Lesson 1: Infant, Child, and Adolescent

 Erik Erikson: psychosocial development

 Sigmund Freud: psychosexual development
 Jean Piaget: cognitive development

Age Range Erikson Freud Piaget Kohlberg

Infancy: birth to 1 year Trust vs mistrust Oral gratification Sensorimotor (birth to 2 Infant has no awareness of right or
years) wrong

Toddler: 1 to 3 years Autonomy vs shame Anal stage: gains a sense Preoperational (2 to 7 years) Punishment and obedience
and doubt of control over instinctive orientation
drives

Preschool: 3 to 6 years Initiative vs guilt Phallic stage: becomes Preoperational (2 to 7 years) Preconventional: conforms to rules
aware of self as sexual to avoid punishment
being

School-age: 6 to 12 years Industry vs inferiority Latency stage: focuses on Concrete operational (7 to 11 Conventional: conforms to rules to
developing peer years) please others
relationships

The Infant
 Skim and low-fat milk should not be given, because the essential
Physical Characteristics fatty acids are inadequate and the solute concentration of protein
 Weight has doubled at 5 to 6 months and tripled by 12 months. and electrolytes is too high.
 By 1 to 2 years of age, head circumference and chest circumference  Fluoride supplementation may be needed starting around 6 months
are equal. of age.
 Anterior fontanel (soft and flat in a normal infant) closes between 12  Solid foods are introduced at 5 to 6 months of age. New foods are
and 18 months. introduced one at a time, usually at intervals of 4 to 7 days, as a
 Posterior fontanel (soft and flat in a normal infant) closes after 2 to 3 means of identifying food allergies.
months.  Sequence of introduction of solid foods: rice cereal; fruits and
 Lower central incisors erupt after 6 to 8 months. vegetables, first yellow and then green; meats; egg yolks, avoiding
 The infant sleeps most of the time. egg whites (introduce egg white toward the end of the first year);
cheese may be used as a substitute for meat and as a finger food.
 Avoid solid foods, such as nuts, foods with seeds, raisins, popcorn,
Vital signs grapes, and pieces of hot dog, that put the infant at risk for choking.
Newborn  Avoid microwaving baby bottles and baby food.
 Axillary temperature: 97.7° F to 99.5° F (36.5 to 37.5° C)  Never mix food or medications with formula.
 Apical rate: 120 to 160 beats per minute (100 sleeping, 180 crying)  To help prevent botulism, never add honey or corn syrup to formula,
 Respirations: 30 to 60 (average 40) breaths per minute water, or other fluid.
 Blood pressure: averages 73/55 mm Hg  Offer fruit juice from a cup. rather than a bottle, to prevent bottle-
 temp 36.5 to 37.5 C mouth caries.

1-Year-Old
 Axillary temperature: 96.8° F to 99° F (36 to 37.2° C)
 Apical rate: 90 to 130 beats per minute
 Respirations: 20 to 40 breaths per minute
 Blood pressure: averages 90/56 mm Hg
 temp 36 to 37.2 C

Nutrition
 The infant may breastfeed or bottle-feed, depending on the
mother's choice.
 Human milk is the best food for infants younger than 6 months.
 Whole milk should not be introduced to an infant until after 1 year
of age.
 Skills  Be sure that bathwater is not hot; do not leave child unattended in
bath.
Age Skills  Do not hold infant while drinking or working near hot liquids.
2 – 3 months  Smiles  Cool vaporizers should be used instead of steam to help prevent
 Turns head from side to side burn injuries.
 Cries
 To help prevent choking, avoid offering food that is round and
 Follows objects
similar in diameter to the airway.
 Holds head in midline
 Be sure that toys have no small pieces.
4 – 5 months  Grasps objects  To help prevent strangulation, hang mobiles and other toys over the
 Switches objects from hand to hand crib well out of reach of the infant.
 Rolls over for first time  Avoid placing large toys in the crib; an older infant may use them as
 Enjoys social interaction steps to climb.
 Begins to show memory  Cribs should be positioned away from curtains and blind cords.
 Aware of unfamiliar surroundings  Cover electrical outlets.
 Remove hazardous objects from low, reachable places.
 Remove chemicals, medications, poisons, and plants from the
6 – 7 months  Creeps
infant's reach.
 Sits with support
 Imitates  Keep the poison-control hotline number available.
 Exhibits fear of strangers
 Holds arms out
 Frequent mood swings The Toddler
 Waves bye-bye Physical Characteristics
8 – 9 months  Sits steadily when unsupported  Height and weight increase in steplike fashion, reflecting growth
 Crawls spurts and lags. (Weight gain is slower during this phase than in
 May stand while holding on to support infancy.)
 Begins to stand without help  The toddler should see a dentist soon after the first teeth erupt,
usually around 1 year of age; a fluoride supplement may be
necessary.
 A toddler should never be allowed to fall asleep with a bottle
10 – 11  Can move from prone to sitting position containing milk, juice, soda pop, or sweetened water because of the
months  Walks while holding on to furniture risk of bottle-mouth caries.
 Stands securely  The toddler typically sleeps through the night and takes one daytime
 Entertains self for periods nap; nap is discontinued around age 3.
 A consistent bedtime ritual helps prepare the toddler for sleep.
 Security objects may also help the toddler get to sleep.
12 – 13  Walks with one hand held
months  Can take a few steps without falling
Vital Signs
14 – 15  Walks alone
months  Can crawl up stairs  Axillary temperature: 97.5° F to 98.6° F; 36.4°C to 37 °C
 Shows emotions such as anger and  Apical rate: 80 to 120 beats per minute
affection  Respirations: 20 to 30 breaths per minute
 Explores away from parent in familiar  Blood pressure: averages 92/55 mm Hg
surroundings

Play
 Solitary
 Enjoys soft stuffed animals, crib mobiles with contrasting colors,
squeeze toys, rattles, musical toys, water toys in the bath, large
picture books, and, after beginning to walk, push toys
Safety
 The home should be baby-proofed.
 Car safety seats are not placed in the front seats of cars; the infant
could be seriously injured if the passenger air bag is released,
because safety seats extend closer to the dashboard.
 Guard infant on bed or changing table.
 Use gates to protect infant from stairs.
 Never vigorously shake an infant.
Nutrition
 The toddler generally does best eating several small, nutritious
meals each day rather than three large meals.
 The MyPlate for Kids food plan provides dietary guidelines for
children as young as 2 years of age.
 Offer a limited number of foods at any one time; avoid concentrated
sweets and empty calories.
 Seat the toddler in a high chair at the family table for meals.
 Allow toddler sufficient time to eat but remove food when he or she
begins playing with it.
 The toddler drinks well from a cup held with both hands.
 Toddlers are at risk for aspiration of small foods that are not easily
chewed (e.g., nuts, foods with seeds, raisins, popcorn, grapes, pieces
of hot dog).

Skills
 The toddler begins to walk with one hand held by age 12 to 13
months, runs by 2 years, and walks backward and hops on one foot
by 3 years.
 Children of this age usually cannot alternate feet when climbing
stairs.
 Toddlers are beginning to master fine motor skills for building,
undressing, and drawing lines.
 The young toddler often uses "no," even when he or she means
"yes," to assert independence.
 The toddler is beginning to use short sentences and has a vocabulary
of about 300 words by age 2; tends to ask many "why" questions.
Bowel and Bladder Control
 The toddler is beginning to exhibit signs of readiness for toilet
training.
 Able to stay dry for 2 hours
 Wakes dry from nap
 Able to sit, squat, and walk
 Able to remove clothing
 Recognizes urge to defecate or urinate
 Expresses willingness to please parent
 Able to sit on toilet for 5 to 10 minutes without fussing or
getting off
 Bowel control develops before bladder control.
 By age 3, the toddler has generally achieved fairly good bowel and
bladder control.
Play
 The major socializing mechanism is parallel play; therapeutic play
may be started at this age.
 A short attention span causes the toddler to change toys often.
 The toddler explores body parts of self and others.
 Typical toys include push/pull toys, blocks, sand, finger paints,
bubbles, large balls, crayons, trucks, dolls, containers, Play-Doh, toy
telephones, cloth books, and wooden puzzles.
Safety
 Toddlers are eager to explore the world around them.
 The toddler should be supervised at play.
 Refer to the American Academy of Pediatrics for information on car
safety.
 Lock all car doors.
 Use back burners on the stove to prepare meals; turn handles
inward and toward the middle of the stove to keep pots from being
pulled off the stove.
 Keep dangling cords from small appliances away from the toddler.
 Place inaccessible locks on windows and doors, and keep furniture
away from windows.
 Secure screens on all windows.
 Place gates at stairways.
 Do not allow the toddler to sleep or play in an upper bunk.
 Never leave a toddler alone near a bathtub, pail, swimming pool, or
any other body of water.
 Keep toilet lids closed.
 Store all medicines, poisons, and other toxic products high and
locked out of reach; keep household plants out of reach as well.
The Preschooler
Physical Characteristics
 Average height and weight at age 5 are 43 inches (102 cm); 32 lbs
(14.5 kg), respectively.
 The preschooler requires about 12 hours of sleep each day.
 A security object and a night light will help the preschooler get to
sleep.
 At the beginning of the preschool period, the eruption of the
deciduous (primary) teeth is complete.
 Regular dental care is essential, and the preschooler requires
assistance with brushing and flossing of teeth; a fluoride supplement
may be necessary.
Vital Signs
 Axillary temperature: 97.5° F to 98.6° F; 36.4°C to 37° C
 Apical rate: 70 to 110 beats per minute
 Respirations: 16 to 22 breaths per minute
 Blood pressure: average, 95/57 mmHg
Nutrition
 The preschooler exhibits food fads and has strong food and taste
preferences.
 By 5 years, the preschooler tends to focus on social aspects of
eating, table conversation, manners, and willingness to try new
foods.
Skills
 The preschooler has good posture.
 Fine motor coordination and athletic abilities begin to develop.
 Increasing skill is demonstrated in activities that require balance.
 The preschooler usually talks in three- or four-word sentences by
age 3, five- or six-word sentences by age 4, and longer sentences
that contain all parts of speech by age 5.
 Speech is easily understood by others, and the preschooler can
clearly understand what others are saying.
Play
 Cooperative
 Imaginary playmates
 Likes to build and create things
 Simple, imaginative play
 Understands sharing and is able to interact with peers
 Enjoys a large space for running and jumping
 Likes dress-up clothes, paints, paper, and crayons for creative
expression
 Activities such as swimming and sports for growth development
 Activities such as puzzles and toys for fine motor development
Safety
 Preschoolers are active and inquisitive (magical thinking).
 Children of this age can learn simple safety practices because they
can follow simple and verbal directions and their attention span is
longer.
 Refer to the American Academy of Pediatrics for information on car
safety.
 Teach the preschooler basic safety rules to ensure safety when
playing in a playground near swings and ladders.
 Never allow the preschooler to play with matches or lighters.
 The preschooler should be taught what to do in the event of a fire or
if clothes catch fire; fire drills should be conducted.
 Guns should be stored unloaded and secured under lock and key;
the preschooler should be taught to leave an area immediately if a
gun is seen and to tell an adult.
 The preschooler should be taught never to point a toy gun at
another person.
 Teach the preschooler that if another person touches his or her body
in an inappropriate way, he or she should tell an adult.
 Teach the preschooler to avoid speaking to strangers and to never
accept a ride, toys, or gifts from a stranger.
 Teach the preschooler his or her full name, address, parents' names,
and telephone number.
 Teach the preschooler how to dial 911 in an emergency situation.
 Keep the poison-control hotline number available.
The School-Age Child
Physical Characteristics
 Average height and weight at age 12 are 59 inches (30.5 cm to 150
cm) and 88 lb (40 kg)
 The first permanent (secondary) teeth erupt around age 6, and
deciduous teeth are gradually lost
 Regular dentist visits are necessary, and the school-age child must
be supervised while brushing and flossing teeth; fluoride
supplements may be necessary
 Sleep requirements range from 10 to 12 hours a night
Vital Signs
 Oral temperature: 97.5° F to 98.6° F; 36.4°C to 37°C
 Apical rate: 60 to 100 beats per minute
 Respirations: 16 to 20 breaths per minute
 Blood pressure: averages 107/64 mmHg
Nutrition
 Increased growth needs
 Feed a balanced diet chosen from foods in the MyPlate food plan.
Skills
 Refinement of fine motor skills
 Continued development of gross motor skills
 Increased strength and endurance
Play
 Play is more competitive.
 Rules and rituals are important aspects of play and games.
 The school-age child enjoys drawing, collecting items, dolls, pets,
guessing games, board games, listening to the radio, TV, reading,
and videos and computer games.
 Many children of this age participate in team sports.
 School-age children also enjoy secret clubs, gang activities, and
scouting organizations.
Safety
 The school-age child experiences less fear in play activities and
frequently imitates real life by using tools and household items.
 Refer to the American Academy of Pediatrics for information on car
safety; (Canadian site).
 Major causes of injuries include bicycles, skateboards, and team
sports as the child's motor abilities and independence increase.
 Children should always wear a helmet when riding a bike or using
inline skates, skateboards, or other items that could result in falls.
 Teach the school-age child water safety rules.
 Instruct the school-age child to avoid teasing or playing roughly with
animals.
 Teach the school-age child traffic safety rules.
 See the safety guidelines for the preschooler for additional
principles.
The Adolescent
Physical Characteristics
 Puberty is the maturational, hormonal, and growth process that
occurs when the reproductive organs begin to function and
secondary sex characteristics develop.
 Body mass increases to adult size.
 Menstrual periods begin about 2½ years after the onset of puberty.
 Oral care, including careful brushing, is important; many adolescents
need to wear braces.
 Adolescents tend to stay up late and, in an attempt to catch up on
missed sleep, sleep late whenever possible; an average of 8 hours
per night is recommended.
Vital Signs
 Oral temperature: 97.5° F to 98.6° F; 36.4°C to 37°C
 Apical rate: 55 to 90 beats per minute
 Respirations: 12 to 20 breaths per minute
 Blood pressure: averages 121/70 mmHg
Nutrition
 Teaching about the MyPlate food plan is important.
 Calcium, zinc, iron, folic acid, and protein are especially important
nutritional needs.
 Body image is very important to children in this age group.
 Eating disorders are a concern in this age group.
Skills
 Gross and fine motor skills are well developed.
 Strength and endurance increase.
Play
 Games and athletics are the most common forms of play.
 Competition and strict rules are important.
 Adolescents enjoy such activities as sports, videos, movies, reading,
parties, dancing, hobbies, computer and other electronic games or
activities, music, and experimenting with makeup and hairstyles.
 Friends are important, and adolescents like to gather in small
groups.
Safety
 Adolescents are risk-takers.
 Instruct adolescents in the dangers of cigarette smoking, caffeine
ingestion, drugs, and alcohol.
 Help adolescents recognize that they have choices when difficult or
potentially dangerous situations arise.
 Advocate the use of seat belts; discuss the causes of motor vehicle
accidents, including the use of cell phones and other electronic
devices while driving.
 Discuss water safety.
 Warn adolescents about the dangers of guns, violence, and gangs.
 Instruct adolescents in the complications associated with body
piercing, tattooing, and tanning.
 Discuss such issues as bullying, date rape, sexual relationships, and
sexually transmitted infections, and the dangers of the Internet in
 regard to communicating and setting up meetings (dates) with
unknown persons.

Priority Points to Remember!

 Human milk is the best food for infants younger than 6 months.
 Skim and low-fat milk should not be used for infants because the
essential fatty acids are inadequate and the solute concentration of
protein and electrolytes is too high.
 Fluoride supplementation may be needed starting around 6 months
of age, depending on the infant's intake of fluoridated tap water.
 Introduce solid foods one at a time, usually at intervals of 4 to 7
days, to identify food allergens.
 Avoid giving solid foods that place the child at risk for choking, such
as nuts, foods with seeds, raisins, popcorn, grapes, and pieces of hot
dog.
 Baby-proof the home; hazardous items must be stored out of reach.
 Toddlers are eager to explore the world around them.
 Preschoolers are active and inquisitive; because of their magical
thinking, they may believe that the daring feats seen in cartoons are
possible and may attempt them.
 Children should always wear a helmet when riding a bike, using
inline skates or skateboards, or participating in other activities that
may result in falls.
 Teach children to avoid speaking to strangers and to never accept a
ride, toys, or gifts from a stranger.
 Teach children how to dial 911 in an emergency situation.
 Teach parents to keep the poison-control hotline number available.
 Adolescents are risk-takers.
 Discuss such issues as bullying, date rape, sexual relationships, and
sexually transmitted infections and the dangers of the Internet with
regard to communicating and setting up meetings (dates) with
unknown persons.