PRELIMS REVIEWER
Chapter 29- Nursing Care of Infants
Growth and Development of an Infant
 Infants grow rapidly both in size and ability to
perform tasks
 Development follows set patterns, some
dependent on cultural factors
Physical Growth
 Physiologic changes occur in the infant year
reflect both increasing maturity and growth of
body organs
Weight
 6 months- double birth weight
o 1st 6 months= 2lb weight gain/month
o 2nd 6 months= 1lb gain/month
 1 year- triple birth weight
o Average boy= 10kg (22lb)
o Average girl= 9.5kg (21lb)
 Relevant only when plotted on a standard
growth chart and compared to child’s own
growth curve
Height
 1st year= height increase by 50% or grows from
the average birth length of 20 inches-30 inches
 Best assessed on standard growth art
 Most growth apparent in the trunk during early
months
 Second half of the year, legs lengthening is most
apparent
 End of first year, legs may still appear short and
bowed
 Accuracy- measure infants lying supine on a
measuring board
Head Circumference
 End of first year, brain has already reach 2/3 of
adult size
 Increases rapidly during infant period to reflect
rapid brain growth
 One sleeping position may cause asymmetrical
head, but gradually corrects itself.
Body Proportion
 Changes during the first year from newborn to
typical infant appearance
 Mandible is more prominent
 Lower jaw is prominent and remains that way
 Chest circumference is less than the head by
2cm
 Abdomen remains protuberant until child walks
 Cervical, thoracic, and lumbar vertebral curves
develop
 Lengthening of lower extremities during the last
6 months of infancy readies child fro walking
o Changes appearance from baby like to
toddler like
Body Systems
 Heart rate= 100-120 beats/minute
 Sinus arrythmia: pulse begins to slow with
inhalation
o More efficient= decreasing pulse and
slightly elevated blood pressure
o From 80/40 to 100/60mmHg
 Infants are prone to physiologic anemia at 2-3
months of age
o Life of a red cell is 4 months, so cells
are disintegrating, but new cells are
not produced
 5-6 months= hemoglobin totally converted to
adult hemoglobin
 6-9 months= second decrease in serum iron
levels as the last iron stores in utero are used
 Respiratory rate= 30-60 breaths per minute
o Lumen of respiratory tract remains
small
o Mucus production by the tract to clear
invading micro-organisms is still
inefficient
o Upper respiratory infections occur
readily and more severe than adults
 Gastrointestinal tract is immature
o Amount of amylase for complex
carbohydrates is deficient until 3rd
month
o Lipase for saturated fat decreased
during entire first year
o Liver of an infant is immature
 Causes inadequate
conjugation of drugs
 Inefficient formation of
carbo, protein and vitamins
for storage
o Kidney remain immature and not as
efficient at eliminating body wastes
o Unable to concentrate urine as much
as adult
o Endocrine system remains immature
in response to pituitary stimulation
o 3-4 months= extrusion reflex prevents
eating efficiently
 Infants can drink from a cup
as long as parent controls
the fluid flow
o 8-10months= independently drink
from a cub
 Immune system functional by 2-month s of age
o Infants can actively produce both IgG
and IgM antibodies by 1 year
o Not plentiful until preschool
 6 months= ability to adjust to cold is mature
o Infants can shiver
o Adipose tissue for insulation
o Brown fat decreases for first year
 Fluid in body compartments shifts to some
extent
AZUSANO.K 1
 o Ext. fluid accounts for 35% of infant’s
body weight
o Intra. Fluid accounts for 40% by the
end of first year in contrast to adult
proportions of 20% to 40%
 This proportional difference increases infant’s
susceptibility to dehydration from illness
o Diarrhea
Teeth
 First baby tooth (central incisor) erupts at 6
months, then new one monthly
 Some newborns may be born with natal teeth
o Erupted within 4 weeks of life-
neonatal teeth
o Usually mandibular incisors
o May be membranous and so be
reabsorbed
o Should be removed if loosely attach or
may cause aspiration
o If not, do not remove until replace at
age 6-7 years old
 Deciduous teeth (temporary or baby teeth) are
essential for protecting growth of dental arch
Motor Development
 Average infant progresses through systematic
motor growth for first year
o Reflects cephalocaudal dev.
o Gross to fine motor dev.
 Control proceeds form head to trunk to lower
extremities in a progressive, predictable
sequence
 To assess motor development
o Gross motor development: ability to
accomplish large body movements
o Fine motor development: Observing or
testing prehensile ability (coordinate
hand movements) should be evaluated
Gross motor development
 Infant is observed in 4 positions
o Ventral suspension
o Prone
o Sitting
o Standing
Ventral Supine Position
 Infant’s appearance when held midair on a
horizontal plane with a hand under abdomen
 Newborn allows head to hang down with little
effort at control
 1 month old= lifts head momentarily then drops
it again
 2-month-old= hold their heads in the same plane
as rest of body, major advance in muscle control
 3 month old= lifts and maintains the head well
above the plane of the body
o Landau reflex- infant’s head, legs and
spine extend
o Head is depressed, the hips, knees and
elbow flex
 Reflex continues to be present until second 6
months of life
 Child with motor weakness or defect will not be
able to demonstrate reflex
 6-9 months= parachute retraction from ventral
position
o Suddenly lowered to table, the arms
extend to protect themselves from
falling
 Hemiplegia- response only
visible in unaffected side
 Cerebral palsy- do not
demonstrate this response
Prone Position
 1 month= infants lift their heads and turns to
side
 2month= raise heads, but cannot raise chest
 3month= lifts head and shoulders well off table;
turn form prone to side-lying position
 4 months= lift chest off bed and look around
actively
o Turns head side to side
o Turn from front to back
o Neck Righting reflex- infant turns to
side and shoulders, trunk and pelvis
turns too, they lose balance and roll
sideways
 5 months= rest weight on forearms when prone
o Turn completely over from front to
back and vice versa
 6 months= infants rest weight on hands with
extended arms
o Raise chests with extended arms and
upper part of abdomen
 9 months= child creeps from prone position
o Advanced hitching (infants slide along
floor)
o Creeping- child has the abdomen off
table and moves one hand and one leg
and then the other hand and leg, using
knees on the floor to locomote
Sitting Position
 Placed on the back and then pulled to sitting
position
 1 month= gross head lag, back is rounded and
only head control
 2 months= holds head when sitting up and bob
forward
 3 month- slight head lag
 4 months= Head lag is no longer present
 5 months= back straightens and propped in
sitting position
 6 months= children sit momentarily without
support
AZUSANO.K 2
  7 months= sits alone, but with hands held
forward for balance
 8 months= sit securely with no additional
support (major milestone)
 9 month- infants sit so steadily and can lean
forward to regain balance
Standing position
 1 month= stepping reflex
 2 months=infants’ knees and hips flex rather
than support
 3 months= infants begin to try to support part of
their weight
 4 months= Able to support weight on their legs,
stepping reflex is gone
 5 months= ability to sustain a portion of weight
 6 months= support nearly full weight in standing
position
 7 months= child bounces with enjoyment in
standing position
 9 months= can stand holding onto a coffee table
for support
 10 months= pull themselves to a standing
position by holding something but cannot let
themselves down again
 11 months= Cruise or move around the crib by
holding onto objects
Fine motor development
 1 month old= strong grasp reflex; clench fists
tightly
 2 months old= Hands are held open, will hold an
object and drop it
 3 months old= Grasp is unpracticed, misses
objects
 4 months= infants bring hands together. Thumb
opposition (ability to bring the thumb and
fingers together), scooping or raking. Infant
limited to handling large objects. Palmar and
plantar grasp reflexes have disappeared
 5 months old= Accept objects by grasping the
whole hand
 6 months old= Child can hold objects in both
hands. They can hold a spoon and start to feed
themselves. Moro, palmar and the tonic neck
reflex have completely faded
 7 months old= Transfer toys from one hand to
the other
 8 months= random reaching and ineffective
grasping have disappeared as a result of
advanced eye-hand coordination
 10 months= Pincer grasp, bringing the thumb
and first finger together, enables picking up
small object such as crumbs of cereal
 12 months= infants can draw a semi straight
line with a crayon. Small blocks in containers
and taking them out again
Developmental Milestones
Language development
 1st month= cooing (dovelike) sounds
 2nd month= Differentiates a cry (hungry, wet,
lonely)
 3 months= squeal with pleasure
 4 months= cooing, babbling, and gurgling
“talkative”, laugh out loud
 5 months= “gah-gah”, “goo-goo”
 6th month= Art of imitating
 7th month= “oh-oh”, “ah-ah”, “oo-o” (initiate
w=vowel sounds”
 9th month= “dada/mama”
 10 months= masters another word “bye-bye” or
“no”
 12 months= two words “ma-ma” and “da-da." 2
words with meaning
Play
 Musical mobiles are best
 Holding infants for long periods of time is not
spoiling
 Hearing is a second sense and is a source of
pleasure
 2nd month= infants will hold light, small rattles
for a short period of time
 3rd month= handle small blocks or rattle
 4th month= Playpen or a sheet spread on the
floor to exercise rolling over
 5th month= Variety of objects (plastic rings,
blocks, squeeze toys, clothespins, rattles and
plastic keys) Small enough to hold but big
enough to not swallow
 6th month= Sit steadily enough. Ready for
bathtub toys such as rubber ducks or plastic
boats, starting to teethe
 7th month= transfer toys, interested in books,
rattles, plastic keys. Mobility increases, begin to
be more interested in brightly colored balls or
toys
 8th month= sensitive to differences in texture
(velvet, fur, fuzzy, smooth or rough items)
 9th month= enjoy toys that go inside on another,
nest of blocks or rings of assorted sizes. Pots and
pans that stack
 10th month= peek-a-boo. Play patty-cake. Can
clap, active part of the household
 11th month= learned to cruise or walk along low
tables
 12th month= Putting things in and talking out of
containers. Likes little boxes that fit inside
another or dropping small blocks into a
cardboard box. Listening to someone saying
nursery rhymes or listening to music
Development of Senses
AZUSANO.K 3
Maturation of senses
Vision
1st month
 Regard an object in the midline of their vision
 Regard humans with a fixed stare
2nd month
 Focus well and follow objects with eyes
 Ability to follow and focus this way is a major
milestone in development
 Binocular vision- ability to fuse two images into
one
 Teach parents to initiate eye to eye contact with
newborns to stimulate vision and promote
socialization
3rd month
 Follow an object across their midline
 Typically hold their hands in front of their face
and study their fingers for long periods of time
(hand regard)
 Until 6 months there is difficulty in eye
coordination
 After 3 months- “cross” eyes should be
examined
4th month
 Infants recognize familiar objects
 Follow parent’s movement
6th month
 Capable of organized depth perception
 Increases accuracy of their reach for objects as
they begin to perceive accurately
7th month
 Children pat their image in a mirror
 Depth perception has matured
 Transferring from one hand to another
10th month
 Beginning of object permanence
Hearing
 Demonstrated by the 1-month-old child who
quiets momentarily at a distinctive sound such
as a bell or a squeaky rubber toy
 2nd month= infants will stop an activity at the
sound of spoken words
 3rd month= turn their heads to attempt to locate
a sound
 4th month= Infants kook at the distinctive sound
 5th month= demonstrate they can localize
sounds downward and to the side, by turning
their head and looking down
 6th month= progressed to being able to locate
sounds made above them
 10 months= infants can regonize their own name
 12th month= easily locate sound in any direction
 Enjoys any soft, musical sounds or soft, cooing
voices
 Start by harsh, raucous rattles or loud bangs
 Urge parents to choose for an infant’s first toys
ones that make these types of welcoming
sounds
Touch
 Touched to experience skin to skin contact
 Clothes should feel comfortable and soft rather
than rough
 Handle infants with assurance and gentleness
 Premature infants need to be kept warm while
being held
 Promoting close physical contact
Taste
 Acute sense of taste by turning away or spitting
out a taste
 Urge parents to make mealtime a time for
fostering trust as well as supplying nutrition
Smell
 Accurately smell within 1 or 2 hours after birth
 Respond to irritating smell by drawing back
 Enjoy pleasant odors and learn early in life to
identify breastmilk
 Alert to substances that cause sneezing when
sprayed into the air
Emotional Development
 Socialization or learning how to interact with
others is an extensive phenomenon
 1st month= differentiate between faces and
other objects by studying a face or picture
 6th month= smiles back at a person
 Social smile is a definite response to the
interaction, not the faint, quick “smile” that
younger infants, even newborns, demonstrate
 Major milestones for assessing several areas
o Vision
o Motor control
o Intelligence
 3rd month= demonstrate social awareness by
readily smiling at parent’s face
o Laughs out loud at a funny face
 4 months= cries when a person who is
entertaining leaves
o Regocnizes primary caregiver
 5 months= infants show displeasure when an
object is taken away
 6 months= increasingly aware of the difference
between people who are regularly care for them
and strangers
 7 months= show obvious fear of strangers. Cry
when taken from their parent
 Eight-month anxiety= stranger anxiety
o Will not got willingly to the nurse
 9 months= very aware of changes in tone of
voice
o Cries not because scolded but because
of parent’s displeasure
AZUSANO.K 4
  12 months= most children have overcome their
fear of strangers
o Alert and responsive again when
approached
o Play interactive nursery rhymes and
rhythm games and “dance” with
others
o They like being at the table for meals
and joining in family activities
Cognitive Development
 Mainly uses simple reflex activity
 Little evidence that infants see themselves as
separate from their environment
 They cannot respond actively or interact with
people
 Tend to enjoy people and faces more than they
do objects
Primary Circular Reaction
 3rd month of life, child enters a cognitive stage as
primary circular reaction
 Infant explores object by grasping them with
hands or mouthing them
Secondary Circular reaction
 6 months of age infants can grasp the idea their
actions can initiate pleasurable sensations
 Infants are still unaware of the permanence of
objects by the end of this stage
o If an object is hidden from vision, an
infant will not search for it: gone is
gone
o Any part of object is exposed, infant
can visualize the whole object and will
reach to obtain it
Coordination of Secondary Schema
 Infants of 10 months discover object
permanence or become aware of an object out
of sight still exists
 Infants are ready for peek-a-boo once they have
gained the concept of permanence
 After 1 year of age, capable of reproducing
interesting events
 Realization on how they are able to control
events in their world
HEALTH PROMOTION OF AN INFANT AND FAMILY
Promoting Achievement of Developmental tasks: Trust vs.
Mistrust
 Form a sense of trust
 Infants learn to trust that when they have a need
or are in distress, a person will come and meet
that need
 Trust= love
 Infants are handled, fed, talked to, and held they
lean
 If infants cannot trust, they cannot enjoy deeply
satisfying interactions with other sand can have
difficulty trusting themselves or experiencing
high self-esteem.
 Difficulty in establishing close relationships as
adults
 Trust rises primarily from a sense of confidence
and that one can predict what is coming next
 Gentle rhythm of care gives infants a sense of
being able to predict what is going to happen
and gives life some consistency
 Infants thrive on routine and care is to be largely
given by one person
 Actively interact with their child to provide a
sense of trust
 Passively caring for infants- not talking to them
or touching or stroking them while feeding or
changing them-amounts to not being with them
 Nursing actions designed to help an ill infant
develop a sense of trust
Promoting Infant Safety
 Accidents are the leading cause of death in
children
 Most accidents occur because parents either
underestimate a child’s ability.
Aspiration Prevention
 Potential threat throughout the first year
 Round, cylindrical objects are more dangerous
than square, or flexible objects in this regard
 A 1-inch (3.2cm) cylinder, such as a carrot or hot
dog, is particularly dangerous because it can
totally obstruct an infant’s airway
 Deflated balloon can be sucked into the mouth
 Educate parents who feed their infant formula
not to prop bottles
 Overestimating infant’s ability to push the bottle
away, sit up, turn the head to the side, cough,
and clear the airway if milk should flow too
rapidly into the mouth and aspiration beings
 Parents underestimate ability to grasp and place
objects in their mouth
 Newborn can wiggle to a new position to reach
an attractive object such as teddy bear
 Caution parents to be certain nothing comes
within an infants’ reach that would not be safe
to put into the mouth
 If an infant is able to put it inside his/her mouth,
then it is not large enough and a risk for
aspiration
Fall Prevention
 Second major cause of infant accidents
 NO infant, beginning with a newborn, should be
left unattended on a raised surface
AZUSANO.K 5
  Normal wiggling can bring a baby to the edge of
a bed, couch, or table top, resulting in a fall
 Teach parents infants roll over by.2 months of
age
 Matress should be lowered to its bottom
 Rails should be 2 3/8 inches apart, narrow
enough so children cannot put their head
between them
 2 months is about the maximum length of time
infants can safely sleep in a bassinet
Car Safety
 Vital preventive health measure
 Car seats used without interruption through
the preschool age, or until child reaches 40
to 60lb.
NOTES ON INFANCY
Oral Phase (0-1 year)
 Puts everything in their mouth
 Breastfeeding every 2-3 hours
 EO 51- Do not give pacifiers. Except when:
o They are on NPO
o May cause nipple confusion
o Will decrease small frustrations
Trust
 Developed by consistency in care giving
 Needs are met
Cognitive development
 Sensorimotor stage- using 5 senses (0-2 years)
o Increasing in motor ability
o Allow them to keep walking
 Seeing
 Hearing
 Listening
 Touching
 Tasting
o Activities could be repetitive then
imitative
Care of the infant
 4-6 months: Doubles
 1 year: triples
 Cephalocaudal development (head to tail)
 Proximodistal (near to far)
0 months: Grasp reflex
2 months: Head control
3 months: Hand regard and misses the object
4 months: Head and trunk
6 months: Sit with support. Palmar grasp (hold ball or
bottle)
2-6 head to trunk development
7 months: Hitching
8 months: Sit without support
9 months: Pincer grasp (can pick up objects, uses tips of
the fingers)
10 months: Stand with support, moves with knees
11 months: Stand holding onto something
12 months: Stand without support. Can hold things and
put down
Bathing
 A form of exercise
 Risks
o Drowning
o Hypothermia
o Fall
o Infection if water will enter the ear or
swallow water
Clothing
 Cotton clothes
 Well-fitting
 Should protect extremities when they start to
creep and crawl (abdomen and trunk)
Sleep and Exercise
 Sleeps for 16-20 hours
 Wake up in between to eat, if diaper is soiled or
discomfort
 Exercise: crawling, standing and eating
Nutrition
 Exclusive breastfeeding
 If the mother cannot breast feed
o Do cup feeding
 6 months: Complimentary feeding
o 1 at a time to observe allergies
o Complete essential nutrients- mashed
with carbs, protein, fats, vitamins and
minerals (ex. Cerelac, Gerber but not
every day- to avoid picky eating)
o Chocolates but no raisins, cashew,
nuts or additives
o It could be fried, but not everyday
o Essential fats or oils (Linoleic and
Oleic- Omega 3 and 6 from fish)
o For vitamins and minerals: green leafy
vegetables
Dentition and Dental Care
 Lower incisor grows first
 Go to dentist when there is a complete set of
teeth
 Dental care:
o Brush teeth as early as possible when
there is teeth already
o Toothpaste should not sting
 Tooth sheds off 6-7 years old
 Replaced by permanent teeth (32 complete set
of teeth
 Play: Solitary
o Give everything to help develop motor
abilities (walking and moving skills)
 Special needs
AZUSANO.K 6
 o Love
o Security
o Comfort
o Small doses of frustration
 Colic
o Paroxysmal abdominal pain or
cramping manifested by loud crying
and drawing the legs up to the
abdomen
o Common to infants less than 3 months
o Possibly caused by too rapid feeding,
overeating, swallowing air, improper
feeding technique, emotional stress,
and tension between parent and child,
milk allergy
 Management:
o Milk allergy- change formula casein
hydrolase
o Drugs: sedatives
o Comfort measures: prone with hot
water, bottle, massage swaddling, car
ride, proper, feeding technique
 Diarrhea
o Leading cause of illness for children
below 5
o Most commonly caused by rotavirus
also by salmonella, shigella
o Contaminated food and water, poor
hygiene, milk allergy
o Major goal treatment is replacement
of fluid
 Constipation
o More common to formula-fed infants
o Give cooled boiled water in between
bottle feeding
o Add cereals, vegetables and fruits
older infant’s diet
 Respiratory infection
o Common colds
o Pneumonia
 Skin Problems
o Miliraria
o Diaper rash
o Cradle cap
o Clean baby at least once a day
o Change diaper every 4 hours or else
ammonia may cause rashes
 Separation anxiety
o Happens between 4-6 months as child
begins to have awareness of self
 Stranger anxiety
o Fear of strangers as they are able to
distinguish familiar and unfamiliar
people
 Maternal separation anxiety
o Analytic depression
o Phases: protest, despair, denial or
detachment
 Limit setting and discipline
o Set safe limits to protect the child
o Set time out safely in the crib
o Provide safe alternative instead of
discouraging exploration
 Burns
o Scalding from hot bath water,
microwaved formula
o Sunburn
o Electrical outlets
 Drowning
o Bathtub, toilet, swimming pools
 Bodily image
o Sharp objects
o Small objects into body orifices
o Excessive noise from toys
o Constriction injuries-tight clothes
o Animal attacks
 Aspiration
o Asphyxiations by foreign materials in
the respiratory tract
o Milk, solid food items
 Suffocation
o Covering of the airway, pressure the
throat or exclusion
o Crib hazards- blankets, mattress, crib
slats
o Sleeping with parents
o Plastic bags
o Cords
 Motor vehicle injuries
o Riding on the lap of another occupant
o Car seat should be at the back of seat
o Use proper infant car seat, semi-
reclined, rear facing at the back of car
until 20 lbs. or 1 y/o
 Falls
o Most common after 4 months (roll-
over)
o Changing tables
o High chairs
o Infant walkers
o Stairs
o Heavy objects like unsturdy furniture
NOTES ON TODDLER
Height and Weight
 Weight gain: 5lbs./year
 Height: 2.5-3 inches/ year
 Slender but sturdy, graceful and posturally erect
Milestones:
3 Years Old: uses alternate feet in going upstairs, walks
backwards, rides tricycle, copies a circle, imitates across,
gives sex and full name, reads really well
3 Years Old:
AZUSANO.K 7
  900 words- “telegraphic speech”  Freud’s Phallic Stage
 3 to 4 words sentence o Forms a strong attachment to the
 Asks many questions opposite sex parents
 Knows on sex and that of others o Oedipal period
o Sexual exploration may be more
4 years Old: pronounced- manipulates their
 Noisier, “stormy stage” genitals
 Walks downstairs with alternating feet o Asks questions about sex (gender
 Skips/ hops on one foot differences and sexual reproduction)
 Throws ball overhead o Sex education
 Copies a square, traces a cross, and diamond, Basic needs
uses scissors  Emotional and social needs
 Vocabulary of 1,500 words, talks with o Individual- separation process is
“imaginary friend” completed
 Question is at peak o Continuous need for parental love and
security, and approval
 Tells exaggerated stories
o Associative games, dramatic plays/
 4- or 5-words sentence
imaginary playmates
o Play is parallel
5 years old:
Physiologic Biologic needs
 Less rebellious; likely to do what is expected of
 Nutrition
him
o 90 cal/g
 Has better manners
o Serve food with pretty dishes,
 Greater strength and improved muscular
comfortable chairs, child-size portions
coordination
o Parents should serve as good role
 Runs skillfully, jumps well, skips rope, skips on models
alternating feet o Do not nibble/ give junk foods
 Throws and catches ball well between meals
 Copies a diamond and triangle  Sleep activity
 Talks constantly 2,100 words (may stutter. o Averages 12 hours
Broken fluency) o Should have own room or portion
 6 to 8 words sentences with all parts of speech  Dental health
 Knows meaning of relatives o Complete deciduous teeth
 Knows days of the week o Avoid sweets
 Dresses and undresses without assistance  Safety measures
 Ties shoelace o Increase initiative and desire to initiate
 Age of superego or conscience development behavior of adult leads them to
o Teach what is right and what is wrong situation
o Parents should also practice what they o Hazardous for them
teach o Emphasize safety measures
 Has developed concept of friendship, o Safe environment especially in nursery
acceptance of responsibility and independence schools
 Erikson’s’ Initiative vs. Guilt Problem Areas
o Stage of energetic learning  Oedipus complex (boys to mothers)/ Electra
o Ready to find out what he can do complex (girls to father)
o Attempts to imitate adults o Family romance
o Imaginative and creative  Fears
o Pretends he can participate in the o Variety of real and imagined fear
adult world o Fear of the dark
o Must learn to assert own will in a way o Being left alone
that will not make him feel too guilty o Of animals
 Piagets Pre-Operational o Of ghost
o Shifts from begin egocentric to ability o Of pain
to see viewpoint of others o Of body mutilation
o Magical thinking- believers that their o Help them deal with these fears (night
thinking is so powerful, they can make light desensitization)
things happen  Use night light to prevent
o Animism nightmares

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  Aggression (hurting others)
o Determine if accidental or intentional
o May be caused by jealousy, frustration,
modeling or imitating behavior if
significant others, reinforcement
(attention getting behavior)
 Destructiveness
o Differentiate between accidental and
intentional
o Remove valuable objects
o Provide space for safe play
o Teach them to value own possession,
“what he values, he will use with care”
 Lying and telling “tall tales”
o Tells fantasy or pretend stories
o Stretching (exaggerating) stories to
make them more interesting
o Parents acknowledges them as fantasy
stories and set realities
o Help child maintain difference
between pretend and real
 Imaginary friends is also normal
 Sibling rivalry
o Jealousy and rejection because of
dethronement by the new baby
o May become hostile to mother
o Needs adequate preparation for the
birth of new sibling
o Help deal with new sibling after birth
 Language problem
o Stuttering or broken fluency or
stammering
o Dyslalia- articulation problem where
child reverts to infantile speech
o Swearing
 Thumb sucking
o Too little sucking pleasure when
younger
o Child may feel unloved
o Parents must provide more sense of
security especially at time it is
observed
 Enuresis (bed wetting)
o Rules out of medical cause first: UTI,
diabetes
 Encopresis
o Uncontrolled stool passage beyond
this time when bowel control is
expected
o Rule out medical cause first (diarrhea,
anal sphincter problem)
o May be due to rigid toilet training

Preparing the Child for School

COVERAGE: Infancy, Toddlerhood, Preschool

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