PEDIATRIC NURSING
and use of language
GROWTH AND DEVELOPMENT
A. DEFINITION OF TERMS
Growth- is a physical change and increase in size.
> Theory: Kohlberg’s Theory
 It can be measured quantitatively
 Indicators: height, weight, bone size and
dentition
> Theory: Freud’s, Erickson’s
 Pattern of growth is similar to all people, but
growth rates vary during different stages of
growth and development
Development – is an increase in the competency of
function and skill progression
> Theory: Fowler Westerhoff
 It is the capacity of a person to adapt to
environment
B. FACTORS AFFECTING GROWTH AND
DEVELOPMENT
a. Genetic or Hereditary
 Established at conception
 Remains unchanged throughout life and
determines such characteristics as: gender,
physical characteristics such as eye color,
potential height
b. Environment/Environmental Factors such as
family, religion, climate, culture, school,
community and nutrition
C. COMPONENTS OF GROWTH AND
DEVELOPMENT
a. Physiologic- physical appearance, body
built, weight, height of an individual
b. Cognitive- result of interaction between
individual and the environment
 It deals on how people learn to think, reason
 Theory: Cognitive Theory by Piaget
c. Moral – identifying right from wrong
d. Psychosocial – refers to the development of
personality
e. Spiritual – refers to individual’s
understanding of their relationship with the
universe and their perceptions about the
direction and meaning of life
D. PRINCIPLES OF GROWTH AND
DEVELOPMENT
1. G. and D. are continues, orderly, sequential
processes influenced by maturational,
environmental and genetic factors.
2. All humans follow the same pattern of
growth and development
3. The sequence of each stage is predictable,
although the time of onset, the length of the
stage and the effects of each stage vary with
the person
4. Learning can either help or hinder the
maturational process, depending on what is
learned
5. Each developmental stage has its own
characteristics
6. G. and D. occur in a cephalo-caudal
direction, that is, starting at the head and
moving to the trunk, the legs and the feet.
7. G. and D. occur in the proximodistal
direction, that is from the center of the body
outward.
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 8. Development proceeds from simple to
complex or from single act to integrated
acts.
9. Development becomes increasingly
differentiated
10. Certain stages of G. and D. are more critical
than others.
11. The pace of growth and development is
uneven
E. THEORIES OF GROWTH AND
DEVELOPMENT
1. Cognitive Theory by Jean Piaget
Discussion:
 Child psychologist jean Piaget described the
mechanism by which the mind processes
new information.
 He said that a person understands whatever
information fits into his established view of
the world
 He described four stages of cognitive
development and relates them to a person’s
ability to understand and assimilate new
information
1. Sensorimotor (birth to about age 2)
 The child learns about himself and his
environment through motor and reflex
actions.
 Teaching for a child in this stage should be
geared to the sensorimotor system
 Examples: modifying behavior by using the
senses, a frown or soothing voice
2. Preoperational (begins about the time the
child starts to talk to about age 7)
 The child begins to use symbols to represent
objects
 The child is now better able to think about
things and events that are not immediately
present
 Oriented to the present, the child has
difficulty conceptualizing time
 His thinking is influenced by fantasy-the
way he’d like things to be and he assumes
that others see situations from his viewpoint
 Implications:
 teaching must take into account the child’s
vivid fantasies and undeveloped sense of
time
 Using neutral words, body outlines and
equipment a child can touch gives him an
active role in learning
3. Concrete (about first grade to early
adolescence)
 During this stage accommodation increases
 The child develops to think abstractly and to
make rational judgments about concrete or
observable events
 Implications:
> Giving the child the opportunity to ask questions
and to explain things back to you allows him to
mentally manipulate information
4. Formal Operations (adolescence)
 This stage brings cognition to its final form.
 This person no longer requires concrete
objects to make rational judgments,
 At this point, he is capable of hypothetical
and deductive reasoning
 Teaching for the adolescent may be wide
ranging because he’ll be able to consider
many possibilities from several perspectives
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 2. Moral Theory by Kohlberg
1. Level 1 (Pre-Conventional)
Stage 1. Obedience and punishment
orientation
(How can I avoid punishment?)
 common in children, although adults can
also exhibit this level of reasoning
 Reasoners at this level judge the morality of
an action by its direct consequences
 individuals focus on the direct consequences
of their actions on themselves.
 For example, an action is perceived as
morally wrong because the perpetrator is
punished.
 "The last time I did that I got spanked so I
will not do it again."
 The worse the punishment for the act is, the
more "bad" the act is perceived to be.[
Level 1 (Pre-Conventional)
Stage 2. Self-interest orientation
(What's in it for me?)
• right behavior is defined by whatever the
individual believes to be in their best
interest
• shows a limited interest in the needs of
others
(Paying for a benefit)-"You scratch my back, and
I'll scratch yours." mentality.
2. Level 2: Conventional
Stage 3: The good boy/girl attitude/golden
rule
 moral reasoning is typical of adolescents and
adults
 To reason in a conventional way is to judge
the morality of actions by comparing them
to society's views and expectations.
 an individual obeys rules and follows
society's norms even when there are no
consequences for obedience or
disobedience.
 Adherence to rules and conventions is
somewhat rigid
Level 2: Conventional
Stage 4: Authority and social-order
maintaining orientation(Law and order
morality)
 it is important to obey laws
 because of their importance in maintaining
a functioning society.
 Most active members of society remain at
stage four, where morality is still
predominantly dictated by an outside force.
 Ten commandments
3. Level 3: Post-Conventional
Stage 5: social contract driven
> the world is viewed as holding different opinions,
rights and values
 Such perspectives should be mutually
respected as unique to each person or
community
 Laws are regarded as social contracts rather
than rigid edicts.
 Those that do not promote the general
welfare should be changed when necessary
to meet “the greatest good for the greatest
number of people
 Level 3: Post-Conventional
Stage 6: Universal ethical
principles(Principled conscience)
 moral reasoning is based on abstract
reasoning using universal ethical principles
 Laws are valid only insofar as they are
grounded in justice, and a commitment to
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 justice carries with it an obligation to
disobey unjust laws
 This involves an individual imagining what
they would do in another’s shoes
 the individual acts because it is right, and
not because it avoids punishment, is in their
best interest, expected, legal, or previously
agreed upon.
4. Psycho Social Theory by Sigmund Freud
 The Father of Psychoanalysis
 Described the concepts of the unconscious
mind, defense mechanism, and the id, ego
and superego
 Unconscious mind- is the part of the
person’s mental life that the person is
unaware of
THREE ASPECTS OF PERSONALITY
1. Id-resides in the unconscious and operating
on the pleasure principle, seeks immediate
pleasure and gratification.
2. Ego – operating on the reality principle,
balances the gratification demands of the id
with the limitations of social and physical
circumstances
 The methods the ego uses to fulfill the needs
of the id in a socially acceptable manner are
called DEFENSE MECHANISM OR
ADAPTIVE MECHANISM, also these are
the results of conflicts between the id’s
impulses and the anxiety that attends these
conflicts due to environmental restrictions
3. Superego- contains the conscience and the
ego idea
 Also contains the DONT’S of society
 FIXATION – is the immobilization or the
inability of the personality to proceed to the
next stage because of anxiety
FREUD’S FIVE STAGES OF DEVELOPMENT
(see at the last page)
DEFENSE MECHANISMs
Compensation – Covering up weaknesses by
emphasizing a more desirable trait or by
overachievement
Example: a high school student too small to play
basketball becomes the star long distance runner for
the track game.
> Allows a person to overcome weakness and
achieve success
Denial – an attempt to screen or ignore
unacceptable realities by refusing to acknowledge
them
Example: a woman though told her father has
metastatic cancer, continues to plan a family
reunion 18 mos in advance.
Use/Purpose: temporary isolate the person from the
full impact of a traumatic situation
Displacement- the transferring or discharging of
emotional reactions from one object to another
object or person.
Example: a husband and wife are fighting and the
husband becomes so angry, he hits a door instead of
his wife
Use/Purpose: allows for feelings to be expressed
through or to less dangerous objects or people
Identification – an attempt to manage anxiety by
imitating the behavior of someone feared or
respected.
Example: a new graduate suddenly left in charge
emulates her faculty role model.
Use/Purpose: Helps a person avoid self devaluation
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Intellectualization – a mechanism which an Regression – resorting to an earlier more
emotional response that normally would accompany comfortable level of functioning that is
an uncomfortable or painful incident is evaded by characteristically less demanding and responsible
the use of rational explanations that remove from
Example: an adult throws an temper tantrum when
the incident any personal significance and feeling
he does not get his own way.
Example: the pain over a parent’s sudden death is
Use/Purpose: allows a person to return to a point in
reduced by saying: “ He wouldn’t have wanted to
development when nurturing and dependency were
live with disability”
needed and accepted with comfort
Use/Purpose: Protects a person from pain and
Repression – an unconscious mechanism by which
traumatic events
threatening thoughts, feelings and desires are kept
Rationalization – justification of certain behaviors from becoming conscious; the repressed material is
by faulty logic and ascribing motives that are denied entry into consciousness
socially acceptable but did not in fact inspire the
Sublimation – displacement of energy associated
behavior
with more primitive sexual or aggressive drives into
Example: a mother spank her child too hard and say a socially acceptable activities
it was alright because he couldn’t feel it through the
Example: a person with excessive sexual drives
diaper anyway
invests psychic energy into a well-defined religious
Use/Purpose: helps a person cope with the inability value system
to meet goals or certain standards
Use/Purpose: protects a person from behaving in
Projection – a process in which blame is attached to irrational, impulsive ways
others or the environment for unacceptable desires,
Substitution – the replacement of a highly valued,
thoughts, shortcomings, and mistakes
unacceptable or unavailable object by a less
Example: a mother was told her child must repeat a valuables, acceptable, or available object
grade in school and she blames this on the teacher’s
Example: a woman wants to marry a man exactly
poor instruction
like her dead father and settles for someone who
Use/Purpose: allows the person to deny the looks a little bit like him.
existence of shortcoming and mistakes; protects self
Use/Purpose : helps a person achieve goals and
image
minimizes frustration and disappointment
Reaction Formation – a mechanism that causes
Undoing – an action or words designed to cancel
people to act exactly opposite to the way they feel.
some disapproved thoughts, impulses or acts in
Example: an executive resents his bosses for which the person relieves guilt by making
calling in a consulting firm to make reparation
recommendations for change in his department but
Example: a father spanks his child and the next
verbalizes complete support of the idea and is
evening brings home a present for his child
exceedingly polite and cooperative
Use/Purpose: allows a person to appease guilty
Use/Purpose: aids in reinforcing repression by
feelings and atone for mistakes
allowing feelings to be acted out in amore
acceptable way

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4. PSYCHOSOCIAL THEORY OF  It must agree with others’ view
DEVELOPMENT by ERIK ERIKSON
 The adolescent who is unable to integrate
1. TRUST VS MISTRUST life experiences and self-image into a
consistent identity experience role diffusion.
 In infancy, the central task is to develop a
Feeling of lost and confusion occur.
sense of trust that basic needs are met. As
these needs are met, infant learned that 6. INTIMACY VS ISOLATION (YOUNG
world is safe to live in. ADULT)
2. AUTONOMY VS SHAME AND DOUBT  Seeks relationship with others to acquire a
(TODDLER) sense of sharing, caring and intimacy.
 Learning to trust begins to test his  An individual who is unable to share close
environment relationship and feel comfortable in intimate
relationship may have a sense of isolation
 Autonomy develops as toddler explores and
from friends or family member
learns control of self and environment
7. GENERATIVITY VS STAGNATION
3. INITIATIVE VS GUILT (PRE-SCHOOLER)
(ADULTHOOD)
 As a pre-schooler tries to be assertive during
 Primary task is satisfaction with productivity
interactions with others and environment,
approval from others fosters initiative. When  This includes work, family, house,
preschoolers action are not permitted or citizenship
disapproved by others, the child develops
8. EGO INTEGRITY VS DESPAIR
sense of guilt
 Important Events: Reflection on life
4. INDUSTRY VS INFERIORITY (SCHOOL
AGE)  "Did I live a meaningful life?"
 Child directs energy towards knowledge and
skills applicable in real world.
 A child who receives satisfaction from those
efforts continues to be industrious
 A child who has difficulty and whose efforts
go unrewarded may feel inferior or
inadequate
5. IDENTITY VS ROLE DIFFUSION
(ADOLESCENCE)
 During this stage the individual searches for
current and future identities
 This is an attempt to integrate life
experiences into a sense of self to master
identity
 The adolescent must feel an internally
consistent self image
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