with their children, examine the
MODULE 4: GROWTH AND
DEVELOPMENT
Assessing for growth and development milestone is
a nursing role in the care of both well and ill
children.
Growth and Development is essential to establish a
complete and effective nursing care plans for
children.
THE PARENT_CHILD RELATIONSHIP:
 What a parent expects a child to
become as an adult varies from culture
to culture and family to family but plays
a role in how a child is guided to try to
achieve in life.
 Cultural norms also play a role because
some cultures value education and
contribution to society as more
important than do others.
 Children who are loved and paid
attention to by their parents thrive
better than those who are not.
 When assessing families, don’t just
examine how much time parents spend
quantity of that time because it is the
quality, not the quantity that is more
important.
Overview of Growth and
Development
Growth and Development is an orderly
and predictable process, and essential physical
data when making assessment and should be
accurately plotted on the growth chart. While
rates of maturation vary from one person and
from stage to stage. Within each person there
is range of “Normal.”
Growth generally takes place during the
first 20 years of life.; development continues
after that.
 GROWTH is generally used to denote an
increase in physical size or quantitative
change.
 DEVELOPMENT is used to denote an
increase in skills or ability to function.
 COGNITIVE DEV’T is the ability to learn
or understand from experience, to retain
knowledge and to solve problems
(Intelligence).
Factors Influencing Growth and
Development
1. Genetic Influences 6. Environment
2. Gender 7. Nutrition
3. Race and Nationality 8. Socio-Economic
Level
4. Intelligence 9. Parent-Child
Relationship
5. Health 10. Ordinal Position (Family)
Principles of Growth and Development- Growing
up is a complex phenomenon because of the many
interrelated facets involved. Children do not
merely grow taller and heavier as they get older;
maturing also involves growth in their ability to
perform skills, to think, to relate to people, and to
trust or have confidence in themselves.

1. Growth and Development is a

continuous process.  Is physical change and increase in
size.
2. Growth and Development proceeds in
 It can be measured
orderly sequence
quantitatively.
3. Different children pass through the  Indicators of growth includes
predictable stages at different rates height, weight, bone size, and
dentition.
4. All body system do not develop at the
 Growth rates vary during
same rate
different stages of growth and
5. Development is cephalo-caudal development.
 The growth rate is rapid during
6. There is optimum time for initiation of
the prenatal, neonatal, infancy
experience or learning
and adolescent stages and slows
7. . A great deal of skill and behavior is
during childhood.
learned by practice
 Physical growth is minimal during
8. Physical development proceeds from
proximal to distal parts
9. Development proceeds from gross to
refined skills  DEVELOPMENT
10. Neonatal reflexes must be lost before
motor development can proceed

 GROWTH

 Is an increase in the
complexity of function and
skill progression.
  It is the capacity and skill of a
person to adapt to the  MORAL DEVELOPMENT
environment.
 Development is the behavioral
aspect of growth.
 Can be measured by observing
a child’s ability to perform
specific tasks.
 Measurement Tool
1. Denver Developmental Screening  refers to the ability to learn
Test (standardized tests) – to test the or understand right from
developmental milestones of a child. wrong.
2. Chronologic Age Assessment - ask  measured by observing the
related to age child’s action.
3. Mental Age Assessment - test for IQ  COGNITIVE DEVELOPMENT
Result: IQ
 90-110 Normal
 70-89 Borderline
 60- 69 mild, but educable
 30- 59 moderate, but trainable  Refers to the ability to learn or
understand from experience, to
below 30 profound & needs assistance
retain knowledge and to solve
• Other Related terms problems (Intelligence).
 HEREDITY – the transmission of
 MATURATION characteristics from parent to offspring by
 MORAL DEVELOPMENT means of genes.
 COGNITIVE DEVELOPMENT  DEVELOPMENTAL TASK – is a skill or a
 MOTOR DEVELOPMENT learning process accomplished at a
 GROSS MOTOR DEVELOPMENT particular time in life that indicates a child is
progressing successfully.
 MATURATION
 Refers to increase in competence or
ability to function at a higher level
 Is the process by which the traits
carried by the child through hiss
genes begin to unfold and are
realized.
 Is synonym for development.
They fall into 3 categories: Walking.

1. Physical tasks 2. Fine motor (dexterity)- is the

(ex. learning to sit, crawl, walk)
2. Psychologic tasks
(ex. Learning trust, self-esteem)
3. Cognitive tasks
between thumb and finger
(ex. Acquire concepts of time and space,
abstract thought)
• Other related terms
 Maturation- refers to progress of
change of an individual w/c occurs
primarily as a function of aging
 Heredity- Genetic transmission of
characteristic from parents to offspring
 Developmental task- skill or
learning process accomplished at the
particular time in life that indicates a
child is progressing successfully.
 Cognitive development- refers to
the ability to learn or understand from
experience, to retain knowledge and to
solve problems (Intelligence).
 Moral development- is the ability
to understand the right from wrong, it
is measured by observing the child’s
action.
coordination of small muscles , in
movements , usually the hands &
fingers
Ex. - holding a spoon
- picking up a piece of cereal/ food
3. Sensory Motor
 seeing, hearing , tasting ,
touching and smelling
4. Language Motor
 being able to talk and be
understood
5. Social Motor
 the ability to play with family
members and other children.
 MOTOR DEVELOPMENT
 The average infant progresses
through systematic motor growth
 Cepahlocaudal development, gross to
fine development
 Gross motor: using large groups of
muscles to sit, stand, walk, run, etc.,
keeping balance, and changing
positions.

The normal growth of infants can be

broken down into the following areas:

1. Gross motor – large movements

using the arms , legs , feet or the entire
body.

Ex. - Controlling the head

- Sitting
 Fine motor: using hands to be able
to eat, draw, dress, play, write, and
do many other things.
Language: speaking, using body
language and gestures, communicating,
and understanding what others say.
Cognitive: Thinking skills: including
learning, understanding, problem-
solving, reasoning, and remembering.
Social: Interacting with others, having
relationships with family, friends, and
teachers, cooperating, and responding
to the feelings of others.
 GROSS MOTOR
DEVELOPMENT
 VENTRAL SUSPENSION POSITION
 PRONE POSITION
 SITTING POSITION
 STANDING POSITION
1. Ventral suspension position
o This is the appearance of the infant
when held in midair or prone on a
horizontal plane, supported by a hand
under the abdomen. With this
position, the infant’s head is allowed
to hang down with little effort on
control.
o One month old (1) infants lift the head
momentarily and drop it again. Flexion
of elbows, hip extension and knee
flexion may be observed.
o By two months of age (2), the head is
held in the same place as the rest of
their body. This signifies a major
advancement in muscle control.
o A month after, the head is lifted and
maintained well above the plane of the
rest of the body in ventral suspension.
o It is at this month where a Landau
reflex is developed. Landau reflex is
the extension of the infant’s head, legs
 and spine when held in ventral
suspension.
o Most infants continue to present this
reflex until 6 months of age.
o Inability to perform this reflex would
suggest further evaluation for possible
motor weakness, cerebral palsy, or
other neuromuscular defect.
o When Landau reflex diminished, the
infant then demonstrates a parachute
reflex.
o By 6 to 9 months of age, infants
suddenly lower towards the examining
table while extending the arms as if
protecting themselves when held in a
ventral suspension position.
o An inability to demonstrate this reflex
would suggest cerebral palsy because
they flex their extremities too tight.
2. Prone position
o Newborns can turn their heads to
move them out of a position where
breathing is impaired when placed
lying on their abdomen. However, they
cannot hold them raised.
o One month old (1) infants can lift their
heads and turn them easily to sides. As
what they usually do during the
neonatal period, they still tend to keep
their knees tucked under their
abdomen.
o A month after, infants can now raise
their heads and maintained the
position. But they cannot raise their
chests and their head is still facing
downward.
o Three month (3) old infants can raise
their head and shoulders well. They
can now look around when prone.
o By four months (4) of age , an infant’s
chest can be raised from the bed.
o Weight is shifted to the forearms when
the child is placed on prone by age 5
months.
o The infant can raise his or her chests
and upper parts of the body off the
table by 6 months of age.
o A new skill is advanced by age 9
months when the infant can creep
from a prone position. Creeping means
that the child has the abdomen off the
floor and moves one hand and one leg
and then the other hand and leg, using
the knees on the floor to move.
3. Sitting Position
o By four months of age the (4) infant
demonstrates an important milestone
by showing no head lag when pulled to
a sitting position.
o An infant can sit without support by 8
months of age.
4. Standing Position
o Some younger infants are able to stand
up with support and bear some weight
on their legs between 2 and 4 1/2
months. This is an expected and safe
developmental stage that will progress
to pulling up independently and won't
cause them to have bow-legs.
 o You may have to wait a little longer
before your baby starts to stand on her
own two feet, though. While some 10-
or 11-month-olds can stand alone for
a second or two, most babies don't
reach this milestone until they're
about 13 months old — and they
usually don't stand without support
very well until 14 months
THEORIES OF GROWTH AND
DEVELOPMENT
A. Sigmund Freud (1856-1939)
Psychosexual / Psychoanalytical
Theory
o Sigmund Freud states that
personality develops through a
series of childhood stages during
which the pleasure-seeking
energies of the id become focused
on certain erogenous areas- oral,
anal, and genital.
o This psychosexual energy, called
libido, is described as the driving
force behind behavior.
o Accdg to Sigmund Freud,
Personality is mostly established by
the age of five and early
experiences play a large role in
personality development and
continue to influence behavior later
in life.
o The individual is expected to
progress satisfactorily through the
tasks of each stage in order to
attain balance between the three
components of personality.
id (operates in the unconscious &
concerned with the pleasure principle,
satisfy basic needs)
ego (operates in the conscious & concerned
with the reality principle, ensures that id
wants are acceptable in the real world )
and
superego (both conscious and
unconscious, moral aspect of personality,
contains the conscience and the ego ideal,
prevents us from doing morally bad things
and motivate us to do what is morally
right).
EXAMPLE:
 ID - “I need to eat right this
second.”
 EGO – “you can’t do that because
you are in the middle of an
important meeting.”
 SUPEREGO – “eating during an
important meeting is rude and
inappropriate.”
o If the psychosexual stages are
satisfactorily & successfully
completed, a healthy personality
results.
o The unsatisfactory progression
through the tasks of each stage of
development may result in fixation
of his personality at that stage.
 Infant – Oral stage: Child explores the
world by using the mouth.
 Toddler – Anal stage: Child learns to
control urination and defecation
 Preschooler – Phallic stage: Child
learns sexual identity through awareness of
genital areas.
 School-age child – Latent stage:
Child’s personality development appears to
be nonactive or dormant.
 Adolescent – Genital stage:
Adolescent develops sexual maturity and
learns to establish satisfactory relationships
with others
B. Erik Erikson’s Stages of Psychosocial
Development Theory (1902-1994)
o Most commonly used by health
professionals
• He believes that people continue to
develop throughout life
• Expanded Freud’s theory of
development to include eight stages
of development , each with a central
task or crisis that must be achieved
to allow the individual to achieve the
next task;
• Emphasizes the strong influence of
the environment & the various
stressors in this environment to the
development of personality .
• Individuals must change & adapt
their behavior to maintain control
over their lives.
• The presence of support groups (i.e
family, friends , caregivers , nurses)
can enhance individual’s adaptation
and strengthen their coping skills in
order to attain positive resolution of
the different developmental tasks.
 Infant – Developmental task is to form a
sense of trust and versus mistrust. Child
learns to love and be loved.
 Toddler – Developmental task is to form a
sense of autonomy versus shame. Child
learns to be independent and make
decisions for self.
 Preschooler – Developmental task is to
form a sense of initiative versus guilt. Child
learns how to do things (basic problem
solving) and that doing things is desirable.
 School-age child – developmental task is
to form a sense of industry versus
inferiority. Child learns how to do things
well.
 Adolescent – developmental task is to
form a sense of identity versus role
confusion. Adolescents learn who they are
and what kind of person they will be.
Stages of Growth and
Development
1. FETAL-EMBRYONIC (Inside womb of mother 9
months)
2. NEONATE/NEWBORN (First 28 days of life)
3. INFANCY (1month to 1 year)
4. TODDLER (1 – 3 years old)
5. PRESCHOOLER (3 – 5 years)
6. SCHOOL-AGE (6-12 YEARS)
7. ADOLESCENT (13 – 18 years old)
8. ADULTHOOD (18 years and above)
1. FETAL-EMBRYONIC
 o cord clamp
 1st day- dry and shrink, brown
color
 2nd – 3rd day- black color
 6th-10th day- breaks freely

 ANAL AND GENITAL AREA

• Inside womb of mother (9 months) • Inspect to ensure that it is present,

patent, and not covered by a
• From onset of conception to 9 membrane (IMPERFORATE ANUS)
months
• How?.. Gloved and lubricated little
finger, insert the tip in the anus

2. NEONATE/NEWBORN • Meconium- first stool should be

passed out in the first 24 hours,
imperforate anus or meconeum
ileus

 SKIN
1. VERNIX CASEOSA – Cheese-like
greasy substances.
Purpose:
 Thermoregulation,
• First 28 days of life Lubricant, Protection
• Behaviour is largely reflexive and 2. LANUGO- fine downy hair; thins
develops to more purposeful out 28 weeks
behaviour 3. ACROCYANOSIS – bluish
discoloration of the extremities
• Abdomen protuberant , scaphoid or 4. CUTIS MARMORATA –normal ,
sunken- missing abdominal contents mottled color of the skin-
or diaphragmatic hernia exposure to cold temp
 Bowel sound present after 1 hour 5. Harlequin color change – pink
color of half side of the body
6. Milia – tiny white ,hard, pale
 Umbilical cord
keratinous nodule formed on the
o Wharton’s jelly
 cheeks, chin and nose typically by
a blocked sebaceous gland
7. Jaundice yellowing of the skin
or whites of the eyes, arising
from excess of the pigment
bilirubin caused by
hyperbilirubinemia.
 Physiologic –occurs 2nd–3rd
wk of life ( Phototherapy)
 Pathologic – occurs 24 hours
after delivery (RH
incompatibility)
8. BIRTHMARKS - marks on the skin
of a lot of newborn babies
A. Mongolian spots – blue- black
macule found at the buttocks
area
B. Telegiectatic nevus / Stork
bite – flat deep pink in nape /
eyelids.
C. Nevus flammeus / Port wine
stain – flat purple red present
at birth in face or extremities.
D. Nevus Vasculosus
/Strawberry hemangioma –
red rubbery nodules with
rough surface.
 Chest circumference usually less than
the head circumference by 2.5cm
 Posterior fontanelle closed by 2nd – 3rd
month of life – triangle on shape
 Anterior fontanelle closed by 12th –
18th month of life – diamond in shape
3. INFANCY - 1month to 1 year
 WEIGHT- @ 4-6 months- doubles birth
wt.
- @ 1 year- triples wt.
 1 lb per month 4-6 mos.-
 1 year: -Female- 9.5 kg
-Male- 10 kg
 HEIGHT- 1 year- 50% increase in ht, use
measuring board
 HEAD CIRCUMFERENCE- Increases due
to brain development, 2/3 adult size- end
of the yr., asymmetry of head- mal
positioning during sleep
 BODY PROPORTION- Lower jaw is
prominent, chest circumference- head and
chest are even (6mos up to 12 mos.),
abdomen- remains protuberant, cervical,
thoracic and lumbar spine develops- in
preparation for lifting head, sitting, and
walking. Lengthening of lower extremities
(last 6 mos.)
 BODY SYSTEMS:
 Heart Rate (HR)- 100-120 B/M
 Blood Pressure (B/P)- 100/60
mmHg
 Hg- 2-3 mos. decreased physiologic
anemia destruction of fetal RBC(3 mos
life span) and new cells are not yet
produce, preventable, give oral iron
 Respiratory Rate (RR)- 20-30 b/m, prone
resp. infection, severe than adult due to
small anatomical and inefficient mucus
production
 GIT:
  1-2 mos.- deficient in amylase-
complex carbohydrates
 1 year- decreased lipase –
saturated fat
 Swallowing coordination until 6
months
 Extrusion reflex present until 3-4
months
 LIVER- immature, iadequate
conjugation of drugs
 NECK - Short, chubby, with creased skin
folds
 CHEST
• Looks small because infant’s head
is larger
• Breast engorgement (M&F)-
hormone, subsides after a week
• Witch’s milk- a thin watery fluid
secreted by newborn’s breasts,
subsides without treatment
• 2 inches less than the head
• Symmetrical
• Respiratory Rate (RR)- 30-60 b/m
• Supernumerary nipple- found
below and in line normal nipple,
maybe removed later for cosmetic
reason
• Retraction- chest in drawing
should be absent
 IMMUNE SYSTEM-
 Functional at 2 mos., IgG and
IgM after 1 year
 Ability to adjust to cold at 6
months
 Shivering present- increase muscle
activity, providing warmth
 Brown fat- protect newborn from cold
decreases in 1 year, it is a special fat that
serves as thermoregulator found on the
neck and other parts of the body.
 Kidneys, endocrine immature.. More
intracellular fluid 40% protection from
dehydration
 TEETH
 6 months- first tooth eruption,
followed by new one monthly
 Natal teeth- baby’s born with
 Neonatal teeth- erupts at 4
weeks
 Decidous tooth erupts between 6 -8
months
4. TODDLER
TODDLER GROWTH AND DEVELOPMENT
• 1 – 3 yrs old
• Slow physical growth but rapid
development
• Mobility and communication skills
improve rapidly
• Controls bladder and bowel
• By 3, toilet trained
• 24 months – weight is 4x the birth
weight
• Continuous eruption of teeth-
• Can stand alone and walk and balance
with one foot
• Sense of touch is very important at this
stage
• Improve and refine their language skills
 SLEEP
a) requires 10-12 hours sleep / day
b) By age 2 or 3 years : with an
established , normal sleep-wake
cycle
c) Midmorning nap decreases;
needs an afternoon nap
 FEARS
A. Separation anxiety: greatest fear
of the stage; peaks at 2 ½ years
B. Bedtime may represent
desertion: give “security
object”- a cuddly toy (eg, stuffed
animal or rag doll)
C. Increasing understanding of
object permanence helps the
toddler.
 tolerate & master brief
periods of separation = an
important developmental
task
 overcome fear of
separation
D. Stages/patterns of separation
anxiety
 protest: screaming and
loud crying when mother
leaves
 despair: whimpering ,
curling up in bed, rocking ,
decreased activity
 denial: ignores mother
when she returns ;
resumes norma
 activity but does not form
psychosocial relationships
 PLAY: PARALLEL PLAY
 TOY CRITERIA:
 SAFETY (MOST IMPORTANT)
 AGE APPROPRIATENES
 USEFULNESS
 Toys that encourage gross motor
activities : push-pull toys ex. Play lawn
mower , push –pull carts , balls , low
rocking horses
 Toys that allow expression of anger &
frustration : pounding pegs , playdrums ,
play hammer
 Toys that provide security ( security )
during periods of separation : stuffed
animals , rag doll
 Toys that promote language
development : play telephone
 Building blocks:
  NUTRITION: c. Be patient

5. High curiosity – leads to accidents ,

 Nutritional problem: physiologic poisoning
anorexia (decrease Appetite)
because the toddler is busy at play DISCIPLINE:

• POTENTIAL ACCIDENT SITUATION  Redirecting child’s attention

 Time out
• BEHAVIORAL TRAITS  Loss of privileges
 Negativism – age of “no-no”  Corporal punishment
management:  Ignoring (BEST for temper
a) recognize negativism as tantrums)
normal in the stage  Explaining, reprimanding &
b) Do not ask questions reasoning ( for older children)
answerable by “ yes” or
TOILET TRAINING
“no”
c) Offer simple choices

2. Ritualism
management: establish , encourage rituals
such as mealtime ,bedtime & toilet training
rituals.

3. temper tantrums – another ways to

assert autonomy . The toddler cries when
 With a certain degree of sphincter
he does not get what he wants/demands.
control necessary for toilet training.
Management:
Schedule of toilet training:
a) Ignore the tantrums ( but not the
child) a) 18 months to 2yrs: start of toilet
b) Allow the child to cry until he is tired. training
c) make sure child is safe during b) 2 to 2 1/2 yrs: attains bowel
tantrums. control
c) 2 1/2 to 3 yrs: attains daytime
4. Dawdling – slowness in accomplishing task
bladder control
management: d) 3 to 4 yrs: attains night time
bladder control
A. assess child’s ability to accomplish task

b. give ample time

 Guidelines for toilet training:
selection of potty chair (wt/ht
appropriate)
1) Keep potty in bathroom
2) Limit session – early in the
morning ( best)
3) Praise for cooperative behaviour
or successful evacuation
4) Clothing is easily removed.
(gartered shorts)
5) Frequent reminders – using the
child’s words such as weewee ,
poo pooh
bladder – 4 years
bowel – 1 ½ - 3yo
6) Encourage imitation by watching
others.
5. PRESCHOOLER
 3 – 5 years
 Slow physical growth (3-5kgs) but
grows more in ht
 Appears thinner than the toddler
 Birth length doubles at 4 yrs ;
length: increases 2 ½ in/ yr
 PHYSICAL
A. Usual Weight gain 1.8-1.7 kg ( 4-6
ibs)
B. Usual Height gain 7.5 cm ( 3
inches)
• Sense of taste, show preferences by
asking “yummy” and refuse “ yucky”
• Self conscious of exposing bodies
• Dress themselves without assistance
• Decidous teethe completely erupted
 FEARS:
1. Imaginative mind – greatest
number of real & imagined fears
2. Fears concerning body
integrity : greatest fear of the
age
•
• dislikes bedtime : requests another
bedtime story , TV program
 PLAY: ASSOCIATIVE & COOPERATIVE
1. Imitative games: imitation of
parental roles such as : dress up
dolls , housekeeping toys ,
gardening toys & carpentry sets
2. Creative games :coloring books ,
modelling clay
3. Tricycles
 MOTOR
 PRE-SCHOOLER-4 YEARS OLD
PHYSICAL:

A. Ht and Wt increases are similar to

previous year

B. Length at Birth is doubled

1. Jumps off bottom step

2. Rides a tricycle using pedals

 MOTOR
3. Walks upstairs alternating feet
1. Skips and hop in one foot
4. Builds tower of 9-10 cubes
2. Walks up and down stairs like an
5. Constructs 3 block bridge adult

6. Can unbutton front or side button 3. Can button buttons and lace
shoes
7. Usually toilet trained at night
4. Throws ball overhead

5. Uses scissors to cut outline

 VOCALIZATION AND
SOCIALIZATION  VOCALIZATION AND
SOCIALIZATION
1. Vocabulary- 900 words, 3-4 word
sentence 1. Vocabulary 1500 words or more

2. May have normal hesitation in 2. Imaginary companion

speech pattern
3. Selfish and impatient
3. Use plurals
4. Takes pride in accomplishment
4. Understands sharing and taking
5. Exaggerates, boasts, and tattles
turns
on others
 MENTAL ABILITY
 MENTAL ABILITIES
1. Beginning understanding of the
1. Unable to conserve matter
past, present, future, or any
aspect of time 2. Can repeat four numbers and is
learning number concept
2. Stage of magical thinking
 3. Knows which is the longer or two
lines
4. Has poor space perception
PRE-SCHOOLER-5 YEARS OLD
 PHYSICAL:
A. Ht and Wt increases are
similar to previous year
B. Length at Birth is doubled
 MOTOR
1. Gross motor activity is well
developed
2. Can balance in one foot for
about 10 sec.
3. Can jump rope, skip, and roller
skate
4. Can draw a picture of a person
5. Prints first name and other
word as learned
6. Dresses and washes self
7. Maybe able to tie shoelaces
 SENSORY
1. Minimal potential for
amblyopia to develop
2. Color recognition is well
established
 VOCALIZATION AND SOCIALIZATION
1. Vocabulary of 2100 words
2. Talks constantly
3. Asks meaning of new words
4. Generally cooperative and
towards others
5. Basic personality structure is well
established
 MENTAL ABILITIES
1. Beginning understanding of time
in terms of days as part of the
week
2. Beginning understanding of
conversation of numbers
3. Has not mastered the concept that
parts equal a whole regardless of
their appearance
 PLAY IN PRE-SCHOOL
A. Loosely organized group play
where membership changes
readily and rules are absent
B. Through play child deals with
reality, learns control of feeling,
and expresses emotions more
through words than through
action
C. Play is still physically oriented but
is also initiative and imaginary
D. Increasing sharing and
cooperation among pre-school
children,-5 y.o.
E. Suggested toys 6. SCHOOL-AGE
1. Puppets

2. Additional dress up clothes, dolls,

house, furniture, small trucks,
animals

3. Painting sets, coloring books,

paste, and cut sets
 SCHOOLER
4. Illustrated books  6-12 YEARS
 Gains weight rapidly but appears
5. Puzzles with large pieces and more
less thin , weight doubles
shapes
 6 years old-deciduous teeth starts to
6. Tricycle, swing, slide, and other lose at about the same the first
playground equipment permanent teeth
 Weight gain occurs from age 10-12
 ISSUES years, 9-12 for girls
1. Imitation
 PHYSICAL GROWTH
2. Fantasy
1. Permanent dentition beginning 6
3. Oedipus and Electra complex year molars and central incisors at
7 or 8 years of age
4. Bruxism – teeth grinding
2. Tends to look lanky because bone
5. Fear of the Dark- imagination development precedes muscular
development
6. Fear of mutilation

7. Separation anxiety
 SLEEPS:
 Sleeps bet 8 to 12 hrs a night ; no
8. Telling tale tales - stretching daytime nap
stories
 FEARS:
9. Imaginary friends
1. Fear of death
10. Difficulty sharing
2. School-related fears – fear of loss
11. Regression- thumb sucking, of positive status (ex. Member of
bedwetting the honor roll) ,
School phobia = psychosomatic
12. Sibling rivalry
 PLAY: COMPETITIVE
1. Quiet games: SORTING &
collecting activities, diaries
2. Bicycle
3. Competitive games: baseball,
basketball, swimming
4. Table games: scrabble , chess
5. Building, repair & mechanical
activities: construction toys &
mechanical tools
NUTRITIONAL PROBLEM: junk food
 MOTOR
• Refinement of coordination,
balance, and control occurs
• Motor development necessary for
competitive activity becomes
important
 SENSORY:
 Visual acuity of 20/20
 MENTAL ABILITIES
1. Readiness for learning, especially in
perceptual organization:
 Names month of year
 Knows right from left
 Can tell time
 Can follow several directions at
once
2. Acquires use of reason and
understanding of rules.
3. Trial-and-Error problem solving becomes
more conceptual rather than action
oriented
4. Reasoning ability allow greater
understanding and use of language
5. Concrete operation (Piaget), knows that
quantity remains the same even though
appearance differs.
 PLAY DURING SCHOOL AGED
YEARS
A. Play activity vary with age.
B. Number of play activities
decreases while the amount of
time spent in one particular
activity increases
C. Likes games with rules because of
increased mental abilities
D. Likes games of athletic
competition because of increased
motor ability
E. Should learn how to work well as
play, with a beginning
appreciation for economics and
finances
F. In beginning school year, boys and
girls play together but gradually
separate into sex oriented type of
activities.
 Common issues
1. Dental carries- progressive
destructive lesions of the tooth
calcium, leading health problem
 2. Broken Fluency- problem in
articulation s, z, th, l, r and w
3. School phobia- resist attending
school manifest physical signs
4. Latchkey children- carry a key or
wear it around their neck so they
can enter their house
5. Stealing
6. Use of recreational drugs
7. Menstruation
 NURSING DIAGNOSES
1. Anxiety related to strange
environment
2. Pain related to disease process
3. Diversional activity deficit related
to situational crisis
6. ADOLESCENT
 13 – 18 years old
 Subdivided into 3:
1. Early adolescent – 12 to 13
2. Middle adolescent – 14 to 16
3. Late adolescent – 17 to 18 or
20
 Maximum height often reached at
about 18-19 (boys) and 15-16 (girls)
 Puberty stage
 Menarche
 Ejaculation
 Primary and secondary sexual
characteristics developed
 SLEEP
1. 8-10 HRS night SLEEP to prevent
fatigue & susceptibility to
infection
2. Change in sleep pattern
3. Occasional afternoon naps
4. wet dreams in boys: orgasm &
release of semen during sleep –
normal phenomenon
 FEARS
1. Fear of the unknown
2. Fear of threat of body image :
body odor , acne ,obesity
3. FEAR OF INJURY OR DEATH: death
is unfulfilled dreams
 PLAY: SOCIAL GAMES and PLAY
1. Recreation & leisure activities
involving the opposite sex :
outing , swimming , picnics &
parties
2. Dating activities, movies
3. Day dreaming activities
4. Lengthy telephone conversations
with friends of the opposite sex
7. ADULTHOOD

 18 years and above

 Subdivided into 3:
1. Young adult (20-40years)
personal lifestyle develops.

-person establishes a relationship with a

significant other and a commitment to
something.

2. Middle adult – 40 to 65
3. Late adulthood – 65 above