GROWTH AND DEVELOPMENT b.

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

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 anticipatory r stage: children’s Initiative vs opportunities
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 2. Allow play to
boundaries.
Pediatric Nursing — Growth &Development
 awareness genitals, as a initiative include adjusting to a
of genital normal area versus guilt activities new body
area of involving image,
exploration. Child learns water, clay (for seeking
2. Help parents how to do modeling), or emancipation
answer things (basic finger paint. from parents,
child’s problem 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 (Level I)
through mental mo preoperational thought period. 2-3 1 Punishment/obedience 1. Child needs help to
combinations Uses memory and imitation to act orientation determine what
Can solve basic problems are right actions.
Preoperational Thought 2 – 7 yr Thought becomes more symbolic; Child does right because a 2. Give clear
can arrive at answers mentally parent tells him or her to and to instructions to
instead of through physical attempt avoid punishment. avoid confusions.
Comprehends simple abstractions
but thinking is basically concrete and • the activity is wrong if the
literal. person is punished and right if
Child is egocentric not punished
Displays static thinking • Your decision is motivation by
Concept of time is now, and concept external pressure, the avoidance
of distance is only as far as they can of punishment or after reward
see 4-7 2 Individualism. 1. Child is unable to
Unable to state cause-effect recognize that like
relationships, categories or Instrumental purpose and situations require
abstractions exchange. carries actions to like actions.
Concrete Operational 7 -12 yr Concrete operations includes satisfy own needs rather than 2. Unable to take
thought systematic reasoning: society’s. Will do something for responsibility for
Use memory to learn broad concepts another if that person does self-care, because
(fruit) and subgroup of concepts something for the child. meeting own needs
(apples, oranges) interferes with this
Classifications involving sorting “Instrumental relativist
objects according to attributes such Orientation”
as color, weight, multiplication.
Follows a route through a maze and • it is good to do good to people
then reverses steps but only because one day they
Understands conservation, sees may return the favor to you.
constancy despite transformation “you scratch my back and I’ll
Formal operational 12 yr Can solve hypothetical problems scratch yours”
thought with scientific reasoning • takes to satisfy one’s need
Understands causality and can deal Conventional (Level
with the past, present, and future. II)
Adult or mature thought 7-10 3 Orientation to interpersonal 1. Child enjoys
relations of mutuality helping others
because this is
“Good boy- nice girl” “nice” behavior.
Kohlberg’s Stages of Moral Development Orientation” Allow child to help
Age Stage Description Nursing Implications with bed making
Preconventional Child follows rules because of a and other like

Pediatric Nursing — Growth &Development

 need to be a “good” person in activities. protect the welfare and rights of
own eyes and eyes of others. 2. Praise for desired others
behavior such as • Personal values and opinion
• The action is taken to please sharing. are recognized and violating the
others/gain approval rights of others is avoided
• Good boy-good girl 6 Universal ethical principle 1. Many adults do not
• Pleasing others esp. those in orientation reach this level of
authority is the right thing to do moral
“Universal-Ethical Principles” development
10-12 4 Maintenance of social order, 1. Child often asks
fixed rules, and authority what are the rules Follows internalized standards
and is something of conduct
“Law and order Orientation” “right’
Child finds 2. May have difficulty • Universal moral principles are
modifying a internalized
Child finds following rules procedure because • Person respects other humans
satisfying. one method may and believes that relationships
Follows rules of authority not be “right” are based on mutual trust
figures as well as parents in an 3. Follows selfcare • Decision of conscience based
effort to keep the “system” measures only if on self-esteem
working. someone is there
to enforce them
• right behavior means doing THEORIES OF CHILD DEVELOPMENT
one’s duty, respecting authority
and maintaining the given social 1. Sigmund Freud “Psychosexual Theory”
order for it’s own sake
• Right behavior is obeying the 3 Levels of Consciousness
law and following the rules a. Id - controls physical needs and instincts of needs
Postconventional b. Ego - conscious self
(Level III) - controls the pleasure principle of the Id by delaying the instincts until
Older 5 Social contract, utilitarian law 1. Adolescents can be an
than 12 making perspectives. responsible for appropriate time
self-care because c. Superego- conscience
“Social Contract and Legalistic they view this as a
Orientation” standard of adult
behavior.
Follows standards of society for Psychosexual Stages
the good of all people
a. Oral Stage (0-2 years)
• Standard of behavior is based Site of Gratification: Mouth
on adhering the laws that Characteristics: sucking, making noises, crying and breathing
Implications:
Pediatric Nursing — Growth &Development
  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)
 Encourage identity Trust Mistrust
Fixations: * discomforts are quickly removed * inconsistent; inadequate
 Difficulties with sexual identity *cuddled * rejection
Pediatric Nursing — Growth &Development
 * 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
(-) 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
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

d. Industry vs. Inferiority (6-12 years) h. Ego Integrity vs. Despair (65- death)
Industry Inferiority Ego Integrity Despair
* seek self-achievement * acceptance of worth and uniqueness * sense of loss
*encourage their efforts to do practical * parents sees their children’s efforts as * acceptance of death
task (collection, projects) mischief
* praise & reward * don’t show appreciation for their 3. Jean Piaget “Cognitive Development”
children’s work
a. Sensorimotor Behavior (0 – 2 years)
(+) resolution: competence & (-) resolution: withdrawal from school & Significant behavior
perseverance peers  Reflexive- responses to the environment
Example: newborn gazes instantly at the mother’s face, smells the
e. Identity vs. Role Confusion (12-20 years) nipple, tastes the milk
Pediatric Nursing — Growth &Development
  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 the  Able to conceive the distant future
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
 Sight not fully developed until 6 years; differentiates light and dark at
d. Formal Operations (11 – adulthood) birth; prefers human face
Significant behavior  2 months – searches and turns head to locate sounds
 Deal with ideas, abstract concepts  6 months – has taste preference
 Begin to understand jokes  7 months – responds to name
Pediatric Nursing — Growth &Development
  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
 Push pull toys
allergenic potential
 12 months – gradual weaning from breast to bottle to cup
 Self-Feeding
e. Recommended immunization schedule
 7-8 months, the baby may grab the spoon
2 4 6 6-18 12-15 12-18 15-18 4-6
 Sticks fingers in the mouth for tasting
months months months months months months months years
 No more than 32 oz formula per 24 hours should be given to
- 1st Hep - 2nd Hep - 3rd DPT -3rd Hep - 4th PVC - 4th Hib - 4th DPT - 4th
infants, to avoid iron deficiency anemia
B B - 3rd Hib B - 1st IPV
- 1 DPT - 2 DPT - 3rd PVC - 3rd IPV
st nd
MMR - 2nd
d. Play and Toys
- 1st Hib - 2nd Hib - MMR
Play: Solitary Play st
- 1 IPV - 2nd IPV Varicella
Toys:
- 1 PVC - 2nd PVC
st
 Rattles, crib gym, squeezy toys, textured balls
 Provide black/white contrast for premature and newborn infants
 Hang mobile 8 – 10 inches from infant’s face
f. Safety
 Provide sensory stimuli (bath water) and tactile stimuli (feel of various
 Infants up to 20 lbs (9kg) should be restrained in a rear-facing car seat in the
objects)
middle of the back seat of the car
 Use variety of primary-colored objects
 Keep siderails of crib up
 Place unbreakable mirror in crib to focus on their face
 Never leave unattended on table, bed, bathtub
 Provide toys that let infants practice skills to grasp and manipulate object
 Check temperature of bath water, formula, food
 Avoid giving bottles at naps or bedtime (dental carries)
Birth to 2 months
 Mobiles, black and white patterns, mirrors
g. Fear: Stranger anxiety
Pediatric Nursing — Growth &Development
 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 back to with delight rattles well
more and eating less - Cries when grasp 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
Age Personal-Social Fine Motor Gross Language Play - Knows family well anticipation sounds toys, rubber
Motor from strangers - Tries to of being ring for
1 mo Some smiling - Keep hands - Lies - Enjoys -Knows likes retrieve a picked up teething
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 manipulatio
others - Can raise toy change position to support n
head and - peaked be able to
upper chest strangers reach for an
when prone anxiety object

4 mo - Responds to - Eye-hand - Gains Need space 9 mo - Creep or Says first Needs space
stimulus coordination head to turn crawls word (dada) for creeping
- Sees bottle, begins control - Stand
squeals and - Rolls from holding
laughs front to onto a
back coffee table
- No head if they are

Pediatric Nursing — Growth &Development

 placed in  Stands alone and walks steadily
that
position c. Psychosocial Development
10 - Does things to Uses pincer Pulls self to - Plays peek- 1. Behavioral Characteristics
mo attract grasp standing a-Boo and  Negativism
attention (thumb and patty cake - toddler’s response to nearly everything is a firm “no”
finger) to  Limit the number of question into options
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 - Be careful not to flush the toilet while the child is sitting on it, this can be
 Piaget: Preconceptual Phase frightening to the child
 Kohlberg: Preconventional (Punishment and Obedience) - The caregiver should not expect perfection, even after control has been
achieved
b. Physical Development - Offering small rewards can be an encouragement to the child who is in the
 Slowed growth process of toilet training
 Gains 5-10 lb and 3 inches in height  Control
 Continued eruption of teeth particularly the molars - Bowel control: 18 months

Pediatric Nursing — Growth &Development

 - 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
 2 ½ - 3 years – deciduous teeth (20) 6) Allow choices
 Teach good dental practices  Toddlers will verbally indicate discomfort (NO, OUCH, HURTS)
 Generalized restlessness, uncooperative, clings to family member
f. Play and Toys
Play: Parallel Play i. Death
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

g. Safety j. Developmental Milestone

 Greater than 20 lb should be in forward acing position in the back seat of the car
 Supervise indoor and outdoor activities Age Personal- Fine Motor Gross Language Play
 Teach use of syrup of ipecac for accidental ingestions (months) Social Motor
 Teach injury prevention 15 - Seek novel - Put small - Walks 4-6 words. - Can stack
1. Childproof the home: stairways, cupboards, medicine cabinet, outlets ways to pursue pellets into alone well 2 blocks or
2. Suffocation: plastic bags, unused refrigerators new small bottles - Can seat cubes
3. Burns: ovens, heaters, sunburns, check water and food temperature experiences - Scribbles self in - Enjoys
4. Falls: stairs, window, balconies, walkers - Imitations of with pencil chair being read
5. Aspiration/ Poisoning: medications people are or crayon - Can to
more advanced - Holds creep - Drops toys
g. Fear: Separation Anxiety spoon well upstairs for adults
but may still to recover

Pediatric Nursing — Growth &Development

 turn it time - 2-words
upside down 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 little of around be
-Sense of - Can open falling 300 words, independent to
power from doors - Throws uses short be interested
saying “no” and kicks sentences, in group
and “mine” a ball speaks experiences
- Increase - Walks intelligently with age mates
independence up and and (e.g. nursery
from mother down understands school)
stairs one simple
step at a instructions.

Pediatric Nursing — Growth &Development

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
 Masturbation g. Safety
- exploration of the genitalia is expected for preschooler  40 lb/4 y.o/40 inches – car seatbelt
- one way the child learns to perceive the body as a possible source of  Able to learn safety habits
pleasure and is beginning of the acceptance of sex as natural and  Teach injury prevention
pleasurable 1) Traffic safety
 A matter-of-fact response to the child found masturbating is the most 2) Strangers
effective. 3) Fire prevention/safety
4) Water safety
3. Sibling rivalry
Pediatric Nursing — Growth &Development
h. Fear
 Fear of the dark Age Personal- Fine Motor Gross Language Play
 Fear of mutilation (months) Social Motor
 Fear of abandonment 4 - Boisterous - Can use - Hops on - -
 Allow a 5-year old child to visit at his first day of school and meet with the - Aggressive scissors one foot; Vocabulary Pretending
teacher if possible, to diminish the fear of the unknown physically - Copies a can control of about
 Offer the child a syringe and doll after receiving injection to have control of and verbally square movement 1500 words
the situation and allow the child to act out her fear in a form of a role play but - Do simple of hands - Constant
developing buttons questions
i. Illness and Hospitalization behaviors to - Sentence
 Magical thinking causes preschooler to view illness as a punishment become of four or
 Fearful to procedures due to the fear of body mutilation socially five words
 Use puppets and dolls to demonstrate procedures acceptable - Uses
 Use adhesive bandages after giving injections - Accepts profanity
 Avoid performing invasive procedures, if possible punishment - Reports
 Reassure the preschooler that he is not responsible for illness for fantasies as
wrongdoing truth
Nursing interventions because it - can
1) Encourage parent to participate in childcare relieves guilt remember
2) Allow child to express feelings nursery
3) Give simple explanations; avoid medical terminology rhymes,
4) Provide therapeutic play – planned play techniques that provide an may have
opportunity for children to deal with their fears and concerns related some
to illness stuttering
5) Allow child to manipulate and play with the equipment 5 - Initiates - Ties - Throws - Like games
6) Maintain trusting relationship with parents and child; allow time for contacts with shoelaces and catches Vocabulary with
questions strangers - Copies a ball of 2100 numbers
7) Praise the child, focus on the desired behavior, give rewards and relates diamond - Jumps words and letters
interesting and rope - Speech is
i. Death: little tales triangle - Walks intelligible
 Believes death is reversible, a temporary departure or sleep - Interested - Print a backward - Asks
 Magical thinking and egocentricity lead to the belief that the dead person in telling and few letters with heel to meaning of
will come back comparing or numbers toe words
o Centration or the inability to attend to more than one aspect of a stories about - Draws 6- - Skips and - Enjoys
situation self part man hops telling
o Egocentricity or the inability to consider the perception of others - Adept on stories
 View death as punishment; believe bad thoughts and actions bicycle and - able to
 Common behaviors: nightmares, bowel and bladder problems, crying, anger, climbing recite
out of control behaviors equipment address and
phone
d. Developmental Milestone numbers,

Pediatric Nursing — Growth &Development

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

Pediatric Nursing — Growth &Development

 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
 Peer pressure is strong
 Seeing one’s body as attractive and functional contributes positive self-esteem Nursing Intervention:

d. Nutrition NB - Infants (0 – 1 year old)

 11 – 14: 1500 - 3000kcal/day a. Never leave alone on raised surfaces
 15 – 18: 2100 – 3900 kcal/day b. Check temperature of bath water
 Approximately the child needs 2400 calories c. Place in upright position during feeding (no peanuts/ popcorns)
d. Give toys without detachable parts
f. Play and Toys e. Guard stairs, windows, highchair, and walker
Play: Games and Athletics f. Cover electrical outlets
g. Lock poisons, chemicals, paints
g. Fear
Pediatric Nursing — Growth &Development
Note:
Toddlers
 they are curious and like to feel and taste everything
 they are fascinated by potential dangers (ACCIDENTS), such as electrical burns,
pools and busy streets, so they need constant supervision and protection
 lead poisoning (plumbism) is a risk for children exposed to lead paint chips,
fumes from leaded gasoline, or any “leaded” substances.
Nursing Interventions
Toddlers (1-3)
a. Place in backseat when traveling
b. Teach the word no and don’ts (its danger and must be obeyed)
c. Teach not to place objects in mouth/ pills
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
g. Teach to swim and never leave in water alone
h. Teach not to run or go biking in streets
i. Keep windows and balconies screened
j. Provide low beds
k. Cover outlets
l. Car Seat: Forward-facing position, safety belts should be worn on the hips and
not on the abdominal area.
Preschoolers
 children of preschool age are active and often very clumsy, making them
susceptible to injury.
 control of the environment must continue, keeping hazards, such as matches,
medicines, gun shots, and other potential poisons out of reach.
 children must be cautioned to avoid hazards, such as (vehicular accidents) busy
streets, swimming pools, and other potentially dangerous areas.
Nursing Interventions
Pre-school (4-5)
a. No running when eating candies
b. Teach children not to put small objects in mouth, nose and ears
c. Teach traffic rules and how to cross the streets
d. Avoid streets
e. Teach children not to play with matches, heating appliance
f. Avoid walking in front of swings
Pediatric Nursing — Growth &Development
g. Avoid approaching animals and making noise when near it
h. Car seat belt: positioned over the child chest and pelvis
School-Age Children
 by the time children attend school, they are learning to think before they act.
 they often prefer adult equipment to toys.
 they want to be active with other children in such pursuits as bicycling, hiking,
swimming, and boating.
 ACCIDENTS are the leading cause of death in school-age children.
o (the most frequent causes of fatalities, in descending order, are motor
vehicle accidents , drowning, fires and firearms)
 they also involved in minor accidents (fractures and dislocations), frequently
resulting from outdoor activities and recreational equipment such as swing,
bicycles, skateboards and swimming pools.
Nursing Interventions
School Age (6-12)
a. Teach safety rules on sports (contact sports), skating, biking
b. Teach not to play with gun powders or firearms. (unload)
c. Teach effects of drugs and alcohol on judgment and coordination
Adolescence
 obtaining a driver’s license is an important in the life of an adolescent.
 teenagers may use driving as an outlet for stress, as a way to assert
independence, or as a way to impress peers.
 adolescents are at risk for sports injuries because their coordination skills are not
fully developed.
 suicide and homicide are two leading causes of death among teenagers (GUN
SHOT WOUNDS)
 adolescent males commit suicide at a higher rate than female.
 suicides by firearms, drugs and automobile exhaust gases are the most common.
 Factors influencing the high suicide and homicide rates:
 economic deprivation
 family breakup
 availability of firearms (which are the most frequently used weapons; cutting
or stabbing tools are the next most frequently used weapons)
o obesity
o diseases like: pelvic inflammatory and kissing disease
 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 Assessment for Newborn
d. Inform dangers of drugs, alcohol and unprotected sex
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
Grimace(irritability) Vigorous cry Limited cry No response to
1. Developmental assessment of the child is the most important consideration for a stimulus
successful assessment.
Activity Actively moving Limited movement Flaccid
Respiratory Effort Strong loud cry Hypoventilation, Absent
AGE APPROACH
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
B. Ballard Score
Allow to inspect equipment
Assess heart and lungs while quiet, then head to The Ballard Score assesses the physical and neuromuscular maturity of newborn infants.
toe Study Parameters:
Eyes, ears, mouth near end
PRESCHOOL Allow to handle equipment  Neuromuscular maturity: 6 parameters
Head to toe if cooperative  Physical maturity: 7 parameters
Same as toddler if uncooperative
SCHOOL AGE Respect privacy Neuromuscular Maturity
Explain procedures Posture: Observe degree of flexion in arms and legs. Muscle tone and degree of flexion
Head to toe increase with maturity
Genitalia last
ADOLESCENT Explain procedure Square Window: Measure angle between base of thumb and forearm.
Proceed as for school age  Method: With thumb supporting back of arm below wrist, apply gentle pressure
with index and third fingers on dorsum of hand without rotating infant’s wrist.
2. Use terms understandable to and appropriate for child and parents
3. Allow child to become familiar with examiner prior to beginning examination. Arm Recoil: Observe rapidity and intensity of recoil to a state of flexion

Pediatric Nursing — Growth &Development

  Method: Fully flex both forearms on upper arms, hold for 5 seconds; pull down
arm 180° NA 110-180° 90-100° < 90° NA
on hands to fully extend and rapidly release arms
recoil
Popliteal Angle: Measure degree of angle behind knee popliteal 180° 160° 130° 110° 90° < 90°
 Method: Flex lower leg on thigh and then flex thigh on abdomen. While holding angle
knee with thumb and index finger, extend lower leg with index finger of other
hand scarf sign elbow elbow to elbow to elbow to elbow to NA
beyond opposite opposite midline axillary
Scarf sign: Determine location of elbow in relation to midline. opposite axillary midclavicular line
 Method: Support head in midline with one hand; use other hand to pull infant’s axillary line line
arm across the shoulder so that infant’s hand touches shoulder line

Heel to ear: Measure distance of foot from ear and degree of knee flexion heel to leg knee knee bent knee bent knee NA
 Method: Pull foot as far as possible up toward ear on same side. Measure ear straight slightly heel reaches to 90° bent heel
distance of foot from ear and degree of knee flexion (same as popliteal angle) toes bent heel 120° from heel reaches
reach reaches prone reaches 45° from
chin 140° 90° from prone
from prone
prone

Neuromuscular Maturity Scoring

0 1 2 3 4 5 Physical Maturity Scoring

posture wrists wrists elbows hips elbows elbows & NA

arms hips bent and and legs hips and legs bent 0 1 2 3 4 5
and legs legs bent but do legs bent and
straight slightly not reach to 90° drawn skin gelatinous smooth superficial cracking parchmen feathery
bent 90° close to red pink peeling pale t deep cracked
body translucen visible &/or rash areas cracking wrinkled
t veins few veins rare no vessels
square 90° 60° 45° 30° 0° NA veins
window
(wrist) lanugo none abundant thinning bald mostly NA
areas bald

plantar no crease faint red anterior creases creases NA

Pediatric Nursing — Growth &Development
 surface marks transverse anterior over
crease two entire sole
only thirds

breast barely flat stippled raised full areola NA

perceptibl areola no areola 1 areola 3 5 mm bud
e bud mm bud mm bud

ear pinna flat slightly well- formed thick NA

stays curved curved & firm cartilage
folded pinna pinna soft with ear stiff
soft with with instant C. Denver Developmental Screening Test II (Denver II)
slow ready recoil
recoil recoil Purpose
1. Detection of potential developmental problems in young children
genitals scrotum NA testes testes testes NA 2. Used to confirm suspicion of developmental delay
male empty no descend- down pendulous 3. Can be used to monitor children at risk for developmental delays
rugae ing few good deep
rugae rugae rugae Description
1. Designed to be used on well children between birth and six years
genitals prominent NA majora & majora majora NA 2. To assess performance on age appropriate tasks
female clitoris & minora large cover 3. Should not be used in place of diagnostic evaluation or physical assessment
labia equally minora clitoris & 4. Assess four areas of functioning
minora prominen small minora a. Personal-social: getting along with people and caring for personal needs
t 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
= SUM (points for each parameter)
Interpretation:
 minimum score: 0
Score Week Score Week  maximum score: 54

5 26 30 36
Correlation of score with gestational age
10 28 35 38

15 30 40 40
Pediatric Nursing — Growth &Development
20 32 45 42

25 34 50 44