PEDIATRIC NURSING
expectations and roles
KOHLBERG’S SIX STAGES OF MORAL
DEVELOPMENT
MORAL DEVELOPMENT THEORY
● Level 1 – pre-conventional (4-10
years old)
● don’t have a personal code of
morality (hindi pa maliwanag sa
kanila ang morality)
● moral decisions are shaped by the
standard of adults (mahilig silang
gumaya sa mga ginagawa ng mga
matatanda sa environment nila) and
the consequences of following or
breaking their rules.
● For example, if an action leads to
punishment is must be bad, and if it
leads to punishment is must be bad,
and if it leads to a reward is must be
good.
● STAGE 1: Punishment and
obedience. Children obey to avoid
being caught and punished
● STAGE 2: Individualism and
exchange
○ children recognize that there
is not just one right view that
is handed down by the
authorities
○ children obey rules but only
for pure self-interest.
Reciprocity: “I scratch your
back, you scratch mine,” –
may kapalit lagi ang good
action when done
● LEVEL 2: Conventional (10-13
years old)
● Stage 3: Good interpersonal
relationships
● children/individual is good in order to
be seen as being a good person by
others
● Focused on living up to social
● children seek approval of other and
adopt the social standard
● Stage 4: Maintaining Social Order
○ children are concerned with
authority and maintaining
social order
○ Correct behavior is “doing
one’s duty”
● LEVEL 3: Post-conventional (13
years and older)
● develop and understanding of
abstract
● Stage 5: Social contract and
individuals rights. Laws are obeyed
because they have been accepted
by society as a whole
● Stage 6: Universal ethical principles.
Individuals follow their own
conscience about what is right,
Behavior is the same no matter who
is present.
COGNITIVE DEVELOPMENT (Jean
Diaget)
● important to check if the child is
delayed
● Sensorimotor Stage (birth to 2
years old)
○ infants and toddlers acquire
knowledge through sensory
experiences and
manipulating objects
○ Learn about the world
through basic actions such
as sucking, grasping,
looking, and listening
○ Object Permanence – learn
that things continue to exist
even when they cannot be
see
 ○ Realize that they are information to a general
separate beings from the principle
people and objects around ○ Accomodation – child can
them adapt to a certain situation
○ Realize that their actions can ○ Decentring – no longer
cause things to happen in the self-centered (appreciate
world around them. other people)
● Preoperations Stage (2-7 years ● Formal Operational Stage (12 and
old) up)
● emergence of languages is one of ○ become capable of seeing
the major hallmarks (picture, hand multiples potential solutions
symbols, etc) to problems and think more
○ 2-4 years old scietifically about the worrld.
(Preconceptual stage) ○ Begins to think more about
○ Language – think moral philisophical, ethical,
symbolically and learn to use social and political issues
words and pictures that require theoretical and
○ 4-7 years old (Intuititive abstract reasoning
Stage) ○ Begins to use deductive
○ child can fix toys according to logic, or reasoning from a
size, color, height one at a general concept to specific
time only information.
○ Egocentrism –
self-centeredness and ESSENTIAL NEWBORN CARE
struggle to see things from
the perspective of others
○ Animism – it interacts with
non-living things; kids learns
through pretend play
● Concrete Operational Stage (7-11
years old)
○ Begin to think logically about
concrete events
○ Begin to understand the
concept of conservation; that
a change in shape doesn’t
mean change in amount and
size
○ Thinking become more
logical and organized, but
still very concrete
○ Begin using inductive, or
reasoning from specific
- prevents hypothermia, wipe but do
not remove the vernix caseosa
- “Unang yakap” program
- dati ina-aspirate agad for airway
pero di na siya routine ngayon
because it will also aspirate oxygen.
- wear bonnet to also prevent
hypothermia and identification band
on ankle
- prevent anemia in waiting the pulse
to stop in umbilical cord before
cutting. (Milking)
- oxytocin given for uterine contraction
and expulsion of placenta.
- hindi mo aalisin para paliguan, skin
to skin contact for the first 6 hours of
life; kahit may vernix pa siya
(protocol)
- then observed with feeding cues
- erythromycin – eye protection

- 0-2 poor
- 3-7 fair
- 8-10 generally the child is normal
- sa appearance hindi makakapag
score ng 2 because of
acrocyanotic; lagi silang cyanotic
and a normal appearance of
- get APGAR twice (one min after newborn (highest is 9)
birth and 5 minutes after birth)
- check kung yung bata has a higher
chance of survival, adjustment of
baby outside the world.
GENERAL MEASUREMENT reflexes will be tested. In
fact, they will continue to be
● Weight Range - 2500 - 4000 gms tested throughout the first
(5lbs. 8oz. - 8 lb. 13 oz) year of life in order to
○ weigh the newborn at the evaluate neurological
same time each day for function and development.
accuracy Absent or abnormal reflexes
○ baby is expected to lose in an infant, persistence of a
weight in their first day of life reflex past the age where the
○ it is very normal to lose reflex is normally lost, or
weight of the baby because redevelopment of an infantile
of urination and excretion of reflex in an older child or
meconium (feces) adult may suggest problems
with the nerve system.
● Length Range - 48 to 53 cms ● gag, blinking, and cough reflex
(19-21 inches) should not be remove.
● Head Circumference - 33-35 cm
○ Expected finding: Head
should be 2 to 3 cms larger
than chest
● Chest circumference - 30.5 to 33
cm
○ Common variations:
● Molding of the head may result in a
lower head circumference
measurement: Fontanelles should
be soft, firm, and flat. Bulging
fontanelles may indicate distress or
deviation from normal Head and
chest circumference may be equal
for the first 24 to 48 hours of life.
● Abnormal findings: bulging
fontanelle on the infant’s head.
● the least mature during the
delivery of the baby is vision, they
have a vision but they haven’t
practiced it yet. Newborn’s vision
was said to be black and white in
the beginning.

● LEAST MATURE SENSE IS VISION

○ once APGAR score and
general measurements are
determined, additional

● hypoxia - decrease oxygenation on
tissues
● in baby, fats are called brown fat
(they need to burn to produce heat)
● as you do thermogenesis, it
consumes oxygen and glucose lead
to hypoxia and hypoglycemia
● this what happen when there is a
cold stress = hypothermia
● some patient are experiencing
bradycardia
● THINGS TO CONSIDER:
○ increase RR
○ low bpm
○ oxygen saturation
● to prevent: not removing vernix will
prevent hypothermia (tapping towel,
convection)
● away the infant to wall (because it’s
cold, radiation)
● CORD CARE: when the patient is
for discharge (teach the mother how
to take care of umbilical cord)
○ do not use binders (bigkis)
pag tinalian, makukulob;
infection won’t be observe
○ air dry
○ do not bathe the infant that
may affect the umbilical
○ full bath should be done
when the umbilical is dry
(as long as it is not yet dry,
just use half bath; it may
contribute to cord
infection)
● Terramycin is given to eyes, to
prevent infection from (std, tetanus)
● do not wash the eyes of the baby
yet, to prevent wearing off of the
terramycin
● how would you know if the
newborn is not adapting well on
the environment?
○ once out, cry (cry because of
the changes in temperature,
and thermal environment)
○ adaptation observe: check
cr, indicating that the baby is
well adapting to the external
environment (when the heart
rate reached 90, not adapting
well) refer to the doctor.
● when bathing, avoid the ear because
it can lead to infection (otitis)
REFLEXES
● Plantar reflex - when a finger is
placed under the toes, the toes will
curl.
○ Present about 9 months - 1
year of age
● Moro Reflex/Startle Reflex -
triggered when the child is startled,
feels like they are falling or their
head drops back. By a loud noise.
○ Arms will fling out sideways
● absence of Moro reflex could have a
neurological problem.
○ Present about 6 months of
age
● Tonic Neck Reflex/Fencing - when
baby’s head is turned on one side,
the arm on that side scratches out
and the opposite arm bends.
○ Present about 4 months of
age
● Grasp Reflex - Stroking the palm
of a baby's hand causes the baby
to close his or her fingers in a
grasp.
○ lasts until the baby is
about 5 to 6 months old.
● Crawling Reflex
○ present few weeks to
months after birth
● Flexion Reflex - mild pinch or
slapping on the bottom of the foot
elicits the flexion reflex. Just like
survival reflex
○ Present since the fetus
● Sucking Reflex - allow the infant to
ingest food from the nipple of a
bottle or breast. Touches the top of
the infant’s mouth (hard palate)
○ Present before birth until 4
months of age
● Rooting reflex - when strike the
corner of the mouth with finger to the
mouth, the head will follow the
direction of your hand, then open
their mouth. It’s helpful when finding
the food source when feeding
○ Present about 4 months of
age
● Babinski reflex/Extensor Plantar
reflex or toe sign - stroke the
bottom of baby’s foot, big toe reflex
toward the foot, the other toes fan
out, and the leg extends outward.
inverted J.
● abnormality can be because of
neurological development (when
baby is 3 years old up)
○ Present about 1 year to 2
years
● Blink Reflex - open and close of
eyes in response to a touch of face,
bright light, and bad taste/different
● Trunk Incurvation (Galant’s
Reflex) - baby in the prone position,
and stroke one side of the 1cm, the
spine will curve to the stimulated
side
● Landau Reflex - A normal
response in infants when held in
a horizontal, face-down position
to maintain a convex arc with the
head raised and legs slightly
flexed.
○ until 3 months old.
● Parachute Reflex - suspend the
baby prone and slowly lower the
head towards the surface
○ Present to 8 months and
not disappear
● Stork bites - vascular lesion typical
in newborn (reddish; darker in
crying) “salmon patches”
○ until 18 months
● Mongolian Spots - macule with a
homogeneous blue-grey/green
pigmentation and indistinct borders,
BENIGN
○ usually in lower back/sacrum
○ consider a lysosomal storage
disease when the macules
are very large and numerous
○ Color and size do not change
in time. NO swelling,
tenderness, or any sign of
injury
○ Pigmentation begins to fade
on the first 2 years of life,
 and resolves completely by
early childhood
● Lanugo - fine downy hair growing
on a newborn’s forehead, back, and
shoulder
○ disappear soon after birth
● Milia - common skin condition that
causes small white bumps (cysts)
under the surface of your skin
○ condition last a few weeks
○ do not use soap when there
are milia (mild soap can be
use; cetaphil)
● Molding - change in the shape of
the head
○ resolves within the day
● Bonding - referring to intense
attachment the parent develops with
the baby, in particular the mother,
due to the biological connection.
● Father newborn-bonding -
“engrossment”
INFANT DEVELOPMENT MILESTONES
0-12 mos (first birthday)
GROWTH AND DEVELOPMENT
● Growth
○ process of physical
maturation
○ occurs by multiplication of
cells and an increase in
intracellular
○ measurable
○ limitations
● Development
○ multiple changes in behavior,
efficiency and capability
○ life long process
● Infancy (29 days to 1 year)
● Neonate (28 days)
● Early childhood
○ toddler (1-3 yrs old)
○ preschool (3-6 yrs old)
● Middle Childhood
○ school age (6-12 yrs old)
● Late childhood
○ Adolescent (13-18 yrs old)
PRINCIPLES OF GROWTH AND
DEVELOPMENT
● Cephalocaudal - head to toe
○ improvement in structure
come first in the head region,
then in the trunk, and last in
the leg region.
○ head lag - gain control of
head but not yet in neck
muscle
○ eg. gaining control of head
and arms, torso, and finally
legs
○ head larger relative to the
rest of the body, lower parts
of the body must do more
growing to reach adult size
● Proximaldistal direction - develop
from center/midline to periphery
direction
● General to specific - children use
their cognitive and language skills to
reason and solve problems
○ first able to hold the big
things using both arms. In
the next part able to hold
things with a single hand and
then only able to pick small
objects like peas, cereals,
etc.
○ Children when able to hold
pencil, first start draw circles
then squares then only
letters after that the words.
○ makes from a generalized to
localized behaviour. In
studying the development
pattern of children, it is
observed that general activity
 always precedes specific
activity.
● WHY DEVELOPMENT
ASSESSMENT?
○ early detection of deviation in
child’s pattern of
development
○ simple and time efficient
mechanism to ensure
developmental progress
○ domain assessed: cognitive.
motor, language,
social/behavioral, and
adaptive
1. Weight
● weight of full-term infant: 2.5 -3.8 kg
● 20% loss of weight in first week of
life
● 25-30gm/day increases til 3 months
● 40gm/month increase til 1 year
● Doubled their birth weight in 6
months old
● Tripled by one year of age
2. Height
● height and improvement indicate
skeletal growth
3. Head circumference
● average head circumference at birth
is about 35cm
● at 3 months = 40cm
● 6 months = 43cm
● 1 year = 45cm
● 2 years = 48cm
● 7 year = 50cm
● 12 years = 52cm
● above eyebrow and ears
4. Fontanelle closure
● anterior fontanelle and posterior
fontanelle present at birth
● posterior closes within 6-8 weeks of
life (2-3mos)
● Anterior 12-18 months (1-2 yrs old)
● early disclosure of fontanelle
indicates craniostenosis due to
premature closure of skill sutures
● delayed closure results from
malnutrition, hydrocephalus, con.
Heart disease
● Suture lines of fontanelles are for
brain development
5. Chest circumference
● also known as thoracic diameter
● measured at the level of nipples, in
between inspiration and expiration,
and is about 3cm less than head
circumference
● at birth 2-8cm less than the head
circumference
● 6-12 months head circumference
becomes equal
● after 1 year head circumference
more than chest circumference
● during birth chest circumference
round in shape, later becomes
transverse diameter increases
6. Mid-upper arm circumference
● helps to found out the nutritional
condition of children
● at birth average, MURC is about
12cm in a normal newborn
● 1 yr = 12-16cm
● 1-5yr old = 16-17cm

7. Dentition/eruption of teeth
● there is a variation in the time of
eruption of teeth
● first appear in 6 to 7 months of age
(lower central mandibular incision)
● can be delayed even up to 15
months, which also can be
considered within the normal range
of time for teething
● so dentition is not dependable
parameters for assessment of
growth. DEVELOPMENT MILESTONES
● Temporary for small dace in small ● GROSS MOTOR
size ○ strength, large muscles,
● permanent teeth bigger in size for coordination, reaction time
growing face ● FINE MOTOR
● TEMPORARY TEETH ○ small muscles, precision and
● also called as Milk teeth/Deciduous a high degree of control,
teeth, which develop after motor skills
● PERMANENT TEETH
● starts at 6 years old to 12 yrs old
● third molar appears at 18 yrs or late
in some children
● some babies born with teeth, it is
called as natal teeth
● Malocclusion of teeth due to thumb
sucking
● DOMAIN 2: LANGUAGE
DEVELOPMENT
○ language is the single best
indicator of intellectual
potential
○ language is the ability to
communicate with symbols
○ a child can usually
understand 10 times
(receptive language) as
many words as he or she can
speak (expressive language)
○ the first two (2) years of life is
the time for optimal language
acquisition.
● PLAYS AND TOYS
○ plays reflects development
and awareness of the
environment
○ basically SOLITARY
(non-interactive) for infants
○ toys should be safe and
age-appropriate (no sharp
objects and no detachable
parts, bright colors)
● APPROPRIATE TOYS
1. 1-3 months old = rattles, stuff toys,
music boxes, mobiles
2. 4-6 months = busy boxes
3. 7-9 months = cloth textured toys,
splashing bath toys, large blocks,
and large balls
4. 10-12 months = durable books, large
pictures, large building blocks,
nesting cups, and push-pull toys.
● RED FLAGS –
● PREVENTION:
○ sleep position: back
○ avoid tobacco smoke
○ remove extra items from the
crib
○ don’t overdress the aby
○ don’t sleep in the same bed
with the infant (can share the
room)
● CHOKING - anything that can be
eaten (esp solid foods) that can risk
for choking.
○ Heimlich maneuver
● INTERVENTION – NURSING CARE
● Trust vs. Mistrust
○ respond to crying
○ keep infant calm, same
nursing staff, play
● Eating plan
○ exclusive for 6 months
○ after 6 mos, start introduce
other food.
● Formula with iron