Growth and Development expresses the because parents often will ask what to expect
sum of the numerous changes that take place
during the lifetime of an individual.
All children pass through predictable
stages of growth and development as they
mature. Understanding the stage of
development a child has reached is important,
GROWTH
− An increase in the physical size of a whole
or any of its parts that is measurable
(QUANTITATIVE CHANGE.)
− an increase in number and size of cells
as they divide and synthesize new proteins;
− Indicators include height, weight, bone size,
and dentition.
DEVELOPMENT
− An increase in functionality, skill and
capacity to function occurring in orderly
fashion (QUALITATIVE CHANGE)
− Can be measured by observing a child’s
ability to perform specific tasks, by
recording the parent’s description of a
child’s progress, or by using standardized
tests such as the Denver II.
MAT URATION
− Increase in competence or ability to
function at a higher level;
from their child regarding his or her
development progress.
Health care visits provide opportunities
for you not only to assess present growth and
development but also to supply anticipatory
guidance on the topic.
− A change in the complexity of function of a
structure that makes it possible for the
structure to begin functioning.
− Synonymous to development
VULNERABLE OR CRIT ICAL PERIODS
− Are those times when the child is most
susceptible to negative or positive
influences.
PHYLOGENY
− the development or evolution of a specie
or group
e.g., the evolution of man from ape.
ONTOGENY
− the development of an individual within a
specie.
e.g., the development of an infant to a full
grown and mature adult.
All of these processes are interrelated,
simultaneous, and ongoing; none occurs apart
from the others.

The processes depend on the sequence of

ENDOCRINE, GENETIC, CONSTITUTIONAL,
ENVIRONMENTAL, & NUTRITIONAL
INFLUENCES.

Clients in Pediatric Nursing

NEWBORN 0-28 days old

INFANT 0-1 year old
TODDLER 1-3 years old
PRESCHOOLER 4-6 years old
SCHOOL-AGE 7-12 years old
ADOLESCENT 12-19 years old

DEVELOPMENTAL TASKS
− Are skill/growth responsibility at a
particular time of an individual’s life that
serve as foundation of the accomplishment
of future tasks.
− Are accomplishments that are expected at
each stage of development and having an
impact on the development of subsequent
stages.
 PRINCIPLES OF
GROWTH and DEVELOPMENT
1. Growth and development occurs in
an orderly sequence.
− Sequential trends: an orderly sequence;
Growth and development occurs in an
orderly sequence.
− Each child displays definite predictable
patterns pf growth and development.
These patterns of growth and
development are universal and basic to all
human beings.
− Each stage is affected by the preceding
stage and affects those stages that follow
− Sequence of growth is characterized by
“spurts and lulls”
− Progression is highly individualized for
each child; Variation at different ages for
specific interaction
− Self- fueling, on going process that
requires physical and psychological energy
2. Growth and development is a
continuous process from
conception until death.
3. Different body structures grow
and develop at different times -
ASYNCHRONOUS GROWTH.
4. Children have different growth
rates/Different children pass
through the predictable stages at
different rates.
INDIVIDUAL DIFFERENCES:
a. Gestation and infancy – most rapid GD.
b. Infancy and adolescence – rapid growth
periods
c. Toddlerhood to School-age – slow growth
periods
d. Puberty and adolescence – growth spurt
occurs.
e. Fetal and Infancy – head and neurologic
tissue grow faster than other tissues.
f. Toddlerhood and Preschool-age – trunk
grows more rapidly than other tissues.
g. School-age – limbs grow most.
h. Adolescence – trunk grows faster than
other tissues.
Maximum height is attained within 2 inches
shortly after the onset of menses in females
5. Growth and development is
interrelated
6. There is an optimum time for
initiation of experience or learning
− The child cannot learn tasks until his NS is
mature enough to allow that particular
learning
7. Development depends on
maturation and learning.
8. Directional trends
− growth and development follow specific
patterns
a. Cephalocaudal development
− development proceeds from the head
downward through the body towards the
feet.
b. Proximodistal development
− development proceeds from the center of
the body outward to the extremities.
c. Differentiation
− development from simple operations to
more complex activities and functions
− processes by which early cells and
structures are systematically modified and
altered to achieve specific and
characteristic physical and chemical
properties.
 Gross motor skills
− acquired during infancy and early
childhood as part of child’s motor
development
− large muscle groups and whole body
movement.(arms, legs,feet or entire
body)
Ex: 2 years old- able to stand–up, walk and
run
 Fine motor skills
− is the coordination of small muscle
movements which occur in the body
parts such as fingers, hands, wrist,
toes, lips , tongue.
− develops once the child is able to
control distal body parts such as
fingers
Ex: 3 year old colors best with large crayons,
12 year old can write with a fine pen
9. Neonatal reflexes must be lost
before development can proceed.
− Neonatal reflexes are replaced by
purposeful movements; e.g., cannot stand
steadily until the walking reflex has faded
MAJOR FACTORS INFLUENCING
GROWTH AND DEVELOPMENT
1. Force of Nature
– heredity & temperament
a. GENETICS
− From the moment of conception when a
sperm and ovum fuse, the basic genetic
makeup of an individual is cast.
− Inheritance determines other
characteristics such as learning style
and temperament. An individual may
also inherit a genetic abnormality, which
may result in disability or at birth or
later in life.
− a family history of diseases may be
inherited by unique genes that are linked
to specific disorders; chromosomes
carry genes that determine physical
characteristics, intellectual potential,
and personality
10. A great deal of skill and behavior
is learned by practice.
− If children fall behind in growth and
development because of illness, they
are capable of “catch-up” growth to
bring them equal again with their age
group.
b. GENDER
− On average, girls are born lighter (by
an ounce or two) and shorter ( by an
inch or two) than boys. Boys tend to
keep this height and weight advantage
until prepuberty, at which time girls
surge ahead because they begin their
puberty growth spurt 6 mos. to 1 year
earlier than boys.
− By the end of puberty (14-16 y.o.), boys
again tend to be taller and heavier than
girls. This difference in growth patterns
is different growth charts used for boys
and girls.
c. INTELLIGENCE
− Children with high intelligence do not
generally grow faster physically than
other children, but they do tend to advance
faster in skills.
− This is due to them spending more time
with books or mental games rather than
with games that develop motor skills and
so does not received practice in these
areas.
d. TEMPERAMENT
− refers to the way by which the child
consistently interacts with the surrounding
environment, including the people she
interacts with. It is among the genetically
determined factor that is believed to shape
social behavior.
− It is the usual reaction pattern of an
individual, or an individual’s characteristic
manner of thinking, behaving, or reacting
to stimuli in the environment.
− It is not developed by stages but is an
inborn characteristic set at birth.
− It is important to explore the concept of
temperament with parents at child health
assessments.
THREE CLASSIFICATIONS OF
TEMPERAMENTS IN CHILDREN
1. THE EASY CHILD (ideal)
− They have a predictable rhythmicity,
approach and adapt to new situations
readily, have a mild to moderate intensity
of reaction, and have an overall positive
mood quality.
− Responds positively to stimuli, has a very
positive attitude
− Have long attention span and high level of
persistence
− Easily soothed when they become upset
− Very adaptable to change
− Sleeps and eats well
− Has a regular and predictable behavior
− Likes to be around people being outgoing
2. THE DIFFICULT CHILD
− They are irregular in habits, have negative
mood quality, and withdraw rather than
approach new situations.
− More fussy, become easily upset, difficult
to soothe
− React more negatively to stimuli
− Not very adaptable to changes
− Requires a structured environment not
being able to adapt easily to change
− Seems to be in constant motion
− Has irregular patterns of behavior
3. THE SLOW-TO-WARM-UP CHILD
− They are overall fairly inactive; respond
only mildly and adapt slowly to new
situations, and have a general negative
mood.
− Reacts passively to change, but after
awhile, he or she will adapt
− Adapts slowly to stimuli
− Loner and socially shy
− Oversensitive and slow to mature
− Primarily inactive
− Quietly withdraws and usually moody
 Stranger’s anxiety
– infant becomes upset when a stranger
appears; starts at 6 mos. and heightens
at 9 mos.
 Separation anxiety
– infant becomes upset or cries when
separated from primary care giver;
appears at 9-10 mos.; peaks at 12-15
mos.; and disappears by 24 mos.
Nursing Implications Regarding
Temperament
 It is useful to talk to parents about their
child’s reactivity patterns at health
maintenance visits because these patterns
tend to persist: the way a child react in the
future depends a great deal on the way a
child reacts today.
 Bringing these characteristics to parent’s
attention helps them better understand
their child and lays the foundation for
beginning to accept and respect him or her
as an individual. It is essential for
successful child-rearing.
 Noticing a child’s temperamental
characteristics when he or she is admitted
to a hospital can help nurses anticipate a
child’s probable reactions to procedures
or pain
2. External Forces
− family, peer group, life experiences,
a. Family and community
− a stimulating environment from the family
helps a child reach his or her potential
− family structure and community support
services influence environment in the
process of growth and development of the
child
b. Cultural factors
− customs, traditions, and attitudes of
cultural groups influence the child’s growth
and development regarding physical health,
social interaction, and assumed roles
b. Socioeconomic level
− children born into families of low
socioeconomic means may not receive
adequate health supervision or good
nutrition.
c. Parent-Child Relationship
− children who are loved thrive better than
those who are not.
“ it is the quality of time spent with children
not the amount of time that is important ”
d. Ordinal Position in the Family
EX: only child or the oldest child in the family
generally excels in language development
because conversations are mainly with adults.
3. Health Environment
– prenatal health; nutrition; rest, sleep, and
exercise; state of health; living environment.
a. Prenatal and environmental
factors
− beginning with the nutrition from the
mother to exposures in utero such as
alcohol, smoking, infections, drugs;
environmental exposures, such as
radiation and chemicals, influence growth
and development of the developing child
b. Nutrition:
− the greatest influence on physical growth
and intellectual development; adequate
nutrition provides essentials for physiologic
needs, which promote health and prevent
illness

GROWTH AND DEVELOPMENT

THEORIES

PSYCHOSOCIAL DEVELOPMENT (Erik Erikson)

Erik H. Erikson envisions life as a sequence of levels of achievement. Each stage signals a
task that must be achieved. The resolution of the task can be complete, partial, or unsuccessful.
He believes that the greater the task achievement, the healthier the personality of the person; failure
to achieve a task influences the person’s ability to achieve the next task.

 A theory that stresses the importance of culture and society in the development of personality.
 These developmental tasks can be viewed as a series of crises, and successful resolution of
these crises is supportive to the person’s ego. Failure to resolve the crises is damaging to the
ego. After attaining one stage, the person may fall back and need to approach it again
 The stages reflect both positive and negative aspects of the critical life periods. The resolution
of the conflicts at each stage enables the person to function effectively in society. Each phase
has its developmental task, and the individual must find a balance between.
 Erikson emphasizes that people must change and adapt their behavior to maintain control over
their lives. In his view, no stage in personality developmental can be bypassed, but people can
become fixated at one stage or regress to a previous stage
 INFANT (Birth - 1 year)
Crisis: TRUST VS. MISTRUST
Virtue: HOPE
 Child learns to love and be loved, learning
confidence
 The task of the first year of life is to
establish trust in the people providing care
specially if their needs are met when those
needs arises( discomforts are quickly
removed, they are cuddled, played with,
talked to)
 Mistrust develops if basic needs are
inconsistently or inadequately met
 Indicator of Positive Resolution:
− Learning to trust others.
 Indicator of Negative Resolution:
− Mistrust, withdrawal, estrangement
Nursing considerations:
 Addressing infant needs timely fosters a
trusting attitude in the child towards the
provider of care
 Provide for infant’s needs
 Care should be done routinely/rhythmically
 The presence of a primary caregiver is
important
 Ensure consistency of actions because it
fosters a sense of security towards the
child
 Visual stimulation is encouraged
Nursing Implications
 Provide a primary care giver
 Provide experiences that add to security
such as soft sounds and touch
 Provide visual stimulation for active child
involvement.
TODDLER (1 - 3 years)
Crisis: AUTONOMY VS. SHAME AND
DOUBT
Virtue: WILL
 Child learns to be independent and make
decision for self
 Has an increased ability to control self
and environment
 Practices and attains new physical skills,
developing autonomy
 Symbolizes independence by controlling
body secretions, saying “no” when asked to
do something, and directing motor activity
 If successful, develops self-confidence and
willpower; If criticized or unsuccessful,
develops a sense of shame and doubt
about his or her abilities
 Indicator of Positive Resolution:
− Self-control without loss of self-
esteem.
− Ability cooperate and to express
one self.
 Indicator of Negative Resolution:
− Compulsive self-restraint or
compliance
− Willfulness and defiance
 Nursing considerations
 Allow child to perform activities fostering
independence
 The child begins to differentiate himself
from his primary caregiver; changes his
negative character towards his caregiver
is a sign of independence
 Provide ways for the child to perform
activities involving muscle control and
impulses while ensuring his safety
 Prevent opportunities for decision making
 Praise child for exhibiting his independence
over reprimanding him for the mistakes he
does.
Nursing Implications
 Provide opportunities for decision making
such as offering choices of clothes to
wear or toys to play with.
 Praise for ability to make decisions rather
than judging correctness of any one
decision
PRESCHOOLER (3 - 6 years)
Crisis: INITIATIVE VS. GUILT
Virtue: PURPOSE
 Learning initiative is learning how to do
things and that doing things is desirable.
 A child explores the physical world with all
the senses, initiates new activities, and
considers new ideas
 Initiative is demonstrated when the child is
able to formulate and carry out a plan of
action
 Develops a conscience
 If successful, develops direction and
purpose; if criticized, leads to feelings of
guilt and lack of purpose
 Indicator of Positive Resolution:
− Learning the degree to which
assertiveness and purpose
influence the environment
− Beginning ability to evaluate one’s
own behavior
 Indicator of Negative Resolution:
− Lack of self-confidence
− Pessimism, fear of wrongdoing
− Over-control & under-restriction of
own activity
− Limited brain storming and
problem solving skills
Nursing considerations:
 Initiative (starting things on his own), in this
case, focuses on the child knowing how to
do things
 Encourage creative/free-form play
 Allow child to have self-initiated activities
 Anticipate the intellectual
initiative/inquisitiveness of the child
 Expose the child on activities involving
exploration
 Acknowledge child’s fantasies/magical
thinking, but orient him so he can
distinguish it from reality
 Role-playing is a good means to
encourage the child’s imagination
 Nursing Implications
 Provide opportunities for exploring new
places or activities.
 Allow play to include activities involving
water, clay or finger paint
 Give freedom and opportunity to initiate
motor play such as running, bike riding,
sliding
 Answer a child’s questions and do not
inhibit fantasy or play activity.
SCHOOL-AGE (6 - 12 years)
Crisis: INDUSTRY VS. INFERIORITY
Virtue: CONFIDENCE
 Child learns how to do things well
 Middle years of childhood displays
development of new interests and
involvement in activities
 Learns to follow rules
 Acquires reading, writing, math, and social
skills
 If successful, develops confidence and
enjoys learning about new things; if
compared to others, may develop feeling
of inadequacy; inferiority may develop if
too much is expected
 Indicator of Positive Resolution:
− Beginning to create, develop, and
manipulate
− Developing sense of competence
and perseverance
 Indicator of Negative Resolution:
− Loss of hope, sense of being
mediocre
− Withdrawal from school and peers
Nursing considerations
 Industry focuses on the ability of the child
to do things well
 Provide opportunities wherein the child
could gain a sense of accomplishment
 Opt for activities that could be completed
on a limited period of time
 Preference to spend time with peers is a
sign of his independence
 With the child’s affinity to conformity,
structured activities with reward systems
are good means to develop his sense of
accomplishment
Nursing Implications
 Provide opportunities such as allowing child
to assemble and complete a short project
so that child feels rewarded for
accomplishment
 Encouraged children in their efforts to do
practical task or make practical things
and are praised and rewarded for finish
results .
ADOLESCENCE (12 - 18 years)
Crisis: IDENTITY VS. ROLE CONFUSION
Virtue: FIDELITY
 Adolescents learn who they are and what
kind of person they will be by adjusting to YOUNG ADULTHOOD (18 - 25
a new body image, seeking emancipation years)
from parents, choosing a vocation, & Crisis: INTIMACY VS. ISOLATION
determining value system. Virtue: LOVE
 Rapid and marked physical changes
 Preoccupation with physical appearance
 Intimacy − the ability to relate well with
 Examines and redefines self, family, peer
other people, not only with members of the
group, and community
opposite sex but also with one’s sex to
 Experiments with different roles
form long-lasting friendships
 Peer group very important
 Indicator of Positive Resolution:
 If successful, develops confidence in self-
− Intimate relationship with another
identity and optimism; if unable to establish
person
meaningful definition of self, develops role
− Commitment to work and
confusion
relationships
 Indicator of Positive Resolution:
 Indicator of Negative Resolution:
− Coherent sense of self
− Impersonal relationship
− Plans to actualize one’s abilities
− Avoidance of relationship, career,
 Indicator of Negative Resolution:
or life-style commitment
− Confusion, indecisiveness, and
inability to find occupational identity

ADULTHOOD (25 - 65 years)

Nursing considerations Crisis: GENERATIVITY VS. STAGNATION

 Identity focuses on the integration of all the Virtue: CARE

roles the child has to play in his daily life
 Body changes  Indicator of Positive Resolution:
 Value system/beliefs − Creativity, productivity, concern for
 Career others
 Emancipation from parents  Indicator of Negative Resolution:
− Self-indulgence, self-concern, lack
Nursing Implication of interests and commitment
 Provide an opportunities to discuss feelings
about events important to him
 Offer support and praise for decision
making.
 ADULTHOOD (25 - 65 years)  Indicator of Positive Resolution:
Crisis: GENERATIVITY VS. STAGNATION − Acceptance of work and
uniqueness of one’s own life
Virtue: CARE
− Acceptance of death
 Indicator of Negative Resolution:
− Sense of loss, contempt for others

PSYCHOSEXUAL DEVELOPMENT (Sigmund Freud)

Sigmund Freud believes that the personality develops in five overlapping stages from birth to
adulthood.

 Psycho sexual development is a specific type of development that refers to developing instincts
or sensual pleasure
 Governed by libido (instinctual drives, primarily of sexual nature) to bring pleasure to the
individual
 The libido changes its location of emphasis within the body from one stage to another. Therefore,
a particular body area has special significance to a client at a particular stage.
 The first three stages are called PREGENITAL STAGES. The culminating stage is the
GENITAL STAGE.

INFANT (birth - 1 year)  An individual who is fixated at this stage

Stage: ORAL may have difficulty trusting others and
may demonstrate nail biting, drug abuse,
Requires oral stimulation for enjoyment,
smoking, over eating, alcoholism,
relief of tension, pleasure, nourishment
argumentativeness, and over-dependence.
(e.g. sucking); mouth as pleasure center.
 Implication:
− Feeding produces pleasure and
 Characterized by infant-seeking pleasure sense of comfort and safety.
via oral activities Feeding should be pleasurable
 Mouth is the center of pleasure. and provided when required.
 Feelings of independence arise and can
persist through life.

TODDLER (2 to 3 years)
Stage: ANAL
Pleasure derived from elimination, which
fosters independence (e.g. toilet training);
anus as pleasure center
 Anus and rectum are the centers of
pleasure.
 This stage occurs during toilet training.
 Fixation at the anal stage can result to
obsessive-compulsive personality trait,
such as obstinacy, stinginess, cruelty, and
temper tantrums.
 Gains neuro-muscular control over the
anal sphincter.
 Conflict of “holding on” and “letting go” is
resolved when bowel control is established
 Implications:
− Controlling & expelling feces
provide pleasure and sense of
control.
− Toilet training should be a
pleasurable experience, &
appropriate praise can result in a
personality that is creative and
productive (method of parent
discipline, may have lasting effects
on child’s personality development)
PRESCHOOLER (4 to 5 years)
Stage: PHALLIC
Pleasure derived from external genital
organs; masturbation is performed by
males, in particular, e.g. exhibitionism
 The child’s genital is the center of
pleasure.
 Characterized by interest and recognition
in differences between the sexes and
becomes very curious about these
differences; often described as interest by
females as penis envy and by males as
castration anxiety.
 Sexual and aggressive feelings associated
with genitals come into focus.
 Masturbation offers pleasure, and the child
experiences the OEDIPUS – son-mother
relationship or ELECTRA COMPLEX –
daughter-father relationship
 Fixation at this stage can result in
difficulties with sexual identity and
problems with authority.
 Implications:
− The child identifies with the parent
of the opposite sex and later
takes on a love relationship
outside the family.
− Encourage identity. At late pre-
school, with strong identification
with parent of the same-sex will
resolve Oedipus and Electra
complex
SCHOOL-AGE (6 - 12 years)
Stage: LATENCY
Stage of relative sexual indifference;
Pleasure centers around social
interaction with others.
 Focus is on concrete thinking; dormant
pleasure derivation
 Energy is directed to physical and
intellectual activities.
 Sexual impulses tend to be repressed.
Sexuality lies dormant while energy is
focused elsewhere
 Characterized by gaining increased skill
on newly acquired traits and skills;
interested in acquiring knowledge and
vigorous play;
 Unresolved conflicts at this stage can
result in obsessiveness and lack of self-
motivation.
 Implication:
− Encourage child with physical and
intellectual pursuits.
− Help children have positive
experiences with learning so their
self- esteem continues to grow.
ADOLESCENCE (13 years and
after)
Stage: GENITAL
Adolescent develops sexual maturity and
learns to establish satisfactory
relationships with others; Genital
Geared on new sexual desires
 Energy is directed toward attaining a
mature sexual relationship.
 This stage involves a reactivation of the
pre-genital impulses. These impulses are
usually displaced, and the individual passes
to the genital stage of maturity.
 Characterized by maturation of the
reproductive system and production of sex
hormones; genital organs become a
source of tension and pleasure; interested
in forming friendships and preparation for
marriage as an adult
 An inability to resolve conflicts can result
in sexual problems, such as rigidity,
impotence, and the inability to have a
satisfactory sexual relationship.
 Implication:
− Encourage separation from
parents, achievement of
independence, & decision making.
− Provide appropriate opportunities
for the child to relate with
opposite and own sex
relationships.
FIXATION
– is immobilization or the inability of the
personality to proceed to the next stage
because of anxiety.
− Freud emphasizes the importance of
infant-parent interaction.
COGNIT IVE DEVELOPMENT (Jean Piaget)

Cognitive development refers to the manner in which people learn to think, reason, and use
language. It involves a person’s intelligence, perceptual ability, and ability to process information. It
represents a progression of mental abilities from illogical to logical thinking, from simple to complex
problem solving, and understanding concrete ideas to understanding abstract concepts.

Cognitive development refers to the ability to learn or understand from experience, to acquire
and retain knowledge, to respond to a new situation, and to solve problems. It is measured by
intelligence tests and by observing a child’s ability to function effectively in his or her environment.

It is an orderly, sequential process in which a variety of new experiences (stimuli) must exist
before intellectual abilities can develop.

In each phase, the person uses three abilities:

1. ASSIMILATION – is the process through which humans encounter and react to new situations by
using the mechanism they already possess.

2. ACCOMMODATION – is a process of change whereby cognitive processes mature sufficiently to

allow the person to solve problems that were unsolvable before.

3. ADAPTATION – or coping behavior; is the ability to handle the demands made by the environment.

Health workers can employ Piaget’s theory when developing teaching strategies. They must
remember that the range of normal cognitive development is very broad, despite the ages
arbitrarily associated with each level.

 Progresses from reflex activity through

SENSORIMOTOR
Age Span: Birth - 2 years
Transition from neonatal reflexes to
integration of learning through the child’s
sensory and motor skills
 An infant learns about the world through
the senses and motor activity
simple repetitive behaviors to imitative
behaviors and purposeful acts at the
completion of this stage
 Information is gained through the senses
and developing motor abilities
 Develops a sense of “cause and effect”
 Problem-solving is by trial and error
 Begin language development - enables the
child to better understand the world

 Sensorimotor intelligence is practical
intelligence because words and symbols
for thinking and problem solving are Not
yet available in this stage.
 High level of curiosity, experimentation, and
exploration and enjoyment in novelty result
in the learning process
 Begin to separate self from others
 Object permanence is fully developed
− Retains a mental image of an
absent object
− Sees self as separate from
others
SENSORIMOTOR PERIODS
Stage 1 - Neonatal reflex
(Birth – 1 mo.)
 Reflexes cause actions
Stage 2 - Primary circular reaction
(1 – 4 mos.)
 Perception of events is centered on the
body. Own body is the center of interest.
 Repeats pleasing actions
 Hand- mouth (to suck)& ear-eye
coordination develop
 Infants spends time looking at objects and
separating self from them.
 Enjoyable activity: rattle or tape of
parent’s voice
Stage 3 - Secondary circular reaction
(4 – 8 mos.)
 Acknowledges the external environment;
refers to activities that are separate from
child’s body
 Actively makes changes in the
environment.
 Characterized by acquired adaptation and
shifting of attention to objects and the
environment.
EX: when Baby hits mobile and notices that it
moves , so he hits again
− Infant learns to initiate, recognize and
repeat pleasurable experiences from
environment.
− Infants learn that objects in the
environment(bottle, blocks, bed , or
even parents) and permanent and
continue to exist even though they are
out of sight.
EX: Infant search for a block hidden by a
blanket knowing the blocks is still exist.
− Infants recognize that a parent remains
the same person whether dressed in
robe or t shirts.
− Memory traces are present: infant
anticipates familiar events(parent
coming near him will pick him up)
 Makes interesting action last; finds
partially hidden object
 Good toy: mirror, good game: peek-a-boo
Stage 4 - Coordination of Secondary
Reactions (8 – 12 mos.)
 Can distinguish a goal from a means of
attaining it.
 Marked by intentionally and consolidation
and coordination of schemes.
 Coordinates more than one action; finds
hidden object
 Perceives that others can cause activity
and that activities of own body are
separate from activity objects.
 Can search for and retrieve toy that
disappears from view.
 Recognizes shapes and sizes of familiar
objects.
 Because of increased sense of
separateness, infant experiences
separation anxiety when primary
caregiver leaves.
Good toy: nesting toys(colored boxes)

Stage 5 - Tertiary circular reaction
(12 – 18 mos.)
 Tries and discovers new goals from a
means of attaining it.
 Trial and error experimentation and
relentless exploration.
 Child is able to experiment to discover new
properties of objects and events.
 Characterized by an interest in novelty
and creativity and discovery of new
means through active experimentation.
 Tries new actions to see what happens
 Capable of space perception and time
perception as well as permanence.
 Object outside self are understood as
causes of actions.
 Good game: throw and retrieve
Stage 6 - Inventions of new means
through Mental Combinations
(18 – 24 mos.)
 Transitional phase to the pre - operational
thought period.
 Rituals are important.
 Interprets the environment by mental
image.
 Beginning of thought , during which toddler
begins to devise new means for
accomplishing tasks through mental
calculations.
 Can solve basic problems, foresee
maneuvers that will succeed or fail
 Uses make-believe and pretend play.
 Uses memory and imitation to act.
 Holds idea for later action.
 Good toy: those with several uses like
blocks, colored plastic rings.
PRE - OPERATIONAL
Age Span: 2 - 7 years
Involves the use of symbols and
representations in learning; pre-logical
thinking
 Forms symbolic thought; Uses symbols
(language, play) to recall past, represent
present, and anticipate future.
 Associates words with objects
 Can arrive at answers mentally instead
of through physical attempt
 Comprehends simple abstractions but
thinking is basically concrete and literal.
 Unable to understand conservation (e.g.
clay shapes, glasses of liquid)
 Concept of time is now; concept of
distance is only as far as he can see.
 Thinking is concrete, tangible; inability to
make deductions of generalization
 No awareness of reversibility(for every
action there is an opposite action) is
present.
 Interpret objects and events in terms of
relationships or use of them
 Increasing ability to use language
 Explores the environment; Play becomes
more socialized
 Can concentrate on only one
characteristic of an object at a time
(centration)
 Centering or focus on a single aspect of
an object causes distorted reasoning.
− failing to put one’s self in another
person’s shoes
 Display high level of imagination and
questioning
 Reasoning is intuitive - ability to see simple
relationships; reasons from simple- to-
simple
 Forms concepts that are not complete or
logical as an adult’s
 Makes simple classifications
 Exhibits Egocentrism
– unable to see the viewpoint of
another; can see things from only
one point of view
– approach to accommodate the
demands of an environment
− Everything is significant and relates
to “me”
− prioritizing his own needs over
others
 Displays Static Thinking
− Inability to remember what is
initially being talked about; hence,
their beginning and ending thought
are not in line with the other
Assimilation: the child fits the
situation/perception of things to his own
thoughts
Role fantasy: the child thinks of how he
wants things to turn out
Deferred imitation: the child remembers an
action he’s observed and imitates it later on
 Good toys: items require imagination such
as modelling clay.
CONCRETE OPERATIONAL
Age Span: 7 - 11 years
Involves the child’s ability to provide
concrete (tangible) solutions to problems;
appreciates the idea of cause and effect
 Thoughts become increasingly logical and
coherent
 Developing logical thinking related to
concrete tasks that are immediate and
physically present; includes systematic
reasoning.
 Able to shift attention from one perceptual
attribute to another (decentration)
 Concrete thinkers: view things as “black
and white”, right or wrong, no in between
or “gray areas”
 Able to classify and sort facts, do
problem-solving
 Uses memory to learn broad
concepts(fruit) and subgroups of
concepts(apples, oranges)
 Classification involves sorting objects
according to attributes such as color ,
seriation(order according to increasing or
decreasing)
 Acquires conservation skills; aware of
reversibility
 Follows a route through a maze and
reverse the steps
 Understand conservation
Accommodation: the child is able to adapt
thought processes to fit what is perceived
Conservation: ability to discern truth despite
change in physical form of an object
Class inclusion: the child is able to
understand that an object can belong in
various groups
 Good activity: collecting and classifying
natural objects such as sea shells, native
plants etc.

FORMAL OPERATIONAL
Age Span: 11 years - death
The child applies the scientific
method/deductive reasoning in learning;
gains appreciation of abstract ideas
 Able to logically manipulate abstract and
unobservable concepts
 Adaptable and flexible; Able to deal with
contradictions
 Uses scientific approach to problem-solve
 Can solve hypothetical problems with
scientific reasoning
 Able to conceive the distant future
 Adult or mature thought.
 Able to conceive the distant future
 Good activity: talk time to sort through
attitudes and opinions.
Stage 1 (Preconventional)
– ability to think in abstract manner
develops, scientific reasoning emerges.
Stage 2 (Conventional)
– ability to order ideas and possibilities.
Stage 3 (True Formal Thought)
– constructions of all possible
combinations of relations; deductive
hypothesis testing.

DEVELOPMENTAL TASK THEORY (Robert Havighurst)

Robert Havighurst believes that learning is basic to life and that people continue to learn
throughout life. He describes growth and development as occurring during six stages, each
associated with from 6 to 10 tasks to be learned. He believes that once a person learns to talk, it is
mastered for life. His developmental tasks provide a framework that the health care worker can use
to evaluate a person’s general accomplishments.

 Developmental Task - arises at or about a certain period in the life of an individual, successful
achievement of which leads to his happiness and to success with later tasks, while failure leads
to unhappiness in the individual, disapproval by society, and difficulty with tasks.

 Achieving psychologic stability

INFANCY & EARLY CHILDHOOD
 Forming simple concepts of social and
 Learning to walk physical reality
 Learning to take solid food  Learning to relate emotionally to parent,
 Learning to talk siblings, and other people
 Learning to control the elimination of body  Learning to distinguish right from wrong
wastes and developing conscience
 Learning sex differences and sexual
modesty

MIDDLE CHILDHOOD
 Learning physical skills necessary for
ordinary games
 Building wholesome attitudes toward
oneself as a growing organism
 Learning to get along with age-mates
 Learning an appropriate masculine or
feminine social role
 Developing fundamental skills in reading,
writing, and calculating
 Developing concepts necessary for
everyday living
 Developing conscience, morality, and a
scale or values
 Achieving personal independence
 Developing attitudes toward social groups
and institutions
ADOLESCENCE
 Achieving new and more mature relations
with age-mates of both sexes
 Achieving a masculine or feminine social
role
 Accepting one’s physique and using the
body effectively
 Achieving emotional independence from
parents and other adults
 Achieving assurance of economic
independence
 Selecting and preparing for an occupation
 Preparing for marriage and family life
 Developing intellectual skills and concepts
necessary for civic competence
 Desiring and achieving socially responsible
behavior
 Acquiring a set of values and an ethical
system as a guide to behavior
EARLY ADULTHOOD
 Selecting a mate
 Learning to live with a partner
 Starting a family
 Rearing children
 Managing a home
 Getting started in an occupation
 Taking on civic responsibility
 Finding a congenial social group
MIDDLE AGE
 Achieving adult civic and social
responsibility
 Establishing and maintaining an economic
standard of living
 Assisting teenage children to become
responsible and happy adults
 Developing adult leisure-time activities
 Relating oneself to one’s spouse as a
person
 Accepting and adjusting to the physiologic
changes of middle age
 Adjusting to aging parents
LATER MATURITY
 Adjusting to decreasing physical strength
and health
 Adjusting to retirement and reduced
income
 Adjusting to death of a spouse
 Establishing an explicit affiliation with
one’s age group
 Meeting social and civil obligations
 Establishing satisfactory physical living
arrangement.
MORAL DEVELOPMENT (Lawrence Kohlberg)
Lawrence Kohlberg studied the reasoning ability of boys and, based on Piaget’s
developmental stages, developed a theory on the way children gain knowledge of right and wrong or
moral reasoning. He focused on the reasons an individual makes a decision. For him, moral
development progresses through three levels and six stages which are not always linked to certain
developmental stage because some people progress to a higher level of moral development than
others.

 Moral development is the ability to know right from wrong and to apply these to real-life
situations. The moral dimension consists of a person’s value system, which helps differentiate
right from wrong.
 Moral maturity is the ability to independently decide for oneself what is “right.”

 Parents serve as basis of child’s morality

 Person is responsive to cultural rules of
labels of good and bad, right and wrong.
 Externally established rules determine
right and wrong actions; Values based on
external events
 Person reasons in terms of punishment,
reward, or exchange of favors.
 Egocentric focus.
Stage 1:
Punishment and Obedient
Orientation
(“heteronomous morality”)
Age: Toddler - 7 years
The child’s behavior is driven by avoiding
punishment
 Parents must be clear in giving their
instructions and in discerning the right and
wrong
 Fear of punishment, not respect for
authority, is the reason for decisions,
behavior, and conformity.
 Child does right because a parent tells him
to and to avoid punishment
 Obeys rules to avoid punishment
 Implication:
− Help child to determine what are
right actions
− Give clear instructions to avoid
confusion.

Stage 2:
Individualism
(Instrumental-Relativist
Orientation)
Age: Pre-schooler - School-Age
The child’s behavior is driven by self-
interests and rewards
 The child prioritizes what is good for him
rather than what is good for the majority
 Conformity is based on egocentricity and
narcissistic needs. There is no feeling of
justice, loyalty, or gratitude.
“ I’ll do something if I get something for it or
because it pleases you. ”
 Conforms to obtain rewards or favors.
 Implications:
− Child is unable to recognize that like
situations require like actions
− Unable to take responsibility of self-care
because meeting own needs interferes
with this.
 Person is concerned with maintaining
expectations and rules of the family group,
nation or society; Societal focus.
 A sense of guilt has developed and affects
behavior.
 The person values conformity, loyalty, and
active maintenance of social order and
control.
 Conformity means good behavior or what
pleases or helps another and is approved.
 Assesses personal consequences
Stage 3:
Interpersonal Concordance
(Good Boy-Nice Girl Orientation)
Age: School-Age - Adulthood
The child’s behavior is driven by social
approval
 The child prioritizes what is good in the
eyes of other people for them to be
distinguished as good children
 Decisions and behavior are based on
concerns about others’ reactions; the
person wants others’ approval or a
reward.
 An emphatic response, based on
understanding of how another person feels,
is a determinant for decisions and
behavior.
“I can put myself in your shoes.”
 Seeks good relations & approval of family
group.
 Implications:
− Child enjoys helping others
because this is “nice” behavior.
− Allow child to help with bed making
and other like activities.
− Praise for desired behavior such
as sharing.
 Stage 4:
Law-and-Order
(Society Maintaining Orientation)
Age: Adolescence - Adulthood
The child’s behavior is driven by obeying
authority and conforming to social order.
 The child relies on following the rules and
an authority figure, even at the cost of
their own safety
 The person wants established rules from
authorities, and the reason for decisions
and behavior is that social and sexual
rules and traditions demand the response.
“I’ll do something because it’s the law
and my duty.”
 Maintenance of social order – shows
respect to authority.
 Child finds following rules satisfying
 Follows rules of authority figures as well
as parents in an effort to keep the
“system working”
 Implications:
− Child often asks what the rules
are and if something is right.
− May have difficulty modifying a
procedure because one method
may not be right.
− Follows self-care measures only
if someone is there to enforce
them.
 The person lives autonomously and
defines moral values and principles that
are distinct from personal; identification
with group values.
 He or she lives according to principles that
are universally agreed on and that the
person considers appropriate for life.
 Universal focus; Shared standards, rights,
duties, and principles
Stage 5:
Social Contact
(Legalistic Orientation)
Age: Middle-Age - Adulthood
The individual’s behavior is driven by
balance of social order and individual
rights
 The person follows the standard of
society in terms of morality – what is good
for the people
 Concern with individual rights & legal
contracts; utilitarian lawmaking
perspective
 The social rules are not the sole basis for
decisions and behavior because the
person believes a higher moral principle
applies such as equality, justice or due
process.
 Implication:
− Adolescents can be responsible for self-
care because they view this as a
standard of adult behavior.
 The person develops his own standard of
morality and lives by it
 Few people attain or maintain this stage;
seen during crisis.

Stage 6:
Universal-Ethical Principles
Age: Middle-Age - Adulthood
The individual’s behavior is driven by
balance of social order and individual
rights

 Decisions & behaviors are based on

internalized rules, on conscience rather
than social laws, & on self-chosen ethical
& abstract principles that are universal,
comprehensive & consistent.
 Higher law & conscience orientation
 Implication:
− Many adults do not reach this
level of moral development.

June Sams