PEDIATRIC NURSING
o Proper positioning for accurate measurement:
STAGES OF DEVELOPMENT
Infant
→ Age: 1-12 months
• Psyche (Sigmund Freud): up to 18 months old
• Freud: oral stage (gratify mouth)
o Via breastfeeding by the mother
• Erickson: trust vs. mistrust
o Will feel consistency when needs are met
therefore achieving trust
→ Neonate: 0-28 days old
→ Key concept (observable during infancy):
• Fastest
o Growth pattern
o Development
FETAL CIRCULATION
Maternal blood carries the oxygen → placenta → umbilical
vein → liver (immature) → ductus venosus (to bypass the
liver) → inferior vena cava → right atrium → foramen ovale
→ left atrium → left ventricle → ascending (head) aorta →
superior vena cava → right atrium → 30% unoxygenated
blood → right ventricle → pulmonary artery → ductus
arteriosus (bypass the lungs) → descending aorta (30% of
blood) – acrocyanosis (bluish discoloration of the extremities
normal)
→ 70% more oxygen is provided to the head for brain
development (oxygenated blood becomes
unoxygenated blood)
→ Consumption of the oxygen → carbon dioxide
→ 70% + 30% = heavy blood
GROWTH
Changes:
→ Size:
• Weight:
o Filipino Child (N): 2500g - 3500g or 2.5kg -
3.5kg
o >3500 grams: LGA/Macrosomia d/t GDM
▪ ↑Sugar→ placenta→ fetus (consumes
excessive sugar of the mother) →
macrosomia (hypoglycemic baby)
▪ PRIORITY: monitor blood sugar
❖ Blood is collected at the corner of
the heel of the baby
❖ Normal adult blood sugar: 70-110
mg/dl
❖ Normal newborn blood sugar: 40-60
mg/dl
➢ d/t size and body mass
▪ ↑Sugar during pregnancy→ delivery→
fetus is removed from hyperglycemic
environment→ hypoglycemia (dangerous)
❖ Sugar is used for heat production
➢ ↓Sugar→ ↓heat production→
hypothermia (fatal effect)
o <2500 grams: SGA/Microsomia d/t Smoking
(**PIH, Alcoholism)
▪ Nicotine→ vasoconstriction of the blood
vessels
▪ Nutrients and oxygen come from the
maternal blood→ placenta→ umbilical
cord
❖ Umbilical cord: 3 blood vessels (2
arteries, 1 vein - AVA)
➢ Small diameter blood vessel -
umbilical arteries
➢ Large diameter blood vessel -
umbilical vein
⬧ Larger because the umbilical
vein carries the oxygenated
blood during pregnancy
▪ Secondhand smoking can also lead to
SGA
• Length:
SUPINE
o Tape measure is used (cm)
o Normal birth length: 45-55 cm
→ Other Name:
→ Quantitative Changes (measurable)
→ Parameters:
→ Criteria to determine the growth
• Weight:
o More important & most sensitive
o Operation Timbang
o To consider in drug dosages
o Males are expected to be heavier at birth
because of larger body mass
• Height:
o “Vertical or linear growth”
o Males are expected to be lengthier at birth
because of larger body mass
DEVELOPMENT
→ The process of maturation
Changes:
→ Skills or capabilities of the child
• Ability to sit, stand, walk
• Language
→ Every child is unique in skills
Other name:
→ Qualitative changes (measurable)
• Assessment Tool for foreigners: DDST (Denver
Developmental Screening Test) - set of exams to
evaluate the development of a foreigner child
• Assessment Tool for Filipinos: MMDST (Metro
Manila Developmental Screening Test) -
designed for pattern of development of Filipino
children
• Consider the environment of the child in utilizing
the assessment tool
• Genetic factor is used as a basis for assessment
tool
Parameters:
→ Gross motor skills
→ Fine motor skills
→ Language
→ Social Skills
• Prone to have Autism if not developed
o First born Male
• Second born children regardless of gender, have a
risk for developing schizophrenia d/t criticisms,
comparisons :<<
Gross Motor Development
→ Cephalo-caudal development (head to toe)
→ 0-1 month: head lag
• Head and neck muscles are not well developed.
Supporting the head is a must
• (+) head lag 2 months: abnormal
o d/t fluid accumulation (hydrocephalus)
→ 2 months: lift the head (prone position)
→ 4 months: lift the chest
• SIDS (sudden infant death syndrome): d/t improper
positioning of the baby
o Prone position causes suffocation→ sudden
death
• Decreased risk for SIDS at 4 months
→ 5 months: roll over (prone to supine)
• WOF: Risk for fall
→ 6 months: sit with support
• Provide chair for stability
→ 7 months: bouncing
• Bouncing foot towards the mouth→ sucking
 • Benefit: strengthen the muscle→ preparation for → Key concept (observable): RENTT
standing and walking (stretch muscles of the leg) • Ritualistic behavior (habitual activities)
→ 8 months: sit without support (sit alone) o Has favorite toy, pillow
• Balance in the upper and lower body o Security objects
→ 9 months: crawl o Temper tantrums
→ 10 months: stand with support ▪ Will act out frustrations when favorite
→ 11 months: cruising toy/pillow has been misplaced
• Cruising - hold two arms of the baby ❖ Language is not well developed
• Walk with support - hold one arm of the baby (cannot verbalize frustrations,
→ 12 months: emotions)
• Stand without support (stand alone) ▪ Management:
• Walk with support 1. Ensure safety (priority)
→ 15 months: walk without support (walk alone) ➢ Provide helmet/pillow for
→ 18 months: jump protection of the head (head
→ 3 years old: run banging)
• Appropriate bike: tri-bike 2. Ignore the behavior
➢ Temper tantrums are done to gain
Fine Motor Development attention
→ Proximo-distal development (hands) • Egocentric: self centered
→ 1-3 months: close fist o Possessive (mine)
→ 5 months: close and open hands / hold o Parallel play
• Toy: Rattle (sensory development) • Negativism
o Colorful stimulating sense of sight o They always reply with “No”
o Creates sound developing sense of hearing o Management:
→ 7 months: ability to transfer object from one hand to ▪ Provide options/choices
another ❖ This is good, because providing
• Skill: Crude Pincer Grasp options enhances the sense of
→ 9 months: Neat Pincer Grasp autonomy of the child
• Thumb and pointing finger are controlled • Toilet training
• Pick tiny objects o Anal stage (Freud): gratify anal area
• Oral stage of development: sinusubo; risk for ▪ Toilet training will become a ritualistic
choking, aspiration, poisoning (WOF) behavior
→ 12 months: o Start at: 18 months and above
▪ Maturation of the sphincters
• Throwing the ball
▪ Bowel control first then bladder control
o Benefit: promote walking
1. Daytime bladder control
• Hold spoon
2. Nighttime bladder control
→ 2 years old: draw lines (vertical and horizontal)
o Toothbrushing
→ 3 years old: draw circle, curve, cross
▪ Ritualistic behavior that will be taken up until the
→ 4 years old: draw square, rectangle (4-sided objects) toddler grow
→ 5 years old: draw triangle, diamond, star (has pointed ▪ Start at: 30 months old
parts/apex)
→ Deciduous teeth
→ 6 years old: draw all shapes
• Other name: milk teeth/ temporary teeth
o Adult permanent teeth = 32 teeth
Language Development
• Complete set: 20 milk teeth
→ First language: cry
o Upper portion: 10 milk teeth
• Determine hunger, wet diaper (basic needs) o Lower portion: 10 milk teeth
• Characteristics: o Observed at 30 months
o Loud/vigorous/strong cry - NORMAL ▪ Toothbrushing
o High pitched cry – ABNORMAL ❖ Provide pear if the toddler refuses to
▪ Indicates: IICP d/t hydrocephalus brush their teeth
→ 1-2 months: cry (open mouth) ➢ Contains tiny fibers that brushes
• Produce loud cry the teeth when bitten
→ 3 months: cooing sounds ➢ Apple causes staining of the teeth
→ 4 months: vowel sounds ⬧ Given to children with asthma
→ 5 months: consonant sounds d/t hypoallergenic effect
→ 7 months: mmm cry (close mouth; humming) ▪ Dental check up
1-7 months: more on sounds language • First eruption: 6 months
o Solid foods are offered
→ 9 months: 2 words o 2 lower central incisors
• Mama: for PNLE o Common discomforts:
• Dada/papa: for NCLEX ▪ Fever
→ 12 months: 4 words ❖ Provide Tepid Sponge Bath
• Mama ❖ Paracetamol/antipyretic every 4 hours
• Dada/papa ▪ Pain
• The additional 2 words depending on the child’s ❖ Cold Teether for anesthetic effect
environment (what they hear) ▪ Diarrhea
→ 2 years old: 50 words ❖ At risk for dehydration
• Prolonged exposure to gadgets delay social ❖ Continue breastfeeding (enough to
development and may lead to autism provide hydration)
→ 3 years old: 100 words • Second eruption: 7 months
→ 4 years old: 200-300 words o Upper central incisors
• Third eruption: 9 months
TODDLER o Upper lateral incisor
→ Age: 1-3 years old • Start to loosen: 6-7 years old
→ Freud: Anal stage o d/t sugar (formula milk - high sugar content)
→ Erickson: psychosocial (autonomy vs shame & doubt)
 o Delayed (bad assessment) causes crooked
• Ball games (indoor)
teeth
• Traditional games (e.g., patintero,
o Maximum of 2 milk teeth per day can be
sungka, luksong baka, hide &
removed to prevent bleeding seek)
• Natal teeth - teeth present at birth d/t excessive • Board games (snakes and
calcium intake of the mother during pregnancy ladders, monopoly, chess,
(rapid bone & teeth development of the fetus) scrabble)
o 1-2 can be observed
o Lower central incisors Competitive Play
o Management: check if the teeth is loosen → E.g.,
ADOLESCENT
▪ Dangerous if loosen d/t risk of aspiration • Outdoor ball games (outlet of
❖ Needs to be extracted energy: ↑hormone → ↑energy)

PRESCHOOLER • Afraid/fear of death

→ Age: 4-6 years old
• 3+ (e.g., 3 years and 1 month): preschooler TYPES OF FEAR
→ Key concept (observable): MISY
• Magical Thinking: Imaginary friend (normal until 6 Stranger Anxiety
years old ONLY) → Onset: 6-7 months old
o Exaggerated imagination INFANT
→ Peak: 8 months
o Fear: body mutilation → End: 9 months
▪ Cover wounds
• Imitative behavior Separation Anxiety
o Role play → Stages
• Sharing (good boy/good girl) • Protest (crying)
o Cooperative/associative play TODDLER • Despair (withdrawn)
• Y (why?) • Denial/detachment (deny the
presence of the caregiver;
o 200-300 question per day (Pilliteri)
ignore)

SCHOOL AGE
→ Body mutilation
→ Age: 7-12 years old → Castration
• 6+: school age PRESCHOOL
→ Ghost, monsters
→ Freud: Latency stage (rest period) → Dark
→ Growth and development: slow
→ Key concept (observable): WAT Death
• Winner/Loser: Competitive play → 1-6 years old: concept of death is
sleeping
TYPES OF PLAY
→ 7-9 years old: concept of death is a
form of punishment
SCHOOL AGE
Solitary Play: prefer to play alone • Punishment is done by
Toy: promote sensory development boogeyman
→ Colorful to develop sense of sight → 10 years old above: concept of
→ Has sound to develop the sense of death is end of life (realistic)
hearing • Death is irreversible
→ Soft to develop the sense of touch
→ E.g., Body Image
INFANT • Rattle
• Musical mobile
• Squeeze toys ADOLESCENT
• Soft stuff toy
o Contraindicated to children
with asthma
o Check if there are buttons
(risk for aspiration)
• Teacher
Parallel Play: a child prefer to play with o Significant person of school age: idol
other children but not interacting with each
other
Toy: provide toys that promote talking and
ADOLESCENT (increased growth and development)
walking (physical development) → Age: 13-18 years old
TODDLER → E.g., • Freud: up to 21 years old
• Ball → Key concept:
• Push and pull toys • Puberty
• Tri-bike - promotes leg muscles o Secondary sex development
• Walkie-Talkie ▪ Thelarche (breast development)
▪ Adrenarche (pubic hair growth)
Cooperative/Associative Play: Role ▪ Menarche (onset of menses)
playing (Lutu-lutuan) o Hormone of puberty: estrogen
→ Magical thinking (exaggerated ▪ Hormone of pregnancy: progesterone
imagination) • Body image (conscious with physical appearance)
PRESCHOOL • Needs to develop creativity o Eating disorders: anorexia, bulimia (binge-
• E.g., eating)
o Coloring books • Acne
o Clay
o ↑hormones → ↑oil production
o Lego

Competitive Play
SCHOOL AGE
→ E.g.,
 FREUD’S PSYCHOSEXUAL THEORY

ORAL STAGE
→ Gratify the mouth by breastfeeding of
the mother
→ Feel consistency when needs are met
developing trust
INFANT
→ If neglected, the oral area will not be
developed leading to oral fixation
• Thumb sucking
• Smoking
• Alcoholism

ANAL STAGE
→ Gratify the anal area by toilet training
→ Presence of the mother is a must to
develop guilt
→ If too rigid, it would cause
TODDLER
overdevelopment of guilt feeling
• Obsessive compulsive disorder
→ If too lax, there is a decreased
development of guilt feeling
• Antisocial personality disorder

PHALLIC STAGE
→ Male (Penis): site of sexual
gratification
• Infantile masturbation: form of
body exploration (normal)
• Management:
o Divert the attention by
providing activities
• Fear of castration (because this
PRESCHOOL is the site of their gratification)
o “Anak puputulin ko yan”
(bad effect -
exhibitionism)
▪ To show people that their
penis is intact
→ Female: Penis envy
• Infantile masturbation does not
apply to females

SCHOOL LATENCY STAGE

AGE
SUMMARY
Erikson Freud Piaget Kohlberg
Age
(Psychosocial) (Psychosexual) (Cognitive stages of development) (Moral development)

Infant (0-18 Trust vs. mistrust Oral stage, the center Sensorimotor
months/ 0-12 So long as you give of gratification is the
months) the needs: food, mouth Learning through the sense
warmth, care trust
will be developed Breastfeeding, Toys given should be toys that would
teethers, pacifiers stimulate the senses (mobile toys,
lighting toys)
(+) risk for aspiration
because everything is
put in the mouth

Fear: stranger anxiety, those who are unfamiliar to them will stimulate fear

Play: solitary play (plays alone) since they are still in the sensorimotor stage, they learn still through the senses

Toddler (18 Autonomy vs. shame Anal stage, the center Preoperational Preconventional
months- 3 and doubt of gratification is the
years old) anus Egocentric, inability to understand the Punishment and
Offer the child point of view of others obedience
choices Most important is the
toilet training Best punishment and
obedience: timeout
Criteria for (remove all stimuli from
readiness for toilet the child)
training:
1. Can sit and squat Place the child in a non-
2. Ability to remain stimulating environment
dry for about 2 hours (face the wall)
3. Ability to verbalize
the need to defecate Rule: should be timed (1
and urinate minute per year of age)
4. Show willingness e.g., The child is 3 y.o.,
to please parents face the wall for 3
5. They want to minutes
immediately change
their soiled diapers

Fear: separation anxiety, they do not want to be separated from their guardians or parents

Play: parallel play (side-by-side play), two kids play side by side but does not play with one another, no sharing or interaction this will
cause fights because both of them are autonomous

Preschooler Initiative vs. guilt Phallic stage→ Preoperational (Highest imagination, Preconventional
(3-6 years complexes can understand symbols/
old): symbolizations) Still egocentric
1. Oedipal- the baby E.g., leaves are imagined as money
boy is close to the
mother
2. Elektra- the baby
first is close to the
father

Loves the opposite-

sex parent, but hates
the same-sex parent

Fear: body mutilation (scared of being injured or wounded)

Play: associative/ cooperative play (plays of children are related with one another) E.g., role-playing, make-believe plays

School-age Industry vs. inferiority Latent stage (same- Concrete operational Conventional (believes
(6-12 years sex orientation- in authority)
old) boys vs girls, no Understand the theory of conservation
mixing of sexes) and reversibility

Conservation- being able to conserve

means knowing that a quantity doesn't
change if it's been altered (by being
stretched, cut, elongated, spread out,
shrunk, poured, etc.)

Reversibility- reverses a sequence of

events or restores a changed state of
affairs to the original condition. It is
exemplified by the ability to realize that
a glass of milk poured into a bottle can
be poured back into the glass and
remain unchanged
Fear: death, they know that death is irreversible and it is final

Play: competitive play (more on indoors- board games, a little on sports)

Adolescent Identity vs. role Genital stage (sexual Formal operational Post conventional
(12-18 years confusion curiosity)
old) Already hypothetical, can rationalize Already knows morals,
Body image is Unwanted, laws, and is already
important at this unexpected responsible
stage pregnancies usually
occur here Knows what is good and
what is bad

Fear: rejection, that is why body image is the focus, peer pressure usually occurs here (nakikisama)

Play: interactive/ competitive (more on outdoors- sports)