NCM 107 Care of the Child Concept

The Concept following Care of the Mother

THE CONCEPTION

a. First 12-14 days = zygote

b. From 15th day up to the 8th week = embryo
c. From 6th week up to the time of birthing period = fetus

THE FETUS
Fetal Development
A. First Lunar Month

1. Germ layers differentiate by the 2nd week (In cases of multiple congenital
anomoalies, the structures that will be affected are those that arise out of
the same germ layer.)
a. Entoderm – develops into the lining of the GIT, the repiratory tract,
tonsils, thyroid (for basal metabolism), parathyroid (for calcium
metabolism), thymus glands (for development of immunity), bladder
and urethra
b. Mesoderm – forms into the supporting structures of the body
(connective tissures, bones, cartilage, muscles and tendons). heart,
circulatory system, blood cells, reproductive system, kidneys and
ureters.
c. Ectoderm – responsible for the formation of the nervous system, the
skin, hair and nails, the sense organs and mucous membrane of the
anus and mouth.
2. Fetal membranes (amnion and chorion) appear by the second week
3. Nervous system very rapidly develops by the 3 rd week (Dizziness is said to
be the earliest sign of pregnancy because as the fetal brain rapidly
develops, glucose stores of the mother are depleted, thus causing
hypoglycemia in the latter)
4. Fetal heart begins to form as early as the 16 th day of life (To the question,
“When does the fetal heart begins to beart?”, the answer is the first lunar
month. But to the question, “When can fetal heart tones be first heard?”,
the answer is fifth month.)
5. The digestive and respiratory tracts exist as a single tube until the 3 rd week
of life when they start to separate.

B. Second Lunar Month

1. All vital organs are formed by the end of the 8 th week.

2. Placenta develops fully.
3. Sex organs (ovaries and testes) are formed by the 8 th week. (To the
question, “when is sex determined?”, the answer is at the time of
conception.)
4. Meconium (first stools) are formed in the intestines by the 5 th-8th week.

1
NCM 107 Care of the Child Concept

C. Third Lunar Month

1. Kidneys are able to function – urine formed by the 12 th week

2. Bud of milk teeth form
3. Beginning bone ossification
4. Fetus swallows amniotic fluid
5. Feto-placenta circulation is established by selective osmosis; no direct
exchange between fetal and maternal blood.

D. Fourth Lunar Month

1. Lanugo appears
2. Buds of permanent teeth form
3. Heart beats audible with fetoscope

E. Fifth Lunar Month

1. Vernix caseosa appears

2. Lanugo covers entire body
3. Quickening (fetal movement) felt
4. Fetal heart beats very audible

F. Sixth Lunar Month

1. Skin markedly wrinkled

2. Attains proportions of fullterm baby

G. Seventh Lunar Month

1. Alveoli begin to form (29 th weeks gestation is said to be the lower limit of
prematurity; if born, cries, breathes, but usually dies)

H. Eight Lunar Month

1. Fetus is viable
2. Lanugo begins to disappear
3. Nails extend to ends of fingers
4. Subcutaneous fat deposition begins

I. Ninth Lunar Month

1. Lanugo and vernix disappear

2. Amniotic fluid volume somewhat decreases

J. Tenth Lunar Month – all characteristics of the normal newborn

2
NCM 107 Care of the Child Concept

THE INFANT

I. Definition: The child from 1 to 12 months of age.

II. Psychosexual Stage (Freud): Oral
III. Psychosocial Stage (Erickson): Trust vs. Mistrust
IV. Cognitive Stage (Piaget): Sensorimotor = 0-2 yrs
V. Play
A. Purposes:
1. To practice motor skills
2. To gain coordination
3. To relate to objects and people
B. Type: Solitary - they love to play with their own bodies.
C. Age-appropriate toys:
1. Mobiles
2. Rattles
3. Musical box
4. Squeeze toys
5. Teething rings
6. Textured balls
7. Large, soft cuddly toys
VI. Greatest Fear: Stranger Anxiety - after 6 months of age.

VII. Growth and Development

A. Definitions
1. Growth = an increase in physical size of the whole body or any of its
parts and can be measured by inches or centimeters and in pounds
or kilograms.
2. Development = progressive increase in skill and capacity of
function.
B. General principles
1. Children are competent – they are well endowed with the qualities
and abilities needed to ensure their survival and promote their
development.
2. Children resemble one another – the physical and behavioral
characteristics of each age and the changes that occur with
increasing age are similar from child to child.
3. Each child is unique – the differences from hild to child are due to a
combination of;
a. Hereditary and constitutional make-up
b. Racial and national characteristics
c. Sex
d. Environment
4. Growth and development are directional

3
NCM 107 Care of the Child Concept

a. Cephalocaudal- growth is more advanced at the near the head

and gradually progresses downward to the neck, the trunk and
the extremities.
b. Proximo-distal- growth proceeds outward from the central axis of
the body toward the periphery.
c. General to specific- e.g., from crying at birth to complete
sentences at preschool age.
d. Simple to complex- e.g., from walking at 12 months of age to
pedaling the trike at 3 years of age.
5. Asynchronous growth – the whole body does not grow at once;
different regions and subsystems develop at different rates and
times.
6. Discontinuity of growth rate- there are only two periods of very rapid
growth; the fetal- infancy period and adolescence.
7. Development is timely – the notion of readiness or maturation
states that learning would come quickly and effortlessly once the
child is ready. (That is why the most common reason for failure in
toilet training is that the child is not yet ready to be trained)
8. New skills tend to predominate- the current development issue
becomes a preoccupation for the child.
9. The many aspects of development (personal)- social, fine motor-
adaptive, gross motor and language) are interrelated. They act
upon and react with one another extensively and inseparably.
C. Developmental screening – by means of standardized tools e.g., the
Metro Manila Developmental Screening Test (MMDST). It is a
1
screening instrument for children aged 0-6 years to detect
2
developmental delays early, thereby preventing further delays.
D. Specific behaviors
1. Newborn – when on prone, avoids suffocation by turning his head
from side to side.
2. One month
a. Lifts head intermittently when on prone
b. Momentary visual fixation on human faces and objects
3. Two months
a. “social smile”
b. Responds to familiar voices by moving the whole body
c. No head control yet; head lags when pulled to sitting
(Implications: support head and neck when carrying the baby).
d. Sheds tears
4. Three months
a. Can raise head, but not chest, when on prone.
b. Head in bobbing motion; some head control when pulled to sit.
c. Babies and coos
d. 180° visual arc
5. Four months

4
NCM 107 Care of the Child Concept

a. Can raise head and chest when on prone

b. When on supine, head maintained in the midline, arms and legs
are asymmetrical and hands brought together in the midline.
c. May have bald occiput.
d. Grasps objects within reach and brings to mouth ( Implication:
diaper pin, clips, etc., should be kept out of reach)
e. Head control when pulled to sit, no lag; no more bobbing, head
steady when upright.
f. Sustains part of own weight when helped to standing position.
g. Laughs aloud
6. Five months
a. Rolls over (Implication: raise side rails of cribs to prevent
accidental falls)
b. Raking grasp
7. Six months
a. Doubles birth weight
b. Eruption of first tooth (usually lower central incisor)
c. Sits with minimal support
d. Can be pulled from sitting to standing position
8. Seven months
a. Plays with feet
b. Says dada or mama but nonspecific
c. Pivots (creeps) when on prone (implication: keep rails on stairs
secured)
d. Thumb-finger grasp
9. Eight months: sits alone steadily without support for an indefinite
period.
10. Nine months
a. Can hold bottle with good hand-mouth coordination
b. Crawls
c. Understands simple gestures and requests (bye-bye or pat-a-
cake)
d. Take some steps when held
e. Neat pincer grasp
11. Ten months
a. Pulls self to stand
b. Responds to own name
12. Eleven months
a. Stands with assistance
b. Attempts to walk with help
13. Twelve months
a. Walks with help
b. Triples birth weight
c. Drinks from cup
d. Can say 2 words

5
NCM 107 Care of the Child Concept

6
NCM 107 Care of the Child Concept

THE TODDLER
I. Definition: the child from 1-3 years of age
II. Psychosexual Stage (Freud): Anal
III. Psychosocial Stage (Erickson): Autonomy vs. Shame and Doubt
IV. Cognitive Stage (Piaget): Stage I (Preconceptual stage) of the
Preoperational Thought Period (2-4 yrs) = characterized by egocentricity
expressed in relating everything to himself.
V. Play
A. Type: Parallel
B. Age-appropriate toys:
1. Push-pull toys
2. Building blocks
3. Toys to ride on
4. Pounding pegs
5. Stuffed toys
1
VI. Greatest Fear: Separation Anxiety – most acute at 2-2 years of age.
2
VII. Behavior traits
A. Toddlers are headstrong and negativistic (their favorite word is “NO!”)
– because they are slowly moving out of infancy and are more closely
defining their own independent activity.
B. They are naturally active, mobile and curious, which makes them
vulnerable to accidents – so, set limits and exert external control
whenever necessary. (Remember: love and consistency are the two
most important concepts in child rearing).
C. There is a distinct decrease in appetite because of the slower growth
rate.
1. Pattern of weight gain:
a. First 6 months of life – 6-8 oz/week
b. Second 6 months of life – 2-4 oz/week
c. Second year of life – ½ lb/month
2. Characteristics
a. Dawdling at meals
b. Fetish with foods

7
NCM 107 Care of the Child Concept

c. Appetite of three-year-olds are more capricious than that of one-

year-olds.
D. They are rigid, repetitive, ritualistic and stereotyped in their behavior.
When things are rearranged or are strange, when persons or places
are unfamiliar, toddlers form into temper tantrums in order to control
self and others. (Management of temper tantrums: ignore the behavior
or direct them to activities that they can master).
E. Toddlers have very poor sense of time. Their time schedules revolve
around their activities, not around the clock.
F. Adults should talk to very young children at eye level – the great
disparity in size between an adult and a toddler can cause fear in the
latter.
1
G. Since all 20 deciduous teeth are out by 2 – 3 years, start teaching
2
brushing of teeth at this time.
H. Toddlerhood is the critical period for toilet training.
1. Clause to readiness for toilet training:
a. Can already stand alone – tracts of the spinal cord are
myelinated down to the anal level.
b. Can walk steadily.
c. Can keep himself dry for intervals of at least 2 hours
d. Can demonstrate awareness of voiding or defecating
e. Is able to use words or gestures regarding toileting needs
f. Is desirous of pleasing the primary caretaker
2. Age of achievement
A. Bowel control – 18 mos of age
1
B. Daytime bladder control - 2 yrs of age
2
C. Nighttime bladder control - 3 yrs of age

8
NCM 107 Care of the Child Concept

THE PRESCHOOLER
I. Definition: the child from 3 to 6 years of age
II. Psychosexual Stage (Freud): Phallic
III. Psychosocial Stage (Erickson): Initiative vs. Guilt
IV. Cognitive Stage (Piaget): Stage II (Perceptual Intuitive Stage) of the
Preoperational Thought Period – reasons can be given for beliefs and actions
but still considered prelogical and termed as preoperational intuitive thinking
V. Play
A. Type: Associative or cooperative
B. Age-appropriate toys
1. Housekeeping toys
2. Playground equipment (swing, seesaw, slide)
3. Tricycles
4. Watercolors; finger-paints; clay
5. Picture/coloring book
6. Materials for cutting/pasting
7. Simple jigsaw puzzles
VI. Greatest fears
a. Castration fear/body mutilation b. Fear of the dark
VII. Behavior Traits
1. They love to watch adults and imitate their behavior
2. They are very creative and curious, that is why their favorite word is “WHY?”
3. Imaginary playmates are common
4. They love to tell “lies” and brag or boast in order to impress others
5. They enjoy offensive language
6. Age of sibling rivalry; oedipal complex/electra complex
7. Questions about sex should be answered honestly at the level of their own
understanding
8. Masturbation may be seen in some - do not make fuss about it or punish the
child; just give toys to play with as substitute
9. Physical Development
A. Three years of age
1. Pedals trike
2. Walks backwards
3. Climbs stairs
4. Uses scissors
5. Helps dress himself
B. Four years of age
1. Climbs and jumps well
2. Uses alternate steps when climbing stairs
3. Throws ball overhand
4. Brushes teeth
C. Five years of age
1. Runs and hops well; jumps rope
2. Ties shoelaces
3. Skips; balances on 1 foot 8 seconds

9
NCM 107 Care of the Child Concept

THE SCHOOLAGE CHILD

I. Definition: the child from 6-12 yrs old.

II. Psychosexual Stage (Freud): Latency
I. Psychosocial Stage (Erickson): Industry vs. Inferiority
II. Cognitive Stage (Piaget): Concrete Operational Thought Period = thinking is now logical
and there is an ability to relate external events to each other, without being egocentric;
the child can understand classes and relations and can handle numbers; intellectual
development proceeds rapidly during this period.
III. Play
A. Type: Competitive
B. Age-appropriate toys
1. Dolls
2. Trains and model kits
3. Games; jigsaw puzzles; magic tricks
4. Books; table games
5. TV; video; records
6. Bicycles; skateboards
7. Collecting objects

IV. Greatest fears

A. Fear of replacement/displacement in school
B. Loss of privacy
C. Fear of death

V. Growth and development

A. General development
1. Moral code/superego becomes rigid
2. They are very modest/private
3. Although the influence of peers is very strong, eating habits are still set by the
examples of parents in the home.
4. When they become bored, they are boisterous and hard to control.
B. Specific behaviors

1. SEVEN YEARS OF AGE

a. Appearance of first molars and lateral incisors

b. Visual acuity is 20/20
 Numerator- the distance at which child is able to see
 Denominator- the distance at which the child is supposed to see
 E.g., a visual acuity of 20/40 means that the child is able to see at
20 feet what he should be seeing at 40 feet.
c. Withdrawn and moody; likes to be alone watching TV or listening to the radio.
a. Is seldom able to complete a task
b. Psychosomatic illnesses maybe common

10
NCM 107 Care of the Child Concept

c. Indulged in Card /Board games.

2. EIGHT YEARS OF AGE

a. With 10-11 permanent teeth

b. Onset of secondary sexual characteristics
c. Prefers playmates of own sex
d. Are dogmatic and self-righteous
e. Collecting stamps, etc. is a favorite hobby
f. Are exurberant and expansive

3. NINE YEARS OF AGE

a. More interested in friends and family

b. Lying and stealing may become prominent
c. Try to be like parent of the same sex
d. Worry and complain a great deal.

4. TEN YEARS OF AGE

a. Cooperative and affectionate

b. Are peer-oriented
c. With secret language
d. Companionship is more important type of play

5. ELEVEN YEARS OF AGE

a. Are critical of adults

b. Beginning hero worship
c. Are moody
d. With beginning interest in the opposite sex.

11
NCM 107 Care of the Child Concept

THE ADOLESCENT

I. Definition: The period from 12 to 18 years

II. Psychosexual Stage (Freud): Genital
III. Psychosocial Stage (Erickson): Identity vs. Role Development
IV. Cognitive Stage (Piaget): Formal Operational Thought Period = logical thinking
and the ability to reason; even theoretical hypotheses can be coped with and
concrete objects need not be introduced for understanding.
V. General Characteristics
A. Are bothered by the statement, “Who am I”
B. Tend to rebel against authority – flexibility of rules is necessary to give way to
a growing sense of independence; make available all sorts of needed
information.
C. Pubescent changes in males usually begin later than in females
D. Sports that require strenuous physical exertion should not be abused because
muscles are still functionally immature and can be injured by indiscriminate
exercise.
E. May easily get tired because body size increases faster than strength.

12