MODULE 1

HEALTH PROMOTION FOR THE DEVELOPING CHILD

Objectives: Upon completion of this chapter the students will be able to:
1. Identify and describe the eight principles of human development
2. Explain how these principles are applied to the various theories of human
development
3. Compare and contrast the major theories of human development
4. Describe, compare and contrast the major theories of human development
5. Explain how major developmental issues can be applied to the theories of
human development
6. Applies theories of human development to pediatric nursing practice

Growth:
- Physiologic increase in size through cell multiplication and differentiation
- Commonly seen in weight and height changes especially during the first year of
life
Maturation
- Refers to changes that are due genetic inheritance rather than life experiences,
illness or injury.
- These changes allow the children to function at increasingly higher or more
sophisticated level as they grow older
Development
- Physiological, psychosocial and cognitive changes occurring over one’s lifespan
due to growth, maturation and learning

A. PRINCIPLES OF GROWTH AND DEVELOPMENT

Principles Examples
Growth and development are Although there are highs and lows in
continuous processes from conception terms of this rate at which growth and
until death. development proceed, a child grows new
cells and learns new skills at all times. An
example of how the rate of growth
changes is a comparison between that of
the first year and later in life. An infant
triples birthweight and increases height
by 50% during the first year of life. If this
tremendous growth rate were to continue,
the 5-yr-old child, when ready to begin
school, would weigh 1,600 lb. and 12 ft. 6
in. tall.
Growth and development proceed in an
orderly sequence.
Different children pass through the
predictable stages at different rates.
All body systems do not develop at the
same rate.
Development is cephalocaudal.
Growth in height occurs in only one
sequence- from smaller to larger.
Development also proceeds in a
predictable order. For example, the
majority of children sit before they creep,
creep before they stand, stand before they
walk, and walk before they run. Some
children may skip a stage (or pass
through it so quickly that the parents do
not observe the stage) or progress in a
different order, but most children follow a
predictable sequence of growth and
development.
All stages of development have a range of
time rather than a certain point at which
they are usually accomplished. Two
children may pass through the motor
sequence at different rates. For example,
one child begins walking at 9 mo. While
another at 14 mo. Both are developing
normally. They are both following the
predictable sequence, they are merely
developing at different rates.
Certain body tissues mature more rapidly
than others. For example, neurologic
tissue experiences its peak growth during
the first year of life, whereas genital
tissues grows little until puberty.
Cephalo is a Greek word meaning “head”;
Caudal means “tail”. Development
proceeds from head to tail. A newborn
can lift only his or her head off the bed
when he or she lies in a prone position.
By age 2 mo., the infant can lift his or her
head and chest off the bed; by 4 mo., he
or she can lift his or her head, chest, and
part of the abdomen; by 5 mo., the infant
has enough control to turn over; by 9
mo., he or she can control the legs
enough to crawl; and by 1 yr., the child
can stand upright and perhaps walk.
Motor development has proceeded in

Development proceeds from proximal to
distal body parts.
Development proceeds from gross to
refined skills.
There is an optimum time for initiation
of experiences or learning.
cephalocaudal order- from the head to
lower extremities.
This principle is closely related to
cephalocaudal development. It can be
illustrated by tracing the progress of
upper extremity development. A newborn
makes little use of the arms or hands.
Any movement, except to put a thumb in
the mouth, is a flailing motion. By age 3
or 4 mo., the infant has enough arm
control to support the upper body weight
on the forearms, and the infant can
coordinate the hand to scoop up objects.
By 10 mo., the infant can coordinate the
arm, thumb, and index fingers sufficiently
well to use a pincer-like grasp or be able
to pick up an object as fine as a piece of
breakfast cereal on a high-chair tray.
This principle parallels the preceding one.
Because the child is able to control distal
body parts such as fingers, he or she is
able to perform fine motor skills (a 3-yr-
old colors best with a large crayon; a 12-
yr-old can write with a fine pen).
A child cannot learn a task until his or
her nervous system is mature enough to
allow that particular learning. A child
cannot learn to sit, for example, no
matter how much the child’s parents have
him or her practice, until the nervous
system has matured enough to allow
back control. A child who is not given the
opportunity to learn developmental tasks
at the appropriate or “target” times for
such tasks may have more difficulty than
the usual child learning the tasks later
on. A child who is confirmed to a body
cast at 12 mo., which is the time he or
she would normally learn to walk, may
take a long time to learn this skill once
free of the cast at, say, age 2 years old.
The child has passed the time of optimal
learning for that particular skill.
Neonatal reflexes must be lost before
development can proceed.
A great deal of skill and behavior is
learned by practice.
An infant cannot grasp with skill until the
grasp reflex has faded nor stand steadily
until the walking reflex has faded.
Neonatal reflexes are replaced by
purposeful movements.
An infants practices taking a first step
over and over before he or she
accomplishes this securely. If a child falls
behind the normal growth and
development rate because of illness, he or
she is capable of “catch-up” growth to
bring him or her on equal footing again
with his or her age group.

Stages, Age Ranges, and Characteristics of Human Development Related to

Pediatric Nursing

Stage Age Characteristics

Infant 0-12 mos Period of rapid growth and change; attachment to family
members and other caregivers are formed, trust develops
Toddler 1-3 years Motor ability, coordination, sensory skills developing, basic
feelings, emotions, a sense of self and being independent is
becoming important
Pre-schooler 3-6 years Continued physiological, psychological and cognitive growth,
better able to care for selves, interested in playing with other
children, beginning to develop a concept of who they are.
School age 6-12 years Interested in achievement, ability to read, write and complete
academic work advances, understanding of the world
broadens
Adolescent 12-19 years Transition period between childhood and adulthood,
physiological maturation occurs, formal operational thought
begins, preparation for becoming an adult takes place

Exercise 1

1. Do you agree that development is orderly, sequential, unique and inter-related?

Support your answer and provide example.
2. “Development becomes increasingly differentiated, integrated and complex as
children get older”. Do you agree on this statement? Support your answer and
provide an example.
3. “Children becomes competent as they grow older and that their new skills
predominate”. How would you explain this statement?
B. THEORIES OF DEVELOPMENT
1. Definition of Theories
Theory – a systematic statement of principles that provides a framework for
explaining some phenomenon. Developmental theories provide road maps for
explaining human development.

Developmental Task – a skill or growth responsibility arising at a particular

time in an individual’s life, the achievement of which will provide a foundation
for the accomplishment of future tasks. It is not so much chronological as the
completion of developmental tasks that defines whether a child has passed from
one developmental stage of childhood to another, For example, a child is not a
toddler just because he or she is 1 year plus 1 day old; he or she becomes a
toddler when or she has passed through the development stage of infancy.

2. Basic Division of Childhood

Stage Age Period

Neonate From 28 days of life
Infant 1 month – 1 year
Toddler 1 – 3 years
Preschooler 3 – 5 years
School-age child 6 – 12 years
Adolescent 13 – 20 years

3. Freud’s Stages of Childhood (Psychosexual Development)

Stage Psychosexual Stage Nursing Implications

Infant Oral stage: Child explores the
0-12 mos world by using his or her mouth,
especially the tongue.
- Erogenous zone in focus:
mouth
- Infant is preoccupied with
activities associated with the
mouth such as sucking, biting,
chewing and satisfying hunger
Provide oral stimulation by
giving pacifiers; do not
discourage thumb sucking.
Breastfeeding may provide
more stimulation than
formula feeding because it
requires the infant to expend
more energy.
 - Children whose oral needs
were not meet appropriately
could result to:
- > thumb sucking
- nail biting
- pencil chewers
- compulsive eaters and smokers
later in life
- overly dependent or have
difficulty developing mature
relations if they were weaned
too early or feed rigidly
Toddler Anal stage: Child learns to control Help children achieve bowel
12-36 mos urination and defecation. and bladder control without
- Erogenous zone in focus: Anus undue emphasis on its
- Sphincter muscles are importance. If at all possible,
maturing and children develop continue bowel and bladder
the ability to eliminate and training while child is
retain fecal materials and hospitalized.
urine
- Best time to begin toilet
training (15-30 min. on a
regular daily schedule)

If the parents are lenient and fail to

toilet train the child properly, the
child will be:
- Excessively sloppy
- Disorganized
- Reckless
- Careless
- Defiant

- If the child received excessive

pressure and punishment
during toilet training

- Experience anxiety over bowel

movement and take pleasure
in being able to withhold such
function.
 - Individuals who fail to progress
pass this state are:
• Very careful
• Stingy
• With holding
• Meticulous
• Conforming
• Passive aggressive

Preschooler Phallic stage: Child learns sexual Accept child’s sexual interest,
3-6 yrs. old identity through awareness of such as fondling his or her
genital area. own genitals, as a normal
- Erogenous zone in focus: area of exploration. Help
genital parents answer the child’s
- Child psychic energy is questions about birth or
redirected to the genitals sexual differences.
- Children are curious,
fascinated with anatomic
differences of genitals
- Find pleasure in touching their
own genitals

Penis Envy
- Girls wish they had a penis
- They believe they had once
before but was remove by a
jealous hostile mother
Electra Complex
- Attachment of female child to
his father

Castration Anxiety
➢ Boys fear of losing their
penis due to an attack or
injury by others
➢ Boys develop incestuous
desire for the caregiver of
the opposite sex
Oedipal complex
➢ Attachment of a male child
to his mother
 School-age Latent stage: Child’s personality Help the child have positive
child development appears to be non- experiences as his or her
6-11 years old active or dominant. self-esteem continues to grow
and as he or she prepares for
the conflicts of adolescence.
- Erogenous zone in focus: None
- Sexual drives are sub-merge
- Oedipal and Electra complex
are resolved
- This is a time of learning,
adjusting to the social
environment outside of home,
absorbing the culture, forming
beliefs and values, developing
same sex friendship, engaging
in sports.

Adolescent Genital stage: Adolescent develops Provide appropriate

12 above sexual maturity and learns to opportunities for the child to
establish satisfactory relationships relate with the opposite sex;
with the opposite sex. allow the child to verbalize
feelings about new
- Erogenous zone in focus: relationships.
Genitals
- Capable of reproduction and
their sexuality is re-awakened
- Sexual desires re-emerge due
to physiological changes,
fluctuating hormone levels and
changing social relationship
Mark by renewed sexual interest
and desire towards opposite sex
and the pursuit of relationship

4. Erikson’s Stages of Childhood (Psychosocial Development)

Stage Developmental Task Nursing Implications

Infant Developmental task is to Provide a primary caregiver.
form a sense of trust versus Provide experiences that add
mistrust. Child learns to love to security such as soft
and be loved. sounds and touch. Provide

Toddler Developmental task is to
form a sense of autonomy
versus shame. Child learns
to be independent and make
decisions for himself or
herself.
Preschooler Developmental task is to
form a sense of initiative
versus guilt. Child learns
how to do things (basic
problem solving) and that
doing things is desirable.
School-age child Developmental task is to
form a sense of industry
versus inferiority. Child
learns how to do things well.
Adolescent Developmental task is to
form a sense of identity
versus role confusion.
Adolescent learns who he or
she will be by adjusting to a
new body image, seeking
emancipation from parents,
choosing a vocation, and
determining a value system.
visual stimulation for active
child involvement.
Provide opportunities for
decision making such as
offering choices of clothes to
wear or toys to play with.
Praise ability to make
decisions rather than judge
or correct the child’s
decision.
Provide opportunities for
exploring new places or
activities. Allow play to
include activities involving
water, clay (for modeling), or
finger paints.
Provide opportunities such
as allowing child to assemble
and complete a short project
so that the child feels
rewarded for the
accomplishment.
Provide opportunities for the
adolescent to discuss feelings
about events important to
him or her. Offer support and
praise for decision making.

Exercise 2

1. Which points of Freud’s theory of psychosexual development do you agree or

disagree with. Provide an example to support your answer.
2. How relevant and current is Freud’s theory today? Explain your thinking.
3. Using psychosocial development in practice, how would you identify children
having developing trust, autonomy, industry and identity.
4. What suggestions would you give parents to help them help their children
positively resolve each developmental crisis?
5. Piaget’s Stages of Cognitive Development

Stages of Age Span Nursing Implication

Development
Sensorimotor 1 month Stimuli are assimilated into beginning
neonatal reflex mental images. Behavior is entirely
reflexive.
Primary circular 1 – 4 months Hand-mouth and ear-eye coordination
reaction develop. Infant spends much time looking
at objects and separating self from them.
Beginning intention of behavior is present
(the infant brings thumb to mouth for a
purpose: to suck it). An enjoyable activity
for the period: a rattle or a tape of parent’s
voice.
Secondary circular 4-8 months Infant learns to initiate, recognize, and
reaction repeat pleasurable experiences from
environment. Memory traces are present;
infant anticipates familiar events (a parent
coming near him will pick him up). Good
toy for this period: mirror, good game:
peek-a-boo.
Coordination of 8 – 12 months Infant can plan activities to attain specific
Secondary reaction goals; can perceive that others can cause
activity and that activities of own body are
separate from activity of objects; can search
for and retrieve toy that disappears from
view; and can recognize shapes and sizes of
familiar objects. Because of increased sense
of separateness, infant experiences
separation anxiety when primary caregiver
leaves. Good toy for this period: nesting
toys (e.g., colored boxes).
Tertiary circular 12 – 18 months Child is able to experiment to discover new
reaction properties of objects and events and is
capable of space and time perception as
well as permanence. Objects outside self
are understood as causes of actions. Good
game for this period: throw and retrieve.
Invention of new 18 – 24 months Transitional phase to the pre-operational
means through thought period. Child uses memory and
mental thought imitation to act, solves basic problems, and
foresees maneuvers that will succeed or
 fail. Good toys for this period: those with
several uses such as blocks and colored
plastic rings.
Pre-operational 2 – 7 years Thought become symbolic. Child can arrive
thought at answers mentally instead of through
physical attempt and can comprehend
simple abstractions, although thinking is
basically concrete and literal. Child is
egocentric (unable to see the viewpoint of
another) and display static thinking
(inability to remember what he or she
started to talk about, so that the end of a
sentence, the child is already talking about
another topic). Concept of time is now, and
concept of distance is only as far as he or
she can see. Centering or focusing on a
single aspect of an object causes distorted
reasoning. No awareness of reversibility (for
every action there is an opposite action) is
present. Child is unable to state cause-
effect relationships, categories, or
abstractions. Good toy for this period:
items that require imagination such as
modeling clay.
Concrete 7 – 12 years Concrete operations include systematic
operational reasoning. Uses memory to learn broad
thought concepts (e.g., fruit) and sub-groups of
concepts (e.g., apples, oranges). Objects are
sorted according to attributes such as
color; seriation, in which objects are
ordered according to increasing or
decreasing measures such as weight; and
multiplication, in which objects are
simultaneously classified and seriated
using weight. Child is aware of reversibility.
An opposite operation or continuation of
reasoning back to a starting point (follows a
route through a maze and back then
reverses steps); understand conversation;
and sees consistency despite
transformation (mass or quantity remains
the same even if it changes shape or
position). Good activity for this period:
 collecting and classifying natural objects
such as native plants, sea shells, etc.
Expose child to other view points by asking
questions like “How do you think you’d feel
if you were a nurse and had to tell someone
to stay in bed?”
Formal operational 12 years Adolescent can solve hypothetical problems
thought with scientific reasoning, can understand
causality, and can deal with the past,
present, future. Adult or mature thought.
Good activity for this period: “talk time” to
sort through attitudes and opinions.

6. Kohlberg’s Stage of Moral Development

Age Stage Description Nursing Implications

(Year)

2-3 1 Punishment/obedience Child needs help to

orientation (“heteronomous
morality”). Child does right
because a parent tells him
or her to do so and to avoid
punishment.
4-7 2 Individualism. Instruction
purpose and exchange.
Carries out actions to
satisfy own needs rather
than society’s. Will do
something for another if
that person does something
for the child.
determine what actions
are right. Give clear
instructions to avoid
confusion.
Child is unable to
recognize that like
actions. Unable to take
responsibility for self-
care because meeting
own needs interferes
with this.

7-10 3 Orientation to interpersonal Child enjoys helping

relations of mutuality.
Child follows rules because
of a need to be a “good”
person in own eyes and
eyes of others.
others because this is
“nice” behavior. Allow
child to help with bed
making and other similar
activities. Praise for

10-12 4 Maintenance of social
order, fixed rules and
authority. Child finds
following rules satisfying.
Follows rules of authority
figures as well as parents in
an effort to keep the
“system” working.
desired behavior such as
sharing.
Child often asks what
are the rules and if is
something “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.

Older than 5 Social contract, utilitarian An adolescent can be

12 law-making perspectives.
Follows standards of
society for the good of all
people.
6 Universal ethical principle
orientation. Follows
internalized standards of
conduct.
responsible for self-care
because he or she views
this as a standard of
adult behavior.
Many adults do not
reach this level of moral
development.

7. Interpersonal Theory (Harry Stack Sullivan)

“The self-concept is the key to personality development”

Stage Age Characteristics

Infant 0-18 mos Learns to rely on others especially mother, good me and
bad me emerge;
Good me: feeling occurs when acceptance is sensed
Bad me: occurs when the infant experiences anxiety when
interacting with caregivers
Early childhood 18 mos-6 Learns to clarify communication, recognizes approval and
years disapproval, delays gratification
Late childhood 6-9 years Increasingly intellectual abilities, learns to control
behavior and own place in the world. Learns to pay
attention to other’s wishes; learn to accept subordination
from authority figures.
Pre- 9-12 years Vulnerable to teasing, “chum” is important.
adolescence Become interested in closely relating to a peer of the same
gender.
Early 12-15 years Mastering independence; develops relationship with
adolescence persons of the opposite gender.
Demonstrate a variety of behavior including, rebellion,
dependence, cooperation and collaboration as they
become independent.
Late 15-19 years Initial feelings of love for the opposite gender emerge.
Adolescence Master expressions of sexual impulses, forms responsible
and satisfying relationship with others.

Exercise 3:
1. Discuss the difference between growth, development and maturation and cite a
specific example relevant to the three distinguish terms.
2. According to Sigmund Freud, what is the most challenging stage in the
psychosexual development? Support your answer.
3. Explain how the Theory of Erik Erikson will influence the normal growth and
development to proceed. Cite a specific example.
4. Think about moral dilemma that has affected you. Why do some people have a
higher moral standard than others? Apply your answer to Kohlberg’s theory.
CASE SCENARIO: What Would You Do?

1. The mother of a 4-month-old infant brings the baby to the health care clinic for
her well-baby check. The baby is measured and weighed and the measurements
are plotted on a growth chart. The baby is in the 75th percentile for height and
the 60th percentile for weight. When the provider examines the baby, the notion
of doing a developmental screening on the child is discussed.
a. What will you explain to this mother when she asks you the purpose of the
growth chart?
b. How often will the baby’s measurements be plotted on the growth charts?
c. What will you expect to see after the child has had several measurements
plotted?
d. What is the purpose of doing a developmental screening?

2. A group of family caregivers is participating in a class discussing influences on

a child’s growth and development. If you were the nurse doing this teaching
session, how would you answer the following questions?
a. What influence does genetics have on growth and development?
b. What are the effects of nutrition on a child’s growth?
c. What are some environmental factors that influence a child’s development?

3. Erikson identified trust as the development task for the first stage of life.
Discuss why successful accomplishment of this task is essential to the person’s
future happiness and adjustment.
REASEARCH LINKING: Read a research that is associated with the concept of
growth and development. Fill out the matrix below.

Problem Methodology

Reference
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Salient Findings Conclusions
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ANALYSIS: How can the findings of this study contribute to the practice of pediatric
nursing.
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