growth and development

LEARNING OBJECTIVES:

On completion of this unit, you are

expected to demonstrate understanding
of the concepts related to the principles
of growth and development.

Specifically, you are able to:

1. Identify key terms related to growth

and development.

2. Describe principles of growth and

development and developmental
stages according to major theorists.

3. Assess the growth and development

of various systems of the body.

4. Integrate knowledge of growth and

development with nursing process to
achieve quality maternal and child
health nursing care.
 PRINCIPLES OF G &D
LESSON 5

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to growth and development. Specifically, students are able to:

1. Differentiate key terms related to growth and development along with parameters and tools
for monitoring.
2. Describe the principles and factors that can influence growth and development.
3. Discuss the various changes in the child’s body systems and how it differs from the adult’s
body systems.
4. Analyze various situations through which growth and development principles can be
applied by a nurse.

INTRODUCTION

Humans keep on changing. The changes that occur include the size, appearance and
psychological make up and such changes differ from individual to individual. Although there is
uniqueness in every person’s growth and development, the fundamental underlying patterns
remain more or less the same and take place in an orderly way. Each individual, with his
unique heredity and the way he is nurtured, determines the way he traverses the broad
highway of his life at his rate of progress. The process of growth and development continues
from conception all the way to death. There are periods of time when growth is more rapid
than others and times when development is slowed. Growth and development is influenced
by many factors (Hatfield, 2011).
Every individual has to go through the various stages of childhood, adolescence,
adulthood, and old age. Both growth and development, at every stage, follow certain
principles. In this unit we shall discuss the concept and principles of human growth and
development. These basic foundations are important for the nurse to understand when
working with infants, children, and adolescents.
 ACTIVITY 5.1

Pre-Test: Let us gauge your current understanding of growth and development. Give your answer
as instructed in each question. Compare your answer with those given at the end of this lesson.

I. Indicate 'G' for 'growth' and 'D' for 'development' for each of the following statements.
_____________a. A six month old baby shows signs of teething.
_____________b. A three month old baby begins to run over and lie on its stomach.
_____________c. An infant begins to focus its eyes on an object dangling before it.

_____________d. A thirteen year old boy begins to have hair on his face.
_____________e. A fourteen year old girl who only makes friends with girls.
_____________f. A seven year old girl who joins almost all club organizations in her school.

_____________g. A four month old infant who doesn’t show strabismus.

_____________h. A three year old boy who says “pee-pee” when feels like urinating.
_____________i. A five year old girl who endlessly asks questions from an adult.

II) Write 'T' for 'true' and 'F' for 'false' for the following statements.

_____________a. A child talking full sentences is part of development.

_____________b. The difference in height between two children is due to the different rates of
their development.
_____________c. All systems of the body follows the same rate of growth.
_____________d. Children follow the same sequence of growth and development.
_____________e. All body systems mature at the same time.
_____________f. Growth and development starts from the body parts nearest to the midline.
_____________g. Fine motor skills develop first before gross motor skills.
_____________h. Nutrition is a factor that affects growth and development.
_____________i. Temperament does not affect growth and development.

_____________j. Ordinal Position in the family is not a factor that impacts growth and
development.
 CONCEPT DISCUSSION

GROWTH & DEVELOPMENT

• Sum of the numerous changes that takes place during the lifetime of an individual

GROWTH DEVELOPMENT
Quantitative change Qualitative change

• used to denote an increase in physical size
or a quantitative change (Pillitteri, 2010)
• physical increase in the body’s size and
appearance caused by increasing numbers
of new cells (Hatfield, 20011)
• used to indicate an increase in skill or the
ability to function; a qualitative change
• can be measured by observing a child’s
ability to perform specific tasks (Pillitteri,
2010)
• capacity to learn and think increases
(Hatfield, 2011)

PATTERNS OF GROWTH & DEVELOPMENT

1.Cephalocaudal: head-to-tail, direction, and reflect the physical development and maturation
of neuromuscular function.
2.Proximodistal: Near-to far, direction (midline to periphery). In the infant, shoulder Control
precedes mastery of the hands, the entire hand is used as a unit before the
fingers can be manipulated.
3.Differentiation: development from simple operations to more complex activities and
functions. Specific and refined patterns of behavior emerge from very broad
and global patterns. All areas of development (physical, mental, social,
emotional) proceed in this direction.
FACTORS INFLUENCING GROWTH & DEVELOPMENT
I. GENETICS
II. TEMPERAMENT
1.ACTIVITY LEVEL
2.RHYTHMICITY
3.APPROACH
4.ADAPTABILITY
5. INTENSITY OF REACTION
6. DISTRACTIBILITY
7. ATTENTION SPAN AND PERSISTENCE.
8. THRESHOLD OF RESPONSE
9. MOOD QUALITY
III. ENVIRONMENT
1. SOCIOECONOMIC LEVEL
2. PARENT–CHILD RELATIONSHIP
3. ORDINAL POSITION IN THE FAMILY
4. HEALTH
5. NUTRITION

PRINCIPLES OF GROWTH & DEVELOPMENT

Process that is continuous
Elevation of skills from gross to fine motor
Development from proximal to distal
It needs an optimum time for initiation of learning experiences
A must to proceed in an orderly sequence
To follow a predictable & definite pattern
Requires practice to learn behavior & skills
It is cephalocaudal
Can develop when neonatal reflexes disappear
Systems in the body don’t develop at the same rate

GROWTH AND DEVELOPMENT OF THE BODY SYSTEMS

Nervous System
• At birth the nervous system is immature.
• As the child grows, the quality of the nerve impulses sent through the nervous system
develops and matures.
• As these nerve impulses become more mature, the child’s gross and fine motor skills
increase in complexity. The child becomes more coordinated and able to develop motor skills

Sensory Organs
A. Eyes
• Newborns do not focus clearly but will stare at a human face directly in front of them.
• 2 months: the infant can focus and follow an object with the eyes
• 7 months: depth perception has matured enough so that the infant can transfer objects
back and forth between his or her hands.
• Visual acuity of children gradually increases from birth, when the visual acuity is usually
between 20/100 and 20/400 until about 7 years of age, when most children have 20/20
vision .
• Although the size is smaller, by the time the child is 5 years old, the heart has matured,
developed, and functions just as the adult’s
• The blood volume in the body is proportionate to the body weight. The younger the child, the
higher the blood volume is per kilogram of body weight.

Gastrointestinal System
• The functioning of the gastrointestinal system begins at birth. The GI tract of the newborn
works in the same manner as that of the adult but with some limitations. (e.g. the enzymes
secreted by the liver and pancreas)
• smaller capacity of the infant’s stomach and the increased speed at which food moves through
the GI tract require feeding smaller amounts at more frequent interval
• small capacity of the colon leads to a bowel movement after each feeding
• Reflexes are present in infants that allow for swallowing and prevention of aspiration when
swallowing
• cardiac sphincter at the end of the esophagus may be lax in the infant, and food may be
regurgitated from the stomach back into the esophagus

Endocrine System and Hormonal Function

• Regulating metabolism, growth, development, and reproduction are all functions of hormones.
• The endocrine system of the infant is adequately developed, although the functions are
immature.
• As the child grows, the endocrine system matures in function.

Genitourinary System
• In infants and children, emptying the bladder is a reflex action.
• Between ages 2 and 3 years, the child is able to hold the urine in the bladder and learns to
urinate voluntarily, thus developing the control of urination.
• Newborn: bladder empties when only about 15 mL of urine is present, (newborn voids as many
as 20 times a day)
• As the child gets older, the bladder has more capacity to hold larger amounts of urine before
the child feels the urge to void.
• urethra in females: much shorter than in males at all ages
• kidneys in children are located lower in relationship to the ribs than in adults- greater risk for
trauma to the kidneys
• kidneys reach their full size and function by adolescence
• reproductive portion in males and females matures at the time of puberty

Musculoskeletal System
• Childhood: bones are more sponge-like and can bend and break more easily than in adults
• since bones are still in the process of growing, breaks in the bone heal more quickly than do
breaks in adults.

FUN FACT

Bone growth takes place

between birth and puberty,
with most growth being
complete by age 20 years.
 B. Ears
• In infants and young children, this tube is straighter, shorter, and wider than in the older
child and adult.
• Hearing in children is acute, and the infant will respond to sounds within the first month
of life.

Respiratory System
CAUTION
• The respiratory tract grows and changes until the child is
about 12 years of age.
• first 5 years: child’s airway increases in length but not in  Because the infant is a
diameter nose breather, it is
• Infants and young children have larger tongues in essential to keep the nasal
proportion to their mouths, shorter necks, narrower passages clear to enable
airways and the structures are closer together the infant to breath and to
eat.

• The ability to breath through the mouth when the nose is  If the child inhales a foreign
blocked is not automatic but develops as the child’s neu- body, it is more likely to be
rologic development increases. drawn into the right
• tonsillar tissue is enlarged in the early school-age child, bronchus rather than the
but the pharynx, which contains the tonsils, is still small, left.
so the possibility of obstruction of the upper airway is
more likely.
• Children older than 2 years, the right bronchus is shorter,
wider, and more vertical than the left  The diameter of the infant
• Infants use the diaphragm and abdominal muscles to and child’s trachea is about
breathe. the size of the child’s little
• Beginning at about age 2 to 3 years, the child starts using finger. This small diameter
the thoracic muscles to breath. makes it extremely
important to be aware that
something can easily
lodged in this small
• The change from using abdominal to using thoracic passageway and obstruct
muscles for respiration is completed by the age of 7 the child’s airway.
years.
• Because accessory muscles are used for breathing,
weakness of these muscles can cause respiratory failure

Cardiovascular and Hematologic Systems

• At birth, both the right and left ventricles are about the same size, but by a few months of age,
the left ventricle is about two times the size of the right.
• infant’s heart rate is higher than the older child’s or adult’s so that the infant’s cardiac output
can provide adequate oxygen to the body
Integumentary and Immune Systems

• newborn’s skin is thin and has less subcutaneous fat between the layers of skin
• Sebaceous secretions in the infant and young child are less than those in the older child and
adult, causing the skin of children to dry and crack more easily.
• Passive immunity is present at birth and decreases during the first year of life.
• during the first year of life immunizations are started to help the infant develop protection
against certain diseases.
• As the child grows and develops, the immune system also develops. The antibodies in the
child increase as the child progresses through childhood.

Nutritional Assessment

• Take dietary history

• May use other tools to increase detail or accuracy of information, including 24-hour recall or
food diaries
• Physical examination can reveal many deficiencies
• Assessment should determine whether child is well-nourished, malnourished, overweight, at
risk for becoming malnourished or overweight

Developmental Assessment

• More complex than growth assessment

• Screening must be conducted at 9, 18 and 24 to 30 months of age
• Observation is the most valuable skill for gauging developmental age of child
• Screening tools
 Must be both sensitive and specific
 Usually centered around major developmental area (language, cognition, socialization,
behavior, motor skills)
 May be given to parents to perform before visit
• Denver Developmental Screening Test II
 Provides overall developmental assessment
 For children 6 years of age and younger
 Test giver must be trained to administer screening
 Child is evaluated first on individual items, and then on overall screening
 Useful for uncovering problems and monitoring development

Critical Periods

• Rapid growth of organs and systems

• Resolution of psychosocial crises at specific developmental stages

Physical Examination

• Preparing a Child
 Examination is not usually painful, but depending on the child’s developmental age,
may be upsetting
 Ensure room is comfortable and inviting; different rooms may be used for different-aged
children
  Involve child in the process
 Take time to allow child to become familiar with you
 For younger children, allow time for play
 Only begin when child is ready
 Conduct examination in a nonthreatening manner; consider using games for youger
children
 Examine the child in a comfortable position (eg, sitting on parent’s lap)

• History Taking
 Most important part of examination
 Direct (ask questions of child and/or parent directly) or indirect (use of a form)
 3 types of history: Complete, initial history; Wellness History; Problem-Oriented History
 Family medical evaluation
 Usually of immediate relatives
 Focus is familial or genetic diseases

 Structure and Function of family: focus is family composition; quality and type of
relationships
 Psychosocial evaluation: observe child for behavior; focus is determining child’s coping
abilities, sense of self-worth

• Sequence of examination
 Systematically work head to toe
 Sequence may be altered to accommodate child’s needs
 Painful part of the examination must be done last

NORMAL VALUES of VITAL SIGNS

VITAL SIGNS Neonate/ Infant Toddler/ Preschool School-Age Adolescent

Temperature Axillary: 36.5-37.3 Axillary: 36.4-37 Oral: 36.4-37 Oral: 36.4-37

Pulse 0-3 mos: 100-160 2-5 y.o.: 70-110 6-10 y.o: 70-110 55-90 y.o.

3-12 mos: 80-150 11-12 y.o: 55-90

Respiration 30-40 breaths/min 20-24 breaths/min 20-24 breaths/min 16-18 breaths/min

Blood Pressure 50th percentile: 55-70 mmHg diastolic to 100-110 mmHg systolic

Levels increase 2-3 mmHg/year starting at 7 years old

Systolic pressure in adolescents: higher in males

Appropriate cuff size: 45-70% of arm width

Sites for assessment: lower extremity for younger children; upper extremity for older children
Growth Rate and Stages of Growth & Development

Most Rapid : Neonate (first 28 days of life),Infancy (1 month-1 y.o)

Slow : Toddler (1-3 y.o)
Alternating : Preschooler (3-5 y.o)
Slower : Schooler (6-12 y.o)
Rapid : Adolescent (13-17 y.o); Late Adolescent (18-21 y.o)

AGE GROWTH FACTS

AGE/STAGE FACTS

INFANT Weight: doubles by 5 or 6 months; triples by 1 year

(0-1 y.o)
Height: increase of 1 ft by 1 year of age

Teeth: erupt by 6 months; has 6-8 deciduous teeth by 1

year of age

TODDLER Weight: Gains 8 oz or more a month from 1 to 2 years;

(1-3 y.o) Gains 3 to 5 lbs a year from 2 to 3 years of age

Height: grows 3-5 inches from 1-2 years of age; from 2-3
years, grows 2-2.5 inches per year

Teeth: has 20 deciduous teeth by 3 years

PRESCHOOL Weight: gains 3-5 lbs a year
(3-5 y.o)
Height: grows 1.5-2.5 inches a year

SCHOOL AGE Weight: gains 3-5 lbs a year

(6-12 y.o)
Height: grows 1.5-2.5 inches a year

ADOLESCENCE Weight Height

(13-18 y.o) Girls: 15-55 lbs Girls: 2-8 inches
Boys- 15-65 lbs Boys: 4.5-12 inches
 EXERCISE 5.1
I
I. PRACTICE QUESTIONS: Answer the following questions by encircling the letter of your cho-
sen answer.
1. The nurse observes that during feeding the newborn looks at the mother’s face and holds
her finger. According to Piaget, these observations indicate the child is in which phase of
development?
a. Sensorimotor c. Concrete operations
b. Preoperational d. Formal operations

2. The nurse is caring for a toddler who has recently turned 2 years old. Of the following behav-
iors by the toddler, which would indicate the toddler is attempting to become autonomous?
The toddler
a. cries when the caregiver leaves.
b. walks alone around the room.
c. “shows off” to get attention.
d. competes when playing games.

3. In working with a preschool-age child, which of the following statements made by the child’s
caregiver would indicate an understanding of this child’s stage of growth and development?
a. “My child always wants her own way.”
b. “Why won’t my child play with other children?”
c. “I will tell my child I will be back after lunch.”
d. “She doesn’t know when she has done something wrong.”

4. In an interview, a 9-year-old child makes the following statement to the nurse: “I like to play
basketball, especially when we win.” This statement indicates this child is developing which
basic task of child development?
a. Trust c. Initiative
b. Autonomy d. Industry

5. In discussing needs of adolescents with family caregivers, the nurse explains that to support
the adolescent in developing his or her own identity, it would be most important for the
adolescent caregiver to
a. respond to physical needs. c. accept the child’s defeats.
b. praise the child’s actions. d. maintain open communication.

II. ASSIGNMENT: Let’s walk through your memory lane. Illustrate a timeline of your growth and
development from infancy to adolescence. Use symbols for the milestones you have
achieved in each stage. Milestones should reflect physical, psychosocial, cognitive,
psychosexual and moral developments. Illustrate in a short bond paper and scan. Sub-
mit the scanned output through the LMS not later than _______, ______ PM.
 FEEDBACK
Let us look into how well you fared. Compare your answers with the
answer key posted in the Learning Management System. If you
answered all questions correctly, congratulations! It shows that you
are already familiar with the topics discussed in lesson 4. If your
answers are quite not close to the discussion, you have some ideas
about the topics covered but need to learn more.
Now, you have a glimpse of the Concept of Growth and
Development. Read on and continue exploring this topic from your
textbook and other references on Maternal and Child Health Nursing.

Quiz 5.1

Congratulations! You are done with Lesson 5. In order to see how much you have learned, an
online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 6 entitled Principles of Growth and
Development
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf
 THEORIES, SELF-CONCEPT & SEXUALITY

LESSON 6

LEARNING OBJECTIVES

On completion of this lesson, you are expected to demonstrate understanding of the

concepts related to the theories on growth and development, self-concept and sexuality.
Specifically, students are able to:

1. Compare and contrast the various theories on child development.

2. Discuss the concept of sexuality and self-concept its significance in growth and develop-
ment.
3. Integrate the various theories on child development with the nursing process to render
quality child health nursing care.

INTRODUCTION

Throughout the years, scientist have been fascinated how a helpless infant grows into a
fully functioning independent adult Theories related to growth and development have
emerged by then wherein such theories exhibit a certain difference and at the same time a
certain degree of relatedness.

Initial theories of human development were focused on how individuals unfold in an orderly
and sequential fashion. Later on, various approaches within the genre of developmental
theories have emerged. Despite the difference in their foci, what unites all of them is the role
of “development” depicted as degree of maturation or directional movement as descriptive
and explanatory of humans, their interactions, and their contexts (Sage, 2020).

Four pioneering researchers whose theories in this area are widely accepted are Sigmund
Freud, Erik Erikson, Jean Piaget, and Lawrence Kohlberg. Their theories present human
development as a series of overlapping stages that occur in predictable patterns. These
stages are only approximations of what is likely to happen in children at various ages, and
each child’s development may differ from these stages (Hatfield, 2011).
 ACTIVITY 6.1

“Who Am I?” Questionnaire.

“To begin with, I’ve found that there is no one else like me, anywhere- like snowflakes. No
one else feels completely the way I do. No one else sees things in the same scope as I do.
So my first discovery about myself is that I’m me.”
- Anonymous-
Fill out the following questionnaire. Please be as open and honest as possible, this will be
kept confidential.
1. In general, school is….
________________________________________________________
2. My best friend is…
________________________________________________________
3. The thing I like best about my class is…
________________________________________________________
4. Something I‟d like to tell my teacher is…
________________________________________________________
5. I don‟t like people who…
________________________________________________________
6. I‟m at my best when I…
________________________________________________________
7. Right now I feel…
________________________________________________________
8. People I trust…
________________________________________________________
9. The best thing that could happen to me is…
________________________________________________________
10. When I don‟t like something I‟ve done, I…
________________________________________________________
11. When I like something I‟ve done, I…
________________________________________________________
12. When I‟m proud of myself, I…
________________________________________________________
13. I‟m very happy that…
________________________________________________________
14. I wish my parents knew…
________________________________________________________
15. Someday I hope…
________________________________________________________
16. I would like to…
________________________________________________________
17. Five adjectives that describe me are…
________________________________________________________
 CONCEPT DISCUSSION

Theory

A theory is a systematic
statement of principles that
provides a framework for
explaining a phenomenon.
Thus, Developmental
theories provide road maps
to explain human
development.

Developmental Task

Skills or competencies
normally occurring at one
stage and having an
effect on the development
of subsequent stages.
Psychoanalytic/ Pyschosexual Development Theory by Sigmund Freud

3 Parts of Personality

•The theory proposes that sexual energy is stronger in certain parts of the body at specific ages
•Experiences from childhood form the unconscious motivations for the things being done later
in life as adults
•Fixation occurs at a specific stage if needs are not met or conflicts are not resolved
•FIXATION- persistent focus of the id’s pleasure seeking energies at an earlier stage of
psychosexual development
 Psychosexual Stages

1.Oral Stage/ Phase

•oral gratification; interested in oral stimulation or pleasure; infants suck for enjoyment or
relief of tension, as well as for nourishment.

Nursing Implications
•Provide oral stimulation by giving pacifiers; do not thumb-sucking. Breastfeeding may
provide more stimulation than formula feeding because it requires the infant to expend
more energy.

2. Anal Stage
•children’s interests focus on the anal region as they begin toilet training; Elimination takes
on new importance for them; find pleasure in both the retention of feces and defecation
•part of toddlers’ self-discovery, a way of exerting independence, and probably accounts
for some of the difficulties parents may experience in toilet-training children of this age

Nursing Implications
•Help children achieve bowel and bladder control undue emphasis on shame. If at all
possible, continue bowel and bladder training while child is hospitalized.
3. Phallic Stage
•children’s pleasure zone appears to shift from the anal to the genital area
•Masturbation is common during this phase
•Children may also show exhibitionism, suggesting they hope this will lead to increased
knowledge of the two sexes
•Gratify physical curiosity

Nursing Implications
•Accept children’s sexual interest, such as fondling their own genitals, as a normal area of
exploration. Help parents answer child’s questions about birth or sexual differences.

4. Latency Stage (6-12 y.o)

•Resolved elektra/oedipal complex
•Quiet period
•children’s libido appears to be diverted into concrete thinking

Nursing Implications
•Help children have positive experiences with learning so their self-esteem continues to
grow and they can prepare for the conflicts of adolescence.

5. Genital Stage
•Great surge of genital sexual development
•establishment of new sexual aims and the finding of new love objects
•Masturbation and sexual fantasies are common

Nursing Implications
•Provide appropriate opportunities for the child to relate with opposite sex; allow to child to
verbalize feelings about new relationships.

Psychosocial Development Theory by Erik Erikson

 • a theory that stresses the importance of culture and society in development of the
personality (Erikson, 1993).
• a person’s social view of self is more important than instinctual drives in determining
behavior, allows for a more optimistic view of the possibilities for human growth.

Trust vs Mistrust
• The child must learn trust as needs are met by the caregiver; Child learns to love and be
loved.

Nursing Implications
 Provide a primary caregiver.
 Provide experiences that add security, such as soft sounds and touch.
 Provide visual stimulation for active child involvement.

Autonomy vs Shame & Doubt

• Child becomes more independent and starts to control over body functions.
• Child learns to be independent and make decisions for self.

Nursing Implications
 Provide opportunities for decision making, such as offering choices of clothes to wear or
toys to play with. Praise for ability to make decisions rather than judging correctness of
decision.

Initiative vs Guilt
• Development of conscience; learning right from wrong
• Child learns how to do things (basic problem solving) and that doing things is desirable

Nursing Implications
 Provide opportunities for exploring new places or activities. Allow play to include activities
involving water, clay for modeling), or finger paint.

Industry vs Inferiority
• Rule-following behavior; forming social relationships is seen as important
• child learns how to do things well

Nursing Implications
 Provide opportunities such as allowing child to assemble and complete a short project so
that child feels rewarded for the accomplishment.

Identity vs Role confusion

• Adolescents learn who they are and what kind of person they will be
• adjusts to a new body image, seeking emancipation from parents, choosing a vocation, and
determining a value system.
• Peers are very important; Working on establishing own identity

Nursing Implications
 Provide opportunities for adolescent to discuss feelings about events important to him or
her.
Offer support and praise for decision making.
Intimacy vs Isolation
• Intimacy is the ability to relate well with other people, not only with members of the opposite
sex but also with one’s own sex to form long-lasting friendships.

Generativity vs Stagnation
• People extend their concern from just themselves and their families to the community and
the world.
• They may become politically active, work to solve environmental problems, or participate in
far-reaching community or world-based decisions.
• People with a sense of generativity are self-confident and better able to juggle their various
lives
• People without this sense become stagnated or self absorbed.
• Those who have devoted themselves to only one role are more likely to find themselves at
the end of middle age with a narrow perspective and lack of ability to cope with change.

Integrity vs Despair
• Older adults with integrity feel good about the life choices they have made;
• those with a feeling of despair wish life could begin over again so that things could turn out
differently.
• A sense of integrity is helpful in a grandparent who provides childcare, as it helps children
develop a sense of trust and learn initiative
Childhood Stage/Developmental Nursing Implication
task
INFANT Provide a primary caregiver. Provide experiences that
adds security.
(TRUST VS MISTRUST)
TODDLER Provide opportunities for independent decision making
such as choosing own clothes
(AUTONOMY VS SHAME AND
DOUBT)
PRESCHOOL Provide opportunities for exploring new places or
activities. Allow free-form play.
(INITIATIVE VS GUILT)
SCHOOL-AGE Provide opportunities such as allowing child to assemble
and complete a short project.
(INDUSTRY VS INFERIORITY)
ADOLESCENT Provide opportunities for an adolescent to discuss
feelings about events important to him or her. Offer sup-
(IDENTITY VS ROLE
port and praise for decision making.
CONFUSION)

Cognitive Development Theory by Jean Piaget

The cognitive
development theory
defined four stages
wherein within each
stage are finer units
or schemas. It has
elaborated how a
child learns and
develops that
quality called
intelligence
(Hatfield, 2011).
Sensorimotor Phase (Ages 0–2 Years)
•“primary” - refer to activities related to a child’s own body
•“secondary” refers to activities that are separate from a child’s body;
•“circulatory reaction” to show that repetition of behavior occurs

Phases
1) Neonatal Reflex
2) Primary Circular Reaction
3) Secondary Circular Reaction
4) Coordination of Secondary Reaction
5) Tertiary Circular Reaction
6) Invention of new means through mental combinations

SENSORIMOTOR PHASES Nursing Implication

Neonatal Reflex Stimuli are assimilated into beginning mental images.
Behavior entirely reflective
Primary Circular Reaction Hand-mouth and ear-eye coordination develop.
Enjoyable activity: a rattle or tape of parent’s voice
Secondary Circular Reaction Infant learns to initiate, recognize and repeat pleasurable
experiences from environment. Good toy: mirror; Good
game: peek-a-boo
Coordination of Secondary Infant can plan activities to attain specific goals. Good
Reaction toy: nesting toys (colored boxes)
Tertiary Circular Reaction Child is able to experiment to discover new properties of
objects and events. Good game: throw and retrieve
Invention of new means Transitional phase to preoperational thought period.
through mental combinations Good toys: those with several uses (blocks, colored
plastic rings)
Preoperational Phase (Ages 2–7 Years)

Nursing Implications
•child in this phase of development is egocentric
•child has no concept of quantity; if it looks like more, it is more sense of time is not yet
developed
•children are able to use symbols to represent objects.
•Toddlers draw conclusions only from obvious facts they see
•Good toy for this period: items that require imagination, such as modeling clay.

Concrete Operations (Ages 7–11 Years)

Nursing Implications
•children develop the ability to begin problem solving in a concrete, systematic way.
•begin to understand that volume or weight may remain the same even though the
appearance changes
•can consider another’s point of view and can deal simultaneously with more than one
aspect of a situation
•aware of reversibility, an opposite operation or continuation of reasoning back to a starting
point
•Good activity for this period: collecting and classifying natural objects such as native plants,
sea shells, etc.
•Expose child to other viewpoints by asking questions such as, “How do you think you’d feel
if you were a nurse and had to tell a boy to stay in bed?”

Formal Operations (Ages 12–15 Years)

Nursing Implications
•adolescent is capable of dealing with ideas, abstract concepts described only in words or
symbols
•begins to understand jokes based on double meanings and enjoys reading and discussing
theories and philosophies.
•Adolescents can observe and then draw logical conclusions from their observations.
•Can solve hypothetical problems with scientific reasoning;
•understands causality and can deal with the past, present, and future
•Good activity for this period: “talk time” to sort through attitudes and opinions.
Moral Development Theory by Lawrence Kohlberg

LEVEL PRE CONVENTIONAL CONVENTIONAL POST CONVEN-

TIONAL
1.OBEDIENCE & PUN- 3. GOOD 5. SOCIAL
STAGES ISHMENT ORIENTATION INTERPERSONAL CONTRACT & IN-
2.INDIVIDUALISM & EX- RELATIONSHIPS DIVIDUAL RIGHTS
CHANGE
4. MAINTAINS SOCIAL 6. UNIVERSAL
ORDER PRINCIPLES

2-7 YEARS OLD 7-12 YEARS OLD 12 YEARS AND

AGE ABOVE
*FOLLOWS RULES SET *SEEKS CONFORMITY *CONSTRUCTS A
CHARACT- BY THOSE IN AU- & LOYALTY PERSONAL &
ERISTICS THORITY FUNCTIONAL VAL-
* FOLLOWS RULES UE SYSTEM INDE-
*ADJUST BEHAVIOR AC- *MAINTAINS SOCIAL PENDENT OF AU-
CORDING TO GOOD/ ORDER THORITY FIG-
BAD & RIGHT/WRONG URES & PEERS
SEXUALITY AND SELF-CONCEPT

SEXUALITY
• Refers to the totality of being a person which includes all aspects of the human being that
relate specifically to being a boy or a girl, a man or a woman

Nursing Responsibilities
 Concept of sexuality must be given in a factual and accurate manner
 Presentation of human reproductive system and the process of reproduction should be
made using simple language
 Use of proper terminology for the different parts of the reproductive system to dispel malice
 Take into consideration the culture, religion, local beliefs, customs & traditions when
teaching sexuality to avoid guilt, anxiety & confusion
 Promote an open communication with parents about physical changes

SELF-CONCEPT
 SELF-CONCEPT

SELF-ACTUALIZATION
 EXERCISE 6.1

INSTRUCTION: Accomplish the following tasks. Answers must be type written in a short bond
paper and passed as pdf file in the Learning Management System. Feedback of your
performance will also be given through the LMS.
1. Using the following table, compare the theories of Freud, Erikson, Piaget, and Kohlberg
regarding children who are in the early elementary school years.

Stage Name of Theorist Main Ideas and Similarities

Between Theorists’ Ideas
Latency stage

Industry stage

Concrete operational stage

Conventional level

2. 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. Write your discussion in a substantial but brief manner on the space provided below.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
3. Research 1 journal for either of the following concepts which discusses their relationship on the
growth and development of a child: sexuality, self-concept. After reading and understanding,
make a reflection journal. Format and grading rubrics will pe posted on the Learning Manage-
ment System.
 FEEDBACK
Let us look into how well you fared. Your answers will be given points
accordingly based on the short answer rubric. The rating for your ac-
complishment of this activity will be given through the Learning Man-
agement System.
Now, you have a glimpse of the Theories on growth and
development, Self-concept & sexuality. Read on and continue
exploring this topic.

Quiz 6.1

Congratulations! You are done with Lesson 6. In order to see how much you have learned, an
online quiz has been prepared for you to answer. Follow the steps stated herewith.
1. Log in to your Learning Management System Account.
2. Go to My Courses and click NCM 107 A.
3. Look for the online quiz prepared under Week 7 entitled Theories, Self-Concept and
Sexuality
4. The quiz is open for answering on _____(date)______, between ____ AM to ____ AM.
5. Your are expected to finish the quiz within the time set in the system.
6. Only 1 attempt is allowed unless reasons such as poor internet connection would have
affected your access to the quiz.

Best of luck and well done!

Hatfield, N.T. Broadribb’s Introductory Pediatric Nursing, 9th Edition. Wolters Kluwer/ Lippincott
Williams & Wilkins, Philadelphia. 2011.

Nursing Key Topics Review: Pediatrics. USA: Elsevier. 2017.

McKinney, E.S. and Murray, S.S. Foundations of Maternal-Newborn and Women’s Health Nurs-
ing, 6th Edition. Elsevier, Singapore. 2014.

Pilliteri, A. & Flagg, J.S. Maternal and Child Nursing, Care of the Childbearing & Childrearing
Family, 8th Edition, Vol. 1. Wolters Kluwer, Philadelphia. 2018.

Bartels’ Scoring Rubric for Concept Maps retrieved June 14, 2020 from https://
teach.its.uiowa.edu

Crossword puzzle retrieved July 6, 2020 fromhttps://worksheets.theteacherscorner.net/make-

your-own/crossword/crossword.php

Grading Rubric for Reflection Paper retrieved June 14, 2020 from https://www.utc.edu/nursing/
pdfs /classes/rubric-reflections.pdf