GROWTH AND DEVELOPMENT

b. Proximodistal Development
“The process of growth & development continues from conception all the way to death.” ➢ Center to periphery
➢ The process by which development proceeds from the center of the body
Definition of Terms outward to the extremities
1. Growth - physical increase in body size and appearance caused by increasing number ➢ Example: The child control the arm before being able to control hand
of new cells. movement
2. Development - progressive change in the child toward maturity or maturation.
• Chronological age - age in years c. Differentiation
• Developmental age - age based on functional behavior and ability to adopt to the ➢ “Mass to specific”
environment ➢ Simple to complex development
➢ The development from simple operations to more complex activities and
Stages functions
A. Prenatal Stage Conception to birth ➢ Example: Before a child learns how to drink from a cup, he must learn first:
eye-hand coordination, grasping hand & mouth coordination; mouth, lip &
B. Infancy Stage tongue movement
Neonatal Birth to 28 days
Infancy 1 month to 12 months 2. These patterns of growth and development are universal and basic to all human
beings
C. Early Childhood Stage 3. Individual differences: although the sequence is predictable, rates of growth vary and
Toddler 1 to 3 years individual variation exists in the age at developmental milestone
Preschool 3 to 5 years 4. There are periods of accelerated and decelerated growth rate.
Example:
D. Middle Childhood Stage 5. Rapid –fetal-infancy and adolescence
School age 6 to 12 years 6. Slow – school 1-3; 3-6
7. Alternating rapid and slow – toddler and preschool
E. Later Childhood 8. Each child is unique
Prepubertal 10-13 years ➢ The differences from child to child due to a combination of:
Adolescent 13 to 21 years 9. Heredity
10. Racial and national characteristics
Pattern of Growth and Development 11. Sex
1. Each child displays a predictable patterns of growth and development 12. Environment
13. Play is the universal language of children
Directional Trends – G ad D proceeds in regular sequential directions (follow a certain 14. Learning will come quickly and effortless if the child is ready.
order) 15. Behavior is the most sensitive indicator of development
a. Cephalaocaudal development
➢ Head to toe
➢ The process by which development proceeds from the head downward Factors Influencing Growth & Development
through the body towards the feet 1. Genetics: a family history of diseases may be inherited by unique genes that are
➢ Example: Able to control the head and neck before being able to control the linked to specific disorders; chromosomes carry genes that determine physical
arms & legs characteristics, intellectual potential, and personality

Pediatric Nursing — Growth &Development

2. Nutrition: the greatest influence on physical growth and intellectual development ; Developmental Theories
adequate nutrition provides essentials for physiologic needs, which promote health
and prevent illness Freud’s Stages of Childhood Erickson’s Stages of Childhood
Stages Psychosexu Nursing Development Nursing Implication
3. Prenatal and environmental factors: beginning with the nutrition from the mother to al stage Implication al Task
exposures in utero such as alcohol, smoking, infections, drugs, environmental Infant Oral Stage: 1. Provide oral 1. Provide a
exposures, such as radiation and chemicals, influence growth and development of the Child stimulation Trust vs primary
developing child explores the by giving Mistrust caregiver
word by pacifiers; do 2. Provide
4. Family and community: a stimulating environment from the family helps a child reach using not To form a experiences
his or her potential; family structure and community support services influence the mouth, discourage sense of trust that add to
environment in the process of growth and development of the child especially thumb- versus security, such
the tongue sucking. mistrust. as soft sounds
5. Cultural factors: customs, traditions, and attitudes of cultural groups in influence the 2. Breastfeeding and touch.
child’s growth and development regarding physical health, social interaction, and may provide Child learns to 3. Provide visual
assumed roles more love and be stimulation for
stimulation loved active child
than formula involvement.
Nursing Responsibilities feeding
Toddler Anal stage: 1. Help children Autonomy vs 1. Provide
1. Knowledgeable of growth and development will help the nurse working with the Child learns achieve Shame and opportunities
child. to control bowel and Doubt for decision
2. Helps the nurse ask age-related questions. urination bladder making such
3. Enable the nurse to communicate at child’s level of understanding and control and To form a as, offering
4. Help the nurse offer suggestions to the caregivers about what behaviors can be defecation even during sense of choices to
expected and what safety precautions need to be initiated for their child hospitalizatio autonomy wear or toys to
n. versus shame play with.
Roles of Pediatric Nurses 2. Praise for
Child learns to ability to make
1. Family Advocate. Nurse assist in identifying the needs and goals of children and their be decisions
families and in developing appropriate nursing interventions. independent rather than
and make judging
2. Health Promoter. Nurse assist in promoting health and preventing disease by fostering decisions for correctness of
growth and development, proper nutrition, immunizations and early identification of self anyone
health problems. decision.
Preschoole Phallic 1. Accept 1. Provide
3. Health Teacher. Nurses provide families with information on topics such as r stage: children’s Initiative vs opportunities
anticipatory guidance, parenting, and disease processes. Child learns sexual Guilt for exploring
sexual interest, such new places or
4. Counselor. Nurses support families through active listening. A therapeutic relationship identity as fondling To form a activities
between a nurse and a child and family includes caring as well as carefully defines through their own sense of
boundaries.
Pediatric Nursing — Growth &Development
 awareness genitals, as a initiative 2. Allow play to adjusting to a
of genital normal area versus guilt include new body
area of activities image,
exploration. Child learns involving seeking
2. Help parents how to do water, clay (for emancipation
answer things (basic modeling), or from parents,
child’s problem finger paint. choosing a
questions solving) and vocation and
about birth that doing determining
or sexual things is value system
differences. desirable.
School-age Latent 1. Help children 1. Provide
Child stage: have positive Industry vs opportunities Piaget’s Stages of Cognitive Development
Child’s experiences Inferiority such as Stage of Development Age Nursing Implications
personality with learning allowing child Span
developmen so their self- To form a to assemble Sensorimotor
t appears to esteem sense of and complete a Neonatal reflexes I mo Stimuli are assimilated into
be continues to industry short project beginning mental images.
nonactive or grow and versus so that child Behavior entirely reflexive.
dormant they can inferiority feels rewarded Primary circular reaction 1-4 mo Hand-mouth and ear-eye
prepare for for coordination develop.
the conflicts Child learns accomplishme I8nfant spends much time looking at
of how to do nt. objects and separating self from
adolescence. things well them.
Adolescen Genital 1. Provide 1. Provide Secondary circular reaction 4-8 mo Infant learns to initiate, recognize,
t stage: appropriate Identity vs opportunities and repeat pleasurable experiences
Adolescent opportunities Role for an from environment.
develops for the child Confusion adolescent to Memory traces are present; infant
sexual to relate with discuss feelings anticipates familiar events
maturity opposite sex. To form a about events Coordination of secondary 8-12 Infant can plan activities to attain
and learns 2. Allow child to sense of important to reactions mo specific goals
to establish verbalize identity him or her. Can search for and retrieve toy tthat
satisfactory feelings versus role Offer support disappears from views.
relationship about new confusion. and praise for Recognizes shapes and sizes of
s with the relationships. decision familiar objects
opposite sex Adolescents making. Tertiary circular reaction 12-18 Child is able to experiment to
learn who mo discover new properties of objects
they are and and events
what kind of Capable of space perception and
person they time perception as well as
will be by permanence
Pediatric Nursing — Growth &Development
 Invention of new means 18-24 Transitional phase to the Preconventional
through mental mo preoperational thought period. (Level I)
combinations Uses memory and imitation to act 2-3 1 Punishment/obedience 1. Child needs help to
Can solve basic problems orientation determine what
Preoperational Thought 2 – 7 yr Thought becomes more symbolic; are right actions.
can arrive at answers mentally Child does right because a 2. Give clear
instead of through physical attempt parent tells him or her to and to instructions to
Comprehends simple abstractions avoid punishment. avoid confusions.
but thinking is basically concrete and
literal. • the activity is wrong if the
Child is egocentric person is punished and right if
Displays static thinking not punished
Concept of time is now, and concept • Your decision is motivation by
of distance is only as far as they can external pressure, the avoidance
see of punishment or after reward
Unable to state cause-effect 4-7 2 Individualism. 1. Child is unable to
relationships, categories or recognize that like
abstractions Instrumental purpose and situations require
Concrete Operational 7 -12 yr Concrete operations includes exchange. carries actions to like actions.
thought systematic reasoning: satisfy own needs rather than 2. Unable to take
Use memory to learn broad concepts society’s. Will do something for responsibility for
(fruit) and subgroup of concepts another if that person does self-care, because
(apples, oranges) something for the child. meeting own
Classifications involving sorting needs interferes
objects according to attributes such “Instrumental relativist with this
as color, weight, multiplication. Orientation”
Follows a route through a maze and
then reverses steps • it is good to do good to people
Understands conservation, sees but only because one day they
constancy despite transformation may return the favor to you.
Formal operational 12 yr Can solve hypothetical problems “you scratch my back and I’ll
thought with scientific reasoning scratch yours”
Understands causality and can deal • takes to satisfy one’s need
with the past, present, and future. Conventional (Level
Adult or mature thought II)
7-10 3 Orientation to interpersonal 1. Child enjoys
relations of mutuality helping others
because this is
Kohlberg’s Stages of Moral Development “Good boy- nice girl” “nice” behavior.
Age Stage Description Nursing Implications Orientation” Allow child to help
with bed making

Pediatric Nursing — Growth &Development

 Child follows rules because of a and other like • Standard of behavior is based
need to be a “good” person in activities. on adhering the laws that
own eyes and eyes of others. 2. Praise for desired protect the welfare and rights of
behavior such as others
• The action is taken to please sharing. • Personal values and opinion
others/gain approval are recognized and violating the
• Good boy-good girl rights of others is avoided
• Pleasing others esp. those in 6 Universal ethical principle 1. Many adults do not
authority is the right thing to do orientation reach this level of
moral
10-12 4 Maintenance of social order, 1. Child often asks “Universal-Ethical Principles” development
fixed rules, and authority what are the rules
and is something Follows internalized standards
“Law and order Orientation” “right’ of conduct
Child finds 2. May have difficulty
modifying a • Universal moral principles are
Child finds following rules procedure because internalized
satisfying. one method may • Person respects other humans
Follows rules of authority not be “right” and believes that relationships
figures as well as parents in an 3. Follows selfcare are based on mutual trust
effort to keep the “system” measures only if • Decision of conscience based
working. someone is there on self-esteem
to enforce them
• right behavior means doing
one’s duty, respecting authority THEORIES OF CHILD DEVELOPMENT
and maintaining the given social
order for it’s own sake 1. Sigmund Freud “Psychosexual Theory”
• Right behavior is obeying the
law and following the rules 3 Levels of Consciousness
Postconventional a. Id - controls physical needs and instincts of needs
(Level III) b. Ego - conscious self
Older 5 Social contract, utilitarian law 1. Adolescents can be - controls the pleasure principle of the Id by delaying the instincts until
than 12 making perspectives. responsible for an
self-care because appropriate time
“Social Contract and Legalistic they view this as a c. Superego- conscience
Orientation” standard of adult
behavior.
Follows standards of society for
the good of all people Psychosexual Stages

a. Oral Stage (0-2 years)

Pediatric Nursing — Growth &Development

 Site of Gratification: Mouth • Encourage identity
Characteristics: sucking, making noises, crying and breathing Fixations:
Implications: • Difficulties with sexual identity
• Feeding produces pleasure and sense of comfort & safety • Problems with authority
• Feeding should be pleasurable and provided when required
Fixation d. Latency Stage (6-12 years)
Characteristics:
• Nail biting • The child sense of moral responsibility is built (based on what has been
• Drug abuse taught by the parents)
• Smoking • The child is involved with learning, developing cognitive skills , and
• Alcoholism actively participating in sport activities
• Argumentativeness • Child’s main relationship are with peers of the same sex
• Overdependence Implications:
• Encourage the child with physical a intellectual pursuits
b. Anal Stage ( 2-3 years) • Developing positive friendships at this stage helps the child learn about
Site of pleasure: anus and rectum caring relationships
Characteristic: occurs during toilet training Fixation:
Implications: • Obsessive ness and lack of self motivation
• Contolling and expelling feces provide pleasure and sense of control
• Toilet training should be a pleasurable experience, and appropriate e. Genital Stage ((13 years and after)
praise can result in a personality that is creative and productive Characteristics:
Fixation • Attaining a mature sexual relationships
• Obsessive- compulsive personality • Involves a reactivation of pre-genital impulses
* Obstinacy * Cruelty • Physical puberty is occurring
* Stinginess * Temper tantrums • There is a biologic drive of finding and relating to a male
Implications:
c. Phallic Stage (4-5 years) • Achievement of independence and decision making
Site of pleasure: Genitals • Privacy is important
Characteristics: Fixation:
• Sexual and aggressive feelings associated with genitals • Sexual problems:
• Masturbation offers pleasure * Frigidity * impotence * unsatisfactory sexual
• The child experiences, Oedipus or electra complex relationship
* Odeipus complex- male child’s attraction for his mother and
hostile
attitude towards his father
* Electra Complex- female’s attraction for her father and hostile
feelings to her mother

Implications: 2. Erik Erikson/ Psychosocial Theory

• The child identifies with the parent of the opposite sex and later takes on
a love relationship outside the family a. Trust vs. Mistrust (Birth- 18 months)
Pediatric Nursing — Growth &Development
 Trust
* discomforts are quickly removed
*cuddled
* played & talked
* consistent maternal- child interaction
(+) resolution: trust other
b. Autonomy vs. Shame and Doubt (18 months- 3 years)
Autonomy
* Allow toddler to do what they are
capable of doing
* explores the environment
* Reward positive behavior & praise and
affection
* Says “No”
* Controls body fixation: self-feeding
(+) resolution: self control
c. Initiative vs. Guilt (3-5 years)
Initiative
* person capacity of thinking
* allow child to help
*children are given freedom and
opportunity to initiate motor play
(+) resolution: assertiveness
d. Industry vs. Inferiority (6-12 years)
Industry
* seek self-achievement
*encourage their efforts to do practical
task (collection, projects)
* praise & reward
Pediatric Nursing — Growth &Development
Mistrust
* inconsistent; inadequate
* rejection
(-) resolution: suspicious, mistrust,
withdrawn
Shame & Doubt
* caregivers are impatient
* Caregivers shame the child
(-) resolution: willfulness & defiance
Guild
* making the child fee that motor activity is
bad
* the play is silly and stupid
* questions are nuisance
(-) resolution: pessimism
Inferiority
* parents sees their children’s efforts as
mischief
* don’t show appreciation for their
children’s work
(+) resolution: competence & (-) resolution: withdrawal from school &
perseverance peers
e. Identity vs. Role Confusion (12-20 years)
Identity Role Confusion
* accept changed body image * unsure what kind of person they can
become
* establish the kind of person * Seek a negative identity
* make a career decision
* being one—the group but at the same
time having a distinct characteristic that
stand out from the group
(+) resolution: actualize one’s ability (-) resolution: inability to find identity
f. Intimacy vs. Isolation (18-25 years)
Intimacy Insolation
* ability to form intimate relationship --- * difficulty in entering into an intimate
is strongly correlated --- sense of trust relationship – the opposite sex
* relate to other people not only with * women with sense of intimacy may have
the opposite sex but also of the same sex more difficulty in accepting pregnancy and
to form lasting relationship child rearing
* sexual relationship is built on a sense
of intimacy, not on sexual attraction
g. Generativity vs. Stagnation (25-65 years)
Generativity Stagnation
* learn to look beyond oneself * lack of interest and commitment
* successful achievement of identity
* interested in establishing and guiding
the next generation
h. Ego Integrity vs. Despair (65- death)
Ego Integrity Despair
* acceptance of worth and uniqueness * sense of loss
* acceptance of death
3. Jean Piaget “Cognitive Development”
a. Sensorimotor Behavior (0 – 2 years)
 Significant behavior d. Formal Operations (11 – adulthood)
• Reflexive- responses to the environment Significant behavior
Example: newborn gazes instantly at the mother’s face, smells the • Deal with ideas, abstract concepts
nipple, tastes the milk • Begin to understand jokes
• Understands cause and effect reaction • Enjoys reading and discussing theories
Example: random arm motion strikes the bell…. • Adaptable and flexible
• Newborns cannot understand words; only through hearing • Able to deal with contradictions
conversation directed to them can they pick out sound and begin to • Uses scientific approach to problem solve
understand ------ language enables the child to better understand • Able to conceive the distant future
the world
• Infants learns about the world through senses and motor activity INFANCY
• Curiosity, experimentation and exploration result in the learning
process Age Bracket: 28 days to 1 year
• Object permanence is fully developed ---- 18 months
a. Developmental Theories:
b. Preoperational Phase (2- 7 years) • Freud: Oral Stage
Significant behavior • Erickson: Trust vs Mistrust
• Egocentric - he cannot look at something from another’s point of • Piaget: Sensorimotor
view
• Has no concept of quantity - lack of conservation b. Physical Development
• A sense of time is not developed - cannot tell if something happened • Head and skull
a day ago, week ago ▪ Head circumference
• Increase ability to use language * Newborn: 13.17 inches (35cm) head is larger than the chest
• Play is socialized * 12 months: 18 inches (47cm) chest also expands
• Centration – can concentrate on only one characteristic of an object • Fontanels and cranial sutures
at a time ▪ Posterior fontanel- close at 2nd to 3rd month
▪ Anterior fontanel- close between 12th to 18th month
c. Concrete Operation (7 -11 years) • Skeletal growth and maturation
Significant behavior ▪ Continues to grow and mature until puberty
• Conserve in all forms, number, area and liquid • Eruption of deciduous teeth
• Multiple classification is mastered by children - classify objects such ▪ 1st deciduous teeth- lower central incisor
as color and size - 6-8 months of age
• They child is able to place herself in the position of others ▪ Teething is a normal process of development and does not
• They can also order objects in heirarchial structure - deals with cause high fever or upper respiratory conditions
number and mathematical problems
• Thoughts are logical and coherent • Weight – doubles in 6 months; triples in 1 year
• Decentration – able to shift attention from one perceptual attribute
to another
• Concrete thinkers – view things as “black or white”, right or wrong c. Sensory development
but no in between • Hearing and touch well developed at birth

Pediatric Nursing — Growth &Development

 • Sight not fully developed until 6 years; differentiates light and dark at • Place unbreakable mirror in crib to focus on their face
birth; prefers human face • Provide toys that let infants practice skills to grasp and manipulate object
• 2 months – searches and turns head to locate sounds
• 6 months – has taste preference Birth to 2 months
• 7 months – responds to name • Mobiles, black and white patterns, mirrors
• 12 months – follow moving objects; 20/50 vision • Music boxes, singing, tape players, soft voices
- vocalize 4 words • Rocking and cuddling
• Moving legs and arms while listening to singing and talking
d. Reflexes in infancy • Varying stimuli – different rooms, sounds, visual images
• Parachute 3 – 6 months
• Landau • Rattles
• Labyrinth righting – provides orientation of the head in space • Stuffed toys
• Body righting – when you turn the hips to the side, the body follows • Soft toys with contrasting colors
• Noise making objects that are easily grasped
e. Nutrition 6 – 12 months
• Supplement vitamin C & D, iron and fluoride • Large blocks
• Infant Feeding • Teething toys
▪ When teeth starts erupting, anytime between 4 and 7 months • Toys that pop apart and back together
of age, the infant appreciate hard toast
• Nesting cups and other objects that fit one another
▪ 9-10 months of age, chopped foods can be substitute for
• Surprise toys – jack in the box
pureed food
• Social interaction with adults and other children
▪ Solids are introduced no sooner than 6 months to avoid
• Peek a boo
exposure to allergens
• Soft balls
▪ Iron – fortified rice cereal is introduced first because of its low
allergenic potential • Push pull toys
▪ 12 months – gradual weaning from breast to bottle to cup
• Self-Feeding
▪ 7-8 months, the baby may grab the spoon e. Recommended immunization schedule
▪ Sticks fingers in the mouth for tasting 2 4 6 6-18 12-15 12-18 15-18 4-6
▪ No more than 32 oz formula per 24 hours should be given to months months months months months months months years
infants, to avoid iron deficiency anemia - 1st Hep - 2nd - 3rd DPT -3rd Hep - 4th PVC - 4th Hib - 4th DPT - 4th
B Hep B - 3rd Hib B - 1st IPV
d. Play and Toys - 1st DPT - 2nd - 3rd PVC - 3rd IPV MMR - 2nd
Play: Solitary Play - 1st Hib DPT - MMR
Toys: - 1st IPV - 2nd Hib Varicella
• Rattles, crib gym, squeezy toys, textured balls - 1st PVC - 2nd IPV
• Provide black/white contrast for premature and newborn infants - 2nd
PVC
• Hang mobile 8 – 10 inches from infant’s face
• Provide sensory stimuli (bath water) and tactile stimuli (feel of various
objects)
f. Safety
• Use variety of primary-colored objects
Pediatric Nursing — Growth &Development
 • Infants up to 20 lbs (9kg) should be restrained in a rear-facing car seat in the
middle of the back seat of the car 4 mo - Responds to - Eye-hand - Gains Need space
• Keep siderails of crib up stimulus coordination head to turn
• Never leave unattended on table, bed, bathtub - Sees bottle, begins control
• Check temperature of bath water, formula, food squeals and - Rolls from
• Avoid giving bottles at naps or bedtime (dental carries) laughs front to
back
g. Fear: Stranger anxiety - No head
lag when
h. Illness and Hospitalization pulled
• Responds to pain by crying, facial gestures, anger and physical upright
resistance 5 mo - Smiles at self - Uses - Rolls from - Squeals Handles
• React to loss of the caregiver with behaviors such as crying, sleeping in mirror Palmar grasp back to with delight rattles well
more and eating less - Cries when front
limits are set or - Moro
i. Death: No concept of death when objects reflex
are taken away fading
j. Developmental Milestone 6 mo -Likes to be - Holds a - Reaches May say Enjoys
picked up bottle fairly out in vowel bathtub toys,
Age Personal-Social Fine Motor Gross Language Play - Knows family well anticipation sounds rubber ring
Motor from strangers - Tries to of being for teething
1 mo Some smiling - Keep hands - Lies - Enjoys -Knows likes retrieve a picked up
fisted primarily in watching and dislikes dropped - Rolls from
- Able to a fixed face of -Fear of article back to
follow position primary strangers - Grasps feet abdomen
objects to caregiver - Sits with
midline - Listening to support
soothing 7 mo - Imitates - Transfers - Sits with Likes objects
sounds simple acts objects from hands on that are
2 mo Social smile - Holds - Cooing Enjoys bright -Responds to one hand to the floor good size for
head up - reciprocal colored “no” another transferring
when prone babbling (2 mobiles - Shows
mo- 6 mo) preferences
3 mo - Aware of new Follow - Grasp, - Laughs Spends time and dislikes for
environment objects from stepping, aloud looking at food
- Smiles at midline tonic neck hands or 8 mo - Dislikes diaper - Adjusts - Sits Enjoys
significant are fading uses them as and clothing body without manipulation
others - Can raise toy change position to support
head and - peaked be able to
upper chest strangers reach for an
when prone anxiety object

Pediatric Nursing — Growth &Development

 • Piaget: Preconceptual Phase
9 mo - Creep or Says first Needs space • Kohlberg: Preconventional (Punishment and Obedience)
crawls word (dada) for creeping
- Stand b. Physical Development
holding • Slowed growth
onto a • Gains 5-10 lb and 3 inches in height
coffee table • Continued eruption of teeth particularly the molars
if they are • Stands alone and walks steadily
placed in
that c. Psychosocial Development
position 1. Behavioral Characteristics
10 - Does things to Uses pincer Pulls self to - Plays peek- • Negativism
mo attract grasp standing a-Boo and - toddler’s response to nearly everything is a firm “no”
attention (thumb and patty cake  Limit the number of question into options
finger) to
pick up small • Ritualism
objects - employed by the young child to help develop security; involves following
11 Hold cup - cruises Cruises routines
mo and spoon - Walk with
well support • Dawdling
- Stands - wasting time or being idle
alone
12 Helps to -Take first - Says 2 - Likes toys • Temper Tantrums
mo dress step words plus that fit inside - an aggressive display of temper tantrums where the child reacts with rebellion
(pushes arm - Walks mama and each other to the wish of the caregiver
into sleeve) without dada, “ - Nursery  Reasoning, scolding and punishing during tantrum is useless
help (15 - usually can rhymes  Caregiver should be calm when dealing with toddler who is having tantrums
months) say a few - Pull toys  Never give in to the child’s whim
words,
imitates • Sibling Rivalry
variety of
vocalization, 2. Toilet Training
waves “bye • Signs to readiness for toilet training
bye” - can already stand alone
- can walk steadily
TODDLER - can keep himself dry for intervals of at least 2 hours
Age Bracket: 1-3 years old - able to use words or gestures regarding toilet needs
• Important Points
a. Developmental Theories - Have the child wash his hands after sitting on the toilet to instill good
• Freud: Anal Stage hygiene
• Erickson: Autonomy vs Shame and Doubt
Pediatric Nursing — Growth &Development
 - Be careful not to flush the toilet while the child is sitting on it, this can be 1. Childproof the home: stairways, cupboards, medicine cabinet, outlets
frightening to the child 2. Suffocation: plastic bags, unused refrigerators
- The caregiver should not expect perfection, even after control has been 3. Burns: ovens, heaters, sunburns, check water and food temperature
achieved 4. Falls: stairs, window, balconies, walkers
- Offering small rewards can be an encouragement to the child who is in the 5. Aspiration/ Poisoning: medications
process of toilet training
• Control g. Fear: Separation Anxiety
- Bowel control: 18 months
- Bladder control: 2 ½ year-3 years old h. Illness and Hospitalization:
• Intrusive procedures are extremely anxiety-producing
d. Sensory Development • Undergoes regression as a form of defense mechanism when hospitalized
• 12 months – knows name • Hospitalization may promote separation anxiety, which has 3 distinct phases:
• 15 months – binocular vision ▪ Protest- verbally cries for parents, attempts to find parents, clings to parents
• 18 months – identifies geometric forms  Use of transitional or parents’ objects that can be left with the child
• 18-2 years – uses short sentences ▪ Despair – disinterested in the environment and play; shows depression and
• 2 years – follow simple direction loss of appetite
- able to speak 300 words ▪ Detachment (denial) – the toddler makes a superficial adjustment and shows
apparent interest, but remains detach
e. Nutrition
• Toddlers appetite varies and unpredictable Nursing interventions related to separation anxiety
• Has food preferences, ritualistic eaters 1) Goal: preserve child’s trust
• Adequate calcium, phosphorus and carbohydrates 2) Reassure that parents will return
• Milk should be whole until age 2 years 3) Provide rooming in to encourage parent-child attachment
• Growth stage slows thus appetite and need for intake decreases (12-18 months) 4) Have parents leave a personal article, picture, favorite toy with child
• Avoid large pieces of food like hotdogs, grapes, cherries, peanuts 5) Maintain usual routine and rituals
6) Allow choices
• 2 ½ - 3 years – deciduous teeth (20)
• Toddlers will verbally indicate discomfort (NO, OUCH, HURTS)
• Teach good dental practices
• Generalized restlessness, uncooperative, clings to family member
f. Play and Toys
i. Death
Play: Parallel Play
Toys: • Death is not a permanent condition
• Push-pull toys, rocking horses, large bocks and balls, finger paints to develop • Believes death is reversible, a temporary departure or sleep
motor and coordination abilities
• Begins as imaginative and make-believe play, may imitate adults
• Enjoys repetitive stories and short songs with rhythm
j. Developmental Milestone
g. Safety
• Greater than 20 lb should be in forward acing position in the back seat of the car
Age Personal- Fine Motor Gross Language Play
• Supervise indoor and outdoor activities
(months) Social Motor
• Teach use of syrup of ipecac for accidental ingestions
• Teach injury prevention
Pediatric Nursing — Growth &Development
 15 - Seek novel - Put small - Walks 4-6 words. - Can stack -Sense of - Can open little 300 words,
ways to pursue pellets into alone well 2 blocks or power from doors falling uses short
new small bottles - Can seat cubes saying “no” - Throws sentences,
experiences - Scribbles self in - Enjoys and “mine” and kicks speaks
- Imitations of with pencil chair being read - Increase a ball intelligently
people are or crayon - Can to independence - Walks and
more advanced - Holds creep - Drops toys from mother up and understands
spoon well upstairs for adults down simple
but may still to recover stairs one instructions.
turn it step at a - 2-words
upside down time sentences,
to the way like “Daddy
to the go”
mouth 30 -Makes Can jump - Verbal - Spends
- uses cup simple lines down language time
well or strokes from increasingly playing
for crosses stairs steady house
18 - Extremely - Better - Can run - 7-20 words - Imitates with a pencil - Knows full - Imitate
curious control of and jump - Begin to household - holds name actions of
- Becomes a spoon in place use chores crayon with - Can name parents
communicative - Begins language in - Parallel fingers (24- 1 color and
social being to walk a symbolic play 30min) holds up
- Parallel play sideways form to - good hand fingers to
-Fleeting and represent -finger show age
contacts with backward images or coordination
other children - Can walk ideas that 36 - Basic - Copies a - Balances - Quests for - Able to
- “Make- up and reflect the concepts of circle and on one information take turns
believe” play down thinking sexuality are straight line foot; furthered by -
begins stairs process established - Grasps jumps in questions Imaginative
holding - Uses some - Separates spoon place; like “why”,
onto a meaningful from mother between pedals “when”,
person’s words such more easily thumb and tricycles “where”,
hand or as “hi”, - Attends to index finger and “how”
railing “bye-bye” toilet needs - Holds cup - Vocabulary
and “all - “Conscience by handle 900 up to
gone” develops. Shy - - Able to 1000 words
- Names 1 with strangers button
body part and inept with clothes
24 -Language - Turns - Runs -has Parallel play peers - Copies O
facilitates pages of a well with vocabulary evident - Sufficiently to and +
autonomy book singly of around be

Pediatric Nursing — Growth &Development

 independent to • Masturbation
be interested - exploration of the genitalia is expected for preschooler
in group - one way the child learns to perceive the body as a possible source of
experiences pleasure and is beginning of the acceptance of sex as natural and
with age mates pleasurable
(e.g. nursery  A matter-of-fact response to the child found masturbating is the most
school) effective.

3. Sibling rivalry
PRESCHOOL • jealousy of a brother or sister partly because children have enough
vocabulary to express how they feel and are more aware of family roles
Age Bracket: 3-6 years of age • Minimizing sibling rivalry
1) After returning home from the hospital, devote attention to the
a. Developmental Theories preschooler
• Freud: Phallic Stage 2) When friends and family visit, encourage them to spend time with
• Erickson: Initiative vs Guilt the child and the baby
• Piaget: Preoperational Period (Intuitive Stage) 3) Teach them to open the baby’s gifts and explain to them that it is
• Kohlberg: Conventional Stage the baby’s birthday and on his birthday he will receive a gift too
4) Provide a special time for a preschooler during each day
b. Physical Development 5) While feeding the baby, read or tell a story to the preschooler
• Height: Slow growth; 2.5 inches
• Weight: 3-5 lb each year e. Nutrition
• Dentition: Begins to be replaced by permanent teeth; The central incisor are • Exhibits food fads and strong taste preference
usually the first to erupt • By 5 years old: tends to focus on social aspects of eating, table conversation
• Visual Development: 6 years old – 20/20 vision manners and willingness to try new foods
• Bed wetting stops at 4 years old • Enjoys five meals a day to keep to with energy demands
• Allow the child to choose his food (with limits)
c. Psychosocial Development • Do not force them to finish the meal
1. Development of Imagination
• “Magical Thinking” f. Play and Toys
- makes preschoolers good audiences for storytelling, simple plays, and Play: Associative play
television • Associative play – occurs when children play together and are engaged in similar
- when preschooler see a television character die, they believe it is real and activities but without organization, rules or a leader.
often cry Toys:
• Imaginary playmate • Housekeeping toys, tricycles, simple jigsaw puzzles, playground equipment,
- has the characteristics that the child might wish for watercolors
• Enjoys imitative and dramatic play
2. Sexual Development • Imitates same sex role in play
• Oedipal or Electra Complex • Parental supervision of TV
• They are curious about their own genitalia and those of peers • Enjoys sing-along song with rhythm
• Best time for sex education is 3 years old
Pediatric Nursing — Growth &Development
g. Safety • Magical thinking and egocentricity lead to the belief that the dead person
• 40 lb/4 y.o/40 inches – car seatbelt will come back
• Able to learn safety habits o Centration or the inability to attend to more than one aspect of a
• Teach injury prevention situation
1) Traffic safety o Egocentricity or the inability to consider the perception of others
2) Strangers • View death as punishment; believe bad thoughts and actions
3) Fire prevention/safety • Common behaviors: nightmares, bowel and bladder problems, crying, anger,
4) Water safety out of control behaviors

h. Fear d. Developmental Milestone

• Fear of the dark
• Fear of mutilation Age Personal- Fine Motor Gross Language Play
• Fear of abandonment (months) Social Motor
 Allow a 5-year old child to visit at his first day of school and meet with the 4 - Boisterous - Can use - Hops on - -
teacher if possible, to diminish the fear of the unknown - Aggressive scissors one foot; Vocabulary Pretending
 Offer the child a syringe and doll after receiving injection to have control of physically - Copies a can control of about
the situation and allow the child to act out her fear in a form of a role play and verbally square movement 1500 words
but - Do simple of hands - Constant
i. Illness and Hospitalization developing buttons questions
• Magical thinking causes preschooler to view illness as a punishment behaviors to - Sentence
• Fearful to procedures due to the fear of body mutilation become of four or
 Use puppets and dolls to demonstrate procedures socially five words
 Use adhesive bandages after giving injections acceptable - Uses
 Avoid performing invasive procedures, if possible - Accepts profanity
 Reassure the preschooler that he is not responsible for illness punishment - Reports
for fantasies as
Nursing interventions wrongdoing truth
1) Encourage parent to participate in childcare because it - can
2) Allow child to express feelings relieves guilt remember
3) Give simple explanations; avoid medical terminology nursery
4) Provide therapeutic play – planned play techniques that provide an rhymes,
opportunity for children to deal with their fears and concerns related may have
to illness some
5) Allow child to manipulate and play with the equipment stuttering
6) Maintain trusting relationship with parents and child; allow time for 5 - Initiates - Ties - Throws - Like games
questions contacts with shoelaces and catches Vocabulary with
7) Praise the child, focus on the desired behavior, give rewards strangers - Copies a ball of 2100 numbers
and relates diamond - Jumps words and letters
i. Death: interesting and rope - Speech is
• Believes death is reversible, a temporary departure or sleep little tales triangle - Walks intelligible
backward

Pediatric Nursing — Growth &Development

 - Interested - Print a with heel to - Asks • Girls have a growth spurt between ages 9 and 10 and boys usually catch up
in telling and few letters toe meaning of by age 13 or 14.
comparing or numbers - Skips and words
stories about - Draws 6- hops - Enjoys c. Psychosocial Development
self part man - Adept on telling 1. 6 – 7 years old
bicycle and stories • “Magical Thinking” is still present
climbing - able to • Most 6 years old can sit still and can understand about taking turns
equipment recite • Judgment about acceptable and unacceptable behavior is not well
address and developed
phone • Children begin to enjoy participating in real-life activities
numbers, • Requires 10-12 hours of sleep
may have
vocabulary 2. 7 – 10 years old
of > 2100 • Begins to shake off their acceptance of parental standards as the ultimate
words authority
- able to use • Interest in group play increases
the past - quickly become all-boy or all-girl groups
tense and - Individual friendship is born
sentences • Beginning of neighborhood team sports
of 4 or 5 • Children see the world from someone else’s point of view
words up to
• Magical thinking begins to disappear
short
• Understanding in the principle of conservation
paragraph
• At 7, the child can already add and subtract
• Has the ability to classify objects
SCHOOL AGE
• Love to collection
Age Bracket: 6-12 years of age •
d. Nutrition
a. Developmental Theories • Boys require more calories than the girls
• Freud: Latency Stage • Adequate calcium fluoride and iron
• Erickson: Industry vs Inferiority • Approximately the child needs 2400 calories
• Piaget: Concrete Operational Period
e. Safety
• Kohlberg: Conventional Stage
• Less accidents
b. Physical Development • Teach proper use of support equipment
• Height: 2 to 2½ inches each year • Discourage risk taking behaviors (smoking, alcohol, drugs)
• Weight: 5 1/2 to 7 pounds each year • Teach injury prevention
• Dentition: The child will begin to lose his baby teeth when he is around 6 to 1) Bicycle safety
7 years old; An average of 4 teeth are lost each year over the next 5 years to 2) Firearms
make room for permanent teeth 3) Smoking education
4) Hobbies/handcrafts
• Puberty: may start in girls as early as 8 or 9 years of age.
Pediatric Nursing — Growth &Development
f. Play and Toys ▪ Common behaviors: difficulty with consideration in school, psychomatic
Play: Competitive or Team play complaints, acting out behaviors
Toys: Board or card games
• Comprehends rules and rituals of games j. Developmental Milestone
• Enjoys team play; helps learn values and develop sense of accomplishment
• Enjoys athletic activities such as swimming, soccer, hiking, bicycling, basketball, Age Motor Personal- Social Language Cognition
baseball, football (mon
• Good eye/hand coordination: interested in video and computer games (needs ths)
monitoring and time limits) 6 - Tie shoes - Increased need to - Uses every form - Recognizes
• Enjoys music, adventure stories, competitive activities - Runs, jumps, socialize with same of sentence simple words
climbs, skips sex - 2500 words -Conservation
g. Fear - Can ride - Egocentric - Sentence length of numbers
• “School” phobia bicycle about 5 words - Defines
• Fear of death and dying - Cuts, paste, - able to write objects by use
prints, draws letters by age 6-7 - Can group
h. Illness and Hospitalization with some years old according to
1. 6-8 years old detail an attribute
• See illness as punishment from
• Rely on others to tell they are ill subclasses
2. 8 – 10 years old
• Identify illness state 7 - More cautious - More cooperative - Can name day, - Begins to
• Recognize that illness is caused by specific factors - Swims - Same-sex ply month, season use simple
group and friends logic
Nursing Interventions: - Can group in
1) Communicate openly and honestly; explain rules ascending
2) Clarify any misconceptions order
3) Encourage child’s participation in care to maintain sense of control and - Grasps basic
independence idea of
4) Provide visit to siblings and peers addition and
5) Use age appropriate therapeutic play to provide an opportunity for subtraction
children to deal with their fears and concerns related to illness -Conservation
6) Art therapy to express feelings of substance
7) Provide explanations; use visual aids - Can tell time
8) Praise the child; focus on desired behavior
8 -Movements - Adheres to simple - Give precise - Increasing
more graceful rules definitions memory span
i. Death - Writes in - Hero worship - Articulation - Interest in
▪ Understands death as permanent, universal and inevitable cursive begins near adult level causal
▪ Understands death is final - can throw and -Same-sex peer - reading relation
▪ Believes own death can be avoided hit a baseball group proficiently by 8 – -Conservation
9 years old of length

Pediatric Nursing — Growth &Development

 - Has symmetric -Can put • Peer pressure is strong
balance and can thoughts in a • Seeing one’s body as attractive and functional contributes positive self-esteem
hop chronologic
sequence d. Nutrition
9-10 - Good - Enjoy team - Can use - Classifies • 11 – 14: 1500 - 3000kcal/day
coordination competition language to objects • 15 – 18: 2100 – 3900 kcal/day
- Can achieve - Moves from convey thoughts - Understands • Approximately the child needs 2400 calories
the strength group to best and look at explanations
and speed friend other’s point of -Conservation f. Play and Toys
needed for - Hero worship view of area and Play: Games and Athletics
most sports intensifies weight
-Describes g. Fear
characteristic • Loss of independence and identity
s of objects • Rejected
-Can group in • Body image disturbance
descending
order h. Death
▪ Understands death as permanent, universal and inevitable
ADOLESCENCE ▪ Seen as personal but distant event
▪ Better understanding between illness and death
Age Bracket: 13 - 18 years of age
i. Health Teachings
a. Developmental Theories • Sexuality and Sexual Responsibility
• Freud: Genital Stage • Routine self-examination
• Erickson: Identity vs Role Confusion ➢ Breast self examination
• Piaget: Formal Operational Period ➢ Testicular examination
• Kohlberg: Post-conventional Stage

b. Physical Development SAFETY MEASURES THROUGHOUT THE LIFESPAN:

• Height: Girls- 3 inches/year, slows at menarche
Boys: 4inches/year, growth spurt at 13 years old Newborns and Infants
• Weight: Girls- 15-55 lb - accidents are a leading cause of death during infancy, especially during
Boys- 15-65 lb the first year of life.
• Final Molars erupt - infants are completely dependent on others for care; they are oblivious
• Puberty: Related to hormonal changes to such dangers as falling or ingesting harmful substances.
Development of secondary sex characteristics - common accidents during infancy include:
1. burns
c. Psychosocial Development 2. aspiration
• Develop a sense of moral judgment and a system of values and beliefs 3. suffocation or choking
• Trends and fads dictate clothing choices, hairstyles, music and other recreational 4. automobile accidents
choices 5. falls, and poisoning
Pediatric Nursing — Growth &Development
 ➢ children must be cautioned to avoid hazards, such as (vehicular accidents) busy
Nursing Intervention: streets, swimming pools, and other potentially dangerous areas.

NB - Infants (0 – 1 year old) Nursing Interventions

a. Never leave alone on raised surfaces
b. Check temperature of bath water Pre-school (4-5)
c. Place in upright position during feeding (no peanuts/ popcorns) a. No running when eating candies
d. Give toys without detachable parts b. Teach children not to put small objects in mouth, nose and ears
e. Guard stairs, windows, highchair, and walker c. Teach traffic rules and how to cross the streets
f. Cover electrical outlets d. Avoid streets
g. Lock poisons, chemicals, paints e. Teach children not to play with matches, heating appliance
f. Avoid walking in front of swings
Note: g. Avoid approaching animals and making noise when near it
h. Car seat belt: positioned over the child chest and pelvis
Toddlers
➢ they are curious and like to feel and taste everything
➢ they are fascinated by potential dangers (ACCIDENTS), such as electrical burns, School-Age Children
pools and busy streets, so they need constant supervision and protection ➢ by the time children attend school, they are learning to think before they act.
➢ lead poisoning (plumbism) is a risk for children exposed to lead paint chips, ➢ they often prefer adult equipment to toys.
fumes from leaded gasoline, or any “leaded” substances. ➢ they want to be active with other children in such pursuits as bicycling, hiking,
swimming, and boating.
Nursing Interventions ➢ ACCIDENTS are the leading cause of death in school-age children.
o (the most frequent causes of fatalities, in descending order, are motor
Toddlers (1-3) vehicle accidents , drowning, fires and firearms)
a. Place in backseat when traveling ➢ they also involved in minor accidents (fractures and dislocations), frequently
b. Teach the word no and don’ts (its danger and must be obeyed) resulting from outdoor activities and recreational equipment such as swing,
c. Teach not to place objects in mouth/ pills bicycles, skateboards and swimming pools.
d. Keep objects with sharp edges out of reach
e. Keep handles of hot pots in burner turned inside
f. Keep chemicals in locked cabinets Nursing Interventions
g. Teach to swim and never leave in water alone
h. Teach not to run or go biking in streets School Age (6-12)
i. Keep windows and balconies screened a. Teach safety rules on sports (contact sports), skating, biking
j. Provide low beds b. Teach not to play with gun powders or firearms. (unload)
k. Cover outlets c. Teach effects of drugs and alcohol on judgment and coordination
l. Car Seat: Forward-facing position, safety belts should be worn on the hips and
not on the abdominal area.
Preschoolers Adolescence
➢ children of preschool age are active and often very clumsy, making them ➢ obtaining a driver’s license is an important in the life of an adolescent.
susceptible to injury. ➢ teenagers may use driving as an outlet for stress, as a way to assert
➢ control of the environment must continue, keeping hazards, such as matches, independence, or as a way to impress peers.
medicines, gun shots, and other potential poisons out of reach.
Pediatric Nursing — Growth &Development
 ➢ adolescents are at risk for sports injuries because their coordination skills are not Eyes, ears, mouth near end
fully developed. PRESCHOOL Allow to handle equipment
➢ suicide and homicide are two leading causes of death among teenagers (GUN Head to toe if cooperative
SHOT WOUNDS) Same as toddler if uncooperative
➢ adolescent males commit suicide at a higher rate than female. SCHOOL AGE Respect privacy
➢ suicides by firearms, drugs and automobile exhaust gases are the most common. Explain procedures
➢ Factors influencing the high suicide and homicide rates: Head to toe
❖ economic deprivation Genitalia last
❖ family breakup ADOLESCENT Explain procedure
❖ availability of firearms (which are the most frequently used weapons; cutting Proceed as for school age
or stabbing tools are the next most frequently used weapons)
o obesity 2. Use terms understandable to and appropriate for child and parents
o diseases like: pelvic inflammatory and kissing disease 3. Allow child to become familiar with examiner prior to beginning examination.
4. Save distressful or intrusive parts of the examination for last
Nursing Interventions 5. Encourage participation of the child or parents as possible.
6. Examine child in a comfortable and secure position.
Adolescents (12-18) – M- (12-16); F-(19-14) 7. Praise cooperation.
a. Have driver’s education course
b. Helmets, use of alcohol while driving
c. Sports safety
d. Inform dangers of drugs, alcohol and unprotected sex Assessment for Newborn
A. Apgar Score
Characteristic 2 1 0
ASSESSING CHILDREN AND INFANCY
Appearance Pink torso & Pink torso, blue Blue all over
extremities extremities
General Consideration
Pulse >100 100 Absent
1. Developmental assessment of the child is the most important consideration for a Grimace(irritability) Vigorous cry Limited cry No response to
stimulus
successful assessment.
Activity Actively moving Limited movement Flaccid
AGE APPROACH Respiratory Effort Strong loud cry Hypoventilation, Absent
irregular
INFANT Child lying flat or held in parent’s arm Total Score: 8-10: normal; 4-6: moderate depression; 0-3: aggressive resuscitation
Assess heart, pulse, lungs, respirations while quiet,
then head to toe
Eyes, ears, mouth near end
Moro reflex last
TODDLER Minimal contact initially
Allow to inspect equipment B. Ballard Score
Assess heart and lungs while quiet, then head to The Ballard Score assesses the physical and neuromuscular maturity of newborn infants.
toe
Study Parameters:
Pediatric Nursing — Growth &Development
 • Neuromuscular maturity: 6 parameters posture wrists wrists elbows hips elbows elbows & NA
• Physical maturity: 7 parameters arms hips bent and and legs hips and legs bent
and legs legs bent but do legs bent and
Neuromuscular Maturity straight slightly not reach to 90° drawn
Posture: Observe degree of flexion in arms and legs. Muscle tone and degree of flexion bent 90° close to
increase with maturity body

Square Window: Measure angle between base of thumb and forearm. square 90° 60° 45° 30° 0° NA
➢ Method: With thumb supporting back of arm below wrist, apply gentle pressure window
with index and third fingers on dorsum of hand without rotating infant’s wrist. (wrist)

Arm Recoil: Observe rapidity and intensity of recoil to a state of flexion arm 180° NA 110-180° 90-100° < 90° NA
➢ Method: Fully flex both forearms on upper arms, hold for 5 seconds; pull down recoil
on hands to fully extend and rapidly release arms
popliteal 180° 160° 130° 110° 90° < 90°
angle
Popliteal Angle: Measure degree of angle behind knee
➢ Method: Flex lower leg on thigh and then flex thigh on abdomen. While holding scarf sign elbow elbow to elbow to elbow to elbow to NA
knee with thumb and index finger, extend lower leg with index finger of other beyond opposite opposite axillary
midline
hand opposite axillary midclavicular line
axillary line line
Scarf sign: Determine location of elbow in relation to midline. line
➢ Method: Support head in midline with one hand; use other hand to pull infant’s
arm across the shoulder so that infant’s hand touches shoulder heel to leg knee knee bent knee bent knee NA
ear straight slightly heel reaches to 90° bent heel
Heel to ear: Measure distance of foot from ear and degree of knee flexion toes bent heel 120° from heel reaches
➢ Method: Pull foot as far as possible up toward ear on same side. Measure reach reaches prone reaches 45° from
distance of foot from ear and degree of knee flexion (same as popliteal angle) chin 140° 90° from prone
from prone
prone

Neuromuscular Maturity Scoring

Physical Maturity Scoring

0 1 2 3 4 5

Pediatric Nursing — Growth &Development

 = SUM (points for each parameter)
0 1 2 3 4 5
Interpretation:
skin gelatinous smooth superficial cracking parchment feathery
• minimum score: 0
red pink peeling pale deep cracked
translucent visible &/or rash areas cracking wrinkled • maximum score: 54
veins few veins rare no vessels
veins Correlation of score with gestational age
lanugo none abundant thinning bald mostly NA
Score Week Score Week
areas bald
5 26 30 36
plantar no crease faint red anterior creases creases NA
surface marks transverse anterior over 10 28 35 38
crease two entire sole
only thirds 15 30 40 40

breast barely flat stippled raised full areola NA 20 32 45 42

perceptible areola no areola 1 areola 3 5 mm bud
bud mm bud mm bud 25 34 50 44

ear pinna flat slightly well- formed thick NA

stays curved curved & firm cartilage C. Denver Developmental Screening Test II (Denver II)
folded pinna pinna soft with ear stiff
soft with with instant Purpose
slow ready recoil 1. Detection of potential developmental problems in young children
recoil recoil 2. Used to confirm suspicion of developmental delay
3. Can be used to monitor children at risk for developmental delays
genitals scrotum NA testes testes testes NA
male empty no descend- down pendulous
Description
rugae ing few good deep
1. Designed to be used on well children between birth and six years
rugae rugae rugae
2. To assess performance on age appropriate tasks
genitals prominent NA majora & majora majora NA 3. Should not be used in place of diagnostic evaluation or physical assessment
female clitoris & minora large cover 4. Assess four areas of functioning
labia equally minora clitoris & a. Personal-social: getting along with people and caring for personal needs
minora prominent small minora b. Fine motor-adaptive: hand-eye coordination, manipulation of small
objects and problem solving
c. Language: hearing, understanding, and using language
d. Gross motor: sitting, walking, jumping, and large muscle movement

Ballard Score
Pediatric Nursing — Growth &Development