEDIATRIC NURSING
Developmental Assessment
 Early detection of deviation in child’s

pattern of development
 Simple and time efficient mechanism to

ensure adequate surveillance of
developmental progress
 Domains assessed:
 cognitive
 motor
 language, social / behavioral
 adaptive
PEDIATRIC NURSING
infant
 Solo, mom interactive

 Facilitate motor & sensory dev’t
 Fear of infancy : stranger anxiety begins at
6-7 months
o PEAKS : 8 months
o Diminished : 9 months
 Communicate :
o Respond to non-verbal
o Slow approach
o Use calm, soothing voice
o Be responsive to cries
o Allow security object ( blanket or pacifier)
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*Bruxism
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DAILY CARE
- bathing
- diaper care
- care of teeth
- dressing
- sleep – 16-20hrs/day;
- 6 mos- 1-2 naps, with
12h at night
- 12 mos old; 1 nap with
12h at night
- exercise
PEDIATRIC NURSING
Gross Motor Development
 Newborn: barely able to lift head

 6 months: easily lifts head, chest and upper
abdomen and can bear weight on arms
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Head Control
Newborn Age 6 months
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Sitting up
 2 months old: needs assistance

 6 months old: can sit alone in the tripod
position
 8 months old: can sit without support and
engage in play
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Sitting Up
Age 2 months Age 8 months
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Ambulation
 9 month old: crawls

 1 year: stands independently from a crawl
position
 13 month old: walks and toddles quickly
 15 month old: can run
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Ambulation
13 month old
Nine to 12-months
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Fine Motor - Infant
 Newborn has very little control. Objects will

be involuntarily grasped and dropped
without notice.
 6 month old: palmar grasp – uses entire
hand to pick up an object
 9 month old: pincer grasp – can grasp small
objects using thumb and forefinger
PEDIATRIC NURSING
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
 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
PEDIATRIC NURSING
Hearing
 BAER hearing test done at birth

 Ability to hear correlates with ability to
enunciate words properly
 Always ask about history of otitis
media – ear infection, placement of
PET – tubes in ear
 Early referral to MD to assess for
possible fluid in ears (effusion)
 Repeat hearing screening test
 Speech therapist as needed
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Fine Motor Development
6-month-old
12-month-old
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** Best color for neonates: black & white
** Best color for infants: red

**Use CAR SEATS for children
according to “Rule of 4’s” when
traveling
= 4 years or younger
= 40 lbs or less
= 40 in. tall or shorter
PEDIATRIC NURSING
DEVELOPMENTAL MILESTONE
Infancy ( 0-12 months )
Physical Growth Weight : 6 months = double the birth weight
1 year ( 12 months ) = triple the birth weight
Length : 1 yr old = increase by 50%
HC :: CC = 1 yr old HC=CC
Gross & Fine 2 mos = social smile ; 4 mos = head control complete , 5 mos = rolls over
motor moro gone
6 mos = sits with support ; LOWER INCISOR erupts, uses palmar grasp
7 mos = transfers object hand to hand; 7-9 mos = object permanence
9 mos = sits without support ; bangs cubes , creeps / crawls ;
2 syllables; UPPER LATERAL INCISOR appears
12 mos = cruises, can walk with one hand being held 6-8 deciduous
teeth
Socialization 1-3 mos = smiles and vocalizes cooing
3-6 mos= laughing aloud
7-9 mos = stranger anxiety
9 mos = say ‘ mama and dada’
10-12 mos = peek -a-boo
12 mos = show affection [ blow kisses on request]
PEDIATRIC NURSINGTheories of Growth & development
Red Flags in infant development
1. Unable to sit alone by age 9

months
2. Unable to transfer objects from
hand to hand by age 1 year
3. Abnormal pincer grip or grasp by
age 15 months
4. Unable to walk alone by 18
months
5. Failure to speak recognizable
words by 2 years
PEDIATRIC NURSING
ADDITIONAL INFO:
 COMPUTATION OF WEIGHT : INFANT &

CHILDREN
 < 6 MONTHS : Age (mos) X 600 + BW (g)
 6-12 months : age (mos) X 500 + BW (g)
 1-6 years old : Age (yrs) X 2 + 8
 7-12 yrs old : Age (yrs) x 7 -5/2
 # of deciduous teeth = age in month - 6
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TODDLER – 1 –3 yo
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Toddler ( 1-3 y )
Physical Growth Weight : 2 ½ y = BW quadrupled
Height : adult Ht 2x Ht at 2 y
HC>CC
2 ½ yrs old = Primary dentition completed ( 20 teeth)
Gross & Fine 15 mos – walks alone well

motor 2 y = handle spoon well , runs & walk backward, copies vertical
line; 50-200 words (2 word sentences)
2-3 yrs = day time bladder control, knows complete name
3 yrs = knows age & sex , achieves bowel bladder control
300-900 words
3-4 yr = night time bladder control
Socialization 12-18 mos = imitates housework, name body part
19-24 mos = name picture

Fine Motor - toddler
 1 year old: transfer objects from hand to

hand
 2 year old: can hold a crayon and color
vertical strokes
 Turns the page of a book
 Builds a tower of six blocks
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Fine Motor – Older Toddler
 3 year old: copies a circle and a cross –

builds using small blocks
 4 year old: uses scissors, colors within the
borders
 5 year old: writes some letters and draws a
person with body parts
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Toddler
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Toddler
Safety becomes a problem as

the toddler becomes more
mobile.
PEDIATRIC NURSING
Toddlers
 Communication :
o Approach cautiously
o Accept verbal communication literally
o Learn the toddler words for common item
and use them in conversations.
o Use short & concrete terms
o Repeat explanation and description
o Use play for demonstration
o Use visual aids
o Explain and allow to handle equipment to use
o Encourage to use comfort object
PEDIATRIC NURSING
Toddlers
 Fear : Separation Anxiety

o don’t prolong good bye
o tell when you will be back
 Characteristic trait
o Negativistic “NO” – way to search for
independence
o Rigid , ritualistic and stereotype
o Temper tantrums- head banging ,
screaming , stamping feet, hold breath
 Ignore behavior
o Love rough tumbling play
o Loves toilet training
PEDIATRIC NURSING
 Temper Tantrums-in order to control self
& others. Mx: IGNORE THE BEHAVIOR
or direct them to activities they can
master.(When things are rearranged or
are strange; or when persons or places
are unfamiliar)
 Accidents because they are naturally
active, mobile & curious –(set limits &
exert external control) .
 LOVE & CONSISTENCY are the 2 most
important concepts in child rearing.
 EGOCENTRIC – uses “ MINE “ for everything
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Issues in parenting - toddlers
 Stranger anxiety – should dissipate by age 2 ½ to 3
years
 Temper tantrums: occur weekly 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
PEDIATRIC NURSING
Toddlers
 Characteristic traits
o Loves toilet training
o Failure of toilet training – unreadiness
 Clues for readiness
Can stand, squat alone
Can communicate toilet needs
Can maintain dry for 2H
PEDIATRIC NURSING
NUTRITION
 Decrease in appetite because of the
slow growth rate
 Picky eaters, dawdling with meals
 1, 300 kcal/day
 Allow self feeding
 Allow choice between 2 types of food
 Offer finger food, appetite of 3 year
olds is more capricious than that of 1
year olds
 Risk of aspiration
PEDIATRIC NURSING
DAILY CARE
- dressing – can put on socks, underpants,

undershirt
- sleeps – 12-14H/night w/ 1 nap
- dependency on security object
(transitional toy)
- may ask to sleep with bottle
- may rebel against going to sleep
- bathing
- care of teeth - since all 20 deciduous teeth
are out by 2 ½ yrs, start teaching
brushing of teeth; first dental check up
shld be bet. 12-18 mos.

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Toddlers
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REACTION TO ILLNESS and NURSING
INTERVENTIONS
 Regressive behaviors - reassurance
 Nutrition – allow finger food
 Dressing changes – allow to pull off tape
 Medication – allow choices of “chaser”

after oral medication
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 Hygiene – allow choice of bath time toy,
allow to put toothpaste
 Pain – allow to express pain
 Stimulation
 Elimination – continue potty training
 Rest – allow choice of toy at bedtime
PEDIATRIC NURSING
NOTES:
1. Accidents are the chief cause of death in
toddlers. Most accidental deaths in children
under age 3 years are related to MOTOR
VEHICLE ACCIDENTS.
2. When caring for a toddler in the hospital,
the nurse should prevent SEPARATION
ANXIETY by encouraging rooming-in. To
help the toddler deal with frustration & loss
of autonomy, the nurse should provide the
toddler with a POUNDING BOARD or
PUNCHING BAG.
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3. SECURITY OBJECT – something a toddler
becomes strongly attached to like doll, stuffed
animal, pillow or blanket; if separated from the
security object, the toddler usually reacts with
extreme frustration & anxiety.
4. The DENVER DEVELOPMENT SCREENING
TEST is used to screen the development of toddlers.
( ex. Most toddlers can remove their own clothes
between 12 & 18 mos. And put their own clothes
between 19-24 mos.
5. Turn pot handles in when on stove top.
6. Poisoning: most common in 2 year olds
PEDIATRIC NURSING
 Consider every non food substance a
hazard and place out of child’s sight/
reach.
 Keep all medications, cleaning materials

etc. in clearly marked containers in
locked cabinets.
 provide barrier on open windows to

prevent falls.
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PRE SCHOOL 3-5 yo
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PRESCHOOL ( 3-6 y )
Physical Growth First permanent teeth are molar
Visual acuity 3y = 20/30 ; 4 y = 20/20
Gross & Fine 3 y = handedness established , rides tricycle

motor 4 y = copies square
5 y = copies diamond , throw & catches ball
Socialization 3 y = 900 words

4 y = enjoy entertaining others
Imaginary friends

Pre-School
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Fine motor and cognitive abilities
 Buttoning clothing
 Holding a crayon / pencil
 Building with small blocks
 Using scissors
 Playing a board game
 Have child draw picture of himself
 Pre-school tasks
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NUTRITION
 Slow/Steady growth
 Decreased appetite
 Offer small servings
 Healthy snack food
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DAILY CARE
- accidents – bicycle safety, seat belts

- dressing – choose own clothes
- sleep – resist taking naps
- exercise – very active
- bathing – can wash and dry hands;
need supervision
- care of teeth – independent brushing
PEDIATRIC NURSING
Red flags: preschool
 Inability to perform self-care tasks, hand

washing simple dressing, daytime toileting
 Lack of socialization
 Unable to play with other children
 Able to follow directions during exam
 Performance evaluation of pre-school

teacher for kindergarten readiness
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Pool Safety
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Preschooler characteristic traits
 Curious, creative, imaginative & imitative

 Favorite word : “WHY” , “HOW”
 Complexes: word identification to parent of
same sex and attachment of parent of
opposite sex.
 Oedipal complex : boy to mom
 Electra complex : girl to dad
 Cause marital discord
 Death : SLEEP ONLY
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PRE-SCHOOL
They love to watch adults & imitate their

behavior
- Oedipus and electra complex
- gender roles – need exposure to parents of
opposite sex
- Socialization – capable of sharing
- Discipline – “time out”
- Common fears – dark, mutilation, separation
- Telling “lies” & brag & boast in order to
impress others
- Imaginary friends & playmates are common
PEDIATRIC NURSING
Preschooler Behavioral Problem
 Telling Tall tales- over imagination

 Imaginary friend- to release tension and
anxiety
 Sibling rivalry – jealousy to new baby
 Regression- going back to early stage
o Thumb sucking
o Baby talk
o Bed wetting
o Fetal position
 Masturbation sign of boredom
o Divert attention- offer toy.
PEDIATRIC NURSING
PRESCHOOL
 Communication
 Offer choices
 Speak in simple sentences
 Be concise and limit length of explanation
 Allow asking question
 Described procedure about to be performed
 Use play to explain procedure & activities
 Allow handling equipment
PEDIATRIC NURSING
REACTIONS/CONCERNS IN
ILLNESS AND NURSING
INTERVENTIONS
- fear of the dark – allow dim light and
parent to sit beside child
- Fear of body mutilation - Prepare for
and explain procedure; reassure
- Fear of injury, pain and the unknown -
Encourage expressive play/medical
play
- Fear of separation/abandonment –
relate time and space to familiar
situations
PEDIATRIC NURSING
PEDIATRIC NURSING
- nutrition – food in animal/alphabet
shapes
- dressing change – allow to measure,
cut tape, see incision site
- medication – allow to choose “chaser”
- hygiene – allow choice of toys, wash
hands and face
- pain – allow pain expression, handle
syringe, analgesic
- stimulation
PEDIATRIC NURSING
School Age 6– 12 yo
PEDIATRIC NURSING
SCHOOL AGED ( 6-12 y )
Physical Growth Ht = 2 inch/yr
Vision completely matured
Lymphoid tissue hypertrophy
Ability to perform complex movement
7 y = complete Myelinization
Gross & Fine
motor
9-12 y = uses tool and equipment , follows direction
enthusiastic at work & play.
Socialization 9-12 yrs old = loves secret, organize secret clubs

Play activity is mostly same sex groups

School-Age
PEDIATRIC NURSING
School Years: fine motor
 Writing skills improve
 Fine motor is refined
 Fine motor with more focus
 Building: models – legos
 Sewing
 Musical instrument
 Painting
 Typing skills
 Technology: computers
PEDIATRIC NURSING
School performance
• Ask about favorite subject

• How they are doing in school
• Do they like school
• By parent report: any learning difficulties,
attention problems, homework
• Parental expectations
PEDIATRIC NURSING
Red flags: school age
 School failure
 Lack of friends
 Social isolation
 Aggressive behavior: fights, fire setting,

animal abuse
PEDIATRIC NURSING
School Age: gross motor
 8 to 10 years: team sports

 Age ten: match sport to the physical and
emotional development
PEDIATRIC NURSING
School Age
PEDIATRIC NURSING
School Age: cognitive
 Greater ability to concentrate and

participate in self-initiating quiet activities
that challenge cognitive skills, such as
reading, playing computer and board
games.
PEDIATRIC NURSING
SCHOOL
 Communication
 Establish limits
 Provide reassurance to help in alleviating
fears and anxieties
 Engage in conversations that encourage
thinking.
 Use medical play technique
 Use photographs, books, doll and videos to
explain procedures
 Explain in clear terms
 Allow time for composure & privacy.
PEDIATRIC NURSING
Traits
 Authority figure : teacher

 Fear :
o School phobia
o Displacement from school
o Loss of privacy
o Fear of death ( 7-9 y ) permanent
 Industrious
 Modest
 Can’t bear to lose – will cheat
 Love collection- stamp
PEDIATRIC NURSING
DAILY CARE
1. dressing – influenced by peers

2. sleep – 8-12 hrs; no naps
3. exercise – games, bike riding, walking
4. hygiene – 8 yo – capable of bathing
alone
5. care of teeth – 2x yearly visit to the
dentist; brush daily
6. safety – bicycle, school bus safety,
prevention of falls and sports injuries
PEDIATRIC NURSING
CONCERNS
- problems w/ articulation – disappears 9 yo

- School anxiety and phobia
- Sex education
- Stealing – 7 yo – importance of money
- Violence/terrorism – education;reassurance
- Bullying
- Recreational drug and alcohol use
- Likes to stay up late; slumber parties
- Nightmares common
- Awakens early in the morning
PEDIATRIC NURSING
REACTION TO ILLNESS
AND NURSING INTERVENTIONS
1. Death and disability - Still need comfort

2. Unknown events & procedures - Allow
to help w/ care & treatment
3. Loss of ctrl & independence - Give choice
4. Loss of contact w/ peers - Allow visits
5. Disruption of school - Talk about interests
PEDIATRIC NURSING
1. nutrition – allow choices
2. dressing – ask opinions on bulk of
dressing and where to apply tape
3. medicine – teach name and action,
allow to choose form if possible
4. pain – allow expression of pain, explain
source and cause
5. stimulation
PEDIATRIC NURSING
ADOLESCENT (13-20 y)
 Androgen inc sebaceous gland activity

resulting in acne
 Apocrine glands inc activity
 13 yo – 2nd molars
 PUBERTY – capable of sexual reproduction
 Secondary sexual characteristics
 32 permanent teeth should be present by
age 18-21 yrs
PEDIATRIC NURSING
13 to 18 Year Old
PEDIATRIC NURSING
Adolescent
 As teenagers gain independence, they

begin to challenge values
 Critical of adult authority
 Relies on peer relationship
 Mood swings especially in early
adolescents
PEDIATRIC NURSING
Adolescent behavioral problems
 Anorexia
 Attention deficit
 Anger issues
 Suicide
PEDIATRIC NURSING
Adolescents
PEDIATRIC NURSING
Adolescent Teaching
 Relationships
 Sexuality – STD’s / AIDS
 Substance use and abuse
 Gang activity
 Driving
 Access to weapons
PEDIATRIC NURSING
Adolescents
PEDIATRIC NURSING
Adolescent
 Fear
 Obesity
 Acne
 Homosexuality
 Death
 Replacement form friends
 SIGNIFICANT PERSON : Opposite sex
 Traits
o Idealistic
o Rebellious
o Reformers
o Conscious with body image
o Adventure some
 Problem :
o Vehicular accident, smoking, alcoholism, drugs
o Premarital sex
PEDIATRIC NURSING
GROWTH AND DEVELOPMENTAL
MILESTONES
 13 yo – sports
 15 yo - enjoys privacy
- stays in room
 16 yo - part time job

- charitable causes
PEDIATRIC NURSING
Pubertal development:
a. Female: pubertal changes start between
ages 8 and 13 years and changes take place
for 3 to 4 years. Breast development
commonly precedes pubic hair development.
Most girls reached adult height midway
through puberty.
b. Male: pubertal changes start between age 9
½ and 13 ½ years and changes take place for
about 3 years. Testicular enlargement is
usually the first sign of male pubertal
development. Most boys reached adult height
during the latter half of puberty.
PEDIATRIC NURSING
Pubertal development
sign of sexual maturity
 BOYS  GIRLS
 Testicular
enlargement  Breast bud
(9 ½ y) (thelarche)
 Pubic/axillary
hair  Pubic hair
 Growth spurt
 Voices  Growth spurt
changes
 Menarche

REACTION TO ILLNESS
AND NURSING INTERVENTION
 Main issue – body image – educate and Allow

participation in tx decisions; compassionate
understanding
 Fears loss of control and independence - Respect

privacy and confidentiality
 Fears injury and pain - Provide opportunities for

self expression
 Separation from peers and lack of emotional

support - Approach w/ caring and understanding,
age compatible roommate, Phone at bedside
PEDIATRIC NURSING
Hospitalized patient :
What will I do ????
PEDIATRIC NURSING
DEVELOPMENTAL STAGES
Hospitalized Pediatric patients
 Infant & toddlers ( 0-3 y )
 Separation anxiety
o Protest – crying, screaming, kicking, verbal
attack
o Despair- withdrawn, depressed
o Detachment-only after lengthy separation
 Fear of injury and pain

o Affected by previous experience, separation
from parents
 Loss of control- toddler has its own rituals
 regression

Hospitalized Pediatrics
 Infant & toddlers ( 0-3 y )
 INTERVENTION:
o Provide swaddling & soft talking to the infant
o Provide
Swaddlingfor oral
is the stimulation
art of likeyour
snugly wrapping pacifier
baby in a blanket for
warmth and security. It can keep him from being disturbed by his
o Provides routine & rituals
own startle reflex
o Provide choices to toddlers
o Allow toddler to express feeling of protest
o Encourage to talk
o Allow as much mobility as possible
o Anticipate temper tantrum
o Maintain pain reduction
 PRESCHOOLER (3-6 Y)
 A. Separation anxiety – less serious
o Protest
o Despair
o Detachment
 B. Fear of injury & pain
o Invasive procedure & mutilation
o Imagine worst thing can happen
o Believe they did something wrong
 C. loss of control

 PRESCHOOLER (3-6 Y)
 INTERVENTION:
o Provide a safe & secure environment
o Communication
o Allow to express anger
o Accept aggressive behavior
o Leave favorite toy
o Allow mobility, provide play and diversional
o Place in the room with same age
o Explain procedure simply on their level
o Allow wearing underpants
 SCHOOL AGED (6-12 Y)
 A. Separation anxiety
o Accustomed to period of separation from the
parents
o More concerned of missing school & friends

o Bodily injury & pain
o Death
o Uncomfortable in any sexual examination
 SCHOOL AGED (6-12 Y)
 INTERVENTION:
o Encourage rooming-in
o Become involved with his own care
o Accept regression but encourage independence
o Provide choices
o Allow expression of feeling verbally & non-verbally
o Acknowledge fear and concerns
o Explain all procedures
o Allow to wear underpants
o Contact friends
o Provide educational need

 ADOLESCENCE (13-20 Y)
 A. Separation anxiety
- Source : separation from friends
o Being different from others
o May give impression they are not afraid
though they are terrified
o Become guarded when any areas R/T to
sexual development are examined
o Seek help and reject
 ADOLESCENCE (13-20 Y)
 INTERVENTION
o Encourage question
o Explore feelings
o May wear own clothes
o Allow privacy
o Use body diagram to prepare for procedure
o maintain contact with peers
o Identify formation of future plans
o Help develop positive coping mechanism

STAGE
Age
Infancy Solitary
Birth-1 yr self is the interest of activities; alone
but enjoys presence of others
Toddler Parallel
1-3 years plays alongside, but not with another;
has not learned sharing yet
Preschool Associative
3-6 years plays in random without group goal;
follows a leader
School Age Cooperative
6-12 years
Adolescence Competitive
13-20 years
PEDIATRIC NURSING
PLAY
Infancy Toddler Preschool School age Adolescence
(0-1y) (2-3y) (3-6y) (6-12) (13-20y)
Solitary Parallel Cooperative Competitive Competitive
Soft Push/pull toys Imaginary Rules & Games &

stuffed Block, sand, playmates rituals Athletics
animals finger paint, Team sport
Crib bubbles, large Dress up Drawing, Competition &
mobiles, ball, crayon, clothes, collecting strict rules is
rattle, telephone, paints , items , dolls important
musical wooden paper , pet ,
toys, push -puzzles crayon . guessing Sports,
toys games , videos,
Loves board movies,
running & games , parties,
jumping TV, radio , dancing ,
videos , hobbies,
computer music ,
games computer
games,
makeup
IT is not enough to have a good
mind;
the main thing is to use it well
-Rene Descartes-
PEDIATRIC NURSING
-end-
PEDIATRIC NURSING

Growth & Development: Mary Lourdes Nacel G. Celeste, RN, MD Ellen H. Tinio, RN, MD

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Growth & Development: Mary Lourdes Nacel G. Celeste, RN, MD Ellen H. Tinio, RN, MD

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Growth &

Mary Lourdes Nacel G. Celeste, RN, MD

Development : used to denote an increased in

 Weight – most sensitive measure of growth

 Height- increases by 1”/mo during 1st 6 mos

 Increase in skills or capability to function

- proceeds in an orderly sequence

2. Not all parts of the body grow at the same time or

• Renal / digestive / circulatory /

- There is an optimum time for initiation of experiences or learning.

4. Occurs in regular direction reflecting a definitive

A. Locomotion- ( crawls > creeps >

III. Secular- worldwide trend of maturing earlier

5. Behavior - most comprehensive indicator of

B. Second stage – from birth to 12 months

C. Third Stage – Early Childhood ( 1-6 y/o)

D. Fourth Stage – Middle Childhood

 Fetal period- infancy = head and

2.Psychosocial development- refers to stages of personality

3.Moral development- is the ability to know right from wrong

 Freud, Sigmund PSYCHOSEXUAL

 Piaget, Jean COGNITIVE

 Erikson, Erik PSYCHOSOCIAL

 Kohlberg, Lawrence MORAL

THEORY Infancy Toddler Preschool School age Adolescence

Freud ORAL Anal Phallic Latency Genital

Piaget Sensori- Sensori- Preoperational Concrete Formal

 Oral phase ( 0-18 months)

 Anal ( 18 months-3 years old)

 Superego and morality development

 Trust vs. Mistrust ( 0-18 months ) infant

 N.I. provide primary caregiver and visual stimulation

 N.I : provide opportunities for decision making and

o Give an opportunity of decision making like offer

 Initiative vs. Guilt ( 4-6 y ) preschool

 N.I. provide opportunities for exploration, answer

 Industry vs. Inferiority ( 7-12 y) school age

 Child learns how to do things well

Ind: how to do things well

 Identity vs. role confusion ( 12-20y )

I: integrate image into a whole

 Sensory Motor ( 0-2 y )

 Children experience the world through

 Magical thinking predominates.

 The child is able to classify, order, and sort

 Formal operational ( 12-20 y )

INFANT (0-12 MOS)

 Infancy  Middle Childhood

 Early detection of deviation in child’s

 Simple and time efficient mechanism to

 Solo, mom interactive

 Newborn: barely able to lift head

Newborn Age 6 months

 2 months old: needs assistance

Age 2 months Age 8 months

 9 month old: crawls

 Newborn has very little control. Objects will

 1-2 months: coos

 BAER hearing test done at birth

** Best color for infants: red

1. Unable to sit alone by age 9

 COMPUTATION OF WEIGHT : INFANT &

 # of deciduous teeth = age in month - 6