1.

Definition of terms
1.1. Growth- is physical change and increased in size. It can be measured quantitatively.

1.2. Development- is an increased in the complexity of function and skills progression. It is the capacity and
skills of the person to adapt to the environment.

1.3. Maturation- It is an increase in competence and adaptability; aging; usually used to describe a qualitative
change; to function at a higher level. It is a synonym for development

1.4. Differentiation- the process by which early cell and structures are systematically modified and altered to
achieve specific and characteristic physical and chemical properties. Development from simple to a more
complex activities and functions.

1.5. Decentering- he ability to project the self into other people’s situation and see the world from their
viewpoint rather than focusing only on their own view.

1.6. Accommodation- is the process of change whereby cognitive processes mature sufficiently to allow the
person to solve problems that were not solved before.

1.7. Conservation- the understanding that certain physical characteristics of objects remain the same, even
when their outward appearance change

1.8. Class inclusion- the ability to understand that objects can belong to more than one classification.
1.9. Reciprocity- Something done mutually or in return.
2. Major Theories of Development
2.1. Freud’s Theory of Psychosexual Development

2.1.1. Theoretical framework

The psychoanalytic techniques used by Freud led him to believe that early childhood experiences form
the unconscious motivation for actions in later life. He developed a theory that sexual energy is centered in
specific parts of the body at certain age. Unresolved conflicts and unmet needs at a certain stage lead to a
fixation of development at that stage.
Freud viewed the personality as a structure with three parts: the id, the basic sexual energy that is present
at birth and drives the individual to seek pleasure; the ego, the realistic part of the person, which develops
during infancy and searches for acceptable methods of meeting impulses; and the superego, the moral and
ethical system, which develops in childhood and contains a set of values and conscience.

2.1.2. Stages
Oral Stage (birth to 1 year) – During infancy the major source of pleasure seeking is centered on oral
activities such as sucking, biting, chewing and vocalizing.

Anal Stage (1-3 years) – Interest during the 2nd year of life centers in the anal region as sphincter muscles
develop and children are able to withhold or expel fecal material at will.

Phallic Stage (3-6 years) – During this stage the genitals become an interesting and sensitive area of the body.
Children recognize differences between sexes and become curious with the dissimilarities. This is the period
around which the controversial issues of the Oedipus and Electra complexes, penis envy, and castration anxiety
 are centered.

Latency Period (6-12 years) – Children elaborate on previously acquired traits and skills. Physical and psychic
energy are channeled into the acquisition of knowledge and vigorous play.

Genital Stage (age 12 and over) – The last significant stage begins at puberty with maturation of the
reproductive system and production of sex hormones. The genitals become the major source of sexual tension
and pleasure, but energies are also invested in forming friendships and preparing for marriage.

2.1.3. Nursing Application

Freud emphasized the importance of meeting the needs of each stage in order to move successfully into
future developmental stages. The crisis of illness can interfere with normal development processes and add
challenges for the nurse who is striving to meet an ill child’s needs. For example, the importance of sucking in
infancy guides the nurse to provide a pacifier for the infant who cannot have oral fluids. The preschool child’s
concern about sexuality guides the nurse to provide privacy and clear explanations during any procedures
involving the genital area. It may be necessary to teach parents that masturbation by the young child is normal
and to help parents deal with it. The adolescent’s focus on relationships suggests that the nurse should include
questions about significant friends during history taking.

2.2. Erikson’s Theory of Psychosocial Development

2.2.1. Theoretical framework
Erikson’s theory establishes psychosocial stages during eight periods of human life. For each stage,
Erikson identifies a crisis, that is, a particular challenge that exists for healthy personality development to
occur. The word crisis in this context refers to normal maturational social needs rather than to a single critical
event. Each developmental crisis has two possible outcomes: When needs are met, the consequence is healthy
and the individual moves on to future stages with particular strengths. When needs are not met, an unhealthy
outcome occurs that will influence future social relationships.

2.2.2. Stages
Trust versus Mistrust (birth to 1 year) – The first and important attribute to develop for a healthy personality
is a basic trust. From warm, responsive care, infant gain a sense of trust, or confidence, that the world is good.
Mistrust occurs when infants have to wait too long for comfort and are handles harshly.

Autonomy versus Shame and Doubt (1-3 years) – Autonomy can be symbolized by the holding onto and
letting go of the sphincter muscles. Using new mental and motor skills, children want to choose and decide for
themselves. Autonomy is fostered when parents permit reasonable free choice and do not force or shame the
child.

Initiative versus Guilt (3-6 years) – This stage is characterized by vigorous and intrusive behavior, enterprise,
and a strong imagination. Children explore the physical world with all their senses and powers. They develop a
conscience. Children sometimes undertake goals or activities that are conflict with those of parents or others,
and being made to feel that their activities or imaginings are bad produces a sense of guilt.

Industry versus Inferiority (6-12 years) – At school, children develop the capacity to work and cooperate
with others. Inferiority develops when negative experiences at home, at school, or with peers lead to feeling of
incompetence.
 Identity versus Role Confusion (12-18 years) – The development of identity is characterized by rapid and
marked physical change. Previous trust in their bodies is shaken, and children become overly preoccupied with
the way they appear in the eyes of others as compared with their own self-concept. Inability to solve the core
conflict results in role confusion.

2.2.3. Nursing Applications

Erikson’s theory is directly applicable to the nursing care of children. The social situations created by
health care in the community provide opportunities for helping caregivers to meet children’s needs. The child’s
usual support from family, peers, and other is interrupted by hospitalizations. The challenge of hospitalization
also adds a situational crisis to the normal developmental crisis a child experiencing. Although the nurse may
meet many of the hospitalized child’s needs, continues parental involvement is necessary both during and after
hospitalization to ensure progression through expected developmental stage.

2.3. Piaget’s Theory of Cognitive Development

2.3.1. Theoretical framework

Based on his observations and work with children, Piaget formulated a theory of cognitive (intellectual)
development. He believed that the child’s view of the world is influenced largely by age and maturational
ability. Given nurturing experiences, the child’s ability to think matures naturally. The child’s incorporates new
experiences via assimilation and changes to deal with these experiences by the process of accommodation.

2.3.2. Stages
Sensorimotor (birth to 2 years) – Infants learn about the world by input obtained through the senses and by
their motor activity. Six substages are characteristic of this stage.

Use of Reflexes (Birth to 1 month) - The infant begins life with a set of reflexes such as sucking,
rooting, and grasping. By using these reflexes, the infant receives stimulation via touch, sound, smell,
and vision. The reflexes thus pave the way for the first learning to occur.

Primary Circular Reactions (1-4 months) – Once the infant responds reflexively the pleasure gained
from the response causes repetition of the behavior.

Secondary Circular Reactions (4-8 months) – Awareness of the environment grows as the infant
begins to connect cause and effect. The sounds of bottle preparation will lead excited behavior. If an
object is partially hidden, the infant will attempt to uncover or retrieve it.

Coordination of Secondary Scheme (8-12 months) - Intentional behavior is observed as the infant
uses learned behavior to obtain objects, create sounds, or engage in other pleasurable activity. Object
permanence (the knowledge that something continues to exist even when out of sight) begins when the
infant remembers where a hidden object is likely to be found; it is longer “out of sight, out of mind”.

Tertiary Circular Reactions (12- 18 months) – Curiosity, experimentation, and exploration

predominate as the toddler tries out actions to learn results. Objects are turned in every direction, placed
in the mouth, used for banging, and inserted in container as their qualities and uses are explored.
 Mental Combination (18-24 months) – Languages provides a new tool for the toddler to use in
understanding the world. Language enables the child to think about events and objects before or after
they occur. Object permanence is now full developed as the child actively searches in various locations
and out of view.

Preoperational (2-7 years) – The young child thinks by using words as symbols, but logic is not well
developed. Suring the preconceptual stage (2-4 years), vocabulary and comprehension increase greatly, but the
child is egocentric (that is, unable to see things from the perspective of another). In the intuitive substage (4-7
years), the child relies on transductive reasoning (that is, drawing conclusion from one general fact to another).

Concrete Operations (7-11 years) – Transductive reasoning has given way to a more accurate understanding
of cause and effect. The child can reason quiet well if concrete objects are used in teaching or experimentation.
The concept of conservation is learned at this stage.

Formal Operations (11 to adulthood) – It is characterized by adaptability and flexibility. Adolescent can
think in abstract terms, use abstract symbols, and draw logical conclusions from a set of observations.

2.3.3. Nursing Applications

Piaget’s theory is essential in pediatric nursing. The nurse must understand a child’s thought processes in
order to design stimulating activities and meaningful, appropriate teaching plans. Understanding a child’s
concept of time suggests to the nurse how far in advance to prepare that child for procedures. Similarly, the
nurse’s decision to offer manipulative toys, read stories, draw pictures, or give the child reading material to
explain health care measures depends on the child’s cognitive stage of development.

2.4. Kholberg Theory of Moral Development

2.4.1. Theoretical framework
Kohlberg’s work has been criticized for insensitivity to cultural differences in moral reasoning and for
sexual bias; however it remain a useful framework for some to help understand moral decision making.
Kohlberg’s focus is on a particular type of cognitive development concerned with moral decisions. He
presented stories involving moral dilemmas to children and adults and asked them to solve the dilemmas.
Kohlberg then analyzed the motives they expressed when making decision about the best course to take. Based
on the explanations given, Kohlberg establishes three levels of moral reasoning. Although he provided age
guidelines, he stated that they are approximate and that many people never reach the highest (postconventional)
stage of development.

2.4.2. Stages
Preconventional level (4-7 years) – Morality is external because conform to rules imposed by authority
figures. Children are responsive to cultural rules and labels of good and bad, right and wrong. It consists of two
stages:

The punishment and obedience orientation – Children determines the goodness or badness of an
action in terms of its consequences. They avoid punishment and obey unquestioningly those who have
the power to determine and enforce the rule and labels.

The instrumental-relativist orientation – the right behavior consists of that which satisfies the child’s
 own needs and sometimes the needs of others. Although elements of fairness, reciprocity and equal
sharing are evident they are interpreted in a very practical, concrete manner without the elements of
loyalty, gratitude or justice.

Conventional level (7-11 years) – Children are concerned with conformity and loyalty actively maintaining,
supporting and justifying the social order; the personal expectations of those significant in their lives. They
value the maintenance of family, groups or national expectations of those significant in their lives. It consists of
two stages:
The interpersonal accordance or “good boy-nice girl” orientation – behavior that meets the approval
and pleases or helps others is viewed as good. Conformity to the norm is the “natural” behavior, and one
earns approval by being “nice”.

The “law and order” orientation – obeying the rules, doing one’s duty, showing respect for authority,
and maintaining the social order is the correct behavior. The rules and authority can be social or
religious, depending on which is most valued.

Postconventional level (12 years and older) – Children have reached the cognitive formal operational stage.
They endeavor to define moral values and principles that are valid and applicable beyond the authority of the
groups and persons holding these principles.

2.4.3. Nursing Applications

Decision making is required in many areas of health care. Children can be assisted to make decisions
about health care and to consider alternative when available. The nurse should keep in mind that young children
may agree to participate in research simply because they want to comply with adults and appear cooperative.

2.5. Social Learning Theory

2.5.1. Theoretical framework
Bandura, a contemporary psychologist, believes that children learn attitudes, beliefs, customs, and values
through their social contacts with adults and other children. Children imitates (model) the behavior they see; if
the behavior is positively reinforced, they tend to repeat it. The external environment and the child’s internal
processes are key elements in social learning theory.

2.5.2. Stages
Basic Social Learning Concepts
1. People can learn through observation.
Observational Learning
In his famous "Bobo doll" studies, Bandura demonstrated that children learn and imitate behaviors they have
observed in other people. The children in Bandura’s studies observed an adult acting violently toward a Bobo
doll. When the children were later allowed to play in a room with the Bobo doll, they began to imitate the
aggressive actions they had previously observed.
Bandura identified three basic models of observational learning:
1. A live model, which involves an actual individual demonstrating or acting out a behavior.
2. A verbal instructional model, which involves descriptions and explanations of a behavior.
3. A symbolic model, which involves real or fictional characters displaying behaviors in books, films,
television programs, or online media.
 2. Mental states are important to learning.
Intrinsic Reinforcement
Bandura noted that external, environmental reinforcement was not the only factor to influence learning and
behavior. He described intrinsic reinforcement as a form of internal reward, such as pride, satisfaction, and a
sense of accomplishment. This emphasis on internal thoughts and cognitions helps connect learning theories to
cognitive developmental theories. While many textbooks place social learning theory with behavioral theories,
Bandura himself describes his approach as a 'social cognitive theory.'

3. Learning does not necessarily lead to a change in behavior.

While behaviorists believed that learning led to a permanent change in behavior, observational learning
demonstrates that people can learn new information without demonstrating new behaviors.
The Modeling Process
Not all observed behaviors are effectively learned. Factors involving both the model and the learner can play a
role in whether social learning is successful. Certain requirements and steps must also be followed. The
following steps are involved in the observational learning and modeling process:

• Attention:
In order to learn, you need to be paying attention. Anything that detracts your attention is going to have a
negative effect on observational learning. If the model interesting or there is a novel aspect to the situation,
you are far more likely to dedicate your full attention to learning.

• Retention:
The ability to store information is also an important part of the learning process. Retention can be affected
by a number of factors, but the ability to pull up information later and act on it is vital to observational
learning.
• Reproduction:
Once you have paid attention to the model and retained the information, it is time to actually perform the
behavior you observed. Further practice of the learned behavior leads to improvement and skill
advancement.
• Motivation:
Finally, in order for observational learning to be successful, you have to be motivated to imitate the
behavior that has been modeled. Reinforcement and punishment play an important role in motivation. While
experiencing these motivators can be highly effective, so can observing other experience some type of
reinforcement or punishment. For example, if you see another student rewarded with extra credit for being
to class on time, you might start to show up a few minutes early each day.

2.5.3. Nursing Applications

The importance of modeling behavior can readily be applied in health care. Children are more likely to
cooperate if they see adults or other children performing a task willingly. A frightened child may watch another
child perform vision screening or have blood drawn and then decide to allow the procedure to take place.
Contact with positive role models is useful when teaching children and adolescents self-care for chronic disease
such as diabetes. Positive reinforcement should be given for desired performance.

2.6. Behaviorism
2.6.1. Theoretical framework
Watson studied the research of Pavlov and Skinner, who demonstrated that actions are determined by
 responses from the environment. Pavlov and, later, Skinner worked with animals, presenting a stimulus such as
food and pairing with another stimulus such as ringing a bell. Eventually the animal being fed began to salivate
when the bell rang. As Skinner and then Watson began to apply these concepts to children, they showed that
behaviors can be elicited by positive reinforcement, such as by scolding or withdrawal of attention. Watson
believed that he could make a child anyone he desired – from professional to a thief or beggar – simply by
reinforcing behavior in certain ways.

2.6.2. Stages
There are two major types of conditioning:
1. Classical conditioning is a technique used in behavioral training in which a naturally occurring stimulus is
paired with a response. Next, a previously neutral stimulus is paired with the naturally occurring stimulus.
Eventually, the previously neutral stimulus comes to evoke the response without the presence of the
naturally occurring stimulus. The two elements are then known as the conditioned stimulus and the
conditioned response.

2. Operant conditioning Operant conditioning (sometimes referred to as instrumental conditioning) is a

method of learning that occurs through rewards and punishments for behavior. Through operant
conditioning, an association is made between a behavior and a consequence for that behavior.

2.6.3. Nursing Applications

Behaviorism has been criticized for its simplicity and its denial of the inherent capability of persons to
respond willfully to events in the environment. This theory does, however, have some use in health care. When
particular behavior are desired, positive reinforcement can be established to encourage this behavior.
Behavioral techniques are also used to alter behavior of children who misbehave or to teach skills to children
whoa are physically challenged. Parents often use reinforcement in toilet training and other skills learned in
childhoods.

2.7. Ecological Theory

2.7.1. Theoretical framework
Urie Bronfenbrenner, an American psychologist, is responsible for an approach to child development that
has risen to the forefront of the field over the past 2 decades. Ecological system theory views the child as
developing within a complex system of relationships affected by multiple levels of the surrounding
environment. Since the child’s biological dispositions joins with the environment forces to mold development.
Before Bronfenbrenner’s theory, many researchers viewed the environment fairly narrowly – as limited
to events and condition immediately surrounding the child. Bronfenbrenner expanded this view by envisioning
the environment as a series of nested structures that includes but extends beyond home, school, and
neighborhood setting in which children spend their everyday lives.
 2.7.2. Stages
Levels or systems

The Microsystem – This is the innermost level of the environment. It refers to activities and interaction
patterns in the child’s immediate surroundings. All relationships at this level are bidirectional and reciprocal.
That is adult’s affect children’s behavior, but children’s biologically and socially influenced characteristics also
influenced the behavior of adults.
The Mesosystem – For children to develop at their best, child-rearing supports must also exist in the larger
environment. Mesosytem encompasses connections between microsystem such as home, school, neighborhood,
and day care center that fosters children’s development.
The Exosystem – It refers to social settings that do not contain children but that affect their experiences in
immediate settings. This may be formal organizations, such as the parent’s workplace or health and welfare
services in the community.
The Macrosystem – consist of overarching cultural patterns such as a dominant beliefs, ideologies and
economic and political system.
The Chronosystem – This final level brings the perspective of time to the previous settings, The time period
during which the child grows up influences view of health and illness

2.7.3. Nursing Applications

Nurses use ecologic theory when they assess the child’s setting to identify influenced on development.
Interventions are planned to enhance the strengths of the child’s setting and to improve on areas that are not
supportive.

2.8. Temperament Theory

2.8.1. Theoretical framework
In contrast to behaviorist such as Watson or maturational theorists such as Piaget, Chess and Thomas
recognize the innate qualities of personality that each individual brings to the events of daily life. They, like
Bronfenbrenner, believe the child is an individual who both influences and is influenced by the environment.
Temperament – a behavioral style demonstrated when one approaches people or situations. It is evident at
birth and is predictive of the adult’s personality. There is evidence that one’s environment can heighten,
diminish or modify in other ways the characteristics of temperament.

2.8.2. Stages
The nine characteristics identified include the following:
Activity level –level of physical motion during activity, such as sleep, eating, play, dressing and bathing.
Rhythmicity – regularity of timing of physiologic functions, such as hunger, sleep, and elimination.
Adaptability – ease or difficulty with which the child’s adapt or adjust to new altered situations.
Approach withdrawal –the behavior when a new experience is introduced.
Intensity of response – energy level of the child’s reaction, regardless quality or direction.
Threshold of responsiveness – amount of stimulation such as sound or light, required to evoke a response in
the child.
Quality of mood – general state of cheerfulness or unhappiness exhibited by the child in various situations.
Distractibility – ease of alternating ongoing behavior by external stimuli.
 Persistance and attraction span – length of time an activity to tolerate frustrations in that activity despite
obstacles.

When taken together, the assessment of child’s characteristics lead to the formation of a personality
structures
.
The Three Personality Types:
The easy child – are even-tempered, regular and predictable in their habits, and they have a positive approach
to a new stimuli. They are open and mild to moderate intense mood that is typically positive.
The difficult child – are highly active, irritable and irregular in their habits, negative withdrawal of their
responses are typical and they require a more structured environment.
The slow-to-warm-up child – they typically react negatively and with mild intensity to new stimuli, and unless
pressured, adapt slowly with repeated contact.

2.8.3. Nursing Applications

The concept of personality type or temperament is useful one for nurses. Nurses can assess the
temperament of young children and alter the environment to meet their needs. This may involve moving a
hospitalized child to a single room to ensure adequate rest if the child is easily stimulated, or allowing a shy
child time to become accustomed to new surroundings and equipment before beginning procedures or
treatments.
Parents are often relieved to learn about temperament characteristics. They learn to appreciate their
children’s qualities and to adapt the environment to meet the children’s needs. A burden of guilt can also be
lifted from parents who feel that they are responsible for the child’s actions. The nurse can teach parents ways
of enhancing goodness of fit between the child’s personality and the environment.

2.9. Resiliency Theory

2.9.1. Theoretical framework
A wealth of evidence shows that environmental risks – poverty, negative family interactions, parental
divorce, job loss, mental illness, and drug abuse – predispose children to future problems
New evidence of resiliency – the ability to spring back from adversity – receiving increasing attention
because investigators wants to find ways to protect young people from the damaging effects of stressful life
conditions. This interest was inspired by several long-terms studies on the relationship of life stressors in
childhood to competence and adjustments in adolescence and adulthood. In each study, some children were
shielded from negative outcomes, whereas others had lasting problems.

2.9.2. Stages
Three broad factors seemed to offer protection from the damaging effects of stressful life events:
Personal characteristics of children – a child’s biologically endowed characteristics can reduce exposure to
risk or lead to experiences that compensate for early stressful events. Temperament is particularly powerful.
Children with calm, easy-going, sociable disposition who are willing to take initiative have a special capacity to
adapt to changes and elicit positive response from others.
A warm parental relationship – A close relationship with atleast one parent who provides affection and
assistance and introduces order and organization into the child’s life foster resilience. But this factor is not
independent of children personal characteristics. Children who are relaxes, socially responsive, and able to deal
with change are easier to rear and more likely to enjoy positive relationship with parents and other people. At
the same tome some children may develop more attractive disposition as a result of parental warmth and
attention.
Social support outside the immediate family – A person outside the immediate family – perhaps grandfather,
teacher, or close friends – who forms a special relationship with the child can promote resilient.

2.9.3. Nursing Applications

Nursesuse concepts of resiliency theory in planning interventions for children and families. Nursing
strategies can target risk factors, such as encouraging family behaviors to ensure gun safety by teaching the use
of gun locks and locked gun cabinets in families with firearms. In addition, protective factors Cn be
emphasized, such as when regular exercise is suggested to help maintain normal weight and cardiovascular
function.