Definition of Terms
woman’s preferences for her care during
Like all areas of medicine, pregnancy and
childbirth has a number of specialised terms,
many of which you will hear during your own
pregnancy and labour and the birth of your
baby. The following list provides definitions for
some of the more common terms.
abortion – termination (end) of a pregnancy.
This can be achieved either through a surgical
procedure or by taking a combination of
prescribed medications (medical abortion)
amniotic fluid – the liquid that surrounds a baby
in the uterus (also called ‘waters’)
amniotic sac – the sac around the baby inside
the uterus
anaesthetic – a drug that gives total or partial
loss of sensation of a part or the whole of the
body
anaesthetist – a doctor who specialises in
giving anaesthetic
antenatal – a term that means ‘before birth’
(alternative terms are ‘prenatal’ and
‘antepartum’)
antepartum haemorrhage – bleeding from the
vagina during pregnancy
Apgar score – a test given one minute after a
baby is born, then again five minutes later, that
assesses a baby’s appearance (skin
colour), pulse, grimace (reflex), activity (muscle
tone) and respiration. A perfect Apgar score is
10; typical Apgar scores are seven, eight or
nine. A score lower than seven means that the
baby might need help breathing
assisted reproductive technology – any
procedure performed to help achieve a
pregnancy
baby blues – mild depression that follows
childbirth; usually the result of hormonal
swings
birth canal – the passageway (made up of the
cervix and vagina) that the baby travels
through during birth
birth plan – a written document describing a
labour and birth
blood transfusion – a procedure where a
woman is given blood
Braxton Hicks contractions – a tightening of the
uterus (womb) that may feel like a labour
contraction. Braxton Hicks contractions are not
painful and do not get stronger and closer
together like true contractions (also called
‘false labour’)
breaking of water – when a healthcare
practitioner bursts the sac holding the amniotic
fluid using an instrument with a pointy tip.
Often used to speed up a labour that has
slowed
breech – when the baby is positioned inside
the uterus with its bottom or feet down, instead
of its head
caesarean section – a surgical procedure in
which a baby is delivered through a cut in the
abdomen and uterus (also called a ‘C-section’)
cervix – the narrow, lower end of the uterus
that softens and opens during labour to allow
the baby to come out
conception – the process of becoming
pregnant,when a sperm and egg join to form a
single cell (alternative terms include
‘fertilisation’, ‘impregnation’ and ‘insemination’)
contraction – the often strong and painful
tightening of the uterus during labour that
causes the woman’s cervix to dilate and that
helps push the baby through the birth canal
crowning – time during labour when the baby’s
head has reached the external vaginal opening
and can be seen from the outside
dilation – the opening of the cervix, measured
as the diameter of the cervix in centimeters
ectopic pregnancy – when a fertilised egg
implants and grows outside of the uterus,
usually in the fallopian tube. In most cases, an
ectopic pregnancy is not viable.
embryo – the name given to a fertilised egg
from the time of conception until the eighth
week
epidural – a type of anaesthetic commonly
used in labour where drugs are used to numb
the lower half of the body
fallopian tubes – the narrow ducts or tubes in a
woman’s abdomen that carry the egg from the
ovaries to the uterus. This is where fertilisation
most often occurs
false labour – see ‘Braxton Hicks contractions’
fertility – being able to conceive and carry a
baby though to the end of the pregnancy
fertility treatment – medical treatment that
helps a woman conceive
first-degree tear – a tear involving only the
perineal skin (adjacent to the vaginal opening)
that occurs at the time of delivery that doesn’t
always require stitches
first trimester – the first 14 weeks of pregnancy
folic acid – a B vitamin found naturally in green
leafy vegetables that helps prevent anaemia
and has been shown to reduce the incidence
of some birth defects including spina bifida
(see definition below)
fontanelles – the six soft spots on a baby’s
head that allow its skull to compress during
birth so it can pass through the birth canal. The
fontanels completely fuse by the time the child
is two years old
forceps – tong-shaped instruments placed
around the baby’s head to help it travel through
the birth canal during childbirth
full term – when a pregnancy is a normal
duration (37–42 weeks gestation)
gestation – the length of time (in days or weeks)
that a baby is in the uterus
gestational diabetes – a condition that
develops during pregnancy when the woman’s
blood sugar levels become too high because
inadequate levels of insulin. The condition is
treatable and usually disappears after
pregnancy
gynaecologist – a doctor who has undertaken
specialist training in women’s health
haemorrhage – excessive bleeding
home birth – labour and delivery that takes
place at home, under the supervision of a
midwife
immunisation – the administration of a vaccine,
often by injection, that makes the body
resistant to certain bacteria or viruses
in utero – a term that means ‘inside the uterus’
in vitro fertilisation (IVF) – the process used to
conceive a child outside the body, where a
woman's eggs are fertilised with a man’s
sperm then placed in the woman's uterus
incontinence – an inability to control your
bladder or bowel movements
induced – when a healthcare professional tries
to artificially ‘start’ a woman’s labour
jaundice – a condition where a person’s skin
and the whites of their eyes take on a yellowish
tinge. It is caused by an excess of a chemical
called bilirubin in the blood and in newborns
often resolves itself
labia – the flaps of skin around a woman’s
vagina
labour – the process a woman’s body goes
through when her baby is born
lactation consultant – a healthcare professional
who is trained to provide information and
support about breastfeeding
low birthweight – when a baby weighs less
than 2,500 grams at birth
maternal and child health nurse – a trained
nurse who specialises in the health and
development of children from birth to school
age
meconium – a tar-like substance passed by a
baby as their first poo. Passing meconium
before birth may be a sign of fetal distress
midwife – a person who has been specially
trained to care for women during pregnancy,
labour, birth and the post-birth period
model of care – the way maternity care is
organised
morning sickness – nausea, vomiting and
aversions to certain foods and smells that
affect most pregnant women to some degree.
Morning sickness can occur at any time of day,
usually begins at four to eight weeks gestation
and generally subsides by week 16 of the
pregnancy
multiple pregnancy – when a woman is
carrying more than one baby
natural birth – birth without any interventions
for example a vaginal delivery rather than a
caesarean section
neonatal period – the time from a baby’s birth
to four weeks of age
Neonatal Intensive Care Unit (NICU) – a unit in
the hospital for babies who need a high level of
special medical care
neonate – a newborn baby, up to four weeks of
age
newborn – a baby between birth and four
weeks old
nursery – a room in a hospital where babies
can stay during the day or overnight
obstetrician – a doctor who has undertaken
specialist training in pregnancy and childbirth
ovaries – the female reproductive organs that
release eggs into the fallopian tubes, where
they may be fertilised if sperm are present
ovulation – the monthly release of a mature
egg from an ovary. A woman is most fertile
around the time of ovulation
ovum –a human egg
paediatrician – a doctor who has undertaken
specialist training in treating children
pelvic floor exercises – exercises a woman can
do to strengthen the muscles in and around
her vagina
perineal haematoma – a collection of blood,
resembling a bruise, in the area between the
vagina and the anus
perineum – the area between the vagina and
anus
placenta – the organ that connects to the wall
of the uterus, that nourishes the baby through
the umbilical cord
postnatal – a term meaning ‘after birth’
(alternative terms are ‘post-birth’ and
‘postpartum’)
postnatal depression – a condition that affects
some mothers in the days, weeks or months
after giving birth
postpartum haemorrhage – when a woman
loses more than 500 ml of blood after birth
premature – when a baby is born before 37
weeks gestation
prenatal – a term meaning ‘before birth’
(alternative terms are ‘antenatal’ and
‘antepartum’)
second-degree tear – a tear of the perineum
involving both skin and muscles, but not the
anus. Second-degree tears often require
stitches
second-stage labour – the time from the
complete dilation of the cervix (10 cm) to the
birth
second trimester – the time from 14 weeks to
26 weeks of pregnancy
special care nursery (SCN) – a unit in a
hospital for babies who need special medical
care
spina bifida – a birth defect that occurs during
the first month of pregnancy when a baby’s
backbone does not fully close, leaving part of
the spinal cord exposed. Spina bifida cannot
be cured, but a range of treatments and
management options is available
spontaneous labour – when labour starts by
itself (without medical help)
stillbirth – the death of a baby after 20 weeks’
gestation but before birth
stretch marks – discoloured stripey patterns
that can appear on the abdomen, breasts,
buttocks or legs during pregnancy because of
skin stretching. They usually fade slowly after
delivery
TENS machine – a ‘trans-electrical nerve
stimulation’ machine used for pain
management during labour
termination of pregnancy – see ‘abortion’
above
theatre – an operating room in a hospital or
other health facility
third- or fourth-degree tear – a severe tear of
the perineum involving the skin, muscles and
anus. Stitches are used to repair these tears
third-stage labour – the time from the birth of
the baby to the birth of the placenta
third trimester – the time from 26 weeks of
pregnancy onwards
trimester – a time span of three months during
pregnancy, each marked by different phases of
fetal development
ultrasound – a scan of a woman’s uterus
(womb) and baby during pregnancy umbilical
cord – the cord that connects the baby to the
placenta, allowing nutrients (vitamins and
minerals) and oxygen to be carried from the
woman to her baby
uterus – a woman’s womb
vacuum cap or ventouse – a suction cap that is
sometimes used during birth to help to pull the
baby out of the birth canal
VBAC (vaginal birth after caesarean) – when a
woman has a vaginal birth after having had
one or more previous caesarean sections
viable pregnancy – a pregnancy that is likely to
continue to full term
walking epidural – an epidural that may still
enable the woman to walk
water birth – where a baby is born fully
submerged in water
waters – the amniotic fluid that surrounds an
unborn baby inside the uterus (see ‘amniotic
fluid’)
NEWBORN SCREENING (NBS)
 Is a simple procedure to find out if the
newborn has a congenital metabolic disorder
that may lead to mental retardation and even
death if left untreated
 Usually, the signs and symptoms of these
metabolic disorders are manifested when the
ill effects are already irreversible.
R.A. 9288 – An act Promulgating a Comprehensive
Policy and a National System for Ensuring Newborn
Screening
Schedule and Method of Screening:
 Ideally done on the 48th hour or at least 24
hours from birth.
 Some disorders are not detected if the test is
done earlier than 24 hours.
 The baby must be screened again after 2
weeks for more accurate results.
 It uses the heel prick method where drops of
blood are taken from the baby’s heel and
blotted on a special absorbent filter card.
 The blood is dried for 4 hours and sent to the
Newborn Screening Laboratory
 Results are available within seven working
days to three weeks after the NBS lab receives
and test the samples sent by the institution.
Results:
 A negative screen means that the result of the
test is normal and the baby is not suffering
from any of the disorders being screened.
 If a positive screen, the NBS nurse coordinator
will immediately inform the coordinator of the
institution where the sample was collected to
recall patients for confirmatory testing.
Newborn Screening Package:
1) Congenital Hypothyroidism (CH)
 CH results from lack or absence of thyroid
hormone, which is essential to growth of
the brain and the body.
 If the disorder is not detected and
hormone replacement is not initiated
within 4 weeks, the baby’s physical growth
will be stunted and he/she may suffer
from mental retardation.
 Long term effects: severe mental
retardation
2) Congenital Adrenal Hyperplasia (CAH)
 CAH is an endocrine disorder that causes
severe salt loss, dehydration and
abnormally high levels of male sex
hormones in both boys and girls.
 If not detected and treated early, babies
may die within 7-14 days.
 Long term effects: Death
3) Galactosemia (GAL)
 Is a condition in which the body is unable
to process galactose, the sugar present in
milk
 Accumulation of excessive galactose in the
body can cause many problems, including
liver damage, brain damage, and
cataracts.
 Long term effects: death or cataracts
4) Phenylketonuria (PKU)
 Is a metabolic disorder in which the body
cannot properly use one of the building
blocks of protein called phenylalanine
 Excessive accumulation of phenylalanine
in the body causes brain damage.
 Long term effects: severe mental
retardation
5) Glucose-6-Phosphate Dehydrogenase
Deficiency (G6PD Def)
 Is a condition where the body lacks the
enzyme called G6PD
 Babies with this deficiency may have
hemolytic anemia resulting from exposure
to certain drugs, foods and chemicals.
 Babies with positive NBS results should be
referred at once to the nearest hospital or
specialist for confirmatory testing and
further management
 Long term effects: severe anemia,
kernicterus
6) Maple syrup urine disease
- A genetic defect in which a person is
unable to break down the amino acid
leucine, isoleucine, and valine
- Urine of affected persons smells like maple
syrup
- Long term effects: death
Postpartum Changes
As the postpartum period sets in, the greatest
change that the woman would notice in her is the
change in her role; she is now a certified mother!
With this modification, other changes will start to
set in slowly and gradually, and the woman must
be armed with information so she would be able to
deal with these life changes.
1. Psychological Changes
The changes that the woman undergoes are crucial
within the first 24 hours of postpartum, especially
the psychological changes. These changes might
affect the woman permanently if not given the
appropriate attention and care.
1.1 Taking-In Phase
 The taking-in phase usually sets 1 to 2 days
after delivery.
 This is the time of reflection for the woman
because within the 2 to 3 day period, the
woman is passive.
 The woman becomes dependent on her
healthcare provider or support person with
some of the daily tasks and decision-making.
 This dependence is mainly due to her physical
discomfort from hemorrhoids or the after
pains, from the uncertainty of how she could
care for the newborn, and also from the
extreme tiredness she feels that follows
childbirth.
 The woman prefers to talk about her
experiences during labor and birth and also
her pregnancy.
 The taking-in phase provides time for the
woman to regain her physical strength and
organize her rambling thoughts about her new
role.
 Encouraging the woman to talk about her
experiences during labor and birth would
greatly help her adjust and let her incorporate
it into her new life.
1.2 Taking Hold Phase
 The taking hold phase starts 2 to 4 days after
delivery.
 The woman starts to initiate actions on her
own and making decisions without relying on
others.
 Women who underwent anesthesia reach this
phase only hours after her delivery.
 She starts to focus on the newborn instead of
herself and begins to actively participate in
newborn care.
 Demonstrate newborn care to the mother and
watch her do a return demonstration of every
procedure.
 The woman still needs positive reinforcements
despite the independence that she is already
showing because she might still feel insecure
about the care of her child.
 Allow the woman to settle in gradually into her
new role while still at the hospital or
healthcare facility because making decisions
about the child’s welfare is a difficult part of
motherhood.
1.3 Letting Go Phase
 During the letting go phase, the woman finally
accepts her new role and gives up her old roles
like being a childless woman or just a mother
of one child.
 This is the phase where postpartum
depression may set in.
 Readjustment of relationship is needed for an
easy transition to this phase.
2. Physiological Changes
Several body systems are also affected after the
birth of the newborn, and these changes may or
may not be noticed by the mother early during
postpartum.
2.1 Reproductive System
 Involution occurs during postpartum wherein
the reproductive organs return to their
nonpregnant state.
 The area where the placenta was implanted is
sealed off to avoid bleeding.
 The uterus returns to its prepregnant size.
 Involution occurs more quickly in women who
are well nourished and ambulate early after
birth.
 Contraction plays a very important role in the
postpartum period for it allows the uterus to
return to its former size quickly and also
prevents hemorrhage.
 The cervix is soft and malleable immediately
after birth, but once contraction of the cervix
takes place it also returns to its prepregnant
state.
 At the end of seven days, the external os has
narrowed to the size of a pencil opening but
appears slitlike or star shaped compared to its
round shape before childbirth occurred.
 The vagina returns to its prepregnant state
through contractions after the entire
postpartum period but remains slightly
distended than before.
 Kegel’s exercise helps return the strength and
muscle tone of the vagina.
 The labia minora and majora are still atrophic
and soft after birth and would never return to
its prepregnant state.
 The perineum is edematous and tender
immediately after birth.
TYPES OF LOCHIA
 Lochia rubra starts to appear as a bloody
discharge for the first 3 days after birth and is
when the bleeding is heaviest.
 Lochia serosa or the brownish to pinkish
discharge starts on the fourth day, and the
amount of blood and tissue decreases. It
contains seroes exudate, erythrocytes,
leukocytes, cervical mucus and
microorganisms.
 Lochia alba (purulenta) appears on the tenth
day and the discharge decreases and almost
looks colorless or whitish. It may last until the
third week after birth. Whitish or yellowish-
white lochia. It contains fewer red blood cells
and is mainly made up leukocytes, epithelial
cells, cholesterol, fat, mucus, and
microorganisms.
2.2 Hormonal System
 As soon as the placenta is no longer present,
pregnancy hormones start to decrease.
 hPL and hCG are insignificant by 24 hours.
 Progestin, estrone, and estradiol return to
their prepregnancy levels a week after birth.
 FSH remains low for 12 days and then starts to
increase to signal the start of a new menstrual
cycle.
2.3 Urinary System
 Immediately after birth, dieresis sets in to rid
the body the excess fluid that has accumulated
during pregnancy.
 On the second to fifth day after birth, the
urinary output of the woman increases to as
much as 3000 mL per day.
 The woman’s abdomen must be assessed
frequently during the postpartum period to
prevent damage to the bladder due to
overdistention.
 Urine may contain more nitrogen postpartum
because of the increased activity of the
woman during labor.
 Lactose levels may be slightly elevated to
prepare the body for breastfeeding.
2.4 Circulatory System
 Blood volume returns to its prepregnancy level
by the first or second week of birth.
 A 4-point decrease in hematocrit and a 1-g
decrease in hemoglobin occur with each 250
mL blood loss.
 Hematocrit levels reach its normal
prepregnancy level 6 weeks after birth.
 An increase in leukocytes and plasma
fibrinogen occurs in the first postpartum
weeks as a defense mechanism against
infection and hemorrhage.
2.5 Gastrointestinal System
 The woman will feel hungry and thirsty almost
immediately after giving birth,
 Digestion and absorption are active again after
birth except for women who underwent a
caesarean section.
 Passage of stool may still be slow because of
the relaxin that is still present in the bowels.
 Bowel evacuation may still be difficult because
of the pain of episiotomy.
Practice Quiz: Postpartum Changes
1. When does postpartum depression usually happens?
A. During the birth of the baby
B. One week after the delivery
C. Immediately after the delivery
D. During the letting go phase
2. What happens during the taking in phase?
A. The woman easily adjusts to her new role as a
mother.
B. The woman is passive and relies mostly on the
people around her.
C. The woman is very active in the care of her newborn.
D. The woman undergoes postpartum depression.
3. What is the most important player during involution?
A. Medications
B. Support persons
C. Contractions
D. Comfort measures
4. How could a woman regain the strength and tone of
her vagina post birth?
A. Through pelvic rocking exercises.
B. Do Kegel’s exercises.
C. Have a hot sitz bath.
D. Apply cold compress to the area.
5. What would you advise a woman who has a urinary
output of 3000 mL per day postpartum?
A. It is a normal occurrence after birth.
B. She should visit her physician and have it consulted.
C. It is a very dangerous complication postpartum.
D. She should restrict her fluids to decrease her output.
Answers and Rationale
1. Answer: D. During the letting go phase
Postpartum depression is common during the letting go
phase after birth.
2. Answer: B. The woman is passive and relies mostly on
the people around her.
During the taking in phase, the woman is dependent on
her healthcare providers or support persons with
simple tasks and making decisions.
3. Answer: C. Contractions
Contractions aid the return of the reproductive system
to its nonpregnant state and also prevent hemorrhage
postpartum.
4. Answer: B. Do Kegel’s exercises.
Kegel’s exercise strengthens the muscle tone of the
vagina.
5. Answer: A. It is a normal occurrence after birth.
The diuresis after birth gets rid of the excess fluid that
has accumulated in the woman’s body during
pregnancy.
These changes are what make a woman a full-fledged
mother. It only takes gradual adjustment and she would
easily slip into her new role as a mother without much
difficulty, especially if she has a strong support system
and reinforced with all the information she needs for
the postpartum period.
APGAR Normal Pediatric Developmental
Milestones

The development of a child mostly takes place in

the early years of his life. At this stage, parents are
still overwhelmed with how fast babies grow and
develop. Parents take much time and patience in
picking the best resource to understand a child’s
development. Therefore, lots of questions are
thrown in the air for the nurse to answer. Some
questions prove to be challenging, and it is
important for nurses to be able to know the
normal developmental milestones like the back of
their hands.

The first word, smile, and roll over are called

developmental milestones. The child can tick off a
milestone on his growing list of firsts depending on
how he play, speak, move, and learn. While it is
always emphasized that children develop at their
own pace, developmental milestones are there to
shed light on the general changes that should be
expected as the child ages.

1. General Principles of Developmental

Milestones

For excellent developmental assessment and

surveillance, nurses must know the general
principles of developmental milestones. The four
key domains that should be periodically assessed
include motor development, language
development, problem-solving, and psychosocial
skills.

Development occurs in an orderly, predictable, and

intrinsic manner. For example, development
proceeds from head to toe in a proximal to distal
fashion. Reactions to stimuli develop from general 6 months Sits alone
into more specific and goal-directed reactions. Leads with head when pulled
from supine position
Children gain independence from early years of
9 months Pulls to stand
total dependence. Cruises
12 months Walks
Lastly, both intrinsic and extrinsic factors can affect Fine Motor Milestones
development. Some examples of intrinsic factors Birth Keeps hands tightly fisted
are physical characteristics, health state, 3-4 months Brings hands together to
midline and then to mouth
temperament, and genetic attributes. On the other
4-5 months Reaches for objects
hand, extrinsic factors include personalities of 6-7 months Rakes objects with whole
family members, economic status, learning hand
experiences in the environment, and cultural Transfers object from hand
setting to which the child is born. to hand
9 months Uses immature pincer (ability
to hold small object between
2. Domain #1: Normal Motor Development thumb and index finger)
12 months Uses mature pincer (ability to
Motor milestones can both be assessed through hold small object between
history interview and observation. Evaluating gross thumb and the index finger)
motor development usually involves neuro
maturational markers like primitive reflexes and Red flags in motor development include: 1)
postural reactions. persistent fisting beyond 3 months which indicate
neuromotor problems; 2) early rolling over, early
For example, Moro reflex is one primitive reflex pulling to stand instead of sitting, and persistent
that is present at birth and disappears usually toe walking which may all indicate spasticity; and 3)
between 3-6 months of age. If the baby has early hand dominance (before 18 months of age),
stronger and more sustained primitive reflexes, a which may signify weakness of the opposite upper
CNS injury might be considered. On the other hand, extremity associated with hemiparesis.
parachute reaction is one postural reaction that is
acquired. This actually helps the body become
oriented in space through an interplay of visual, 3. Domain #2: Normal Language Development
proprioceptive, and vestibular adjustment done by Language is the single best indicator of intellectual
cerebral and cerebellar brain structures. Delayed potential. Language is the ability to communicate
development of postural reactions can signify CNS with symbols. It is often mistaken as synonymous
damage. with speech, the latter being defined as a vocal
expression of language. This is the domain with the
On the other hand, fine motor skills involve the use most number of delays.
of small muscles of the hands. The control
progresses from the use of proximal muscles to the It is also interesting to note that a child can usually
distal muscles. As the baby improves on balance understand 10 times (receptive language) as many
during sitting and moving, the hands become more words as he or she can speak (expressive language).
focused on manipulation of objects. The first two (2) years of life is the time for optimal
language acquisition.
Here is a table of motor development milestones:
Gross Motor Milestones Here is a table of basic language milestones:
Age Milestone
Birth Turns head side to side Age Milestone
2 months Lifts head when lying prone
Head lags when pulled from Birth Attunes to human voice
supine position Develops differential
4 months Rolls over recognition of parents’
No head lad when pulled voices
from supine position
2-3 months Cooing (runs of vowels),
Pushes chest up with arms musical sounds (e.g. ooh-
 ooh, aah-aah)
6 months Babbling (mixing vowels with
mixed consonants) [e.g. ba-
ba-ba]
9-12 months Jargoning (e.g. babbling with
mixed consonants, inflection,
and cadence)
Begins using mama, dada
(nonspecific)
12 months 1-3 words, mama and dada
(specific)
18 months 20-50 words
Beginning to use two-word
phrases
2 years Two-word telegraphic
sentences (e.g. mommy
come)
25-50% of child’s speech
should be intelligible
3 years Three-word sentences
More than 75% of the child’s
speech should be intelligible
4. Domain #3: Cognitive Development
This domain talks about thinking, memory, learning,
and problem-solving. By evaluating problem
solving and language milestones, infant
intelligence can be estimated. There is a poor
correlation between gross motor skills and
cognitive potential.
5. Domain #4: Social Development
It refers to the ability to interact with people and
the environment. It is dependent on cultural and
environmental factors.
Here is a table of social milestones:
Age Concept
12-36 months Attachment (bonding with a
primary caregiver begins at
birth and empathy
development is critical
during this period).
15 months A sense of self and
independence (process of
separation and individuation
begins).
12-24 months Social play (exhibit parallel
play during the first 2 years
of life).
In the grand scheme of things, it is essential for
nurses to understand normal development as well
as the variations that are considered acceptable so
nurses can recognize pathologic patterns and
developmental delays. Prompt planning and
intervention will then be instituted for children
who may benefit from referral to early
intervention programs.

Here is a table of cognitive concepts:

Age Concept
9 months Object permanence (people
and objects continue to exist
even when an infant cannot
see them). This ability to
maintain an image of a
person is the reason why
separation anxiety (6-18
months) develops when a
loved one leaves the room.

9-15 months Cause and effect

(understanding which actions
cause certain results).

1-3 years Magical thinking


Growth and
Development
Review
This reviewer is prepared to give you a brief
knowledge of growth and development,
including the different theories, physiologic
changes, hospital reactions by age, and the
different developmental milestones.
Theories of Growth and Development
The following are some of the theories
involving child development that have been
proposed by these well-known theorists:
Erik Erikson’s Theory of Psychosocial
Development
 According to Erickson, a human being
must go through a series of psychosocial
developmental stages that must be
balanced throughout the lifespan.
 Each stage is characterized by a
psychosocial conflict that must reach a
resolution to allow the individual to go
on the next phase of development.
Erik Erikson’s 8 Stages of Psychosocial
Development
 Trust vs Mistrust: Infancy (birth to 18
months)
 Task: attachment to the
mother/caregiver
 Successful outcome: feeling of trust
 Unsuccessful outcome: mistrust,
suspicion, uncertainty of the future
 Autonomy vs Shame and Doubt: Early
childhood (18 months to 3 years)
 Task: develop a sense of personal
control over physical skills and sense
of independence
 Successful outcome: feeling of self-
control, self sufficiency
 Unsuccessful outcome: lack of
independence, feelings of self-doubt
 Initiative vs Guilt: Late childhood (3
to 6 years)
 Task: become purposeful and
directive
 Successful outcome: sense of
purpose
 Unsuccessful outcome: sense of guilt,
self-doubt, and lack of initiative
 Industry vs Inferiority School age (6
to 12 years)
 Task: develop physical, social, and
learning skills
 Successful outcome: self-confidence,
competence
 Unsuccessful outcome: feelings of
inferiority, poor self concept
 Identity vs Role Confusion:
Adolescence (12-20 years)
 Task: develop sense of self and
personal identity
 Successful outcome: sense of strong
identity
 Unsuccessful outcome: self-
confusion
 Intimacy vs Isolation: Early adulthood
(20-35 years)
 Task: form intimate, loving
relationship with other people
 Successful outcome: strong
relationship
 Unsuccessful outcome: loneliness,
isolation
 Generativity vs Stagnation: Middle
adulthood (35 to 65 years)
 Task: achieve life goals and creating
positive change for the benefit of
others
 Successful outcome: feelings of
accomplishment
 Unsuccessful outcome: inability to
grow as a person
 Integrity vs Despair: Late adulthood
(65 years to death)
 Task: reflection on life
  Successful outcome: sense of
fulfillment and integrity
 Unsuccessful outcome: regret,
bitterness,dissatisfaction with life
Jean Piaget’s Theory of Cognitive
Development
 The theory focuses on concepts of
language, scientific reasoning, memory,
and moral development.
 According to Piaget, to progress from
one stage to the next, the child
reorganizes his or her thinking process
to bring them close to reality.
4 Stages of Cognitive Development
 Sensorimotor stage (birth to 2 years)
 Present at birth, the infant/child uses
reflexes like sucking, grasping,
looking, and listening to gain an
understanding about the
environment.
 Object permanence (objects
continue to exist even though it can
no longer be seen or heard) and
separation anxiety develops in this
stage.
 Preoperational stage (2 to 7 years)
 The child begins to use language
and think symbolically.
 Egocentrism (inability to see a
situation from another person’s
point of view) is evident in this stage.
 Comprehends simple abstract but
thinking is usually concrete and
literal
 Concrete operational stage (7 to 11
years)
 The child can think logically but can
only apply it to physical objects.
 The child starts to use concepts of
number, time, space, and volume.
 Formal operational stage (11 years to
adulthood)
 Individuals demonstrate the ability
to think abstractly, reason
logically, and draw conclusions.
 Can engage in hypothetical thinking
and scientific reasoning.
Sigmund Freud’s Psychosexual
Development
 According to Freud, the child’s
development goes through a series of
psychosexual stages in which the child’s
desires become focused on a particular
body part.
 Each stage is presented with a conflict
that will help build or suppress growth
depending on how they are resolved.
Stages of Psychosexual Development
 Oral stage (birth to 1 year)
 Mouth is the center of gratification
through sucking, chewing,
swallowing, breastfeeding, and biting.
 Improper resolution in this stage,
may lead to oral fixation habits such
as nail-biting, thumb sucking,
smoking, and excessive drinking.
 Anal stage (1 to 3 years)
 Child finds pleasure and sense of
control through retention and
defecation of feces
 Toilet training is present that
provides the child a sense of self-
control.
 Parents that are too lenient during
toilet training will result in an anal-
expulsive personality which includes
being messy, disorganized,
rebellious, and careless.
 Parents that are too strict or start
toilet training too early will result to
anal-retentive personality which
includes being overly obsessive, and
rigid.
  Phallic stage (3 to 6 years)
 Interest in the genital area and
masturbation are sources of pleasure
in this stage.
 Awareness of sexual difference can
result in Oedipus complex (Electra
complex in women), an unconscious
desire for the parent of the opposite
sex while developing a conflict for
the parent of the same-sex.
 Latent stage (6 to 12 years)
 Sexual urges diminish and children
start to channel their sexual energies
in honing their values and
developing their new skills to form
relationships with other people.
 Fixation in this stage can lead to
immaturity and a failure to form
relationships as an adult.
 Genital stage (12 years to adulthood)
 Starts with the onset of puberty
when physical maturity prepares the
body for reproduction.
 Individuals starts to develop sexual
and emotional interest towards the
opposite sex.
 months while a growth of 1 cm per
Lawrence Kohlberg’s Theory of Moral
Development
 Kohlberg believed that a person can
acquire knowledge of moral values
through active thinking and reasoning.
Stages of Moral Development
Here are three levels of moral development,
with each level consists of different stages:
Level 1: Preconventional Morality
 Stage 0 (birth to 2 years). Egocentric
Judgement: no concept of right or
wrong
 Stage 1 (2 to 3 years). Obedience and
Punishment: behavior driven by
avoiding punishment.
 Stage 2 (4 to 7 years). Individualism and
Exchange: behavior is driven by rewards
or have favors returned.
 Level 2: Conventional Morality
 Stage 3 (7 to 10 years). Good Boy-
Nice Girl Orientation: behavior is
determined by social approval.
 Stage 4 (10-12 years). Law and Order
Orientation: social rules and laws
determine behavior.
 Level 3: Postconventional Morality
 Stage 5: Social Contract and
Legalistic Orientation: rules and laws
exist for the greater good of all.
 Stage 6: Universal Ethical Principles
Orientation: development of own
moral principles even if they conflict
with the law of the society.
Physiologic growth and development
 Weight. Most babies doubled their
weight at the rate of 5 to 7 ounce
weekly for 6 months and tripled at 12
months.
 Length. A growth of 1.5 to 2.5 cm is
seen monthly from birth to age 6
month is expected from ages 6 to 12
months.
 Fontanel. Anterior fontanel closes by 12
to 18 months of age; Posterior fontanel
closes by the end of the second month.
 Head circumference. The average head
circumference of a newborn is about 33
to 35 cm, 2 to 3 cm more than chest
circumference.
 Teeth. Lower front teeth normally
appear by the age of 5 to 9 months
while upper front teeth begin to appear
by 8 to 12 months. All deciduous teeth
(20 in total) will erupt by the 2 ½ years
of age.
Developmental Milestones
Here are the important milestones that an
infant goes through:
2 to 3 months
 Begin to smile
 Coos, makes gurgling noises
 Turn head toward sounds
 Follow objects with eyes
 Hold head and chest up when prone
4 to 5 months
 Smile spontaneously
 Cooing and babbling when spoken to
 Grasp objects
 Rolls over by self
 Hold head steady, unsupported
6 to 7 months
 Recognize familiar faces and begins to
show fear of strangers
 May say vowel sounds when babbling
(oh oh) and imitate sounds
 Responds when own name is heard
 Sit with support
 Rolls back and forth and vice versa
 Show feelings of joys and annoyance
8 to 9 months
 Say first words such as (ma-ma-ma, ba-
ba-ba)
 Uses index finger and thumb to pick up
objects
 Can sit securely unsupported
 Crawls
 Stands, holding on
 Begin to stand without help
10 to 11 months
 Use simple gestures such as waving
“bye-bye”
 Walk with support while holding onto
objects
 Stand alone
12 months
 Say simple words like “mama” or “dada”
 Get to a sitting position with no help
 Can drink from a cup and hold spoon to
feed self
15 to 18 months
 Say several single words
 Understand and follow simple
instructions
 Can point to one body part
 Walks alone
 Walk up and down stairs while holding
on
 Can help undress oneself
Hospitalized Reaction by age
A summary of the normal developments
expected in a child during hospitalization at
different age stages:
 Infant and toddler. Characterized by
separation anxiety, loss of control
(shown in behaviors related to toileting,
feeding, bedtime), and fears of
bodily pain and injury
 3 phases of separation anxiety:
 Protest- hours and several days
of screaming, crying, and is
inconsolable.
 Despair- child becomes
withdrawn, hopeless, and
apathetic.
 Detachment- occurs after
prolonged separation of parent;
child appears to have adjusted to
the loss; becomes more
interested in the environment;
appears to be happy and content
with caregivers and other
children.
 Interventions:
 Encourage parents to stay with
and participate in the care as
often as possible.
 Continue and maintain the same
routine to what the infant/toddler
is accustomed to.
 Provide comfort measures such
as their favorite toy, pacifier for
oral and sucking stimulation, and
blanket.
  Provide a safe environment
especially during temper
tantrums such as side rails up,
keeping equipment out of reach.
 Allow toddler with opportunities
to make choices to gain some
control.
 Provide age appropriate
distraction and pain reducing
techniques.
 Preschooler. separation anxiety
decreases, fears loss of family routine
and schedules, and fear of bodily injury
from invasive procedures; believes that
hospitalization is a punishment for bad
actions.
 Interventions:
 Encourage parents to stay with
and participate in the care as
often as possible.
 Acknowledge and allow
expression of fears and anger
 Explain procedures in simple
terms
 Encourage interaction and play
with other children of the same
age
 Encourage the preschooler to be
independent
 Bring a familiar items with the
child
 Continue to set normal limits and
provide structure
 School age. Fears of getting behind in
school, fear of disability and death, loss
of control and independence, separation
from family and friends, child may ask
many actions and relate his or her
actions with the cause of condition.
 Interventions:
 Explain illness, and treatment to
child and patent (use body
diagrams, models or videotapes)
 Encourage independence and
provide choices as much as
possible
 Allow participation in discussion
and expression of feelings and
fears
 Continue doing school
work/assignments if possible
 Provide privacy
 Set limits, and establish routines
 Adolescence. Experience fear of being
different, concerns with appearance,
fears of separation from friends, loss of
privacy and independence, may
exhibit withdrawal and noncompliance
with the treatment regimen.
 Interventions:
 Encourage questions and open
discussion regarding the effect of
illness or treatment in their
appearance and relationship
 Provide clear information about
the condition and treatment (may
use body diagrams) and involve
them in decision making as much
as possible
 Maintain privacy such as wearing
pajama instead of gown
 Allow visitation from peers if
possible
 Encourage interaction with
friends and others in the same
age group