Republic of the Philippines

Bulacan State University

City of Malolos

CARE OF MOTHER, CHILD AND ADOLESCENTS: WELL CLIENTS

NCM 107A

GROWTH AND DEVELOPMENT

Prepared by:

Ana Guballa, MAN, RN, RM

A.Y. 2020-2021- 1st Semester

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Introduction

Everybody once became a child, you start to crawl, walk, run, and explore
the environment. Mother taught you how to read and write. You enjoy singing and
dancing with playmates and play with them the whole day without getting tired.
It's happy to reminisce about those years where you can freely play outside
home.
Nowadays with our “new normal” children were not allowed to go outside
their houses, their movements were limited inside their home, engaged
themselves in indoor games, rarely they communicate with other children, and
excel themselves with the use of gadgets and indoor games. As a nursing
student you must develop an eye to assess children's growth and development in
whatever setting it may be.
This module will help you understand the different stages of growth and
development of a child and apply the principles in taking care of them. Included in
this module are ways to promote health for normal growth and disease
prevention for children, this will help you as a nurse in the provision of effective
nursing care for children.

 Tables that keep information organized and easy to find.

 Memory Aid, that will help you remember important information.

 Learning MCN is hard work, Gyne make it easy. Gyne will be

your personal learning assistant that will provide you with clear
simple explanations of concepts or topics.

This particular module is divided into 3 lessons:

 Lesson 1 Theoretical Approaches to the Growth and Development
of Children
 Lesson 2 Nursing Process for Promotion of Normal Growth and
Development
 Lesson 3 Health Promotion and Disease Prevention in Different
Stages of Development

Objectives/Competencies
Upon completion of this module, you are expected to:
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1. Explain theories related to growth and development of children.
2. Apply principles of growth and development in the care of children.
3. Document own developmental milestone.

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Lesson 1: Theoretical Approaches to the Growth and Development
of Children

Duration: 4 hour

Good Day! Welcome to “New Normal” although we

don't see each other, we, your teachers will try our best to
teach you, for whatever method possible we could. I hope
and I pray that this pandemic will soon end so we can see
each other face to face... But for this time we have to
adapt and be flexible, for us to learn and be able to take
care of our clients, especially children, since you will be
the future front liners, you must learn as early as today the
profession you are taking and that is to serve and take
care of people whether they are sick or not.

Since you were done with the maternal part of this

course, the pregnant woman you are taking care of was
already delivered a child so we will then proceed with the
pediatric (child) portion of the course, first and foremost
we have to understand what growth and development
means;

Definitions of Terms:

1. Growth - means an increase in the physical size of a whole or any of its

parts.
Example of this is the height and the weight increases as the child grows, the
hair, finger nails, legs and arms, become longer.

2. Development - means the progression toward maturity in mental, physical,

and social markers (milestones) of normal development. Ability to perform
specific tasks or increase in skill.
Example is the ability of the baby to roll, smile, crawl and sit without support.
how the child picks up small objects. Maturation is a synonym for
development

The term chronological age is defined as the age in years, which differs
from developmental age which refers to the age based on functional
behaviour and ability to adapt to the environment.

Principles of Growth and Development

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1. Growth and development are continuous processes from conception
until death.
From the unison of two cells or what we call fertilization growth and
development starts… the fertilized egg (zygote) divides into more cells until it
reaches into a mature fetus… until it was delivered became a child, to
adulthood growth and development never stops and it only stop at the time of
the person's death.

2. Growth and development proceed in an orderly sequence.

Growth occurs from smaller to bigger. Development follows also a sequence,
the baby must roll first before he can lie its abdomen, then crawl, sit, stand,
walk and run.

3. Children pass through the predictable stages at different rates.

Children must learn how to walk for them to explore the environment, but
they learn to walk at different rates, for example a child walks at 9 months but
the other walks when she reaches the age of 12 months.

4. All body systems do not develop at the same rate.

There are body systems that mature rapidly and there are slow to mature...
like the reproductive system, it starts to mature when the child reaches
puberty.

5. Development is cephalocaudal.
“Cephalo” means head, “Caudal” means tail. Development starts from head
to tail, this means the child will start to lift first the head, then chest,
abdomen, then the legs and by one year she can stand upright and starts to
walk.

6. Development proceeds from proximal to distal body parts.

like the cephalocaudal that starts from the head to the tail or legs, proximo
distal is from near to far, example for this is the arm from thumb sucking to
pincer like grasp when she picks up small thing during toddler years (age 1 to
3-year-old)

7. Development proceeds from gross to refined skills.

The child when grasping an object uses the whole palm to get the thing, but
as the child grows older, it starts to use its finger to get a thing and not the
whole palm.

8. There is an optimum time for initiation of experiences or learning.

Mature nervous system plays an important role in the child's development,
even the parent trains a month old child to sit every day the child can't do so
unless the child reaches a certain age in which the nervous system matures

9. Neonatal reflexes must be lost before development can proceed.

Reflexes like grasp reflex must be faded before the child can pick up object,
reflex must be replaced by purposeful movement since reflexes are
involuntary body movements.
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 10. A great deal of skill and behavior is learned by practice.
Walking can be trained by letting the child walk on its own or the child must
practice, but if the child is always cuddled there will be a delay in the walking
skills of the child.

Factors influencing Growth and Development

Factors influencing Growth and Development

 Genetics
 Gender
 Health
 Intelligence
 Temperament
 Environment

1. Genetics - the characteristics that passes from parents to their children such
as eye and skin color, height... if the parents are small then most likely their
children are small

2. Gender - baby girl when born is slightly smaller than baby boy, boys
keep their height and weight until pre puberty age, at which time girls
tend to grow faster than boys during puberty age.

3. Health - a sickly child tends to develop slower compared to a healthy child

4. Intelligence - Children with high intelligence do not generally grow faster

physically than other children, but they do tend to advance faster in skills.
Intelligent children spend more time reading their books or studying that's
and they play mind games rather than engaged in a games that involved
motor activities

5. Temperament - An inborn characteristic at birth is how the child reacts to a

situation, parents should observe this reaction for them to deal with
individualized care for each child.

Categories of Temperament:
1. The Easy Child - easy to care for, can easily adapt to a situation,
mostly have positive mood
2. the Intermediate Child- with some characteristics of easy and difficult
child
3. The Difficult child -irregular habits, hard to please, withdraw rather
than approaches to new situation

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 4. The Slow to Warm up Child -fairly inactive to respond and slowly
adapt to new situations

6. Environment
 Socio economic level - children born in a poor family that cannot
provide good nutrition for their children are at risk of developing illness
thereby their growth and development is compromised.
 Parent- child relationship - children who received loved and
attention thrive better compared to those who received less
 Ordinal position in the family - (eldest, middle, youngest) the eldest
child communicates better because the parents still have time to
spend talking to their child, and sometimes there are parents who do
“baby talking” then the child develops the same way of talking.
 Health - an illness influence child growth and development compared
to a healthy child
 Nutrition - proper nutrition during growing years influences a child's
growth and development, food that has poor nutrients does not
sustain the needs of the body to grow. lack of energy prevents them
from learning at their best. Too much food makes the child obese.

Basic Division of Childhood

Table 4.1 Basic Division of Childhood

Stage Age period

Neonate first 28 days of life

Infant 1 month - 1 year
Toddler 1-3 years
Pre-schooler 3-5 years
School age 6 - 12 years
Adolescent 13 -21 years
Young Adult 21 - 30 years

Theories of Child Development

There are many theories regarding child development but i will limit my discussion
to three theorists only, namely Erickson, Freud and Piaget, the rest is for you to
study in your reference book

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 Theories of Child Development

 Erik Erikson's Theory of Psychosocial Development

 Sigmund Freud Psychosexual Theory
 Jean Piaget Stages of Cognitive Development

Erik Erikson's Theory of Psychosocial Development

Trained in psychoanalysis, his theory stresses the importance of culture and

society in the development of personality of a child

Table 4.2 Erik Erikson's Theory of

Psychosocial Development

Stage Developmental Task

(Psychosocial Stages)

Infant Trust vs. Mistrust

Toddler Autonomy vs. Shame/Doubt

Pre-schooler Initiative vs. Guilt

School age Industry vs. Inferiority

Adolescent Identity vs. Role Confusion

1. The infant- Trust vs. Mistrust- infants are dependent being, from feeding,
bathing, changing of diapers, when fully given and when needs are met and
discomforts were relieved, who are cuddled, played with, talked to suddenly
will developed trust, However, when the care given is inadequate and
inconsistent mistrust will set in., infants become fearful and suspicious of
people.

2. The toddler - Autonomy vs. Shame/ Doubt - children wants to do

everything alone or being independent (autonomy), whether it is unwrapping
a candy, selecting a food to eat, flushing a toilet is a big accomplishment for
them, and if parents recognize what they are capable of doing, children may
develop a sense of control over muscles and impulses. But when caregivers
are impatient and do everything for them, they will doubt that they cannot do
it by themselves.

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 3. Pre-schooler - Initiative vs. Guilt - initiative is learning how to do things,
when parents gives freedom, support and opportunity for their children to
learn on their own like running, biking, wrestling, sliding, and let their children
play sand, clay, water, and finger paints, their sense of initiative is reinforced,
However, if the child was given a limited movement in the environment like
strict and overprotective parents, busy to answer children's questions, then,
guilt over self will develop, and those children who do not develop initiative
will need guidance from others before deciding or doing things.

4. School aged children - Industry vs. Inferiority -children environment

grows to school and community, when school age children were praised or
rewarded of their work their sense of industry grows, like giving a gift when
they got 100% on a quiz, but if the parent do not appreciate their child's effort
and work, sense of inferiority will develop.

5. Adolescent - Identity vs. Role Confusion - to achieve identity, adolescents

must first understand who she really was, her role of being a son/daughter, a
friend, a student, an athlete, a cook, or an artist and these images must be
integrated as a whole. If an adolescent cannot do so, she/he may be
confused about its roles, and not sure what kind of person she/he is.

(stages like young adult, adult, older adult will not be discussed in this lesson
since our focus is only child development)

Sigmund Freud Psychosexual Theory

An Australia neurologist, he described behavior as being the result of instinctual

drives that is primarily sexual in nature (libido), and the (id) as the result of conflicts
that is arise from the instincts of a person, reality (the ego), and society (as the
superego) he described his theory of child development as a series of psychosexual
stages in which the child's sexual gratification becomes focused on a certain body
part.

Table 4.3 Sigmund Freud Psychosexual Theory

Stages Developmental Task

(Psychosexual Stages)

Infant Oral Stage

Toddler Anal Stage

Pre-schooler Phallic Stage

School age Latent Stage

Adolescent Genital Stage

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 1. Infant - Oral Stage - “Oral Phase “infant satisfaction and source of enjoyment
is through the mouth especially the tongue, they get pleasure from suckling,
if they are hungry and fed immediately, tension is already relieved.

2. Toddler - Anal Stage - “Anal Phase” as soon as the child learns to walk, they
must be taught where to eliminate, this is important to them as part of their
new discovery and a way of independence, they find pleasure in defecation
and urination
.
3. Pre-schooler - Phallic Stage - awareness of both sexes starts in this phase,
a boy and girl, they don't want to change clothes in front of many people,
they start to be aware of their playmates and classmates' gender.

4. School Age - Latent Phase - from libido appears to be focused on concrete

thinking, since they are in formal schooling, they begin to be competitive in
school, peers and siblings.

5. Adolescent - Genital Phase - during this stage, sexual maturity develops, the
focus is finding a new love object and finding satisfaction from it, intimate
relationships may start.

Jean Piaget Stages of Cognitive Development

A psychologist, she introduced cognitive development, or the way children learn
and think. She also suggests an appropriate play for each span of age. That could
be useful in taking care of a child

Table 4.4Jean Piaget Stages of Cognitive Development

Stage of Development Age Span

Sensorimotor 1 month - 24 months

Preoperational 2 - 7 years old

Concrete Operational 7 - 12 years old

Formal Operational 12 years

1. Sensorimotor – new born behavior is more on reflexes, hand - mouth and

eye- ear coordination develops, starts to look at an object and puts thumb
inside mouth. They also begin to recognize parents and memorize their
faces, and at the end of six months, can search and look for objects that
disappear from view, and a sense of separateness develops, separation
anxiety appears when the caregiver leaves. By the end of 24 months, they
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 can memorize and imitate an act. toys for a one to four months old child are
rattle, activity is peek-a-boo, for one year old is colored boxes and activity is
throw and retrieve.

2. Preoperational - answers questions mentally, perceived animals and objects

have feelings or the “magical Thinking” example the doll is feeling sad
because she was left alone inside the cabinet, but this magical thinking will
fades a s soon as the child learns accommodation, that is, knowing the
reality, they can do simple comprehension, and are egocentric which only
focuses on themselves, concept of time is now a good toy for them is
modelling clay to stimulate imagination.

3. Concrete Operational - able to do systematic reasoning, can explain broad

concepts (food) to a particular concept (burger), can count according to
order, increasing and decreasing, memorize multiplication tables, and
understands conservation. During this stage the best or the common activity
for them is collecting things, for girls they collect stickers, note pads. for boys,
they collect matchboxes.

4. Formal Operational - can solve problems using scientific basis, the best
activity is “talk time”.

Self-Check 4.1

Totoy, 6 years old, is a school aged child. What must he learn, according to
Erikson, to complete the developmental task of this period?
a. How to be creative
b. How to think abstractly
c. How to trust other
d. How to do things well

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Lesson 2: Nursing Process for Promotion of Normal Growth and
Development

Duration: 4 hours

You as a nurse have a big role to help a parent

specially the first time parent in the achievement of normal
growth and development of a child, even if you are still
single you can do health teaching, and demonstrate
proper care, you must also develop a love for children so
you can enjoy every moment with them and enjoy your
profession as well, to begin with, let's study first the normal
growth and development of an infant. Below is the table of
summary of infant growth and development,

Infant

Table 4.5 Developmental Milestones of an Infant

Month Motor Fine Motor Language Play

Development

0-1 Largely reflex Keeps Watch face

hands of
fisted, caregivers,
follow listening to
object to sounds
midline

2 Holds head up Displays Makes Enjoys

when prone social smile cooing bright
sounds colored
mobiles

3 Holds head and Follows Spends

chest up when in object fast time looking
prone midline at hands or
makes them
as toy

4 Grasp, tonic neck Needs

reflexes are space to
fading turn

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 5 Turn front to Handles
back, no head rattles well
lag when pulled
upright, bears
partial weight on
feet

6 Turns both ways, Uses May say Enjoy

Moro reflex palmar bowel bathtub
fading grasp sounds (oh- toys, rubber
oh) ring for
teething

7 Reaches out to Transfer Fear of Likes

be picked up, object hand strangers objects that
first tooth(central to hand are good
incisor)erupts, size for
sits unsteadily transferring
needs support

8 Sits securely Peak fear of Enjoys toys

without support stranger of different
textures

9 Creeps or crawl Says first needs

(abdomen off word da-da space for
floor) creeping

10 Pulls self to Uses pincer Plays game

standing grasp like patty-
(thumb and cake and
finger) to peek-a-boo
pick up
small
objects

11 “Cruises” walks Cruises

with support)

12 Stands alone, Holds cup Says two Likes toys

some take first and spoon word ma-ma that fits
step well, helps and da-da inside each
to dress other (pots
(pushes and pans)
arm into nursery
sleeve) rhymes, pull
toys

Taking care of infants varies from culture to culture, and different moms have
different styles of taking care of their children, some mothers carry their child in their
arms, some use sling. In bathing their child, some mom bathes the child daily, some
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do not bathe their babies every Friday, put on coins on the navel so not to become
protruded,, putting on binder is an old tradition of umbilical care, wrong practices
that may put the child at risk, you can help mother to correct the wrong way of
nursing their child. All the things you’ve learned from the classroom must be shared
to mother and not to keep them for your own benefits.

Growth and Development of an Infant

During this period of infants' life, we will be surprised that there is a rapid growth in
size and their ability to perform their tasks.

1. Weight
Most babies double their birth weight when they reach 6 months old and
triple it by 1 year, so if the new born weighs 3kgs, we expect that when he is
6 months old, the weight is 6kgs, and 9 kg when he is 1 year old. During the
first 6 months of life weight gain is 2lbs/month, and in the second 6 months
weight gain is 1lb/month. The average 1-year-old weighs 10kg, while the girls
weigh 9.5kg.

2. Height
Height during the first year of life grows by 50% from its birth length

3. Head circumference
New born usually have a bigger head and are 2cm bigger than the chest, and
that is because of the rapid brain growth. You, as a nurse, must explain to
the parent that this occurrence is normal, and advise them to put a cap on
the new born head.

4. Body Proportion
If you are going to observe the body of an infant it seems that it is not
proportionate, the head is big, abdomen is protruded, short extremities, but
for us it seems cute. In the long run when the child's reach the end of first
year the appearance will transform from “baby like to toddler like”.

5. Body system
● Cardiovascular system - from 110-160 it slows to 100 -120 beats /min,
blood pressure increases from 80/40 to 100/60 mmHg.
● Respiratory rate - from 30 -60 to 20 -30 breaths /min.
● Gastrointestinal tract - digestive system is still immature... at 4 months
an extrusion reflex is present (when food was placed in an infant's
tongue it pushes them out,) food introduction during this time would
not be effective, by the age of 9 to 10 months the infant can hold cup
independently
● Urinary system - kidneys remain immature and unable to concentrate
urine compared to adult which may make them prone to dehydration
● Immune System - is functional until at the age of 2 months, and
actively produced until 1 year of age

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 6. Teeth
● The first tooth usually erupts at 6 months of age, followed by a new
one monthly, natal teeth newborn with teeth

Motor Development

1. Gross Motor Development

To assess gross motor development, infants must be placed in four positions.
(I will give you some of the developmental tasks achieved during the first
month and I held you responsible to study the task in the succeeding months
in your reference book.)

 Ventral Suspension position - infants is held midair on a horizontal

position supported by a hand under abdomen, a one-month old child lifts
the head and drops it again
 Prone position - when lying on the abdomen, a one-month old infant lift
head and turn to one side easily
 Sitting Position - from lying position, pulled the baby to a sitting position,
at one month the child' back appears rounded and the head can control
momentarily
 Standing Position - stepping reflex is still present at one month of age.
When the child stands, you will observe that the hips and the knees are
flexed and do not support the whole body weight.

2. Fine motor development

Strong grasp reflex is present during the first month of infant’s life, thumb
opposition (ability to bring the thumb and fingers together)

3. Language Development
An infant makes cooing sounds by the end of the first month.

Parental concerns and Problems related to Normal Infant Development

1. Teething - rubbing the gum line with cloth helps the teeth to erupt, tethers to
sooth the pain of the gums should be kept inside refrigerators. Fever,
vomiting, earache, loose stool are not signs of teething it indicates infection
2. Thumb sucking – thumb sucking is normal until 18 months and it does not
deform the jaw.
3. Use of pacifiers - infant who is still looking for something to suck even they
are full need a pacifier, it makes them relax and comfortable, the problem
with the pacifiers is when they fell to the floor and it is not properly washed,
and if it is hang on the neck it could strangle the infant. pacifiers should be
weaned during 6 to 9 months were in sucking reflex fades
4. Head banging - advised parents that head banging is a way to relieve
tension in infants, make sure that the crib railings are padded to prevent
injury.

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 5. Constipation - breastfed infant has a natural loose stool, constipation is the
problem of formula fed infant, because of its water deficient, offer water after
each feeding to prevent constipation.
6. Loose stools - mother must understand the description of the infant stool,
for breastfed infant stool it is softer than formula fed infant, proper
assessment like frequency, consistency, color and presence of blood must
be asked to the parent.
7. Colic - abdominal pain that occurs to infants under three months of age, the
abdomen is tender to touch, cries loud, legs pull up and fist clenched,
advised mother to burp baby after each feeding.

Toddler

Nursing Care of a Family with a Toddler

1. Physical Growth

a. Weight, Height, body mass index, head circumference - these are

the things to monitor and should be plotted on the growth chart. for the
child who is not walking, height must be measured when lying.
b. Body contour - still the abdomen is prominent, because abdominal
muscle is not yet fully developed and can't support fully the abdominal
content and walk with a wide stance
c. Body system - body system continuously matures during this stage,
respirations and heart rate slows, blood pressure increases, brain
develops to 90 % of adult size
d. Teeth - 8 teeth erupt, at 2 years’ old

Table 4.6 Developmental Milestone of Toddler

Age in Fine motor Gross motor Language Play

month

15 Put small Walks alone, 4-6 words Can stack

pellets into can seat in a two blocks,
bottle, holds chair, can enjoys being
spoon well creep upstairs read to.
but may turn
it upside
down to the
mouth,
scribble
pencil and
crayons

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 18 No longer Can run and 7 - 20 words Imitates
rotates the jump, can go household
spoon to up stair holding chores,
bring it to the handrail parallel play
mouth

24 Can open Walks up stairs 50 words Parallel play

door alone (playing with
playmate
beside)

30 Makes can jump down knows full Imitating

simple line or stairs name, can parents
strokes name one action
color, and
make hand
gesture of
age

Toddler period is very critical, this is the time in which they start everything, they
explore their environment, they are curious, you must encourage children to
converse so they can express themselves and strengthen their vocabulary, some
parents are overprotective that they limit their movement, asked them what they
want and guide them, help them to trust themselves and do things according to their
likes and dislikes. allow them to play with other children, do not force them to share
their toys with others if they do not want to, parallel play is playing with playmates
besides them not with them, meaning they have their own toys, they play on their
own even if they sit beside each other.

Parental Concerns Associated with the Toddler Period

1. Toilet training - as soon as the toddler learns to walk and can understand
instruction, children can be toilet trained. Make sure that the pants can be
easily pulled down, potty chairs must be placed in a location that can easily
be reached or if a child will use a regular toilet they must place a footstool so
the child can sit easily.

2. Ritualistic behavior - A child enjoys routine activities like using his own
spoon or a cup, he will not eat unless you bring out his cup or spoon.

3. Negativism - children do not want to do what their parents want, they always
say “NO”, they are trying to break rules of their parents, and parents must
understand that the child is trying to exercise its independence.

4. Discipline - imposing discipline to toddlers is setting rules for the child to

follow, punishment is the consequence if they break the rules, parent must
set some rules for the child protection and safety, like “do not hit others”, “do
not go out on the street”, parents must be consistent in setting rule, rule is

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 best learned if they praise the child for doing right things rather than giving
punishment if they don't follow.

5. Separation Anxiety - this is the universal fear for a child to be separated

from parents, especially if somebody will take care of them temporarily while
parents are at work. Parents must explain and assure the child that they will
be back after work and will take care of him. Crying is normal when the
parents leave, prolonged goodbyes make the child cry more, but parents
must be firm in explaining things to the child.

6. Temper Tantrums - most parents get irritated when their child throws, kicks,
shouts, screams, flails arms and legs, bangs head and bite, this is a natural
consequence of development for a toddler, because child knows what they
want but they cannot express their wants in an appropriate way. The best
approach is to explain to the child that tantrum is not a good thing, and will
talk with the child after the tantrums.

Pre-schooler

Nursing Care of a Family with Pre-schooler

1. Physical Growth - from the wide-legged gait and prominent lordosis of a

toddler, the child body became slimmer and taller or ectomorph body build
(slim body build) or it could be an endomorph body build (large body build).
The use of right or left hand is obvious during this stage, muscles become
stronger that they could engage in sports and other physical activity, some of
the children experience genu - valgum (knock knees), but it will correct itself
as the child grows.
a. Weight, Height, - there is a slight weight gain during this period is 2kg
per year, for the height only 2 to 3.5 in. (6 to 8 cm) a year.
b. Teeth - preschool child have 20 deciduous teeth by
3 years of age; permanent teeth don’t replace these until school
age.
c. Play - they enjoy games that are imitating and pretending, like
pretending to be a teacher, nurse, doctor, engineers, they also have
imaginary friends and these are normal until they begin schooling.

2. Emotional Development
a. Initiative - they want to explore and feel that it is fun to learn new
things
b. Imitation - they want to imitate people around them, role modelling of
parents is important in this period.
c. Fantasy - magical thinking is very active during this stage, they don't
know the difference between reality and fantasy, they perceived
cartoon characters as real, that sometimes they lost their own identity
and stuck into it.

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 d. Oedipus and Electra complexes - oedipal complex refers to the strong
emotional attachment a preschool boy has toward his mother; an
Electra complex is the attachment of a preschool girl to her father.
(“Daddy’s girl – Mama’s Boy)
e. Gender role - child becomes aware of the sexes difference and their
roles, like the role of a girl to do house chores and the boy to do
carpentry or office work
f. Socialization - children during this period are capable of sharing and
playing with other children

Table 4.7 Developmental Milestone of Pre-schoolers

Age in Fine motor Gross Motor Language Play

years

3 undresses runs alternate 900 words very

self, stacks feet on stairs, imaginative
tower tricycle, stands
on foot

4 can do simple constantly in 1500 words pretending

buttons motion, jumps,
skips

5 can tie shoes, throws 2100 words likes games

can draw six overhand with letters
figure or numbers

Parental Concerns of Preschool Parents

1. Common Health Problem - cough and colds is the common health problem
experienced by preschooler, or respiratory problem especially if one parent is
smoking, gastrointestinal problem like diarrhea and vomiting, because of the
child exposure to others.

2. Common Fears
a. Fear of the dark - because the child is imaginative they developed this
fear, parents must reassure children that they are safe inside the
house.
b. Fear of mutilation - this is an intense reaction if something has
happened to them even a small scrape on knee. They feel that the
train will come out of the wound, boys are afraid of being castrated.
c. Fear of separation or abandonment - being left on the Day care center
is a big deal to the preschooler, they do not understand time and
space, they don't know that they will be picked up at 3pm, but instead
you will be picked up after you’ve taken your snacks.
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 d. Behavior Variations
● Tell tales - stretching stories to make them more interesting, they add
stories to what really happened.
● Sibling rivalry - jealousy of a brother or a sister or a new baby.
● Imaginary friends - they have imaginary friends and this is normal
among preschooler as long as they have real friends that play with
them
● Difficulty sharing - this is a difficult concept to understand among
preschooler, what is theirs is theirs, what is yours is yours. Defining
limits set by parents (we, they, us) is important for the child to
understand sharing.
● Regression - Some preschooler, generally in relation to stress, revert
to behavior they previously outgrew, like thumb-sucking, negativism,
loss of bladder control, and inability to separate from their parents

3. Preparing for a new sibling - explaining to the child about the upcoming
baby, rather than hearing it to others, transferring the baby from a crib to new
bed three months ahead might help and explain that the new baby will
occupy the crib

4. Sex education - do not let the children feel that something should not to be
talk, there should be an open communication about that topic, answer
questions truthfully.

School Aged Children

Nursing Care to Family with School Aged Children

1. Physical Growth
The average weight gain for a school-age child is approximately 3 to 5 lb (1.3
to 2.2 kg) per year; the increase in height is 1 to 2 in. (2.5 to 5 cm). Knock
knees and lordosis will disappear now. At the age of 10, brain development
has already completed. Malocclusion and mal-alignment may be present.
The eruption of permanent teeth and growth of the jaw do not correlate with
final head growth.

2. Teeth - child gains 28 teeth between 6 and 12 years of age: the central and
lateral incisors; first, second, and third cuspids; and first and second molars

3. Sexual maturation - during this time the hypothalamus transmits an enzyme

to the anterior pituitary gland to begin production of gonadotropic hormones,
which then activate changes in the testes and ovaries to cause puberty.
Puberty varies between 8 and 14 years old. Physical changes may occur.
● Concern for girls - girls are usually taller by about 2 in. (5 cm) or more
than boys because their typical growth spurt begins earlier. Breast
starts to develop and Pelvic begins curves and vaginal secretions is

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 present, irregular menstruation is present 1 to 2 years after menarche
(first menstruation)
● Concern for boys - boys are not that prepared compared to girls when
it comes to physical maturity, boys become aware of increasing
genital size. If they do not know testicular development precedes
penis growth, they can worry that their growth will be inadequate

Table 4.8 Chronologic Development of

Secondary Sex Characteristics

Age in Boys Girls

years

9 - 11 Pre pubertal weight gain Breasts: Elevation of papilla

occurs. with breast bud
formation; areolar diameter
enlarges

11- 12 - Growth of straight, - Straight hair along the

downy, slightly labia. Vaginal
pigmented epithelium becomes
hair at base of penis horny.
- Scrotum becomes - pH of vaginal secretions
textured; growth of becomes acidic; slight
penis and testes mucous vaginal
begins. discharge is present.
- Sebaceous gland - Sebaceous gland
secretion increases. secretion increases.
- Perspiration increases. - Perspiration increases.
- Dramatic growth spurt.

12 - 13 - Pubic hair present - Pubic hair grows

across pubis.
- Penis lengthens.
- Dramatic linear growth
spurt.
- Breast enlargement
may occur
darker; spreads over
the entire pubis.
- Breasts enlarge, still no
protrusion of nipples.
- Axillary hair present.
- Menarche occurs.

Parental Concern of School Aged Period

1. Problems Associated with Language Development - The usual problem of

school aged children is articulation, some of them cannot pronounce letters
properly; frequent reading will help in correcting pronunciation.

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 2. Common Fears and Anxieties of a School-Age Child
● Anxiety Related to Beginning School.
● School Refusal or Phobia.
● Home schooling
● Children Who Spend Time Independently
● Sex Education
● Stealing
● Bullying
Traits associated with school Bullies
a. Advanced physical size and strength for their age
b. Aggressive temperament (both male and female)
c. Parents who are indifferent to the problem or are
permissive with an aggressive child
d. Parents who typically resort to physical punishment
e. There is the presence of a child who is a “natural victim”
(e.g., small, insecure, with low self-esteem)
● Recreational drugs

School should be a learning place for children, but most of them had bad
experiences inside the school. they encounter bullying that they don't want to go to
school, parental support is very important at this point. This is also a place where
they learn bad things that are being influenced by friends, like stealing and using
prohibited drugs, these things should be reported to the school personnel. Stated
above are the traits of a bully child and its victim. Really, school will teach you the
good and sometimes experienced bad thing; the important is how you must
overcome those.

Adolescent

Nursing Care of a Family with Adolescent

1. Physical Growth

a. The major milestones of physical development in the adolescent

periods are the onset of puberty at 8 to 12 years of age, and the
cessation of body growth around 16 to 20 year.
b. Puberty is the time at which an individual first becomes capable of
sexual reproduction. A girl has entered puberty when she begins to
menstruate; a boy enters puberty when he begins to produce
spermatozoa.
c. Secondary sex characteristics, such as body hair and breast growth,
are those characteristics that distinguish the sexes from each other
but that play no direct part in reproduction.

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 Table 4.9 Sexual Maturation in Adolescents

Age in Males Females

years

13 - 15 Growth spurt; pubic hair Pubic hair thick and curly,

abundant and triangular in distribution;
curly; testes, scrotum, and breast areola and papilla form
penis enlarge; secondary mound;
axillary hair present; facial hair menstruation is ovulatory,
fine and downy; making pregnancy possible
voice changes happen with
annoying frequency

15 - 16 Genitalia adult; scrotum dark Pubic hair curly and abundant;

and heavily rugated,
facial and body hair present;
sperm production mature
may extend onto medial
aspect of thighs; breast tissue
appears adult; nipples
protrude; areolas no longer
project as separate ridges
from breasts; may have some
degree of facial acne

16 - 17 Pubic hair may extend along End of skeletal growth

medial aspect of thighs;
testes, scrotum, and penis
adult in size; may have
some degree of facial acne;
gynecomastia (enlarged
breast tissue)

17 - 18 End of skeletal growth

Above is the table that shows sexual maturation for both male and female, as
an adolescent you will experience those, most of you find it exciting as it prepares
you to the next level of maturity, but you must be careful in taking care of your body.
It is important that you understand what is happening or the changes of your body,
from being a child to a grown up one, so as not to get confused. As a nurse you
have to share what you have learned from the classroom, for them to understand
the normal process of becoming an adolescent

2. Developmental Milestone

a. Play - From school-age activities of active games, to more adult forms of

recreation such as listening to music, texting or chatting, or following a sports
team’s wins and losses.
b. Emotional development
● Accepting their changed body image
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 ● Establishing a value system or what kind of person they want to be
● Making a career decision
● Becoming emancipated from parents
Being an adolescent is not that easy with so many stressful events
happening around them, role expectations from the family, from peers
to be accepted, from school to choose what career to take in the
future and being independent or emancipated from parents. Parents
can play a big part by encouraging them to be a righteous and honest
person.
c. Cognitive Development
It involves the ability to think in abstract terms and use the scientific method.
With their ability of problem solving methods they can start planning their
future.

Self-Check 4.2

Jun, 5year old, awakes screaming because a monster with red eyes is chasing
after him, his father response should be
a. ‘Go back to sleep, you’re just having nightmares’
b. ‘There’s no such thing as red eye monster’
c. ‘Turn on the light so that monster will disappear’
d. ‘Sleep with us, monster will not harm you’

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Lesson 3: Health Promotion and Disease Prevention in Different
Stages of Development

Duration: 4 hours

We are done discussing the normal growth and

development of each age group, you are now aware of
what is happening for each age group, as a nurse you can
now determine the deviation from normal and suggest
some recommendations to promote a healthy lifestyle that
fits them. The next lesson will help you further learn on
ways to promote health and prevent disease. That you
can use in the application of nursing care to children.

Infant

Health Promotion of a family with an infant

1. Promoting infant safety

Infant can't take care of itself, the immediate caregiver must protect the
child against accidents.

a. Aspiration prevention - feeding babies in a lying position puts them

at risk of aspirations, make sure that during feeding the best position is
sitting position or semi sitting position.
b. Fall prevention - make sure that the child is always being watched
especially when the child starts to move or wiggle that puts them on
the edge of a bed.
c. Car safety - use of car seats is important during travelling with an
infant.
d. Safety with siblings - playing with siblings sometimes brought
accidents, playing too rough for an infant will put them in danger,
parents must be advised to be with their infant when playing with
siblings
e. Bathing and swimming safety - never leave the infant in a tub,
wiggling may cause the infant to slip down under water. There are
swimming school that accept as early as 6 months child, parents are
confident enough to let their infant swim, chlorinated water damages
lung epithelium that may be a factor to childhood asthma
f. Childproofing - making the house child proof “safe” , like covering the
electrical outlet, moving furniture out of the child's pathway, putting
small objects off the floor, use paints that is not harmful, sharp corners
must be padded, rubber mats can be placed to prevent head bang,
avoid giving small toys that can be swallowed, door must always be
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 closed to prevent them from roaming out the house and do not leave
the child unattended

2. Promoting Nutritional Health of an infant

Breast Milk is best for baby, it has complete nourishment that the child’s
need until 6 months, all vitamins are included except Vitamin K, which is
given IM at birth, early weaning from breastfeeding can lead to obesity, since
formula milk has sugar in it, and prolonged breastfeeding until preschool
might impair child's growth since the nutrients are not enough to sustain the
body needs of a growing child.

a. Recommended dietary intake for an infant - during the first year of

life of a child there is a rapid growth so high-protein, high calorie intake
is necessary, both formula milk and breast milk contain 20calorie/oz.
calorie allowances can be reduced gradually during the first year from
120 per kilogram of body weight at birth to 100 per kilogram (45
calories per pound) at the end of the first year to prevent overweight.
b. Introduction of Solid Food - many parents are excited to feed their
child, they must be reminded that they have to wait until extrusion
reflex (everything that is placed on the new born tongue will be pushed
out) fades that is 3 to 4 months in time when the digestive tract
matures.
c. Techniques for feeding solid food - usually the first solid food that is
being offered is
● iron fortified cereal with breast milk - this is to prevent anemia
● vegetable can be pureed as a source of Vitamin A
● fruits can be strained as a source of Vitamin. C
● flaked meats as a source of protein, iron and B vitamins
encourages chewing when the teeth erupt
● at the end of first year egg yolk can be added as a source of
iron
● Advised parents to be cautious in giving allergenic food, like
peanuts, tomatoes, wheat, fish and eggs, avoid using of honey
as sweetener because it may contain botulism spores
● introduce food one at a time and may be eaten for 3-7 days
before introducing a new one, to check the child's allergy for a
certain food
● do not overfed, new born can only hold 2tablespoons (30ml)
and by a year it can hold up to 1 cup only (240 ml)
d. Establishment of healthy eating patterns the main purpose of
feeding is to provide nourishment right food, should be eaten at the
right time with the right amount and should be nutritious.
● healthy, happy infants will be hungry at meal time and will eat
● if infant refused to eat, ask parent the food they are offering
● an infant who is stressed or over stimulated may not eat well,
provide quiet environment away from siblings before mealtime

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 ● encourage parents not to force infants to eat if they are not
hungry, forcing may lead to regurgitation and vomiting that
could result in feeding problem
● infant who is not eating and thriving for food should be
examined.
e. Weaning - breastfeeding is good for babies up to 6 months old, since
sucking reflex starts to fade during this month, parents may consider
weaning their child, choose a feeding within a day and introduce fluid
by a cup, after a week another feeding but still offer fluid until the child
gets used to the routine. Offer more fluids if the weather is hot to
replace fluid lost because of respiration.
f. Self-feeding - at the age of 6 months a child is excited to hold a
spoon and feed by themselves, although it is not neat eating, parents
may spread newspaper on the floor to catch spillage. If the child plays
with the food, squeeze it or place it on their body that is the time to
end the meal.

3. Promoting Infant Development in Daily Activities

Taking care of the infant daily activities occupies most of the time of the
caregiver, although exhausting but it is a joyful activity for a new parent.
Advised parents to find time in which they can sleep, most parents sleep
while their child is asleep or they have to manage their time for other
household chores.

a. Bathing - according to your book, infants do not need daily bath,

except hands, face and diaper area. But here in the Philippines where
we are in a tropical country we can advise parents to do daily baths,
especially the scalp that sometimes becomes crusty, or what we call
seborrhea or cradle cap, that needs everyday washing. Make bath
time fun for infants. It also gives opportunity for exercise and child-
parent bonding.
b. Diaper area care - diaper may be changed every 2 to 4 hours, clean
the area after each change using clean water or non-alcohol diaper
wipes. If rashes occur air drying may be a solution and use warm
water to cleanse the rashes. Baby powder and lotion should not be
applied on the diaper area

c. Care of teeth - it is recommended that fluoride application is best at

the age of 6 months, especially to breastfed infants because breast
milk does not have fluoride. Oral care must be provided even when
there are no teeth by wrapping the fingers with soft clean cloth and
carefully rubbing it on the gums. If the teeth erupt you may advise the
parent to use a soft bristle toothbrush or the commercial rubber brush
for babies.
d. Dressing - clothing should not be tight to give rooms for moving, it
should be simply tailored so that dressing is not a struggle for them,
socks should be worn to provide warmth and protection against rough
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 texture, long pants are advisable when the child's start to crawl to
protect its knees.
e. Sleep – new born sleep most of the time, 10-12 hours of sleep is
required for infants, there are parents who sleep with their infant
specially the breastfed one, because the mother can easily feed the
baby and attend to its need, but danger of accidental suffocation might
happened for this sleeping arrangement. For babies who sleep
separately, quiet themselves and go back to sleep whenever they are
awake, except if they are wet.
f. Exercise - crawling, kicking, sitting are the physical exercises for
infant, they may go outside for sunlight, exposure to sunlight should
be 15 to 20 minutes only, it should be done when the sun is not
intense or too hot, do not let the infant stare the sun, face its back to
the sun.

Toddler

1. Promoting Toddler Safety

a. Motor vehicles - toddler should always be with adults especially

outside the house, whenever crossing the street or playing at the
lawn, if travelling they should be in a car seat, assisting them when
they are biking.
b. Falls - make sure that the crib is locked whenever you are leaving,
supervise them if they want something up in a cabinet, always walk
with them.
c. Aspiration - avoid food and toys that are choking hazard, avoid giving
small hard candies.
d. Drowning - do not let children swim alone even if they know how to
swim, or leave them unattended during bath time because they might
slip under water.
e. Animal Bite - supervise them when they are playing with pets
f. Poisoning - medicines, detergents, chemicals should be kept properly
inside the cabinet.
g. Burns - make sure that hot pots, coffee, hot noodles should be out of
reach of children

2. Promoting Nutritional Health for Toddlers

Educate parents not to force the child to eat too much, offer only a small
portion of a food serve so they could finish it on a clean plate, allow self-
feeding to strengthen independence.

a. Sedentary children ages 1 to 3 years should consume 1,000 kcal daily;

active children in this age group may need up to 1,400 kcal daily.
b. Calories may be subdivided into three meals a day

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 c. Sweet foods must be avoided to prevent obesity, carbohydrates and
protein is important nutrients during this stage
d. Whole milk is best source of calcium for bone mineralization

3. Promoting Toddler Development in Daily Activities

a. Dressing - encourage children to dress on their own, most toddlers

can wear socks and underpants during this time, if they are to wear
shoes sometimes they switch the right from the left shoe, change it
using a positive statement to encourage autonomy.
b. Bathing - makes bath time a fun time, toddler enjoys bath time, but
do not leave them unattended, even if they can sit well still they might
slip on a tub.
c. Dental care - to prevent dental caries because of eating sweets and
carbohydrate rich food, encouraging parents to offer fruits, instead of
cookies, drinking milk is important as a calcium source for strong bone
and teeth, brushing teeth before going to bed is best time rather than
frequent tooth brushing.
d. Sleep - A toddler needs 12 hours of sleep, with afternoon nap, if the
child encounters difficulty in sleeping at night parent must shorten the
afternoon nap, tired child may easily fall asleep.

Pre-schooler

1. Promoting Safety of Pre-schooler

a. Keeping children safe, strong and free - educate children about the
potential threat or harm from strangers and how to deal with bullying
from people around them, explain to them that they should not talk to
strangers
b. Motor vehicle and bicycle safety - they should be buckled up to car
seats, bicycle safety such as wearing of helmets and knee pads

2. Promoting Nutrition of Pre-schooled children

● Make sure they eat a variety of foods, and do not offer a great deal of
meat because it is hard to chew.
● Supplementary vitamins are sometimes unnecessary as long as the
child eats foods from all five food groups and meets the criteria of a
healthy child that is alert, and active, height and weight are within
average.
● A child who has eaten a vegetarian diet, to serve food it must be
colorful and therefore appealing to preschoolers. Vegetables, fruits,
and grains are also healthy snack foods.

3. Promoting Daily Activities

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 a. Dressing - they can dress themselves, they prefer bright colored
clothes, and select clothes that are appealing rather than matching.
b. Sleep - they don't want afternoon naps even they are tired, they fear
of the dark, and experienced bad dreams, suggest to parents to avoid
horror movies before getting to bed
c. Hygiene – preschoolers can wash their hands, they can bathe
themselves but still with supervision of an adult because they tend to
swim in a bathtub, and they cannot really clean themselves especially
the ears and hair, they need somebody to really wash their hair.
d. Exercise - this is an active period, they love to do physical play, like
running, ring around the rosy, promoting this kind of play will prevent
obesity
e. Care of the teeth - they can do tooth brushing, but parents must
check if all teeth surface is clean.

School Aged Children

1. Promoting School aged Safety

Good education on safety measures is needed among school aged

children. The same with adults, accidents happen when they are not focused
on what they are doing. Carrying heavy backpacks more than they can,
School age backpack that weighs more than 10% of the child’s body weight
is enough to cause a child to lean forward that can cause back pain.

2. Promoting Nutrition

a. Establishing Healthy Eating Patterns - before going to school,

children must eat their breakfast to provide them energy for the
morning school activity, ask the child food preference for pack lunch,
after school children are hungry and want a snack, offer fruits, cheese,
corn or milk rather than cookies and soft drinks so not to dull child's
appetite for dinner.
b. Recommended Dietary Intakes - Both girls and boys require more
iron in pre puberty than they did between the ages of 7 and 10 years.
Adequate calcium and fluoride intake remains important to ensure
good teeth and bone growth.

3. Promoting Daily Activities

a. Dress - school-age children can fully dress themselves, they are not
skilled at taking care of their clothes until late in the school-age years.
This is the right age, however (if not started already), to teach children
the importance of taking care of their belongings.
b. Exercise - school aged children spend most of their time in school,
they tend to be tired after the school, parent must have encouraged

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 their children to at least do bicycling, walking with the dog, so as to
prevent obesity
c. Sleep - Younger school age children typically require 10 to 12 hours of
sleep each night; older ones require about 8 to 10 hours
d. Hygiene - parents must emphasize the importance of cleanliness
especially during this period in which sebaceous glands are very
active. For girls, daily bath is important especially during menstruation,
they might be afraid that taking a bath is bad during menstruation, and
for boys who are uncircumcised may develop inflammation under the
foreskin, they must be informed of the proper way of cleaning
themselves.

Adolescent

1. Promoting Adolescent Safety

 Unintentional Injury
 Motor vehicles
 Firearms
 Drowning
 Sports

These are the leading cause of death among teen age, since they are
at the peak of physical and sensory-motor functioning they tend to attract
attention by being risk takers, that lead them to careless actions. Parents
must insist on emotional maturity rather than age maturity, proper driving
lessons and securing license is very important. They must learn also on how
to swim to prevent them from drowning. Consider guns as a lethal weapon.
Proper and safe handling of firearms must be learned first before going
hunting. Remember to always take safety measures when engaging in sports
such as wearing protective gear and hydrating yourself.

2. Promoting Nutritional Health for an Adolescent

Adolescents love to eat, since they are experiencing rapid growth. They are
always hungry, they do not consider the amount and the nutritional value of
food they are taking, and are always busy in school and activities, always
having fun with friends that they enjoy eating junk foods. Parents must
remind them of what food to eat and avoid soft drinks and chips.

The nutrients that are needed most of both male and female
adolescent diets are iron, calcium, and zinc. Iron is necessary to meet
expanding blood volume requirements. Females require a high iron intake to
replace blood lost during menstruation. Increased calcium and vitamin D plus
are necessary for rapid skeletal growth.

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 3. Promoting Development of an Adolescent in Daily Activities
 Dress and Hygiene
 Sleep
 Care of teeth
 Exercise
 Sun Exposure

Adolescents are capable of self-care and since they are conscious of

their body changes they are particular in their appearance and personal
hygiene, although they need to be reminded to use deodorants and
antiperspirants, since they perspire actively. Nowadays, they sleep late at
night and wake up late. Everybody needs 8 hours of sleep, to gain strength
for the next day. Exercise is required to keep their muscles toned and an
outlet to release tension, advising adolescents to do simple exercise even at
home since they are busy at school from morning until night; they are rare
exposed to the sun

4. Promoting Healthy Family Functioning

a. Common Health Problems of an Adolescent

● Hypertension - Adolescents who like to eat fatty and salty foods are
likely to develop hypertension and those who have a family history of
hypertension. 120/80 is the average blood pressure for adolescents.
Low salt low fat diet is recommended for hypertensive adolescents.
● Posture - It is developed to adolescents who are taller than their
peers they tend to slouch, so as not to appear taller than the other,
one way to correct it is to remind them of their poor posture or refer
posture problem to medical professionals.
● Body Piercing and Tattoos - It is a strong marked of adolescent’s
identity, make sure that the needles they are using must be sterile and
they do not share same needles
● Fatigue - make sure that they received adequate nutrients, otherwise
it indicates something medical like anemia, or they are avoiding going
to school.
● Menstrual Irregularities - common problem of adolescent can be
referred to a Gynecologist.
● Acne - sometimes it is hormonal in nature or an active sebaceous
gland that is being infected, suggests do not touch face, and do not
use any commercial creams unless it is prescribed by the doctor.
avoid too much sun exposure

Self-Check 4.3

John, 6 years old, active and playful, her mother asks him if he didn’t get tired, “I
feel strong”, the mother asks if she can give vitamins to her son, to boost his
immunity because he is always playing outside their house. The best response
Page | 42
a. You can give multivitamin
b. Vitamin A is to increase immunity
c. Vitamin C is to increase resistance
d. As long as he is alert and active, vitamin is not needed

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Suggested Readings and Websites

Pilliteri, Adelle. (2018). Unit 5 Chapter 29 and 30. Nursing Care of a Family with
an Infant, Toddler, Preschooler and Adolescent. Maternal & Child Health
Nursing: 7th Edition. Lippincott Williams & Wilkins. Philadelphia, USA.

Pilliteri, Adelle. (2018). Unit 5 Chapter 28. Principles of Normal Growth and
Development. Maternal & Child Health Nursing: Care of the Childbearing
& Child Rearing Family. 7th Edition. Lippincott. Williams & Wilkins
Philadelphia USA

Pilliteri, Adelle. (2018). Unit 5 Chapter 28. Theoretical Approaches to the

Growth and Development of Children the Nursing Role in Health
Promotion for Child Rearing Family. Maternal & Child Health Nursing:
Care of the Childbearing & Child rearing Family. 7th Edition. Lippincott
Williams & Wilkins Philadelphia USA

YouTube.com (2017). Eight stages of Development by Erik Erikson. Retrieved

from https://www.youtube.com/watch?v=aYCBdZLCDBQ

YouTube.com (2019). Freud's theory of psychosexual development. Learn my

Test. Retrieved from https://www.youtube.com/watch?v=WBX7IDuh1bU

YouTube.com (2018). Piaget’s theory of development. Retrieved from

https://www.youtube.com/watch?v=IhcgYgx7aAA

YouTube.com (2020). Preventing Disease Through a Healthy Environment.

Retrieved from WHO. https://www.youtube.com/watch?v=tupJDf13jBo

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Reference

Durham, Roberta (2010). Maternal - Newborn Nursing. The Critical

Components of Nursing Care. FA Davis Company Philadelphia

Pilliteri, Adelle. (2018). Maternal & Child Health Nursing: Care of the
Childbearing & Child Rearing Family. 7th Edition. Lippincott Williams &
Wilkins. Philadelphia USA

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