INFANCY

● 1-12 months of age

● Psychosexual stage: Oral
● Psychosocial stage: Trust vs. Mistrust
● Cognitive stage: Sensorimotor (0-2 years)
● Fear: Strangers anxiety

Oral Stage: Mouth is point of gratification

Cognitive Stage: Sensorimotor Development

Stage 1 - Cognitive Development Theory

Sensorimotor Stage
(birth to age 2)

Oral Stage: Failure to resolve this stage may During this stage, the child begins to develop:
lead to: ● Reflexes
● Habits
Symptoms of Oral Fixation ● Hand-eye coordination
● Smoking ● Object Permanence (knowing something
● Constant chewing on gum, pens, exists, even though it can’t be seen)
pencils, etc. ● Experimentation and creativity. Piaget
● Nail biting referred to the children in this stage as “little
● Overeating and eating disorders scientists”
● Drinking ● Trial and error experiments
● Sarcasm “the biting personality”
● Verbal hostility
Fear: Stranger’s Anxiety
● Narcissism
● Passivity
● Stranger anxiety & attachment
● By nature human beings are social animals
Trust vs. Mistrust Crisis
● Bonds are formed at birth with care givers
○ Prefer familiar faces
○ A fear of strangers develops soon
after object permanence takes
place: starts at 8 to 9 months above
- This shows that the brain,
mind & social emotional
behavior develop together
- By the 12th month babies
form an intense bond with
their caregivers so the
attachment here is an
 emotional tie with another
person
- Attachment originates from a
number of elements like
comfort, familiarity and those
who are responsive to their
needs
Physical Growth
A. Weight: double birth weight at 4-6 months
and triples it by 1 year
● First 6 months : average gain 2
lb/month
● Second 6 months : Weight gain
1lb. / month
● Average 1 year old boy: weighs 10
kg
● Average girl: 9.5 kg
B. Height: first year increases by 50% growth
more in the trunk
C. Head Circumference: increases rapidly
reflecting rapid brain growth
● End of first year, brain reched ⅔ of
an adult size
● Head asymmetric due to one
sleeping position causing the skull
bones to flatten on that size
● Gradually corrects as the child
sleeps and spends more time with
the head in an erect position
D. Body Proportion: changes from newborn
to a typical infant appearance
● Mandible becomes more prominent
● 1 year old : lower jaw becomes more
prominent
● Chest circumference less than the
head by 2 cm
● Abdomen remains protuberant : how
they balance their walk (Lordosis)
● Cervical, thoracic and lumbar
vertebral curves develop
● Lengthening of the lower extremities
during the last 6 months
E. Body Systems _ increases
1. Heart rate: 100-120 bpm by the end of 1st
year
● Pulse rate slows with inhalation
● Blood pressure (average of 80/40 -
100/60 mmhg) : measure through
machines
● Heart is more efficient
2. Respiratory System
● Respiratory rate : 30-60 breaths/ min
to 20-30 breaths per minute
● Respiratory infections occur more
often because of the lumen or tubal
cavity of the respiratory tract is small
and mucus production is already
inefficient
● Mucus production is one way to
protect us from respiratory infection
3. Gastrointestinal Growth _
● Immature ability to digest food &
mechanically move it : not allowed
choking hazard food such as grapes
and peanuts
● Amylase for digestion of complex
carbohydrates deficient until 3
months
● Lipase for digestion of saturated fat
decreased during entire 1st year
● Liver remains immature causing
inadequate conjugation of drugs &
inefficient formation of
carbohydrates, protein and vitamins
for storage
4. Urinary System _
● kidneys immature, inefficient at
eliminating body wastes
5. Endocrine System _
● immature response to pituitary
stimulation
6. Immune System .
● functional by 2 months; produce IgG
and IgM by 1 year
● Ability to adjust to cold mature by 6
months, can shiver
● Develops additional adipose tissue
for insulation
● Extracellular fluid : 35% of body
weight
● Intracellular fluid : 40% which
susceptibility to
dehydration : advice to have
breastfeeding at 6 months beyond
7. Teeth .
● First baby tooth erupts at 6 months
starts at the lower area usually
followed by a new one monthly
● Natal teeth present at birth
● Neonatal teeth erupts in the first 4
weeks of life
● Deciduous teeth or baby teeth it
protects the growth of dental arc

Motor Development

● ability to move and to control the body

○ The body movement is
uncoordinated
○ Reflects the principles of
cephalocaudal development & gross
to fine motor development
● Control proceeds from head-trunk to lower
extremities in a progressive and predictable
sequence
○ 2 months : can lift their head
● Different infants accomplish different tasks
at different ages.

Gross Motor Development

● Ability to accomplish large body

movements
○ Standing up
○ Ventral Suspension Position-
move legs, arms
○ Prone position : can move
head, crawl, flex extremities
○ Sitting position
○ Standing position
 Fine Motor Development

● Ability to use smaller muscles to accomplish

small body movements
○ Grasp
○ Neat Pincer Grasp
○ Transfers objects from hand to hand
○ Hold cup and spoon well

Language Development

● 1 month: begins to make small, cooing

sounds
● 2 months: make throaty, gurgling, or
cooing sounds
● 3 months: will squeal with pleasure
● 4 months : very “talkative”, cooing,
babbling, & gurgling
● 5 months: says simple vowel sounds
● 6 months: learn the art of imitating
● 7 months: can imitate vowel sounds well
● 9 months: speaks a first word: “da-da” or
“ba-ba”
● 10 months: masters another word such as
“bye-bye” or “NO”
● 12 months: can say two words besides
“ma-ma” and “da-da”; use those two words
with meaning.

Play

● Solitary play wherein they play with their

own body
Age Play Toys

0-1 Enjoys watching face Black and white or

of primary caregiver, brightly colored
listening to soothing mobiles; musical
sounds mobiles

2 Enjoys bright-colored Small rattles held

mobiles for a short period
of time; mobiles or
cradle gyms
strung on cribs

3 Spends time looking at Small blocks or

hands or uses them as small rattles
 toys during the month
(hand regard)
4 Needs space to turn
5 Handles rattles well
Playpen or a
sheet spread on
the floor to
exercise their new
skill of rolling over
Objects small
enough so that
infant can lift with
one hand, yet big
enough that the
baby cannot
possibly swallow
Cognitive Development
● PRIMARY CIRCULAR REACTIONS :
Infants explore the world by mouthing
objects or fingering them. They also help
separate self from the environment.
● OBJECT PERMANENCE : 10-month-old
infants became aware that an object out
of sight still exists
Developmental Milestone

6 Enjoys bathtub toys, Rubber toys such

rubber ring for as ducks; teething Age Physical Motor Sensory Socializatio
teething rings n and
Vocalization
7 Likes objects that are Blocks, rattles,
a good size for plastic keys; 1 Weight 1. Can turn 1. Eye 1. Watches
transferring brightly colored mo. gain head side movemen face intently
balls or toys that about to side ts while being
rolls out of reach 150-210 when coordinat spoken to
g/week prone ed most 2. Utters
8 Enjoys manipulation, Toys made of during 2. Lifts of the small,
rattles and toys of rough or smooth the 1st 6 head time throaty
different textures items such as months momentaril 2. Follows sounds
velvet, fur, etc. y from bed light to
3. Primitive midline
9 Needs space for Toys that gi inside reflexes 3. Visual
creeping one another; pots still acuity
and pans that present 20/100
stack Hands
closed
10 Games like patty-cake Peek-a-boo; can
and peek-a-boo clap; play 2-3 1. 1. Lift head 1. Follows 1. Social
patty-cake mos Weight for a short light to smile
triples time and the 2. Shed
11 “cruises” Cruise or walk 2. With raise chest periphery tears
along low tables total of supported 2. Listen 3. Laughs
by holding on 6-8 teeth on to sounds aloud, show
forearms pleasure in
12 Likes toys that fit Boxes that fit 2. Primitive making
inside each other; inside one reflexes sounds
nursery rhymes; will another, dropping fading
like pull toys as soon blocks into a 3. Plays
as walking cardboard box; with
pull toys; listening fingers and
to nursery rhymes hands
or music
4-5 Drools 1. Can Recogniz 1. Coos and 10-1 1. Visual 1. Shows
mos raise both e familiar gurgles 2 Creeping acuity emotions
head and objects when talked mos 2. Stands 20/50 such as
chest on and to with jealousy,
prone (4 people 2. Enjoys support affection
mos.) social (10 mos.) and anger
2. Can roll interaction 3. Stands 2. Fear with
over from 3. Vocalizes without strangers
abdomen displeasure support and strange
to back (5 when an (12 mos.) situations
mos.) object is 4. Walks 3. May
taken away with develop a
support habit of
6-7 Weight 1. Sits with 1. Has 1. Strangers (12 mos.) “security
mos doubles support (6 taste anxiety 5. Can eat blanket”
Teething mos.) preferenc 2. Cries from spoon 4. Can say
begins 2. Can turn es easily but and drink 2 words
with over well 2. Object laughs from cup with
eruption equally permanen quickly but needs meaning
of 2 from ce help 5.
lower stomach or Prefers Understand
incisors back using s simple
3. Palmar fingers request
grasp (6
mos.)
4. Can Health Promotion during Infancy
approach a
toy and
1. Nutrition .
grasp it
with 1
Guidelines for infant feeding: .
hand to the
● Breast milk is the most complete diet
other from
for the 1st 6 months but requires
hand to
supplementation
mouth
● Solid foods can be introduced at 6
5. Plays
months
with feet
● First food is often commercially
and puts
prepared iron-fortified cereals up to
them to
18 months
mouth
● Introduced food one at a time and
8-9 1. 1. Sits Displays 1. Definite allow the child to eat that item for
mos Weight steadily interest social one week before introducing another
doubles alone (8 on small attachments food; vegetables, fruits then meats
2. mos.) objects 2. ● First solid foods are strained, pureed
Teething 2. Pincer Responds or mashed
begins grasp (9 to own ● Finger foods such as toast, crackers
with mos.) name or raw fruits are introduced at 6-8
eruption 3. Crawls 3. Has months
of 2 imitative ● Chopped table food or commercially
lower and prepared foods can be started by
incisors repetitive 9-12 months
speech
 2. Guidelines in Weaning .
Immunizations
● Giving up the bottle or breast for a
cup is psychologically significant
● Usually, readiness develops during
2nd half of the first year because of
pleasure from receiving food by a
spoon and desire for more freedom
and control over body and
environment
● If breastfeeding must be terminated
before 6 months of age, a bottle
should be used to allow for
continued sucking needs; after about
6 months wean directly to a cup

Health Teaching in Infants

0-3 months _
1. Feeding only breast milk or formula for the
first 6 months of life
2. Always hold infant when feeding and never
prop bottle when feeding
3. Limit water intake to ½ - 1 oz. at a time
4. Avoid use of honey or corn syrup
5. Allow non-nutritive sucking

4-6 months _
1. Introduce solid foods without added salt or
sugar. Give iron-fortified cereal, one type of
food at a time
2. Avoid use of juice or sweetened drinks
3. Feed with the use of spoon only

7-9 months _
1. Introduce finger foods and cup when infant
is able to sit up
2. Allow infant to join family meal times
3. Allow self feeding with supervision
4. Offer fluids after solid foods
5. Introduce limited amount of diluted juice in a
cup
6. Avoid sugary desserts and cola

10-12 months _
1. Offer 3 meals and healthy snacks
2. Begin to wean from bottle, begin table foods
3. Avoid fruit drinks and flavored milk
4. Allow infant to feed self with spoon
 ○ Weight loss greater
Safety Promotion among Infants
than 10%
○ Diminished skin
● Accidents are a leading cause of death from turgor and dry
1 month through 2 years of age mucous membranes
● Most accidents occur because parents ○ Depressed
either underestimated or overestimated a fontanelles and
child’s ability-base sunken eyeball
○ Decreased urine
Common Health Related Problems output
○ Irritability
○ Metabolic acidosis
A. Constipation _ ★ Management: .
● Hard, dry stools that are difficult to 1. Monitor intake and output,
pass or infrequent weight and frequency of stool
● Usually a result of diet, may have 2. Correct fluid and electrolyte
psychological component imbalance
● Indicative of Hirschsprung’s disease 3. Identify causative agent and
➢ Assessment: . institute proper therapy
○ Stool withholding behavior C. Lactose Intolerance .
○ Pain on defecation ★ Inability to tolerate lactose as a
★ Management: . result of the absence or deficiency of
1. Increase fiber and fluid lactase, an enzyme found in the
2. If mineral oils is used, it secretions of the small intestines
should not be given with that is required for digestion of
food, it decreases the lactose
absorption of nutrients ➢ Assessment: .
3. Avoid enemas; bowel ○ Symptoms usually occur
retraining should be instituted after the ingestion of milk
4. Place infant in knee-chest products
position if distention and ○ Abdominal pain distention
cramping is present ○ Crampy or colickly abdominal
5. History of constipation for pain
more than 1 week should be ○ Diarrhea and excessive
examined for an anal fissure flatus
or tight sphincter ★ Management: .
B. Diarrhea . 1. Eliminate offending dairy
● Frequent watery stools caused by products
increase peristalsis 2. Administer an enzyme
● Classification: replacement
○ ACUTE:sudden change in 3. Substitute milk with
the frequency and lactose-free milk
consistency of stool 4. Provide calcium and vitamin
○ CHRONIC:persists longer D supplements to prevent
than 2 weeks, often caused deficiency
by chronic conditions such as 5. May drink milk with other
inflammatory bowel disease, foods rather by itself
food allergy, lactose 6. Encourage consumption of
intolerance, etc. cheese or yogurt
➢ Assessment: _ 7. Encourage consumption of
1. Frequent watery stools small amounts of dairy foods
2. If fluid loss is severe
 8. to help colonic bacteria adapt to
ingested lactose
D. Colic
● Paroxysmal abdominal pain or cramping
● Common to infants under 3 months of age
● Associated with excessive swallowing of air,
size of nipple opening or shape of, too rapid
feeding or overfeeding, maternal diet or
anxious caregiver
➢ Assessment:
○ Pulling up of arms and legs
○ Red-faced crying over
○ Presence of excessive gas
★ Management:
1. Watch the parent or caregiver feed
the child before attempting to
counsel
2. Provide smaller but frequent
feedings
3. Offering a pacifier may
comforting
4. Teach the parent to burp infant after
feeding
E. Diaper Dermatitis/ Rashes
● Sensitive skin
● Urine that is left in diapers too long breaks
down into ammonia, a chemical that is
extremely irritating to infant’s skin
★ Management:
1. Frequent diaper change
2. Applying prescribed ointment
(Desitin)
3. Exposing the diaper area to air
4. Change of diaper brand because
infant may have allergy on the
material used
5. If diaper area is covered with lesions
that are bright red with or without
oozing, last longer than 3 days and
appear as red pinpoint lesions,
suspect a fungal infection
F. Spitting
● The baby who spits up a mouthful of milk
2-3x a day is normal
● May be interpreted as vomiting
● Projectile vomiting and large amount of
spitting up each meal need attention
★ Management:
1. Burping thoroughly after feeding
2. Maintain in an upright position for
half an hour after feeding
Other Parental Concerns
_
A. Teething .
● Gums are sore and tender before a
new tooth breaks to the surface
● Acetaminophen 10-15 mg/kg every 4
hours may be used
● Teething rings that can be placed in
_ the refrigerator
B. Thumb Sucking .
● Begin to suck a thumb or finger
about 3 months of age
. ● Sucking reflex peaks 6-8 months
● Thumb sucking peaks at 18 months
● Thumb sucking is normal, stops by
school age
C. Use of Pacifier .
● Depending on how parents feel
be about them and their infant’s needs
● Wean a child from a pacifier anytime
after 3 months
● Sucking reflex is fading at 6-9
. months
D. Head Banging .
● Rhythmic banging of heads against
the bars of a crib for a period of time
before sleeping
. ● To relax and fall asleep
● Advise parents to pad the rails of the
cribs so infants cannot hurt
themselves
● A normal mechanism for relief of
tension in children of this age
E. Sleep Problems .
● Due to colic or difficulty in adjusting
to sleeping through the night
● Delay bedtime by 1 hour; shorten
afternoon sleep period
● Do not respond immediately to
infants at night so that they will have
_ to fall back to sleep on their own
● Provide soft toy or music so that
they could play quietly alone
.
 Eruption Pattern of Deciduous Teeth

○ Lower Central incisor : first teeth to

erupt

F. Baby-Bottle Syndrome .
● A condition wherein decay of all the
upper teeth and the lower posterior
teeth occurs when a bottle is
propped continuously causing the
liquid to continuously soak the teeth
● Advise parents never to put the baby
to bed with a bottle
● If parents insist, fill it with water and
use a small nipple to minimize the
amount of fluid the baby will receive

Overview of MMDST

● Metro Manila Developmental Screening Test

is a simple, clinically useful tool used in the
early detection of children with serious
developmental delays
● Developed by Dr. Phoebe D. Williams
● Modification and standardization of the
original Denver Developmental Screening
Test by Dr William K. Frankenburg
● Designed to detect developmental delays in
children 2 weeks - 6 ½ years
● Evaluates 4 aspects of the child’s
development: personal social, fine
motor-adaptive, language, and gross
motor behavior
● Not an intelligence test, it is a screening
instrument to determine if the child’s
development is within normal
 ○Forward curve of the
TODDLERHOOD
spine at the sacral area
(lordosis)
Developmental Milestone of a Toddler ○ Waddle or walk with a
wide stance
3. Body Systems .
● Age: 1-3 years old ○ Continue to mature
● Psychosocial stage: Autonomy vs ○ Respiratory: Slow tightly
Shame and Doubt continue to be abdominal
● Psychosexual Stage: Anal ○ Heart rate: slows from
● Cognitive stage: Tertiary Circular 110-90 bpm; blood
Reaction/ Preoperational Period/ pressure increases to
Pre-conventional Stage 99/64 mm.hg
○ Brain: develops to about
Physical / Biological Development 90% of its adult size
○ Respiratory system: the
lumens of vessels enlarge
1. Weight, height and head progressively threat of
circumference lower respiratory infection
○ Gains only about 5-6 lb. (2.5 kg) become less
and 5 in. (12 cm) a year ○ Stomach: secretions
○ Changes from a plump baby into become more acid;
a leaner, more muscular body gastrointestinal infection
○ Appetite decreases, adequate less common
intake of all nutrients is essential ○ Stomach capacity
○ Head circumference increases increases, can eat 3
about 2 cm during the second meals a day
year ○ Control of urinary and
○ By 2 years, chest circumference anal sphincters due to
is now bigger than the head the complete myelination
circumference of spinal cord
○ IgG and IgM antibody
production becomes
mature, passive immunity
from intrauterine life is no
longer operative

4. Teeth .
● 8 new teeth (canines and first
molars) erupt during 2nd year
● 20 deciduous teeth are present
by 2.5-3 years old

2. Body Contour _
● Pouchy belly
○ abdominal muscles not
yet strong enough to hold
abdominal contents
Language Development

● Critical time for language development,

rate varies
○ Need enough practice time
○ Frequently use the word “NO”-
manifestation of autonomy

Moral Development

Toddlerhood (2-3 years old)

● Although at this age your toddler may not

yet be able to differentiate between right
and wrong, he will have learnt the
concept of 'others* And will begin to take
people into account before taking any
action, While he can't tell why he can't
take his sibling's toys away or why he
can't hit others, he will learn not to do so
because he understands that he will be
punished or reprimanded in some form.
At this age, your toddler will play by your
rules in order to avoid reinforcement
Anal Stage
● Stage of potty training child’s pleasure is
from the anus and elimination
➢ Fixation (a) Anal expulsive
○ Symptoms: giving to
charity, potters,
gardeners, (sublimating
the wish to smear),
disorganized
➢ Fixation (b) Anal retentive
○ Symptoms: miserity,
thrifty, orderly, obstinate,
tidy, stubborn, obsessive
Cognitive Development
● “Little scientist”- the interest in trying to
discover new ways to handle objects or
new results that different actions can
achieve
● Deal more constructively with symbols
● Begin to use of assimilation- to change
the situation to fit their thoughts
Social Development
● Resistant to sitting in laps and being
cuddles
● 15 month olds are enthusiastic about
interacting with people
● Imitates things they see a parent do
● By 2 or more years- aware of gender
differences

Psychosocial Development

● Recognize that they are separate

individuals
● Realize that they do not always have to
do what others want them to do
● Negativistic, obstinate and difficult to
manage
 ● Toddler are interested in toilet
Behavioral Characteristic
training as an expression of
autonomy
1. Head strong and negativistic : ● Psychological readiness
autonomous a. Aware of the act of
2. active , mobile and curious : set limits, elimination
exert external control when necessary b. Able to inform the need to
● Love and consistency must be defecate or urinate
considered at all times c. Desire to please the
3. Decrease in appetite because of slower parent
growth rate d. Able to remove clothing
● Dawdling with meals ● Process of training .
● Fetish with foods a. Bowel control develops
● Appetite of 3 year old more first before bladder control
capricious than a 1 year old b. Choose specific word for
4. Repetitive, rigid, ritualistic, stereotyped in the act
their behavior c. Have a specific time and
5. Go into temper tantrums in order to place
control self and others d. Do not punish for
● Ignore the behavior accidents
● Direct them to activities that they e. May use potty chair
can master 1. Bring the child to
6. Need for independence without the potty chair not
overprotection : be consistent, set the other way
realistic limits around
● Reinforce desired behavior 2. Do not allow the
● Be constructive, geared to teach child to stay at the
self control potty chair for
● Punish immediately and more than 10 mins
appropriately for wrong doing 3. Do not wake the
7. Poor sense of time, time schedules child at night to
revolve around activities, not around the void
clock f. Praise child
8. Adults should talk to toddlers at eye level g. Remind to wash hands
9. All deciduous teeth are out at 2 ½ to 3 h. Do not wake the child
years. Start tooth brushing during the night and carry
10. Anterior fontanel closes at 12-18 months the child to the bathroom
to void
● Age of achievement .
Parenteral Concerns
a. Bowel control : 18 months
b. Daytime bladder control :
1. Toilet training . 2 ½ years
● Physical maturation must be c. Nighttime bladder training
reached before training is : 3 years
possible 2.Temper Tantrums .
a. Sphincter control ● May kick, scream, stamp feet,
adequate when the child shout, lie on the floor or bang
can walk their heads
b. Able to sit, squat and walk ● Natural consequence of toddler’s
c. Able to retain urine for at development
least 2 hours
 ● Independent enough to know
what they want but do not have
the vocabulary or wisdom to
express feelings in a more
socially acceptable way
● Occurs more often when they are
tired, unrealistic by parents,
parents saying NO to request
3. Negativism
● Do not want to do anything a
parent wants them to do
● Reply to every request is a
definite “NO”
● NORMAL phenomenon,
positive stage in development
● Indicates they are learning that
they are a separate individual
with separate needs
4. Ritualistic Behavior
● Way of relieving anxiety
● They will use only “their” spoon at
mealtime, their washcloth at bath
time, will only go outside when
they have their favorite cap
5. Dawdling
● Move at their own slow-motion
pace
● Used to help develop
independence and security
● Do whatever catches their
attention at that particular
moment
● Time is an abstract concept
6. Discipline
● Means setting rules or road signs
so they will know what is
expected to them
● Punishment is a consequence
that results from a breakdown in
discipline
● 2 general rules to follow:
1. Parents need to be
consistent
2. Rules are learned best if
correct behavior is praised
rather than punishing
wrong behavior
Promotion of Health
1. Health Examination /
● Tend to develop upper respiratory
and ear infections
● Brought to the health facilitates
only for health maintenance visit
and immunization
_ ● Early detection of any growth and
development delays
● Parents should be encouraged to
promote the healthy development
of independence in their toddler
a 2. Nutrition /
● Physiologic Anorexia is normal
1. Use small plates, spoon
or fork, let child feed
himself
/ 2. Be calm and relax in
feeding
3. Offer choices when
possible, offer variety of
nutritious foods
4. Small, frequent feeding,
/ provide finger foods
13-18 months
1. Discontinuation of bottle feeding
2. Offering of textured solids in small
portions & frequent feeding
3. Continued use of spoon and self-feeding
/ 4. Avoid force feeding
5. Give healthy snacks
19-24 months
1. Use of drinking water for thirst
/ 2. Limit fluids before meals
3. Include iron and protein rich foods
4. Regular meal time
25-36 months
1. Healthy food choices including
vegetables
2. Healthy snacks in between meals
3. Safety- accounts for over half of all
accidental deaths during childhood

Supervise child
1. Dangers of throwing and hitting
2. Safe way to interact with pets
3. Street dangers
4. Dangers of weapons and fire
5. How to get help when feeling
scared or in danger
6. Stranger danger
● Preventing access to
electrical outlets, cords,
appliances and tools
● Secure gates and doors
● Store all chemicals,
cleaners, personal care
products, matches and
lighters out of reach
● Use of car seats
● Ensure multiple barriers to
pools and hot tubs
● Select toys according to
manufacturer’s
recommendations
● Use of appropriate helmet
for bike riding
7. Dental health
● Reduce high carbohydrate
snacks - promotes tooth
decay
● High Calcium for strong
teeth
● Tooth brushing under
supervision
● First visit to the dentist by
age 2
6. Daily Activities
A. Dressing / ●
● Can put on their socks ,
underpants, and undershirt
● Put shoes on the wrong feet, shirt
and pants on backwards
● If able to walk. Need shoe soles
that are form enough to provide
protection from rough surfaces
B. Rest and Sleep / ● Prolonged crying, consoled by no
● Sleep gradually decreases as
they grow older
● Starts with nap 2x a day, sleep 12
hours at night
● End it with one nap a day, 8
hours sleep at night
● If unable to sleep at night, omit or
shorten the afternoon nap
C. Elimination /
● Some toddlers smear or play with
feces
● Provide with play substances of
similar texture
● Change diapers immediately after
defecation
D. Bathing /
● Depend on parents’ or child’s
wish or schedule
● Provide toy= rubber duck, boat or
plastic fish
● Should not be left alone in a
bathtub without supervision
E. Play /
● Parallel play : play alongside
other children but not with them
● Free, spontaneous, no rules or
regulations
● Attention span very short, like to
change toys frequently
● Safety in selecting the type of
toys
● Suggested toys: play furniture,
dishes, cooking utensils,
telephone, clay, sandbox toys,
crayons,pounding toys,
blocks,push and pull toys
7. Hospitalization
● Experience fear of loss of love,
fear of the unknown or fear of
punishment
Immobilization and isolation
represent additional crises
● May result to regression in some
cases
Stages of Separation Anxiety
1. Protest /
one but the parent or usual
caregiver
● Continually asks to go home
● Rejection of the nurse or any
stanger
2. Despair /
● Alteration in sleep pattern
● Decreases appetite and weight
loss
● Diminished interest in
environment and play
● Relative immobility and
listlessness
● No facial expression
● Unresponsive to stimuli
3. Detachment or Denial /
● Child becomes interested in
environment, may ignore parents’
return
 PRESCHOOLER
5. Love to tell lies and brag or boast
in order to impress others
6. Love to use offensive language
3 - 6 Years of age
7. Sibling rivalry at this stage is
common
Psychosocial Theory / 8. Oedipal and Electra complex
● Initiative vs. Guilt can be observed
Psychosexual Theory / 9. Questions about sex should be
● Phallic stage answered
Cognitive Theory / 10. Masturbation may be seen in
● Preoperational some : do not make fuss about it
● Thought Period or punish the child, give toys to
Moral Theory / play or divert the attention
● Pre-Conventional (Stage II) 11. May exhibit genu valgum or
Fear / knock-knee disappears with
● Castration, Body mutilation, Fear of the increased skeletal growth at the
dark end of the preschool period
Play / 12. Length at birth is doubled at 4
● Associative or Cooperative years
● Preschoolers are interested in sharing
activities with others
DEVELOPMENT MILESTONES OF
● Preschoolers like to imitate the roles of
PRESCHOOL
adults

Physical/Biological Development

A. Physical Growth /
● Body contour
○ Ectomorphic : slim body
built
○ Endomorphic :large body
built
● Handedness begins

B. Weight, Height and Head

Circumference /
● Gains about : 4.5 lb. (2 kg) a year
● Height gain : 2-3.5 inches (6-8
cm) a year Psychosocial Development
● Head circumference not routinely
measured on children over 2
C. Teeth / ● Phallic stage : child learns sexual
● All 20 deciduous teeth present by identity thorugh awareness of genital
3 years area
D. Characteristics of a Preschooler / ● Developmental task : initiative vs. guilt
1. Love to watch adults and imitate ● Learns how to do things, doing things is
their behavior desirable
2. Very creative and curious ● Provide opportunities for exploring new
3. Favorite word is “why?” places or activities
4. Imaginary playmates are
common
 Cognitive Development
B. Imaginary Friends _
● Normal, as long as they do not
● Lack the insight to view themselves as take center stage in children’s
others see them minds, does not prevent them
● Feel that they are always right- arguing from socializing
most of the time ● Parents should help separate fact
● Unaware of the property of from imagination
conservation : ability comprehend that a
procedure done 2 separate ways is the C. Difficulty Sharing _
same procedure ● Start to understand that some
things are theirs and some
belong to others, some can
Social Development belong to both
● A difficult concept, needs practice
● Sensitive and critical time for to understand and learn it
socialization ● Accompany experiences with
● 4 years old : argues a lot- aware of role experiences in learning property
in the group rights
● 5 years old begin develop “best”
friendships D. Sibling Rivalry _
● Jealousy of a brother or a sister
Moral Development ● Have enough vocabulary to
● Determine right from wrong based on express how they feel, aware of
their parent’s rules family roles responsibility
● Little understanding of the rationale of ● Help the to feel secure and
the rules promote self esteem
Spiritual Development
2. Fears
● Begin to have an elemental concept of
God A. Fear of the dark /
● Enjoy religious holidays and religious ● Result of the heightened vivid
rituals such as prayer and grace before imagination
meals ● Monitor stimuli that the child had
been exposed to before bedtime
● Dim night, lamp can be left on
PARENTAL CONCERNS IN PRESCHOOL ● Explain that nightmares are
PERIOD dreams- assure that he is safe

B. Fear of Mutilation _
1. Behavior Variation ● Intense reaction to even a simple
injury such as falling and scraping
A. Telling Tall Tales _ a knee
● Stretching stories to make them ● Do not know which body parts
seem more interesting are essential and which ones can
● Not lying but merely supplying an easily be replaced
expected answer ● Boys: fear of castration are
● Do not encourage this kind of more attuned with their body
storytelling, help separate fact parts, starts to identify with the
from fiction same sex parent
● Afraid that if blood is taken out of
their body, they will all leak out
 ● Dislike invasive procedures
● Need good explanations on the
limits of health care procedures in
order to feel safe
C. Fear of Separation or Abandonment__
● Believe that they are being
deserted
● Sense of time is still distorted,
sense of distance is limited
● Relate time and space to
something a child knows
3. Nursery School or Day care experience
● Take time to prepare physically and
mentally
● Discuss school as rewarding, satisfying
experience
4. Regression
● Reverting to behaviors previously
outgrown, such as thumb sucking,
negativism, loss of bladder control,
inability to separate from parents
● A result of stress such as a new baby in
the family, a new school, seeing
frightening, and graphic television news,
hospitalization, etc.
5. Discipline
● Have definite opinions on things which
may bring them into opposition
● Guide without discouraging the child’s
right to have an opinion
● “Timeout” - good technique to correct
the behavior
● Allow the parents to discipline without
using physical punishment and allows a
child to learn a new way behavior without
extreme stress
6. Speech Problem - broken Fluency
● Repetition, prolongation of sounds,
syllables, words
● Secondary stuttering- child begin to
speak without problem, during preschool
years, develops it
● Simple rule to follow to resolve the
problem:
1. Do not discuss in child’s
presence the difficulty, do not
2. label as a “Stutterer”- becomes
conscious of speech patterns and
compounds the problem
3. Listen with patience. Do not
interrupt or fill in a word. Do not
tell to speak more slowly or to
start over- make a child
conscious of her speech-broken
fluency increases
4. Talk to the child in a calm, simple
way. If adults talk slowly to her,
she sees no need to rush and so
speaks more clearly
5. Provide space for her to talk if
there are other children in the
family. Rushing to say something
before a second child interrupts is
the same as rushing to conform
to adult speech
6. Do not force a child to speak if
she does not want to. Do not ask
her to recite or sing for strangers
7. Do not reward her for fluent
speech or punish her for non
fluent speech
- Note: Broken fluency is a
developmental stage in
language formation, not
an indication of regression
or a chronic speech
PROMOTION OF HEALTH DURING
PRESCHOOL
1. Nutrition /
● Not a time for fast growth
● Offer small servings of food
● Make mealtime a happy and
enjoyable part of the day
● Offer variety of foods based on
the food pyramid
2. Preschool Safety /
● Pseudo- independence attitude to
have ability to take care of their
own needs
● Must be repeatedly reminded
about automobile safety
● They imitate adults, never take
medicines in front of children
3. Dental Health /
● Start independent tooth brushing
as a daily practice
● Drink fluoridated water or receive
a prescribed fluoride supplement
● Serve fruits rather than candies
during snack
● First visit to a dentist by 2.5 years
of age

4. Daily Activities /

A. Dressing /
● Can dress themselves
except for difficult buttons
● Prefer bright colors or
prints
● May select items that do
not match
B. Rest and Activity /
● Aware of their needs
when they are tired
● Often curl up in a couch
and fall asleep
● May refuse to go to sleep
because of fear of the
dark
● Promote active games-
help children develop
motor skills to prevent
childhood obesity
● Associative or
Cooperative Play- a
loosely organized group
play where membership
and rules changes readily
● Child deals with reality,
control feelings,
expresses emotions more
though action than words
● Play is physically oriented
but it also imitative and
imaginary
5. Bathing /
● Can wash, dry their hands, if
faucet is regulated
● Should not be left alone
unsupervised during bath
● Begin to be interested in taking
showers rather than baths
 SCHOOL AGE FINE MOTOR DEVELOPMENT

6: can tie shoes, cut and paste well, draw a

6 - 12 years of age
person with good details

● Psychosexual Stage: Latency Stage 7 :concentrate on fine motor skills

● Psychosocial Stage: Industry vs.
inferiority ● Eraser year: never content with
● Cognitive Stage: Concrete Operational what they have done
Thought ● Can read regular size, types well
● Fear:
○ Fear of replacement/ displacement PSYCHOSEXUAL STAGE
in school
○ Loss of privacy
○ Fear of death ● Latency Stage
● Play: Competitive Play ○ libido appears to be diverted into
concrete thinking.
PHYSICAL G&D
PSYCHOSOCIAL DEVELOPMENT
● Annual average weight gain: 3 to 5 ln. (1.3
to 2.2 kg) ● Industry vs. Inferiority
● Increase in height: 1 to 2 inches (2.5 to 5 ○ Industry is learning how to do things
cm) well
● Posture is more erect ○ Inferiority is the feeling that they
● By 10 years of age, brain growth is cannot do things they can actually
complete do.
● IgG and IgA reach adult levels
● Sexual maturation:
● Girls : 12 and 18 years
● Boys : 14 and 20 years
● Girls are taller by 2 inches (5cm) more
than boys
● Gains 28 permanent teeth between 6 and
12 years of age
● Central and lateral incisors; first, second,
and third cuspids; and first and second
molars. A. Socialization /

6: play in groups, when tired, prefers 1 on 1

GROSS MOTOR DEVELOPMENT
contact

6 : endlessly jump, tumble, skip and hop 7: aware of family roles and responsibilities,
promises must be kept
7:quieter, gender differences are manifested
in play 8: actively seeks thee company of other
children
8: more graceful, ride bicycle well, enjoy
sports 9: take values of peer groups, ready for
activities away from home
9: always on the go, have enough eye-hand
coordination 10: enjoys privacy
 11: increasingly interested in the opposite
sex PROMOTION OF HEALTH

12: feels more comfortable in social

situations 1. Safety /
● Ready for time on their own
B. Play / without direct adult supervision
● Competitive Play – games with ● Stay by themselves after school
rules die to increased mental ● Kow how to use seatbelts in car
abilities and bicycle safety around cars
● Like athletic competition to ● Secual abuse is also a common
increased motor ability hazard for children
● Boys and girls play together, 2. Nutrition /
gradually separate into sex-oriented ● With good appetite, meal is
type of activities. influenced by the day’s activity
● Food is also influenced by peers
and mass media
LANGUAGE DEVELOPMENT ● Very fond of junk foods, fast food
– results to obesity
6: talk in full sentences, uses language 3. Daily Activities /
A. Dress /
easily with meaning ● Can fully dress
7: can tell time in hours, months themselves
● Have definite opinions
9: like to tell dirty jokes, uses swear about clothing styles often
words to express anger based on likes of friends
or popular sports or rock
12: with a sense of humor, can carry on star
adult conversation B. Exercise /
● Need daily exercises like
games, walking with
EMOTIONAL DEVELOPMENT parents, or bicycle riding
C. Hygiene /
● 6-7 – needs help in
● Has the ability to trust others regulating bath water
● With a sense of respect for their own worth temperature and in
● Can accomplish small tasks independently cleaning ears and nails
○ sense of autonomy ● 8 – capable of bathing,
becomes interested in
MORAL & SPIRITUAL DEVELOPMENT showering
D. Care of the Teeth /
● Should visit a dentist at
Preconventional Stage: / least twice year
● Concentrate on “niceness” and “fairness”
● Cannot see the highest level of moral PARENTAL CONCERNS
reasoning yet
● Begins to learn about rituals and
1. School Experience /
meaning behind religious practices
● Adjusting to grade school is a big
● Distinction between right and wrong
task
becomes important
● Health assessment should
include an inquiry about progress
in school
● Biggest task is learning to read
2. Latchkey Children / malocclusion and the jaw
● A latchkey kid/child, is a child size
who returns to an empty home 7. Sex Education /
after school, or often left alone at ● Educate about pubertal changes
home with no supervision, and responsible sexual practices
because their parent is/aree away ● Sex education should be
at work. incorportated into health
● Will develop an increased educatuon
tendency to accidents, delinquent 8. School Health /
behavior, alcohol or beginning A. Anxiety related to Beginning
drug abuse, or decreased school School: /
performance from lack of adult ● Adjusting to grade school
supervision. is a big task
3. Discipline / ● Spend time with child after
● Punishments are avoided, school or in the evening,
withdrawal of privileges is used to feel secure in the family
● Parents should be consistent in and does not feel pushed
implementing discipline out by being sent out to
● Time-out is a technique of school
helping children learn that actions B. School Phobia: /
have consequences ● Fear of attending school
4. Dishonesty Behavior/Stealing / ● May develop physical
● Occurs when child is gaining an illness such as vomiting,
appreciation for money, but not diarrhea, headache, or
yet balanced by strong moral abdominal pain on school
principles days
● Importance of property rights ➢ Management: /
should also be reviewed ● Coordination among the
5. Acquisition of Skills / school, school nurse and
● Biggest tasks is learning to read health care provider who
● Prepare the school age child for can diagnose the
this by reading to them since problems
infancy 9. Injury Prevention /
6. Dental Health / ● Parents should be able to talk to
A. Dental Caries / their children about a disaster
● Progressive, destructive plan for the family for the major
lesions or decalcification effect of increasing a feeling of
of the tooth enamel and safety
dentin 10. Bullying /
● Preventable with proper ● Frequent reason for feeling so
brushing, use of unhappy
fluoridated water or ● Traits commonly associated with
fluoride application school age bullies:
B. Malocclusion / a. Advanced physical size
● Deviation from the normal and strength for their age
alignment of teeth, b. Aggressive temperament
congenital or related to c. Parents who are
conditions such as cleft indifferent, permissive
palate, a small lower jaw, with an aggressive child,
or other familial traits may resort to physical
● Time of correction varies punishment
with the extent of d. Presence of a child who is
a natural victim
 ADULTHOOD MORAL CHANGES

EARLY ADULTHOOD ● capable of moral thinking

(18 TO 35 YEARS OLD) ● Men use an "ethic of justice" define
moral problems in terms of rights and
rules
PSYCHOSOCIAL DEVELOPMENT ● Women define moral problems in terms
of social obligation to care and to avoid
hurt
Intimacy vs Isolation /
● Intimacy : ability to relate well with other SEXUAL CHANGES
people, the opposite sex and with one's
own sex to form, long-lasting friendships. ● have the emotional maturity to develop
● separate from family of origin sexual relationship
● adapt to new situations and environment ● at risk for sexually transmitted diseases
● give more attention to occupational and
social pursuits
● make decisions regarding career, MIDDLE ADULTHOOD
marriage and parenthood
PHYSICAL CHANGES
COGNITIVE DEVELOPMENT
● occur between 40 and 65 years of age
Formal Operational Thought Stage / ● aware that changes in reproductive and
● characterized by thinking throughout the physical abilities signify beginning of
stage another stage in life
● most capable of forming new concepts,
to solve A. Appearance .
● Hair begins to thin, gray hair
starts to appear
PHYSICAL CHANGES ● Wrinkles occur due to poor skin
turgor, decreaser moisture and
● Completed physical growth by age 20 loss of subcutaneous fats
● musculo-skeletal system well developed ● Fat deposits in the abdominal
and coordinated area develop
● different systems of the body are B. Musculoskeletal System .
functioning at their peak ● decreased bulk of skeletal
● reproductive years for the majority of muscles at age 60
persons ● decrease in height, 1 inch due to
● Severe illnesses are less common active thinning of the vertebral disks
and tends to ignore physical symptoms ● Calcium loss from bones,
of illnesses, postpone seeking health common postmenopausal women
care C. Cardiovascular System .
● Lifestyle habits such as smoking, stress, ● Blood vessels lose
lack of exercise, poor personal hygiene elasticity,become thicker
and family history of disease increase D. Sensory Perception .
the risk for future illnesses ● decreased visual acuity for near
vision :Presbyopia
● decreased auditory acuity for
high-frequency sound particularly
in men :Presbycusis
● diminished taste sensations
E. Metabolism .
● Weight gain is due to slowed
metabolism
F. Gastrointestinal System .
● Constipation due to decreased
tone of large intestine